I guess ASPN really *is* the future of pain medicine. The dystopic one.

[DrJackieW]

I am a consultant for a number of companies. Typically, these are in teaching capacities. The reality is, I use those devices because I work in a small practice and I kept my device portfolio small. That being said, when I post on social media... I am not being paid by any of those companies to post. And was I the first to implant the ProclaimXR? Yes. And the patient selected the device on her own. She has options. And chose the non-rechargeable Abbott system over the medtronic Intellis battery. I give them a choice between the brands that I use. And admittedly, through my training and practices I have used all the devices. I get great outcomes with medtronic and Abbott and again keep my portfolio small because I like their product lines for the things I do. And I don’t want to have to manage reps from 10 different companies for follow ups.

But I again do not get any financial endorsement for posting my patient success stories.

Maybe other people are?

But I’m doing it for patients to get more information about Neuromodulation.

And I disclose to my patients that I work with and teach courses for these companies. Not because they pay me to do so... but because I have great outcomes with those devices. And I want other physicians to learn how to enhance their techniques and surgical skills.

To clarify, my volumes are not high.

I don’t do 40-50 stims a month. I probably do that volume over the course of a year. And it’s divided between the products I use.

Again I choose these products because I have used others and after 5-10 that I didn’t get the results I was hoping for... I just discontinued my use.

Now... if it would make people feel better that I add all my consulting on my linked in profile and social media? No problem. I’m not embarrassed to admit that I teach courses or consult for companies to give my feedback on how things can be improved.

Unfortunately, the technologies have changed in the last 10 years.

And to stay relevant I think for our patients... it’s imperative that we continue to enhance and improve our skills with new techniques.

Some people are happy to just stay in their practice and practice great medicine. Some of us want to practice great medicine and help people get access to therapies and use it appropriately.

Do I get great outcomes 100% time? Of course not. But posting failures doesn’t help people get access to care. Do I manage and discuss expectations? Absolutely. Are there complications? For sure. But I obviously try to minimize them by using the appropriate recommendations for best care practices.

If there was any standardization of fellowship training programs and there was not a need for industry sponsored teaching to help people get access to training for these advanced procedures.... then I think your utopian pain management specialty that you all are hoping for would actually exist.

---

Members don't see this ad.

 

[drusso]

I am a consultant for a number of companies. Typically, these are in teaching capacities. The reality is, I use those devices because I work in a small practice and I kept my device portfolio small. That being said, when I post on social media... I am not being paid by any of those companies to post. And was I the first to implant the ProclaimXR? Yes. And the patient selected the device on her own. She has options. And chose the non-rechargeable Abbott system over the medtronic Intellis battery. I give them a choice between the brands that I use. And admittedly, through my training and practices I have used all the devices. I get great outcomes with medtronic and Abbott and again keep my portfolio small because I like their product lines for the things I do. And I don’t want to have to manage reps from 10 different companies for follow ups.

But I again do not get any financial endorsement for posting my patient success stories.

Maybe other people are?

But I’m doing it for patients to get more information about Neuromodulation.

And I disclose to my patients that I work with and teach courses for these companies. Not because they pay me to do so... but because I have great outcomes with those devices. And I want other physicians to learn how to enhance their techniques and surgical skills.

To clarify, my volumes are not high.

I don’t do 40-50 stims a month. I probably do that volume over the course of a year. And it’s divided between the products I use.

Again I choose these products because I have used others and after 5-10 that I didn’t get the results I was hoping for... I just discontinued my use.

Now... if it would make people feel better that I add all my consulting on my linked in profile and social media? No problem. I’m not embarrassed to admit that I teach courses or consult for companies to give my feedback on how things can be improved.

Unfortunately, the technologies have changed in the last 10 years.

And to stay relevant I think for our patients... it’s imperative that we continue to enhance and improve our skills with new techniques.

Some people are happy to just stay in their practice and practice great medicine. Some of us want to practice great medicine and help people get access to therapies and use it appropriately.

If there was any standardization of fellowship training programs and there was not a need for industry sponsored teaching to help people get access to training for these advanced procedures.... then I think your utopian pain management specialty that you all are hoping for would actually exist.

