How to Overcome Pain Resource Challenges: Part 1

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Peter Learned Barelka, MD.
Peter Learned Barelka, MD.

A challenge frequently encountered at pain management clinics is the need to deliver an abundant amount of resources for patients. To meet this need, clinicians are expanding staff, services, and establishing new facilities to accommodate the growing number of individuals in need of treatment for pain.

Peter Learned Barelka, MD, graduated from the University of Colorado at Boulder, majoring in molecular biology, biochemistry, and Russian language. He attended Georgetown University Medical School and completed the Georgetown Transitional Medical Internship. He then completed his residency in anesthesiology and a pain medicine fellowship at Stanford University.

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Dr Barelka joined the VA Palo Alto Health Care System (VAPAHCS) in 2008 and works as both a clinical anesthesiologist and pain medicine physician. He currently serves in the capacity of the clinical chief of the pain clinic and is co-chair of the VAPAHCS Pain Committee.

"The Refill" is a Q&A column designed to provide Clinical Pain Advisor's readership with clinical perspective and suggestions for operating a pain management practice.

Clinical Pain Advisor: What is the greatest challenge to your practice?

Dr Barelka: Our greatest challenge is getting the available resources to our patients. I work at the VA hospital in Palo Alto, California, which is one of the 153 VA hospitals throughout the United States. As such, we have a significant catchment basin of patients. It is not uncommon for our patients to drive several hours to reach the hospital. This long travel time is difficult for our patients and leads to canceled appointments, no-shows, and eventually longer wait times for all our patients. Additionally, the traditional compartmentalization of pain services results in patients having to return to the hospital for clinic visits from a variety of providers.

To meet these challenges, we have recently established a spine clinic. This is a highly specialized clinic with staff from pain, neurosurgery, physical medicine and rehabilitation, physical therapy, and behavioral medicine. A spine clinic is significantly different from the traditional multidisciplinary pain clinic in that it addresses patients with complicated spinal pathology. Traditionally, these patients require input from several services and therefore are high utilizers of resources. Having these services under one clinical umbrella streamlines their care, saving them time and the hospital resources while at the same time closing the communication loop between providers. It is truly a win-win for everyone.

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