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Fight back against midlevel encroachment, contribute to our map!

Discussion in 'Anesthesiology' started by NicMouse64, Jan 6, 2019.

  1. NicMouse64

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    DISCLAIMER:
    1) Participation is voluntary. Participants are not paid, either monetarily or otherwise for their participation, and no remuneration is offered or expected.

    2) SDN is not responsible for any adverse reactions to participation in this project or the results.

    3) SDN and its membership are owners of the material insofar as their participation makes up the majority of the data collected.

    All,
    I am a medical student working with a physician advocacy group to make a map of physician only practices. The goal is to give healthcare consumers the option to go to practices with either physician only practices--marked in green on the map, or low supervision ratio practices--labelled in yellow on the map. If you know of any anesthesia groups that are physician only or have low supervision ratios (1:1 or 2:1 MLP-physician ratio) please add a submission here: Map Entry of Physician-only or Physician-led Practices.

    You can also view the map here: Physicians For Patient Protection | Find a Physician.

    Let me know of any questions.

    EDIT: Thanks for those who are submitting: please indicate if you work within a hospital system if your specialty (anesthesia) is physician only or if the whole hospital is physician only.

    Thanks.
     
    #1 NicMouse64, Jan 6, 2019
    Last edited: Jan 11, 2019
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  2. chocomorsel

    chocomorsel Senior Member
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    Awesome. I hope people participate. I have.
     
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  3. FFP

    FFP Wiseguy
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    The moment they added "physician-led" practices, it turned into BS. The only true physician-led practices are physician-only practices.

    I used to work in a "physician-led" private practice with mostly 1:2 coverage. Still, older CRNAs would not wait for me for induction, would do stuff I disagreed with, and generally would function more independently than I would have liked. I work 1:3 now and the CRNAs are following my instructions 10x more than at my previous job.

    This specialty is full of lazy private partners who would just sit on their ass, chat in the workroom, and count their fat profits. The alternative are the corporate ****s who do the same. The only quality practices are physician-only practices, period.
     
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    #3 FFP, Jan 7, 2019
    Last edited: Jan 7, 2019
  4. chocomorsel

    chocomorsel Senior Member
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    Don’t forget “greedy”. Preach on!!
     
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  5. mmag

    mmag Member
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    Still better than CRNA only practices. For ACT practices, it's worth it to know if one can requests and get physician only care.
     
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  6. OP
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    NicMouse64

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    You don't have to go to yellow. Physician only practices are still marked in green. I am cross checking all submissions, if I see any midlevels or people lie, they are put on our black list and won't be added.
     
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  7. OP
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    NicMouse64

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    Also, for anyone who has a submission with the use of midlevels, they are required to note their supervision techniques. If consumers don't want to deal with it then they can go to physician only. Problem is I am not sure if Anesthesia has enough physician only practices. I am not familiar with the job market.
     
  8. Mman

    Mman Senior Member
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    it'd be nice if the map could be broken down by specialty by clicking or unclicking some boxes to add/remove layers. Seeing a bunch of dots on a map that have nothing to do with the specialty you are looking for is kinda pointless.
     
  9. OP
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    NicMouse64

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    I'm working on doing that. Right now we only have 230 practices added. Once there are enough for each specialty I will start to discriminate by specialty.

    I'll cut you all a deal, once 25 physician only practices are added for anesthesia I will give you guys your own layer.
     
    #9 NicMouse64, Jan 8, 2019
    Last edited: Jan 8, 2019
  10. Mman

    Mman Senior Member
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    I don't have any within 500 miles of me, at least not at a large hospital, maybe 1000 miles.
     
  11. OP
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    NicMouse64

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    That's sad :(. I didn't know it was THAT bad. ACT models with low supervision ratios? hospitals that will accommodate physician only requests?
     
  12. ProRealDoc

    ProRealDoc ASA Member
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    How do we know you ain't working for an AMC and are looking for practices ripe for take over?






     
  13. OP
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    NicMouse64

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    I don't know, did you look at the map? It has plenty of DPC practices, and derm only practices. I am also a medical student. I wish I had that much power and money though.............

    Really I just want this MLP encroachment to end, and I want my family and friends to have physician only care as an option. This country is moving away from that model and it's incredibly sad, and this is the only thing I could think of that I could directly do that would affect anything....
     
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  14. chocomorsel

    chocomorsel Senior Member
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    What's your definition of a "large" hospital?
     
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  15. Mman

    Mman Senior Member
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    > 8 ORs.

    I say that because I know just about all those personally. We are very active politically and coordinate efforts with all the private groups anywhere near us. There might be a 2 or 3 OR shop somewhere I'm not aware of.
     
