AANA-"removing physician supervision is the right thing to do"

[secretasianman]

Nobody cares. The overwhelming majority of these cases go off without a hitch. The bean counters care about profits/loss this month or quarter. They don’t give a $hit about some lawsuit which may pay out 5 years after the event which may (or may not) have been prevented by the presence of a physician.

We are just ford pintos.

“
Putting the NHTSA figures together with other statistical studies, the Ford report arrives at the following overall assessment of costs and benefits:

Benefits​

Savings:	180 burn deaths, 180 serious burn injuries, 2,100 burned vehicles
Unit cost:	$200,000 per death, $67,000 per injury, $700 per vehicle
Total benefit:	(180 X $200,000) + (180 X $67,000) + (2,100 X $700) = $49.5 million

Costs​

Sales:	11 million cars, 1.5 million light trucks
Unit cost:	$11 per car, $11 per truck
Total cost:	12.5 million X $11 = $137.5 million

Thus, the costs of the suggested safety improvements outweigh their benefits, and the “Fatalities” report accordingly recommends against any improvements–a recommendation that Ford followed.”

Case: The Ford Pinto | Business Ethics

philosophia.uncg.edu

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[dhb]

On the topic of playing doctor, literally everyone is doing it these days:

Opinion | Is There a Doctor in the White House? Not if You Need an M.D.

Jill Biden should think about dropping the honorific, which feels fraudulent, even comic.

www.wsj.com

The reactions to this excellent piece will please @FFP

 

[Matthew9Thirtyfive]

On the topic of playing doctor, literally everyone is doing it these days:

Opinion | Is There a Doctor in the White House? Not if You Need an M.D.

Jill Biden should think about dropping the honorific, which feels fraudulent, even comic.

www.wsj.com

The reactions to this excellent piece will please @FFP

She has an EdD, which I understand is kind of like the DNP version of the education doctorates with a PhD being the real deal. Anecdotally, every time I’ve seen someone use the honorific “dr” in public, they have had kind of a joke of a doctorate. But also, who cares?

 

[deleted126335]

On the topic of playing doctor, literally everyone is doing it these days:

Opinion | Is There a Doctor in the White House? Not if You Need an M.D.

Jill Biden should think about dropping the honorific, which feels fraudulent, even comic.

www.wsj.com

The reactions to this excellent piece will please @FFP

The reactions to the piece are pretty virulent depending on where you look.

https://www.washingtonpost.com/nation/2020/12/14/dr-jill-biden-wsj-oped/

 

[GassYous]

She has an EdD, which I understand is kind of like the DNP version of the education doctorates with a PhD being the real deal. Anecdotally, every time I’ve seen someone use the honorific “dr” in public, they have had kind of a joke of a doctorate. But also, who cares?

I care because each little damage to the prestige and respect of medical doctors adds up. It is why we are in this situation today.

Covid-19 Live Updates: U.S. Starts Vaccine Rollout as Shots Given in New York

High-risk health care workers are being given priority as the U.S. surpassed more than 300,000 virus-related deaths. Australia and New Zealand intend to establish a travel bubble.

www.nytimes.com

"Dr Michelle Chester" is administering the covid vaccine to "ICU Nurse Sandra Lindsay". Except that the nytimes doesn't tell you that this supposed "doctor" is actually just a nurse practitioner and works as a director for employee health. She is not a medical doctor despite dressing up as one.

 

[secretasianman]

When they ask if there’s a doctor in the house on a plane, does anyone ever go, “I’m here to help! I am a doctor of philosophy!”

 

[Matthew9Thirtyfive]

I care because each little damage to the prestige and respect of medical doctors adds up. It is why we are in this situation today.

She’s not in healthcare and isn’t even trying to appear like she is. Do you get bothered when astrophysicists call themselves doctor in public?

 

[Matthew9Thirtyfive]

When they ask if there’s a doctor in the house on a plane, does anyone ever go, “I’m here to help! I am a doctor of philosophy!”

I wouldn’t be surprised if a DNP responded and said they were a doctor.

 

[drmwvr]

LA County Department of Public Health

publichealth.lacounty.gov

From the LA county website: Dr. Ferrer has a doctorate in social welfare from Brandeis University, where she was a Pew Doctoral Fellow. She also holds master’s degrees in public health from Boston University and in education from UMass, Boston. She earned her bachelor’s degree at UC Santa Cruz.

 

[GassYous]

She’s not in healthcare and isn’t even trying to appear like she is. Do you get bothered when astrophysicists call themselves doctor in public?

I don't know any that do this because they don't do this. That's what happens when someone is secure in their value and standing. Can you imagine an astrophysicist sauntering into a hospital like "hey I'm Dr. Feynman".

