Pain Medicine Board Certification Status Among
Physicians Performing Interventional Pain
Procedures in the State of Florida Between 2010
and 2016
Authors: Epstein Richard H. 
Published: March 2021

Background: The US Department of Health and Human Services has recommended that
physicians performing interventional pain procedures be credentialed based on criteria‑based
guidelines and minimum training requirements.
Objectives: To quantitatively assess gaps in certification related to pain medicine fellowship
requirements, 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 January
2010 and December 2016 were obtained from the Florida Department of Health. The National
Provider 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 Interventional
Pain Physicians (ABIPP) corresponding to this time frame were also obtained.
Methods: The datasets were linked to determine the specialty of physicians performing
interventional pain procedures, and whether or not they were pain medicine diplomates of the
ABMS, the ABPM, or the ABIPP. The similarity index Θ was calculated for the distribution of
interventional pain procedure codes among medical specialty groups, and with respect to the
practitioners’ pain medicine board certification status.
Results: Of the interventional pain procedures, anesthesiologists performed 63.5%, physiatrists
19.1%, neurologists or psychiatrists 5.2%, and other practitioners 12.3%. Among procedures
performed by anesthesiologists, physiatrists, and psychiatrists or neurologists, 66.2%, 50.3%,
and 50.4% were by ABMS pain board-certified practitioners, respectively. Practitioners without
ABMS pain medicine boards performed 45.8% of interventional pain procedures. Practitioners
without such boards from either the ABMS, ABPM, or ABIPP performed 37.7%. There was very
large similarity (Θ > 0.9) in the distribution of procedures comparing ABMS pain medicine boardcertified 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 certification
is relatively recent, there may be a higher percentage of interventional pain procedures performed
by individuals without certification than we report. In “opt-out” states, where nurse anesthetists
can independently perform interventional pain procedures, the percentage of interventional
pain procedures performed by individuals without physician pain medicine board certification
may also be higher. The datasets we used do not contain information to allow assessment of
outcomes or effectiveness resulting from pain medicine board certification.
Conclusions: Approximately one-third of interventional pain procedures were performed
by physicians without at least 1 of the 3 pain medicine board certifications. In addition, the
practitioners performed very similar distributions of procedures (i.e., those without pain medicine
board certification, overall, have not restricted their practice). These results suggest the need for
additional 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, physicians
without board certification performing intervention procedures would need to obtain ABPM or ABIPP certification, or ABMS
certification after completion of a full-time Accreditation Council of Graduate Medical Education pain medicine fellowship.
Key words: Chronic pain, education, medical, graduate, specialty boards