EM docs in Michigan justifying replacing their anesthesiologist colleagues

[kidthor]

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Now EM anesthesiologists.

What did we think was going to happen when we said medicine is a capitalist system and we invited private corporations to partake in the fun?

Perhaps now HCA can open an EM "sedation" fellowship where an EM doctor has to both supervise an ED while also supervising a midlevel supervising a tech giving sedation in an "OR" (converted trauma bay where they now charge OR facility fees) for any case that comes from the ED. Perhaps even do it in a stand alone urgent care next to a Starbucks in a strip mall? The EM docs should be careful what they wish for.

 

[GravelRider]

Perhaps now HCA can open an EM "sedation" fellowship where an EM doctor has to both supervise an ED while also supervising a midlevel supervising a tech giving sedation in an "OR" (converted trauma bay where they now charge OR facility fees) for any case that comes from the ED. Perhaps even do it in a stand alone urgent care next to a Starbucks in a strip mall? The EM docs should be careful what they wish for.

I love where you are going with this. Having the ER staff a trauma bay converted to OR for level 1 type traumas would be a dream come true. Those cases are miserable time sucks. Be careful what you wish for.

 

[Dantrolene FC]

Your friend should never have agreed to be "standby". If I get called for an airway I'm doing it.

I agree with you. If they ever call for you to be standby on an airway. Just tell them you have chest tube in PACU that you would like them to on standby while you do it.

 

[aneftp]

What’s the captain liabilty aspect? Either you are the guy that does it or the guy that watches.

You make business decisions at this point in regards to liability. Do u draw urself into this mess or not.

I’m sure 1/4 of us have been name as peripheral names in lawsuits at one point in any 20-30 year career. It’s just the laws of averages working. That’s what I mean as locums doc plus trying to not involved yourself in a rescuer situation for someone who f’d up the airway.

 

[Arantius]

This is the clown. Looks like he failed out of ortho residency and then did emergency medicine. Next thing he is going to be saying ER docs are uniquely able to perform ortho surgery because they do ortho reductions and splinting in the ER.View attachment 410278

He was probably promised some c suite role or something and sold out for this. What an idiot.

 

[PpfSuxTube]

I love this. They can't hack their own ****ty job so think they can replace us. **** the bed the second they got a real case without a million back up ppl...

I just cant wait for the 1st court case and then we really find out how brave they are...

Theyve literally never done an elective case. That's some shakey ground right there to assume insurance will cover their ass

 

[Lab Lover]

I love this. They can't hack their own ****ty job so think they can replace us. **** the bed the second they got a real case without a million back up ppl...

I just cant wait for the 1st court case and then we really find out how brave they are...

Theyve literally never done an elective case. That's some shakey ground right there to assume insurance will cover their ass

If they are judicious-only use CRNAs who have at least five years experience and are above average and limit to PS1 and 2 and select PS 3 and routine cases... They can get away with a lot for maybe a long time. Maybe have anesthesiologists in the department not involved with the case as the fire department... How many of us would actually say "NO" when asked to come help a dying patient in another OR that they weren't involved in because they didn't like the staffing model?

 

[arkgal]

I don't see the advantage of hiring EM to do sedation in a hospital when you have anesthesia already in house. Seems like a turf war anesthesia with anesthesia.

 

[Lab Lover]

I don't see the advantage of hiring EM to do sedation in a hospital when you have anesthesia already in house. Seems like a turf war anesthesia with anesthesia.

They are hiring them to provide “physician supervision” for CRNAs doing more than sedation. Basically a meaningless rubber stamp of independent CRNA practice.

 

[aneftp]

They are hiring them to provide “physician supervision” for CRNAs doing more than sedation. Basically a meaningless rubber stamp of independent CRNA practice.

Im confused. So the GI docs are over seeing the Grand Rapids crnas? But the EM docs are over seeing the crnas?

 

[Lab Lover]

Im confused. So the GI docs are over seeing the Grand Rapids crnas? But the EM docs are over seeing the crnas?

That was my interpretation of the article. I may be wrong though. GI docs oversee CRNAs all the time so not newsworthy IMO. Again, I may be wrong.