 

[Matthew9Thirtyfive]

I don't know any that do this because they don't do this. That's what happens when someone is secure in their value and standing. Can you imagine an astrophysicist sauntering into a hospital like "hey I'm Dr. Feynman".

No, I can’t. Do you have any evidence whatsoever that she will “saunter” into a hospital like “hey I’m Dr. Biden”?

 

[GassYous]

I don't know what you're even trying to say

 

[Matthew9Thirtyfive]

I don't know what you're even trying to say

Really? You seem to be convinced that Jill Biden using the honorific “dr” somehow devalues physicians using the title, despite her having literally zero to do with healthcare. You claim she will go into hospitals and introduce herself that way, with a clip from Friends as your evidence. Do you not see how absurd that is?

Edit: for what it’s worth, I agree that it’s dumb for anyone to call themselves dr in public and that most people will assume anyone who does is a physician. I just don’t think Jill Biden doing it is really a top priority since she has nothing to do with healthcare and isn’t trying to pass herself off as a physician.

 

[dhb]

Really? You seem to be convinced that Jill Biden using the honorific “dr” somehow devalues physicians using the title, despite her having literally zero to do with healthcare. You claim she will go into hospitals and introduce herself that way, with a clip from Friends as your evidence. Do you not see how absurd that is?

She devalues the Dr title because she flaunts it (it's her twitter handle) although she "got it" with a bs degree.
Everybody's a winner everybody's a doctor

 

[Matthew9Thirtyfive]

She devalues the Dr title because she flaunts it (it's her twitter handle) although she "got it" with a bs degree.
Everybody's a winner everybody's a doctor

Yeah I understand the argument. I just don’t think Jill Biden is the one actively hurting physician value. People are writing articles about her calling herself dr. Biden but I don’t see any articles about the DNP who administered the first COVID vaccine in NY going by Dr. in a clinical context and being called Dr. by the governor of NY.

 

[dhb]

Yeah I understand the argument. I just don’t think Jill Biden is the one actively hurting physician value. People are writing articles about her calling herself dr. Biden but I don’t see any articles about the DNP who administered the first COVID vaccine in NY going by Dr. in a clinical context and being called Dr. by the governor of NY.

I referenced it the context of people usurping titles and degrees not because it directly hurts physicians although indirectly it does promote the idea that "anybody" can call themselves Dr.

 

[Matthew9Thirtyfive]

I referenced it the context of people usurping titles and degrees not because it directly hurts physicians although indirectly it does promote the idea that "anybody" can call themselves Dr.

She’s not usurping anything. She’s using a title granted to her by the degree she holds. Now whether the use of that title in public is misleading or pretentious or whatever is up for debate, but she’s not inappropriately taking the title by using it on Twitter any more than any of the psychologists, English professors, etc who use it on Twitter.

 

[dhb]

She’s not usurping anything. She’s using a title granted to her by the degree she holds. Now whether the use of that title in public is misleading or pretentious or whatever is up for debate, but she’s not inappropriately taking the title by using it on Twitter any more than any of the psychologists, English professors, etc who use it on Twitter.

As you can see i didn't say she was usurping it.
But you are saying she's at the same level as a lot of other idiots...

 

[Matthew9Thirtyfive]

As you can see i didn't say she was usurping it.
But you are saying she's at the same level as a lot of other idiots...

So you’re saying that when you said “I referenced it the context of people usurping titles” you were not saying she’s usurping the title?

And yes, I think it’s pretentious to call yourself dr. Whatever on Twitter no matter who you are.

 

[DrOwnage]

You can't win in this situation. Obviously calling "Dr" Biden out on over-credentialing herself (which she is) is correct. There's nothing I hate more than people who claim to be something they're not, especially when you have to go through hell to get it as we have. When **** hits the fan these are the first people to revoke their "expertise." However almost nothing ever comes of it, and now people will cry sexism. "Oh I guess female educators aren't seen as the same." The only people who should be called doctors are physicians, PhDs, dentists, and lawyers. Blurring the lines has consequences and cheapens what we are.

 

[Matthew9Thirtyfive]

You can't win in this situation. Obviously calling "Dr" Biden out on over-credentialing herself (which she is) is correct. There's nothing I hate more than people who claim to be something they're not, especially when you have to go through hell to get it as we have. When **** hits the fan these are the first people to revoke their "expertise." However almost nothing ever comes of it, and now people will cry sexism. "Oh I guess female educators aren't seen as the same." The only people who should be called doctors are physicians, PhDs, dentists, and lawyers. Blurring the lines has consequences and cheapens what we are.

