Neurology Procedural Training

[Boxer1]

I'm trying to put together a list of Neurology programs to apply to. I'm interested in doing EMGs as part of my practice. I have also heard that your average program doesn't give you enough time doing EMG's to become proficient. Are there some programs that offer sufficient exposure to EMGs to be able to do them without a fellowship? Roughly how many months of EMG training would I need in residency to be proficient, and get privileges to do them?

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[bustbones26]

From what I hear, UC SAn Diego brags that they give you so much EMG training, that you are ready to go.

I am not sure exactly what is required, from what I understand, there is nothing to stop a healthcare provider (any specialty, remember, PM&R does these too without fellowship), from doing EMG and claiming reimbursement if they feel comfortable doing so. So really, there is nothing legally stopping you from performing EMG's in your office outpatient and claiming reimbursement.

My experience, take it for what is worth, is that your interpretations will never be taken seriously by other providers who are fellowship trained. I know for a fact that most PM&R programs actually do more EMG's in their residency than neurology residents, yet I have seen several patient go to an EMG fellowship trained neurologist for a referral carrying an EMG report done by a physiatrist and the neurologist pretty much throws it in the trash and does their own study.

 

[Claymore]

I'm pretty sure you can get certified in EMG if you do your residency at Mayo...they do something like 5 months of it as a PGY-2

 

[bustbones26]

Per American Board of Clinical Neurophysiology Guidelines, you must either do the fellowship, or show adequate evidence of post residency training. Does this mean that you can't do EMG's? No, its just means that you can never claim to be a board certified neurophysiologist. Would there be any benefits to getting certified? Yes.

Some hospitals have neurophysiology labs were primary care docs can refer patients to have studies done without first seeking a neurology consult. Let's face it, a primary care doc is smart enough to know that if you want to fully work up a patient for say carpal tunnel, you need an EMG and don't necessarily need a neurology consult, so they refer the patient to these labs. When the patient gets to the lab, the study is read by a board certified neurophysiologist. Unlikely that a hospital would creditial you to read studies in their lab without some evidence of adequate training. I think if you just bite the bullet and do the fellowship, your creditials would not be in question, inpatient or outpatient.

 

[minstral]

Does doing such a fellowship increase your base pay? I realize more procedures means more $ but are you automatically bumped on a base salary? for instance I know a neuro intensivist will probably be payed about 15-25k more than adult neuro to a few years in.

 

[bustbones26]

Does doing such a fellowship increase your base pay? I realize more procedures means more $ but are you automatically bumped on a base salary? for instance I know a neuro intensivist will probably be payed about 15-25k more than adult neuro to a few years in.

It is not that you're base salary is bumped. But rather if you are known as an electrodianostics expert in your hospital community, other physicians will send patients to you to have these studies done. Hence, you make extra cash for the procedure. In addition, as a neurologist, since many of your own patients require electrodiagnostic work up, you will not have to refer them to another neurologist or physiatrist, but can do the studies yourself, hence, more money. So it does boost your overall earning potential

Now, since I myself am interested in doing electrodiagnostics, what I learned was this, if you do 6 months of preceptorship in electrodiagnostics, whether in residency, or fellowship, you can sit for the certification exam. This is how physiatrist get away with doing electrodiagnostics without fellowship. But you probably would be an EMG/NCV pro by doing this, perhaps EEG too.

Doing the actual fellowship though increases your exposure to things other than EMG/NCV and simple EEGs, you'd get to do evoked potentials, sleep studies, in some cases intraoperative monitoring.