"MD ANES" listed below "Non-ICU MD" in Society of Critical Care Medicine's U.S. ICU resource Availability for COVID-19 Report. WTF

[cocopuff]

Infographic says it all........

SCCM | United States Resource Availability for COVID-19

With the onset of COVID-19, and the strong possibility of large percentages of the U.S. population being admitted to the hospital and intensive care unit (ICU), the Society of Critical Care Medicine (SCCM) has updated its statistics on critical care resources available in the United States.

sccm.org

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[Ronin786]

It's specifically for ventilator management.

 

[Modanq]

Reach out to Neil Halpern who has his name at the bottom of the link listed at mskcc. It the only way to make a change.

 

[drmwvr]

Weird...The US has the highest per capita CC beds in the world...I thought our system was a dumpster fire that could take some learning from the UK (7th) and everyone else...huh...weird....

 

[abolt18]

This kind of stuff just surprises me, because by the time I finish my residency I will have spent 5-6 months doing ICU (mostly CVICU w ECMO and mucho ARDS, VADS etc., Some Neuro, some SICU) and I feel like I could definitely take that position at the top of that pyramid, but I guess not all residencies are the same.

 

[deleted171991]

There is no mistake there. It's a great model, potentially doable as long as the intensivists don't waste time writing notes, and anesthesiologists manage just vents, not patients (little liability).

 

[Ronin786]

Another point to think about, RTs have no idea how to use anesthesia machines as vents if that were to be the case. Many of them don't know how to set up ICU ventilators outside of the basics (not bashing RTs, a good one is worth their weight in gold. They're just a rare resource that doesn't get appropriate training/education).

 

[MoMoGesiologist]

So MDA is equivalent to CRNA is equivalent to RT, and all are less than non ICU MD. WTH is this!?

 

[deleted171991]

So MDA is equivalent to CRNA is equivalent to RT, and all are less than non ICU MD. WTH is this!?

It's a pyramid.

Intensivists manage multiple teams. Each team is run by a non-intensivist MD (my guess, hospitalist), helped with vent management by RT/CRNA/Anesthesiologist (whoever is available), and by advanced practice providers. It's pretty much the coverage model in many ICU fellowships, except it's with residents/interns/APPs instead of non-ICU MD/APP. Anesthesia is for vent management, coupled with non-intensivists who have no idea how to do that.

As long as the intensivist is king, I LOVE IT.

 

[GravelRider]

Seems fine to me. I imagine in an “all hands on deck” situation that I would be doing a lot of monkey skills like intubations, lines, and setting up drips. There’ll still be need for anesthesia, though, because hips will get broken and bowels will get obstructed.

To be fair, I would trust my old internist-self more than my current anesthesiologist-self when it comes to quarterbacking an ICU team.

 

[dannyboy1]

Seems fine to me. I imagine in an “all hands on deck” situation that I would be doing a lot of monkey skills like intubations, lines, and setting up drips. There’ll still be need for anesthesia, though, because hips will get broken and bowels will get obstructed.

To be fair, I would trust my old internist-self more than my current anesthesiologist-self when it comes to quarterbacking an ICU team.

Agreed. We are great at procedures and stabilizing, but we have very little clue what to do after that. (At least I don’t ). I barely remember how to do the routine ICU stuff (GI/DVT prophylaxis, abx management, tube feeds, etc.) To say nothing about the complex stuff.

 

[nimbus]

I know my limits. I’d prefer to play the role of a resident with an actual intensivist supervising me.

 

[dhb]

As long as the intensivist is king, I LOVE IT.

I don't they need a graph to believe it.

Show we where the coffee machine is i'll take charge of that

 

[chocomorsel]

I don't they need a graph to believe it.

Show we where the coffee machine is i'll take charge of that

Question. Do you work in the ICU? Do all European Anesthesiologists?

 

[dhb]

Question. Do you work in the ICU? Do all European Anesthesiologists?