That's a balanced perspective: Still, this is a field/specialty that has almost been destroyed by special interests, COI, and hype. What could Pope, Sayed, and Deer learn from a having a beer with Fishman, Webster, and Portenoy? All of them received Big Money. They would probably learn that "Industry will never really love you." Hyping products, be they chemical or electrical, puts profits over patients. Industry only sees KOL's a mean to an end.

We're in an era when pain specialists are promoting themselves not just as doctors but as a Brand. What do you want your Brand to be? How should new Fellows be mentored about responsible use of social media and creating their own Brand? Where do your ethical and Hippocratical obligations do patients begin your social media Brand begin? How many ways is this specialty fractioned? PMR vs Anesthesia; SIS vs ASIPP; Needlejockeys vs Pill-pushers; Addictionologists vs Injectionologists; Independent MD vs HOPD MD, Regen Med vs Corticosteroid, etc.

Do we need yet ANOTHER group do separate us? Or, do we need to combine and marshall our resources to advocate for common interests?

 

[NJPAIN]

That's a balanced perspective: Still, this is a field/specialty that has almost been destroyed by special interests, COI, and hype. What could Pope, Sayed, and Deer learn from a having a beer with Fishman, Webster, and Portenoy? All of them received Big Money. They would probably learn that "Industry will never really love you." Hyping products, be they chemical or electrical, puts profits over patients. Industry only sees KOL's a mean to an end.

We're in an era when pain specialists are promoting themselves not just as doctors but as a Brand. What do you want your Brand to be? How should new Fellows be mentored about responsible use of social media and creating their own Brand? Where do your ethical and Hippocratical obligations do patients begin your social media Brand begin? How many ways is this specialty fractioned? PMR vs Anesthesia; SIS vs ASIPP; Needlejockeys vs Pill-pushers; Addictionologists vs Injectionologists; Independent MD vs HOPD MD, Regen Med vs Corticosteroid, etc.

Do we need yet ANOTHER group do separate us? Or, do we need to combine and marshall our resources to advocate for common interests?

Well said.

 

[Needlejockeys]

I am a consultant for a number of companies. Typically, these are in teaching capacities. The reality is, I use those devices because I work in a small practice and I kept my device portfolio small. That being said, when I post on social media... I am not being paid by any of those companies to post. And was I the first to implant the ProclaimXR? Yes. And the patient selected the device on her own. She has options. And chose the non-rechargeable Abbott system over the medtronic Intellis battery. I give them a choice between the brands that I use. And admittedly, through my training and practices I have used all the devices. I get great outcomes with medtronic and Abbott and again keep my portfolio small because I like their product lines for the things I do. And I don’t want to have to manage reps from 10 different companies for follow ups.

But I again do not get any financial endorsement for posting my patient success stories.

Maybe other people are?

But I’m doing it for patients to get more information about Neuromodulation.

And I disclose to my patients that I work with and teach courses for these companies. Not because they pay me to do so... but because I have great outcomes with those devices. And I want other physicians to learn how to enhance their techniques and surgical skills.

To clarify, my volumes are not high.

I don’t do 40-50 stims a month. I probably do that volume over the course of a year. And it’s divided between the products I use.

Again I choose these products because I have used others and after 5-10 that I didn’t get the results I was hoping for... I just discontinued my use.

Now... if it would make people feel better that I add all my consulting on my linked in profile and social media? No problem. I’m not embarrassed to admit that I teach courses or consult for companies to give my feedback on how things can be improved.

Unfortunately, the technologies have changed in the last 10 years.

And to stay relevant I think for our patients... it’s imperative that we continue to enhance and improve our skills with new techniques.

Some people are happy to just stay in their practice and practice great medicine. Some of us want to practice great medicine and help people get access to therapies and use it appropriately.

Do I get great outcomes 100% time? Of course not. But posting failures doesn’t help people get access to care. Do I manage and discuss expectations? Absolutely. Are there complications? For sure. But I obviously try to minimize them by using the appropriate recommendations for best care practices.

If there was any standardization of fellowship training programs and there was not a need for industry sponsored teaching to help people get access to training for these advanced procedures.... then I think your utopian pain management specialty that you all are hoping for would actually exist.

sounds about right.

