No-Needle No-Scalpel Vasectomy (NNNSV) Training for Physicians
by Dr. Doug Stein

Having dedicated my practice to vasectomy and office-based vasectomy reversal since 1999, not to mention having had a pretty brisk vasectomy and reversal practice when I was still seeing new general urology patients prior to 1999, I have gotten pretty good at those procedures. What surprises me is the fact that I feel more comfortable with vasectomy this year after 20,000 procedures than I did last year after 18,000 procedures. While no-one can understate the value of practice (after reading the book and watching the videos), there may also be value in hands-on training with someone who has already had a lot of practice, subtle things like patient relaxation and the nuances of hand and finger position.

Because 40% of American pregnancies are unintended, and because many of these occur within couples who are perfectly content with the number of children that they already have, and because other forms of contraception fail so frequently, and because vasectomy fails so infrequently, and because I hate to see the environment degraded by suburban sprawl and habitat loss due to never-ending population growth, I am an enthusiastic promoter of vasectomy. I would like to see the reputation of vasectomy (as an almost painless and simple procedure) soar to the extent that more men who feel they have enough children get vasectomies before they cause unintended pregnancies rather than after. By sharing what I have learned with present and future vasectomists, so that patients rave about the simplicity of their vasectomies, perhaps that goal will be achieved.

So I offer NNNSV training (for some we will call it "refinement") at my Tampa office. Here is how:

1. When you, the practitioner/trainee, decide that you want training, you contact me know by telephone or e-mail (via my Contact Us page). Then, by phone or e-mail, we decide on a date that works well for both of us.

2. I recruit patients for the training day. A link on the homepage of my website http://www.vasweb.com conveys an offer for vasectomies at $100 or $200 or 50% off the usual fee on that date (we increase the amount off as the day approaches if needed to recruit enough patients). Clicking the link (there could be one there now if anyone has scheduled a training day) brings up the page that explains the arrangement ... something like this:

Note: On Thursday, June XX, 2008 at his Tampa office, Dr. Stein will host a training day for Dr. John Doe, a [Specialty Resident] [Urologist] [Family Doctor] in Hometown, State or Country. Dr. Doe would like to learn to perform vasectomies in order to be able to provide the service for [his own patients] [a local Planned Parenthood clinic which serves men of all income levels] [his county health department] in the Hometown area. Observation is helpful, but there is no substitute for "hands-on" training. Vasectomies performed while Dr. Stein trains another physician usually will take about 30 minutes, whereas Dr. Stein's routine vasectomy procedure takes 10-15 minutes. So we are looking for men with patience and a desire to save $100.00 (20%) off the usual vasectomy fee. Since Drs. Stein and Doe will work together on each patient, there should be no increased risk of either complications or pain, but there will be more manipulation of the vas tubes as Dr. Stein shows Dr. Doe how to position and access the vas on each side. Patients will hear Dr. Stein explain the procedure. Some hardy men will even be interested enough to lift up on their elbows and observe, which is always fine with Dr. Stein. Because of the reduced rate and the need for men who are not likely to postpone to a later date at the last minute (Dr. Doe cannot learn on men who don't show up), we ask for a non-refundable deposit of $100 at the time that June XX procedures are scheduled. Thank you.

The recruited patients know beforehand that they are training subjects. They are very cooperative and patient.

3. My usual vasectomy fee is $490 and although we schedule 4 per hour, we usually end up averaging about 3 per hour because of cancellations and no-shows. So over the course of a 4-hour morning or afternoon, I will do 12 procedures at $490 = $5880. If I am training, we perform 8 vasectomies in 4 hours at either $390 apiece = $3120, or if we have to drop to 50% of the usual fee to fill the training spots, $245 apiece = $1960. So there is a potential income loss of ~$4000. I say "potential" because some insured patients will choose a training day for altruistic reasons and we will get the full fee from the insurance company. So the trainee is charged $250 per hands-on training case. This fee, payable by check or Visa/MasterCard, is due within one week of scheduling the training day, and it is not refundable after a date 2 weeks before the training day.

4. If you choose, you may order a MadaJet and at least one set of instruments (the "Vasectomy Pak") from AMI for $999.00 and have it shipped to my office before the training day, so that you do not have to carry them on an airplane. That way we can use your own MadaJet and instruments so that you are totally familiar with their preparation and function. You may then return home with them or we will mail them to your home office if you are traveling to Tampa by air with just carry-on luggage.

With proper handling, sterile storage, and periodic (once or twice a year) maintenance by the manufacturer, a MadaJet provides wonderful service . Filled with your choice of anesthetic, a MadaJet can be used for ~5 patients before a refill (accomplished in ~30 seconds) is needed. And the same MadaJet can be used for as many cases as you have in a single day (I have performed as many as 31 vasectomies in a single day with one MadaJet). But after each day, the MadaJet should be emptied and sterilized by autoclave before the next day's use. So a MadaJet is most beneficial for a series of vasectomies and much easier to prepare than a whole bunch of pre-filled sterile syringes. But if you have just one case on a certain day, a needle and syringe are easier. So if you are using a MadaJet, plan to group your vasectomies on a certain day. And if you do that, perhaps you should have more than one set of NSV instruments, all sterilized and individually packaged, for "Vasectomy Days". I own 80 sets because I perform vasectomies at different "outfield" sites, sometimes during 3 consecutive days, during which I cannot re-sterilize my sets. I suggest that a vasectomist own at least 3 sets, perhaps more depending on your patient load and availability of staff to re-sterilize instruments while you work.

6. Before a hands-on session, a trainee usually finds it helpful to watch me perform a few vasectomies at my normal pace in order to appreciate the nice rhythm that develops in the course of doing a series of vasectomies. You may bring your digital or video camera and take photos of my office setup and of the procedures of men who provide permission. You are welcome to take samples of my brochures, consent form, op report, and patient instruction sheets.

7. If my staff forgets to ask, please let us know your surgical glove size so that we may have them available on your training day. I wear size 7. If that is your size, we will have no need to make a special order.

To discuss training, please call my office at 813-972-1365 any weekday or my cell phone at 813-390-3032 any evening until 9:30 PM Eastern Time. If you would like to discuss the training process with a former trainee, please request a trainee referral list via our Contact Us page.

Thank you.