Topics Dividing Pain Management Professionals

Recently, a New Jersey doctor’s license was suspended after the New Jersey attorney general accused him of performing minimally invasive spinal surgery without the proper training. This board-certified anesthesiologist owns an interventional pain center, and also operates at ambulatory centers throughout New Jersey and New York; however, according to reports, he is not a board-certified minimally-invasive spine specialist.

On April 2, 2012, the attorney general received a complaint that this doctor had been performing open spinal surgery and discectomies, as well as minimally invasive spinal fusions with instrumentation. The attorney general declared he did so without the “appropriate surgical training, without hospital privileges or board sanction to perform the surgeries, and without evidence that the procedures were appropriate.” The doctor’s license was later revoked at the New Jersey Board of Medical Examiners’ June 13 meeting after an 11-1 member vote.

According to the article, NJ Interventional Pain Doctor Suspended Over Invasive Spine Procedures by Rosemary Frei, Frank J. E. Falco, MD, President of the American Society of Interventional Pain Physicians (ASIPP), asserted that:

“ASIPP does not approve, encourage or endorse, but rather condemns the performance of complex spine surgery such as open fusions of the cervical, thoracic or lumbar spine by interventional pain physicians.” [1]

Additionally, Frei’s article states that Peter Staats, MD, ASIPP’s Director-at-Large and Integrity Committee Chairman, as well as President-elect of the New Jersey Society of Interventional Pain Physicians, and a Pain Medicine News editorial board member, contributed by stressing that interventional pain procedures need be performed by “highly qualified, high-integrity physicians” rather than those “who have entered the field without adequate training or are motivated by financial gain.”

“Physicians who are not meeting the standard of high-quality care and ethics give the field of interventional pain medicine a bad name, jeopardize their patients as well as all future patients who would potentially benefit from minimally invasive pain procedures,” Dr. Staats continued.

Although many medical professionals believe that the complaints are legitimate, others are concerned that this may be just “another attempt to push them [interventional pain physicians] out of the spine intervention arena.”¹

“Although I don’t specifically support Dr. Kaul’s case, I believe that an interventional pain physician with appropriate skill and training should be able to perform minimally invasive spinal procedures,” Says Andrea Trescot, MD, ASIPP past-President and Pain Medicine News editorial board member. “The scope of practice is dynamic, and as equipment and procedures change, there is an expansion and change of what an interventional pain physician can and should be able to do. There have been a lot of sniper shots taken at pain physicians about spine surgeries, and I believe this is where we have to make a stand.” ¹

“Making a stand” seems to be a recurring theme in today’s ever-dividing pain world. There has also been an ongoing debate regarding Certified Registered Nurse Anesthetists (CRNAs) performing pain management services. On June 13, 2012, CRNAs celebrated as the California Supreme Court denied a petition to review Gov. Arnold Schwarzenegger’s decision to opt out of a federal Medicare regulation requiring CRNAs to be supervised by a physician while rendering anesthesia services in order to receive reimbursement. This decision ended a three-year long legal battle that has divided many nurses and anesthesiologists. California now joins the sixteen other states that have opted out of the federal supervision requirement since being given the option in 2001.

Recently, CRNAs have gained further ground as CMS proposed a rule authorizing direct reimbursement of CRNA pain care. If this rule becomes a law, nurse anesthetists would become equal to anesthesiologists when it comes to treating pain management patients. However, many anesthesiologists are avidly opposed to this possibility, especially when dealing with interventional pain management.

“[We] strongly object to any consideration of CRNA’s request to practice outside the field of anesthesia services, specifically in the field of medicine defined as Interventional Pain Management,” says Laxmaiah Manchikanti, MD, Chairman and CEO of the American Society of Interventional Pain Physicians. “CRNAs are not qualified to perform these procedures with or without supervision. We strenuously oppose these regulations. Facet injections, imaging guidance and other interventional pain management techniques are not part of CRNA anesthesia training. CRNAs are demanding to be paid precisely the same as board-certified IPM doctors for procedures that are disallowed by many national insurance companies if performed by board certified anesthesiologists who do not have additional board certification in pain management.” [2]

He is not alone. A while back, Hartley Medical re-posted a news article that discussed this topic. In response, we received a comment from a doctor in Wyoming stating that:

“There is a significant gulf separating nurses from physicians in terms of education, training and experience. “¦ This, of course, is a result of not receiving the astonishing quantity of information imparted during Medical School and Residency and of not being trained to practice Medicine independently as we are.”

However, CRNAs strongly disagree with the mentality of these anesthesiologists.

“There is an assault on advanced practice nursing by organized medicine,” says Jay Horowitz, CRNA, of Quality Anesthesia Care Corp. “CRNAs are fully capable and, in most states, legally able to provide these pain care procedures.” ²

Hartley Medical is intrigued by these arguments that are dividing pain management professionals. We understand the controversy surrounding both of these issues, and we are interested in hearing your opinions. We urge you to leave comments in the box provided below, or e-mail us at questions@hartleymedical.com.

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