 

[DrJackieW]

That's a balanced perspective: Still, this is a field/specialty that has almost been destroyed by special interests, COI, and hype. What could Pope, Sayed, and Deer learn from a having a beer with Fishman, Webster, and Portenoy? All of them received Big Money. They would probably learn that "Industry will never really love you." Hyping products, be they chemical or electrical, puts profits over patients. Industry only sees KOL's a mean to an end.

We're in an era when pain specialists are promoting themselves not just as doctors but as a Brand. What do you want your Brand to be? How should new Fellows be mentored about responsible use of social media and creating their own Brand? Where do your ethical and Hippocratical obligations do patients begin your social media Brand begin? How many ways is this specialty fractioned? PMR vs Anesthesia; SIS vs ASIPP; Needlejockeys vs Pill-pushers; Addictionologists vs Injectionologists; Independent MD vs HOPD MD, Regen Med vs Corticosteroid, etc.

Do we need yet ANOTHER group do separate us? Or, do we need to combine and marshall our resources to advocate for common interests?

I’m open to suggestions. How do we fix it? Unfortunately the technologies we use are expensive and without partnering with industry for new innovations, tactics and techniques there will be a failure of new development. I’m not trying to fracture things more. I tell patients why I use the devices I use and why I don’t use others. But again... until Pain Managment becomes its own specialty designation as a residency... there will never be any parity in the field in my personal opinion.
And I’m sharing a quote I saw yesterday from an author of an op ed on travel reports because I feel the same way. We can disagree about things. But that’s part of the joy of life. We are allowed to disagree and still move forward.

 

[No Pain All gain]

Nobody disagrees with industry partnerships in this space. It occurs across the board in medicine. Training on devices is valuable and discrepancies in training across centers is reality.

This thread has gone off the rails. Jackie got mentioned because of a mistaken meaning behind her role with ASPN related to training APPs and the simultaneous social media coverage of Proclaim XR. Bad timing.

We need to all be aware of our reputation as a speciality and the visibility of what we do in our clinics, on podiums, and on social media platforms.

No one ever got in trouble for disclosures and most of them are publicly available anyway. It is in all our interests to be as open in our clinics and social media feeds as we are in peer-reviewed journals and conference podiums. We need to set the bar high. There are many bad actors in this space. None of whom would care to be on this forum and most of whom who do not practice evidence-based pain medicine with the breadth of those among us.

 

[jettavr6]

Others have alluded to it, but it hasn't been explained. How did the ASPN start? Are they meant to replace NANS?

On a separate note, all I'm seeing on my Linkedin page now are selfies with the first to implant, not just from state, but even from a portion of the state. I just saw one this morning for the first to implant in the NE of Florida. Next to come, will be the first to implant in the SW of a particular county --- I question the value in this type of a media campaign, although the product may be sound.

 

[NJPAIN]

I think that this says a lot about the integrity of many in our field. I don’t believe that this type of fake news is as rampant in other fields as it is in ours. Is it??

 

[drusso]

Nobody disagrees with industry partnerships in this space. It occurs across the board in medicine. Training on devices is valuable and discrepancies in training across centers is reality.

This thread has gone off the rails. Jackie got mentioned because of a mistaken meaning behind her role with ASPN related to training APPs and the simultaneous social media coverage of Proclaim XR. Bad timing.

We need to all be aware of our reputation as a speciality and the visibility of what we do in our clinics, on podiums, and on social media platforms.

No one ever got in trouble for disclosures and most of them are publicly available anyway. It is in all our interests to be as open in our clinics and social media feeds as we are in peer-reviewed journals and conference podiums. We need to set the bar high. There are many bad actors in this space. None of whom would care to be on this forum and most of whom who do not practice evidence-based pain medicine with the breadth of those among us.

Actions have consequences; so do inactions.

 

[deleted472101]

ASPN is not meant to take the place of any existing society

 

[clubdeac]

midlevel creep is in every specialty.
the quality of relationship with CRNAs is at an individual facility/practice and institutional level despite what is happening at a state level with CRNA seeking independence and the overall discourse nationally.
The reason being there are far too many surgeries and there has been an explosion in off site anesthesia procedures and it is just not cost effective to provide anesthesia by solo anesthesia doctor to one particular surgeon. it eats up time and resources that can be more efficiently utilized. now im not saying its not possible to do solo cases anymore. it is, and many practices do so and even with crna heavy practices, docs will often do solo cases - but gone are the days of MD only practices dominating the markets simply because of volume. check the OR schedules of any busy hospital...its packed. anesthesiologists are working hard.
the way to handle nurses is by displaying superior knowledge everyday, taking leadership roles and being a model of discipline and hard work. in short, make them respect you.

