Bone Marrow Biopsies in the community?

[EEtoPre-Med]

I’m a 1st year fellow in a big program with plans to go into community heme/onc. I have done about 15 bone marrows and I’m sure I’ll do several dozen more over the next couple of years. How many practicing community heme onc docs are doing bone marrows? If not, who is doing them (IR?)?

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[gutonc]

I’m a 1st year fellow in a big program with plans to go into community heme/onc. I have done about 15 bone marrows and I’m sure I’ll do several dozen more over the next couple of years. How many practicing community heme onc docs are doing bone marrows? If not, who is doing them (IR?)?

I do a couple a month on average. I'm community, rural generalist. IR is an hour drive from my office (and many of my patients are over an hour from me), so I generally only send the real squirrelly ones to IR where I know they can get sedation for. Also, we don't keep the "excalibur" Jamshidi on hand so I'll generously sized there as well.

When I was at a tertiary community referral hospital with all the sub-specialties I would send more to IR just because it was easy. But it's far more expensive to do that and it can take a long time to get it done. I can usually get one scheduled same/next week and sometimes even same day if I'm doing it.

 

[osprey099]

I've done >100 when I was a fellow and have done zero as a community heme onc. But we do have a good IR group here who does them

 

[Plutarch02]

I've done a few bone marrow biopsies for patients who don't want to go to the hospital for IR for whatever reason. I would say less than 5 a year though and even then could probably convince them to go to IR if really tried. It's less pain for them and I prefer IR. Also the reimbursement for time for doing a bone marrow vs seeing 2-3 patients, you end up losing money.

 

[HemeOncHopeful19]

We have an NP and PA that do 85% of ours

 

[EEtoPre-Med]

Okay, that’s helpful. It kind of gives me some perspective. I don’t see any of my attendings do them outside of the VA system so I was wondering if proceduralists did all of them, everywhere. But it’s nice to know that I may do a handful after training and therefore it’s a useful skill to have. I don’t enjoy them much (don’t hate them) but I do enjoy being able to get it done quickly for the patient. So it seems that I’m not wasting my time by learning how to do them well.

 

[RainerMaria]

They stop my clinic dead and I have no time for them. We have a service that does them outpatient, or IR for tricky cases. IR does not always aspirate spicules first / smear the way you want so it is labor intensive, requires one of us to be there to prepare slides.

 

[gutonc]

They stop my clinic dead and I have no time for them. We have a service that does them outpatient, or IR for tricky cases. IR does not always aspirate spicules first / smear the way you want so it is labor intensive, requires one of us to be there to prepare slides.

I consent them on the day I tell them they need it. My MA sets up the kit the way I like it ahead of time including drawing up the lido and opening the chlorapreps onto the sterile field. From Chloraprep to bandage typically takes me 10-15 minutes. I book them in a regular f/u slot.

 

[bobbyknightranger]

I do them here in clinic, maybe 1-2 a month, on patients that I know I'll be able to do easily. Much easier/faster/cheaper for patient. If body habitus concerns I send to IR. I enjoy doing them, let's me use my hands a bit, and they take me about 15 minutes all said.