not just CRNAs

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nvrsumr

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  1. Attending Physician
I'm digging that gold jacket. And that belt...she must have forgotten to take it off after her last set of deadlifts!

Nonetheless, she appears to be a pretty good businessperson.
 
outrageous.

i guess we should get used to. This is who is going to providing medical services in the near future...
 
I love ths quote:

A PA can work side by side with a specialist and learn from one, and then change and learn from another which can be a huge advantage when it comes to creating an arsenal of weapons with which to bombard a disease


What a friggin IDIOT!!!!! She's never going to "bombard" anyone in my family, that's for sure. Why aren't the PA's doing interventional cardiology procedures?....because cardiologists know how to protect their turf (and these PA's are scared of touching the heart (or carotids or GI tract or coronaries, etc) but they think every epidural they've done under the supervision of some douche attending is easy even though they don't know the proper treatment algorithm and are messing around with someone's spine)
 
painstop said:
I love ths quote:

A PA can work side by side with a specialist and learn from one, and then change and learn from another which can be a huge advantage when it comes to creating an arsenal of weapons with which to bombard a disease


What a friggin IDIOT!!!!! She's never going to "bombard" anyone in my family, that's for sure. Why aren't the PA's doing interventional cardiology procedures?....because cardiologists know how to protect their turf (and these PA's are scared of touching the heart (or carotids or GI tract or coronaries, etc) but they think every epidural they've done under the supervision of some douche attending is easy even though they don't know the proper treatment algorithm and are messing around with someone's spine)
Click to expand...
Are PAs doing epidurals?

I know the original poster gave the link that shows she is the OWNER/founder of this group. But is she actually doing ESIs?

If she is, she shoudl have her license reported on. Whoever knows the doc in that group should tell him that he's doing a disservice...
 
In my area there is a huge pain practice that, off of the top of my head, has about a 3 to 1 ratio of mid levels to MDs. I know of a local pt who went there and the eval, provedure, and follow up were all done by a PA. Pt got a less than expected response, saw me, and the MD owner of that group sent me a long nasty letter asking why I had a problem with PAs doing this. Huh?
 
Wow! Send him back a letter telling him the ASA, ISIS, ASIPP, NASS, and several other prominent national organizations have a problem with him letting PAs do interventional pain procedures. It is substandard care and any bad results are automatically deemed malpractice by the majority of interventional physicians in the country, and that we will fry him in court (along with his PA)
 
specepic said:
In my area there is a huge pain practice that, off of the top of my head, has about a 3 to 1 ratio of mid levels to MDs. I know of a local pt who went there and the eval, provedure, and follow up were all done by a PA. Pt got a less than expected response, saw me, and the MD owner of that group sent me a long nasty letter asking why I had a problem with PAs doing this. Huh?
Click to expand...


Who is this guy and his practice?

This sort of thing should be exposed. I'm all about protecting physicians and would never be a plaintiff's expert witness.

But this sort of thing is ridiculous. Completely. Maybe if he doesnt listen to you, he'll listen to someone else on this forum. This is clearly malpractice and substandard care.
 
it looks like they primarily do personal injury/motor vehicle cases - and she works as a referral coordinator plugging people in with chiropractors until they exhaust their med-pay benefits...
brilliant...
 
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PinchandBurn said:
Are PAs doing epidurals?

I know the original poster gave the link that shows she is the OWNER/founder of this group. But is she actually doing ESIs?

If she is, she shoudl have her license reported on. Whoever knows the doc in that group should tell him that he's doing a disservice...
Click to expand...

All anyone has to do is call and ask if you could schedule an ESI with her.
 
From the website: "If necessary, you will be referred to one of the attorneys on our legal team to handle the your legal issues."

They have their own legal team?
 
facetguy said:
From the website: "If necessary, you will be referred to one of the attorneys on our legal team to handle the your legal issues."

They have their own legal team?
Click to expand...

this is what is wrong with healthcare...oi vey...
 
specepic said:
In my area there is a huge pain practice that, off of the top of my head, has about a 3 to 1 ratio of mid levels to MDs. I know of a local pt who went there and the eval, provedure, and follow up were all done by a PA. Pt got a less than expected response, saw me, and the MD owner of that group sent me a long nasty letter asking why I had a problem with PAs doing this. Huh?
Click to expand...

Post the letter here!
 
Ligament said:
Post the letter here!
Click to expand...

Not sure how much I want to air dirty laundry on the non-private forum. Happy to PM folks the practice name as I think some action needs to be taken and this guy does not care what another local doc thinks. On the other hand, what exactly can be done? I read my state law on this and it says that a PA can pretty much do whatever a doc does as long as their superv. MD/DO is 'available', not in the same room, but building/campus/etc. Now, I have no doubt that ASA, ISIS, etc. have standards that go beyond that but is their really any enforcement power? There were other issues with this case including exaggerating the percentage relief to MBB to meet threshold for payor per pt. Images were also not saved and I was told this was standard for them for MBB's (?other procedures). I usually do not comment much on the work of other pain docs and did not initially believe it when the pt told me, so my staff looked into it and it was true per their office (and no shame whatsoever). I should add this practice is a steady advertiser on this site.

