Went to a fellows cadaver course this weekend. It was interesting. The hands on learning was a great experience but the top guys in neurostim were pushing stimulator implants hard. When they took a poll of how many of the fellows did SCS in fellowship- it wasn't many. Yet, they spent the entire course aggressively encouraging that we enter the work force and do these procedures. Do most pain doctors do implants? If so how to you deal with the complications if you weren't trained to do so in fellowship. How do you protect yourself in lawsuits in this situations, can't a lawyer point out that you were trained to do them or to deal with the complications? Is it possible to practice pain anymore without doing implants?
Fellows Cadaver Course
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It's the future.
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I work with a pain doc who usually does one a week and he has no fellowship at all, so I think you're good.
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I know a few pain docs who do trials only. In private practice that may work out better financially for you. You can have a colleague do the implant or refer to a spine surgeon. I wasn’t 100% comfortable doing implants on my own out of fellowship but after one of my patients had to wait 3 months for a neurosurgeon to add her to his schedule, I buckled up and made myself comfortable. Your device rep will give you an idea of who to refer to for implant if you don’t want to do it.
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i do trials only.
there are a lot of neurosurgeons you can partner with that will do an implant and technically paddle leads may be more secure. you could even partner with a fellow pain doc.
in terms of your meeting, please look in to the potential confounding factors.
1. its November. most attendings need more time to be comfortable with the fellow to be more active on implants. so most fellows so far havent had a lot of stim experience. in any good program, that will come
2. this is a cadaver course to learn about stims, right? you dont need a cadaver course to learn, say, a SIJ or even an epidural. so you'll hear a lot of talk pushing stims...
3. your cadaver course may have been sponsored by a stim company... who is going to preferentially want to have teachers who strongly advocate for stim implants
once you are out there and doing your own, there are a lot of resources to ask for advice/help, including the good people on this forum who are more than willing to give advice on implantation "concerns".
there are a lot of neurosurgeons you can partner with that will do an implant and technically paddle leads may be more secure. you could even partner with a fellow pain doc.
in terms of your meeting, please look in to the potential confounding factors.
1. its November. most attendings need more time to be comfortable with the fellow to be more active on implants. so most fellows so far havent had a lot of stim experience. in any good program, that will come
2. this is a cadaver course to learn about stims, right? you dont need a cadaver course to learn, say, a SIJ or even an epidural. so you'll hear a lot of talk pushing stims...
3. your cadaver course may have been sponsored by a stim company... who is going to preferentially want to have teachers who strongly advocate for stim implants
once you are out there and doing your own, there are a lot of resources to ask for advice/help, including the good people on this forum who are more than willing to give advice on implantation "concerns".
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I was at the same course. It was held by Abbott so naturally they will push Neuromodulation and their product. That aside though, I did appreciate how those faculty encourage us to push the boundaries during the course of our careers to advance the field of pain medicine. They were clear when they said that early in our career we should stick to “simple” procedures and not push boundaries but that as we become more comfortable and develop a good reputation in the community and have good outcomes, we shouldn’t become complacent with being docs who only do ESIs and RFAs. Nothing wrong with that if that’s all you prefer to do, but clearly Pain Medicine is headed towards a much more interventional realm.
It’s just like cardiology and GI became more interventional a couple decades ago. It took “leaders” in those fields to encourage fellows at that time to become more interventionally adept (while being safe), contribute to research to establish safety and efficacy of their procedures, and push the boundaries of their fields. Now look at those guys….
It’s just like cardiology and GI became more interventional a couple decades ago. It took “leaders” in those fields to encourage fellows at that time to become more interventionally adept (while being safe), contribute to research to establish safety and efficacy of their procedures, and push the boundaries of their fields. Now look at those guys….
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The future is surgical.
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You go to an Abbott SCS cadaver course and are offended by the push for scs. Sigh.
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Pain doctors: CRNAs doing procedures is outside of their scope of practice
Also pain doctors: We're surgeons!
The future is cosmetic surgery anyway. Cash pay. I was reading up on some new non-surgical cosmetic procedure being heavily touted in my area and the people advertising them were an Obgyn-cosmetic surgeon and a Orthopedic spine-cosmetic surgeon. Apparently there's some BS cosmetic surgery fellowship you can do and suddenly everyone is a plastic surgeon.
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There's an orthopedic guy in my town who has completely retired from ortho and now does vasectomy reversals.
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He was really committed to the title “Bone Doc”There's an orthopedic guy in my town who has completely retired from ortho and now does vasectomy reversals.
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There's an orthopedic guy in my town who has completely retired from ortho and now does vasectomy reversals.
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Absolutely the message being touted at the Abbott meeting
You can’t expect different from an implant company and their KOLs who will tell you that an SCS will fix every problem and never results in complications. Just look at LinkedIn.
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Turf battles between physicians is an age old tale. Encroachment into our field by non-physicians is a different story and one that we should be wary of because 1) it’s bad for patient care and 2) it does threaten our job.
For the people who think we shouldn’t be doing minimally invasive spine procedures, I’m genuinely curious about what you guys think about cardiologists and GI docs expanding the “scope of their practice” to include minimally invasive therapies which are replacing procedures surgical procedures?
If you get a lot of referrals for trials from implant surgeons they arent going to want you invading their wheelhouse.
solution: get referrals from pcps and send to surgeons if u think they need paddles or lami