  16. psychbender

    psychbender Cynical Member
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    Mman, you're in the southeast, right? I know of several physician-only groups in Virginia, Maryland, Ohio, and Indiana (or, at least they were when I last spoke to them about a year ago), but those may be greater than 500 miles from you, still, if you're in southern Georgia or Florida. In that part of the country, really most of the east coast, I agree that it is heavily ACT.

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  17. Arch Guillotti

    Arch Guillotti Senior Member
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    Not correct.
     
  18. OP
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    NicMouse64

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    Please submit those if you know of them.
     
  19. AdmiralChz

    AdmiralChz ASA Member
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    ACT models with low supervision ratios don’t do much for your bottom line - it's almost (or is) a net loss when you consider nurse/AA salary. That's why nearly all ACT practices out there are 1:3 or 1:4 unless they are subspecialty-only groups for cardiac or peds cardiac (which is why many of those groups, even on the east coast, are still MD only). So you'll pretty much see MD only or ACT 1:3 or 1:4 for the most part around here in the Mid Atlantic.

    Not including academics here as ACGME stipulates a 1:2 max supervision ratio with residents.

    I'm also not sure how helpful this map is - it's a bit of a jumbled mess with a mix of random hospitals and outpatient practices including all sorts of specialties. Of course a solo MD primary care doc is "green," but all it does it jumble the map. Needs some cleaning up.
     
  20. OP
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    NicMouse64

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    The point is for people to be able to look in their area for a certain specialty, not be clean when you are looking at the whole country. Once there are enough data points I will be cleaning it up and doing it by specialty, but that requires enough submissions in each specialty. If you zoom in, it won't be as jumbled. Visit the google maps link that I give on the website or here: Physician directed, patient focused practices - Google My Maps.
     
  21. Stagg737

    Stagg737 Illegal in all 50, Unlynchable Wolf
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    I'm part of the same advocacy group and will vouch for OP. The project has been discussed in the group for a while now, glad to see someone is finally getting off the ground.
     
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  22. mmag

    mmag Member
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    Good for you for trying to change the tide as a med student. Admire your courage and dedication. Since you aren't very familiar with anesthesia practices, some groups will cover more than one site (hospital or surgery center) so the address of the practice would be the site (and not the corporate office). Maybe yellow for anesthesia would be sites where the practice is ACT but it's possible to request anesthesiologist only care and get accommodated. I can see the scenario where a patient has a surgeon with privileges at a hospital and multiple surgery centers and requests his/her surgery be done at a place that is anesthesiologist only or willing to accommodate such a request.
     
    #22 mmag, Jan 8, 2019
    Last edited: Jan 8, 2019
  23. OP
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    NicMouse64

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    All of these things can be added in the description, I am aware it's a bit more complicated, than say Direct Primary Care. However, I think it's still worth a shot, and through this I've already found a rare pepe in San Diego! go to san diego on the map and you'll see :). I would name the practice, not the hospital for the location. Check out what I did for san diego and santa barbara physician only group.

    Edit: TBH it looks like ya'll should move to Cali, except for the high tax and COL......
     
    #23 NicMouse64, Jan 8, 2019
    Last edited: Jan 8, 2019
  24. HIPAAHasOneP

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    I requested anesthesiologist only (in advance) at 2 hospitals and an outpatient surgery center in Houston, and I didn't have any problems. I'm about to have another surgery at a 3rd hospital in Houston, and I put anesthesiologist only on the pre-op paperwork. We'll see what happens. I'm willing to cancel it and go elsewhere if they don't agree.
     
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  25. Mman

    Mman Senior Member
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    none that I am aware of anywhere near me of any reasonable size in Virginia, NC, SC, or Georgia. Which groups in Virginia?
     
  26. OP
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    NicMouse64

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    supposedly there is a MD only group in charlottesville, VA. It's on the map.
     
  27. Mman

    Mman Senior Member
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    there is but as I understand they are covering a small (<200 bed) community hospital that isn't very busy
     
  28. OP
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    NicMouse64

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    So what. If patients start requesting them more than an ACT group maybe they can expand to a larger hospital? I don't know, I may be very idealistic, but patients don't have a choice right now. The goal of this map is just to give patients a physician only option. Adding the yellow color was a compromise to make sure that settings where MLPs can be properly supervised can still be added to the map.
     
  29. SaltyDog

    SaltyDog Homey O'Stasis
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    CHKD is essentially MD only although they do have a couple CRNAs which are relegated only to low acuity cases.

    Norfolk General has a separate group for cardiac which is MD only, although everything else there is ACT.
     
