Ortho group hired CRNA to do pain??

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neuroride

neuroride

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So the main ortho group that we work with and have a partnership with in a surgery center have decided to hire a CRNA in their office to do their pain procedures with fluoro. We have been getting their referrals for years and doing pain in the surgery center that we collectively share. Now they will just have the CRNA do their patients epidural/hips etc instead of send them to us. Makes no sense other than money.

With a super liberal state willing to let CRNA's do just about anything, we are at odds what to do? Hopefully he will be as bad as we think and they will give up. Worst case scenario they try to steal our other 75% FM referral base. I have started calling the medicine groups around the area to describe what is happening and who will be doing the procedures now trying to get them to see how dumb this is.

Thoughts?
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why do you think he will be bad? I know crnas who are pretty good at procedures. doing procedures is not all that difficult, especially if the workup leading to the patient needing an interventional pain procedure has already been done by an actual physician. unfortunately it IS all about money and hoping he will be bad is probably all you can do.
 
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A number of people have seen this coming. Anything that's "monkey see monkey do" will be up for grabs. This should be a huge warning sign for some anesthesiologists, the kind that are just CRNA++.

Oh, and people get pissed when I say that a good number of regional/pain procedures could be learned during a weekend conference (one per procedure). If they can do spinals/epidurals blindly in OB, playing videogames with a needle is not such a big deal. It's just a matter of routine. This is not advanced cardiac echo (and even that is not needed for nonvalvular cardiac surgery).

This is going to happen more and more, because in ALL the states CRNAs can practice under the supervision of ANY physician. Top of the license, remember?

@neuroride, if you guys are good, this shouldn't be a problem; the patients will notice the difference in outcomes. If you are like the average pain shaman, it's gonna be tough.
 
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How is the malpractice situation in your state? If it's anything like mine the pain docs get sued a lot. That seems like a risky endeavor for the orthos if they are "supervising" this CRNA...and his/her malpractice policy may become so pricy it's not worth it for them to have a nurse doing this anymore if he does in fact suck.
 
Even if he sucks at the beginning, he'll be good after doing them every day for a month. Unless he's a ******.
 
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Curious if the ortho guys are comfortable writing pain scripts besides the usual Percocet / Vicodin . Is the crna allowed to write scripts ? Most of the pain guys who do hi volume have that volume because they also write. a lot of scripts . I dunno why would you refer a pt out to a pain doc or in this case crna if you have to write pain meds yourself or refer to another pain doc that will do the scripts also.


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This sounds like orthopods getting greedy and wanting to make some cash while doing pre-op epidurals that preferably wouldn't work, which justifies going with the surgical solution.
I bet you these guys do spine, so they need to document that they offered the patient less invasive pain management that did not work, then they can convince the insurance company or Medicare to pay for the laminectomy or even for a joint replacement. It's a common scheme, a bit sleazy but they seem to get away with it.
actually if this CRNA turns out to be good they might have to fire him!
 
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neuroride said:
So the main ortho group that we work with and have a partnership with in a surgery center have decided to hire a CRNA in their office to do their pain procedures with fluoro. We have been getting their referrals for years and doing pain in the surgery center that we collectively share. Now they will just have the CRNA do their patients epidural/hips etc instead of send them to us. Makes no sense other than money.

With a super liberal state willing to let CRNA's do just about anything, we are at odds what to do? Hopefully he will be as bad as we think and they will give up. Worst case scenario they try to steal our other 75% FM referral base. I have started calling the medicine groups around the area to describe what is happening and who will be doing the procedures now trying to get them to see how dumb this is.

Thoughts?
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Goes to show how much they respect your work.

What is FM referrals? Family Medicine?
 
Planktonmd said:
This sounds like orthopods getting greedy and wanting to make some cash while doing pre-op epidurals that preferably wouldn't work, which justifies going with the surgical solution.
I bet you these guys do spine, so they need to document that they offered the patient less invasive pain management that did not work, then they can convince the insurance company or Medicare to pay for the laminectomy or even for a joint replacement. It's a common scheme, a bit sleazy but they seem to get away with it.
actually if this CRNA turns out to be good they might have to fire him!
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They might bring the crna into the OR taking those spine cases from you too.
 
