Entrepreneurial Opportunities in Anesthesiology

[dchz]

Absolutely. MILD pts come back clickin their heels. RFA’s can achieve excellent results. I dont understand why anesthesiologists think pain doctors are all crackpots.

I'm saying this without an intent to offend.

This is how the conversation played out as I read it:

@OptionOffense : is pain still lucrative?
@TheLoneWolf : no, reimbursement going down.
@TeslaCoil : well it is lucrative if you perform spine surgery and instrument the spine.

I do not think pain docs are all crackpots. I had EXCELLENT pain docs as mentors (eg presidents of ASRAs, caring physicians, and great anesthesiologists).

But for everyone one of those, I've met 4-5 pain docs that are willing to do anything for money, including people without an actual fellowship in interventional pain.

On the flip side, you see these EP and interventional cards trying to give out watchman and amulets as they are tickets to heaven, with a heavy financial or economic influence. Are the MILD, Minuteman, and Vertiflex procedures any worse? If EP and interventional cards can profit off of barely proven hardware, why can't pain doctors?

I don't know where the line should be drawn and I'm not the moral police. But I think it's not unreasonable to assume the worst in some of these people...

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[kidthor]

I'm saying this without an intent to offend.

This is how the conversation played out as I read it:

@OptionOffense : is pain still lucrative?
@TheLoneWolf : no, reimbursement going down.
@TeslaCoil : well it is lucrative if you perform spine surgery and instrument the spine.

I do not think pain docs are all crackpots. I had EXCELLENT pain docs as mentors (eg presidents of ASRAs, caring physicians, and great anesthesiologists).

But for everyone one of those, I've met 4-5 pain docs that are willing to do anything for money, including people without an actual fellowship in interventional pain.

On the flip side, you see these EP and interventional cards trying to give out watchman and amulets as they are tickets to heaven, with a heavy financial or economic influence. Are the MILD, Minuteman, and Vertiflex procedures any worse? If EP and interventional cards can profit off of barely proven hardware, why can't pain doctors?

I don't know where the line should be drawn and I'm not the moral police. But I think it's not unreasonable to assume the worst in some of these people...

To that end all too many spine surgeons are happy to do surgery for “pain” despite most pathologies not having a clear surgical benefit (without neuro symptoms of course). And IR is happy to do ESIs with no med management or adjuncted services too. Unfortunately it all seems like a bit of a mess.

When it comes down to it I think most pain doctors do a good job and make an honest effort to help, but the financial incentive of procedural stuff does skew things.

 

[TheLoneWolf]

I'm saying this without an intent to offend.

This is how the conversation played out as I read it:

@OptionOffense : is pain still lucrative?
@TheLoneWolf : no, reimbursement going down.
@TeslaCoil : well it is lucrative if you perform spine surgery and instrument the spine.

I do not think pain docs are all crackpots. I had EXCELLENT pain docs as mentors (eg presidents of ASRAs, caring physicians, and great anesthesiologists).

But for everyone one of those, I've met 4-5 pain docs that are willing to do anything for money, including people without an actual fellowship in interventional pain.

On the flip side, you see these EP and interventional cards trying to give out watchman and amulets as they are tickets to heaven, with a heavy financial or economic influence. Are the MILD, Minuteman, and Vertiflex procedures any worse? If EP and interventional cards can profit off of barely proven hardware, why can't pain doctors?

I don't know where the line should be drawn and I'm not the moral police. But I think it's not unreasonable to assume the worst in some of these people...

Academic pain management (mostly salaried) are a different beast than private practice pain management. PP guys tend to be very procedurally aggressive, upsell procedures, and cognizant of working against large overhead costs. I have met these types at university settings and they quickly consider themselves a poor fit and leave for PP.

The Academic guys have a mantra of most things don't work or provide marginal benefit. They tend to focus heavily physical therapy, psych and coping skills, prudent medication management, cancer pain, addiction management and multidisciplinary therapy. These are, for the most part, lacking in PP settings and considered money losers.

