I have had the privilege of being a part of an interventional Pain management practice in the greater Richmond, Virginia area for the past 20 years. This could be a good point in time to share some of our experiences with our other colleagues.
Being an independent, or more correctly interdependent, medical specialty practice comes with many advantages and some challenges. We have been offering a variety of services over the years and, like most other practices, have made some changes to the way we practice to be compliant with new evidence and guidelines and regulations. One of our challenges has been to find a balance between interventional treatment modalities and medication management. I think we all may know providers who are in favor of, or against, one or the other.
We may also have heard phrases like “I don’t believe in injections or opioids, etc.” One could find pretty good arguments or counter-arguments on each side but I think the answer we have found at this point has been to try and balance the two and hopefully choose the modalities that pose the patients and sometimes the providers to the least amount of risk. These could be medical risks or even financial risks, where patients’ and healthcare funds are spent on one modality and there is not enough funds left to cover the basic life needs or preventative services.
The following are some of the advantages/challenges of practicing at a focused and interdependent specialty practice:
One major advantage is that making decisions and implementation of new services and products are easier in general. The practice is smaller compared to a larger healthcare system. Asking four providers to possibly change to a different EMR service is far easier than asking a couple of hundred.
Being smaller could also mean limited access to some higher cost products and administrative talent. Some EMR services are out of our reach due to cost but the gap has been narrowing in some cases. We have also been looking at using fractional talent for higher level and more expensive administrative needs.
I think one of the choices we have made that has worked to the advantage of the patients and us tremendously, has been to look at the specialty of pain management as a multidisciplinary one and try to focus on what we are truly passionate about and trained to do.
As I was told by my mentors, do what you like best and odds are you will do it more often and be better at it. I believe this advice has served us well in the past 20 years at our practice. At present, we are focusing on fluoroscopy guided spinal injections, Neuromodulation, percutaneous balloon Kyphoplasty and medication management.
We have offered most of these services for the better part of the past two decades except for balloon Kyphoplasty, which we have added more recently. Performing these services in an office setting has proven to be safe, efficient and cost-effective.
In summary, it has been our experience that office based and independent specialty practices offer a focused, highly specialized, and cost-effective alternative to hospital based services and that there is a role for both models. We hope that patients will continue to have access to both services for the foreseeable future.