Haha good luck...I think you’re being naive and foolish to think they’ll be satisfied “respecting you” bc of your “superior knowledge and work ethic”. In 10 years your specialty will be obsolete as nurse anesthetists take over your field - which has been happening for the last decade. I mean one of the bigger anesthesia groups in the country recently lost their contract with Atrium health bc of disagreements over CRNA oversight ratios. All the hospital cared about was $$$$. 90 anesthesiologists lost their jobs. This is what’s really happening around the country

 

[drpainfree]

I just went to the website and looked at the agenda.

All this trolling/garbage for Trigger point injections, joint injections, botox, pump refills and patient selection? - if a mid level cant do that or you think thats going to take over your job you must not be in a relevant practice in 2019. Occipital nerve blocks - a stretch and shouldn't be on the curriculum.

Thinking about some other fields

Orthopedic PA - Joint injections, Assist in OR drilling into bone and inserting screws, suturing

Cardiac PA - Harvesting vein grafts for CABG

Dermatology PA/NP - Botox

NPs in and outpatient taking care of pain patients under physician supervision all the time.

Basic Home Infusion - RNs pump refills

ASPN didactic - all of the above.

Help me understand the outrage

hey, just because other specialties are f***ing medicine, doesn't mean we, as pain specialist shouldn't get into this mess and f*** up pain specialty, right? heck, anesthesiologists have used CRNA to f*** up anesthesiology, why can't we do it to our specialty if we can make a boatload of $$$?

It's disgusting you even asked the question.

 

[Orin]

As long as these leaders disclose their COI that should be fine because you know it’s an ad. The challenge is those people who do not disclose. This is unfortunately rampant on LinkedIn

Unfortunately the greatest COI is the love of accolades, attention, and money that'll come regardless of industry sponsorship, and probably the most insidious issue is the emotional investment people have in ideas/beliefs. There's an almost religious component to that which you can't control for. Whether you get it at the church in WC or NC or CA or MN, the evangelical manner we espouse the dogmatic beliefs of our mentors or our own experiences is a problem.

Patients buy in though.
Social media posts by doctors about clinical devices are no different than direct to patient advertising by a pharmaceutical company.

I'm all about growing the pie of patients that come in contact with a pain physician, but we've got to figure out a better way to help patients and physicians know our paid and unpaid biases.

 

[Needlejockeys]

hey, just because other specialties are f***ing medicine, doesn't mean we, as pain specialist shouldn't get into this mess and f*** up pain specialty, right? heck, anesthesiologists have used CRNA to f*** up anesthesiology, why can't we do it to our specialty if we can make a boatload of $$$?

It's disgusting you even asked the question.

You are right

 

[NJPAIN]

We will never find a common ground. With all due respect, those of you a few years out of fellowship tagged as instructors, consultants, and officers in “our” organizations have not personally experienced the decline in medical practice. You think “ I’m too busy and too talented to do that BS, my PA does that”. You either can’t or won’t think about - what if? What if reimbursement declines or your volume tanks and you can’t make a living flipping in devices?? Pain medicine is a different animal than surgical specialties. They will always have their bread and butter stuff to make a living on; life threatening conditions that need to be fixed. I don’t see us as having that much job security.

 

[Agast]

Great point - but if its social media, does it count?

Actually, yes it does. The law has been in place for a long time, ever since the first Kardashian tweeted about a weight loss product that worked for her and she turned out to be a paid spokesperson. It’s why some plastic surgeons and dermatologists recently got in trouble for instagramming about a new Botox rival while they were on an all-expense-paid island vacation

A Rival to Botox Invites Doctors to Party in Cancun, With Fireworks, Confetti and Social Media Posts (Published 2019)

Plastic surgeons’ Instagram accounts of the weekend trip didn’t note the drug company’s sponsorship, which some ethicists say should be disclosed.

www.nytimes.com

 

[Agast]

I’ve seen at least two patients from other pain practices who were referred to me by an outside doctor for procedures. In each case the patient was under the treatment of the midlevel for their medication refill or trigger point injections. They were not appropriately referred back to their doctor for their new complaint of radicular pain at a different area, because somehow the midlevel didn’t pick up on it.