I actually don’t disagree with you, but when you’re calling the soon to be First Lady “kiddo” in an article, you’re going about it the wrong way.

 

[Matthew9Thirtyfive]

In England for a while they had everyone go by Firstname Lastname, Degree because there were so many fake doctorates around. Maybe we should do that here.

 

[nimbus]

Jesus. I'm a new grad PP partnership track and I'm walking around before I leave every day making sure no-one needs anything, staying post call to help get morning pre-ops done, reviewing every consult chart I can get my hands on, and restructuring the curriculum for rotating med students. What is wrong with my generation? (Granted I am a non-trad... but I'm not that much older).

In my experience, it’s not generational. These characters have existed in every generation.

 

[ugm12]

In England for a while they had everyone go by Firstname Lastname, Degree because there were so many fake doctorates around. Maybe we should do that here.

Not at the hospital I used to work at. On my first day I asked why my ID badge didn’t have Dr before my name. The response was “we don’t allow titles on name badges, it’s hospital policy”. I do hope it wasn’t anything to do with ?microaggression?...

 

[coffeebythelake]

We are just ford pintos.

“
Putting the NHTSA figures together with other statistical studies, the Ford report arrives at the following overall assessment of costs and benefits:

Benefits​

Savings:	180 burn deaths, 180 serious burn injuries, 2,100 burned vehicles
Unit cost:	$200,000 per death, $67,000 per injury, $700 per vehicle
Total benefit:	(180 X $200,000) + (180 X $67,000) + (2,100 X $700) = $49.5 million

Costs​

Sales:	11 million cars, 1.5 million light trucks
Unit cost:	$11 per car, $11 per truck
Total cost:	12.5 million X $11 = $137.5 million

Thus, the costs of the suggested safety improvements outweigh their benefits, and the “Fatalities” report accordingly recommends against any improvements–a recommendation that Ford followed.”

Case: The Ford Pinto | Business Ethics

philosophia.uncg.edu

Not we. Corporate Healthcare.

 

[deleted126335]

Not at the hospital I used to work at. On my first day I asked why my ID badge didn’t have Dr before my name. The response was “we don’t allow titles on name badges, it’s hospital policy”. I do hope it wasn’t anything to do with ?microaggression?...

Blurring the difference between providers. You elitist.

 

[Matthew9Thirtyfive]

Not at the hospital I used to work at. On my first day I asked why my ID badge didn’t have Dr before my name. The response was “we don’t allow titles on name badges, it’s hospital policy”. I do hope it wasn’t anything to do with ?microaggression?...

So what does it say? You don’t have a badge that says MD or DO? Or physician or something?

 

[Fart Daddy Smooth]

Using Dr outside of a professional setting is lame, and pushing the "Dr Biden" thing in a pandemic is misleading. Why not "Professor Biden"? It would be nice if our nation's educators had a high profile advocate for once.

I don't particularly care much for the man but nobody in the media was calling Ben Carson "Dr.". Disappointing to see our media display such bias

 

[ugm12]

So what does it say? You don’t have a badge that says MD or DO? Or physician or something?

Nope. Just first name last name department and training year. So “ST3” specialty trainee year 3

 

[Matthew9Thirtyfive]

Nope. Just first name last name department and training year. So “ST3” specialty trainee year 3

Wow.

 

[DrOwnage]

Using Dr outside of a professional setting is lame, and pushing the "Dr Biden" thing in a pandemic is misleading. Why not "Professor Biden"? It would be nice if our nation's educators had a high profile advocate for once.

I don't particularly care much for the man but nobody in the media was calling Ben Carson "Dr.". Disappointing to see our media display such bias

A fellow Ben Shapiro watcher, nice

 

[dannyboy1]

Only time I refer to myself as Dr is when I’m on the phone with customer services. Seems to work a little.

 

[GassYous]

I save it for cocktail parties

 

[deleted500612]

I actually don’t disagree with you, but when you’re calling the soon to be First Lady “kiddo” in an article, you’re going about it the wrong way.

To clarify... the use of the term "kiddo" to refer to Jill in the article is clearly just mocking Joe Biden's own frequent and recurring use of the word to refer to females including an environmental activist who confronted him during his campaign, his own VP Kamala Harris, and yes... even his own wife Jill, among others. Of course Joe gets zero flak for it though, while WSJ is eviscerated. Partisan politics is fun.

Joe Biden (circa 2012) addressing his wife Jill regarding a marriage proposal: “I don’t know what I would have done, kiddo, had you on that fifth time said no.”

