Anesthesiologist Assistant Subspecialty Postgraduate Fellowship Term Paper

Pages: 6 (1837 words)  ·  Style: APA  ·  Bibliography Sources: 8  ·  Level: College Sophomore  ·  Topic: Health - Nursing

¶ … Subspecialty postgrad pain

As most of us are aware the U.S. population is aging at a never before seen rate, based on the availability of good medical care, proper nutrition and other positive aspects that increase longevity. (Takamura, 1999, p. 232) Yet, with age often come health tradeoffs, and especially those that are specific to chronic diseases that require improved pain care. (Kadushin, 2004, p. 219) an emphasis has also recently been placed on the offering of palliative care as apposed to heroic end of life care that often results in only very limited success, during certain stages of disease and is very costly to patients, families and hospitals. (Davison & Hyland, 2003, p. 109)

In addition to the previously mentioned demographic changes are changes in the medical industry that attempt to reduce costs of care provision, by providing practitioners who can manage care without the high per visit rates of physicians. Some examples of these highly trained alternative care providers are nurse practitioners, physician's assistants, nurse anesthetists and anesthesiology assistants. (Bandlow, 1995, p. 89) All of these care providers currently practicing and who will practice in the future have been around for a long time but are currently increasing in number and watching their professions change and progress, with regard to specialization and continuing education offerings and requirements. ("Boom Careers for the," 1994, p. 79)

Pain management has become an exceedingly technology driven area of medicine, with increased options and alternatives for chronic pain treatment, improved drugs and delivery methods. Anesthesiologists, currently have the opportunity to specialize in pain management to assist patients in the difficult task of improving quality of life, while living with chronic pain. Physicians including anesthesiologists have the alternative of sub-specializing in pain medication through the American Board of Pain Medicine (ABPM) or in pain management from their participating professional organization, in the case of Anesthesiology, the Anesthesiology Specialty Board or the ABA. (NPF, 2008. NP) Pain management specialists and pain medicine specialists who are anesthesiologists have a full cornucopia of pain management options including spinal blocks and epidural treatment, in some extreme cases, as mentioned below in the comprehensive definition of pain medicine. This work will demonstrate the need for sub-specialty opportunities for nurse anesthetists and anesthesiology assistants, with regard to pain management. The program would be similar to the sub-specialty currently offered to anesthesiologists but would be administered as a post graduate fellowship subspecialty in pain management.

Specialized Pain Management Growth:

The growth of specialized care in pain management has been exponential over the last twenty years, as more and more is understood about chronic pain, the changing population and a growing emphasis on palliative care. Palliative care, though it may be controversial to some is regarded as a humane way to allow patients lives to end without suffering, when the end is inevitable, given the current disease state. (Davison & Hyland, 2003, p. 109) Chronic pain related diseases, such as end stage cancer is an example of how the aging population frequently dies in this culture and pain management is one of the most crucial issues associated with it. Pain management is defined by the American Board of Pain Medicine, the sub-specialty licensing organization for physicians in pain management as:

The specialty of Pain Medicine is concerned with the prevention, evaluation, diagnosis, treatment, and rehabilitation of painful disorders. Such disorders may have pain and associated symptoms arising from a discrete cause, such as postoperative pain or pain associated with a malignancy, or may be syndromes in which pain constitutes the primary problem, such as neuropathic pains or headaches. The diagnosis of painful syndromes relies on interpretation of historical data; review of previous laboratory, imaging, and electrodiagnostic studies; behavioral, social, occupational and avocational assessment; interview and examination by the pain specialist; and may require specialized diagnostic procedures, including central and peripheral neural blockade or monitored drug infusions. The special needs of the pediatric and geriatric populations are considered when formulating a comprehensive treatment plan for these patients..

The pain physician serves as a consultant to other physicians but is often the principal treating physician and may provide care at various levels, such as direct treatment, prescribing medication, prescribing rehabilitative services, performing pain relieving procedures, counseling of patients and families, direction of a multidisciplinary team, coordination of care with other healthcare providers and consultative services to public and private agencies pursuant to optimal healthcare delivery to the patient suffering from a painful disorder. The pain physician may work in a variety of settings and is competent to treat the entire range of painful disorders encountered in delivery of quality health care. (ABPM, 2008, NP)

Patients who are treated at home, in hospices, extended care facilities or even in hospitals have more options for pain management today than ever before and those options should be increased by the available opportunity of having trained professional anesthesiologist assistants who can help manage pain with methods that are alternative to systemic medication, which frequently reduces or eliminates pain but can be harmful to quality of life. Patients who desire the opportunity to interact with family and friends even in their most dire state are often challenged to do so not only by their current disease state but by the medications used to alleviate pain. Though medications have also improved many patients also face what is titled intractable pain, or pain which cannot be completely eliminated no matter how many systemic medications they take. Intractable pain, is in fact one of the biggest reasons why alternative pain management should become more readily available to patients in every setting. It is also clear from the above definition of pain management that the system, as it is described is a holistic system that often includes multiple referrals or care that will aide in the alleviation of pain. Everything from nutrition to psychological care is looked at by pain management physicians as a way to help treat a chronic pain condition, and it would only seem logical that some pain eliminating procedures, such as those which could be performed by an anesthesiology assistant could also be referred and therefore become more cost effective procedures for the patient.

Increased Opportunity for Care:

The use of spinal blocks and epidurals has previously been associated mainly with child birth and delivery and yet it has also become an increasingly popular alternative for patients undergoing lower body surgical procedures and in some cases for more long-term chronic pain management. This is especially true in cases where surgical general anesthesia is contraindicated or in chronic pain patients where mobility is limited by disease. (Block, Kremer, & Fernandez, 1999, p. 412) the efficacy of such treatment for chronic pain has grown as a logical acceptance of the fact that bathing a portion of the spinal nerves, effecting pain transmittal signals to the brain is essentially treating the symptom at its source, rather than after such medication has transgressed through the entire blood stream or even through the digestive tract. (Koestler & Myers, 2002, p. 18)

It is in these circumstances that there should be an alternative to anesthesiologist administration, which is most often required to be done in a strictly controlled environment, mostly a hospital setting and can be so costly that insurers tend to reject claims for such treatment, especially if an individual is not already hospitalized. If there was an increased pool of trained practitioners able to administer these types of treatments, and if those people where nurse anesthetists or anesthesiology assistants the cost of such services would likely decrease significantly and there might be a broadening of allowable administration environments and an increase in insurer acceptance of such treatment. (Block, 1996, p. 108)

Current Opportunity for Specialization in Pain Management/Proposed AA System:

The current system for subspecialty certification for physicians, in pain medicine comes in the form of an annual exam offered by the ABPM. The organization certifies about 2200 physicians per year in this specialty through the successful completion of the exam, which has about an 80% pass rate. (ABPM, 2008, NP) it would be conducive to structure the AA system in a similar manner with the inclusion of preparatory post grad fellowship continuing education opportunities. Individual AA's who took the seminar style two semester prep classes, and who were signed off by a governing anesthesiologist or their work institution as working within this field successfully for greater than one year would be eligible to sit for the exam and would then be certified in the subspecialty of pain medicine if success was achieved on the exam. All preparation would also qualify the individual for continuing education credits, toward their general licensure and facility requirements. Some legislation for a broadening of services offered might also be needed to alter the current state of allowable practical functions of an AA. The development of such legislative changes would likely be welcomed, as cost reduction seems to be the rule of the day with regard to medical care and spending, and this would likely improve… [END OF PREVIEW]

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