IONM Meets Chiropractic: The Perfect Career Combination

There are worlds out there we know nothing about, but that in the end could mean the world to us. There are subjects that do not come up often that are important enough to learn about in great detail.  There are widely unknown education tracks that inspire lifelong transformations. There are technologies and services that can shape the outcomes of surgeries, and there are careers that parallel your own that can make all the difference for you and others.

When we learn about new subjects, new worlds open up to us. Our eyes widen as directions change and previously unimaginable opportunities arise. When I first learned about intraoperative neuromonitoring (IONM), I found the possibilities to be as amazing as the fact that I was not aware the field even existed. I started my career after receiving a master’s degree in human nutrition from the University of Bridgeport and a doctorate from the University of Bridgeport’s School of Chiropractic. I went on to practice in the chiropractic field for nine incredible years before deciding to add IONM education to my resume.

As chiropractors, we try to treat conservatively to help avoid surgery or help to rehabilitate after the procedure. However, when surgery is necessary, it must be performed in the safest way possible to achieve the greatest possible outcome. Not unlike a surgeon, a chiropractor’s main role is to alleviate pain and improve body functions — a mission that I’ve always been passionate about. While the vast differences between the roles are obvious, there is much knowledge that the two forms of practitioners share. Both see patients with similar conditions and often refer them to specialists outside of their fields of expertise. As I prefer to take a more conservative approach, I never went so far as to pursue a career in surgery, but the medical side of healthcare has always deeply fascinated me.

After doing some research, I realized that I could grow to become more involved in medical work while continuing to be there for patients through the thriving field of IONM. By becoming a surgical neurophysiologist, I could be an advocate for patients who are under anesthesia and speak for them while they cannot speak for themselves. My experience in patient care made me a perfect candidate, and the science behind neuromonitoring even builds on the knowledge obtained during chiropractic training.

By monitoring the nervous system during surgical procedures, neurophysiologists serve as an essential layer of protection between patients and potential neurological deficits. By being present during surgeries, I am equipped to make a difference at the time of the operation. Seeing firsthand how various spinal procedures are performed, I’ve also gained a greater understanding of the type of rehabilitation patients will need after surgery.

In the end, I have found that being a surgical neurophysiologist and a chiropractor is not only more fulfilling; it also makes me a better, more well-rounded physician.

Yevgenia Boyko, DC

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A Career Change Success Story: How a Chiropractor Came to Appreciate the Value of IONM

I went to school for one career, but in that very institution, I found another. A valuable part of my chiropractic education was a specialty that many overlook or simply don’t expect. Part of my chiropractic education at Life Chiropractic College included electrodiagnostic proficiency training. During that training, there was discussion about the utilization of intraoperative neuromonitoring (IONM) during surgery. It was not just the vast potential of the technology and service that interested me, it was also the fact that Doctors of Chiropractic (DCs) could play a vital role in the field of IONM due to their previous medical experience and advanced capabilities. Some chiropractors had even taken that skillset and later started their own IONM businesses.

After I embarked on my professional career as a DC, I was reintroduced to the field of electrodiagnostic medicine and entered an 18-month long program in Pennsylvania with other MDs, PTs, and other New York state DCs. This program awakened my interest in the fields of electrophysiology and the contributions I could make to patients.

With my previous high-level training, experience, and success in the diagnostic electromyography (EMG) field—I had become an electrodiagnostic contributor at the NY State Chiropractic Association—and my passion for electrophysiology as a whole fueled my interest in the prospects of an IONM business. I also felt that I had the business skills to run and grow a healthcare practice in the future, having already started and successfully grown a chiropractic practice.

I’m a fairly analytical and cautious person and while I understood the medical benefits of IONM very well, I wanted to research the future of IONM from a business standpoint. My research solidified my decision to make the move into IONM. In particular,  I learned that IONM is a fast-growing industry, that more and more surgeons are insisting that IONM be part of their surgical procedures and, that hospitals see the benefit of having an extra layer of patient safety.

