Residents, what can you do to set yourself apart in PP?

[Noyac]

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I've been lucky to only have two jobs in my nearly 15 yrs post residency. One thing I did in residency that has made a great difference in my practice and has separated me from other anesthesiologists is to spend time in the pain clinic during residency. I pretty much knew I didn't want to do full time pain management but I wanted to be able to treat pain syndromes and do some specialty blocks as they came up. The most important blocks are the sympathetic blocks like lumbar sympathetically and stellate ganglion blocks. There are few people out there that are still doing these. If you find yourself in a ortho heavy practice you will undoubtedly see CRPS. The surgeons won't necessarily inform you of them but I have not seen a surgeon that was very good at treating this. I would recommend you learn to treat these pts not only with blocks but with meds and PT, etc. I get about 1-3 referrals per year for these pts. I do the block and consult on the pt with recommendations as to meds and PT. I have the surgeon prescribe everything, this way the relationship remains with the surgeon after a few weeks to months. I will tell you this is very gratifying and the pts absolutely love you. Not to mention the surgeons, when you make a difference in their pts which is almost always the case. It separates you from the pack and will add some much needed additional job security.

As a side note, I have now started performing stellate ganglion blocks for menopausal women who suffer from severe vasomotor syndrome and cannot take hormones (i.e: s/p breast cancer) and for pts with PTSD. Yeah, that's correct. Look it up.

Be versatile. I didn't do a fellowship in pain obviously but I paid attention and it carried over.

 

[Chloroform4Life]

I've been lucky to only have two jobs in my nearly 15 yrs post residency. One thing I did in residency that has made a great difference in my practice and has separated me from other anesthesiologists is to spend time in the pain clinic during residency. I pretty much knew I didn't want to do full time pain management but I wanted to be able to treat pain syndromes and do some specialty blocks as they came up. The most important blocks are the sympathetic blocks like lumbar sympathetically and stellate ganglion blocks. There are few people out there that are still doing these. If you find yourself in a ortho heavy practice you will undoubtedly see CRPS. The surgeons won't necessarily inform you of them but I have not seen a surgeon that was very good at treating this. I would recommend you learn to treat these pts not only with blocks but with meds and PT, etc. I get about 1-3 referrals per year for these pts. I do the block and consult on the pt with recommendations as to meds and PT. I have the surgeon prescribe everything, this way the relationship remains with the surgeon after a few weeks to months. I will tell you this is very gratifying and the pts absolutely love you. Not to mention the surgeons, when you make a difference in their pts which is almost always the case. It separates you from the pack and will add some much needed additional job security.

As a side note, I have now started performing stellate ganglion blocks for menopausal women who suffer from severe vasomotor syndrome and cannot take hormones (i.e: s/p breast cancer) and for pts with PTSD. Yeah, that's correct. Look it up.

Be versatile. I didn't do a fellowship in pain obviously but I paid attention and it carried over.

Great advice.

I'm curious as to how you start such service and the logistic of how you do the blocks. Did you tell the surgeons to refer these patients to you? When and where do you block these patients? Do they come in for whatever surgery they are having and you do the block in the pre-op area? How do you bill for them?

 

[Noyac]

I'm curious as to how you start such service and the logistic of how you do the blocks. Did you tell the surgeons to refer these patients to you? When and where do you block these patients? Do they come in for whatever surgery they are having and you do the block in the pre-op area? How do you bill for them?

It's more like the service fell to me. My partners know I do these blocks and surgeons get wind of it. I have a few surgeons that have sent me pts that luckily got much better and they pass it on to their peers. When I interview for a job I mention that I do these blocks. And that I can treat sympathetically mediated pain syndromes. Word usually travels.

In my first job I had a pain clinic 1-3 days a week for a couple hours. I would do a CABG in the morning then go to my clinic for a bunch of blocks and then back to the heart room or some other disaster case. I loved it. Now I'm in a much more mellow practice. I just schedule these blocks in random gaps or on my call day. The last lumbar sympathetic took 18 min so it isn't difficult. Stellates take 5 min. I do them in our block room or the OR with fluoro for the lumbar sympathetic block room too small for fluoro.

I bill as a pain management procedure.

 

[GA8314]

Awesome to hear Noy. Thanks for sharing.

Good to see another person not interested in self imposed limitations on his practice. Yes, know your limitations, but if you had great training in any number of things, then utilizing them as a board certified physician is perfectly warranted. Needed even (as evidenced by the patients you are helping).