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Psychiatrists aren't going to treat Parkinson's regularly. But just like how my colleagues in neurology use depakote to treat migraines while I use it to treat mania now, both specialists will have a use for TMS. The only reason we don't use TMS more is due to overhead costs and no or limited reimbursement by insurance/Medicaid/Medicare. I would love to be able to offer TMS. There will always be some crossover. I treat HTN all the time, though I'd rather primary care do it.
Short answer is we will do what benefits the patient, what is safe, and what will get reimbursed. Time will tell.
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If neurologists can get institutional privileges and malpractice coverage for TMS being considered within their scope of work, then they will be performing it if it is in their financial interest to do so. I think all the above is likely if there is FDA approval for PD treatment. Psychiatrists won't lose their depression treatment privileges, though. I guess in that case it would be up to institutions and malpractice providers to decide whether a psychiatrist trained in TMS could treat PD or a neurologist trained in TMS could treat MDD. From a technical standpoint, I doubt it would matter. Since many neurologists treat mental illness independent of psychiatrists, I'd think it would be easy for them to argue competence in that treatment. Not sure the same would be true for a psychiatrist treating PD.
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the answer is there is no hard and fast rules. we do ECT here for treatment-refractory status epilepticus. the neurologists dont do ECT so they refer to us to do it. if the psychiatrists have the TMS
chair then they will refer to psychiatry. if they dont and the neurologists want it they'll get their own one. there are already neurologists using TMS for neurological conditions btw, its just very limited.
at the local VA here they do TMS (and ketamine). where i did residency, they didn't do TMS but the VA used to fee-service out to the local TMS group to treat pts with it.
chair then they will refer to psychiatry. if they dont and the neurologists want it they'll get their own one. there are already neurologists using TMS for neurological conditions btw, its just very limited.
at the local VA here they do TMS (and ketamine). where i did residency, they didn't do TMS but the VA used to fee-service out to the local TMS group to treat pts with it.
Which VA is this? I'm asking because I'd love to contact them and see if the VA I work at could set up a similar resource.
Dunno about ketamine, but the Pittsburgh VA certainly does TMS in a fairly active way and is also spearheading a few TMS-related research projects.
IMO psychiatrists should get and hold the turf on TMS, ECT, and all other technologies in this vein. I say that as somebody who has an interest in these fields but is not a resident (yet).
