Black list

[urge]

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How common is it for anesthesiologists to get black listed with surgeons?

It is getting more and more common IMHO. I think some anesthesiologists do it on purpose so that they do not work with an annoying surgeon. I wish I belonged on some of those lists. You might think that it is bad for the anesthesiologists but all I can say is that their working environment is better than mine. Those surgeons are the ones nobody wants to work with anyway.

Does that stuff happen in your group?

How many of you have the opposite, surgeons on your black list?

 

[Planktonmd]

In a perfect world this should not be allowed to happen.
If a surgeon has a problem with a certain anesthesiologist that problem should be discussed and the issues addressed.
Unfortunately we don't live in a perfect world and sometimes the leadership of a group might choose to allow a surgeon to decide who does and who does not work for him, this usually happens to avoid conflict but it is very harmful to the integrity and respect of the whole group.

How common is it for anesthesiologists to get black listed with surgeons?
It is getting more and more common IMHO. I think some anesthesiologists do it on purpose so that they do not work with an annoying surgeon. I wish I belonged on some of those lists. You might think that it is bad for the anesthesiologists but all I can say is that their working environment is better than mine. Those surgeons are the ones nobody wants to work with anyway.

Does that stuff happen in your group?

How many of you have the opposite, surgeons on your black list?

 

[SleepIsGood]

In a perfect world this should not be allowed to happen.
If a surgeon has a problem with a certain anesthesiologist that problem should be discussed and the issues addressed.
Unfortunately we don't live in a perfect world and sometimes the leadership of a group might choose to allow a surgeon to decide who does and who does not work for him, this usually happens to avoid conflict but it is very harmful to the integrity and respect of the whole group.

I dont understand why anesthesiology groups allow for this type of behavior by surgeons to one...especially when they have exclusive rights to anesthetizing pts in the entire hospital. The surgeons really have no choice BUT to go with someone in your group anyways.

 

[militarymd]

I dont understand why anesthesiology groups allow for this type of behavior by surgeons to one...especially when they have exclusive rights to anesthetizing pts in the entire hospital. The surgeons really have no choice BUT to go with someone in your group anyways.

Let's think about this.

Would YOU go to just ANY surgeon if you needed to have some part of your body removed?

Just a random pick of whoever is on the medical staff of the hospital........or would you pick your own surgeon based on whatever criteria you use to determine quality?

Of course not....or at least I hope that's what your answer would be.

So why do WE expect SURGEONS just to take ANY anesthesia provider to do anesthesia for their cases?

I'm with URGE....there are a number of folks who I WOULD NOT mind being on their black list....but guess what? They are the customers of the business....they decide ....just like the surgeons CANNOT demand referrals....the people who MAKE a referrals decide who GETS them.

There is nothing wrong with it.....

If you are getting BLACK LISTED, then you have to ask yourself...what YOU are doing wrong to get BLACK LISTED.

 

[pgg]

People go to the hospital to have surgery, not to have anesthesia.

Not that any one of us is obligated to put up with outright abuse, but we ought to keep in mind that the surgeon is as much our customer as the patient.

 

[SleepIsGood]

People go to the hospital to have surgery, not to have anesthesia.

Not that any one of us is obligated to put up with outright abuse, but we ought to keep in mind that the surgeon is as much our customer as the patient.

Practically speaking you guys are correct. We all know that surgeons/patients are the customer in a sense.

I think what the original poster was getting at is this. if you are a very outspoken anesthesiologist and you are 'by the book'...surgeons will likely not want to work with you since you are perceived non-negotiable. On the other hand you have a push over anesthsiologist or a 'cowboy', the surgeon will LOVE to work with that person. Maybe this is in academics, but it seems like anesthesiologist A is the one that gets 'blck listed'.

Anesthesiologist A, is likely very skilled and is not an 'obstructionist' as MilMD would likely call him..but rather he just has principles that he as a board certified physicians requires to be met. BTW..I'm not talking about the acdemic types that just cancels cases because they are lazy, just the ones that believe certain criteria or labs are needed for 'safe' aneshesia.