No, depends on the countries: in Belgium you need to do 1 more year of residency to be certified for ICU (to bring the total to 6y as the internists) and then practice at least 50% of your time in the ICU (so very uncommon to be doing both), in France there is still a big involvement of anesthesiologists in the ICU, don't know for sure in the other countries.

 

[Consigliere]

So MDA is equivalent to CRNA is equivalent to RT, and all are less than non ICU MD. WTH is this!?

Reality

 

[Choo]

Anesthesiologists are non-ICU MD. They didn’t differentiate between Anesthesiologists and Internists at that level - only at the level of vent management. It’s not that hard to prescribe colace.

 

[JiPo]

Agreed. We are great at procedures and stabilizing, but we have very little clue what to do after that. (At least I don’t ). I barely remember how to do the routine ICU stuff (GI/DVT prophylaxis, abx management, tube feeds, etc.) To say nothing about the complex stuff.

So you think orthopods are better than you at managing patients overall? All those you mentioned can be refamiliarized with 1-2 days of review before you start your shift, and will come to you very easily as long as you have medical foundation, which we all have. I find this SCCM guideline very offensive and shows lack of respect to anesthesiologists. Even our colleagues consider us mid-levels.

 

[deleted171991]

So you think orthopods are better than you at managing patients overall? All those you mentioned can be refamiliarized with 1-2 days of review before you start your shift, and will come to you very easily as long as you have medical foundation, which we all have. I find this SCCM guideline very offensive and shows lack of respect to anesthesiologists. Even our colleagues consider us mid-levels.

And that's the sound of a grasshopper being crushed by real life.

 

[MoMoGesiologist]

If you look at all the non-US medical stories, guidance coming out re COVID, it’s all being led by anesthesiologists (because outside US, anesthesiologists run ICU and are hospital leaders). Hopefully we can regain some respect in America by having our European colleagues vouch for us!

 

[deleted697127]

And that's the sound of a grasshopper being crushed by real life.

President Trump Meeting with Nurses on Coronavirus Response

President Trump met with the heads of nurses organizations to discuss the coronavirus pandemic and the government's response.

www.c-span.org

On a separate note, trump met with the heads of major nursing organizations yesterday at his press conference. Start the video at 3 min to hear their intros. I would be surprised if the agenda for emergency independent practice isnt getting pushed through as we speak.

I don’t know what the right answer is for who should be at the head of that graphic but i think it is largely irrelevant. The surgeons i work with aren’t exactly pushing us out of the way to be involved with caring for corona patients. To be honest, if this is as bad as it might be, we will likely need anyone willing to work.

 

[turnupthegas]

It's weird to specify us out of all of it. I mean ortho? psych? pmr? radiology? ob-gyn? Have you seen them in a code or have asked them a basic question. We're routinely doing critical care on a daily basis at pace and have done more ICU than most fields. Offensive. Whatever. Maybe they assume were in the OR.


(waiting for FFP's response on how were useless)

 

[turnupthegas]

They fixed it.

 

[anbuitachi]

i dont quite understand this pyramid. in this situation, anesthesiologist only manage vent and nothing else? doesnt make sense. dont even understand how this is a pyramid. is this pyramid representing a hierarchy?

if pathologist (non ICU MD) is one level above us, anesthesiologists, does that mean in this model, if pathologist tells us to clean the patients butt, we have to do it? or can we say screw you, we only manage vents?

 

[anbuitachi]

They fixed it.

how did this mess this up in the first place.

 

[deleted171991]

It's weird to specify us out of all of it. I mean ortho? psych? pmr? radiology? ob-gyn? Have you seen them in a code or have asked them a basic question. We're routinely doing critical care on a daily basis at pace and have done more ICU than most fields. Offensive. Whatever. Maybe they assume were in the OR.


(waiting for FFP's response on how were useless)

We are specified out for vent management. Besides intensivists and RT, there is nobody who knows vents like anesthesia providers.

A lot of other doctors can play resident/fellow to the intensivist, but no other specialty can help manage the vents in a disease where 5-10% will end up intubated.

Btw, this discussion is moot. They have honored our request and written MD/DO in the figure.