Most Fellows I had met are envisioning doing shots all say and going home at banker hours with little concern for the above issues. Rude awakening when they actually graduate and see what's out there.

Welcome to check out the pain forum and the annual applicants thread where they wish to go to heavily interventional programs without strong consideration of the above matters.

@Planktonmd made a post years ago joking that pain management is patients showing up for procedures in the hopes of you refilling their opioid of choice.

Before my fellowship, I thought the comment was silly, crass and parody of true pain management. It turns out he was describing the pills for shots model so prevalent in PP pain management.

Check out the pain forum for going salaries. There are fully interventional clinics closing because of insufficient revenue.

Another important topic is the co-optation of pain procedures and management in recent years. @Aether2000 had a post regarding this. Essentially, ortho and neurosurgery want to send patients for procedures without interference to their foreseeable and planned surgery. Rather than have your management change or delay these surgeries, it's easier for them to send to a proceduralist with no followup eg IR or in house "block jock".

On the other hand they are more than happy to refer patients who had failed surgery for "optimization of their pain management ".

Caveat Emptor

I don't write this to discourage people from pain but to have an open and honest understanding of what we can offer to chronic pain patients. Just know what you are getting into.

The academics for the most part are legit and have difficult conversations with patients and their referral base and are not reluctant to put their foot down or say no. Doing the same in PP can get you canned (depending on who you work for) or results in your referral base drying up.

BTW I worked in both academic and PP pain settings.

 

[epidural man]

As non patient “owning” specialists, what are some entrepreneurial opportunities specific for anesthesiologists?

While sitting on the stool in the OR, sell 45 day-to expire SPX Iron Condors.

 

[dchz]

@Planktonmd made a post years ago joking that pain management is patients showing up for procedures in the hopes of you refilling their opioid of choice.

Before my fellowship, I thought the comment was silly, crass and parody of true pain management. It turns out he was describing the pills for shots model so prevalent in PP pain management.

It took me about 3 hours into my chronic pain rotations to realize the truth of the statement.

Glad I saved myself some time.

While sitting on the stool in the OR, sell 45 day-to expire SPX Iron Condors.

Unsure if this is a joke but the leader of my group legit does this.

 

[TeslaCoil]

I'm saying this without an intent to offend.

This is how the conversation played out as I read it:

@OptionOffense : is pain still lucrative?
@TheLoneWolf : no, reimbursement going down.
@TeslaCoil : well it is lucrative if you perform spine surgery and instrument the spine.

I do not think pain docs are all crackpots. I had EXCELLENT pain docs as mentors (eg presidents of ASRAs, caring physicians, and great anesthesiologists).

But for everyone one of those, I've met 4-5 pain docs that are willing to do anything for money, including people without an actual fellowship in interventional pain.

On the flip side, you see these EP and interventional cards trying to give out watchman and amulets as they are tickets to heaven, with a heavy financial or economic influence. Are the MILD, Minuteman, and Vertiflex procedures any worse? If EP and interventional cards can profit off of barely proven hardware, why can't pain doctors?

I don't know where the line should be drawn and I'm not the moral police. But I think it's not unreasonable to assume the worst in some of these people...

Mmk, first of all I would never perform a procedure on anybody with the primary intent of making money. Nor would I perform any procedure which I didnt think had at least a very solid chance of helping somebody. What you’re saying could apply to ANY specialty. I know pcp’s who shell out UDS’s and hpv vaccines like theres no tomorrow. I know spine surgeons who would fuse a dog if they had the chance. Dont give me this self riteous nonsense. The advanced procedures help more than any of the other things we do. Not to mention that I still think there is something to be said for opiates, injections, and rfa for the right patients.

 

[TheLoneWolf]

Mmk, first of all I would never perform a procedure on anybody with the primary intent of making money. Nor would I perform any procedure which I didnt think had at least a very solid chance of helping somebody. What you’re saying could apply to ANY specialty. I know pcp’s who shell out UDS’s and hpv vaccines like theres no tomorrow. I know spine surgeons who would fuse a dog if they had the chance. Dont give me this self riteous nonsense. The advanced procedures help more than any of the other things we do. Not to mention that I still think there is something to be said for opiates, injections, and rfa for the right patients.

