Virginia iSpine Physicians, PC is committed to training fellows in the diagnosis and treatment of a wide array of painful spine and musculoskeletal disorders. Fellows learn to effectively treat patients and to develop an efficient and productive clinical practice optimizing their marketability. We focus on teaching fellows how to: maximize their clinical acumen and decision-making pathways; become competent in fluoroscopically guided spine and musculoskeletal procedures; read and interpret diagnostic imaging studies; perform astute electrodiagnostic evaluations; and recognize indications for referring to surgical colleagues. Prior ViSP fellows have successfully secured practice opportunities across the country with highly competitive compensation packages. Fellows may have an exciting opportunity to stay onboard with Virginia iSpine Physicians, which has a very strong local, regional, and national reputation, and benefit from their productivity.

Located in Richmond, VA, Virginia iSpine Physicians is the only private practice fellowship in Virginia and has a robust clinical research infrastructure. Fellows receive hands-on training in a variety of fluoroscopically guided cervical, thoracic, and lumbosacral procedures such as: epidurals, medial branch blocks/neurotomy, discography, intradiscal heating procedures, percutaneous discectomy, percutaneous augmentation, spinal cord stimulation, and cooled radiofrequency ablation. In addition, fellows are exposed to proper billing and coding, practice management, and the essentials to developing a successful interventional practice. We have an in-office procedure suite and also perform cases in a free-standing ASC as well as in a hospital based ASC. Additionally, fellows may attend national training workshops in neuromodulation and regenerative medicine.

Richmond, VA is a comfortable and affordable city in proximity to the beach and mountains, and offers ample top notch restaurants, shopping, outdoor activities, and sporting events. The Richmond restaurant scene boasts two James Beard Award semi-finalists in 2017 and has been recognized as having the most craft breweries and wineries per capita in the United States in 2016. Recently, Garden & Gun magazine named Richmond one of The South’s Best Food Towns, and Conde Nast Traveler magazine included Richmond as one the six best places to visit in November. The climate is inviting with a true, but manageable, 4 seasons.

Program Description:

Each fellow works under the direct one-to-one supervision of Dr. Michael DePalma. Fellows are given graded autonomy to independently work with patients and make decisions. A representative week consists of a balance of seeing patients, completing EMG/NCS’s, and performing fluoroscopically guided procedures. Fellows spend time in the procedure suite five half days per week. Our case mix is generally 75% spine and 25% peripheral musculoskeletal.

Two fellows are selected each year to complete the twelve-month curriculum. Although the start dates are somewhat flexible, one fellow will commence his or her training mid-summer while the second will start in early fall.

Scope of practice:

ViSP Fellows participate in the evaluation, diagnosis, and treatment of a wide range of spine and musculoskeletal disorders. In addition, Fellows participate as sub-investigators on various FDA regulated clinical trials. Thus, ViSP Fellows stay abreast of latest advances in technology and are ideally positioned to pursue innovative new treatments after graduating.

Fluoroscopically-guided procedures:

In total, 3200-3400 fluoroscopically-guided procedures are performed within the practice annually. Each Fellow gets hands-on training on at least 50% of these cases over the course of the year under close supervision.

At the completion of their year, Fellows are expected to be competent performing the following:

• Transforaminal epidural steroid injections/selective nerve root blocks: cervical, thoracic, and lumbosacral
• Medial Branch Blocks: cervical, thoracic, and lumbosacral
• Medial Branch Radiofrequency Ablation Neurotomy: cervical, thoracic, lumbosacral
• Sacroiliac intra-articular joint injections
• Hip intra-articular joint injections
• Bursa injections
• Provocation Discography: cervical, thoracic, and lumbosacral
• Analgesic Discography: lumbosacral
• Percutaneous Discectomy: lumbosacral
• Intradiscal heating procedures: lumbosacral
• Spinal cord stimulator trials
• Genicular nerve diagnostic blocks and cooled radiofrequency ablation neurotomy

Diagnostic evaluations:

• Electrodiagnostic evaluations – Fellows learn and develop evidence-based EMG/NCS electrodiagnostic skills throughout the fellowship and typically perform 8-10 EMG/NCS cases per week.
• Radiographic and Advanced imaging – Fellows learn how to read and interpret plain radiography, computed tomography, magnetic resonance imaging, and nuclear imaging. Additionally, fellows learn evidence based medicine regarding assessing imaging findings for clinical implications.

Research and education:

• Fellows participate in regular didactic sessions reviewing research publications and book chapters and learn the evidence behind our clinical pathways
• Fellows author or co-author research papers, review articles, or book chapters
• Fellows serve as sub-investigators on clinical research trials including: Percutaneous Image Guided Lumbar Decompression; Intradiscal Biologic/Stem Cell Technologies; Genicular Nerve Cooled Radiofrequency Ablation.
• As opportunities arise, Fellows participate in teaching medical students and/or visiting residents.
• ViSP encourages and supports fellows to participate in Neuromodulation procedural workshops and at times Regenerative Medicine workshops

“Working with Dr. DePalma has definitely prepared me well for practice. The hands-on experience and knowledge of current evidence-based interventional spine care are invaluable aspects of the training but so are the unique business and operational insights.”

Dan Kline, M.D., Former iSpine Fellow 2015-2016

Living in Richmond, VA:

Richmond has many of the amenities of a larger city and appeals to both singles and families. Richmond is one of the most popular culinary destinations in the country. Outdoor activities are abundant such as kayaking, hiking, golfing, water activities, boating, and biking. Popular attractions include world-class museums such as the Virginia Museum for Fine Arts, The Valentine, and VCU Institute for Contemporary Art.

Application Process:

Physicians who are in good standing in, or have graduated from, a clinical American Board of Medical Specialties (ABMS) residency in Physical Medicine and Rehabilitation are eligible to apply. Applicants must be ABPMR board certified or eligible and must have successfully completed USMLE Step 3 (or the COMLEX equivalent), in order to be considered. Please contact us directly via ispine.fellowship@vaispine.com.

We start accepting applications in March for the following year’s positions. To apply, please submit a letter of intent, personal statement, current CV, three (3) letters of recommendation, USMLE (or equivalent), $50 application fee and SAE scores to: ispine.fellowship@vaispine.com.

Selected candidates will be invited to interview. An interview visit is two days, which allows ample time for the candidate to interact with faculty and current fellows, and to observe our office and procedures.

In addition, we welcome PM&R residents to rotate with us on an externship rotation. If interested, please contact Dr. Michael DePalma at ispine.fellowship@vaispine.com.