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OTOSwap

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I am a firm believer in not taking short cuts. If one is not prepared to handle all complications, then they should not be doing said procedure. It does not say what procedures she is doing. However, I think the dumping on surgical services that takes place from practitioners across all specialties is not a good thing. Sounds like a disaster just waiting to happen.
 
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anonperson

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The race to the absolute bottom is just starting. It's funny how administrators and bureaucrats will stop at nothing to increase the bottom line especially when it comes to appropriate care from physicians . Yet I never hear of situations where they try to decrease the number of administrators to save money.

The disturbing thing is this is the potential future of medical care. An army of semi competent mid levels with physicians supervising them and putting out fires while assuming all of the risk.

I think back to the scene in Fight Club where Edward Nortons character talks about how a recall is initiated. If the total costs of the settlement and deaths is less than a recall, then it won't happen.

If the cost of various malpractice settlements is less than the potential savings, then this will go forward. I'm sure the number crunchers have already calculated it.

Any physician who sells out their profession by being involved with teaching these nurses needs to be stripped of their medical license. Look what's happened to anesthesia as a specialty because of this mid level encroachment. There was a thread about a patient requesting a physician to provide their anesthesia. It was sad to read some of the anesthesiologists consider this such an inconvenient request that it would be impossible to allow.
 
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Goro

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You guys know this has already been happening in the states for a long time, right?

Not saying it's right or wrong, but surgical PAs do minor procedures like skin excisions (which is all that article described) and other similar complexity procedures unsupervised.
I remember hearing about stuff like this back when I was in college! (Hint: Ford/Carter Administration).
 
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Wordead

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You guys know this has already been happening in the states for a long time, right?

Not saying it's right or wrong, but surgical PAs do minor procedures like skin excisions (which is all that article described) and other similar complexity procedures unsupervised.
"with possible skin grafts and flap reconstructions, without a consultant by her side".

I'd agree that a simple ellipse of tissue is whatever and any monkey can do those but when you start talking about skin grafts and local tissue rearrangement that seems like a bit much.
 

ElwayFan

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Certified Nurse Midwives already deliver babies, repair perineal lacerations, place IUDs, and do colposcopy. Cutting an ellipse around a nevus or small basal cell isn't more difficult than fixing a jagged bleeding perineal laceration.

I know this is the surgery forums and not the OB/GYN forums, but I just want to point out that there are already nurses operating in other fields so the precedent is there. It's not like GYN has not set a precedent for all surgeons before (eg laparoscopy).

You also have to realize that article is in Europe where nurse midwives are more common than USA so the precedent may be stronger over there.
 
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DoctwoB

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Saphenous harvests (including endoscopic), opening and closing a chest, harvesting internal mammary artery? Those complicated enough?

PAs have been doing that solo in cardiac for a long time.

I'm not arguing for this, I'm just saying what's out there. This isn't new
In my mind there is a difference between those cases, where a PA is performing a part of the case independently but under the supervision (albeit often remote) of a CT surgeon, and a nurse operating independently as the attending on a case, including the preoperative decision making. From a technical standpoint, there’s no reason he/she couldn’t competently do simple cases, but there’s a reason that we’re doctors and not technicians.
 

cpants

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I understand the slippery slope arguments, but does anyone really think an RN couldn't be trained to do basic skin lesion excisions and wound closure? That's all they seem to be talking about in the article.
 
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vhawk

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I understand the slippery slope arguments, but does anyone really think an RN couldn't be trained to do basic skin lesion excisions and wound closure? That's all they seem to be talking about in the article.
I dont think people are objecting to their technical competence in performing the procedures. We let residents do them, after all.
 
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cpants

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I dont think people are objecting to their technical competence in performing the procedures. We let residents do them, after all.
Right, I just think it's kind of a sensationalized article. I'm not sure excising some skin lesions should be considered "performing surgery".
 
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vhawk

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Right, I just think it's kind of a sensationalized article. I'm not sure excising some skin lesions should be considered "performing surgery".
I agree with that, for sure.
 

Wordead

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Saphenous harvests (including endoscopic), opening and closing a chest, harvesting internal mammary artery? Those complicated enough?

PAs have been doing that solo in cardiac for a long time.

I'm not arguing for this, I'm just saying what's out there. This isn't new
Basically as said below, those are harvested under a CT surgeon's supervision for their use so I don't necessarily have a problem with that if the CT attending is fine with his ass on the line.

As I recall, this article was about midlevels doing these procedures alone. And like I said, a simple skin ellipse in an area of redundant tissue is easy enough but the article was talking about her basically doing facial lesion excisions and recons solo. I mean most ENT/plastics residents aren't comfortable doing those alone. You can really **** those up and there's not a lot of redundancy most of the time and if you drag the eyelid down or disrupt nasal tip supports or something you probably just committed that patient to a huge procedure down the line.
 
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evilbooyaa

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Wordead said:
Basically as said below, those are harvested under a CT surgeon's supervision for their use so I don't necessarily have a problem with that if the CT attending is fine with his ass on the line.

