APRNs for surgery

[Modanq]

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Will we also look at our CRNA practices....

Top surgeon Dr. David Samadi employed barely trained nurse in major procedures
https://nypost.com/2018/12/23/top-s...-trained-nurse-to-assist-in-major-procedures/

 

[AdmiralChz]

This article indicates his first assist was an LPN, which actually has less schooling than an RN...

 

[Psai]

This article indicates his first assist was an LPN, which actually has less schooling than an RN...

Right because an RN has a plethora of surgical schooling. oh wait...

 

[Modanq]

Oh jeez, I didn't even catch that. With all the APRN, LPN, RN, BSN, CRNA, MSN, PhDRN, CNA I lose track of the titles.

 

[chocomorsel]

I am trying to figure out what a surgeon does to get paid 7 million dollars. How many surgeries is he doing? Do they all have BC/BS Cadillac plans or similar?
I am sorry, but this is the type of story that makes us look bad. Advertising that he made that much? The public loves “hating rich doctors”.
And at @AdmiralChz, it doesn’t matter what their title or education. What should matter but doesn’t always is, do they go to surgical assistant schools? There are plenty of places though that will teach one on the job. I had the opportunity to do that as an LPN in my younger days. Their training is not standardized across the board. There are lots of avenues. So I don’t know why they are making a big deal of it in the article.

Update..Oh now I see his scheme and why he’s under investigation.

 

[AdmiralChz]

Totally fair! Was more saying it’s not uncommon to see an APRN First Assist (just like a PA), but definitely is odd to see an LPN (rather than a SA, or even RNFA),

 

[Southpaw]

I'm more curious as to what he's done to get $6.8 mill as a surgeon then I am with a LPN assisting in the OR.

 

[deleted126335]

A lot of state institutions and non-profits must by law disclose salaries, particularly of highly paid employees. For those of you who work at one of them do a search. Form 990.


Sent from my iPhone using SDN mobile

 

[jwk]

Totally fair! Was more saying it’s not uncommon to see an APRN First Assist (just like a PA), but definitely is odd to see an LPN (rather than a SA, or even RNFA),

I know a GYN guy who used dental assistants because they were even cheaper.

 

[kidthor]

While it seems odd the guy had an LPN assisting him, it might not be that bad. I suppose it all depends on the scope of her assistance. Holding a retractor or a camera while the surgeon does the heavy lifting seems possibly ok. Yet, it's odd.

And why couldn't he just have a surgical PA? Most of the surgical PAs I've interacted with have been relatively skilled, have good judgment, and know their limits.

7 million as a surgeon? Something is markedly off with that practice.

 

[deleted875186]

Seems very greedy. Should just spend the extra money for a surgical PA. However, it says he’s primarily doing robotic prostate surgeries, so all the assistant is really doing is movin robot arms and helping dock new instruments.

 

[Painted]

It gets worse if you click on the link in the article:

One of New York City’s highest paid surgeons — who made $7.3 million last year — was a virtual ghost in the operating room, leaving more than 1,000 patients in the hands of unsupervised residents for delicate prostate procedures and other surgeries, according to two new lawsuits.

Dr. David Samadi would claim to be performing the surgeries but was actually in another operating room at Lenox Hill Hospital, according to the lawsuits filed Friday in Manhattan Supreme Court.

Samadi, the head of urology at Lenox Hill, went so far as to put the patients under general anesthesia rather than a milder sedative so they would be knocked out and not realize he wasn’t in the OR, the suits charge.

 

[deleted171991]

Criminal fraud. For every million he's ever made, he will sit a year in federal prison, hopefully (and still wouldn't be enough).

I hate hacks like this; they give doctors a bad name. It's heartbreaking to have patients thank me because I "care, unlike many others". (And I am NOT the schmoozing kind.) WTF is wrong with this world? I guess, when people elect as president a conman with 6,000 documented lies, nothing should come as a surprise.

 

[deleted171991]

7 million as a surgeon? Something is markedly off with that practice.

He wasn't present, so he could "do" multiple surgeries at the same time?

 

[abolt18]

He wasn't present, so he could "do" multiple surgeries at the same time?

Yeah, but we'll often have our CT surgeon in 2 ORs at once. Once off pump and doing well, he'll have a senior resident or fellow start the next case. The PA is doing the vein harvest while the resident/fellow does the sternotomy plus LIMA dissection. All the while, he's dictating the first case in the 2nd OR and another resident is closing the chest in the 1st OR.

*It's an integrated program, so that senior resident is effectively a pgy6 fellow.


Or, a surgeon will be split out into 2 rooms and he'll have the upper level resident start a case with him while a jr resident closes in the other room.

So this idea of being in 2 rooms is not so strange to me. These guys aren't letting residents do cases totally unsupervised and they are present for the important parts of the case. Like my anesthesia attendings who are present for the important components of the anesthetic.

 

[Mman]

So this idea of being in 2 rooms is not so strange to me. These guys aren't letting residents do cases totally unsupervised and they are present for the important parts of the case. Like my anesthesia attendings who are present for the important components of the anesthetic.

Nobody said the idea was strange. What's not clear is probably how much the patients were informed about it preop and if it woulda/coulda/shoulda been part of the consent. I recall a large lawsuit in Boston not long ago regarding a spine surgeon bouncing back and forth between 2 cases at once. In terms of your anesthesiologist attending, it's called ACT model and as long as the patient is aware that is the model of care it is perfectly safe and legal. I don't think all patients are quite as clear that their surgeon won't be doing a large portion of their procedure.

