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HI All,

Newly minted RMSK Sport and Emergency med doc.  Any ideas how to market the RMSK and use it effectively in Canada?

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Hi NC!

I am a RMSK radiologist doing a bit of this in Ireland. The hospital where I provide service has no MRI and the closest scanner is 1.5 hours away. As such, musculoskeletal ultrasound has been very popular. The GP's in the area send me a variety of studies but shoulders predominate. I have had a very positive response from guided SAB injections as they seem to be more effective than the ones given by the GP's. I give these for tendinopathy/impingement and all manner of tears as surgery is uncommon here no matter how bad the cuff may be. The treatments most long lasting for patients have been De Quervain injections, barbotage for rotator calcific tendonitis, and plantar fascia needling for refractory plantar fasciosis. I don't do PRP.

I suppose the way that things really got jump started occurred after I gave a talk on the subject to the local GP's at their annual meeting. I actually had to ask for GP's to send their patients to physio first so that 1) I could get a better H&P before seeing the patient and 2) Appropriate physio could be tried before any injection. This has helped a lot with regard to more appropriate patient referrals.

Lastly, I advise having a good relationship with an musculoskeletal radiologist so that you can get MRI's reviewed in those patients who have had a scan before they see you. It is common that ultrasound finds pathology either not seen on MRI or uncovered by your evaluation of "what hurts". So, don't be dissuaded by MRI findings that don't concur with your findings, just have a friendly radiologist look again at the study to see if your findings can be seen either in retrospect or with another imaging sequence. Of course, I get a plain xray on every patient I scan but those I read myself.

I haven't answered your question pertaining to starting a Canadian practice but perhaps some of this can be useful.

Hi Daniel, 

Thanks for your response.  I'm currently in office based sport med practice 3 days a week where I do a tonne of u/s guided injections, tenotomy, aspirations etc.  ER on the weekends.  At this point the Ontario government (OHIP) doesn't pay me for this part of the work as I'm not a radiologist and they won't officially let me charge patients since the service is, in theory, available through radiology (1-2 year wait often).  Many of my colleagues are still charging patients and waiting for OHIP to catch up, I thought getting the RMSK designation might strengthen my position with them.  We shall see.  

Agreed, Physio in house is working well.  

Anyway, I like the u/s part of my practice and patients seem to as well

Thx again

Andi

Paxton Holt Daniel said:

Hi NC!

I am a RMSK radiologist doing a bit of this in Ireland. The hospital where I provide service has no MRI and the closest scanner is 1.5 hours away. As such, musculoskeletal ultrasound has been very popular. The GP's in the area send me a variety of studies but shoulders predominate. I have had a very positive response from guided SAB injections as they seem to be more effective than the ones given by the GP's. I give these for tendinopathy/impingement and all manner of tears as surgery is uncommon here no matter how bad the cuff may be. The treatments most long lasting for patients have been De Quervain injections, barbotage for rotator calcific tendonitis, and plantar fascia needling for refractory plantar fasciosis. I don't do PRP.

I suppose the way that things really got jump started occurred after I gave a talk on the subject to the local GP's at their annual meeting. I actually had to ask for GP's to send their patients to physio first so that 1) I could get a better H&P before seeing the patient and 2) Appropriate physio could be tried before any injection. This has helped a lot with regard to more appropriate patient referrals.

Lastly, I advise having a good relationship with an musculoskeletal radiologist so that you can get MRI's reviewed in those patients who have had a scan before they see you. It is common that ultrasound finds pathology either not seen on MRI or uncovered by your evaluation of "what hurts". So, don't be dissuaded by MRI findings that don't concur with your findings, just have a friendly radiologist look again at the study to see if your findings can be seen either in retrospect or with another imaging sequence. Of course, I get a plain xray on every patient I scan but those I read myself.

I haven't answered your question pertaining to starting a Canadian practice but perhaps some of this can be useful.

Ah yes, the bane of musculoskeletal ultrasound: getting paid for it. 

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