From your posts in your own words:

Am I underpaid ?

I see 27pts on average (about 20 -22 fu, 5-7 np) a day, 3.5-4 days a week and roughly 35-40 procedures (bread and butter, scs and kypho once in a blue moon) a week. I'm employed and my base is 350k or 40% total collections on the west coast single specialty private practice in office only. I...

forums.studentdoctor.net

"Wanna hear about underpaid? Between myself and 2 PA's I'm seeing 40-60 pts per day, 5 days a week and performing 50-70 procedures per week. Usually this consists of mostly axial injections, 1 stim trial a week, and anywhere from 6-15 RFA's/week. Fridays I travel 2 hours each way to one of our clinics. Also I'm an area director, which means I have a bunch of managerial crap to do. I make 520k plus benefits. Total comp is probably 550k with retirement account matching. By my calculation between me and my two PA's we are doing something like 12-15k work RVU's/yr. Each of them gets 120k/year. Overhead is relatively low because the owner owns the buildings. So every cent that goes to "rent" goes into his holdings company. But hey im not miserable... 550k aint bad. One of these days though I will either negotiate up or high tail it."

Respond to the actual arguments. For you to jump immediately to calling it self-rightous nonsense is not an argument. You are just telling me what you feel, it's not anything objective.

No ad hominem attacks, no need to make this personal.

I did not make any statement of your intent or accuse specifically you of anything in particular.

If you are stating that there is little evidence for most procedures in medicine, I agree and would recommend the following to you:

Surgery, The Ultimate Placebo: A Surgeon Cuts through the Evidence​

Amazon product

Scummy behavior exists in all fields though I argue that current PP pain management is the pinnacle of such behavior. Both of those statements can be true.

"The advanced procedures help more than any of the other things we do."

So I directly quote neurosurgical professional society's saying don't do advanced spine procedures, leave it to them and you call it self righteous nonsense. Ok lets examine this:

Do you send these patients to a spine surgeon for consultation prior to performing these procedures? If not, why not?

Is their pain so uncontrolled that they need your procedure but not formal surgery? Where do you draw the line?

Why are you doing a lumbar decompression for spinal stenosis rather than a spine surgeon?

Do you tell your patients that you are not a spine surgeon performing spinal Instrumentation?

Do you tell them that you had one year of pain fellowship training and are doing this ( not done with significant volume at most training programs due to limited indication; or worse, learned at a weekend course)?

Do you tell them that surgical professional societies have formal position statements saying it's in their realm and not yours?

These are not just medicolegal questions, these are larger questions of patient autonomy and consentability.

 

[TheLoneWolf]

What about kyphoplasties?

good question

Cochrane metanalysis:

Vertebroplasty for treating spinal fractures due to osteoporosis​

Authors' conclusions:

We found high- to moderate-quality evidence that vertebroplasty has no important benefit in terms of pain, disability, quality of life or treatment success in the treatment of acute or subacute osteoporotic vertebral fractures in routine practice when compared with a sham procedure. Results were consistent across the studies irrespective of the average duration of pain.

Also,

Spinal Fractures Can Be Terribly Painful. A Common Treatment Isn’t Helping. (Published 2019)

Injections of bone cement into fractured vertebrae fail to relieve pain any more than a placebo does, researchers found.

www.nytimes.com

 

[sloh]

Academic pain management (mostly salaried) are a different beast than private practice pain management. PP guys tend to be very procedurally aggressive, upsell procedures, and cognizant of working against large overhead costs. I have met these types at university settings and they quickly consider themselves a poor fit and leave for PP.

The Academic guys have a mantra of most things don't work or provide marginal benefit. They tend to focus heavily physical therapy, psych and coping skills, prudent medication management, cancer pain, addiction management and multidisciplinary therapy. These are, for the most part, lacking in PP settings and considered money losers.

Most Fellows I had met are envisioning doing shots all say and going home at banker hours with little concern for the above issues. Rude awakening when they actually graduate and see what's out there.