Again, if you have an EXCLUSIVE contract, it would seem you dont need to 'bow down'....

 

[SleepIsGood]

People go to the hospital to have surgery, not to have anesthesia.

.

100% true

 

[militarymd]

Practically speaking you guys are correct. We all know that surgeons/patients are the customer in a sense.

I think what the original poster was getting at is this. if you are a very outspoken anesthesiologist and you are 'by the book'...surgeons will likely not want to work with you since you are perceived non-negotiable. On the other hand you have a push over anesthsiologist or a 'cowboy', the surgeon will LOVE to work with that person. Maybe this is in academics, but it seems like anesthesiologist A is the one that gets 'blck listed'.

Anesthesiologist A, is likely very skilled and is not an 'obstructionist' as MilMD would likely call him..but rather he just has principles that he as a board certified physicians requires to be met. BTW..I'm not talking about the acdemic types that just cancels cases because they are lazy, just the ones that believe certain criteria or labs are needed for 'safe' aneshesia.

Again, if you have an EXCLUSIVE contract, it would seem you dont need to 'bow down'....

don't bow down...INSIST on having your 'safe' anesthesia...whatever that means...criteria are meant...piss off the surgeon...so that he goes some where else....


That contract won't be so EXCLUSIVE for much longer....

If you want to go the high road...and stick with your so called 'safe' method...then you better hope that the HHEAT syndrome mortality rate starts going up.

 

[SleepIsGood]

don't bow down...INSIST on having your 'safe' anesthesia...whatever that means...criteria are meant...piss off the surgeon...so that he goes some where else....


That contract won't be so EXCLUSIVE for much longer....

If you want to go the high road...and stick with your so called 'safe' method...then you better hope that the HHEAT syndrome mortality rate starts going up.

Again....I didnt personally say I would be going down that road. However, I feel like if a colleague in the future decided to stick with his criteria, the group should be 'unified' and back him up (granted he's not an obstructionist, cancelling cases left and right). Not 'bow down' to the surgeon.

Keep in mind, surgeons just dont 'pick up and leave' unless they are some really big time guy who created a certain procedure or something. Usually, surgeons pick a hospital among many things because it's convenient and it's where the patient's insurance allows it. How many times have you heard a surgeon say, "this hospital is soo slow with its turnover. Hospital X does _____ better. Nevertheless, the surgeon keeps COMING back to said hospital that he/she constantly complains about. When I was rotating at a private hospital and even at the academic place, I saw this a lot. It's actually funny....because when you talk to the nurses that worked at the 'other hospital', with said surgeon, he would say the same thing there.

 

[militarymd]

Again....I didnt personally say I would be going down that road. However, I feel like if a colleague in the future decided to stick with his criteria, the group should be 'unified' and back him up (granted he's not an obstructionist, cancelling cases left and right). Not 'bow down' to the surgeon.

Keep in mind, surgeons just dont 'pick up and leave' unless they are some really big time guy who created a certain procedure or something. Usually, surgeons pick a hospital among many things because it's convenient and it's where the patient's insurance allows it. How many times have you heard a surgeon say, "this hospital is soo slow with its turnover. Hospital X does _____ better. Nevertheless, the surgeon keeps COMING back to said hospital that he/she constantly complains about. When I was rotating at a private hospital and even at the academic place, I saw this a lot. It's actually funny....because when you talk to the nurses that worked at the 'other hospital', with said surgeon, he would say the same thing there.

a friend of mine just did it....took all his cases somewhere else....he apologized to me....knowing it wasn't my fault that caused his unhappiness...and he said..."it's business"....and I said...then he said"when are we going to the skeet range again?"

Can they leave? depends on your location.

If you're the only game in town...well do what ever you want.

 

[SleepIsGood]

a friend of mine just did it....took all his cases somewhere else....he apologized to me....knowing it wasn't my fault that caused his unhappiness...and he said..."it's business"....and I said...then he said"when are we going to the skeet range again?"

Can they leave? depends on your location.

If you're the only game in town...well do what ever you want.

