Outpatient TMS practice for neurology group

[Gavanshir]

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I'm a licensed CAP 1 fellow and was contacted by a local neurology practice owner to potentially work with them as a moonlighter now and later part-time. They have recently started offering TMS in the practice and want to work with a psychiatrist to start building up a psychiatry clinic (from scratch). They do already have 4-5 neurologists on staff. Credentialing with their panels would take a few months so I will likely be CAP-2 by the time I start.

The location is in a very urban area near me which is attractive. I think it's a safe assumption that a psychiatry clinic will fill fast. The idea is that I would later attract other psychiatrists to help grow the practice. I'm wondering if anyone has any experience working within a neurology group. How viable is walking into an outpatient private TMS practice? It seems to me negotiating the right contract will be key. Any other things to consider?

 

[Sushirolls]

Devil is in the details of the contract. Need more details.

Clinically you will want to know who gets the dementia patients?
Are they expecting you to see all their conversion disorder patients?
HA/Migraine patients, are they going to have you see them?
They may be setting themselves up for financial loss with TMS.

I believe working with a neurology group could be quite nice.

 

[Sushirolls]

For the rare Huntington's patient, will you prescribe the Tetrabenazine? Will they?
If anyone is doing Neurology/Sleep Medicine, are they looking to give you all their insomnia patients or that you would be doing CBTi for these patients?

More complex Parkinson patients, are they receptive to ECT as possible adjunct for reducing motor symptoms, not just mood and psychosis?
Epilepsy patients who want to avoid neurosurgery, are the receptive to supporting documentation for insurance auth to use ECT to raise seizure threshold before considering Nsx?

 

[whopper]

TMS can be a very hands-off type of practice for the provider of it so I wouldn't be against a neurologist doing it. Similarly to ECT, the doctor doing it usually just does the procedure while not seeing the patient outside of it (yes I know there's exceptions). The problems are that people who'd typically get a TMS have moderate to severe treatment resistant depression and if a neurologist did it they'd likely not know anything about treating this type of depression outside the TMS.

I also see some advantages of a neurologist doing it over a psychiatrist but this is more reserved for the type of psychiatrist with a poor foundation of knowledge outside of psychiatry in the equation (which as we know isn't rare). E.g. when doing a motor threshold test on a Neurostar unit the knowledge of the homunculus comes into play especially in relation to how the hand shakes in reaction to a EMP pulse. Psychiatrists in general have no experience with the homunculus anymore than medstudents do. Muscle contractions from the EMP pulse do affect the sensitivity of the hand to later EMP pulses if done very quickly. This is something neurologists would have more experience with if they did a TMS.