As I recall, this article was about midlevels doing these procedures alone. And like I said, a simple skin ellipse in an area of redundant tissue is easy enough but the article was talking about her basically doing facial lesion excisions and recons solo. I mean most ENT/plastics residents aren't comfortable doing those alone. You can really **** those up and there's not a lot of redundancy most of the time and if you drag the eyelid down or disrupt nasal tip supports or something you probably just committed that patient to a huge procedure down the line.
Yeah but that's not something the nurse has to worry about, just refer out when she subtly maims a patient or the patient will self-seek out a second opinion, because once again, nurses don't know what they don't know, and will cut and suture, potentially with better skill than a 3rd year medical student, but with a similar level of understanding.
 
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anonperson

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Certified Nurse Midwives already deliver babies, repair perineal lacerations, place IUDs, and do colposcopy. Cutting an ellipse around a nevus or small basal cell isn't more difficult than fixing a jagged bleeding perineal laceration.

I know this is the surgery forums and not the OB/GYN forums, but I just want to point out that there are already nurses operating in other fields so the precedent is there. It's not like GYN has not set a precedent for all surgeons before (eg laparoscopy).

You also have to realize that article is in Europe where nurse midwives are more common than USA so the precedent may be stronger over there.

Delivering babies isn't surgery. Neither is Colposcopy or placing an iud. Midwives at most can repair a basic second degree lac. The ones who try to repair third degree ones end up doing a poor job.
 

Jolie South

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Certified Nurse Midwives already deliver babies, repair perineal lacerations, place IUDs, and do colposcopy. Cutting an ellipse around a nevus or small basal cell isn't more difficult than fixing a jagged bleeding perineal laceration.

I know this is the surgery forums and not the OB/GYN forums, but I just want to point out that there are already nurses operating in other fields so the precedent is there. It's not like GYN has not set a precedent for all surgeons before (eg laparoscopy).

You also have to realize that article is in Europe where nurse midwives are more common than USA so the precedent may be stronger over there.
I still wouldn’t trust a nurse to sew up my knee, let alone perineum. And as another poster mentioned, those procedures aren’t surgery.

Saphenous harvests (including endoscopic), opening and closing a chest, harvesting internal mammary artery? Those complicated enough?

PAs have been doing that solo in cardiac for a long time.

I'm not arguing for this, I'm just saying what's out there. This isn't new
Literally the only thing those PAs do day in and day out is vein harvest so I hope that they are able to do it. The risk of messing up a vein harvest is pretty minimal other than ruining a conduit for a CABG. The fear of wrath of the CT surgeon is probably enough to make them be wary considering that the CT surgeon needs the product of their work to be able to finish the main part of the case. So actually they are not operating autonomously.
 

northernpsy

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Apparently the UK is starting to train nurses to become “surgical care practitioners”. Looking at how aggressively NPs have pushed to take over other areas of medicine (NPs can now practice medicine independently in about half of the states and I do know of physicians in non-surgical fields who have lost jobs to NPs already ), I am very concerned this will become an issue in America too within the next few years.

I strongly encourage all of you to do what you can to make sure that your specialty organizations and state medical societies are prepared to shut this down as soon as the talk starts about “improving access” and “lowering costs” with surgical care practitioners in the US too.

Patients may expect a surgeon to operate on them, but Dalby is one of a small group of nurses who have advanced to the role of surgical care practitioner (SCP).

Soon Dalby’s role will become even more special: come September, she will be able to carry out surgeries, such as facial skin cancer excisions, with possible skin grafts and flap reconstructions, without a consultant by her side.

Unlike other nursing roles in the surgical team, an SCP, as defined by the Royal College of Surgeons (RCS), is involved with the patient from the moment they set foot in the hospital until the moment they go home. Dalby’s nursing background has certainly helped her to this point. She says: “I have a wealth of knowledge from being a nurse that’s helped me take the next step into advanced practice.”
Meet the nurse who will soon perform surgery on patients alone

We can now have a situation where a patient is seen solo by a nurse practitioner in the clinic, who then refers the patient to a nurse who performs surgery solo, assisted by operating room nurses, while anesthesia is given by a nurse anesthetist. There is no need for an actual physician or surgeon except, perhaps, to absorb the liability in case things go awry. I value the nurses who are an integral part of our health care team, but I would not want to be the patient in this scenario.
https://blogs.jamanetwork.com/topics-in-ophthalmology/blog/nurse-will-see-now-operating-room/
 
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DarknightX

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Anyone who is arrogant or foolish enough to take someone to the OR for an operation without the proper training will learn the hard way how difficult it is. So will their patients.

If some NP or PA thinks they can do a lap chole on their own without doing hundreds of them, then they should have their head examined. Surgery is not like other fields. You can't BS or shortcut your way through it. Only way you can learn is doing it over and over and over again. Which is why surgical residency is different than other residencies.

Good luck on the malpractice insurance for these practitioners. These carriers are not stupid. They know the risks very well.
 
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kidthor

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Good luck on the malpractice insurance for these practitioners. These carriers are not stupid. They know the risks very well.
Oh they'll just have a physician "supervise" them in some sense... to put out fires or to be a liability sponge after the fact. That's what's happened to us in anesthesiology... (to be clear I'm an anesthesiologist wandering by y'all the surgery forum)
 
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boogaaloo

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How long before this catches on in the US?
 
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