A cave man can do it!

[Planktonmd]

Years and years in practice... and I always hoped this will change, but it doesn't seem to.
Everyone on the other side of the drape thinks that we are not doing anything and that they can do it better.
It seems that even the new generations of surgeons, nurses, other medical specialties, nurse practitioners, PAs, doctors in nursing, cleaning staff, patients, pharmacy technicians, and administrators are being taught that anesthesia does nothing!
So, if that's true, why are we still employed?
I mean if we just suck money from the system and do nothing why on earth would you hire us???
This is really a subject for debate... if the American healthcare system has determined that anesthesiologists are just an overpriced unnecessary commodity why the hell are we still employed???

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[nimbus]

 

[Mman]

because we keep patients safe and we keep ORs moving efficiently. It cannot be done as safely or as well without us. Period.

 

[anaesthetic]

Years and years in practice... and I always hoped this will change, but it doesn't seem to.
Everyone on the other side of the drape thinks that we are not doing anything and that they can do it better.
It seems that even the new generations of surgeons, nurses, other medical specialties, nurse practitioners, PAs, doctors in nursing, cleaning staff, patients, pharmacy technicians, and administrators are being taught that anesthesia does nothing!
So, if that's true, why are we still employed?
I mean if we just suck money from the system and do nothing why on earth would you hire us???
This is really a subject for debate... if the American healthcare system has determined that anesthesiologists are just an overpriced unnecessary commodity why the hell are we still employed???

Anesthesia is easy... until it's not. We do enough sick cases around here that there's never any doubt why we're there. That being said, I can't help but wonder what it would be like to trade this for an "easy" gig where the worst drama is that there's so much "nothing" going on that people think they can do my job.

 

[Dr. Rude]

Years and years in practice... and I always hoped this will change, but it doesn't seem to.
Everyone on the other side of the drape thinks that we are not doing anything and that they can do it better.
It seems that even the new generations of surgeons, nurses, other medical specialties, nurse practitioners, PAs, doctors in nursing, cleaning staff, patients, pharmacy technicians, and administrators are being taught that anesthesia does nothing!
So, if that's true, why are we still employed?
I mean if we just suck money from the system and do nothing why on earth would you hire us???
This is really a subject for debate... if the American healthcare system has determined that anesthesiologists are just an overpriced unnecessary commodity why the hell are we still employed???

Try saying something like: Yup. “Must be terrible for you. You surgeons work so much harder and we make as much or more in most cases. I can’t imagine your pain.”

 

[morri493]

Try saying something like: Yup. “Must be terrible for you. You surgeons work so much harder and we make as much or more in most cases. I can’t imagine your pain.”

This reminds me of something my father told me. He was a transplant surgeon, who was oddly pleased with my choice to go into anesthesia. But the first thing he told me was "just don't be one of those anesthesiologists that reads a book in the OR. I can't tell you how much that would piss me off. i remember doing a liver after being up all night, and I look over and its the 3rd anesthesiologist on the case, and hes sitting down reading a book! He just took a break, he's sitting down reading a novel, AND the son of a bitch made more than me!"

 

[Twiggidy]

I always tell these types that my side of the drapes is an open door and if want to come back here and do it feel free and I’ll go do something else. Now I don’t get this as much because most of my patients are pretty sick and even people in my own practice don’t want to take care of the patients my division deals with daily.

Basically everyone hates the anesthesiologist until they NEED the anesthesiologist. Our hospital knows our department keeps the ship sailing and it would’ve sunk long ago without us

 

[secretasianman]

Same reason why the plumber welds one piece of pipe and charges $500, but for some reason no one wants to buy a welding tool from Amazon and do it themselves. Also, no one really considers the high stakes, that the alternative to our success is usually death.

 

[dabears505]

What cases are the anesthesiologists making more than the surgeon? We may make more, but its because we are in the or 5 days compared to a surgeon who is there 2 days probably.

 

[anbuitachi]

What cases are the anesthesiologists making more than the surgeon? We may make more, but its because we are in the or 5 days compared to a surgeon who is there 2 days probably.

dont know about overall, but thats the case here. anesthesiologists here overall WORK more than surgeons, and have way less controllable schedule. we pretty work based on surgeons schedule except we dont know it in advanced and we dont control their schedule. surgeons here work about 2 days a week in OR (anesthesiologists work 5 minimum if not including weekend in house call). the other 3 days , surgeons are in clinic, which starts at 8-830 here. in the OR we get there at 630..., surgeon gets there at 7-715

 

[anbuitachi]

because we keep patients safe and we keep ORs moving efficiently. It cannot be done as safely or as well without us. Period.

except we cant be the only one saying and believing this. if government, admins, insurance, etc dont say it and dont believe it then its useless

 

[Dr. Rude]

What cases are the anesthesiologists making more than the surgeon? We may make more, but its because we are in the or 5 days compared to a surgeon who is there 2 days probably.