I have recently served in a management role for an IONM company as a Director of Clinical Competency and Proficiency and I have absolutely no regrets. Everything that I expected to gain from my transition has been fulfilled. I particularly enjoy the challenges of working in an OR setting. While surgeries may have the same name, as a surgical neurophysiologist, I must thoughtfully apply knowledge of each patient’s unique, comprehensive health history and the type of surgery being performed, while also taking into consideration anesthesia’s effects on signals and the surgeon’s preferences for neuromonitoring. The surgical team is a complex array of individuals, but the goal is always to make certain the patient wakes up safely and able to function normally. I consider it a privilege to be a valued member of that team.

Nestor Nicolaides, DC, CNIM
Director of Clinical Competency and Compliance

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CEN Program Now Available to Foreign Students: You Can Play an Essential Part in Closing the Global Healthcare Gap

Healthcare needs are everywhere, but Intraoperative Neurophysiologic Monitoring (IONM) is not. Our goal is to close that gap. IONM clinicians are integral members of surgical teams, helping to create a better quality of life for thousands of patients. And the field is growing. However, there’s a global gap, as countries outside the United States lag behind in IONM services with patients and communities are suffering as a result. In a recent survey, respondents from 11 countries indicated that the largest barrier to the use of IONM was a lack of clinical training. Additionally, surgeons and hospital staff reported that IONM equipment purchased based on physician requests for neuromonitoring are not used due to the lack of clinical staff. The bottom line: the world needs more professionally trained and certified IONM technicians to fill the gap and play a critical role in increased surgical success worldwide.

The Center for Electroneurodiagnostics (CEN) is at the epicenter of the United States’ IONM educational and training community. CEN’s focus on comprehensive, didactic education and training during live surgical cases in its network of hospitals has combined to produce excellent employee placement rates and 100% passage rate on the Certification Examination in Neurophysiologic Intraoperative Monitoring (CNIM) for those students who have moved on to take the exam. (*as of December 2020). In recognition of the global gap, CEN has launched the Intraoperative Neurophysiologic Monitoring for International Students program. This program is designed specifically for students* living outside the U.S. who are interested in a healthcare career and excited about the opportunity to keep patients safe during surgical procedures that put the nervous system at risk.

The program is split into three modules—online didactic, classroom, and practicum—and can be completed in approximately six months. The first module is online and can be completed in six weeks while living in your home country. The second module combines live training on equipment and software in CEN’s New York-based classrooms and segues into actual participation in live surgeries at top hospitals.

If you’re considering a profession in the healthcare sector and are passionate about helping patients and communities in your home country, contact us to discuss our international program and take the first step toward a rewarding, lucrative, and fulfilling career.

*Admission standards include M Visa qualification and an equivalent Bachelor’s degree.

Contact us here to learn more about CEN’s Intraoperative Neurophysiologic Monitoring for International Students program.

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To Be or Not to Be a Physical Therapist?

“Do you miss being a physical therapist?” It’s a question I’m frequently asked, and my response is always the same. That little voice in my head starts taking on a slightly exasperated tone. Last time I checked, I am still licensed as a physical therapist in a couple of states and still consider myself a PT, working in a subspecialty of a subspecialty. I have also come to realize that some people think that if you specialize too much, you are not really in a subspecialty of a subspecialty, but have rather wandered into a different field entirely. However, that is a debate for another day.

Most of the time, what the person asking the question really means is, “Since you practice surgical neurophysiology, do you miss doing typical PT work?” The answer to this question is not straightforward, so I will preface it by providing a bit more information about my background.

I graduated from Creighton University with a Doctor of Physical Therapy degree in 2001. One of the last classes I took was in clinical electrophysiology.

For those of you who are not familiar, clinical electrophysiologists are the practitioners that place very long needles into patients’ muscles to see what kind of electrical activity is taking place in the middle of the muscle. If that isn’t creepy enough, they also place metal prongs on the patient’s skin and shock the nerves to see how fast electrical impulses are conducted. Naturally, being the “physical terrorist” (a name coined for me during my clinical practice), I thought that was what I wanted to do for the rest of my life.

