WHAT DOES “BOARD CERTIFIED” IN PAIN MANAGEMENT REALLY MEAN?
Question: The topic of being board certified before performing pain management procedures seems to be confusing. What does it mean?
Answer: First, board certification is a voluntary activity. There's no mandate that anybody become board certified. But it has become a gold standard when looking for credentials of physicians. For the public, it assures them that doctors have a certain amount of training in their specialty and have been tested by examination in their field of training. For doctors, it helps keep our skills up to date.
Question: Who provides the certification for pain management?
Answer: The ABA (the American Board of Anesthesiology), and its certification program as overseen by the American Board of Medical Specialties (ABMS). The ABMS was originally developed through the Council on Medical Education of the American Medical Association and has 24 member boards.
Question: Aren't there other agencies that offer certification?
Answer: It's confusing because the term 'board certified' is used by many self designated boards. There are organizations out there that offer certificates in various areas of medicine, and they create their own certifying agency that does not report to any central organization. When talking about board certification, people need to find out if it's a legitimate board, and if it has a testing process that is recognized and acknowledged as a valid method for determining qualifications. There are over a hundred self-created boards that are not part of ABMS but provide some type of certification.
Question: What about the American Board of Pain Management (ABPM) or the American Academy of Pain Management (AAPM)?
Answer: Those are self-designated boards. They are organizations whose members come from different training programs such as neurology, neurosurgery, physical medicine and rehabilitation, psychiatry, nursing, and other areas of medicine, but who indicate an interest in pain management. Their members may be anesthesiologists who chose not to complete an optional one year fellowship in pain management. Their members could also be anesthesiologists who completed their anesthesiology training prior to the development of the one year fellowship program, but they chose not to take a written examination in order to “grandfather” into pain management certification. The ABPM and AAPM created their own certification process, but are not members of ABMS.
Question: What's the advantage of certification overseen by the ABMS?
Answer: The ABMS is recognized for its training and its educational process. It has a 75-year history and works with the Accreditation Council for Graduate Medical Education -- which is the accreditation body for approval of residency training programs for the 24 recognized medical specialties. The Residency Review Committee reviews each training program and accredits each program. They can also disapprove a program for deficits in their training.
Question: How can I verify that my physician completed the one year fellowship in pain management?
Answer: Fortunately, this is easy. Since most pain management physicians are anesthesiologists, credentials can be verified by visiting the American Board of Anesthesiology website. Physicians with pain management fellowship training are listed as having certification not just in anesthesiology, but also in pain medicine.
To verify other specialty credentials refer to the American Board of Physical Medicine and Rehabilitation or the American Board of Psychiatry and Neurology.
Question: Is it tough to get certification from the ABMS?
Answer: There are prerequisite training requirements to satisfy the ABA testing process, such as completing a 4 year anesthesiology residency and passing both a written and oral examination to become board certified by the ABA. After completing this one year fellowship, the candidates must pass a written examination in order to hold board certification in pain management (actually called a “Certificate of Added Qualifications in Pain Management).
Question: Can doctors also be certified to perform certain pain management procedures through other specialties?
Answer: Yes. There are different venues, such as neurology, psychiatry or physical medicine and rehabilitation, to get into a pain management training program. These candidates must be board certified by the American Board of Neurology and Psychiatry or the American Board of Physical Medicine and Rehabilitation. The American Board of Anesthesiology then allows those candidates to enroll in its one year pain management fellowship.
Question: Are there issues related to the variety of people doing these procedures?
Answer: It comes down to, "Do I have the appropriate training, skills, and experience to do what the patient is seeking that I do?" Patients, on the other hand, need to spend time verifying that their doctor has that kind of training.
Question: What sorts of skills or knowledge does the ABA-certified pain management physician have that others don't?
Answer: ABA training and testing covers the entire spectrum of pain management. A big part of the certification process is Maintenance of Certification, which means doctors stay up to-date with changes in their particular specialty. Changes occur in medicine rapidly -- new technologies, new approaches to treatment, new surgical techniques. It's an evolutionary process, and tough to keep up with. If you maintain board certification, you're more on top of things. If we're really interested in the patients that we say we're there to take care of, then it behooves us to be committed to lifelong learning.
Question: Are there data showing differences in outcomes between procedures performed by ABA certified people and ones who aren't?
Answer: There is no reliable database that reports outcomes. The problem is each organization collects its own statistics. For instance, the ABA and the ABPM both have databases showing the numbers of procedures done by their members. The ABA Doctors can also be members in more than one society, and may provide data to more than one group. So, comparing statistics is difficult.
Question: Do you have any key messages for doctors in general about these topics?
Answer: With physicians it's often a discussion about another examination, more training, and another testing modality. The process of certification and its maintenance is so patients know we are who we say we are. For doctors, it assures we have the training to take care of people and do things right. It's about doing the right thing for patients for the right reasons. It lets us sharpen our skills, and gives us incentive to learn new processes. It behooves us to stay up-to-date and informed, and to make sure the public understands that we're informed as well. The certification boards are, in reality, consumer protection organizations.