Pain Medicine Board Certification Status Among Physicians Performing Interventional Pain Procedures in the State of Florida Between 2010 and 2016

摘要

Background: The US Department of Health and Human Services has recommended thatphysicians performing interventional pain procedures be credentialed based on criteria?basedguidelines and minimum training requirements.Objectives: To quantitatively assess gaps in certification related to pain medicine fellowshiprequirements, we studied the distribution of such procedures in Florida between 2010 and 2016.Study Design: This research involved a retrospective analysis with a sample size of n =1,885,442 interventional pain procedures.Setting: Data describing interventional pain procedures performed in Florida between January2010 and December 2016 were obtained from the Florida Department of Health. The NationalProvider 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 InterventionalPain Physicians (ABIPP) corresponding to this time frame were also obtained.Methods: The datasets were linked to determine the specialty of physicians performinginterventional pain procedures, and whether or not they were pain medicine diplomates of theABMS, the ABPM, or the ABIPP. The similarity index Θ was calculated for the distribution ofinterventional pain procedure codes among medical specialty groups, and with respect to thepractitioners’ pain medicine board certification status.Results: Of the interventional pain procedures, anesthesiologists performed 63.5%, physiatrists19.1%, neurologists or psychiatrists 5.2%, and other practitioners 12.3%. Among proceduresperformed by anesthesiologists, physiatrists, and psychiatrists or neurologists, 66.2%, 50.3%,and 50.4% were by ABMS pain board?certified practitioners, respectively. Practitioners withoutABMS pain medicine boards performed 45.8% of interventional pain procedures. Practitionerswithout such boards from either the ABMS, ABPM, or ABIPP performed 37.7%. There was verylarge similarity (Θ > 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.Limitations: In countries other than the United States, where pain medicine board certificationis relatively recent, there may be a higher percentage of interventional pain procedures performedby individuals without certification than we report. In “opt?out” states, where nurse anesthetistscan independently perform interventional pain procedures, the percentage of interventionalpain procedures performed by individuals without physician pain medicine board certificationmay also be higher. The datasets we used do not contain information to allow assessment ofoutcomes or effectiveness resulting from pain medicine board certification.Conclusions: Approximately one?third of interventional pain procedures were performedby physicians without at least 1 of the 3 pain medicine board certifications. In addition, thepractitioners performed very similar distributions of procedures (i.e., those without pain medicineboard certification, overall, have not restricted their practice). These results suggest the need foradditional 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, physicianswithout board certification performing intervention procedures would need to obtain ABPM or ABIPP certification, or ABMScertification after completion of a full?time Accreditation Council of Graduate Medical Education pain medicine fellowship.