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Radiology encroaching on pain?

TheLoneWolf

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Yes, a trend that has been ongoing for years. @algosdoc mentioned the coopting of pain procedures to other specialties in a prior post. Lots of spine surgeons and ortho will either have an in house pain guy, an NP or PA doing fluoro injections, or will send to interventional radiology for their requested procedure.Also, many orthos have in house PRP ,stem cell, BMAC. Largely this has to do with teeing patients up for a planned surgery with an optimization of flow.

This is not only in PP. Had seen lots of this during fellowship. Kyphos, vertebroplasties, fluoro guided blocks, RFA, peripheral joint injections preferentially going to a technician who can perform the procedure without follow up and without interfering in the big picture. Patient follows up with surgeon and goes from there.

I am not attributing this to any nefarious reason. Most of the ortho and neurosurgery referrals are legitimate.I have seen that many do not want "too many chefs in the kitchen". Their words not mine.

Referrals from FM and IM are less so, lots of vague myofascial pains, central pain syndromes, opioid mismanagement, and secondary gain.

It makes sense from an administrative standpoint though I don't think it gives the patient a full view of options, rather it leads them down a predefined treatment pathway.

Referral base can make or break a practice, not so much financially but in the day to day practice.

Where I did fellowship, most legit referrals with a good base went to PMR. I rotated with them for about a month. Referral to PT, some form of imaging, neurosurgery, ortho, IR for procedures. Pain referrals were either because of previous or existing opiate therapy, kicked out of other pain clinics, failed multiple surgeries, failed non opioids, heavy psychiatric overlay, or having very nonspecific and vague imaging and physical exam. For this reason, I had turned down an associate professorship position in a good location because I hated being the "dumping ground" of other services. I also hated being "end of the line care". You dont want to end up being a guy just giving infusions, stims, pumps, and spacers.
 
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Agast

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I’d be curious to see what the outcomes were in docs referring to IR when no one had done a physical exam on the patient. I got one who was wondering why their L1 kyphoplasty didn’t work, when they had an L5 radic.
 
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TIVAndy

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I’d be curious to see what the outcomes were in docs referring to IR when no one had done a physical exam on the patient. I got one who was wondering why their L1 kyphoplasty didn’t work, when they had an L5 radic.

I see this all the time. they should not be touching the patient if not managing them.
 

clubdeac

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Lol wtf crnas doing sca trial?

Anesthesia attendings that trained these crnas should be ashamed of themseves
It's happening all around the country and we as a specialty need to do something about it soon otherwise they're going to run over all the legitimate MD ACGME trained pain physicians. Their lobby is much larger and much more powerful.
 
D

deleted993114


They always have done so. The problem is that the radiologists only do a procedure and say "adios"- there is very little, if any, follow up and essentially no primary diagnosis made. They are functioning as technicians for a single procedure, which makes their approach have a very high failure rate and is not popular with referring physicians or patients.
 
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deleted993114

It's happening all around the country and we as a specialty need to do something about it soon otherwise they're going to run over all the legitimate MD ACGME trained pain physicians. Their lobby is much larger and much more powerful.

Interestingly, they are doing exactly that even in states which have stated that CRNAs doing "pain management" is illegal. Unfortunately, the board of medical examiners in those states say that is the scope of the nursing boards and the nursing boards don't care.
 
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