So is the CRNA evaluating patients with chronic pain, making a diagnosis, coming up with a treatment plan, and then performing the epidural steroid injections?

Or is a licensed physician (an orthopod) evaluating patients with chronic pain, making a diagnosis, coming up with a treatment plan, and then sending him to CRNA to do the epidural steroid injections?
 
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pgg said:
So is the CRNA evaluating patients with chronic pain, making a diagnosis, coming up with a treatment plan, and then performing the epidural steroid injections?

Or is a licensed physician (an orthopod) evaluating patients with chronic pain, making a diagnosis, coming up with a treatment plan, and then sending him to CRNA to do the epidural steroid injections?
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If you really think it is worthwhile then file a complaint with both the med and nursing boards then take them to court. This is essentially practicing medicine without a license as chronic pain management is a board recognized field. Stand up for yourself.
 
turnupthegas said:
Insulting and ridiculous.
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Honestly the only room I see for any complaint is if the CRNA is practicing medicine, ie diagnosing and treating. And OP's post didn't make that clear.


If the orthopods are doing the "medicine" part of it (diagnosis) ... is there really a problem? It it any different than neurosurgeons getting angry about orthopods doing spines?

It sounds like we have pain-trained anesthesiologists getting angry because a different group of physicians are straying into their turf. The fact that those other physicians employ a midlevel to offload the monkey skills is a red herring.


nimbus said:
What are you talking about? Except for friends and family we don't refer anybody anywhere. We are bottom feeders with no leverage. That is the problem.
Click to expand...

Pain groups certainly do refer some patients to spine surgeons.
 
PainDrain said:
This is essentially practicing medicine without a license as chronic pain management is a board recognized field.
Click to expand...
So are many other fields, full of APRNs working under supervision, or even independently.

I have said it before: American physicians were castrated when they allowed the board of nursing to regulate APRNs under the excuse that advanced nursing practice is not practice of medicine. Bullsh*t! If a janitor were to practice medicine without a license, he couldn't use in court the excuse: "Your honor, this is practice of environmental services, not medicine." ;)

This is something that physician organizations should be suing about in every state.
 
FFP said:
If a janitor were to practice medicine without a license, he couldn't use in court the excuse: "Your honor, this is practice of environmental services, not medicine." ;)
Click to expand...

Some areas of gastroenterology can reasonably be considered "environmental maintenance and improvement".
 
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neuroride said:
So the main ortho group that we work with and have a partnership with in a surgery center have decided to hire a CRNA in their office to do their pain procedures with fluoro. We have been getting their referrals for years and doing pain in the surgery center that we collectively share. Now they will just have the CRNA do their patients epidural/hips etc instead of send them to us. Makes no sense other than money.

With a super liberal state willing to let CRNA's do just about anything, we are at odds what to do? Hopefully he will be as bad as we think and they will give up. Worst case scenario they try to steal our other 75% FM referral base. I have started calling the medicine groups around the area to describe what is happening and who will be doing the procedures now trying to get them to see how dumb this is.

Thoughts?
Click to expand...


This seems like an extremely desperate measure by the ortho group. Most ortho groups I know make their money off of surgeries. Attending orthos will make 800k-1mill and pay a pain guy in the group 400k. Sometimes they make them partner under no obligation and I still dont understand why. Seems extreme to try and get away with changing to a CRNA and paying, im guessing 200k. I bet the group is not doing well and I would look for a backup referral source. Ah the joy's of private practice pain.
 
neuroride said:
So the main ortho group that we work with and have a partnership with in a surgery center have decided to hire a CRNA in their office to do their pain procedures with fluoro. We have been getting their referrals for years and doing pain in the surgery center that we collectively share. Now they will just have the CRNA do their patients epidural/hips etc instead of send them to us. Makes no sense other than money.