 

[NPJR]

That was my interpretation of the article. I may be wrong though. GI docs oversee CRNAs all the time so not newsworthy IMO. Again, I may be wrong.

Didn't Michigan opt-out of the supervision requirement a bit ago? What's the problem then?

 

[NPJR]

Didn't Michigan opt-out of the supervision requirement a bit ago? What's the problem then? Just have all CRNAs, no need for docs.

 

[cockblockandrun]

Im confused. So the GI docs are over seeing the Grand Rapids crnas? But the EM docs are over seeing the crnas?

No. EM docs are solo in endo giving propofol sedation.
I got friends there right now doing locums. Absolute circus from what I hear- locum docs are now getting canceled a week after starting because hospital overbooked.

 

[aneftp]

No. EM docs are solo in endo giving propofol sedation.
I got friends there right now doing locums. Absolute circus from what I hear- locum docs are now getting canceled a week after starting because hospital overbooked.

My two friends have not gotten canceled yet.

Crnas are getting canceled left and right. Because there are 2-4 crnas many days sitting around floating and not assigned.

Calls are solo for docs at night. Hard to run up 160 hours a week with solo calls there. That’s why I avoid places like that. Play the long game if u wanna make real locums money.

U can get solid 12-15 hrs a day there though so the money is good.

One locums doc making $430/hr did get canceled last week.

 

[NPJR]

My two friends have not gotten canceled yet.

Crnas are getting canceled left and right. Because there are 2-4 crnas many days sitting around floating and not assigned.

Calls are solo for docs at night. Hard to run up 160 hours a week with solo calls there. That’s why I avoid places like that. Play the long game if u wanna make real locums money.

U can get solid 12-15 hrs a day there though so the money is good.

One locums doc making $430/hr did get canceled last week.

what are they paying? I meant to call the agencies to ask

 

[aneftp]

what are they paying? I meant to call the agencies to ask

I literally just told u guys what the guy getting canceled was getting paid.

There are guys making a little more who are staying (for now). There are guys making a little less as well.

Anyways. When you chase locums jobs like this. It’s like chasing hot stock. Your luck will vary how long it rides.

 

[cockblockandrun]

My two friends have not gotten canceled yet.

Crnas are getting canceled left and right. Because there are 2-4 crnas many days sitting around floating and not assigned.

Calls are solo for docs at night. Hard to run up 160 hours a week with solo calls there. That’s why I avoid places like that. Play the long game if u wanna make real locums money.

U can get solid 12-15 hrs a day there though so the money is good.

One locums doc making $430/hr did get canceled last week.

Yeah the ones I know who got canceled refused to go to other sites and don't want to sit their own cases- so inflexibility is the main reason.

 

[potcake76]

As a board certified pediatric anesthesiologist I can start my own plastic surgery clinic and operate as much as I want. Heck I can even start doing general surgery, ENT and Derm procedures in my office if I had the ego. But I can’t get malpractice insurance.

Are these EM doctors able to be insured for doing anesthesia? Is Corewell health self insuring?

On the other side of the insurance equation, are these EM doctors able to be reimbursed for doing anesthesia?

 

[aneftp]

On the other side of the insurance equation, are these EM doctors able to be reimbursed for doing anesthesia?

Yes!

 

[BLADEMDA]

The CMS document goes on to state that hospitals “must establish policies and procedures, based on nationally recognized guidelines that address whether specific clinical situations involve anesthesia versus analgesia” and “address whether the sedation typically provided in the emergency department or procedure rooms involves anesthesia or analgesia.” Hospitals would be free to use ACEP guidelines and recognize them as authoritative. Furthermore, if sedation administered in the ED is termed “analgesia” (which it is), it would not fall under anesthesia-services oversight. The CMS document allows for this carve out for emergency medicine by stating that “it is important to note that anesthesia services are usually an integral part of surgery.” ED sedation is unique, and the credentialing and verification of competency of providers, selection and preparation of patients, informed consent protocols, equipment and monitoring requirements, staff training and competency verification, criteria for discharge, and continuous quality improvement should be overseen by emergency medicine.

