Mentorship

Myofascist said:

Hello all, I am a PGY-4 who decided against a fellowship for numerous reasons. I have been offered a job in a multi-disciplinary pain practice w/ anesthesiologists, PM+R, and neurologists. The head doc said he would provide a mentorship for me early on w/ some guidance on spine injections until I get comfortable. I know the whole ACGME vs no ACGME thing has been beaten to death but I just wanted to get any thoughts on this matter. The practice has its own C-arms, I wouldnt need hospital priveledges for anything, so couldnt I just work there, do bread-n-butter injections, and not worry about the future???

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Sounds like a great Gig *for now.* But, let's say things change and you relocate? Then what? There is no magic to the whole fellowship experience. It mostly just crosses "t's" and dots "i's."

drusso said:

Sounds like a great Gig *for now.* But, let's say things change and you relocate? Then what? There is no magic to the whole fellowship experience. It mostly just crosses "t's" and dots "i's."

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I think it would only be a problem if you wanted to go solo. If you relocate and join another practice, they will probably have their own ASC or a C arm in the office.

Louisville04 said:

I think it would only be a problem if you wanted to go solo. If you relocate and join another practice, they will probably have their own ASC or a C arm in the office.

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Most ASC's require that you first obtain hospital privileges prior to them granting you privileges themselves.

Most hospitals these days require that you demonstrate proficiency in procedures from some form of formal training prior and the ability to document a minimum number of procedures before allowing you to do them

Thus not doing a fellowship may put you in the unenviable position of not being able to get privileges in future, either at hospitals or ASCs

Myofascist said:

The practice has its own C-arms, I wouldnt need hospital priveledges for anything, so couldnt I just work there, do bread-n-butter injections, and not worry about the future???

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As with anything else, there would be a certain degree of risk/uncertainty. If you took the job I would create a procedural log/reusable cover letter and have your mentor sign it, then go get priviledges at some hospital (for your own benefit). You can then take ABPM, ABIPP or the proposed PM&R certification, whichever one or more of these 3 becomes recognized.

Pros: You can learn on the job and make a full salary right away.

Cons: What if the above 3 options don't pan out?

How difficult is it to go into a fellowship after being in practice for a few years?

i'd imagine that its difficult to go from 150-200K/year back to 45 for a fellowship from a reality standpoint.

Myofascist said:

If hospitals are requiring documentation of procedures wouldnt doing hundreds of procedures under the supervision of a board certified pain doc count?

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Usually. Each hospital has its own rules and it all depends who is on the credentialing committee.

For example, one hospital I applied to had a section on the application entitled PM&R procedures and listed most procedures up through discography. However, that same hospital required implant priviledges to be signed off by the department head of Neurosurgery.

Why do ASCs owned by a physician group require hospital priveledges? Is it in case something goes wrong and the pt ends up in a nearby hospital?

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Yes, that is one reason. Not all ASCs hold themselves to high standards and thus not all ASCs require hospital priviledges. Obviously, if your group has its own ASC, they are going to forego the hospital priviledges requirement.

Remember, if you're ASC/office based, you don't need priviledges at multiple hospitals. You can get priviledges at a small hospital that you rarely use if necessary.

In your situation, if you're worried that you won't always have the backing of your mentor if you switch jobs, I would get priviledges at some hospital and then continue your procedure log and keep copies of your Op reports. Then, if you move away, your history of previous credentialing, procedure logs, Op reports, CME credits and whatever certification you may have attained by that time will facilitate credentialing in your new location.

Myofascist said:

Thanks for the advice. I will do that. Is it easier to get priveledges in another state if you have had priveledges already?

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Not generally, but some states and/or hospitals are easier than others.

Myofascist said:

Thanks for the advice. I will do that. Is it easier to get priveledges in another state if you have had priveledges already?

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I don't know if going to another state has any bearing one way or another. All the little pieces just help your application a little bit, i.e. it will show that you've already passed another elses standards, the Op-reports demonstrate that you at least know proper technique, your CMEs show where you're getting extra training, logs show your reps, etc.

Then again, like I said above, all hospitals have their own rules and politics.