Physician Assistant doing Fluoro Guided Procedures

[TeslaCoil]

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See Mitch's post above. Daily, I get to see things that aren't real, true, accurate, or remotely correct. CRPS patient came in today complaining of how her fat was exposed on her nerve as the sheath was stripped away. Chiro office saw it on MRI. Gave her stem cells and visco in her knee. Normal MRI report.

Sure, I judge other practitioners quality of care too. I do so on a case by case basis. I dont just question every other doctor's quality of care without even knowing how they practice in blanked fashion...

 

[callmeanesthesia]

“You’re all valuable providers”

Seriously guys, this is why we fail at defending our turf. Any attempt to start up a conversation about protecting ourselves turns into tearing each other apart.

 

[MitchLevi]

It's funny how many medical students have zero hope of matching into Dermatology, but a PA can do a few rotations and be "just as good."

This is a great point, and one I never thought about until I read this.

 

[TeslaCoil]

Sure, I judge other practitioners quality of care too. I do so on a case by case basis. I dont just question every other doctor's quality of care without even knowing how they practice in blanked fashion...

Also, im not talking about chiros and midlevels, im talking about doctors.

 

[Pain Applicant1]

Hey man, Im not even gonna hurl an insult back at you. Your posts do a pretty good job of making you look bad. My outcomes are, so far, immaculate (knocking on wood). I put patient safety first every single day. Its sad that you and Dr. Lobel love to look down on all your fellow physicians as inferior. We're all committing malpractice, putting patients at risk, blah blah blah. Just seeing what you post here, I wouldnt trust your judgement with 2 sheep drawn on a piece of paper, much less any medical care of mine.

so don't

 

[Agast]

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

“You’re going to hate the way I look. I guarantee it.” - lobelsteve

 

[lobelsteve]

“You’re going to hate the way I look. I guarantee it.” - lobelsteve

I do, why can't you.

 

[lobelsteve]

And here is a thread from 2007, Iowa. iowa crnas doing fluoro procedures
Also same thing in a facebook post for pain doctor group. Oreos is there. LA pain group wants to hire PA to do joint injections, facet blocks, stem cells.

 

[MitchLevi]

And here is a thread from 2007, Iowa. iowa crnas doing fluoro procedures
Also same thing in a facebook post for pain doctor group. Oreos is there. LA pain group wants to hire PA to do joint injections, facet blocks, stem cells.

When I was interviewing PAs to join my team, I interviewed a guy who was doing all spine procedures for a NS group. It was 2 or 3 NS and this PA basically stayed in the procedure suite every day doing ALL of that group's procedures.

CESI included...I do 230-250 shots per month, with a decent chunk of them being CESI, and I feel I'm very good at that injxn and most pts don't feel anything (Lobel technique)...But I STILL take that procedure seriously.

 

[buddababa]

we should rename this thread physician associate or doctor of medical sciences is what they are now; smh.

 

[Tboned]

When I was interviewing PAs to join my team, I interviewed a guy who was doing all spine procedures for a NS group. It was 2 or 3 NS and this PA basically stayed in the procedure suite every day doing ALL of that group's procedures.

CESI included...I do 230-250 shots per month, with a decent chunk of them being CESI, and I feel I'm very good at that injxn and most pts don't feel anything (Lobel technique)...But I STILL take that procedure seriously.

Did you hire him so you could sip coffee and do real medicine in the clinic all day?

 

[bedrock]

When I was interviewing PAs to join my team, I interviewed a guy who was doing all spine procedures for a NS group. It was 2 or 3 NS and this PA basically stayed in the procedure suite every day doing ALL of that group's procedures.

CESI included...I do 230-250 shots per month, with a decent chunk of them being CESI, and I feel I'm very good at that injxn and most pts don't feel anything (Lobel technique)...But I STILL take that procedure seriously.

Wow. That is disturbing. Also tells you how much the neurosurgeons value the expertise of a pain physician

 

[MitchLevi]

Did you hire him so you could sip coffee and do real medicine in the clinic all day?

No.

