How do you find an Anesthesiologist for ECT?

[Blitz2006]

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So I'm interested in doing ECT after residency, and my attending was telling me that it is primarily done as outpatient setting.

He said the hardest part is finding an anesthesiologist, cause they would rather be in the OR doing hernias and gall bladders. True?

Also,

1) How do Psychiatrists find Anesthesiologists to team up with for ECT?

2) My attending also said Mt. Sinai does like 20-30/day. If I want to do ECT, is it better to join an academic faculty?

3) On average, what are the hours like for ECT? 7am to 9am? 6am to 8am?

Thanks,

 

[vistaril]

So I'm interested in doing ECT after residency, and my attending was telling me that it is primarily done as outpatient setting.

He said the hardest part is finding an anesthesiologist, cause they would rather be in the OR doing hernias and gall bladders. True?

Also,

1) How do Psychiatrists find Anesthesiologists to team up with for ECT?

2) My attending also said Mt. Sinai does like 20-30/day. If I want to do ECT, is it better to join an academic faculty?

3) On average, what are the hours like for ECT? 7am to 9am? 6am to 8am?

Thanks,

I'm not sure your attending knows what he is talking about. I don't do ect,but the VAST majority of cases I've ever heard of are not done outpt. They generally aren't done in major or suites either of course, but a lot are done in post-op type rooms. Not psych owned outpt practices.

Anesthesia bills by unit, so all they care about is making sure their units come out ok. They would be ok with doing ect cases IF there was absolutely no down time that preventing them from acquiring appropriate units. But given the nature of eft, I doubt that is likely.....

Anesthesiologists are going to want to collect enough units to take home 2500+ per day after their very minimal expenses(basically just a few percent for billing and collections). I seriously doubt an 'ect practice' could generate that for them.

Also the vast majority of anesthesia for cent is of course going to be crnpcrnp

 

[Blitz2006]

I'm not sure your attending knows what he is talking about. I don't do ect,but the VAST majority of cases I've ever heard of are not done outpt. They generally aren't done in major or suites either of course, but a lot are done in post-op type rooms. Not psych owned outpt practices.

Anesthesia bills by unit, so all they care about is making sure their units come out ok. They would be ok with doing ect cases IF there was absolutely no down time that preventing them from acquiring appropriate units. But given the nature of eft, I doubt that is likely.....

Anesthesiologists are going to want to collect enough units to take home 2500+ per day after their very minimal expenses(basically just a few percent for billing and collections). I seriously doubt an 'ect practice' could generate that for them.

Also the vast majority of anesthesia for cent is of course going to be crnpcrnp

Cool, thanks.

Well I just want to do ECT like 3 mornings a week or something. I'm sure this is possible in a large urban area...or no?

 

[st2205]

We do plenty of outpatient ECT (nearly all is outpatient). That said, it's in our PACU. I'll likely be going to a state where there's almost no ECT. Haven't given it a whole lot of thought, but the idea floating in my head is an outpatient surgical center that's part of a larger multispecialty physician clinic. I'm sure it'd be advantageous to send in CRNAs at 7 am. So, I would not be looking for a person but rather a place.

 

[Shikima]

You'll need to associate yourself with a hospital most likely while building the practice and generating referrals. Collaborating with hospital admin and the OR dept chiefs will help you get started as they'll book a room block 1 day/week for ECT. This is traditionally how I've seen it done in ORs I've worked with. I don't know the full in's/out's but a surgical center many not be the right place, but don't quote me verbatim.

 

[Blitz2006]

We do plenty of outpatient ECT (nearly all is outpatient). That said, it's in our PACU. I'll likely be going to a state where there's almost no ECT. Haven't given it a whole lot of thought, but the idea floating in my head is an outpatient surgical center that's part of a larger multispecialty physician clinic. I'm sure it'd be advantageous to send in CRNAs at 7 am. So, I would not be looking for a person but rather a place.

Nice. How many ECTs does the average attending do at your outpatient setting in a week? And roughly what are the hours in the AM?

 

[Blitz2006]

You'll need to associate yourself with a hospital most likely while building the practice and generating referrals. Collaborating with hospital admin and the OR dept chiefs will help you get started as they'll book a room block 1 day/week for ECT. This is traditionally how I've seen it done in ORs I've worked with. I don't know the full in's/out's but a surgical center many not be the right place, but don't quote me verbatim.

Thanks again. Is it realistic to do a full day (7-5) of ECT per week?

We don't do much ECT at my program, so I'm a bit ignorant of the N patients for ECT for the typical psychiatrist.

 

[vistaril]

We do plenty of outpatient ECT (nearly all is outpatient). That said, it's in our PACU. I'll likely be going to a state where there's almost no ECT. Haven't given it a whole lot of thought, but the idea floating in my head is an outpatient surgical center that's part of a larger multispecialty physician clinic. I'm sure it'd be advantageous to send in CRNAs at 7 am. So, I would not be looking for a person but rather a place.

of course, but I don't think a pacu of a large system is what the OP was talking about when he said outpt(my impression was that he was referring to psych owned outpt practices that would also collect facility fees and such for the procedure). ie talking about 'finding an anesthesiologist'.

I don't think finding a crna to work with is going to be a big problem at all. Their group is just going to assign someone to do them, probably because their group has to cover all cases as part of the contract with the system. The vast majority of psychiatrists who do ect in non academic settings are billing for the procedure code only.....they could care less how the system finds the crna to stand there chewing gum for a few minutes.

 

[st2205]

Nice. How many ECTs does the average attending do at your outpatient setting in a week? And roughly what are the hours in the AM?

All ECT is done at the same place whether inpatient or outpatient. This is in the hospital and not literally outpatient in setting (i.e. a clinic). That said, typically 2-5 cases MWF from 7 am - 8 am.

Thanks again. Is it realistic to do a full day (7-5) of ECT per week?

No. You also have to consider how these people are evaluated. For example, are you going to have other people refer to you without you seeing them and finding them appropriate for ECT? I'd imagine that most places, when they're doing ECT on someone they don't know, the referral was placed by a colleague within the same system. So determining where you're getting your cases from would probably be important, I'd imagine, but I can't say I have real world working knowledge of this.

of course, but I don't think a pacu of a large system is what the OP was talking about when he said outpt(my impression was that he was referring to psych owned outpt practices that would also collect facility fees and such for the procedure). ie talking about 'finding an anesthesiologist'.

I don't know. I clarified above, if that's the case. I read it as he/she just wants to do ECT.

 

[milesed]

We always did it in the recovery room of a hospital with a nurse anesthetist. They could do it and head on to other cases very quickly.

 

[doctorpilgrim]

1 ECT with turnover time is 15 minutes and that is in an efficient system, usually done in endoscopy/day surgery suite room with a CRNA. I have only seen/done maximum 10 to 12 a day. A practice with only ECT will be a major metro health system in academic center. The main limiting factor is the referral base of appropriate patients.
The most commonly cited figure in the US is 100,000 patients receiving ECT annually.

 

[scudiera]

of course, but I don't think a pacu of a large system is what the OP was talking about when he said outpt(my impression was that he was referring to psych owned outpt practices that would also collect facility fees and such for the procedure). ie talking about 'finding an anesthesiologist'.

So what would a Psychiatrist have to do/own to collect facility fees? Essentially they'd need to buy in to that portion of a practice, correct? Just wondering the practice logistics of this.