May 1, 2017 | F. Ray Nickel, MD
All you know is that it hurts. Trying to figure out what’s causing it, whether or not it is serious, will it go away on its own and what options you have for treating it can drive you nuts, let alone trying to find the right doctor to see to give you that information. There are no easy answers to those questions. “It depends…” is an understandable but true refrain. That being said, there are some general guidelines that may provide some clarity to the process. They are provided here with that intent but are not ordered in any particular priority.
1. You don’t need a referral to be seen by an orthopedic surgeon. Many doctors throughout Ventura County refer their patients to Ventura Orthopedics and we are happy to be the doctors to whom other doctors send their patients. We are just as happy to be the first doctor that you see for a musculoskeletal problem. On the plus side, your family doctor knows you and your medical history, current medications, etc. and is able to direct your diagnostic studies and treatment within that context. Conversely, we have much greater depth of training in terms of treating musculoskeletal problems and can perhaps save you some time and treatment expenses because of that depth. We are happy to assist you in either situation.
2. We are orthopedic surgeons but surgery is not our only, nor even necessarily our most preferred treatment. We are justifiably proud of our craftsmanship. Our doctors come from some of the finest surgical training programs in the United States. We are proud of our history of providing the newest and best surgical treatments for our patients. We have been the surgeons on some of the “first time this procedure was ever done in this county” occasions. However, and this is a big however, the reality is that only one out of three new patients who visit Ventura Orthopedics will end up having surgery. Even that number is inflated for two reasons. The first being there are a number of patients who are referred to us specifically for surgery because of the nature of their injury. The second is that many of those patients who wind up having surgery do so only after having completed a fairly lengthy nonsurgical treatment course. Therefore, the likelihood that surgery is going to be the initial recommended course of treatment is fairly low, although, occasionally it is the most appropriate conservative option. We are deeply committed to educating you regarding your diagnosis and treatment options and will work with you regarding the most appropriate course. If surgery is the best option, you can be confident that we will execute it well.
3. No matter which doctor you start with within Ventura Orthopedics, you are getting a specialist. Almost all of us have completed a five year, 80+ hours per week residency program with training across the breadth of orthopedics. The others have completed similar rigorous training programs in plastic surgery, anesthesiology and other disciplines which are complementary to orthopedics. All of us are board-certified, meaning that we participate in ongoing medical education as well as take a test periodically which measures our knowledge of the current state of the art of musculoskeletal care. Our schedulers will try to guide you to the most appropriate person for your problem, but if it turns out that the only time you have available for an appointment is with a doctor that you question is a specialist for that problem, you are still going to get very good care. If it turns out that your problem is very unique, you may eventually be referred to somebody who is more specialized within a particular area within orthopedics. It’s all about you, the patient. We will do our best to try to balance the urgency of your problem, your schedule limitations and the availability of our doctors to provide the best care for you.
4. Every doctor within Ventura Orthopedics sub-specializes, especially in the surgical procedures they perform. The historical trend within medicine to increasingly specialize mirrors the explosion of knowledge. Orthopedic surgery arose from general surgery in the late 1920s. Hand surgery developed as a specialty in response to the injuries to our veterans in World War II. Other subspecialty areas developed in the 70s and 80s. Specific training in these areas has in the recent decades been structured as a fellowship year which is usually an additional year of training which focuses on that one area after five years of broad orthopedic residency training. (Some have joked that if this trend continues, you’re going to end up with right thumb surgeons and left thumb surgeons!) Many of our doctors have completed such fellowship training. Some have additionally completed special testing programs called certificate of additional qualifications -- or CAQs -- in hand surgery or sports medicine. Some finished their training before such fellowship programs were widely available but have focused their practice within a more limited scope for a long time. There is so much information being made available that no one person can keep up with it all. We have attempted to provide a list as a general guide regarding which of our doctors have completed fellowships, CAQs and their areas of expertise but it is a general guide. Once again, our schedulers will work with you to schedule you to the one who seems to be the best for your problem. We are committed to guiding you through the world of orthopedics and, if it turns out that your shoulder problem is really a neck problem, then you may be eventually referred to the neck doctor, especially if it appears that you will need to have surgery.
5. One of the biggest advantages of a group like Ventura Orthopedics is the ability to collaborate. It would be incorrect to imply that every patient for every visit is discussed with another doctor. That would be inappropriate because common things are common and usually fairly straightforward. On the other hand, discussion of a patient’s symptoms, MRI scan findings, etc. occurs not infrequently between physicians when a patient’s condition does not appear to be straightforward or responding appropriately to treatment. Finding a fellow physician who has special experience within a specific area is as simple as walking down the hall or picking up the phone. We have invested in digital x-rays and medical records to make sure the exchange of information is easy and real time.
6. Our physician assistants, physical therapists and other clinical staff are colleagues, not simply employees. They possess various levels of training and expertise and provide different perspectives. For the physical therapists, two-way communication with the doctors of Ventura Orthopedics happens regularly when clarification or adjustments need to be made in the treatment plan. Similarly, if the doctor that is the most appropriate for your problem is not available because of his or her surgical schedule, meeting schedule, etc., you may be scheduled initially to see the physician assistant that works closely with them to get the initial evaluation and treatment started. In either situation, you will be in good hands with our professionals.
7. The office charges for visiting your primary care physician or an orthopedic specialist are usually the same, although some insurance plans have specific restrictions. Our experience is that it is not easy to know which doctors are covered by their plans. Sometimes their websites lag behind adding new information. If you do not know whether Ventura Orthopedics is on your plan, call us. We will be happy to help you know whether you can see us.