As a physical therapist, I was fortunate enough to have many diverse practice experiences that brought me many deep friendships, intellectual stimulation, and clinical satisfaction. Over the years, I was able to work in varied practice settings where I had the opportunity to enter a variety of PT subspecialties. It was challenging, fulfilling, and fun to help a heart transplant patient walk the day after their surgery. The respiratory therapist would be on one side, “bagging” the patients to help them breathe. A nurse would be on the other side, pulling the IV pole along. Myriad lines and tubes would be everywhere, keeping the patient alive.

I’ve had the pleasure of being there for people when strokes, traumatic spinal cord injuries, and major traumatic accidents changed their lives in an instant. I’ve taught people how to sit in, transfer to, and operate their wheelchairs, but one of the most rewarding things for me was teaching them how to walk again.

The most moving experience that I ever encountered occurred when a former patient invited me to dine with him and his family at a golf course country club. When I walked in to join him, he immediately stood up at our table, and I’ll remember that moment for eternity. In a loud, emotional voice that garnered the attention of all of his friends and acquaintances, he introduced me by name and declared, “This is my physical therapist; he is the one that taught me how to walk again!”

So, how does someone who received so much personal satisfaction as a PT wind up working as a surgical neurophysiologist in an operating room? Many people don’t realize what a physical toll being an acute care or rehabilitation PT has on your body. On more than one occasion, people would lose their balance while walking or go limp while I helped them move from a bed to a chair. I caught and carried a few too many others, and I detached the biceps tendons on both my arms within three weeks of each other. It was the wake-up call that I needed to get serious about following my passion for clinical electrophysiology.

Following my PT school graduation, I became acquainted with Dr. Richard Nielsen, a legend in the physical therapy field, who also does clinical electrophysiology. Dr. Nielsen went on to found and became the President of Rocky Mountain University of Health Professions. Even before the University came into existence, I shadowed Dr. Nielsen and took several of his clinical electrophysiology classes.

At that time, he hadn’t yet rolled out the residency program that I would later use as my gateway into clinical electrophysiology. However, while I was recovering from the bicep surgery that would change my professional trajectory, serendipity struck. Nanette Sturgill, manager of the Intraoperative Neurophysiological Monitoring (IONM) program at Primary Children’s Hospital, reached out to Dr. Nielsen to see if he knew of anyone who could run the program. He connected us, and I was able to begin learning pediatric surgical neurophysiology.

My new position at Primary Children’s Hospital was like a dream come true. Half of the time, I was able to work in the OR with some amazing surgeons like Dr. John Smith, who is considered one of the top 20 pediatric orthopedic surgeons in the US. I spent the other half of my time in the clinic, working with babies who were under a year old. It was perfect for me as my patients didn’t weigh very much, and my shoulders weren’t strained as I raised them. As time went on, my surgical responsibilities increased until I was working full-time in the OR.

I worked in myriad leadership roles for seven years until I happened upon my true dream job at Neuro Alert, where we work with surgeons to test and monitor patients’ nervous systems during complex surgeries. We speak for patients who can’t speak for themselves and ensure they leave the operating room safely. I was thankful for the path I had been on before, but I’m eternally grateful for the outcome. My time at Neuro Alert has brought me an amazing sense of fulfillment and incredible opportunities.

My first role was to oversee the surgical neurophysiology services and, since then, my duties have continued to expand. I am currently Neuro Alert’s Director of Clinical Program Development, and on a day-to-day basis, I still put my traditional PT clinical skills to use. I evaluate patients preoperatively and postoperatively. Before surgery, I get a clinical picture of what to expect during the surgery. After surgery, I check for any changes that may have happened to the nervous system during the procedure.

