EM docs in Michigan justifying replacing their anesthesiologist colleagues

[sevo00]

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[sevo00]

Saying they are qualified to even provide general anesthesia

 

[TheLoneWolf]

🤣 sounds like they are running cover for those yokels covering endoscopy when the anesthesia group left.

Can someone please give Apfel a call. Several juicy cases inbound

Also, the ASA needs to put out some sort of statement that unequivocally states this is wholly inappropriate.

 

[sevo00]

🤣 sounds like they are running cover for those yokels covering endoscopy when the anesthesia group left.

Can someone please give Apfel a call. Several juicy cases inbound

Also, the ASA needs to put out some sort of statement that unequivocally states this is wholly inappropriate.

Agree. Anyone here have contacts at the ASA?

 

[TheLoneWolf]

Agree. Anyone here have contacts at the ASA?

Imagine a bumbling general surgeon who believes they can suddenly do MOHs surgery. All they need is a slimy third party to give them access to the equipment.

Same situation

 

[aneftp]

Scope of practice is catch all phrase.

Let them do it. Sucks for the first morbidly obese patient who dies from moderate to deep sedation.

But we gotta run these test trials on real patients.

Everyone knows I love drama. Let them have at it.

Remember medicine is all reactionary these days. Complications need to happen for people to be put in their place.

 

[cockblockandrun]

This is already happening at a big hospital system in Michigan. I was blown away when I found out.

 

[sevo00]

This is already happening at a big hospital system in Michigan. I was blown away when I found out.

Yes at corewell health. This is what he wrote this in response ti. Basically saying it’s ok for EM docs to replace anesthesiologists

 

[aneftp]

This is already happening at a big hospital system in Michigan. I was blown away when I found out.

Yup and they almost lost the airway I know about it already.

 

[DrOwnage]

Just today I had an EGD colo spew tons of crap out of their mouth and laryngospasm during the colo portion. Even with my anesthesia machine and circuit ready (always preset on PCV ventilation in case) and succ'ing him almost immediately dude still desatted into the low 70s. Bad stuff gonna happen when someone else not trained encounters this stuff.

 

[cockblockandrun]

Yes at corewell health. This is what he wrote this in response ti. Basically saying it’s ok for EM docs to replace anesthesiologists

Yup. The locum anesthesiologists are not in endo- they were told EM docs are doing "conscious sedation with propofol"

My question is what is the incentive for these EM docs to even sign up to do this? How much would be the financial incentive have to be for someone to even consider doing this?

 

[TheLoneWolf]

Yup. The locum anesthesiologists are not in endo- they were told EM docs are doing "conscious sedation with propofol"

My question is what is the incentive for these EM docs to even sign up to do this? How much would be the financial incentive have to be for someone to even consider doing this?

My dude, the EM market is in the turlet. AMCs took over and put them in these lose lose positions. Always will have a subset of cowboys who think they can do anything.

 

[arkgal]

This discussion has been ongoing on the Emergency Medicare forum. Everything commenting thinks that this is a bad idea.

 

[circleK]

This discussion has been ongoing on the Emergency Medicare forum. Everything commenting thinks that this is a bad idea.

Except for the ones actually doing it

 

[cockblockandrun]

My dude, the EM market is in the turlet. AMCs took over and put them in these lose lose positions. Always will have a subset of cowboys who think they can do anything.

That is my point- what is the financial incentive from the hospital to do this? If none, then just doing this for ego is absolutely insane and unethical IMO.

 

[pgg]

Except for the ones actually doing it

They say every person and soul has a price.

 

[NukHopkins]

I wonder what the malpractice coverage is. Would an insurer be willing to cover anesthetic complications, despite the practitioner not being formally trained delivering anesthesia in these settings.

If I were one of these EM docs, I’d be worried about personal assets being fair game and collectible in the event of a malpractice judgment against me.

I don’t know enough about this kind of stuff.

 

[GravelRider]

Scope of practice is catch all phrase.

Let them do it. Sucks for the first morbidly obese patient who dies from moderate to deep sedation.

But we gotta run these test trials on real patients.

Everyone knows I love drama. Let them have at it.

Remember medicine is all reactionary these days. Complications need to happen for people to be put in their place.

There won’t be any complications. There’s probably some sucker anesthesiologist taking in-house call 24/7 who will be called emergently for the lost airway or will have to take over in the middle of a sedation case when the patient is “hard to fully sedate.”

