Department of Anesthesiology Perioperative Medicine and Pain Management, University of Miami, Miami, FL.
Department of Anesthesia, University of Iowa, Iowa City, Iowa.
Pain Physician. 2020 Jan;23(1):E7-E18.
The US Department of Health and Human Services has recommended that physicians performing interventional pain procedures be credentialed based on criteria based guidelines and minimum training requirements.
To quantitatively assess gaps in certification related to pain medicine fellowship requirements, we studied the distribution of such procedures in Florida between 2010 and 2016.
This research involved a retrospective analysis with a sample size of n = 1,885,442 interventional pain procedures.
Data describing interventional pain procedures performed in Florida between January 2010 and December 2016 were obtained from the Florida Department of Health. The National Provider Identifier file and board certification lists from the American Board of Medical Specialties (ABMS), the American Board of Pain Medicine (ABPM), and the American Board of Interventional Pain Physicians (ABIPP) corresponding to this time frame were also obtained.
The datasets were linked to determine the specialty of physicians performing interventional pain procedures, and whether or not they were pain medicine diplomates of the ABMS, the ABPM, or the ABIPP. The similarity index theta was calculated for the distribution of interventional pain procedure codes among medical specialty groups, and with respect to the practitioners' pain medicine board certification status.
Of the interventional pain procedures, anesthesiologists performed 63.5%, physiatrists 19.1%, neurologists or psychiatrists 5.2%, and other practitioners 12.3%. Among procedures performed by anesthesiologists, physiatrists, and psychiatrists or neurologists, 66.2%, 50.3%, and 50.4% were by ABMS pain board-certified practitioners, respectively. Practitioners without ABMS pain medicine boards performed 45.8% of interventional pain procedures. Practitioners without such boards from either the ABMS, ABPM, or ABIPP performed 37.7%. There was very large similarity (theta > 0.9) in the distribution of procedures comparing ABMS pain medicine board-certified practitioners to non-ABMS pain medicine board-certified anesthesiologists, physiatrists, or all other specialties.
In countries other than the United States, where pain medicine board certification is relatively recent, there may be a higher percentage of interventional pain procedures performed by individuals without certification than we report. In "opt-out" states, where nurse anesthetists can independently perform interventional pain procedures, the percentage of interventional pain procedures performed by individuals without physician pain medicine board certification may also be higher. The datasets we used do not contain information to allow assessment of outcomes or effectiveness resulting from pain medicine board certification.
Approximately one-third of interventional pain procedures were performed by physicians without at least 1 of the 3 pain medicine board certifications. In addition, the practitioners performed very similar distributions of procedures (i.e., those without pain medicine board certification, overall, have not restricted their practice). These results suggest the need for additional accredited pain medicine fellowship training positions for newly graduated residents. The results also show that, for the recommendations of the Department of Health and Human Services to be satisfied, physicians without board certification performing intervention procedures would need to obtain ABPM or ABIPP certification, or ABMS certification after completion of a full-time Accreditation Council of Graduate Medical Education pain medicine fellowship.
Chronic pain, education, medical, graduate, specialty boards.
美国卫生与公众服务部建议，实施介入性疼痛治疗的医生应根据循证指南和最低培训要求获得认证。
为了定量评估与疼痛医学研究员要求相关的认证差距，我们研究了 2010 年至 2016 年间佛罗里达州的此类手术分布情况。
这是一项回顾性分析，样本量为 n=1,885,442 例介入性疼痛治疗。
从佛罗里达州卫生部获得了 2010 年 1 月至 2016 年 12 月期间在佛罗里达州进行的介入性疼痛治疗的数据。还获得了美国医学专业委员会（ABMS）、美国疼痛医学委员会（ABPM）和美国介入性疼痛医师委员会（ABIPP）的国家提供者标识符文件和董事会认证名单，这些文件与这一时期相对应。
将数据集进行链接，以确定实施介入性疼痛治疗的医生的专业，并确定他们是否是 ABMS、ABPM 或 ABIPP 的疼痛医学专家。计算介入性疼痛治疗代码在医学专业组之间以及与医生疼痛医学委员会认证状态的分布的相似性指数 theta。
在介入性疼痛治疗中，麻醉师进行了 63.5%，物理治疗师进行了 19.1%，神经病学家或精神科医生进行了 5.2%，其他从业者进行了 12.3%。在麻醉师、物理治疗师和精神科医生或神经病学家进行的手术中，分别有 66.2%、50.3%和 50.4%是由 ABMS 疼痛委员会认证的从业者进行的。没有 ABMS 疼痛医学委员会认证的从业者进行了 45.8%的介入性疼痛治疗。没有 ABMS、ABPM 或 ABIPP 任何一个委员会认证的从业者进行了 37.7%。ABMS 疼痛医学委员会认证的从业者与非 ABMS 疼痛医学委员会认证的麻醉师、物理治疗师或其他所有专业的从业者在手术分布上具有非常大的相似性（theta>0.9）。
在除美国以外的国家，疼痛医学委员会认证相对较新，因此实施介入性疼痛治疗的个人中没有认证的比例可能高于我们报告的比例。在“选择退出”的州，注册护士麻醉师可以独立进行介入性疼痛治疗，因此没有医生疼痛医学委员会认证的个人进行的介入性疼痛治疗的比例可能也会更高。我们使用的数据集不包含评估疼痛医学委员会认证导致的结果或效果的信息。
大约三分之一的介入性疼痛治疗是由至少没有 3 种疼痛医学委员会认证之一的医生进行的。此外，从业者实施了非常相似的手术分布（即，没有疼痛医学委员会认证的从业者总体上并没有限制他们的实践）。这些结果表明需要为新毕业的住院医师提供更多经过认证的疼痛医学研究员培训职位。结果还表明，为了满足卫生与公众服务部的建议，没有认证的从事干预程序的医生需要获得 ABPM 或 ABIPP 认证，或者在完成了为期一年的研究生医学教育疼痛医学研究员培训后获得 ABMS 认证。
慢性疼痛、教育、医学、研究生、专业委员会。