The answer to the original overarching question is: No, I don’t really miss being a physical therapist because I still think of myself as being one, albeit a little incognito. Do I miss the personal satisfaction of using my skills to help people recover from injuries? Sometimes. However, there is a different but powerful satisfaction that comes from protecting patients in the OR. Working in IONM, I get to be there for patients when they need it most (when they are under anesthesia and can’t speak for themselves). Without me or someone like me working with the surgeon and surgical team, there would have been many more catastrophic outcomes. And knowing my role in preventing those catastrophes brings tremendous joy to my heart.

My advice for PTs looking for a new challenge would be to learn about IONM and shadow a few cases to see if it is a good fit for you. Currently, it is much easier for a physical therapist to enter the field of surgical neurophysiology. There are excellent education programs like Center for Electroneurodiagnostics (CEN), which offers hands-on training in the OR. These initiatives provide opportunities that didn’t exist even just a few years ago. For PTs that don’t want to give up on their traditional clinical practice, remember, it doesn’t have to be an all or none proposition. PTs have the option of working part-time in the clinic and part-time in the OR.

However, this advice is not just limited to PTs.The IONM field has an unusual mix of clinicians from across the medical spectrum. Neurologists and other MDs from many specialties, audiologists, chiropractors, and many other degreed individuals in healthcare have come together to provide the rich foundation that we see in the field today. If you find yourself needing a new change of challenge, please feel free to reach out to me. I would love to share the meaning I’ve found in IONM, and discuss the amazing opportunities that are open to anyone who has an interest.

Craig Crookston
Director of Clinical Program Development
ccrookst[email protected]

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What It’s Like to Be Part of the Surgical Team

I have been a surgical neurophysiologist for six years, and during those six years, I have had many challenging experiences. I’m sure most SNP’s can attest to the fact that our jobs can be stressful and challenging at times but also very rewarding. This is one of those times.

Over the past several months, the world has changed drastically. Routine daily work life is no longer routine. Our everyday experiences with simple tasks such as getting into hospitals, communication with patients, and normal physical attire have become very different. For example, before COVID-19, we could easily get into the hospital, walk through a busy lobby, and enter the OR without issue. Now, appropriate PPE is a requirement for interacting with patients. Entry necessitates a series of steps, including temperature checks and more.

Everyone’s mood and energy are different too, but that is expected during a crisis of this magnitude. Several months ago during the height of Covid in the Greater NY area, most operating rooms and pre-op areas that were once super busy with multiple cases a day became ghost towns with few patients and staff. Most patients couldn’t even have visitors due to heightened risk and current restrictions. Patients, staff, surgeons, and vendors were all reminded of the risks every time a coworker fell ill or turned on the news.

Despite all the new challenges,  I am proud of my job,  my company and the surgeons/hospitals with whom I work. Everyone has everyone else’s safety in mind. We make sure to use proper sanitizing techniques and anesthesiologists and CRNAs (certified registered nurse anesthetists) make sure everyone is far away from the patient during intubation and extubation. We all work together as a team to provide optimal care and to make sure we all leave the hospital as safe as possible. So, even though COVID-19 has caused many difficulties in our everyday lives, it has also created a stronger, more collaborative environment for those working to ensure positive patient outcomes, and for that, I am truly grateful.

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Career Comparison: EEG vs. IONM

Intraoperative Neurophysiologic Monitoring (IONM) uses a variety of tests such as EEGs to detect potential injuries to a patient’s nervous system in real-time while undergoing surgical procedures. IONM is typically used during orthopedic spine and neurosurgical procedures but is also used during vascular, ENT, and other surgeries where the nervous system is at risk, while EEGs are not exclusively used during operations. In contrast, EEG tests are often used to detect brain abnormalities or disorders and other nerve function issues throughout the body outside of surgeries.

Whether you specialize in IONM or EEG, you can make a difference in people’s lives. Having studied and worked in both areas, I can confirm that while there’s a fair amount of overlap between the two, there are also big differences, and they’re not what you might think.