Welcome to check out the pain forum and the annual applicants thread where they wish to go to heavily interventional programs without strong consideration of the above matters.

@Planktonmd made a post years ago joking that pain management is patients showing up for procedures in the hopes of you refilling their opioid of choice.

Before my fellowship, I thought the comment was silly, crass and parody of true pain management. It turns out he was describing the pills for shots model so prevalent in PP pain management.

Check out the pain forum for going salaries. There are fully interventional clinics closing because of insufficient revenue.

Another important topic is the co-optation of pain procedures and management in recent years. @Aether2000 had a post regarding this. Essentially, ortho and neurosurgery want to send patients for procedures without interference to their foreseeable and planned surgery. Rather than have your management change or delay these surgeries, it's easier for them to send to a proceduralist with no followup eg IR or in house "block jock".

On the other hand they are more than happy to refer patients who had failed surgery for "optimization of their pain management ".

Caveat Emptor

I don't write this to discourage people from pain but to have an open and honest understanding of what we can offer to chronic pain patients. Just know what you are getting into.

The academics for the most part are legit and have difficult conversations with patients and their referral base and are not reluctant to put their foot down or say no. Doing the same in PP can get you canned (depending on who you work for) or results in your referral base drying up.

BTW I worked in both academic and PP pain settings.

It’s a shame posts like this are only in the anesthesia subforums. This should be a sticky in the pain and PM&R subforums. I’m PM&R and I was a second year resident when I heard for the first time from my program director about the “pills for shots” model which is rampant in PP pain practices, whether it’s explicit or not.

 

[dchz]

Dont give me this self riteous nonsense.

Self-righteous:
Adj. having or characterized by a certainty, especially an unfounded one, that one is totally correct or morally superior.

The advanced procedures help more than any of the other things we do.

My previous post was not meant to offend.

My current post is meant to ridicule and offend.

 

[nimbus]

From your posts in your own words:

Am I underpaid ?

I see 27pts on average (about 20 -22 fu, 5-7 np) a day, 3.5-4 days a week and roughly 35-40 procedures (bread and butter, scs and kypho once in a blue moon) a week. I'm employed and my base is 350k or 40% total collections on the west coast single specialty private practice in office only. I...

forums.studentdoctor.net

"Wanna hear about underpaid? Between myself and 2 PA's I'm seeing 40-60 pts per day, 5 days a week and performing 50-70 procedures per week. Usually this consists of mostly axial injections, 1 stim trial a week, and anywhere from 6-15 RFA's/week. Fridays I travel 2 hours each way to one of our clinics. Also I'm an area director, which means I have a bunch of managerial crap to do. I make 520k plus benefits. Total comp is probably 550k with retirement account matching. By my calculation between me and my two PA's we are doing something like 12-15k work RVU's/yr. Each of them gets 120k/year. Overhead is relatively low because the owner owns the buildings. So every cent that goes to "rent" goes into his holdings company. But hey im not miserable... 550k aint bad. One of these days though I will either negotiate up or high tail it."

Respond to the actual arguments. For you to jump immediately to calling it self-rightous nonsense is not an argument. You are just telling me what you feel, it's not anything objective.

No ad hominem attacks, no need to make this personal.

I did not make any statement of your intent or accuse specifically you of anything in particular.

If you are stating that there is little evidence for most procedures in medicine, I agree and would recommend the following to you:

Surgery, The Ultimate Placebo: A Surgeon Cuts through the Evidence​

Amazon product

Scummy behavior exists in all fields though I argue that current PP pain management is the pinnacle of such behavior. Both of those statements can be true.

"The advanced procedures help more than any of the other things we do."

So I directly quote neurosurgical professional society's saying don't do advanced spine procedures, leave it to them and you call it self righteous nonsense. Ok lets examine this:

Do you send these patients to a spine surgeon for consultation prior to performing these procedures? If not, why not?

Is their pain so uncontrolled that they need your procedure but not formal surgery? Where do you draw the line?

Why are you doing a lumbar decompression for spinal stenosis rather than a spine surgeon?