With a super liberal state willing to let CRNA's do just about anything, we are at odds what to do? Hopefully he will be as bad as we think and they will give up. Worst case scenario they try to steal our other 75% FM referral base. I have started calling the medicine groups around the area to describe what is happening and who will be doing the procedures now trying to get them to see how dumb this is.

Thoughts?
Click to expand...
Sounds like you are tipping off the FM docs about a business plan that they could also use to make extra money by hiring their own needle jockey crna.
 
neuroride said:
So the main ortho group that we work with and have a partnership with in a surgery center have decided to hire a CRNA in their office to do their pain procedures with fluoro. We have been getting their referrals for years and doing pain in the surgery center that we collectively share. Now they will just have the CRNA do their patients epidural/hips etc instead of send them to us. Makes no sense other than money.

With a super liberal state willing to let CRNA's do just about anything, we are at odds what to do? Hopefully he will be as bad as we think and they will give up. Worst case scenario they try to steal our other 75% FM referral base. I have started calling the medicine groups around the area to describe what is happening and who will be doing the procedures now trying to get them to see how dumb this is.

Thoughts?
Click to expand...

This sums up why I dislike and never will work within the ACT model.
I refuse to be part of the problem.
 
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Steroid is pretty forgiving. As long as they're in the wheelhouse and aren't dropping lungs or paralyzing folks, you might could be okay. I assume they aren't doing it blind?
 
Pain is not Anesthesia.

Plase contact ASIPP and SDSIPP and they are the folks who make things happen. This is a state by state fight and when reaources applied by specialty societies we have had favorable outcomes.

I would also file a complaint with the medical board against the Ortho for lack of ethics. Complaints must be answered whether or not the medical board takes any action. It sends a clear message. Nothing to lose as they don't give a flip about you.
 
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We have had several local surgeons who do some cases at surgery centers come to our group to try and get us to send them an MD to provide anesthesia for them at their surgery center because they are disappointed with the CRNAs. However, they are only guaranteeing 1/2 day per week of work and that would have required us to hire an MD, which wouldn't be cost effective for a small group like ours.

At least we are somewhat recognized by the surgeons as being more desirable than unsupervised CRNAs. If only that was enough for them to get over their desire for extra income by taking their insured patients to their own surgery centers. In their defense, who knows how long the good times will last? Another change in pay structure or stricter enforcement of anti-kickback laws will dry up the well.
 
I'm noticing the ortho guys (even residents) talking about "passive income streams" and "additional income sources". I think they are getting this from consultants pitching them at their national and regional society meetings........
 
GA8314 said:
I'm noticing the ortho guys (even residents) talking about "passive income streams" and "additional income sources". I think they are getting this from consultants pitching them at their national and regional society meetings........
Click to expand...
A few years ago, in a town I used to live in, a hospital system built a shiny new hospital. Next door they built a new surgicenter and got a number of surgeons to invest to be part owners.

I remember those guys talking about passive income streams. Except one crusty old surgeon on the edge of retirement who thought it was stupid.

They went to open the place and discovered it was built wrong and the ORs weren't up to code. Too small, or too narrow hallways or some such nonsense. It's been maybe 4 years and not a single case has been done there. The building is being 1/2 used (if that) as office/clinic space. You can't make this stuff up.

Some people looking for passive income streams lost their asses. Careful who you give your money to ...
 
So how it goes is that the family medicine person refers to the ortho doc for hip pain. The ortho doc then will have us do a hip injection (for example); if it works, then we will usually have a patient in the future for more hip injections as long as they work. If injections fail, then they get the hip replacement. Same goes for epidurals that could lead to spine surgery. Now they apparently can just have their guy do this instead of us. Its all money driven but their crap they have really doesn't pay well in the first place, they have just burned bridges more than anything.

Most of our referals are epidurals for radiculopathy diagnosed by the family med doc. Occasionally they are wrong and we do SI, facets etc.
 
I don't care if they want to inject or fix major joints; that's their territory. But to PROPERLY advise patients about most anything beyond that requires knowledge of ALL the options available. Unless these guys know the intricacies of pain management, including the various injections, pumps, stims, and drugs; and indications/contraindications and available data on the the options, they're doing their patients a HUGE disservice.
 
