current state of intraoperative neurophysiological monitoring

[chicoborja]

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Is it common for neurologists to participate in or be a consultant in the area of intraoperative neurophysiological monitoring? My understanding is that this form of monitoring is fairly useful in certain spinal and intracranial surgeries. Also insurance companies reimburse monitoring for many of these procedures. It seems that there are 2 levels of persons who perform this monitorings. CNIMs who typically have a bachelors degree and a background as an EEG/EP tech and DABNMs who have a masters or doctorate as well as more experience than the CNIMS. The former are technologists whereas the latter are interpreting neurophysiologists. However, these interpreting neurophysiologists cannot bill except under a physician (or I suppose a physician extender) which would most likely be a neurologist.

The reason I am inquiring about these things is that I would like to train with someone locally (I have a PhD and am an allied health professional). I have been surprised that I cannot find many people involved in this field within my area (city is around 300,000 persons). I had contacted a founder of the ABNM and he indicated that it is not uncommon for RNs with minimal training to simply be present in front of the monitor so that the physicians can be reimbursed for them. This sounded somewhat alarming if this were to compromise the potential benefits of the IOM procedures.

Does anyone have any thoughts on the practical utility of IOM or any advice on how to get in the field locally when there are no formal programs or fellowships available locally.

Note: there is a local med school but it has neither neurology nor neurosurgery departments and there are no local IOM companies. There are 1 to 2 neurologists who have completed fellowships in clinical neurophysiology but I do not know if they actively participate in IOM...I am hesitant to contact them because I feel what I am looking for is too self-serving (training to work in this field)

 

[RAD345]

What is that you are looking for and what's the question? Thanks!

 

[bakerj88]

There are several attendings at my neurology residency program that actively are involved in intraoperative neurophysiologic monitoring in spinal, intracranial, and aortic surgeries among others. The staff here are all clinical neurophysiology training technicians and technologists, originally Sleep, EP, and EEG trained. The attending that spends most time on IOM is course instructor for and deeply involved in the American Clinical Neurophysiology Society's meetings on IOM and CN. There does seem to be a slow trend from Sleep reimbursement which has plateaued to now epilepsy/presurgical monitoring which is likely to hit its peak soon to the future of IOM, which is still on the rise. Our sleep, epilepsy, and clinical neurophysiology fellowship programs here all have the availability, if not the requirement for the latter two, to learn IOM.