Do you tell your patients that you are not a spine surgeon performing spinal Instrumentation?

Do you tell them that you had one year of pain fellowship training and are doing this ( not done with significant volume at most training programs due to limited indication; or worse, learned at a weekend course)?

Do you tell them that surgical professional societies have formal position statements saying it's in their realm and not yours?

These are not just medicolegal questions, these are larger questions of patient autonomy and consentability.

Factory work.


I guess the GIs do it too. But pain is not simple while polyps are.

Have you considered stool sitting? It’s a LOT less work for the same money.

 

[epidural man]

MUnsure if this is a joke but the leader of my group legit does this.

Nope - not kidding.

This is my return for the last six months…compare to S&P.

The ups and downs are where the market makes big swings and are not gains or losses, just “current” account value.

I’ve also recently added the wheel strategy - which seeks naked PUTs and with assignment, then sells covered calls until the stock is called away, then sell the naked PUTS, and repeat.

 

[TeslaCoil]

From your posts in your own words:

Am I underpaid ?

I see 27pts on average (about 20 -22 fu, 5-7 np) a day, 3.5-4 days a week and roughly 35-40 procedures (bread and butter, scs and kypho once in a blue moon) a week. I'm employed and my base is 350k or 40% total collections on the west coast single specialty private practice in office only. I...

forums.studentdoctor.net

"Wanna hear about underpaid? Between myself and 2 PA's I'm seeing 40-60 pts per day, 5 days a week and performing 50-70 procedures per week. Usually this consists of mostly axial injections, 1 stim trial a week, and anywhere from 6-15 RFA's/week. Fridays I travel 2 hours each way to one of our clinics. Also I'm an area director, which means I have a bunch of managerial crap to do. I make 520k plus benefits. Total comp is probably 550k with retirement account matching. By my calculation between me and my two PA's we are doing something like 12-15k work RVU's/yr. Each of them gets 120k/year. Overhead is relatively low because the owner owns the buildings. So every cent that goes to "rent" goes into his holdings company. But hey im not miserable... 550k aint bad. One of these days though I will either negotiate up or high tail it."

Respond to the actual arguments. For you to jump immediately to calling it self-rightous nonsense is not an argument. You are just telling me what you feel, it's not anything objective.

No ad hominem attacks, no need to make this personal.

I did not make any statement of your intent or accuse specifically you of anything in particular.

If you are stating that there is little evidence for most procedures in medicine, I agree and would recommend the following to you:

Surgery, The Ultimate Placebo: A Surgeon Cuts through the Evidence​

Amazon product

Scummy behavior exists in all fields though I argue that current PP pain management is the pinnacle of such behavior. Both of those statements can be true.

"The advanced procedures help more than any of the other things we do."

So I directly quote neurosurgical professional society's saying don't do advanced spine procedures, leave it to them and you call it self righteous nonsense. Ok lets examine this:

Do you send these patients to a spine surgeon for consultation prior to performing these procedures? If not, why not?

Is their pain so uncontrolled that they need your procedure but not formal surgery? Where do you draw the line?

Why are you doing a lumbar decompression for spinal stenosis rather than a spine surgeon?

Do you tell your patients that you are not a spine surgeon performing spinal Instrumentation?

Do you tell them that you had one year of pain fellowship training and are doing this ( not done with significant volume at most training programs due to limited indication; or worse, learned at a weekend course)?

Do you tell them that surgical professional societies have formal position statements saying it's in their realm and not yours?

These are not just medicolegal questions, these are larger questions of patient autonomy and consentability.

I dont care what the neurosurgical society says. You cant recognize that they have an agenda?? I have done way more than enough MILD procedures to recognize that they help people and with minimal risk. One single documented dural tear. Ever. In the history of the procedure. The neurosurgeons had an opportunity to make the procedure theirs. They passed on it before giving serious consideration. In my opinion, probably because they dont get paid enough for it as compared to acdf’s and ALIFs.

In my own words yes. Whats your point exactly with that?

 

[TeslaCoil]

From your posts in your own words:

Am I underpaid ?