I'm sure your friend's spot will be taken by some new guy surgeon that wants to bring cases to your hospital for the reasons I stated above. Probably w/i 6months or so. Your group will likely forget him in six months. Unfortunately or fortunately, how the game works it appears.

 

[Noyac]

The way I see it is if a surgeon doesn't want to work with a specific anesthesia provider then they must file a formal complaint with either the group (in PP) or the employer. They must discuss issues that make the provider unfit for the surgeons cases. This must include clinical details. Personality issues are not permitted. With that being said, it is wise to separate conflicting personalities for a period of time.

 

[militarymd]

Let's think about this.

Would YOU go to just ANY surgeon if you needed to have some part of your body removed?

Just a random pick of whoever is on the medical staff of the hospital........or would you pick your own surgeon based on whatever criteria you use to determine quality?

Of course not....or at least I hope that's what your answer would be.

So why do WE expect SURGEONS just to take ANY anesthesia provider to do anesthesia for their cases?

I'm with URGE....there are a number of folks who I WOULD NOT mind being on their black list....but guess what? They are the customers of the business....they decide ....just like the surgeons CANNOT demand referrals....the people who MAKE a referrals decide who GETS them.

There is nothing wrong with it.....

If you are getting BLACK LISTED, then you have to ask yourself...what YOU are doing wrong to get BLACK LISTED.

I'm sure your friend's spot will be taken by some new guy surgeon that wants to bring cases to your hospital for the reasons I stated above. Probably w/i 6months or so. Your group will likely forget him in six months. Unfortunately or fortunately, how the game works it appears.

I like how you chose to side step my initial question...and go on to making suppositions about how powerless surgeons are when it comes to choosing where they operate, and that it really does not impact your practice.

Seeing how you side stepped the question, I must assume that you really don't care who operates on you...and any joe schmoe on the medical staff is fine.

 

[SleepIsGood]

I like how you chose to side step my initial question...and go on to making suppositions about how powerless surgeons are when it comes to choosing where they operate, and that it really does not impact your practice.

Seeing how you side stepped the question, I must assume that you really don't care who operates on you...and any joe schmoe on the medical staff is fine.

To answer your question...

When I was an intern, a patient came into the ER after we made the dx of appendicitis and stated, "I want the chief of surgery to do my appendectomy". We called the chief. It was 3 AM. What do you think his answer was.

My point. You dont always get what you want. If everyone comes in requesting to be operated on by the 'chief of surgery', who is presummed to be the best, it's simply not practical.

Furthermore, I'm not saying surgeons are 'helpless' or powerless. All I'm saying is that they arent as powerful as they were in the earlier days of medicine. Nowadays, there are a multitude of external factors (ie insurance companies, location,etc) that dictate where they must or should operate.

Again, ideally I think surgeons and anesthesiologists should work together collegially. They both need each other to be good at what they each do.

 

[SleepIsGood]

The way I see it is if a surgeon doesn't want to work with a specific anesthesia provider then they must file a formal complaint with either the group (in PP) or the employer. They must discuss issues that make the provider unfit for the surgeons cases. This must include clinical details. Personality issues are not permitted. With that being said, it is wise to separate conflicting personalities for a period of time.

Your group seems like its very pro-physician and very unified.

 

[militarymd]

To answer your question...

When I was an intern, a patient came into the ER after we made the dx of appendicitis and stated, "I want the chief of surgery to do my appendectomy". We called the chief. It was 3 AM. What do you think his answer was.

My point. You dont always get what you want. If everyone comes in requesting to be operated on by the 'chief of surgery', who is presummed to be the best, it's simply not practical.

Furthermore, I'm not saying surgeons are 'helpless' or powerless. All I'm saying is that they arent as powerful as they were in the earlier days of medicine. Nowadays, there are a multitude of external factors (ie insurance companies, location,etc) that dictate where they must or should operate.

Again, ideally I think surgeons and anesthesiologists should work together collegially. They both need each other to be good at what they each do.

Once AGAIN, you have side stepped my question, and AVOIDED answering.

