Intra operative monitoring for neurologist, do we need fellowship ?

[hindidoc]

Can we do intra operative monitoring without doing clinical neurophysiology fellowship, is it a good option of making some extra money, any one with experience out there

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[typhoonegator]

Where are you going to learn the techniques? You asked "can we", and technically you probably legally could do it, but I doubt anyone would give you those hospital privileges without some certification of training.

Also, you've now started threads about pain fellowship, headache fellowship, and now intra-op. Are you actually interested in any of these subspecialties, or are you simply looking for an easy way to make money? If so, just do a headache fellowship, get Botox certified, and join a private-pay headache clinic in Connecticut.

 

[rockydoc]

Sorry to jump in here, but I am curious what an intraoperative monitoring-neurologist does. Is this something that people do full-time or just as a small part of your practice? I've tried to look up things about this aspect of neurology, but it seems hard to find good info related to it.

 

[danielmd06]

Sorry to jump in here, but I am curious what an intraoperative monitoring-neurologist does. Is this something that people do full-time or just as a small part of your practice? I've tried to look up things about this aspect of neurology, but it seems hard to find good info related to it.

It's an shoot-off from neurophysiology and has been discussed (briefly) on the forums before. IOM is usually offerred as elective months in EEG and neurophysiology fellowships. You can check various program websites for a bit more detail, but you may have to do some digging:

http://my.clevelandclinic.org/neurological_institute/professionals/education/fellowships.aspx

You basically participate in neurosurgeries for epilepsy etc and observe EEG information in real time as the procedure proceeds. It can possibly be done from an office or home (after all, you're monitoring digital data) and because you're doing a procedure it reimburses well:

http://en.wikipedia.org/wiki/Intraoperative_monitoring

I'm not sure about the credentialling. It is not a separate, recognized specialty by the ACGME or the UCNS:

http://www.ucns.org/go/home

But it does appear on the AAN fellowship directory section and you can search programs this way:

http://www.aan.com/education/fellowships/

Some people reportedly actually do IOM full-time, whereas others utilize it as a sub-section of their practice, making it an interesting component of career options available to neurologists.

 

[aaddnl]

Actually that's not quite true Daniel. It's done mostly on spine surgeries and some chest procedures an it is looking at evoked potentials (or an average of these) in real time and monitoring for any change particularly as the surgeon approaches the spinal cord and potentially puts pressure on the cord or delicate structures. The neurophysiologist doing IOM communicates with the technologist in the OR and the surgeon when necessary. You need neurophysiology training (fellowship) to do this. It is tedious work but u can do it remotely from home. You could do it in addition to other clinical work, but need to find the time to dothis. Sometimes it is done on craniotomy cases like acoustic neuroma and others. There is a new set of guidelines about this posted on the AAN website.

 

[danielmd06]

Actually that's not quite true Daniel. It's done mostly on spine surgeries and some chest procedures an it is looking at evoked potentials (or an average of these) in real time and monitoring for any change particularly as the surgeon approaches the spinal cord and potentially puts pressure on the cord or delicate structures. The neurophysiologist doing IOM communicates with the technologist in the OR and the surgeon when necessary. You need neurophysiology training (fellowship) to do this. It is tedious work but u can do it remotely from home. You could do it in addition to other clinical work, but need to find the time to dothis. Sometimes it is done on craniotomy cases like acoustic neuroma and others. There is a new set of guidelines about this posted on the AAN website.

Thank you for the comments.

I actually did know of the variety of surgical casework beyond epilepsy and intended for the "etc" and the wiki link in my post to further explicate this. I can completely see where my post would have been misleading. Thanks for pointing that out so other readers aren't confused.

I hereby amend my previous statement!

 

[sarcoid]

I'm only an ms3 here but I know for a fact that at a hospital I rotated at for neurosurgery, the IOM was done by various medical people, many hadn't even been to a medical school. No joke. One was a chiropractor. Another was a Carib school grad who failed to match and says he was recruited by the company as a neuromonitoring tech. This was in NY last fall. Oh and they said they earned well.

 

[aaddnl]

Those people may be the technologists in the OR doing the test but that's usually different than the physician interpreting. However due to a shortage of availability and lack of standardization there are hospitals using some people without qualifications to interpret their tests so that may have been the case at your hospital. The AAN statement addresses the need for more standardized testing and qualifications and in order to get paid for billing those codes in the future you'd be better off with some formal training-neurophysiology fellowship would be best. That's not to say you couldn't do it without that training, but for the OP/current med student/resident if you want to do it in the future, would advise doing that fellowship.

 

[bustbones26]

I'm only an ms3 here but I know for a fact that at a hospital I rotated at for neurosurgery, the IOM was done by various medical people, many hadn't even been to a medical school. No joke. One was a chiropractor. Another was a Carib school grad who failed to match and says he was recruited by the company as a neuromonitoring tech. This was in NY last fall. Oh and they said they earned well.

Think of it this way, some technician may perform your echocardiogram, but the cardiologist is still going to interpret it and generate a formal report. This can be the case for a number of neurophysiology studies too.

By the way, trends are changing. Back in 2003, before I had brain surgery on myself, I was required to get pre-op SSEP. The technician was a college grad in biology that was simply taught how to do the studies via apprenticeship. However, in the tech world, trends are changing. I was told by a tech that there is a difference between a registered tech and a certified tech and trends in billing are catching onto this.

 

[umneuro]

Does anyone know of any active academics in the field?
I'm curious about what research topics are being studied.

 

[neurolddoc]

Does anyone know of any active academics in the field?
I'm curious about what research topics are being studied.

http://www.georgetownuniversityhospital.org/body_fw.cfm?id=8&action=detail&ref=3598

Google his publications.

 

[Mattchiavelli]

Those people may be the technologists in the OR doing the test but that's usually different than the physician interpreting. However due to a shortage of availability and lack of standardization there are hospitals using some people without qualifications to interpret their tests so that may have been the case at your hospital. The AAN statement addresses the need for more standardized testing and qualifications and in order to get paid for billing those codes in the future you'd be better off with some formal training-neurophysiology fellowship would be best. That's not to say you couldn't do it without that training, but for the OP/current med student/resident if you want to do it in the future, would advise doing that fellowship.

This- and if a place is trying to get you to oversee it without a fellowship I would consider that a big red flag. Does anyone know if IOM is a common feature of temporal lobectomy and/or the radiosurgery in the gamma knife trial?

 

[typhoonegator]

We aren't using IOM in our straightforward temporal lobe whacks (for epilepsy or temporal pole tumors), but we are using sensory and/or motor mapping for anything that goes back further than 3cm from the pole, and obviously anything close to the fissure.