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  30. psychbender

    psychbender Cynical Member
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    The group at Carilion Roanoke Memorial is about 50 anesthesiologists, maybe 10 CRNAs. Group in Harrisonburg at Rockingham Memorial is about 22 anesthesiologists, all solo care. Group at Augusta Medical Center in Fisherville is a little over a dozen anesthesiologists. The dozen anesthesiologist solo group at Virginia Baptist in Lynchburg just got absorbed by Centra, and now has some CRNAs. Winchester Anesthesia, Inc is still 50-70% solo physician, 3:1 ACT the remainder (a lot of that at their critical access hospital sites). Most of NOVA and the I95 corridor is now AMC territory, unfortunately.

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  31. OP
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    NicMouse64

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    Are these groups that are hospital employed or are they practices that contract with the hospital? I will add them to the map, just would like clarification of the group names.
     
  32. OP
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    NicMouse64

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    CHKD anesthesia? Or do they contract with CHKD? It would help me if you submit the form.
     
  33. psychbender

    psychbender Cynical Member
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    Work the exception of the Lynchburg hospital, they are all private groups. Since I am not affiliated with any of those practices, I'd not publish those unless you hear from someone from those groups saying that they want to be on that map.

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  34. SaltyDog

    SaltyDog Homey O'Stasis
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    I agree with @psychbender. I'm not gonna speak for any other groups and put them on the map. CHKD = Children's Hospital of the King's Daughters. No idea what the actual anesthesia group's name is.

    LOL. All PP's in SD are MD only.
     
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  35. OP
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    NicMouse64

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    That's fair. I thought you were associated. I am doing self submissions so that people can volunteer to be on the map. I don't want it to be without the knowledge of the practice.
     
  36. mmag

    mmag Member
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    Is the map for groups to advertise themselves or is it for patients to find anesthesiologists? Doximity harvested everyone's pubically available data (from NPI, state licenses, webpages, and who knows who else they paid) for their website and I had to write to them to opt out. You can put a disclaimer that the map is based on self reporting and publicly available information (many groups put on their webpage that they are physician only) and any group can ask to opt out.
     
  37. OP
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    NicMouse64

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    I modified the disclaimer. It is for groups to advertise themselves and for patients to find anesthesiologists/physicians. It is free advertising for those we believe are doing the right thing by not hiring MLPs to increase their bottom line.
     
  38. chocomorsel

    chocomorsel Senior Member
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    Roanoke is 90% MD. In fact one of the attendings has posted on here looking for partners. And that hospital is large. It’s Carrillion and I spoke to them two years ago. They pay well, have immediate financial parity and do most of their own cases.
    @toddlasher where you be at man? Represent!!
     
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  39. SaltyDog

    SaltyDog Homey O'Stasis
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    The only problem is that you have to live in Roanoke.
     
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  40. OP
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    NicMouse64

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    I'd love to put them on the map pending approval from someone in that group. I have friends who live in the area, and a couple have been in the ICU there and received very good treatment by the anesthesiologists. Roanoke is pretty cool IMO!
     
  41. FFP

    FFP Wiseguy
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    That's a beautiful area. I would be worried only about the wild redneck population.
     
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  42. OP
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    NicMouse64

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    It's more hippy/collegey than redneck.
     
  43. chocomorsel

    chocomorsel Senior Member
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    Waaiiit a stinking minute. They do ICU too? If so a sista girl needs to know.
     
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  44. SaltyDog

    SaltyDog Homey O'Stasis
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    Meh, I guess if you like trees and big bugs. If there's not either saltwater or 10,000ft peaks within 20 miles I'm not interested.

    Wild rednecks sound fun though.
     
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  45. psychbender

    psychbender Cynical Member
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    They do not, unfortunately. ICU is entirely separate. Story I heard from someone there is there were some issues with a previous partner that wanted to do more ICU, but they didn't see eye to eye. So, they haven't looked too fondly on people that wanted to spend time it if the OR. Great hospital, though, spent a lot of time there as a med student.

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  46. psychbender

    psychbender Cynical Member
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    The rednecks are there, but mostly in the surrounding counties (Floyd, Giles, Buchanan), and shipped in for medical care.

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  47. OP
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    NicMouse64

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    Sorry meant to say they had surgery, then went to the ICU, from my understanding.
     
  48. FFP

    FFP Wiseguy
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    There is saltwater. What are you talking about?

    Oh, wait, you guys were talking about VA not NC. I so did not pay attention... :oops:
     
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  49. Noyac

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    Just added mine. Physician only.
     
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  50. OP
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    NicMouse64

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    We have about 20 submissions from you all, thanks. I will work on stratifying by specialty this weekend. Thanks for the submissions so far!
     

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