It’s only speculation but my guess is their NP/PA was in a rush to see as many people as possible and asking your patient if anything is new takes time and effort. And they’re not the one getting paid to do procedures so why should they care.

The kicker is, the patient themselves didn’t realize their pain doctors could do the procedure they were sent to me for. Patients don’t really understand who their specialists are, they just thought I was a spine doctor and their pain doctor wasn’t. And because I try to be ethical and not jank procedures while some other sucker does the meds, I sent them back to their pain doctor even though they wanted to schedule the shot and be done with it.

So I’ve caught it twice, who knows if it happens more often than that. That’s one reason why I’ve decided not to hire a midlevel.

 

[NJPAIN]

I’ve seen at least two patients from other pain practices who were referred to me by an outside doctor for procedures. In each case the patient was under the treatment of the midlevel for their medication refill or trigger point injections. They were not appropriately referred back to their doctor for their new complaint of radicular pain at a different area, because somehow the midlevel didn’t pick up on it.

It’s only speculation but my guess is their NP/PA was in a rush to see as many people as possible and asking your patient if anything is new takes time and effort. And they’re not the one getting paid to do procedures so why should they care.

The kicker is, the patient themselves didn’t realize their pain doctors could do the procedure they were sent to me for. Patients don’t really understand who their specialists are, they just thought I was a spine doctor and their pain doctor wasn’t. And because I try to be ethical and not jank procedures while some other sucker does the meds, I sent them back to their pain doctor even though they wanted to schedule the shot and be done with it.

So I’ve caught it twice, who knows if it happens more often than that. That’s one reason why I’ve decided not to hire a midlevel.

You’re a real doctor. Don’t change. You’re at risk for extinction.

Similarly I have a patient that I treat for LSS. She mentions her knee pain and I know she treats with the big ortho group in town, in fact, with head head of the group. So I ask her “ what does Dr X say?” She says “ I haven’t seen Dr X in 3 years. I see his assistant Dr (PA name) and get a steroid injection every 3 months.” Now she is going to find another doc to do her knee replacement because Dr X has not cared enough to say hello for 3 years.

 

[neutro]

Haha good luck...I think you’re being naive and foolish to think they’ll be satisfied “respecting you” bc of your “superior knowledge and work ethic”. In 10 years your specialty will be obsolete as nurse anesthetists take over your field - which has been happening for the last decade. I mean one of the bigger anesthesia groups in the country recently lost their contract with Atrium health bc of disagreements over CRNA oversight ratios. All the hospital cared about was $$$$. 90 anesthesiologists lost their jobs. This is what’s really happening around the country

Thank you for your opinion. Yeah sure extreme examples exist everywhere but that’s not the general practice. We have been obselete as anesthesiologists for 40 years with Crna’s taking over our profession apparently. Yet the demand and salaries for anesthesiologists keeps rising. Hmmmm
Being a fellowship trained pain physician and experienced both pp, hospital based and solo work, I’d
Rather be an anesthesiologist than deal with pain patients and deal with psychopaths and play kiss ass to my referring physicians.

Enjoy your awesome pain practice and cure the world with steroids and stimulators...

 

[Orin]

Rather be an anesthesiologist than deal with pain patients and deal with psychopaths and play kiss ass to my referring physicians.

I'm unclear if you're talking about patients or surgeons/administrators as psychopaths?

 

[drusso]

Thank you for your opinion. Yeah sure extreme examples exist everywhere but that’s not the general practice. We have been obselete as anesthesiologists for 40 years with Crna’s taking over our profession apparently. Yet the demand and salaries for anesthesiologists keeps rising. Hmmmm
Being a fellowship trained pain physician and experienced both pp, hospital based and solo work, I’d
Rather be an anesthesiologist than deal with pain patients and deal with psychopaths and play kiss ass to my referring physicians.

Enjoy your awesome pain practice and cure the world with steroids and stimulators...

Have you been keeping up with pain salaries?