I consider this to be yet another hole in the sinking ship that is anesthesiology. In residency we are bombarded with attendings telling us to do fellowships to be competitive in the marketplace. Somehow that already cheapens the 4 years of residency. That's not enough to compete with a bunch of midlevels? Now we have to do even more training just so we can justify our existence. Wrong again. If you think pain is the only subspecialty at risk here then you are incorrect. I've already heard CRNAs talking about how they are "TEE certified."
 
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GravelRider said:
I consider this to be yet another hole in the sinking ship that is anesthesiology. In residency we are bombarded with attendings telling us to do fellowships to be competitive in the marketplace. Somehow that already cheapens the 4 years of residency. That's not enough to compete with a bunch of midlevels? Now we have to do even more training just so we can justify our existence. Wrong again. If you think pain is the only subspecialty at risk here then you are incorrect. I've already heard CRNAs talking about how they are "TEE certified."
Click to expand...

https://www.linkedin.com/in/dr-jody-heriot-dehart-dnp-crna-56a1bb18

Wow.
 
Pooh & Annie said:
I don't care if they want to inject or fix major joints; that's their territory. But to PROPERLY advise patients about most anything beyond that requires knowledge of ALL the options available. Unless these guys know the intricacies of pain management, including the various injections, pumps, stims, and drugs; and indications/contraindications and available data on the the options, they're doing their patients a HUGE disservice.
Click to expand...
I wonder if internists think the Perioerative Surgical Home(tm) project, which puts anesthesiologists in outpatient clinics, is outside the anesthesiologists' "territory" ... how can gas docs know the intricacies of BP management, smoking cessation, and other bits of outpatient medicine? Surely it's a disservice to cut the PCMs out of that picture.

You may consider ortho doing pain a disservice to patients, and I'd generally agree, but (jokes aside) orthopedic surgeons are doctors licensed to practice medicine, and they can do whatever they want, subject to credentialing in the building they're in at the moment.

What are you going to do?
 
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pgg said:
I wonder if internists think the Perioerative Surgical Home(tm) project, which puts anesthesiologists in outpatient clinics, is outside the anesthesiologists' "territory" ... how can gas docs know the intricacies of BP management, smoking cessation, and other bits of outpatient medicine? Surely it's a disservice to cut the PCMs out of that picture.

You may consider ortho doing pain a disservice to patients, and I'd generally agree, but (jokes aside) orthopedic surgeons are doctors licensed to practice medicine, and they can do whatever they want, subject to credentialing in the building they're in at the moment.

What are you going to do?
Click to expand...
I didn't say they CAN'T do whatever they want. I said it's a disservice to patients and is therefore not in the patient's best interest.
 
https://www.linkedin.com/in/dr-william-wade-crna-dnp-1b773436

"
University of Michigan
Doctorate Nursing Practice, Anesthesia and pain management

2014
Barry University
MS Anesthesiology, Anesthesiology Residency Program
1998 – 2000
Proficient in ultrasound-guided nerve blocks

University of Michigan-Flint
Master of Business Administration (MBA), Health/Health Care Administration/Management
2015

Hamline University
certificate chronic pain management, Chronic pain management"


This doctor also became proficient in USGNB's during his "anesthesiology residency"
 
nimbus said:
What are you talking about? Except for friends and family we don't refer anybody anywhere. We are bottom feeders with no leverage. That is the problem.
Click to expand...

The reason that we are "bottom feeders" with no "leverage" is because there are just plain too many of us...and when I say us...I mean anesthesiologists and CRNA's.

Every time, some loser comes on here and asks "what are my chances"...and you numb nuts give encouragement and support, I just cringe.

If half of the anesthesiologists and CRNA's just up and dies tomorrow from some odd viral illness that targets volatile anesthetic gas exposure...AND we cut half of our training programs...programs that exist to take money from medicare and insurance companies.......things would be a little different.
 
