Physician Assistant doing Fluoro Guided Procedures

[SpineandWine]

Hi, I am joining a practice next year and not sure what liability is regarding PA's doing procedure.
I would ideally like them to do fluoro guided hips/knees/shoulder injections if possible. Is that something that requires supervision or can they operate fluoro machine when I'm not present.

Would anyone recommend this or would you say not to have PAs do procedures? I feel as if hips/knees/shoulders are fairly low risk and unless severe tom****erry, will be safe for them to do.

---

Members don't see this ad.

 

[DOctorJay]

please don't do this

 

[Doctodd]

Hi, I am joining a practice next year and not sure what liability is regarding PA's doing procedure.
I would ideally like them to do fluoro guided hips/knees/shoulder injections if possible. Is that something that requires supervision or can they operate fluoro machine when I'm not present.

Would anyone recommend this or would you say not to have PAs do procedures? I feel as if hips/knees/shoulders are fairly low risk and unless severe tom****erry, will be safe for them to do.

if the PA can do procedures, they dont need you

 

[Baron Samedi]

Don't do it.

Not only because it's unsafe, but also because it screws the rest of us. We all had to do 9 years of medical training to do it -- why should a PA be able to after a few days of on the job training?

 

[buddababa]

Hi, I am joining a practice next year and not sure what liability is regarding PA's doing procedure.
I would ideally like them to do fluoro guided hips/knees/shoulder injections if possible. Is that something that requires supervision or can they operate fluoro machine when I'm not present.

Would anyone recommend this or would you say not to have PAs do procedures? I feel as if hips/knees/shoulders are fairly low risk and unless severe tom****erry, will be safe for them to do.

dont do it, soon they wont need you anymore

 

[Ferrismonk]

I would say no to flouro. If the machine is available you should be doing the shot.

FWIW, most ortho practices will allow the APP to do ultrasound guided peripheral joints at office visits. I don't have any inherent problems with this, but you should know that APPs will never be as good as you are. I've trained one in my last job and he could do basic injections but they always hurt more and had worse results. At my current job we had a PA was ortho before who we allowed to do peripheral joints, but we stopped her once we saw how she was doing things.

Remember, an APP only knows how they are taught to do something, they don't have the clinical training to make better choices or handle complications.

 

[MitchLevi]

Echo Ferris...

US yes, but understand they're gonna miss it prob 1/3 - 1/2 the time. I promise you that is true, and you may not believe me but you'll see after 12-18 months when you realize you've had to repeat them with different results.

 

[drrosenrosen]

Come on, man....

 

[SpineandWine]

Okay good to know.
Valid points all around. You're right, don't want what happened with anesthesias and CRNAs.

 

[SSdoc33]

AKA:

ill just agree to everyone and then join the practice that does it anyway.....

 

[lobelsteve]

If you supervise and it goes wrong, add your name to the malpractice suit. And expect me in a suit.

 

[MitchLevi]

If you supervise and it goes wrong, add your name to the malpractice suit. And expect me in a suit.

Ralph Lauren? Armani?

 

[SSdoc33]

Ralph Lauren? Armani?

birthday

 

[SpineandWine]

AKA:

ill just agree to everyone and then join the practice that does it anyway.....

No, not necessarily. I am employing the PA's myself personally. Wanted to crowd source whether it's good to teach them but i have full control on whether I'd like to do it.
Based on the response, it seems better job security/less liability to do myself.

 

[lobelsteve]

Ralph Lauren? Armani?

Jos A Bank. No idea on label.
If I am this big a jerk on the forums, imagine me in the courtroom.

 

[mid|ine]

Im going to be the odd man out as normal. The near term future of medicine in supervision of mid-levels. Refusal by a few docs will not reverse the trend and only make your practice suffer. In the long run, I think there will be continued expansion of mid-level scope of practice. The best we can hope for is maintaining as much of a supervisory role as possible.

 

[DrSpine]

For some reason, I never like or feel comfortable with the idea of a PA or NP. I am so phobic about my medical license. If they see a patient, and they miss something, and I sign off on it, or do a procedure wrong and I ultimately sign off on it, I'm held liable. The only thing an NP or PA is good for is perhaps following up post procedure or visit and just seeing how the patient did. If it's "I did great" - sweet close them out. If it's "no" - back to seeing me. Or, they see the patient, initially screen, and then present it to me and I see the patient myself and make the final judgement calls. But having them see patients and just signing off, or doing procedures? No thanks.