 

[Ducttape]

I just went to the website and looked at the agenda.

All this trolling/garbage for Trigger point injections, joint injections, botox, pump refills and patient selection? - if a mid level cant do that or you think thats going to take over your job you must not be in a relevant practice in 2019. Occipital nerve blocks - a stretch and shouldn't be on the curriculum.

Thinking about some other fields

Orthopedic PA - Joint injections, Assist in OR drilling into bone and inserting screws, suturing

Cardiac PA - Harvesting vein grafts for CABG

Dermatology PA/NP - Botox

NPs in and outpatient taking care of pain patients under physician supervision all the time.

Basic Home Infusion - RNs pump refills

ASPN didactic - all of the above.

Help me understand the outrage

all of those things you talk about are done under the supervision of a physician, who can monitor for potential complications and, if ethically based, can help determine that these procedures are not done for financial gain.

ortho PAs doing joint injections is probably an overreach.

there have been serious cases of morbidity and mortality from pump refills. pump refills by rns appear to vary based on state as to whether it is in their scope of practice.

you hit the key point taking care of pain patients under physician supervision.

the problem becomes that there are and will be PAs and NPs that decide that their scope of practice far exceeds what is safe for patients, and they don't know/don't care, due to financial gain.

 

[Ducttape]

DrJackieW, thanks for posting.

however, there are multiple ways of teaching, and providing knowledge as to treatments that can help patients, that is not proclaiming the benefits of a particular technology or company while receiving financial reimbursement for such devices. im not sure if you have gotten financial gain for ProclaimXR, but your past history suggests that you might have. I know that $41,000 from 2014-2016 doesn't seem like that much money over a 3 year period of time, but it taints my opinion of whether that person is truly a neutral party who is not interested in whether the product succeeds and only interested in the patient's best interest.


i do understand that most doctors have had payments from companies. but given the history of this field of medicine, with multiple COI affecting many thought leaders in the past, outwardly proclaiming that a particular device on social media - that patients who are desperate for something and view - leaves an uncomfortable taste...

 

[DrJackieW]

DrJackieW, thanks for posting.

however, there are multiple ways of teaching, and providing knowledge as to treatments that can help patients, that is not proclaiming the benefits of a particular technology or company while receiving financial reimbursement for such devices. im not sure if you have gotten financial gain for ProclaimXR, but your past history suggests that you might have. I know that $41,000 from 2014-2016 doesn't seem like that much money over a 3 year period of time, but it taints my opinion of whether that person is truly a neutral party who is not interested in whether the product succeeds and only interested in the patient's best interest.


i do understand that most doctors have had payments from companies. but given the history of this field of medicine, with multiple COI affecting many thought leaders in the past, outwardly proclaiming that a particular device on social media - that patients who are desperate for something and view - leaves an uncomfortable taste...

Thanks for your opinion. That reimbursement over the past few years was teaching cadaver labs for fellows and other physicians.

Per my other post, I don’t get reimbursed for social media posts. And I absolutely didn’t get reimbursed for this last one.

That being said, nothing stops patients who have had bad trials from making it to the Internet and posting their negative stories when they have had a bad outcome. Here is an opportunity for patients to see a good outcome. Is spinal cord stimulation a panacea? Of course not. Are Meds? Injections? Anything a panacea? No.

I guess the same could be said about people who do cash procedures for PRP, stem cell, etc. it’s not covered by insurance and the ROI is multiple times higher than the COI. But people still do it? Right? I think people practicing ethical medicine do the right thing. Always.

If me teaching courses, mentoring fellows, and accepting money for that from industry means that you feel my opinion is invalid? Well I’d say you’re entitled to your opinion but I wholeheartedly disagree. have a nice day.

 

[No Pain All gain]

DrJackieW, thanks for posting.

however, there are multiple ways of teaching, and providing knowledge as to treatments that can help patients, that is not proclaiming the benefits of a particular technology or company while receiving financial reimbursement for such devices. im not sure if you have gotten financial gain for ProclaimXR, but your past history suggests that you might have. I know that $41,000 from 2014-2016 doesn't seem like that much money over a 3 year period of time, but it taints my opinion of whether that person is truly a neutral party who is not interested in whether the product succeeds and only interested in the patient's best interest.


i do understand that most doctors have had payments from companies. but given the history of this field of medicine, with multiple COI affecting many thought leaders in the past, outwardly proclaiming that a particular device on social media - that patients who are desperate for something and view - leaves an uncomfortable taste...