I see 27pts on average (about 20 -22 fu, 5-7 np) a day, 3.5-4 days a week and roughly 35-40 procedures (bread and butter, scs and kypho once in a blue moon) a week. I'm employed and my base is 350k or 40% total collections on the west coast single specialty private practice in office only. I...

forums.studentdoctor.net

"Wanna hear about underpaid? Between myself and 2 PA's I'm seeing 40-60 pts per day, 5 days a week and performing 50-70 procedures per week. Usually this consists of mostly axial injections, 1 stim trial a week, and anywhere from 6-15 RFA's/week. Fridays I travel 2 hours each way to one of our clinics. Also I'm an area director, which means I have a bunch of managerial crap to do. I make 520k plus benefits. Total comp is probably 550k with retirement account matching. By my calculation between me and my two PA's we are doing something like 12-15k work RVU's/yr. Each of them gets 120k/year. Overhead is relatively low because the owner owns the buildings. So every cent that goes to "rent" goes into his holdings company. But hey im not miserable... 550k aint bad. One of these days though I will either negotiate up or high tail it."

Respond to the actual arguments. For you to jump immediately to calling it self-rightous nonsense is not an argument. You are just telling me what you feel, it's not anything objective.

No ad hominem attacks, no need to make this personal.

I did not make any statement of your intent or accuse specifically you of anything in particular.

If you are stating that there is little evidence for most procedures in medicine, I agree and would recommend the following to you:

Surgery, The Ultimate Placebo: A Surgeon Cuts through the Evidence​

Amazon product

Scummy behavior exists in all fields though I argue that current PP pain management is the pinnacle of such behavior. Both of those statements can be true.

"The advanced procedures help more than any of the other things we do."

So I directly quote neurosurgical professional society's saying don't do advanced spine procedures, leave it to them and you call it self righteous nonsense. Ok lets examine this:

Do you send these patients to a spine surgeon for consultation prior to performing these procedures? If not, why not?

Is their pain so uncontrolled that they need your procedure but not formal surgery? Where do you draw the line?

Why are you doing a lumbar decompression for spinal stenosis rather than a spine surgeon?

Do you tell your patients that you are not a spine surgeon performing spinal Instrumentation?

Do you tell them that you had one year of pain fellowship training and are doing this ( not done with significant volume at most training programs due to limited indication; or worse, learned at a weekend course)?

Do you tell them that surgical professional societies have formal position statements saying it's in their realm and not yours?

These are not just medicolegal questions, these are larger questions of patient autonomy and consentability.

I went to a residency program and a fellowship where I did plenty of these with a seasoned pain surgeon. I hate to tell you but modern pain mgmt IS A SURGICAL specialty. Instrumenting the spine? Instrumenting the spine is a core competency of anesthesia. What do you call epidurals and spinals? Spinal cord stimulators? Intrathecal pumps? As part of my training for MILD was also trained to read MRI’s for surgical planning. I dont need a neurosurgeons permission for fuggle. If a patient has claudication and its largely due to flavum hypertrophy, its worth trying MILD before condemning them to a laminectomy or fusion.

 

[TeslaCoil]

I went to a residency program and a fellowship where I did plenty of these with a seasoned pain surgeon. I hate to tell you but modern pain mgmt IS A SURGICAL specialty. Instrumenting the spine? Instrumenting the spine is a core competency of anesthesia. What do you call epidurals and spinals? Spinal cord stimulators? Intrathecal pumps? As part of my training for MILD was also trained to read MRI’s for surgical planning. I dont need a neurosurgeons permission for fuggle. If a patient has claudication and its largely due to flavum hypertrophy, its worth trying MILD before condemning them to a fusion.

Self-righteous:
Adj. having or characterized by a certainty, especially an unfounded one, that one is totally correct or morally superior.



My previous post was not meant to offend.

My current post is meant to ridicule and offend.