Joe Biden calls Kamala Harris, 54, ‘kid’ so she she calls ex-VP 'senator'

DEMOCRATIC presidential front-runner Joe Biden and his rival Kamala Harris threw subtle jabs at each other as they clashed in a TV debate. In a rocky start to last night’s battle, Biden, 76, …

www.thesun.co.uk

Biden calls environmental activist 'kiddo' as he defends fundraiser with fossil-fuel company's founder

Joe Biden on Friday forcefully defended his appearance the previous evening at a top-dollar campaign fundraising event in New York City that was held at the home of a supporter who helped found a natural gas company.

www.foxnews.com

 

[Matthew9Thirtyfive]

To clarify... the use of the term "kiddo" to refer to Jill in the article is clearly just mocking Joe Biden's own frequent and recurring use of the word to refer to females including an environmental activist who confronted him during his campaign, his own VP Kamala Harris, and yes... even his own wife Jill, among others. Of course Joe gets zero flak for it though, while WSJ is eviscerated. Partisan politics is fun.

Joe Biden (circa 2012) addressing his wife Jill regarding a marriage proposal: “I don’t know what I would have done, kiddo, had you on that fifth time said no.”

Joe Biden calls Kamala Harris, 54, ‘kid’ so she she calls ex-VP 'senator'

DEMOCRATIC presidential front-runner Joe Biden and his rival Kamala Harris threw subtle jabs at each other as they clashed in a TV debate. In a rocky start to last night’s battle, Biden, 76, …

www.thesun.co.uk

Biden calls environmental activist 'kiddo' as he defends fundraiser with fossil-fuel company's founder

Joe Biden on Friday forcefully defended his appearance the previous evening at a top-dollar campaign fundraising event in New York City that was held at the home of a supporter who helped found a natural gas company.

www.foxnews.com

I suspected that might have been a reference to something Biden said, but wasn’t sure. But yes, that’s politics in America now. Anything our side does is justified or ignored completely, and the other side doing the same thing is the devil.

 

[vector2]

Kudos to Epstein for his ability to lure people in with this level of idiotic pearl clutching troll bait. Almost didn’t notice that Barr resigned, we passed 300,000 COVID deaths, the electoral college voted, Russia hacked us again etc.

 

[Nivens]

Kudos to Epstein for his ability to lure people in with this level of idiotic pearl clutching troll bait. Almost didn’t notice that Barr resigned, we passed 300,000 COVID deaths, the electoral college voted, Russia hacked us again etc.

agreed. we’ve all got bigger fish to fry.

 

[T-burglar]

only in this field do you get physicians so passive and weak that they will happily throw their colleagues under the bus and cede their territory to poorly trained NURSES. Imagine hearing a surgeon say “i don’t feel sorry if you chose surgery thinking you could do appys and hernias all day”.

how pathetic. We are in sad times when we have people who won’t even defend their field anonymously from behind a keyboard.

I don’t know what to tell you man. The vast majority of cases can be done start to finish by a nurse with no great difference in outcome.

I see TONS of nursing level care from physicians too.

 

[teacher2md]

I don’t know what to tell you man. The vast majority of cases can be done start to finish by a nurse with no great difference in outcome.

I don’t know what to tell you, man. As a resident I could probably do most CT cases without an CT attending supervision without any difference in outcome.

I don’t see the point of CT fellowship training just for those remaining ~10% of cases that may have bad outcomes.

/s

 

[chocomorsel]

I don’t know what to tell you man. The vast majority of cases can be done start to finish by a nurse with no great difference in outcome.

I see TONS of nursing level care from physicians too.

Only in America.

 

[GassYous]

I don’t know what to tell you man. The vast majority of cases can be done start to finish by a nurse with no great difference in outcome.

I see TONS of nursing level care from physicians too.

It's easy to say that but I regularly hear from my friends about the idiotic things that crnas do and I'm actually a little surprised that they don't have more patients stroking out or dying. I will have physicians take care of me thank you very much.

 

[chocomorsel]

It's easy to say that but I regularly hear from my friends about the idiotic things that crnas do and I'm actually a little surprised that they don't have more patients stroking out or dying. I will have physicians take care of me thank you very much.

Because it’s actually a little difficult to kill someone. Easier to temporarily screw them up for a bit though.

 

[dannyboy1]

I don’t know what to tell you man. The vast majority of cases can be done start to finish by a nurse with no great difference in outcome.

I see TONS of nursing level care from physicians too.

Unfortunately you are correct. Glidescope was a game changer, in more ways than one .....

 

[coffeebythelake]

It's easy to say that but I regularly hear from my friends about the idiotic things that crnas do and I'm actually a little surprised that they don't have more patients stroking out or dying. I will have physicians take care of me thank you very much.

