Peripheral, imaged-guided injections, employment and credentialing

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drg123

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If one wanted to do injections all in the periphery (no spine), just joints, nerves, muscles, tendons, what are your thoughts on whether advanced training (Spine or Pain fellowship) is needed? I realize that's a two part question - one is, can you get the skills needed in residency alone, the second is, even if you have the skills, will an employer allow you to perform the injections. Let's assume one gets adequate exposure in residency (100's of USIs) and focus on the second part - will hospitals, AMCs, PP, let you do (and bill for) the injects?. Thoughts?

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If you are PM&R that would fall within your scope of practice. Just keep track of what you do in residency with details of locations. If private practice there isn't going to be anyone to sign off on you - just can you do the procedure or not. If you can get the skills (IMO - 50+ injections independently performed) then personally I would sign off on you doing things like hips, knees, shoulders, wrists, and ankles if you needed something like that at a facility/system. You just have to be smart about your limitations and not get yourself into trouble - i.e. don't go doing cervical facet injections under US if you know you're a beginner/intermediate skill level (IMO - never do that regardless of US skill).

Most hospitals/ASCs are not going to want to waste resources on you doing USG injections in a pain suite as they don't get any money out of it compared to spine/pain procedures.
 
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If you are PM&R that would fall within your scope of practice. Just keep track of what you do in residency with details of locations. If private practice there isn't going to be anyone to sign off on you - just can you do the procedure or not. If you can get the skills (IMO - 50+ injections independently performed) then personally I would sign off on you doing things like hips, knees, shoulders, wrists, and ankles if you needed something like that at a facility/system. You just have to be smart about your limitations and not get yourself into trouble - i.e. don't go doing cervical facet injections under US if you know you're a beginner/intermediate skill level (IMO - never do that regardless of US skill).

Most hospitals/ASCs are not going to want to waste resources on you doing USG injections in a pain suite as they don't get any money out of it compared to spine/pain procedures.
Thanks for your helpful reply! Makes sense.
 
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FYI…the pay on USGI is rough. I personally was doing better with OMT and much better with Botox. You’d have to be efficient…because if it takes twice as long to setup and perform USGI than palpation, it’s not worth it. Right now USGI is really only worth it for trigger points, and for injections that are more difficult to do without guidance.
 
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Agree - if you want to make procedures a big part of your practice (which I would recommend if you want to be 100% outpatient) then I would strongly consider finding a way to get fluoro spine skills (even if just ESIs and MBB/RF). US is the fad right now, but it pays crap.
 
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