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militarymd said:
The reason that we are "bottom feeders" with no "leverage" is because there are just plain too many of us...and when I say us...I mean anesthesiologists and CRNA's.

Every time, some loser comes on here and asks "what are my chances"...and you numb nuts give encouragement and support, I just cringe.

If half of the anesthesiologists and CRNA's just up and dies tomorrow from some odd viral illness that targets volatile anesthetic gas exposure...AND we cut half of our training programs...programs that exist to take money from medicare and insurance companies.......things would be a little different.
Click to expand...

Well, that explains the doom and gloom on here.
 
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vector2 said:
https://www.linkedin.com/in/dr-william-wade-crna-dnp-1b773436

"
University of Michigan
Doctorate Nursing Practice, Anesthesia and pain management

2014
Barry University
MS Anesthesiology, Anesthesiology Residency Program
1998 – 2000
Proficient in ultrasound-guided nerve blocks

University of Michigan-Flint
Master of Business Administration (MBA), Health/Health Care Administration/Management
2015

Hamline University
certificate chronic pain management, Chronic pain management"


This doctor also became proficient in USGNB's during his "anesthesiology residency"
Click to expand...



Hamline university! Wow! I'm so impressed!!!
 
militarymd said:
The reason that we are "bottom feeders" with no "leverage" is because there are just plain too many of us...and when I say us...I mean anesthesiologists and CRNA's.

Every time, some loser comes on here and asks "what are my chances"...and you numb nuts give encouragement and support, I just cringe.

If half of the anesthesiologists and CRNA's just up and dies tomorrow from some odd viral illness that targets volatile anesthetic gas exposure...AND we cut half of our training programs...programs that exist to take money from medicare and insurance companies.......things would be a little different.
Click to expand...
One of the most accurate statements EVER posted on SDN.
 
MilMD is like ... :ninja:

Def. good to see an 'ol SDN anesthesia ninja on here.
 
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pgg said:
I wonder if internists think the Perioerative Surgical Home(tm) project, which puts anesthesiologists in outpatient clinics, is outside the anesthesiologists' "territory" ... how can gas docs know the intricacies of BP management, smoking cessation, and other bits of outpatient medicine? Surely it's a disservice to cut the PCMs out of that picture.

You may consider ortho doing pain a disservice to patients, and I'd generally agree, but (jokes aside) orthopedic surgeons are doctors licensed to practice medicine, and they can do whatever they want, subject to credentialing in the building they're in at the moment.

What are you going to do?
Click to expand...
Distract them with a shiny hammer and some x-rays?
 
militarymd said:
The reason that we are "bottom feeders" with no "leverage" is because there are just plain too many of us...and when I say us...I mean anesthesiologists and CRNA's.

Every time, some loser comes on here and asks "what are my chances"...and you numb nuts give encouragement and support, I just cringe.

If half of the anesthesiologists and CRNA's just up and dies tomorrow from some odd viral illness that targets volatile anesthetic gas exposure...AND we cut half of our training programs...programs that exist to take money from medicare and insurance companies.......things would be a little different.
Click to expand...
Look who came back after a 3 year hiatus... This should be interesting ..
 
militarymd said:
The reason that we are "bottom feeders" with no "leverage" is because there are just plain too many of us...and when I say us...I mean anesthesiologists and CRNA's.

Every time, some loser comes on here and asks "what are my chances"...and you numb nuts give encouragement and support, I just cringe.

If half of the anesthesiologists and CRNA's just up and dies tomorrow from some odd viral illness that targets volatile anesthetic gas exposure...AND we cut half of our training programs...programs that exist to take money from medicare and insurance companies.......things would be a little different.
Click to expand...

Welcome back!
749956.png
 
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criticalelement said:
Look who came back after a 3 year hiatus... This should be interesting ..
Click to expand...

3 years...wow ..seemed like yesterday...anyways thanks for the welcomes.

Although I guess a lot has changed for medicine in the 3 years since I last posted. I'm not seeing any silver linings in general for physicians. Our leadership certainly is not helping any.
 
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