As an EEG technologist who became a Surgical Neurophysiologist, here is my take on what’s exciting about IONM:

1. The career opportunities are endless.
Studies show that the use of IONM has grown 267% in recent years. Surgeons graduating from medical school are now exposed to IONM during their residency programs and consider it standard of care. As they obtain positions at hospitals throughout the United States, they will be requesting the service and driving the need for skilled clinicians.

2. Meaningful relationships lead to development and fulfillment.
In IONM and EEG work alike, great relationships are made, but I’ve made a wider variety of more meaningful relationships in IONM. From the start of surgery, you will be communicating directly with the patient to obtain their health history so that you can make informed decisions about how to perform testing best. You will converse with Biomedical Engineering, OR managers, nurses, and hospital staff regarding equipment safety and set-up. You will speak with the surgeon about the types of monitoring he/she will require anesthesia for and how best to collaborate so that you can gather optimal signals. The professional relationships you forge with hospital and facility staff members allows for both professional and personal development.

3. You gain exposure to diverse types of surgical procedures.
It is not atypical for EEG technologists to monitor the same types of cases on the regular. With IONM, you can perform monitoring during a vast array of surgical cases performed by a wide variety of surgeons who use neuromonitoring techniques to help reduce adverse surgical outcomes.

4. Advanced challenges require an advanced skill set.
IONM clinicians are required to have an advanced understanding of anatomy and physiology. They must have knowledge and experience in performing not only EEGs (brain activity) but also very specialized modalities that monitor the central nervous system such as SSEPs, MEPs, BAERs, cranial nerve monitoring, and language mapping.

5. You make real-time decisions in a fast-paced environment.
IONM allows you to be an integral part of the fast-paced operating room environment.Unlike in typical EEG cases, where post-test results are passed on to a physician for interpretation, diagnoses, and recommendations, IONM clinicians communicate directly with a remote supervising physician throughout the surgical procedure to discuss alerts and troubleshoot issues.

6. You are the voice for patients who can’t speak for themselves.
While under anesthesia, a patient has no means of indicating that they have lost motor or sensory function. The data you collect makes it possible to detect potential problems before they arise so that the surgical team can make informed decisions to keep patients safe. The ability to be there for people when they need it most is something uniquely fulfilling that you can’t gain from many other lines of work outside of IONM.

Lisa Tapsell, R.E.T, R. EEG. T, CLTM, Surgical Neurophysiologist

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Gear Up for the Future

If you are like many during this unprecedented period, you are hunkered down at home, wondering what the future will hold for you, your family, and your career. However, if there is one thing that previous crises have all told us, we will overcome this trying time, and we will have learned some valuable lessons from it and throughout it. While we shelter in place, now is the time to challenge ourselves to grow, to plan ahead, and to find all the hope we can.

To come out from this crisis feeling both fulfilled and secure, ask yourself– What do you value? Does what you do align who you are? What unique qualities and skills do you have that you can use or improve? When we move past this pandemic, what will be your next steps? What opportunities can you make for yourself, and how will you emerge? 

If you’ve been watching the news, one career opportunity should be more than evident– there’s an unprecedented need for healthcare workers. On Tuesday, March 24th, Governor Mario Cuomo stated that as we head towards flattening the curve in New York state, he is willing to send clinical workers to assist with efforts in other areas of the country where the virus infection rates have increased. 

With a moratorium on elective surgeries, from the Centers for Medicare and Medicaid Services (CMS), surgeons and hospitals anticipate a backlog of procedures as the outbreak subsides. Now, given the 267% increase in the use of Intraoperative Neuromonitoring (IONM), and over 800,000 spine surgeries performed each year, there was already a shortage of skilled surgical neurophysiologists, despite the manageable requirements.

Surgical neurophysiologists– also known as neuromonitorists or intraoperative neuromonitoring (IONM) clinicians– speak for patients who cannot speak for themselves. It’s a role that’s both financially and emotionally rewarding. Working in tandem with the surgical team while patients are under anesthesia, they perform tests that provide surgeons with additional information about the functionality of the neuromuscular system. It’s their duty to ensure that patients awake safely.