 

[Ferrismonk]

Jos A Bank. No idea on label.
If I am this big a jerk on the forums, imagine me in the courtroom.

Yes, I've heard the devil went down to Georgia.

 

[RoloTomassi]

I vote no as well, but it's funny because fluoro is easier, safer, more accurate in less skilled hands than ultrasound/blind and docs have no problem letting midlevels do those.

 

[BobBarker]

No, I don’t think it is wise to teach them and do this in your practice.


However, the IR PA’s are doing much, much more risky and invasive procedures at most teritiary hospitals including every myelogram.

 

[bedrock]

No, I don’t think it is wise to teach them and do this in your practice.


However, the IR PA’s are doing much, much more risky and invasive procedures at most teritiary hospitals including every myelogram.

And that is why they think they can open up their own pain practices

 

[DOctorJay]

Memorial Hospital Launches Interventional Pain Service

For many patients suffering with chronic pain, narcotics are a common choice to manage their pain. Helping patients better manage pain without turning to narcotics is the goal of the interventional pain clinic at Memorial Hospital.

mainehealth.org

"Specially-trained nurse anesthesiologists provide treatment using a variety of spinal injections and other procedures all administered in a hospital setting. Zachary Chase, director of anesthesia and interventional pain services at Memorial, is part of a team of four Certified Registered Nurse Anesthetists (CRNAs) who oversee the service. Pain intervention procedures at Memorial maximize patient safety by taking place in a full operating room, not in an exam room in an outpatient practice."

 

[Baron Samedi]

No, I don’t think it is wise to teach them and do this in your practice.


However, the IR PA’s are doing much, much more risky and invasive procedures at most teritiary hospitals including every myelogram.

Very true, I've watched them do CESIs.

 

[GoBeers]

For some reason, I never like or feel comfortable with the idea of a PA or NP. I am so phobic about my medical license. If they see a patient, and they miss something, and I sign off on it, or do a procedure wrong and I ultimately sign off on it, I'm held liable. The only thing an NP or PA is good for is perhaps following up post procedure or visit and just seeing how the patient did. If it's "I did great" - sweet close them out. If it's "no" - back to seeing me. Or, they see the patient, initially screen, and then present it to me and I see the patient myself and make the final judgement calls. But having them see patients and just signing off, or doing procedures? No thanks.

i've always wondered when PAs or NPs dose escalate chronic opioids on these chronic patients and something bad happens, does the supervisor who signs off the notes bear 100% liability?

 

[clubdeac]

it's a sad sad situation we're in. either we need to start defending our turf or like midline says, we will be replaced in the next 5-10 years. have your exit plan in place. I know midline has his and that's why he don't care what happens to medicine.

 

[Ducttape]

yes.

but i do care what happens in medicine.

and my exit plan is retirement.

 

[mid|ine]

it's a sad sad situation we're in. either we need to start defending our turf or like midline says, we will be replaced in the next 5-10 years. have your exit plan in place. I know midline has his and that's why he don't care what happens to medicine.

I certainly care, but I can also see the writing on the wall. Docs are expensive, and if you're honest, midlevels can handle a lot of what we do. They don't know what they don't know, and can certainly miss a lot. The trend is towards cost cutting and midlevels.

 

[lobelsteve]

I certainly care, but I can also see the writing on the wall. Docs are expensive, and if you're honest, midlevels can handle a lot of what we do. They don't know what they don't know, and can certainly miss a lot. The trend is towards cost cutting and midlevels.

Totally wrong.

Letters to the Editor: Don't blame doctor pay for the high cost of U.S. healthcare

Physicians' salaries account for a small fraction of U.S. healthcare costs; furthermore, doctors in this country often graduate deeply in debt.

www.latimes.com

 

[mid|ine]

Hospitals are the primary employers of "health care providers". They just see us as widget makers. If you are the CEO of a hospital, would you prefer to pay someone 1x or 3-5x to make your widgets on the factory floor?? Physicians have lost control of healthcare. It doesn't matter what is driving the cost, we are an expensive line item with a much cheaper alternative.