We're NOT talking about emergencies here. We ARE talking about CHOOSING who we want to take care of us.

Your persistence in NOT answering a DIRECT question shows me that YOU have not thought this through to the logical conclusion...

You want to ANSWER what I asked, or you want to give us another tap dance.

 

[militarymd]

To answer your question...

When I was an intern, a patient came into the ER after we made the dx of appendicitis and stated, "I want the chief of surgery to do my appendectomy". We called the chief. It was 3 AM. What do you think his answer was.

My point. You dont always get what you want. If everyone comes in requesting to be operated on by the 'chief of surgery', who is presummed to be the best, it's simply not practical.

Furthermore, I'm not saying surgeons are 'helpless' or powerless. All I'm saying is that they arent as powerful as they were in the earlier days of medicine. Nowadays, there are a multitude of external factors (ie insurance companies, location,etc) that dictate where they must or should operate.

Again, ideally I think surgeons and anesthesiologists should work together collegially. They both need each other to be good at what they each do.

Actually you're wrong....for the most part, the surgeon's who are the most successfully financially don't needs us....hell, they don't even need a hospital...they have these little facilities that I think are called "surgery centers"...where they employ their own CRNA's.

So...try and answer my question WITHOUT side stepping it.

Given the choice....would you let just ANY SCHMO on the medical staff operate on you?

When you come into the ER with an acute abdomen...YOU HAVE NO choice unless you have a LOT of money or are the Chief of anesthesia at that particular hospital.

Having insurance doesn't count as having a lot of money.

 

[Coastie]

I have been trying to educate my fellow residents recently on the idea that we have to get used to the idea of catering to surgeons, and that in the private world, we are interchangeable, for the most part.

The above being true, what can we bring to the table which makes us a cut above the "other guy"?

Is it clinical skills, people skills, or both? Are people skills truly more important in PP?

Thanks..

 

[coprolalia]

I think the blacklist thing is real and, in some cases, not necessarily wrong.

When I was in residency, there was a horrible peds academic attending that a few of the surgeons who regularly did pediatric cases stated that they did not want to work with her when she got a room alone. This went to the chairman, and nothing was done about it.

As a result, one of these surgeons - who told this directly to me, even when I was "just a resident" - said that they began to call their patients at home the day before and advise them to reschedule the case, if they could, for another day.

True story. Of course, that's academic medicine for ya.

-copro

 

[coprolalia]

The way I see it is if a surgeon doesn't want to work with a specific anesthesia provider then they must file a formal complaint with either the group (in PP) or the employer. They must discuss issues that make the provider unfit for the surgeons cases. This must include clinical details. Personality issues are not permitted. With that being said, it is wise to separate conflicting personalities for a period of time.

Fine. What actually happens if/when they do this?

I shared a real scenario. This is what happened. It wasn't a "personality" issue. Nothing was done. The surgeon took matters into their own hands.

I don't know if I agree with this methodology, but I have to say that this peds anesthesiologist really sucked... I wouldn't have wanted her to give anesthesia to any kid of mine. And, after being addressed at the chairman level it was ignored? I would've thought that this type of "pass" would only occur in academics, but based on what I've seen over the past 5 months I'm not so sure.

And, if anything, thinking through it for me as a mental exercise at least shows that it is incredibly hard to quantify when someone sucks and is dangerous. In fact, nothing is usually done until someone gets injured or killed. And, even then, I've seen nothing done (at least while in residency).

-copro

 

[maceo]

the surgeon's who are the most successfully financially don't needs us....hell, they don't even need a hospital...they have these little facilities that I think are called "surgery centers"...where they employ their own CRNA's..

Not only is this un ethical and un professional it is illegal. It violates anti kickback laws. as stark described it for medicare patients.

You make it sound like it is common place for surgeons to do this, it is not common and most counsel advise surgeon not to enter arrangements that you describe

 

[coprolalia]

Fine. What actually happens if/when they do this?

I shared a real scenario. This is what happened. It wasn't a "personality" issue. Nothing was done. The surgeon took matters into their own hands.

