Primary Requirements:

1) Must be an ASIPP Member in good standing
2) Must be American Board of Medical Specialties (ABMS) or AOS (American Osteopathic Association) board certified
3) Must have provided outstanding service to interventional pain management

Checklist Categories:

1) Professionalism
2) Service to ASIPP
3) Leadership
4) Educational Service
5) Scholarship
6) Advocacy/Public Political Service
7) Charitable Activities

The following are examples of eligible activities within each category. This is not an exhaustive list.

Professionalism Checklist:

1) Ethical behavior
2) Altruistic attitude
3) Responsible conduct
4) Intellectual development
5) Skills and Knowledge competence
6) Demonstrates respect for others (patient, staff, other physicians, residents, fellows, students etc.)
7) Empathy and Compassion for others
8) Appropriate response to the patient and family members as well as staff
9) Calm & Compassionate demeanor
10) Must attest to a code of ethics

Service to ASIPP Checklist:

1) Serve on the Board of Directors for ASIPP/ABIPP
2) Board Examiner
3) Editorial Board &/or reviewer for Pain Physician or Case Reports
4) Committee Member
5) ASIPP Workshop or Meeting Course Director
6) ASIPP meeting moderator
7) ASIPP meeting presenter
8) ASIPP Webinar presenter
9) ASIPP meeting abstract reviewer
10) ASIPP Cadaver Lab trainer
11) Submit articles to Pain Physician or Case Reports
12) Submit an educational exhibit at an ASIPP meeting

Leadership Checklist:

1) Military or government leadership position
2) Leadership position in a subspecialty of other medical society
3) Hospital or Practice leadership
a) Chief of Staff
b) Member of Hospital Joint Advisory Board
4) IPM or another committee or subcommittee member (other than ASIPP)
5) Local community leadership
6) IPM or another committee (other than ASIPP) chair
7) Member of a task force
8) Member of a Board of Directors (other than ASIPP)
9) Member of a State committee
10) Member of a State Medical Licensing Board
11) Officer in a State Medical Licensing Board
12) Service Awards (includes Military and Governmental awards)

Educational Service Checklist:

1) Fellowship Director
2) Residency Director
3) Student educational program director
4) Director of Medical Education
5) Invited Lecturer
6) Department Chair
7) Section Chair
8) Active involvement in teaching in a non-academic center
9) Active involvement in teaching in an academic center
10) Research in IPM
11) Educational program developer
12) Editor for publications other than Pain Physician or Case Reports
13) Article reviewer other than Pain Physician or Case Reports
14) Subspecialty of other Medical Board Certification
15) Presentations non- ASIPP National, International, State
16) Grant recipient
17) Webinar presentation non-ASIPP
18) Educational exhibit non-ASIPP
19) Program Chair non-ASIPP

Scholarship Checklist:

1) Author:
a) Book and/or Book chapter
b) Peer reviewed articles (differs from non-peer reviewed articles)
2) Inventions leading to new techniques or medical advances
3) Development of new treatments/therapies that transform patient care
4) Work leading to new treatment paradigms
5) Seminal Trial leadership

Advocacy/Public Political Service Checklist:

1) Congressional visits for ASIPP
2) Medical Advisory Board
3) Legislative Task Force
4) RUC
5) AMA
6) FDA
7) NIH
8) Public Relations activity for IPM
9) You-tube channel for IPM
10) Pod Casts for IPM
11) Patient Education Activities
12) Public Service Announcements for IPM
13) Lecture(s) to civic groups including those related to IPM
14) Radio or TV appearances for IPM
15) Participation in ASIPP advocacy efforts (letters, meetings, phone calls) other than the congressional visit

Charitable Activities Checklist:

1) Charitable care for patients
2) Volunteer in a community service project
3) Medical Mission trip
4) Participation in a domestic or overseas medical clinic