 

[narcusprince]

This story stinks of bs. What did Dr Samadi do that upset the hospital executive staff? This sounds like someone who got blacklisted by the hospital. Im sure whatever rules that were broken which seem minor were not the cause of the rest of the filings. Why didnt the system change his surgical booking? How much money did he make for the hospital? Did he comply with the hospitals business rules? This smells of something else.

 

[deleted171991]

Yeah, but we'll often have our CT surgeon in 2 ORs at once. Once off pump and doing well, he'll have a senior resident or fellow start the next case. The PA is doing the vein harvest while the resident/fellow does the sternotomy plus LIMA dissection. All the while, he's dictating the first case in the 2nd OR and another resident is closing the chest in the 1st OR.

*It's an integrated program, so that senior resident is effectively a pgy6 fellow.


Or, a surgeon will be split out into 2 rooms and he'll have the upper level resident start a case with him while a jr resident closes in the other room.

So this idea of being in 2 rooms is not so strange to me. These guys aren't letting residents do cases totally unsupervised and they are present for the important parts of the case. Like my anesthesia attendings who are present for the important components of the anesthetic.

Except I am not so sure that the surgical version is legal, while the anesthesia one is.

 

[Ronin786]

Except I am not so sure that the surgical version is legal, while the anesthesia one is.

Ironically, the surgical version is arguably much safer than the anesthesia one.

 

[chocomorsel]

Sounds like he was doing two cases at once. Not overlapping them with one case finishing and another starting. That sounds like one of the ways he was able to bring in such a large amount of money.
But I am w @narcusprince. He pissed off someone in administration who tattled because for a while they were all in it together to make money.
Or possibly one of the residents/nurses/anesthesiologists/CRNAs got tired of the waiting and tattled.
I have seen this system with senior residents in academics though with two rooms going at the same time. Usually the long ENT cases.

 

[TraumaLlamaMD]

Samadi, the head of urology at Lenox Hill, went so far as to put the patients under general anesthesia rather than a milder sedative so they would be knocked out and not realize he wasn’t in the OR, the suits charge.

Are others doing their prostatectomies under sedation?

 

[Psai]

It gets worse if you click on the link in the article:

One of New York City’s highest paid surgeons — who made $7.3 million last year — was a virtual ghost in the operating room, leaving more than 1,000 patients in the hands of unsupervised residents for delicate prostate procedures and other surgeries, according to two new lawsuits.

Dr. David Samadi would claim to be performing the surgeries but was actually in another operating room at Lenox Hill Hospital, according to the lawsuits filed Friday in Manhattan Supreme Court.

Samadi, the head of urology at Lenox Hill, went so far as to put the patients under general anesthesia rather than a milder sedative so they would be knocked out and not realize he wasn’t in the OR, the suits charge.

That's stupid. Trendelenburg with ports in the belly? You think these cases are done with light sedation or something lmao

 

[Mman]

Ironically, the surgical version is arguably much safer than the anesthesia one.

you can argue that, but we have data on millions of anesthetics that says otherwise

 

[Mman]

That's stupid. Trendelenburg with ports in the belly? You think these cases are done with light sedation or something lmao

he may have been doing cystos in one room with prostates going on in the other room.

 

[narcusprince]

Where is the evidence patients were harmed by the setup? Surgeon cant book cases by himself? Sounds like a really good surgeon who upset someone important and they decided to tell on him. Dude must have rocked the boat. Key thing here even if you are a good surgeon do not rock the boat keep the peace and bounce when a offer comes up. No one is immune from this.

 

[Mman]

Where is the evidence patients were harmed by the setup? Surgeon cant book cases by himself? Sounds like a really good surgeon who upset someone important and they decided to tell on him. Dude must have rocked the boat. Key thing here even if you are a good surgeon do not rock the boat keep the peace and bounce when a offer comes up. No one is immune from this.

it's a slippery slope IMHO when surgeons dictate that they were present for key portions of the procedure. Who determines what the key portions are? For a CABG, can a surgeon just walk in and sew distals and let the PAs and fellows do the rest? If so, can he have 5 concurrent CABGs going at the same time? I mean what's the limit for concurrent surgeries?

I mean I think we all (I assume all) understand it's totally fine for a PA to close skin and the nurse to put the dressing on while the surgeon is starting another case. It gets less clear when significant portions of procedures are happening at the exact same time in different rooms.

 

[narcusprince]

Honestly, in my mind their are 3 tiers of surgeons.... terrible surgeons no one in their right mind would electively choose, good surgeons who have good outcomes solid in the operating rooms, generational talents pioneers of surgical technique extremely low failure rate and peer accepted data stating they are the best and top of their game. So what if a generational mind has two operating rooms staggered and present during critical points in the procedure? If the dude is a baller and can get my prostate out and keep me sexually intact with an extremely high success rate who cares if an lpn passes him a scalpel or a pa closes ports or skin. Unfortunately in anesthesia we fall into two categories 10% freak out cant get it done bounces from job to job 90% can put patients to sleep and wake them up and practice acceptable anesthesia within a set system. No room for generational minds by evidence of OR outcomes or technical skills. Maybe in the research world we have those minds. Let this man take out as many prostates as he wants to the statistics do not lie.