Pain med procedures after FM

[NRAI2001]

I had an Attending in residency Who would do a lot of epidurals injections (he had a fluoroscopy lab ) in addition to shoulders, knee, hip injections.

What are your opinions on FM docs doing spinal pain procedures like epidural injections, facet injections… Etc. of course after the proper training and certifications (not fellowship)?

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[FrustratedFamDoc]

Shoulder, hip, knee, Gt bursa, lateral epicondylitis, plantar fascia… sure.

Anything spinal without fellowship training?

 

[NRAI2001]

Shoulder, hip, knee, Gt bursa, lateral epicondylitis, plantar fascia… sure.

Anything spinal without fellowship training?

what if you re received more training (courses,preceptorships)??

 

[VA Hopeful Dr]

what if you re received more training (courses,preceptorships)??

I wouldn't. If something goes wrong, you won't have much in the way of a defense.

 

[smq123]

Shoulder, hip, knee, Gt bursa, lateral epicondylitis, plantar fascia… sure.

Anything spinal without fellowship training?

On a very marginally related side note, the phone number listed at the beginning of the video is an 813 number, which is the area code for Tampa.

Once I realized that, the rest of the video made more sense.

 

[FrustratedFamDoc]

I wouldn't. If something goes wrong, you won't have much in the way of a defense.

If you can even find somewhere to credential you.

 

[FrustratedFamDoc]

That's how we do!

 

[Ironheme]

what if you re received more training (courses,preceptorships)??

You're making me worried for your patients......

Spine is not an area I would mess with. Also, just for funsies, I looked up epidural injection total RVU - it's 7.85 (work RVU is 1.95) and about $266 for non-facility.

For 99214, it's $128 for non-facility, 3.79 total RVU (1.92 work RVU).... I'd rather do 2 diabetic visits than a spinal injection. I'm much more likely to kill someone with one of those....and it's not the diabetic visit.

 

[I_Cant_tell_you]

If you do a sports medicine fellowship and feel comfortable doing injections and have exposure do folks who did spine procedures with ultrasound it could work. I don't know of anyone personally who does epidurals with ultrasound, but you can. You have to consider whether it's fair to have you dick around and try to do procedures that are important for people when you can just send it to someone who will get it right the first time. Sometimes I'll do SI joint injections in folks without ultrasound if they're thin enough, but I'd never try it on someone bigger because I'd just be guessing about proper placement. Some procedures are pretty straight forward like greater and lesser occipital nerve blocks, which I do without ultrasound because the landmarks are straight forward.

Spine takes a lot of training. Anesthesiology and PMR trainees are doing all sorts of image guided injections throughout residency to make them qualified to take on spine with a fellowship.