Move to private forum?
 
Pain organizations have the power to strip a person of membership. The state medical board can be approached from the standpoint of public safety and substandard practices reported. If there are other docs in your state that agree this is substandard care, a joint letter to the state medical board may have significant impact. Also, become a delegate to the state medical association and work to create a resolution asking for legislative action that would prevent substandard care.
 
DocShark said:
this is what is wrong with healthcare...oi vey...
Click to expand...


I don't know how the American legal system works, but this site / clinic seems awfully geared towards obtaining med / legal consults ( with the related revenue related to this ).

Yes?

"Hurt in a car? Call Willam McKarr!"

Ambulance chasing behavior.
 
facetguy said:
From the website: "If necessary, you will be referred to one of the attorneys on our legal team to handle the your legal issues."

They have their own legal team?
Click to expand...

Do you get to see a real lawyer or just the paralegal? 😀
 
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My wife was in a MVA a few years ago. She started receiving letters from chiros a few days later. They must sift through the police reports.
 
specepic said:
Not sure how much I want to air dirty laundry on the non-private forum. Happy to PM folks the practice name as I think some action needs to be taken and this guy does not care what another local doc thinks. On the other hand, what exactly can be done? I read my state law on this and it says that a PA can pretty much do whatever a doc does as long as their superv. MD/DO is 'available', not in the same room, but building/campus/etc. Now, I have no doubt that ASA, ISIS, etc. have standards that go beyond that but is their really any enforcement power? There were other issues with this case including exaggerating the percentage relief to MBB to meet threshold for payor per pt. Images were also not saved and I was told this was standard for them for MBB's (?other procedures). I usually do not comment much on the work of other pain docs and did not initially believe it when the pt told me, so my staff looked into it and it was true per their office (and no shame whatsoever). I should add this practice is a steady advertiser on this site.

Move to private forum?
Click to expand...

according to my source, this pain guy voluntarily submitted his medical license after under medicare investigations. I could be wrong.
 
Don't knock her. She has a "BS is advertising" and a "BS in physicians assistant".

That is some serious BS.
 
Mister Mxyzptlk said:
My wife was in a MVA a few years ago. She started receiving letters from chiros a few days later. They must sift through the police reports.
Click to expand...

Yeah, I had the same thing when I lived in Wisconsin. Had a minor MVA, started getting calls from lawyers to represent me and chiros to treat me.

The most fun was asking the chiro's phone reps "Would you like to guess what I do for a living?"

Even after telling her my occupation, one said "well sometimes you have injuries that you don't even know about and it takes a skilled chiropractor to find those injuries and treat them." I'm not sure how long I laughed at her, but it was probably several minutes.
 
We have a group here with a couple of satellite offices on the outskirts of the city that are manned by PA's with some form of traveling "Doc" to each site. Came by to see me with folders,flyers etc. Talked about medication management they offer and mentioned they do trigger point injections too. The she, the PA, said enthusiastically "we are hoping to get a c-arm soon!" to which I replied, "what will you do with that?" then it was just silence.
 
mdvol said:
We have a group here with a couple of satellite offices on the outskirts of the city that are manned by PA's with some form of traveling "Doc" to each site. Came by to see me with folders,flyers etc. Talked about medication management they offer and mentioned they do trigger point injections too. The she, the PA, said enthusiastically "we are hoping to get a c-arm soon!" to which I replied, "what will you do with that?" then it was just silence.
Click to expand...


the physician assistants at the office in question apparently do all manner of fluoroscopically guided procedures, apparently to even include things like discograms.
 
specepic said:
the physician assistants at the office in question apparently do all manner of fluoroscopically guided procedures, apparently to even include things like discograms.
Click to expand...

Interesting. I will definitely look into this more now.
 
make sure your local medical board does as well. Gotta wonder about the ethics of the physician supervising those "interventional PAs". The way to stop them from doing inappropriate procedures is through him.
 
The war is over guys, our side just can't see it yet.

Mid levels are taking over primary care and moving on to specialty care. Physicians are becoming an endangered species.

I can't wait for the day PAs and NPs are doing brain surgery w/o a phsycian present. I give it less than 10 years. The PA will have a professional surgical assistant and a CRNA keeping the pt asleep. MDs will be paper-pushers and dinosaurs.
 
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PMR 4 MSK said:
The war is over guys, our side just can't see it yet.

Mid levels are taking over primary care and moving on to specialty care. Physicians are becoming an endangered species.