I was talking about annual income.

 

[chessknt]

What cases are the anesthesiologists making more than the surgeon? We may make more, but its because we are in the or 5 days compared to a surgeon who is there 2 days probably.

I'm almost certain that you guys make more than I do on ebus cases, especially if it is difficult to sample and takes over an hour since I get paid the same if I do a ****ty single pass biopsy or gold standard of care 7 pass biopsy because medical billing makes a ton of ****ing sense.

 

[GravelRider]

Stop being so slick all the time. The surgeons have no problem telling me “this is the toughest gallbladder I’ve had” for the third time in a single week. The best way to seem essential is to create unnecessary complexity.

 

[Twiggidy]

I'm almost certain that you guys make more than I do on ebus cases, especially if it is difficult to sample and takes over an hour since I get paid the same if I do a ****ty single pass biopsy or gold standard of care 7 pass biopsy because medical billing makes a ton of ****ing sense.

And that's where it depends what the pay structure is the practice uses. There are definitely some on here who get paid the same whether that ebus takes 10 hours or 10 minutes. While others will say "take all the time you need" depending on the case.

The moral is that even for surgeons, it pays, quite literally, to be with a be in a strong position of negotiation. Either being in a big group that can battle for reimbursement from insurance, or being in a specialty that's in demand. Certain surgical specialties don't grow on tree and they know who they are.

 

[secretasianman]

And that's where it depends what the pay structure is the practice uses. There are definitely some on here who get paid the same whether that ebus takes 10 hours or 10 minutes. While others will say "take all the time you need" depending on the case.

The moral is that even for surgeons, it pays, quite literally, to be with a be in a strong position of negotiation. Either being in a big group that can battle for reimbursement from insurance, or being in a specialty that's in demand. Certain surgical specialties don't grow on tree and they know who they are.

It boggles my mind why ortho and spine cases pay so much more than gen surg cases.

 

[chessknt]

And that's where it depends what the pay structure is the practice uses. There are definitely some on here who get paid the same whether that ebus takes 10 hours or 10 minutes. While others will say "take all the time you need" depending on the case.

The moral is that even for surgeons, it pays, quite literally, to be with a be in a strong position of negotiation. Either being in a big group that can battle for reimbursement from insurance, or being in a specialty that's in demand. Certain surgical specialties don't grow on tree and they know who they are.

From my end I make the same if I do a single pass in a single lymph node which is borderline malpractice because the sampling error would be so high as I do if I do 7 passes in 2 different nodes which, depending on the tech experience, takes an extra 30 minutes easily. 30 minutes of my time for free to make sure I do a good job. At least anesthesia billing is always by time, even if you don't see that money someone does. Speed alone dictates pay in procedures.

 

[secretasianman]

From my end I make the same if I do a single pass in a single lymph node which is borderline malpractice because the sampling error would be so high as I do if I do 7 passes in 2 different nodes which, depending on the tech experience, takes an extra 30 minutes easily. 30 minutes of my time for free to make sure I do a good job. At least anesthesia billing is always by time, even if you don't see that money someone does. Speed alone dictates pay in procedures.

Time x Medicaid or self pay = negative ev

 

[chessknt]

Time x Medicaid or self pay = negative ev

Isn't any better on the procedure side except for the super subspec surgeons whose predecessors managed to scam their way with the AMA in to high rvu per time procedures like joints. A single TKA bills the same as 5 hours of critical care and is rarely more than 2 hours, I think average time has to be around 1 hour for experienced surgeons. Absolutely surreal.

 

[Twiggidy]

It boggles my mind why ortho and spine cases pay so much more than gen surg cases.

I mean, if you listen to Dr. Death, you'd know that it doesn't take much to mess up someone's spine. I think Neuro surgeons deserve every dollar they get reimbursed. I think all surgeons and proceduralists are reimbursed pretty well, it's just the largest factor is what insurance they carry or whether they work for a large group or not.

 

[Robotic Wis-Hipple]

It boggles my mind why ortho and spine cases pay so much more than gen surg cases.

Because every case gets an excel spreadsheet of hardware purchases that the hospital gets a cut of and typically it’s a higher proportion of private payors.

I did a rib plating just the other day where the rep was saying every single screw is like $75.