Guidelines On Administering Sedation to Patients Unnecessarily Restrictive for ED Physicians - Page 3 of 3 - ACEP Now

ACEP Now offers real-time clinical news, news from the American College of Emergency Physicians, and news on practice trends and health care reform for the emergency medicine physician. ACEP Now is an official publication of the American College of Emergency Physicians.

www.acepnow.com

 

[BLADEMDA]

ACEP organized a multidisciplinary effort to create a clinical practice guideline specific to time-sensitive unscheduled procedural sedation, which differs in important ways from scheduled, elective procedural sedation. This guideline, which outlines the underlying background, rationale, and issues relating to staffing, practice, and quality improvement, is a resource for practitioners who perform unscheduled procedural sedation, regardless of location or patient age. Read the guidelines and FAQs

 

[jwk]

Didn't Michigan opt-out of the supervision requirement a bit ago? What's the problem then?

billing issue only.

 

[jwk]

On the other side of the insurance equation, are these EM doctors able to be reimbursed for doing anesthesia?

I wondered that as well. Do they just use anesthesia CPT and ICD codes?

 

[circleK]

I’m sure the insurance companies will happily deny these anesthesia charges, but the EM docs are prob getting an employment flat rate and the hospital is able to get their cases done and facility fee, so they all might not care

 

[narcotics999]

One Lawsuit can ruin your life and career. Those ER guys are being very very foolish without verifying their malpractice insurance will cover routine, elective anesthetics outside the ER. Wouldn't it be cheaper to hire a bunch of CRNAs at $250 per hour to do the anesthesia solo? The ER docs have to be getting at least $200 per hour. Once you start practicing another specialty you are expected to deliver the same standard of care as that specialty and typically insurance companies DO NOT cover malpractice incidents outside your area of certification.

I would rather to sit my axx home watching netflix than being forced to practice out of my specialty and potentially dragged into a multiple year lawsuit.

 

[narcotics999]

I love where you are going with this. Having the ER staff a trauma bay converted to OR for level 1 type traumas would be a dream come true. Those cases are miserable time sucks. Be careful what you wish for.

Continuity of care. ER Doc should escort the trauma pt to OR and c/w the anesthesia, lol

 

[arkgal]

They are hiring them to provide “physician supervision” for CRNAs doing more than sedation. Basically a meaningless rubber stamp of independent CRNA practice.

But what's the advantage? EM hourly pay is competitive with anesthesia.

 

[arkgal]

ACEP organized a multidisciplinary effort to create a clinical practice guideline specific to time-sensitive unscheduled procedural sedation, which differs in important ways from scheduled, elective procedural sedation. This guideline, which outlines the underlying background, rationale, and issues relating to staffing, practice, and quality improvement, is a resource for practitioners who perform unscheduled procedural sedation, regardless of location or patient age. Read the guidelines and FAQs

Hiya Blade! Missed seeing your posts. Short of gross negligence, a single lawsuit won't ruin your career if you have malpractice insurance. I will admit that it's not pleasant. I've been sued before, even though I was not at fault for a bad outcome. Pharmacy administered the wrong dose of lamotrigine >> horrific case of SJS that was life-altering. The patient was aware of the risks of skin rashes, consented to treatment, and did not seek care or follow up with me when they first had symptoms of SJS. The plaintiff voluntarily dismissed me from the case with prejudice...but those were some very long two years of my life. Anyone can be sued for any reason. Not sure why EM docs would knowingly put themselves in a situation that increases their liability.

 

[aneftp]

I would rather to sit my axx home watching netflix than being forced to practice out of my specialty and potentially dragged into a multiple year lawsuit.

Some people have 2 ex wives and 5 kids to support.

 

[Maz777]

Your friend should never have agreed to be "standby". If I get called for an airway I'm doing it.

Yup, never stand by. All it takes it one jackal to write your name down on the chart without your knowledge. Then you are effed.

If any Michigan-based plaintiff lawyers are reading this, we would be happy to assist with the inevitable reviews of these cases.

I’m sure this has already been reported to the MI medical board. These EM guys are nuts.