Supporting the Physiatrist, Strengthening the Specialty

The American Academy of Physical Medicine and Rehabilitation (AAPM&R) in collaboration with the American Board of Physical Medicine and Rehabilitation (ABPMR) and the Association of Academic Physiatrists (AAP), recently reviewed and submitted comments on the current Accreditation Council for Graduate Medical Education’s (ACGME) Program Requirements for Pain Medicine.

As physiatrists, we have the distinctive ability to bring together and lead an interdisciplinary care team focused on managing patients’ pain and optimizing function, so it’s imperative for the Academy to be the voice of our members and provide input on important issues related to GME.

Through the ACGME’s call for comment process, the Academy has advocated for changes to be made to 9 specific training requirements, with 7 of them being updated based on our recommendations. While this is positive, the Academy will continue work with the ACGME to ensure the training requirements are reflective of best practices and creating an environment of ideal training.

In addition to commenting on specific training requirements, there are larger program requirements the 3 organizations have addressed:

• There are negative implications with only allowing a program in pain medicine to be conducted in an institution and/or its participating sites that sponsor(s) ACGME-accredited residencies in at least 2of the following specialties: anesthesiology, physical medicine and rehabilitation, and child neurology/or neurology. This requirement has had a significant negative impact on PM&R-based programs that are not associated with or a part of a multi-residency institution. This requirement is especially egregious given the fact that all other multispecialty fellowships only require a single ACGME- accredited residency.
  
  
• Current requirements allow for only 1 ACGME-accredited pain medicine program within a sponsoring institution. By prescribing the specific number of programs that a sponsoring institution can have, the ACGME is both limiting the number of fellows that can be trained in Pain Medicine and creating unintentional bias with regard to who is accepted to these programs.
  
  
• By changing the wording of the requirements for the qualifications of a program director, which currently states that the program director and core faculty must be board certified by an ABMS-recognized board, the ACGME is encouraging Pain Medicine programs to be housed exclusively in anesthesiology departments and run by anesthesiology departments. There is no evidence these proposed rule changes would improve fellowship training or patient outcomes, and it grants an unfair advantage to one of the participating sponsoring specialties.

While we applaud the ACGME’s efforts in attempting to revise the Program Requirements for Graduate Medical Education in Pain Medicine, we feel there are requirements within the revisions that will continue to negatively impact the field of PM&R as written.

To address these key issues, the Academy calls for more transparency within the pain programs to ensure there is oversight on application and admission processes for each program. We believe an audit should be conducted to show there is an equal opportunity for residents to apply to a pain program, regardless of the specialty sponsoring the fellowship. The audit should also ensure pain programs are utilizing a multidisciplinary faculty, which addresses both fair processes in admission and a comprehensive coverage of the curriculum.

We also believe there should be a multidisciplinary Review Committee (RC) to review all pain programs on an ongoing basis. This would ensure adherence to requirements for a multidisciplinary core faculty and comprehensive coverage of all components of the curriculum.

The Academy is actively advocating for these changes as it’s essential for physiatrists to be involved with all components of GME training because of our ability to provide excellent comprehensive pain care. By doing so, we are establishing ourselves as leaders who are developing solutions to overcome the current public health crisis regarding pain management and the opioid epidemic. AAPM&R looks forward to continuing its work with ABPMR and AAP to further enhance the Program Requirements for Graduate Medical Education in Pain Medicine to ensure equality and accurate representation across physical medicine and rehabilitation in this space.

Read the entire comment letter here.

The American Academy of Physical Medicine and Rehabilitation (AAPM&R) in collaboration with the American Board of Physical Medicine and Rehabilitation (ABPMR) and the Association of Academic Physiatrists (AAP), recently reviewed and submitted comments on the current Accreditation Council for Graduate Medical Education’s (ACGME) Program Requirements for Pain Medicine.

As physiatrists, we have the distinctive ability to bring together and lead an interdisciplinary care team focused on managing patients’ pain and optimizing function, so it’s imperative for the Academy to be the voice of our members and provide input on important issues related to GME.

Through the ACGME’s call for comment process, the Academy has advocated for changes to be made to 9 specific training requirements, with 7 of them being updated based on our recommendations. While this is positive, the Academy will continue work with the ACGME to ensure the training requirements are reflective of best practices and creating an environment of ideal training.

In addition to commenting on specific training requirements, there are larger program requirements the 3 organizations have addressed:

• There are negative implications with only allowing a program in pain medicine to be conducted in an institution and/or its participating sites that sponsor(s) ACGME-accredited residencies in at least 2of the following specialties: anesthesiology, physical medicine and rehabilitation, and child neurology/or neurology. This requirement has had a significant negative impact on PM&R-based programs that are not associated with or a part of a multi-residency institution. This requirement is especially egregious given the fact that all other multispecialty fellowships only require a single ACGME- accredited residency.
  
  
• Current requirements allow for only 1 ACGME-accredited pain medicine program within a sponsoring institution. By prescribing the specific number of programs that a sponsoring institution can have, the ACGME is both limiting the number of fellows that can be trained in Pain Medicine and creating unintentional bias with regard to who is accepted to these programs.
  
  
• By changing the wording of the requirements for the qualifications of a program director, which currently states that the program director and core faculty must be board certified by an ABMS-recognized board, the ACGME is encouraging Pain Medicine programs to be housed exclusively in anesthesiology departments and run by anesthesiology departments. There is no evidence these proposed rule changes would improve fellowship training or patient outcomes, and it grants an unfair advantage to one of the participating sponsoring specialties.

While we applaud the ACGME’s efforts in attempting to revise the Program Requirements for Graduate Medical Education in Pain Medicine, we feel there are requirements within the revisions that will continue to negatively impact the field of PM&R as written.

To address these key issues, the Academy calls for more transparency within the pain programs to ensure there is oversight on application and admission processes for each program. We believe an audit should be conducted to show there is an equal opportunity for residents to apply to a pain program, regardless of the specialty sponsoring the fellowship. The audit should also ensure pain programs are utilizing a multidisciplinary faculty, which addresses both fair processes in admission and a comprehensive coverage of the curriculum.

We also believe there should be a multidisciplinary Review Committee (RC) to review all pain programs on an ongoing basis. This would ensure adherence to requirements for a multidisciplinary core faculty and comprehensive coverage of all components of the curriculum.

The Academy is actively advocating for these changes as it’s essential for physiatrists to be involved with all components of GME training because of our ability to provide excellent comprehensive pain care. By doing so, we are establishing ourselves as leaders who are developing solutions to overcome the current public health crisis regarding pain management and the opioid epidemic. AAPM&R looks forward to continuing its work with ABPMR and AAP to further enhance the Program Requirements for Graduate Medical Education in Pain Medicine to ensure equality and accurate representation across physical medicine and rehabilitation in this space.

Read the entire comment letter here.