I’ve been at hospitals where I’ve been called to the ER to take over sedation in something like a reduction of a shoulder dislocation or an airway in an upper GI bleed that the ER was attempting to intubate prior to GI doing the endo. The ER has already been doing nerve blocks and sedation for minor procedures. This doesn’t seem that new to me. If it keeps patients out of the OR in the middle of the night for something minor then I’m all for it. It doesn’t sound like emergency physicians are clamoring to come and sit in the OR for a 5 hour ex-lap.

 

[dizzy21]

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?

 

[dannyboy1]

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?

Bad outcomes are inevitable especially in this situation. Will be nice as this is clearly a hospital decision and they will be on the hook.

 

[aneftp]

There won’t be any complications. There’s probably some sucker anesthesiologist taking in-house call 24/7 who will be called emergently for the lost airway or will have to take over in the middle of a sedation case when the patient is “hard to fully sedate.”

I’ve been at hospitals where I’ve been called to the ER to take over sedation in something like a reduction of a shoulder dislocation or an airway in an upper GI bleed that the ER was attempting to intubate prior to GI doing the endo. The ER has already been doing nerve blocks and sedation for minor procedures. This doesn’t seem that new to me. If it keeps patients out of the OR in the middle of the night for something minor then I’m all for it. It doesn’t sound like emergency physicians are clamoring to come and sit in the OR for a 5 hour ex-lap.

These are calculated risks the hospitals take when deciding to do this.

 

[CopaceticOne]

These are calculated risks the hospitals take when deciding to do this.

I guess if they can make 20 million extra despite 10 million in payouts then it will be worth it in their minds.

 

[aneftp]

I guess if they can make 20 million extra despite 10 million in payouts then it will be worth it in their minds.

Correct. It’s like many of the AMC are now “self insured”. Rather than pay extra for premiums

if there is a lawsuit they will pay it out in cash

 

[dannyboy1]

These are calculated risks the hospitals take when deciding to do this.

There is no calculation of anything. Hospital admin focuses on quarterly cash flow. Potential lawsuits don’t go on any spreadsheet. IF they happen they take years to resolve and payout. Whichever exec made this short sighted decision is long gone by then.

 

[aneftp]

There is no calculation of anything. Hospital admin focuses on quarterly cash flow. Potential lawsuits don’t go on any spreadsheet. IF they happen they take years to resolve and payout. Whichever exec made this short sighted decision is long gone by then.

It is discussed. Remember when AOL executives discussed self insured payouts and than two of the women employees had muti million dollar pregnancy and premature baby care.

Companies now the risks way before hand.

Just complain about it after the fact

 

[narcotics999]

Yes at corewell health. This is what he wrote this in response ti. Basically saying it’s ok for EM docs to replace anesthesiologists

There is a Facebook post about Corewell attempting to use EM doc to do endo and C/S, P/Nicu to do ENT, and train surgical residents to do anesthesia. ASA, ACGME needs to act.

 

[narcotics999]

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?

Come on, when something bad happens, the doc will just be thrown under the bus.

 

[coffeebythelake]

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.

 

[coffeebythelake]

The flies see the honey and they are trying to claim a share.

If I am ever asked to bail out an ER doc who gets in over their head I will say no.

 

[BLADEMDA]

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.

 

[aneftp]

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.

My colleague was asked to help last week. In ER. Big fat dude desaturated. Usual stuff

He just stood as standby. Watch as er doc failed to put ett in even with glidescope vocal cord seen.

Couldn’t maneuver the stylet

 

[Arch Guillotti]

My colleague was asked to help last week. In ER. Big fat dude desaturated. Usual stuff

He just stood as standby. Watch as er doc failed to put ett in even with glidescope vocal cord seen.

Couldn’t maneuver the stylet

Ur friend sounds like a fool. If he was down there why didn’t he just do it?

 

[GravelRider]

The flies see the honey and they are trying to claim a share.

If I am ever asked to bail out an ER doc who gets in over their head I will say no.

Is this a thing we can do? If you are the anesthesiologist on call and are asked to help out in an emergent situation, can you say no?

I guess you just have to be picky and inquisitive about where you work. If the hospital is credentialing ER docs for moderate or deep sedation and you don’t want to be a backstop for that then you shouldn’t take a job there.