What non-patient issues are keeping your up at night?

I recently published a few questions on Survey Monkey and then contacted folks on LinkedIn and Facebook, asking them to complete the survey. Because I got so many responses, I decided to publish answers to each question separately. This is just the first of several surveys that I have planned to address different topics.

My survey began with the following instructions:

You have been invited to participate in this survey because you are a neurophysiologist, neurologist or technologist practicing intraoperative neurophysiological monitoring (IONM). Please answer as many of the following questions as you’d like. You can choose to maintain anonymity, or you may elect to identify yourself by writing your name at the end of each answer. Once the survey is closed, the answers will be published in a blog post on NeurologicLabs.com. Thanks for your participation!

Note: All responses are presented below as submitted though Survey Monkey. The only responses that I eliminated are the ones that were racist, sexist or otherwise egregiously unprofessional and/or inappropriate. If you didn’t have an opportunity to participate in the survey, it is still open. Responses truly are anonymous. To participate, just click here.

What non-patient issues are keeping your up at night?

  1. I have two main issues. 1) the market seems as if it’s being flooded with cnim a everyday. Big companies mass produce sub par techs that only know one way of doing thing. It concerns me that these companies make it so hard for techs to get the proper training by developing “stages” from basic to advanced which can take techs years to achieve. It would be beneficial to the industry to teach every incoming tech all aspects of Neuromonitoring from the start. And give them experience. It’s a difficult field, but way more achievable than companies make newbies believe. That’s a two in one answer. ~ Anonymous.
  2. Shitty working conditions running rampant in this industry. ~Anonymous
  3. Get a life and you won’t ask yourself this questions. ~Anonymous
  4. Surgeon lack of knowledge of IONM. ~Anonymous
  5. Monitoring systems using non trained staff (e.g., sales reps) to provide a “service” without informing patients that no-one trained and experienced in Neurophysiology is watching over the operation and providing information to the surgeon. ~Anonymous
  6. Lack of staffing. ~Anonymous
  7. Recent ABRET changes to CNIM pathways that undermine industry based education. While I see the point in university based education, dismissing 30 years of highly successful programs for university programs run by people with less than 10 years in the field is silly. ~Anonymous
  8. Disparity between interpreter stated competencies and actual performance. ~Anonymous
  9. Staffing. ~Anonymous
  10. I wouldn’t say that anything keeps me up at night, but I get the point of your question. There are a lot of problems with our field, and they’re all caused by greed. The single most destructive force in IONM today is the presence of corporations and their support of the physician supervision model. Corporations serve as vendors to hospitals and treat patient care as if it is equal to selling spinal implants. They send under-trained and under-educated techs to the OR to care for patients, and these techs are “supervised” by online physicians who simultaneously watch dozens of surgeries from their couch at home. These physicians claim to be experts, to be knowledgeable of the field, but nothing could be further from the truth. Even the “fellowship-trained, board-certified” physicians are tragically ignorant about what IONM is, how it works, what’s happening in the OR, what’s at risk in the surgery, etc., etc., etc…. and they deny this fact… and people actually believe them. This biggest joke of all is the idea that IONM is the practice of medicine. What a scam! The fact is that well over 90% of physicians involved in the field of IONM don’t belong here, but that’s the model that we’ve adopted to increase reimbursements and it’s all driven by corporations and heavily backed by the AMA. You want to clean up this field over night? Eliminate the professional component of reimbursements and educate patients about the dangers of automated IONM systems. ~Anonymous
  11. A lack of sufficient training for our clinicians. A lack of national clinical standards/benchmarks. Unethical business practices in IONM. Our lack of ability to sufficiently educate our surgical, anesthetic, and nursing colleagues on what good IONM is and what it can bring to patient safety. ~Anonymous
  12. Management changes and company instability. ~Anonymous
  13. Nothing. ~Anonymous
  14. The viability of the profession. This response takes into consideration several factors that are driving healthcare in general and IONM specifically (e.g. reimbursement, declining quality, VC money, etc.). ~Anonymous
  15. Work/Life balance. ~Anonymous
  16. Remote oversight. ~Anonymous
  17. Financial impacts on the field. ~Anonymous
  18. How to raise the level of education and professionalism in the field of neurodiagnostic technology, helping to ensure an increase in patient safety and ensure a well defined scope of practice . How to achieve professional licensure for the field of neuro diagnostic technology. ~Anonymous
  19. Cost of healthcare and all of the medicare fraud. ~Anonymous
  20. Availability of technology and supplies used (e.g. electrodes) at reasonable cost in a developing countries, where I work, teach and train. ~Anonymous
  21. The scam of MD supervision. ~Anonymous
  22. We need to have standardization of our title. What are we? Neurmonitoring Tech? Surgical Neurophysiologist? Surgical Neurophysiology Tech? Or God forbid, Intraoperative Neuromonitorist (what IS that?). ~Anonymous
  23. Self-entitled surgeons that think they have a right to participate in the IOM revenue stream. Both the technical performance and the professional oversight of IOM are outside of the STANDARD OF CARE for most surgeons. ~Anonymous

That’s what I have so far. I’m sure more answers will come in over time. Feel free to comment below.

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