There is absolutely no congruence between difficulty of case, duration of case, good it does for the patient, and reimbursement. I mean compare the endo day or knee/shoulder room of cases to your cardiac or vascular room…..

 

[Robotic Wis-Hipple]

From my end I make the same if I do a single pass in a single lymph node which is borderline malpractice because the sampling error would be so high as I do if I do 7 passes in 2 different nodes which, depending on the tech experience, takes an extra 30 minutes easily. 30 minutes of my time for free to make sure I do a good job. At least anesthesia billing is always by time, even if you don't see that money someone does. Speed alone dictates pay in procedures.

Yet surgeons are tripping over themselves to think up ways to use the damn robot and add an hour to cases. I mean, they do robot bronchs….

 

[GravelRider]

Yet surgeons are tripping over themselves to think up ways to use the damn robot and add an hour to cases. I mean, they do robot bronchs….

No one has come clean with me about the robot economics. I can only assume there are higher facility fees or procedure reimbursements for robotic everything?

 

[Robotic Wis-Hipple]

No one has come clean with me about the robot economics. I can only assume there are higher facility fees or procedure reimbursements for robotic everything?

Oh that’s gotta be the case now. At first I just figured it was so the hospital could put a big billboard up saying how they were cutting edge and using minimally invasive techniques. Or that initially they were decreasing pain/length of stay etc. But now when you’re doing half as many robotic outpt surgeries as you could do without it there’s got to be an up charge.

 

[thinkorswim]

No one has come clean with me about the robot economics. I can only assume there are higher facility fees or procedure reimbursements for robotic everything?

A surgeon once pulled out the robot for an end of day add-on appendectomy. It was kind of funny to hear the mental gymnastics used to justify its use, especially when asked about the larger port sites and more expensive stapler/bag.

 

[anonperson]

There is a HCPCS code for robotic assistance. I don't think Medicare reimburses hospitals more for using the robot but some commercial payers may pay more.

The professional reimbursement is the same regardless.

My reasons for using the robot:

1. It's physically more comfortable to sit at the console rather than do the case at the beside. My back feels so much better. I am wiped out of I operate all day doing open or regular laparoscopic cases.

2. My skills with regular laparoscopy are average at best. With the robot, I can do difficult cases fairly easily. I did a hysterectomy on a patient with 3 prior c sections. A lot of adhesions but the case was done in under 3 hours and she went home the same day.

With my skill set, I would have had to open her and that's 2 nights in the hospital on average.

I suspect this is the case for a lot of other surgeons as well.

3. I don't have to depend on the assist to do too much. I can control the camera easily and be more independent.

At this point, it's here to stay. Even Kaiser, as tight fisted as they are, has begrudgingly started to open up robotic use for benign cases (previously cancer only).

 

[jwk]

There is a HCPCS code for robotic assistance. I don't think Medicare reimburses hospitals more for using the robot but some commercial payers may pay more.

The professional reimbursement is the same regardless.

My reasons for using the robot:

1. It's physically more comfortable to sit at the console rather than do the case at the beside. My back feels so much better. I am wiped out of I operate all day doing open or regular laparoscopic cases.

2. My skills with regular laparoscopy are average at best. With the robot, I can do difficult cases fairly easily. I did a hysterectomy on a patient with 3 prior c sections. A lot of adhesions but the case was done in under 3 hours and she went home the same day.

With my skill set, I would have had to open her and that's 2 nights in the hospital on average.

I suspect this is the case for a lot of other surgeons as well.

3. I don't have to depend on the assist to do too much. I can control the camera easily and be more independent.

At this point, it's here to stay. Even Kaiser, as tight fisted as they are, has begrudgingly started to open up robotic use for benign cases (previously cancer only).

We do tons of robots - I think we have about 10 between our 3 hospitals. I can see them for a fair number of cases. But lap choles? Nope. Appendectomies? Hell no. Inguinal hernias - seriously? I don't know about the surgeon's fee, but the procedure itself adds thousands of dollars in disposable equipment, OR time, and anesthesia time.

 

[GassYous]

We have robot cranis, robot knees and robot tonsils.

I like robot choles esp for the fatties.

 

[Southpaw]

robot tonsils.

I have a robotic vasectomy coming up. Soon to be followed by a robotic nail clipping. I also use the robot to brew my morning americano - man that thing is on point.

 

[Twiggidy]

I don't mind the robot. If I were a surgery resident going into an area where it could be used I would get myself up to speed on it. The patients do have a better recovery whether that's proven (prostates) or not. As far as skill, what our surgical colleague is saying is true. A comfortable surgeon will operate better number one and also, the way the robot moves allows for more accurate dissection versus regular laparoscopy. Sure, it's slower, but I'm paid by the hour, and unless I have an appointment, I really don't mind since we have wifi and my iPad is charged.

