It takes at least 9 years of higher education to become a licensed medical doctor. Becoming a specialist in your field, however, takes even longer. Let's look at what is involved:

• 4 years of undergraduate school (college)
• 4 years of medical school leading to a MD (Medical Doctor) or DO (Doctor of Osteopathy) degree
• 1 year of internship, after which the physician may apply for a medical license
• 2-5 years of residency training in a medical specialty (consider this "on the job training" in a teaching hospital)
• 1-2 years of training in a subspecialty (this is called a Fellowship)

All physicians must be licensed to practice medicine. A license is issued by the state in which the physician wishes to practice medicine. This is different from Board Certification. Board Certification involves additional testing by the American Board of Medical Specialties. Once a doctor has obtained board certification, the whole process must be repeated again every 10 years to re-certify, thus ensuring a doctor has continued his or her education in all of the advancements of that medical specialty. You may have seen MD's who advertise: Board Certified in Orthopedics, Pain Management or another medical specialty.

Now that you understand what goes into becoming a specialist in medicine, allow me to share with you how it applies to me:

• 4 years undergraduate school (Wheaton College)
• 4 years of medical school (Rush Medical College)
• 1 year of internship in General Surgery
• 2 years of residency in Anesthesiology
• 1 year of fellowship training in Pain Management

That's 12 years of education. Others who tout themselves as pain specialists have considerably less training. By comparison, a chiropractor completes 4 years of chiropractic school beyond their college degree (8 years total). A chiropractor (D.C.) is not a medical doctor. They are not licensed to prescribe medications, nor can they perform injections. A nurse practitioner (NP) or Physician's Assistant (PA) has two years of nursing school or PA school beyond their undergrad degree (6 years total). Although they are allowed to prescribe medication and perform some injections, they must do so under the direction of a physician. In my newly elected position of President and Executive Director of the Tennessee Society of Interventional Pain Physicians, I've learned of both chiropractors and nurse practitioners who advertise themselves as pain management specialists.

There are many clinics in Middle Tennessee that offer relief from back pain through injections and other treatments, but I am concerned that not all of the providers are properly or thoroughly trained. A pain specialist needs to be able interpret diagnostic tools such as MRIs, CT scans or discography in order to diagnose the source of the patient's pain. He or she needs to be trained in the use of fluoroscopy (X-ray guidance), knowledgeable of anatomy and highly skilled in performing procedures for them to be safe and effective. A pain specialist must be able to recognize the loss of function that frequently accompanies pain conditions, and the ability to recognize and treat complications. Therefore, I highly recommend you ensure the physician treating you is more than simply licensed; make certain they are Board Certified in Pain Management.

Before I started my own practice here in Tennessee, I taught other physicians in the field of Anesthesiology at New England Medical Center in Boston. When I did my Fellowship in pain management, there weren't that many programs available. Now, it is a rapidly growing field and a recognized board certified specialty. The precision and technique required to be skillful in this area of medicine is complicated.

Last summer, I was one of two physicians chosen nationally by the International Spine Intervention Society (ISIS) to be a faculty member, which means I now train other physicians how to perform interventional pain procedures. In April, I taught at a national conference where I instructed physicians who specialized in Anesthesiology, Physical medicine and Rehabilitation, Radiology, Neurology, Orthopedic Surgery and others in the advanced techniques and new treatments for spine pain. It was a prestigious honor to receive, and I enjoyed meeting other physicians who knew and respected the complexity of this work.

It is my patients, their good results, and their positive outcomes here at Precision Pain Care that keeps me going. But I will have to admit that being singled out as an expert by my peers was a good feeling. I imagine it's what it's like to win an Academy Award in the film industry.

To your health!

Graf Hilgenhurst, M.D.