 

[TeslaCoil]

Hi, I am joining a practice next year and not sure what liability is regarding PA's doing procedure.
I would ideally like them to do fluoro guided hips/knees/shoulder injections if possible. Is that something that requires supervision or can they operate fluoro machine when I'm not present.

Would anyone recommend this or would you say not to have PAs do procedures? I feel as if hips/knees/shoulders are fairly low risk and unless severe tom****erry, will be safe for them to do.

whoa dude, no. Just no.

 

[drusso]

Hospitals are the primary employers of "health care providers". They just see us as widget makers. If you are the CEO of a hospital, would you prefer to pay someone 1x or 3-5x to make your widgets on the factory floor?? Physicians have lost control of healthcare. It doesn't matter what is driving the cost, we are an expensive line item with a much cheaper alternative.

Facts.

 

[drusso]

Hi, I am joining a practice next year and not sure what liability is regarding PA's doing procedure.
I would ideally like them to do fluoro guided hips/knees/shoulder injections if possible. Is that something that requires supervision or can they operate fluoro machine when I'm not present.

Would anyone recommend this or would you say not to have PAs do procedures? I feel as if hips/knees/shoulders are fairly low risk and unless severe tom****erry, will be safe for them to do.

I've seen neurosurgical PA's put ICP bolts in patients in the ICU.

 

[TeslaCoil]

Hospitals are the primary employers of "health care providers". They just see us as widget makers. If you are the CEO of a hospital, would you prefer to pay someone 1x or 3-5x to make your widgets on the factory floor?? Physicians have lost control of healthcare. It doesn't matter what is driving the cost, we are an expensive line item with a much cheaper alternative.

These dejected responses from physicians with no suggestions to solve the problem are exactly what I hate seeing. Our lack of proactivity is exactly what got us into this mess.

 

[drusso]

These dejected responses from physicians with no suggestions to the problem are exactly what I hate seeing. Our lack of proactivity is exactly what got us into this mess.

It's like doctors have just said f uck it. Our grandparents in great grandparents in this profession who took time away from their practices and families to help establish no corporate practice of medicine laws and enforce scope of practice, etc would be pissed if they saw this.

 

[Ducttape]

the primary driver for the increased cost of healthcare are not physicians, but are hospital administrators, big pharma and big device.

we are not expensive compared to the main drivers of this pseudo-capitalistic form of healthcare.




what got us in to this mess is that big business realized almost immediately how much money they could make for themselves. even if doctors had been more proactive, without some degree of (gasp) socialized medicine, we physicians were doomed from the get go.

 

[TeslaCoil]

yes.

but i do care what happens in medicine.

and my exit plan is retirement.

What have you suggested to your kids?

 

[Ducttape]

to not go in to medical school, but if they must, to be an NP.

but thankfully none of them are interested in healthcare...

 

[TeslaCoil]

it's a sad sad situation we're in. either we need to start defending our turf or like midline says, we will be replaced in the next 5-10 years. have your exit plan in place. I know midline has his and that's why he don't care what happens to medicine.

I agree we need to be more proactive but next 5-10 years is a bit of a stretch, dont you think?

 

[RoloTomassi]

NYC nurses know how to get it done. We docs can't really get it together.

 

[clubdeac]

We definitely need to ban together and act more like nurses. They are savage

 

[Pain Applicant1]

Im going to be the odd man out as normal. The near term future of medicine in supervision of mid-levels. Refusal by a few docs will not reverse the trend and only make your practice suffer. In the long run, I think there will be continued expansion of mid-level scope of practice. The best we can hope for is maintaining as much of a supervisory role as possible.

I certainly care, but I can also see the writing on the wall. Docs are expensive, and if you're honest, midlevels can handle a lot of what we do. They don't know what they don't know, and can certainly miss a lot. The trend is towards cost cutting and midlevels.

You are 100% correct. The insightful person will accept reality and adapt to survive. Those with less insight will cry and moan (despite no one listening) while reminiscing about the ways things were and how they should be. All the while their ship is sinking.