I can't wait for the day PAs and NPs are doing brain surgery w/o a phsycian present. I give it less than 10 years. The PA will have a professional surgical assistant and a CRNA keeping the pt asleep. MDs will be paper-pushers and dinosaurs.
Click to expand...

YUP! Game has been over for a while now. MD/DOs will just become medicolegal, non-clinical managers who essentially sit in an office and oversee the clinicians mid-levels.
 
Mister Mxyzptlk said:
My wife was in a MVA a few years ago. She started receiving letters from chiros a few days later. They must sift through the police reports.
Click to expand...

And it's unfortunately easy to extrapolate to the whole chiro profession. Crap like this makes it more difficult for the majority of us that would never engage in this shady behavior.
 
Actually i think the CRNAs plan to do the surgery, have CRNAA to assist, and family docs will keep the patient asleep....
 
algosdoc said:
Actually i think the CRNAs plan to do the surgery, have CRNAA to assist, and family docs will keep the patient asleep....
Click to expand...

I'm thinking of going back to nursing school and then CRNA school.
 
Just keep doing what you're doing. Let someone else get bitten on the ass for supervising under-trained staff doing medical procedures. Have you seen what happens when a CRNA screws up? The doctor takes the med-mal bullet.

You don't need that.
 
Agree. I also think PA's will eventually push for independence so they can get rid of the overseer and make more money.
 
PMR 4 MSK said:
The war is over guys, our side just can't see it yet.

Mid levels are taking over primary care and moving on to specialty care. Physicians are becoming an endangered species.
Click to expand...

The VAST majority of my referrals come from people whose credentials end in FNP or PA-C.

I feel bad for the patients when I see how complex their histories are, and how little they realize they're being screwed. That is not intended as a slight against mid-levels- many are well trained and mean well, but from my perspective it appears they take on way more than they can reasonably handle.
 
altap said:
Agree. I also think PA's will eventually push for independence so they can get rid of the overseer and make more money.
Click to expand...

hasn't happened in over 40 yrs and won't happen.
many supervised specialty pa's already make more than primary care docs. we don't need to overthrow anyone to make good money. a derm pa friend of mine working for a dermatologist 4.5 days/week with no weekends and no call made 187k last yr. ( the docs probably made 3x that based on his collections before doing any work themselves). docs make a lot of money from us so we are a good investment.
the highest earner in my em pa group made 200k last yr. there are many em and surgical pa's who routinely make 150k+/yr with no overhead.
if I was independent I would need to start buying my own malpractice and benefits and funding my own retirement. no thanks.
 
Last edited by a moderator:
PMR 4 MSK said:
The war is over guys, our side just can't see it yet.

Mid levels are taking over primary care and moving on to specialty care. Physicians are becoming an endangered species.

I can't wait for the day PAs and NPs are doing brain surgery w/o a phsycian present. I give it less than 10 years. The PA will have a professional surgical assistant and a CRNA keeping the pt asleep. MDs will be paper-pushers and dinosaurs.
Click to expand...



I have been saying this for years. Soon it will be nurse midwives doing C-sections, surgical PAs/NPs doing lap choles and appendectomies, ortho PAs doing simple pinnings and placing ex-fixes, and the list goes on. Eventually practice privileges will expand to more complex procedures as state nursing boards become more powerful. The main problem isn't the lack of physicians warning about this, but its the fact insurance companies are supporting this by paying for it and states see this as a cheaper way to pay for medical care. And no one can argue that mid-level care is comparable to physician care, it is clearly inferior. I have seen mid-levels (apparently supervised by physicians) almost kill patients with medication overdoses, prescribe antipsychotics to a diabetic obese woman with mild depression (not considering the serious metabolic issues that come with these meds), butcher woman with vacuum assisted deliveries, and the list goes on. We go through hours and hours of training for a reason, because human physiology and pathology is complex and requires critical thinking. I knew this was coming when, as a resident, I was being "supervised" placing lines by a PA who had never placed an IJ before and the number I had already done was upwards of 30.
 
I can't wait for the day that you can just go to the hospital and write orders for "please implant SCS, two leads at T8" in the chart and let the nurse-doctors take care of it while I'm sitting out in the sun holding a drink with a little umbrella in it.
 
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W222 said:
We go through hours and hours of training for a reason, because human physiology and pathology is complex and requires critical thinking.
Click to expand...

This is the line that always comes up to defend MD/DO level care vs mid-level care. We go through so much more training... therefore we're better equipped to deliver the highest standard of care. While this is true, it ignores what I feel is an even larger piece of the puzzle, and that's the aptitude of those entering medical school vs PA/NP/CRNA/etc mid-level school. Whereas there are clearly some very smart folks becoming mid-levels, and a few dummies do manage to end up with MD/DO after their name, on average comparing physicians to midlevles is apples to oranges. Both may have had a 3.72 GPA in undergrad, but the physician is much more likely to have earned that from a highly competitive top 25 or 50 institution. Now take that highly select group, and force them to compete over grades in med school-- you end up with exceptionally well trained people. It's ludicrous to even compare a midlevel program to this pool of talent. Anyone can "train longer" or "train thoroughly", but the key is the pool of talent in which you're completing that training. Physicians vs midlevels are like pro vs high school sports.
 
pmr 4 msk said:
the war is over guys, our side just can't see it yet.

