Midlevels and procedures?

[itzamemario]

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Can midlevels (PA or NP) do nerve blocks, Nerve ablation, SIJ injections? My job is asking the doctors to teach the midlevels how to do these, and I'd love some insurance guidelines that says no. I haven't found anything so maybe this is a common thing throughout the country?

 

[BobBarker]

If you are going to to have a midlevel do a cervical rfa there is no point in having doctors in the practice. You are training your replacement.

 

[itzamemario]

If you are going to to have a midlevel do a cervical rfa there is no point in having doctors in the practice. You are training your replacement.

I agree. I'm guessing it's more shoulder RFA and nerve block , but I'd be terrified having Mbbs or RFA someone who hasn't done thousands.

 

[Multimodal]

You can tell them that you will train them once they've gone to med school, completed residency, and are doctors. Midlevels are not intended for procedural work although there are examples of midlevel run block shops. yikes

 

[mdo1738]

Tell them no.

I know they allow it some states. Doesn’t mean it’s right or that you should be contributing to the problem. I have a patient that used to live in Colorado tell me on her first visit “shots just don’t work for me doc, they already tried a bunch there.” Managed to track down the fluoro images where a CRNA had performed a couple paraspinal blobograms. An actual TFESI worked great. Don’t enable malpractice.

 

[Agast]

It’s a formal training process for doctors to become proficient on it, how could midlevel possibly pick it up on the fly? Even CRNAs get some sort of certification practicing on dead bodies.

 

[Laryngospasm]

Find a new job

 

[oneforfighting]

Can midlevels (PA or NP) do nerve blocks, Nerve ablation, SIJ injections? My job is asking the doctors to teach the midlevels how to do these, and I'd love some insurance guidelines that says no. I haven't found anything so maybe this is a common thing throughout the country?

Is this private practice or HOPD

 

[Gnarvin]

I am confused how it is your job to ask physicians to teach midlevels procedures…

 

[itzamemario]

Find a new job

Working on it haha

 

[itzamemario]

Is this private practice or HOPD

Private

 

[Kissmyabjj]

Tell them no.

I know they allow it some states. Doesn’t mean it’s right or that you should be contributing to the problem. I have a patient that used to live in Colorado tell me on her first visit “shots just don’t work for me doc, they already tried a bunch there.” Managed to track down the fluoro images where a CRNA had performed a couple paraspinal blobograms. An actual TFESI worked great. Don’t enable malpractice.

lol at paraspinal blobograms

 

[lobelsteve]

Private

equity

 

[clubdeac]

The big radiology group in town has their PAs do all of their fluoro guided PICC lines, chest tubes, organ biopsies, LPs etc. just heard one of them introduce himself as the interventional radiologist to a patient the other day. Really pissed me off

 

[interjectionreflection]

I've seen this before. Some surgeons train their PAs to do cryal ablation, MSK injections, nerve blocks and all sorts of spine injections. It's motivated by greed no matter what they tell you. It does not increase access to care. It just increases access to Lamborghinis for the doctor using them. That is of course until they go off on their own

 

[DOctorJay]

View attachment 4

 

[SSdoc33]

maybe joints and TPIs. thats it. nothing close to the spine

 

[interjectionreflection]

maybe joints and TPIs. thats it. nothing close to the spine

Slippery slope. That's how it always starts. I've seen NPs do colonoscopies and saw an article about PA being trained to do TAVI in UK. I'm sure those also started with minor procedures

 

[SpineandWine]

Don’t do it.
It’ll bite you
Make them do follow ups and med refills

 

[DOctorJay]

what are the qualifications of the people asking you this question?

 

[Ducttape]

The big radiology group in town has their PAs do all of their fluoro guided PICC lines, chest tubes, organ biopsies, LPs etc. just heard one of them introduce himself as the interventional radiologist to a patient the other day. Really pissed me off

well, given what i have experienced with interventional radiologists, it is a relatively low bar for someone to call themselves an interventional radiologist

 

[Baron Samedi]

maybe joints and TPIs. thats it. nothing close to the spine

When the patient comes back with a septic knee is the midlevel going to manage it?

Or more likely how happy will the patient be when all their viscosupplement ends up in Hoffa's fat pad and they can barely move their knee?

 

[SSdoc33]

When the patient comes back with a septic knee is the midlevel going to manage it?

Or more likely how happy will the patient be when all their viscosupplement ends up in Hoffa's fat pad and they can barely move their knee?

give them the scraps from Longshanks' table

i dont like the idea of midlevel creep, but its a fact of life

 

[Dansk2011]

Tell them no.

I know they allow it some states. Doesn’t mean it’s right or that you should be contributing to the problem. I have a patient that used to live in Colorado tell me on her first visit “shots just don’t work for me doc, they already tried a bunch there.” Managed to track down the fluoro images where a CRNA had performed a couple paraspinal blobograms. An actual TFESI worked great. Don’t enable malpractice.

Yeah I live in Colorado. It's insane. There are crnas doing pain procedures all over. A lot of the more rural places don't have physicians. Instead the hospitals hire crnas probably because it's cheaper. They do a bunch of injections that don't work then send them to us when things have failed. It's aggravating.

 

[buddababa]

Yeah I live in Colorado. It's insane. There are crnas doing pain procedures all over. A lot of the more rural places don't have physicians. Instead the hospitals hire crnas probably because it's cheaper. They do a bunch of injections that don't work then send them to us when things have failed. It's aggravating.

need to get in bed with insurance to only allow board certified doctors to do this

 

[clubdeac]

need to get in bed with insurance to only allow board certified doctors to do this

Honestly not sure why insurance and Medicare don’t limit who can bill for these services. Seems like a no brainier way to control costs and rein in over utilization. Surprised they didn’t do this years ago. Unless of course they secretly don’t want to decrease over utilization so they can justify further payment cuts 🤔

 

[Malayil]

Don’t do it.
It’ll bite you
Make them do follow ups and med refills

I read it as “I’ll bite you” 😂

 

[Joosbocks]

Don't train midlevels to do anything. They should be fully formed coming out of their training programs, or they have no business endangering patients. You would never allow a new grad med student to do full independent physician work. If these midlevels want to claim equivalence to doctors to keep replacing us, cut them off from our knowledge streams and see what the blind leading the blind does.

Medicine is sometimes a cruel hazing ritual, but we should not falsely deny (complaints about gen z aside) that it creates people who know medicine, how to learn new medicine, and are (on average) of general higher intellect and ethics than almost all of the rest of the general population. Doctors are the only ones who deserve the trust of these patients. And given the fallibility of certain physicians, we should be even stronger in our self-policing of ethics, not give up the project altogether and open the floodgates.