Outpatient ideas

[Dansk2011]

Doing primarily outpatient and helping build out a clinic for a hospital. Just essentially getting started but wanting to get busy fast. Was curious if anyone has any suggestions on types of patients I could expand to seeing. There are already 2 interventionalists and also a FM sports medicine so not sure much room for spine procedures which is fine. Currently a fair bit of inpatient follow ups, chemodenervation/spasticity management/baclofen pumps, and some pain management (not wanting to do much opiate management). I'm expecting/hoping there is spill over of msk patients. Don't currently do EMGs but open to it...would need a refresher. Wanting to do an amputee and wheelchair clinic. Iffy on concussions but also open to it. Have the option to do consults at the hospital which I could theoretically do in the mornings before clinic or split my day half clinic/half consults but currently working 4 days a week (not wanting to change my schedule) and not sure if doing so would set some sort of precedent and expectation of consults every day or at least 5 days a week. 2 other pmr docs split a small in hospital unit and they have essentially haven't been doing consults as of now so not really anything formally established. Anything else I might be missing out? Any suggestions greatly appreciated.

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[Iamnew2]

Doing primarily outpatient and helping build out a clinic for a hospital. Just essentially getting started but wanting to get busy fast. Was curious if anyone has any suggestions on types of patients I could expand to seeing. There are already 2 interventionalists and also a FM sports medicine so not sure much room for spine procedures which is fine. Currently a fair bit of inpatient follow ups, chemodenervation/spasticity management/baclofen pumps, and some pain management (not wanting to do much opiate management). I'm expecting/hoping there is spill over of msk patients. Don't currently do EMGs but open to it...would need a refresher. Wanting to do an amputee and wheelchair clinic. Iffy on concussions but also open to it. Have the option to do consults at the hospital which I could theoretically do in the mornings before clinic or split my day half clinic/half consults but currently working 4 days a week (not wanting to change my schedule) and not sure if doing so would set some sort of precedent and expectation of consults every day or at least 5 days a week. 2 other pmr docs split a small in hospital unit and they have essentially been skirting doing consults as of now so not really anything formally established. Anything else I might be missing out? Any suggestions greatly appreciated.

Migraine management? if you have been trained.

 

[Dansk2011]

Yes definitely planning on that as well. Thank you.

 

[j4pac]

If you are a DO, OMT is nice (and lucrative). I’d definitely look into spasticity management, and EMG. The problem is that if your group already has Sports and PM, you are going to get dumped the stuff they don’t want to see. You’ll turn into their pill guy and spend the rest of the time educating patients on central sensitization. You’ll get volume, but it’ll be the type of setup that will burn you out.

I’d highly recommend establishing a relationship with Hem/Onc and Neurology. I worked in a similar setup and made it work with a strong referral base. Neurosurgery is likely to utilize their current referral sources unless the current SM and Pain guys aren’t good.

Be careful about migraines. That often turns into chronic pain patients. I’d recommend having neurology manage headaches and be their proceduralist. I did nothing but OMT, dry needling, trigger points, and Botox for dystonia/migraines for neurology.

 

[Dansk2011]

If you are a DO, OMT is nice (and lucrative). I’d definitely look into spasticity management, and EMG. The problem is that if your group already has Sports and PM, you are going to get dumped the stuff they don’t want to see. You’ll turn into their pill guy and spend the rest of the time educating patients on central sensitization. You’ll get volume, but it’ll be the type of setup that will burn you out.

I’d highly recommend establishing a relationship with Hem/Onc and Neurology. I worked in a similar setup and made it work with a strong referral base. Neurosurgery is likely to utilize their current referral sources unless the current SM and Pain guys aren’t good.

Be careful about migraines. That often turns into chronic pain patients. I’d recommend having neurology manage headaches and be their proceduralist. I did nothing but OMT, dry needling, trigger points, and Botox for dystonia/migraines for neurology.

Much appreciated. Yeah my fear is being dumped on for opiate management if I start accepting whatever. Don't mind doing some but definitely not wanting to be inundated with it. MD so don't do OMT, although I wish I did.

 

[j4pac]

Much appreciated. Yeah my fear is being dumped on for opiate management if I start accepting whatever. Don't mind doing some but definitely not wanting to be inundated with it. MD so don't do OMT, although I wish I did.

if you don’t want to prescribe opiates for non-cancer pain, I’d commit to that early. Truth be told, the moment you start writing chronic opiates, you own that patient. You’re going to struggle to walk away from it unless you switch jobs. If you are ok with “doing some”, you’re going to do more than you want. I’d only prescribe for acute pain, and let that be your policy. Then, if you want to make a rare exception, you’d have the liberty to do it. Otherwise, both providers and patients will pursue you for opiates. It was honestly the worst (and at times scary) aspect of my prior job. Even “cancer pain” burned me a few times…had a few cancer patients abusing and misusing my meds.

 

[Dansk2011]

if you don’t want to prescribe opiates for non-cancer pain, I’d commit to that early. Truth be told, the moment you start writing chronic opiates, you own that patient. You’re going to struggle to walk away from it unless you switch jobs. If you are ok with “doing some”, you’re going to do more than you want. I’d only prescribe for acute pain, and let that be your policy. Then, if you want to make a rare exception, you’d have the liberty to do it. Otherwise, both providers and patients will pursue you for opiates. It was honestly the worst (and at times scary) aspect of my prior job. Even “cancer pain” burned me a few times…had a few cancer patients abusing and misusing my meds.

most definitely. I practiced pain prior and the opiate aspect is what made me stop. that and working for ****ty people who's practices ended up revolving around opiate management and drug screens. not ideal. appreciate your input.

 

[dmk21]

I’d definitely look into spasticity management, and EMG.

I’d highly recommend establishing a relationship with Hem/Onc and Neurology. I worked in a similar setup and made it work with a strong referral base.

Few quick questions if you dont mind answering.
- Do you do EMGs and if so do you plan on continuing it or just using it as a referral base.
-When you establish with hem/onc and neurology what do you advertise yourself as specifically, managing anything specifically or just pm&r?
-If you do interventional spine, what percent of your practice consist of this?