How much value would you place on a weekend away from your family?

Agree w Jackie - teaching fellows courses is a worthwhile endeavor and the consulting fees associated really just offset your time.

$41,000 over 3 years for anyone on this thread is not a substantial enough sum to influence opinions.

 

[drusso]

I guess the same could be said about people who do cash procedures for PRP, stem cell, etc. it’s not covered by insurance and the ROI is multiple times higher than the COI. But people still do it? Right? I think people practicing ethical medicine do the right thing. Always.

How could it be that a cash procedure is a COI? There's no third party to benefit. It's not the patients nor the physician's fault that it's not a covered benefit. And the decision to use one's own personal money for a professional service is a private choice. Can you imagine what kind of country we would live in if people couldn't use their own personal money to buy health-related and medical services??

 

[DrJackieW]

If

How could it be that a cash procedure is a COI? There's no third party to benefit. It's not the patients nor the physician's fault that it's not a covered benefit. And the decision to use one's own personal money for a professional service is a private choice. Can you imagine what kind of country we would live in if people couldn't use their own personal money to buy health-related and medical services??

If by COI I assumed you were referring to cost of investment (sorry don’t hang around SDN that much anymore to know what the lingo is...) then the cost to purchase the equipment etc for regenerative medicine procedures is low compared to the return on the investment. It’s not anyone’s fault that cash procedures aren’t covered... but there are plenty of physicians out there charging thousands of dollars for these things... and wouldn’t you say that is maybe a bit unethical? Of course people have a choice how to spend their money. But what happens to the patients who can’t afford it?

 

[lobelsteve]

Thanks for your opinion. That reimbursement over the past few years was teaching cadaver labs for fellows and other physicians.

Per my other post, I don’t get reimbursed for social media posts. And I absolutely didn’t get reimbursed for this last one.

That being said, nothing stops patients who have had bad trials from making it to the Internet and posting their negative stories when they have had a bad outcome. Here is an opportunity for patients to see a good outcome. Is spinal cord stimulation a panacea? Of course not. Are Meds? Injections? Anything a panacea? No.

I guess the same could be said about people who do cash procedures for PRP, stem cell, etc. it’s not covered by insurance and the ROI is multiple times higher than the COI. But people still do it? Right? I think people practicing ethical medicine do the right thing. Always.

If me teaching courses, mentoring fellows, and accepting money for that from industry means that you feel my opinion is invalid? Well I’d say you’re entitled to your opinion but I wholeheartedly disagree. have a nice day.

Rationalizing your dirty habit. The wheel goes round and round. Dirty. Dirty. Dirty.

 

[DrJackieW]

Rationalizing your dirty habit. The wheel goes round and round. Dirty. Dirty. Dirty.

Cool. Thanks. I feel like I’ve given this post thread enough energy at this point and people have their opinions and are entitled it.

Sorry you think teaching outside of training programs is a “dirty habit.” I don’t understand that attitude but to each their own. Have a good one guys.

 

[BobBarker]

And this is why we can’t have nice things! Good job guys.

 

[drusso]

And this is why we can’t have nice things! Good job guys.

History doesn't repeat itself, but it does rhyme...

 

[SSdoc33]

You are fighting a losing battle, dr. JackieW. Rational, reasoned arguments dont fly on this forum

 

[lobelsteve]

I get cash back from credit card. Same thing.

 

[drusso]

You are fighting a losing battle, dr. JackieW. Rational, reasoned arguments dont fly on this forum

Are you defending capitalism and free agency?

 

[SSdoc33]

I'm defending the fact that you give us grapes, we won't make wine, we will make horse piss

 

[Needlejockeys]

Keep doing you DrJackieW. Im with you.

Ill let Wayne and Garth take it from here.

Redirect Notice

 

[lobelsteve]

You see what I did there?

 

[Ducttape]

Thanks for your opinion. That reimbursement over the past few years was teaching cadaver labs for fellows and other physicians.

Per my other post, I don’t get reimbursed for social media posts. And I absolutely didn’t get reimbursed for this last one.