 

[coffeebythelake]

Im told the robot cases can occasionally shorten the surgical time. Some robot cases have been shown to improve outcomes. But overall agree that it can be very wasteful in terms of resource utilization, disposables, and personnel time. Also might involve tucking arms which are otherwise out for non robot cases which can be a pain

 

[VisionaryTics]

We have robot cranis, robot knees and robot tonsils.

I like robot choles esp for the fatties.

I mean, to be fair, the robotic tonsil is not a standard pediatric tonsil. It's a radical pharyngectomy, and the robot allows superior visualization and much more freedom of movement compared to using a headlight, loupes, and long instruments in the back of the throat. It gives visualization of the oropharynx you can only achieve with a mandibulotomy. It's essentially standard of care now for transoral pharyngeal surgery.

In residency, one of my attendings who was not robot trained hit the carotid in the parapharyngeal space doing a radical pharyngectomy with headlight and loupes. I'm pretty sure the anesthesia team would trade an extra 20-40 minutes of futzing around every case to avoid that happening ever again.

 

[GassYous]

I mean, to be fair, the robotic tonsil is not a standard pediatric tonsil. It's a radical pharyngectomy, and the robot allows superior visualization and much more freedom of movement compared to using a headlight, loupes, and long instruments in the back of the throat. It gives visualization of the oropharynx you can only achieve with a mandibulotomy. It's essentially standard of care now for transoral pharyngeal surgery.

In residency, one of my attendings who was not robot trained hit the carotid in the parapharyngeal space doing a radical pharyngectomy with headlight and loupes. I'm pretty sure the anesthesia team would trade an extra 20-40 minutes of futzing around every case to avoid that happening ever again.

AMEN to that

 

[FutureInternist]

We have robot cranis, robot knees and robot tonsils.

I like robot choles esp for the fatties.

Ummm… it’s “weighing-machine challenged”

 

[ambiturner]

I mean, to be fair, the robotic tonsil is not a standard pediatric tonsil. It's a radical pharyngectomy, and the robot allows superior visualization and much more freedom of movement compared to using a headlight, loupes, and long instruments in the back of the throat. It gives visualization of the oropharynx you can only achieve with a mandibulotomy. It's essentially standard of care now for transoral pharyngeal surgery.

In residency, one of my attendings who was not robot trained hit the carotid in the parapharyngeal space doing a radical pharyngectomy with headlight and loupes. I'm pretty sure the anesthesia team would trade an extra 20-40 minutes of futzing around every case to avoid that happening ever again.

I have had the privilege of anesthetizing a standard, outpatient, teenage robot tonsil for OSA. I think the guy stopped doing them though, probably added too much time and tough to book the robot. I’m in academics though so stuff like this happens all the time.

 

[nimbus]

I mean, to be fair, the robotic tonsil is not a standard pediatric tonsil. It's a radical pharyngectomy, and the robot allows superior visualization and much more freedom of movement compared to using a headlight, loupes, and long instruments in the back of the throat. It gives visualization of the oropharynx you can only achieve with a mandibulotomy. It's essentially standard of care now for transoral pharyngeal surgery.

In residency, one of my attendings who was not robot trained hit the carotid in the parapharyngeal space doing a radical pharyngectomy with headlight and loupes. I'm pretty sure the anesthesia team would trade an extra 20-40 minutes of futzing around every case to avoid that happening ever again.

Prior to robotic prostatectomy, it was not uncommon to see 500-1500ml blood loss during radical retropubic prostatectomies when the urologists couldn’t get good visualization and control of the dorsal venous plexus.

 

[nimbus]

It’s so easy, it can even be done in a cave

Thailand Cave Rescue - details of anesthesia and positioning during rescue

Deep anaesthesia: The Thailand cave rescue and its implications for management of the unconscious diver underwater Check out the section “anesthesia in Thailand cave rescue”. Some crazy $hit

forums.studentdoctor.net

 

[zizzer]

Your description of attitudes towards anesthesiologists reminds me of my residency hospital. I'm now at a similar metro academic tertiary care hospital where I feel our group is very valued across the board by nearly all surgeons and nurses. Perhaps it's regional.

 

[abolt18]

Just throw pads on and hook up the Zoll prior to induction and everyone in the room suddenly feels a sense of "oh crap, what's going on. Glad I don't have their job". I think it adds a certain level of appreciation for what you do.