 

[Pain Applicant1]

It's not the job of the NPs and PAs to show that the care they offer is equivalent to that of physicians but it is the job of the physician to show that the care they offer is superior. Otherwise, justifying salary discrepancies and practice limitations will be impossible.

 

[SSdoc33]

You are 100% correct. The insightful person will accept reality and adapt to survive. Those with less insight will cry and moan (despite no one listening) while reminiscing about the ways things were and how they should be. All the while their ship is sinking.

(drusso)

 

[TeslaCoil]

It's not the job of the NPs and PAs to show that the care they offer is equivalent to that of physicians but it is the job of the physician to show that the care they offer is superior. Otherwise, justifying salary discrepancies and practice limitations will be impossible.

Yesterday, I had an NP come up to me asking me how to read an antibiotic sensitivity report. She had no idea what a MIC was. And shes a wound care nurse. What does it take to prove that doctors are better trained than nurses I mean really.

 

[TeslaCoil]

I certainly care, but I can also see the writing on the wall. Docs are expensive, and if you're honest, midlevels can handle a lot of what we do. They don't know what they don't know, and can certainly miss a lot. The trend is towards cost cutting and midlevels.

So what you’re saying is prepare for a world without doctors? FAFSA will stop funding medical schools? Med schools will close their doors? The world will be run by midlevels? Cost cutting maybe, but there will always be a place for physicians in healthcare. Its just a matter of how much we’re willing to tolerate before we walk out and they’re stuck with a true socio-economic crisis on their hands. News flash: patients dont want to see nurses. They want to see doctors. Eventually doctors need to organize and fight back. Period. Or else yes, prepare to be ripped off.

 

[TeslaCoil]

You are 100% correct. The insightful person will accept reality and adapt to survive. Those with less insight will cry and moan (despite no one listening) while reminiscing about the ways things were and how they should be. All the while their ship is sinking.

Heh, you can only adapt so much before they start really hitting you in the pockets. If by adaptation you mean organization, representation and reclamation. Then yes. But as a whole not just individuals.

 

[Pain Applicant1]

Yesterday, I had an NP come up to me asking me how to read an antibiotic sensitivity report. She had no idea what a MIC was. And shes a wound care nurse. What does it take to prove that doctors are better trained than nurses I mean really.

Certainly not anecdotal evidence from those who have a vested interest.

I imagine that some type of studies that show different quality of outcomes. Are they out there? I don't know. Are studies out there that show there is no difference in outcome? think there might be.

Either way, you don't have to waste your precious time trying to convince me. I don't pay the bills or set the pay scales.

 

[Pain Applicant1]

Heh, you can only adapt so much before they start really hitting you in the pockets. If by adaptation you mean organization, representation and reclamation. Then yes. But as a whole not just individuals.

That's what the ama is supposed to do. I thought they were one of the most powerful lobbies.

I don't think any lobbying will work anyway. The system is not sustainable in its current form and no one other than physicians will lose sleep if physician pay decreases.

I'm not too concerned either way because it really doesn't impact me at this point in my career If it did, I would probably try to figure out a way to capitalize on NPs and PAs. You know, if you can't beat em, join em type of thing. Just my opinion.

 

[TeslaCoil]

Certainly not anecdotal evidence from those who have a vested interest.

I imagine that some type of studies that show different quality of outcomes. Are they out there? I don't know. Are studies out there that show there is no difference in outcome? think there might be.

Either way, you don't have to waste your precious time trying to convince me. I don't pay the bills or set the pay scales.

Right since I meant for my whimsical example on SDN to be taken for scientific fact. Stupid me. 😏🙄

 

[TeslaCoil]

That's what the ama is supposed to do. I thought they were one of the most powerful lobbies.

I don't think any lobbying will work anyway. The system is not sustainable in its current form and no one other than physicians will lose sleep if physician pay decreases.

I'm not too concerned either way because it really doesn't impact me at this point in my career If it did, I would probably try to figure out a way to capitalize on NPs and PAs. You know, if you can't beat em, join em type of thing. Just my opinion.

Hmm if it doesn't affect you at this point, maybe you should consider not commenting? Those of us who are relatively early in our careers are not ready to go down without a fight. I certainly am not. How do we organize is my only question to, ahem, productive commenters…