At that point pt is pawned off to someone else

 

[dannyboy1]

It's easy to say that but I regularly hear from my friends about the idiotic things that crnas do and I'm actually a little surprised that they don't have more patients stroking out or dying. I will have physicians take care of me thank you very much.

I have lost count of how many vasclopaths I have seen bottom out and need quite a bit of pressors to bring them up. Yet when the case is over wake up like nothing ever happened. Fortunately for the patients and unfortunately for us patients seem to do ok so long as the airway is secure and they have a pulse.
For those of you who think that independent CRNA practice will lead to measurably worse outcomes, consider the fact that most CRNA practice is independent anyway. Do you really think that the MD in the lounge signing the charts and not coming even close to TEFRA requirements is contributing anything? Think again. I wish it weren’t so but that’s the reality as I see it.

 

[dannyboy1]

It's easy to say that but I regularly hear from my friends about the idiotic things that crnas do and I'm actually a little surprised that they don't have more patients stroking out or dying. I will have physicians take care of me thank you very much.

I have lost count of how many vasclopaths I have seen bottom out and need quite a bit of pressors to bring them up. Yet when the case is over wake up like nothing ever happened. Fortunately for the patients and unfortunately for us patients seem to do ok so long as the airway is secure and they have a pulse.
For those of you who think that independent CRNA practice will lead to measurably worse outcomes, consider the fact that most CRNA practice is independent anyway. Do you really think that the MD in the lounge signing the charts and not coming even close to TEFRA requirements is contributing anything? Think again. I wish it weren’t so but that’s the reality as I see it.

 

[coffeebythelake]

I have lost count of how many vasclopaths I have seen bottom out and need quite a bit of pressors to bring them up. Yet when the case is over wake up like nothing ever happened. Fortunately for the patients and unfortunately for us patients seem to do ok so long as the airway is secure and they have a pulse.
For those of you who think that independent CRNA practice will lead to measurably worse outcomes, consider the fact that most CRNA practice is independent anyway. Do you really think that the MD in the lounge signing the charts and not coming even close to TEFRA requirements is contributing anything? Think again. I wish it weren’t so but that’s the reality as I see it.

I think it is a matter of risk assessment and response. 1. The vast majority of patients are reasonably healthy and have cardiopulmonary reserve, and might do well even with suboptimal care. If your study endpoint is death or major disability you miss a lot. That doesn't mean it is right. 2. When things go bad they go bad quickly. There is a reason why anesthesiologists with their physician training make a difference. We use our knowledge and understanding of physiology, not just protocols.

You can drive your car all your life without a seat belt or air bags and probably come out ok. I wouldnt advocate doing that.

 

[dannyboy1]

I think it is a matter of risk assessment and response. A lot of patients do well even with suboptimal care. If your study endpoint is death or major disability you miss a lot. That doesn't mean it is right. You can drive your car all your life without a seat belt or air bags and probably come out ok

Not saying it’s right. But our specialty is now run by AMC’s or hospitals (no real difference, it’s all about the bottom line). From a business standpoint it makes very little sense to pay an MD twice as much as a CRNA especially when that MD is essentially extra as he is “supervising” the CRNA not actually doing a case. If I ran an anesthesia business I would come to that conclusion quickly. Really the only thing that is keeping us afloat is the supervision requirement by insurance, Medicare and some states. Once that goes, and it will, we are well and truly fu(ked.

 

[coffeebythelake]

Not saying it’s right. But our specialty is now run by AMC’s or hospitals (no real difference, it’s all about the bottom line). From a business standpoint it makes very little sense to pay an MD twice as much as a CRNA especially when that MD is essentially extra as he is “supervising” the CRNA not actually doing a case. If I ran an anesthesia business I would come to that conclusion quickly. Really the only thing that is keeping us afloat is the supervision requirement by insurance, Medicare and some states. Once that goes, and it will, we are well and truly fu(ked.

Basically there is a huge difference in the alignment of goals between patients and healthcare systems especially corporate systems. Independent CRNAs do not save patient money (billed exactly the same as physician only or ACT model) and worsen patient care, but they generate a lot of money for the hospital. This is warped by the AANA into the lie that CRNAs are cheaper. It is not cheaper to patients or health insurance. It is cheaper for hospital admins clamering to line their pockets with executive bonuses.

 

[nimbus]

It's easy to say that but I regularly hear from my friends about the idiotic things that crnas do and I'm actually a little surprised that they don't have more patients stroking out or dying. I will have physicians take care of me thank you very much.

I was a CA-1 at one time so I’m not surprised at all