Mid levels are taking over primary care and moving on to specialty care. Physicians are becoming an endangered species.

I can't wait for the day pas and nps are doing brain surgery w/o a phsycian present. I give it less than 10 years. The pa will have a professional surgical assistant and a crna keeping the pt asleep. Mds will be paper-pushers and dinosaurs.
Click to expand...

1+.
 
Def agree. Having been a TA for the nursing students chemistry...I can tell you the course was not the same. I was a different class. It was chemisty for nursing majors...actually allied health, but it was much less rigorous. And the papers I graded...oi vey

powermd said:
This is the line that always comes up to defend MD/DO level care vs mid-level care. We go through so much more training... therefore we're better equipped to deliver the highest standard of care. While this is true, it ignores what I feel is an even larger piece of the puzzle, and that's the aptitude of those entering medical school vs PA/NP/CRNA/etc mid-level school. Whereas there are clearly some very smart folks becoming mid-levels, and a few dummies do manage to end up with MD/DO after their name, on average comparing physicians to midlevles is apples to oranges. Both may have had a 3.72 GPA in undergrad, but the physician is much more likely to have earned that from a highly competitive top 25 or 50 institution. Now take that highly select group, and force them to compete over grades in med school-- you end up with exceptionally well trained people. It's ludicrous to even compare a midlevel program to this pool of talent. Anyone can "train longer" or "train thoroughly", but the key is the pool of talent in which you're completing that training. Physicians vs midlevels are like pro vs high school sports.
Click to expand...
 
DocShark said:
Def agree. Having been a TA for the nursing students chemistry...I can tell you the course was not the same. I was a different class. It was chemisty for nursing majors...actually allied health, but it was much less rigorous. And the papers I graded...oi vey
Click to expand...

Coming for the Canadian perspective: this is NUTS !!!!!!!!

I REALLY don't see how this can be justified: from a medical, financial, or medical - legal perspective (or any perspective you can think of). This is straight up crazy.

The only thing we have close to this is that of the nurse practioner.

Having said this, however, Toronto has just started a Physician's Assistant program. God , I hope this is NOT a taste of the future.

If you want to be a MD: hey , here's a zany idea- go to medical school.
 
powermd said:
The VAST majority of my referrals come from people whose credentials end in FNP or PA-C.

I feel bad for the patients when I see how complex their histories are, and how little they realize they're being screwed. That is not intended as a slight against mid-levels- many are well trained and mean well, but from my perspective it appears they take on way more than they can reasonably handle.
Click to expand...


A good PA/NP is like a good resident; they know their limits.

The dangerous ones are the one who don't recognize this.

We take Tricare; the midlevels in the armed forces, at best, are undertrained. At worst...I think our active duty folks deserve a lot better.
 
my worst experiences with PAs/NPs have been with spine surgery PA/NPs... they think they can read imaging, think they can make surgical decisions... dangerous...
 
Part of me wants to say let midlevels be independent and take all the liability that goes with the territory, but like some have said a lot of patients don't know enough about medicine to know when they are being grossly mismanaged by a midlevel.

This whole push is coming from a portion of midlevels (some really do enjoy the lack of liability d/t supervision and the smaller scope of practice) and payors, not patients. I think we as physicians need to help patients understand the crap care they are getting when they are getting it, and I think any major pushback against what's happening needs to come from patients over physicians. A constant argument from pushy midlevels is "physicians are protecting their turf, they're trying to keep their marketshare etc" and I think having patients really come out in force and say "I want to be cared for by a physician and not a midlevel" will take the wind out of that tired turf-protection argument.
 
Mattchiavelli said:
Part of me wants to say let midlevels be independent and take all the liability that goes with the territory, but like some have said a lot of patients don't know enough about medicine to know when they are being grossly mismanaged by a midlevel.

This whole push is coming from a portion of midlevels (some really do enjoy the lack of liability d/t supervision and the smaller scope of practice) and payors, not patients. I think we as physicians need to help patients understand the crap care they are getting when they are getting it, and I think any major pushback against what's happening needs to come from patients over physicians. A constant argument from pushy midlevels is "physicians are protecting their turf, they're trying to keep their marketshare etc" and I think having patients really come out in force and say "I want to be cared for by a physician and not a midlevel" will take the wind out of that tired turf-protection argument.
Click to expand...

The 'push' is coming from none other than Don Berwick.
 
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