As elective orthopedic neurosurgeries begin to ramp up again, Surgical neurophysiologists will be in high demand. For anyone who finds themselves struggling to figure out their future and find fulfillment right now, there are comprehensive IONM education and training options out there that can bring work and purpose into your world. While no single choice is for everyone, IONM is one way to forge a future for yourself and make a difference in people’s lives at the same time. Whether or not IONM is the path that’s right for you, as history shows and time has already told, there will be plenty of lights at the end of this tunnel, we will overcome the uncertainty we face, and we will each find our own way forward. 

https://www.cms.gov/newsroom/press-releases/cms-releases-recommendations-adult-elective-surgeries-non-essential-medical-surgical-and-dental

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You: The Future of Healthcare

Are you a people person? Do you like technology? Are you looking for a challenging, rewarding career in a fast-growing industry?

The Center for Electroneurodiagnostics (CEN) can help you launch a career as a surgical neurophysiologist. Working as part of a clinical team, these professionals work in the in-demand field of intraoperative neurophysiological monitoring, a state-of-the-art practice that protects an anesthetized patient’s neuromuscular system during surgery.

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    The Most Interesting Man in IONM

    Right. Left. Right. The third baseman sprints across the field in an effort to outrun a 90-mile-per-hour ball. A waiter swiftly makes his way around the tables in a crowded restaurant to deliver another long-awaited check. Another FedEx package arrives on time after a journey many never come to think about. An Uber turns around the corner to drop off another satisfied customer in another part of the world. A man reluctantly schedules a trip to a military recruitment office, ready for his life to take yet another turn. The baseball player, restaurant employee, delivery person, taxi driver, and potential recruit are all the same man— Robert Anderson.

    With at least five different careers to date, he is living evidence that the road to success is far from easy or obvious. It’s filled with options, but not always full of fulfillment. However, it is never too late to make a change. Rob’s advice to the world is to pursue every interest no matter the stage of your career. Whether it be left, right, straight, or backward, go whichever way your heart desires. It was this philosophy that first drew Rob to the military, but it was also this philosophy that prevented him from ever making the trip. 

    Before life took him in a different direction, Robert Anderson’s first dream was to work in healthcare. Although he worked with Uber, FedEx, in the foodservice industry, and even as a professional baseball player overseas, Rob originally studied Health Science and Exercise & Fitness. A real “people person,” he explored his options for patient work early on, but quickly concluded that none were sensible for him, in terms of time commitment and finances. Thankfully, he had other paths to pursue.

    Rob learned a lot from his many jobs, but none were quite right for him. While he loved the sport, he felt playing baseball wasn’t giving as much to fans as he wished he could. Although Rob enjoyed meeting different people in restaurants, Ubers, and at their doors, he felt he always could do more. Rob wanted to serve people in a bigger way than he had before. That’s why the navy appealed to him on some level. However, on the fateful week of his appointment, instead of finding a job in the military, he found Stephanie. 

    The morning before his life-changing decision, the two old friends bumped into each other, by coincidence. As they caught up, Robert explained to Stephanie that he always wanted to help people, but medical school wasn’t an option. He went on to tell her what he planned to do the next day, and she responded that he would do no such thing. She told him about a patient care option he never heard of— one that she chose as her own profession— IONM. Stephanie recommended CEN’s program. Rob skipped his appointment. And now, his career-shuffling days are over. 

    Today, Rob is finally able to give people the care he always wished to, as a Surgical Neurophysiologist. Over his many different careers, he has received much appreciation from fans and customers alike. But he proudly says that none compare to the gratitude he receives from patients daily. Working in IONM, Rob also gets to meet different patients and connect with other healthcare professionals who share his passion. He takes great pleasure in putting people at ease in the moments before their surgery, and he takes even greater pride in keeping them safe. After a long, exciting road with many turns, Rob finally found a career in which he is happy to stay. So, whether it be left, right, straight, or backward, go whichever way your heart desires until you find your IONM.

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