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.

 

[aneftp]

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

Forgot to complete the story

ER doc freaked out. Called another ER doc to do cric the patient as he panicked and airway got bloody.

Very messy situation. As the patient was taken to the or days later this week to to proper trach

The er doc just wanted standby

These er docs can be bravo in their attitudes. Worse than many of us here.

 

[coffeebythelake]

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.

They'll have to call for their supervising physician to help them. Maybe they have this Michael Gratson shmuck on speed dial. Or call a code blue.

 

[Ronin786]

Forgot to complete the story

ER doc freaked out. Called another ER doc to do cric the patient as he panicked and airway got bloody.

Very messy situation. As the patient was taken to the or days later this week to to proper trach

The er doc just wanted standby

These er docs can be bravo in their attitudes. Worse than many of us here.

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

 

[aneftp]

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

I’m just telling u guys there are er docs who make rash decisions.

This isn’t some novice anesthesiologist here. He’s still in tip top shape age 59 does everything solo

But he’s doing locums so u aren’t a regular guy there being called to help out.

 

[SRYSPAC]

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.

"Wouldn't it be cheaper" is always a good question, but hospital admin ignores this in their unlimited capacity for hubris and thinking that any staffing shortfall is temporary.

"Wouldn't it be cheaper to give full time staff even a 30% raise than pay locums and their agencies 2X that?"

"Nah, F that; we'll hire 10 FTE in a year, don't worry about it" 😆

 

[ambiturner]

Sedation services run by picu/pediatricians are common in children’s hospitals for mri, heme/onc, and IR. They can pay the intensivists less than anesthesiologists and free them up to do more challenging cases. The sedation services are also are way less efficient and give worse anesthesia, which is understandable, and cost/benefit analyses typically favor using the anesthesia team since the improved throughput more than covers the cost. My guess is that will be found here as well, ASA1-2 cases will do fine but the sedation will be worse and will slow down the GIs. But if they’re desperate this is better than nothing and the GIs, who love money, are not going to be told they can’t do cases.

This is a stupid fix but if the cost of anesthesia keeps going up we’re going to keep seeing more of these workarounds (non-anesthesia MDs, collaborative models, CRNA-only groups) proliferate.

 

[pgg]

I’m just telling u guys there are er docs who make rash decisions.

Well yeah.

This isn’t some novice anesthesiologist here. He’s still in tip top shape age 59 does everything solo

Then what was he doing in the ER on "standby" in the first place, if he didn't intervene and help?

But he’s doing locums so u aren’t a regular guy there being called to help out.

What does that even mean?

 

[pgg]

the GIs, who love money, are not going to be told they can’t do cases.

In fairness, most GI can be done without anesthesia.

There is nothing inherently unsafe about a colonoscopy or EGD done with an ordinary RN giving a bit of midazolam and fentanyl. It's less pleasant for the patient, sure. The patient will be sort of zonked for a while after the procedure, sure. The GI doc has to be gentler, slower, more skilled ... sure.

Propofol given by us has become the norm because the patients AND endoscopists have acquired an expectation of general anesthesia. But they don't need it.

 

[aneftp]

Well yeah.


Then what was he doing in the ER on "standby" in the first place, if he didn't intervene and help?


What does that even mean?

When u do locums your approach is different to these situations.

You barely knows the place and don’t know how things are handled. And the captain obviously liability aspect when trying to figure to help someone when the airway is already a bloody mess

 

[coffeebythelake]

In fairness, most GI can be done without anesthesia.

There is nothing inherently unsafe about a colonoscopy or EGD done with an ordinary RN giving a bit of midazolam and fentanyl. It's less pleasant for the patient, sure. The patient will be sort of zonked for a while after the procedure, sure. The GI doc has to be gentler, slower, more skilled ... sure.

Propofol given by us has become the norm because the patients AND endoscopists have acquired an expectation of general anesthesia. But they don't need it.

Midaz fentanyl might be a bit safer than propofol for an ER doc sedating

 

[Bryan O’Blivion]

As someone who *almost* applied for an EM residency, I find it pretty telling that people who work in emergency medicine seem so desperate to find alternatives to working in the ED that they will try to take the worst aspects of my job. The ED has to be fairly awful for the endo suite to look good.

 

[aneftp]

Midaz fentanyl might be a bit safer than propofol for an ER doc sedating

It has always been the safer choice since it can be reversed with meds.

 

[VA Hopeful Dr]

As someone who *almost* applied for an EM residency, I find it pretty telling that people who work in emergency medicine seem so desperate to find alternatives to working in the ED that they will try to take the worst aspects of my job. The ED has to be fairly awful for the endo suite to look good.

The money isn't all that good anymore. 10 years ago when they were all managing $300-400/hr or more you didn't see nearly this much jumping ship.

 

[turnupthegas]

This is insane.