Your original post was offensive whether you meant it or not. Good thing I personally don't care what people say behind anonymous posts. All Im saying is that if what you said is true, its not specifically true for only pain doctors, but for all doctors. Therefore dont frame it in the form of specifically applying to pain doctors. I have a clinic full of patients who resent and down right hate their neurosurgeons for “destroying their lives”. There is a place for neurosurgery, but you dont think that people are over-surgerized?? If you dont think that people are over-surgerized by neuro and ortho then you are absolutely clueless.

 

[TheLoneWolf]

I dont care what the neurosurgical society says. You cant recognize that they have an agenda?? I have done way more than enough MILD procedures to recognize that they help people and with minimal risk. One single documented dural tear. Ever. In the history of the procedure. The neurosurgeons had an opportunity to make the procedure theirs. They passed on it before giving serious consideration. In my opinion, probably because they dont get paid enough for it as compared to acdf’s and ALIFs.

In my own words yes. Whats your point exactly with that?

Ok so rather than answering my acutal point by point questions directed to you, I received a response of neurosurgical societies have an agenda to limit you from performing percutaneous spine surgery that irrevocably alters the spinal anatomy.

n=1 and you are clearly incentivised to perform the procedures. There is a definitive bias.

I am happy to continue this conversation if you respond to my above posted questions.

 

[TheLoneWolf]

I went to a residency program and a fellowship where I did plenty of these with a seasoned pain surgeon. I hate to tell you but modern pain mgmt IS A SURGICAL specialty. Instrumenting the spine? Instrumenting the spine is a core competency of anesthesia. What do you call epidurals and spinals? Spinal cord stimulators? Intrathecal pumps? As part of my training for MILD was also trained to read MRI’s for surgical planning. I dont need a neurosurgeons permission for fuggle. If a patient has claudication and its largely due to flavum hypertrophy, its worth trying MILD before condemning them to a laminectomy or fusion.

Ok so you believe that the practice of pain management is primarily surgical in nature? If that is the case then leave it to spine surgeons. Can you perfect their technique in a one year fellowship? We are multimodally based, with a procedural aspect. There is a KOL fringe in the past few years a la ASIPP and NANS that is pushing for more and more invasive procedures but it really begins to blur the line of proceduralist vs surgeon. This had forced the spine societies to respond. I am saying, now that they have a position statement, how does it alter your practice? The procedures you mentioned do not irrevocably alter anatomy and the implants can be explanted. With that being said, I beleive SCS is overutilized. IT pumps are going the way of the dodo.

 

[TheLoneWolf]

Your original post was offensive whether you meant it or not. Good thing I personally don't care what people say behind anonymous posts. All Im saying is that if what you said is true, its not specifically true for only pain doctors, but for all doctors. Therefore dont frame it in the form of specifically applying to pain doctors. I have a clinic full of patients who resent and down right hate their neurosurgeons for “destroying their lives”. There is a place for neurosurgery, but you dont think that people are over-surgerized?? If you dont think that people are over-surgerized by neuro and ortho then you are absolutely clueless.

The utilization of surgery and pain procedures has boomed over the past few decades with no long term literature showing improved outcomes. What we have is short term device funded studies that sensationalize results and play with numbers to achieve the funders conclusion. They know docs in general suck at critically evaluating the data. The ones that do tend to stay academic. Not hard to play with parameters to get a P<0.05.

Check out cochrane and pretty much nothing works or shows mild to moderate short term benefits at best. No hype or conflicts of interest.

It's not specific to just pain management or spine surgery. Eg cardiac stents for stable angina, arthroscopies compared to PT.

 

[sevo00]

LOL at thinking a one year pain fellowship makes you a surgeon. Wow

 

[nimbus]

LOL at thinking a one year pain fellowship makes you a surgeon. Wow

I can’t help but see the parallel when CRNAs claim to be our equal. I mean they can put a tube in too, right?

 

[sevo00]

I can’t help but see the parallel when CRNAs claim to be our equal. I mean they can put a tube in too, right?

Absolutely Correct. Same logic. Both claims are idiotic

 

[BIGphysician]

realistically. basically two options. 1) start own business outside of medicine using your job for start up costs (its a deduction), 2) start a Locums company.