I don't know if I agree with this methodology, but I have to say that this peds anesthesiologist really sucked... I wouldn't have wanted her to give anesthesia to any kid of mine. And, after being addressed at the chairman level it was ignored? I would've thought that this type of "pass" would only occur in academics, but based on what I've seen over the past 5 months I'm not so sure.

And, if anything, thinking through it for me as a mental exercise at least shows that it is incredibly hard to quantify when someone sucks and is dangerous. In fact, nothing is usually done until someone gets injured or killed. And, even then, I've seen nothing done (at least while in residency).

-copro

Let me clarify that for a second... in that specific reference, I'm speaking about one of "our" (i.e., hospital employed) CRNAs.

-copro

 

[militarymd]

To answer your question...

When I was an intern, a patient came into the ER after we made the dx of appendicitis and stated, "I want the chief of surgery to do my appendectomy". We called the chief. It was 3 AM. What do you think his answer was.

My point. You dont always get what you want. If everyone comes in requesting to be operated on by the 'chief of surgery', who is presummed to be the best, it's simply not practical.

Furthermore, I'm not saying surgeons are 'helpless' or powerless. All I'm saying is that they arent as powerful as they were in the earlier days of medicine. Nowadays, there are a multitude of external factors (ie insurance companies, location,etc) that dictate where they must or should operate.

Again, ideally I think surgeons and anesthesiologists should work together collegially. They both need each other to be good at what they each do.

Once AGAIN, you have side stepped my question, and AVOIDED answering.

We're NOT talking about emergencies here. We ARE talking about CHOOSING who we want to take care of us.

Your persistence in NOT answering a DIRECT question shows me that YOU have not thought this through to the logical conclusion...

You want to ANSWER what I asked, or you want to give us another tap dance.

Sleep ....so I'm know you've read this....how come no answer?

 

[coprolalia]

Sleep ....so I'm know you've read this....how come no answer?

Ehh... Barking up the wrong tree? Don't expect too much.

-copro

 

[SleepIsGood]

Sleep ....so I'm know you've read this....how come no answer?

Ah Mil...didnt know I meant that much to you. I've sort of stopped posting since I have a few presentations coming up.

To answer your question....well let's assume jus that...wht you mentioned, that is I am NOT the chief of anesthesia and suppose I didnt have any money.

It's a moot point.

I have no choice...even for a non-emergency. I want someone that is competent. However, if my insurance or my PCP doesnt get me access (or pays for )to one of these guys, I'm out of luck. So in reality, you have NO CHOICE....therefore moot point.

Totally different, if youre the CHIEF or have LOTs of money.

Obviously exceptions. In a similar manner. Surgeons, especially 'picky' ones should get the anesthesiologist assigned tothem. As NOY stated, practcally and to 'quite' soeone temporarily, exceptions CAN be made.

 

[militarymd]

Ah Mil...didnt know I meant that much to you. I've sort of stopped posting since I have a few presentations coming up.

To answer your question....well let's assume jus that...wht you mentioned, that is I am NOT the chief of anesthesia and suppose I didnt have any money.

It's a moot point.

I have no choice...even for a non-emergency. I want someone that is competent. However, if my insurance or my PCP doesnt get me access (or pays for )to one of these guys, I'm out of luck. So in reality, you have NO CHOICE....therefore moot point.

Totally different, if youre the CHIEF or have LOTs of money.

Obviously exceptions. In a similar manner. Surgeons, especially 'picky' ones should get the anesthesiologist assigned tothem. As NOY stated, practcally and to 'quite' soeone temporarily, exceptions CAN be made.

You rested my case for me...by, once AGAIN, side stepping the question...and NOT answering what I asked you.

Everyone HAS a choice...so why shouldn't a Surgeon?

 

[SleepIsGood]

You rested my case for me...by, once AGAIN, side stepping the question...and NOT answering what I asked you.

Everyone HAS a choice...so why shouldn't a Surgeon?

You dont always get what you want my man.....

 

[militarymd]

You dont always get what you want my man.....

That wasn't the question now....was it?