 

[chocomorsel]

If you look at all the non-US medical stories, guidance coming out re COVID, it’s all being led by anesthesiologists (because outside US, anesthesiologists run ICU and are hospital leaders). Hopefully we can regain some respect in America by having our European colleagues vouch for us!
[/QUOTE
Is this a joke? How many anesthesiologists do you know actually like the unit?

 

[chocomorsel]

Wait, based on the latest pyramid, seems like Anesthesiologists be “Non ICU MD” label.

But based on the first pyramid, it is insulting to put us all with the CRNAs and RTs and not with the “Non ICU MDs”.

I still don’t understand it though.

 

[vector2]

We are specified out for vent management. Besides intensivists and RT, there is nobody who knows vents like anesthesia providers.

A lot of other doctors can play resident/fellow to the intensivist, but no other specialty can help manage the vents in a disease where 5-10% will end up intubated.

Btw, this discussion is moot. They have honored our request and written MD/DO in the figure.

To be fair though, how many anesthesiologists work in tertiary/quaternary centers? And of those how many actually take ICU patients with sick lungs to surgery with any regularity? And of those how many put much thought into a ventilation strategy esp if there is no need to change the settings from whatever they were on in the ICU?

Personally, I know at least 2 dinosaur anesthesiologists who still use 100% Fi and 9-10cc/kg Vt all the time....

 

[anbuitachi]

To be fair though, how many anesthesiologists work in tertiary/quaternary centers? And of those how many actually take ICU patients with sick lungs to surgery with any regularity? And of those how many put much thought into a ventilation strategy esp if there is no need to change the settings from whatever they were on in the ICU?

Personally, I know at least 2 dinosaur anesthesiologists who still use 100% Fi and 9-10cc/kg Vt all the time....

i dont think people are saying anesthesiologists should be at the top next to the intensivist. but there should be no reason to put anesthesiologist underneath other MDs like pathologists/pmr/radiologists etc, bc they have less icu experience than i do.

overall i think the pyramid model is very confusing. even with the revision im not sure how it works.

 

[vector2]

i dont think people are saying anesthesiologists should be at the top next to the intensivist. but there should be no reason to put anesthesiologist underneath other MDs like pathologists/pmr/radiologists etc, bc they have less icu experience than i do.

overall i think the pyramid model is very confusing. even with the revision im not sure how it works.

That pyramid even after the revision is quite confusing...

 

[WholeLottaGame7]

We are specified out for vent management. Besides intensivists and RT, there is nobody who knows vents like anesthesia providers.

A lot of other doctors can play resident/fellow to the intensivist, but no other specialty can help manage the vents in a disease where 5-10% will end up intubated.

Btw, this discussion is moot. They have honored our request and written MD/DO in the figure.

You're giving RT a lot of credit. Yours must be better than the ones at any of the places I've been to.

 

[MoMoGesiologist]

You're giving RT a lot of credit. Yours must be better than the ones at any of the places I've been to.

Outside of tertiary care specialty centers with specialized RTs, RTs are dum-dums. Basically techs who can only set what an intern tells them to do.

 

[turnupthegas]

Our RT's are *****s that don't keep quiet.

 

[Urzuz]

Personally, I know at least 2 dinosaur anesthesiologists who still use 100% Fi and 9-10cc/kg Vt all the time....

Not to derail the thread, but I routinely ventilate patients for routine surgery at an FiO2 of 1.0. The way I figure it, the risk of serious morbidity associated with a potential airway complication (inadvertent extubation, aspiration, etc) is significantly higher than the potential morbidity associated with atelectasis, oxygen toxicity, etc. Obviously comorbidities like ARDS, ILD, etc will change how I manage patients, but for routine cases on relatively normal patients I use an Fi of 1.0.

Now on the other hand, 9-10 cc/kg Vt is obscene...

 

[Planktonmd]

I would prefer to be classified with those who can work from home

 

[deleted171991]

I would prefer to be classified with those who can work from home

Break a leg!

Just wishing you the best.