That being said, nothing stops patients who have had bad trials from making it to the Internet and posting their negative stories when they have had a bad outcome. Here is an opportunity for patients to see a good outcome. Is spinal cord stimulation a panacea? Of course not. Are Meds? Injections? Anything a panacea? No.

I guess the same could be said about people who do cash procedures for PRP, stem cell, etc. it’s not covered by insurance and the ROI is multiple times higher than the COI. But people still do it? Right? I think people practicing ethical medicine do the right thing. Always.

If me teaching courses, mentoring fellows, and accepting money for that from industry means that you feel my opinion is invalid? Well I’d say you’re entitled to your opinion but I wholeheartedly disagree. have a nice day.

why don't you teach these courses pro bono?

your opinion is not invalid, because it is your opinion. however, your opinion has bias beyond a purely scientific basis. the degree of bias can vary, as someone such as Dr. Deer has significantly more COI than, for example, you.

this is not something to take lightly, which you clearly do. in my opinion, we should be sticking to the science, not posting what may amount to hyperbole (just look back the past 10 years about all the various "next big thing" in terms of pain management and see how many have stood the test of time).


fwiw, I have had over 10 people in the past 2 months ask about "that stimulator thing", because they saw something on social media. none of them had appropriate neuropathic pain (they had axial pain without prior surgery, fibromyalgia, myofascial pain, SI dysfunction, did I mention fibromyalgia?) and all were sure that such treatment was for them.

 

[drusso]

why don't you teach these courses pro bono?

your opinion is not invalid, because it is your opinion. however, your opinion has bias beyond a purely scientific basis. the degree of bias can vary, as someone such as Dr. Deer has significantly more COI than, for example, you.

this is not something to take lightly, which you clearly do. in my opinion, we should be sticking to the science, not posting what may amount to hyperbole (just look back the past 10 years about all the various "next big thing" in terms of pain management and see how many have stood the test of time).


fwiw, I have had over 10 people in the past 2 months ask about "that stimulator thing", because they saw something on social media. none of them had appropriate neuropathic pain (they had axial pain without prior surgery, fibromyalgia, myofascial pain, SI dysfunction, did I mention fibromyalgia?) and all were sure that such treatment was for them.

No one should be forced to work for free.

 

[BobBarker]

Work for free for ABT teaching young physicians how to implant devices with an average sales price of $25,000... yep that makes total sense.

 

[Ducttape]

No one should be forced to work for free.

you are teaching and helping teach future generations.

when residents rotate through here, I am not getting any extra compensation.

 

[drusso]

you are teaching and helping teach future generations.

when residents rotate through here, I am not getting any extra compensation.

I volunteer for many, many things. But I can't let others dictate what my time is worth.

 

[Ducttape]

do you volunteer your social media page to companies that are primarily focused on financial gain?


oh wait, who am I talking to......

 

[drusso]

do you volunteer your social media page to companies that are primarily focused on financial gain?


oh wait, who am I talking to......

I receive no financial gain. My glory is only pointing at the Naked Emporer...

 

[lonelobo]

Don't think anyone cares much about 41K in 3 years, But $1.5 million in 3 years .........

 

[drusso]

Don't think anyone cares much about 41K in 3 years, But $1.5 million in 3 years .........

What should the cap be?

 

[lobelsteve]

What should the cap be?

5k total per year. More than that and i think whoring for industry. Been there. Done that.

 

[calvnandhobbs68]

The desire for PAs and NPs to practice "at the top of their license" is one of the most disingenuous and dangerous talking points utilized by midlevel interest groups, venture capitalists and private for-profit health corps, and hospital administrators. It's really a euphemism for "hey doctors, just let midlevels do stuff and if something goes wrong you'll be honorable enough to deal with their mistakes and shoulder responsibility." And unfortunately it sounds innocuous enough to patients who end up getting harmed.

Put another way, the "top" of my medical license technically allows me to do all of the following in a single day: do brain surgery, counsel somebody on their high-risk pregnancy, replace somebody's hip, treat acute-angle glaucoma, do some well-child exams in the clinic, treat a few patients in thyroid storm, and then finish up the afternoon in the path lab reading slides.

The whole thing is a farce.

Was just happening to read this thread and 100% this.