To anyone looking to hire a PA, if that individual has been around spine and MSK and pain for 10+ yrs, inquire about their procedural experience and you'll be surprised at some of the stories you hear.

That same PA I mentioned above was telling me about his surgical experience during spine cases and how he can do all this different BS. He opens and exposes the spine and the surgeon comes in and puts in hardware or does the discectomy and he does the closure from deep fascia to skin. All types of BS.

I interviewed a number of PAs. He was the most outlandish and of course we didn't hire him.

He's also something like 5'1"...Which is itself odd...If you're part of my team you gotta be jacked and hot bc we're tryna be examples of lifestyle and American righteousness.

 

[MitchLevi]

Wow. That is disturbing. Also tells you how much the neurosurgeons value the expertise of a pain physician

They value your ability to do whatever it is you do so they leave the clinic room and move on to the next potential surgical case they can schedule.

Which isn't wrong IMO.

 

[lobelsteve]

Windsor had a PA who did not take directions or listen. He thought he was a fellow. Saw him cauterize 3 nerve roots in a year. Then he got let go.

 

[MitchLevi]

Windsor had a PA who did not take directions or listen. He thought he was a fellow. Saw him cauterize 3 nerve roots in a year. Then he got let go.

You know what's crazy?

One of my partners has a sister who had a local pain guy do a series of injxns. SIJ, ESI x 2 then RFA.

Apparently, the RFA was aborted outright bc his motor testing was abnml at the L4 MB and L5 DPR.

She came to me and I did the RFA with no issues. Not entirely sure what happened with that other guy. Routine RFA. No problems.

Have any of you ever cooked a spinal nerve?

Not only have I never done that, I've never had motor testing make a leg jump...At least not that I can remember.

How F'd up do you have to be to lesion a nerve root?

 

[TeslaCoil]

I cant understand burning a nerve root. How dumb/poorly trained do you have to be to put your needle into the foramen and then run the machine. In my mind its very hard to lesion a nerve root…

 

[Ducttape]

its possible. more likely is to lesion the nerve itself. ive never done it, but i see it as a potential complication and am mindful of the possibility.


its more likely in spines that you guys probably dont see - 90 year olds where the transverse process and pedicle are so osteoporotic that they turn translucent and i have stuggled at times to identify where the target is.





eventually, with time and exposure, everyone will face an injection that will challenge their knowledge and skills and makes one reassess how good they really think they are.


unless one is too egotistical to ever have that self-realization, in which case, burn baby burn...

 

[TeslaCoil]

its possible. more likely is to lesion the nerve itself. ive never done it, but i see it as a potential complication and am mindful of the possibility.


its more likely in spines that you guys probably dont see - 90 year olds where the transverse process and pedicle are so osteoporotic that they turn translucent and i have stuggled at times to identify where the target is.





eventually, with time and exposure, everyone will face an injection that will challenge their knowledge and skills and makes one reassess how good they really think they are.


unless one is too egotistical to ever have that self-realization, in which case, burn baby burn...

I hear all of that, but if radiographic guidance is poor, isnt that why sensory/motor testing exists? Trust me I respect the possibility of a nerve injury, but 3 in a year? C’mon. Thats clear negligence. Thats clearly somebody who doesnt understand the anatomy or the technique of the procedure.

 

[TeslaCoil]

its possible. more likely is to lesion the nerve itself. ive never done it, but i see it as a potential complication and am mindful of the possibility.


its more likely in spines that you guys probably dont see - 90 year olds where the transverse process and pedicle are so osteoporotic that they turn translucent and i have stuggled at times to identify where the target is.





eventually, with time and exposure, everyone will face an injection that will challenge their knowledge and skills and makes one reassess how good they really think they are.


unless one is too egotistical to ever have that self-realization, in which case, burn baby burn...

I think its far more likely to make overconfident moves with the needle and inadvertently enter the foramen and skewer a nerve than it is to actually burn a nerve or root. That is, if you’re using remotely proper technique to begin with.

 

[clubdeac]

I think you're taking this the wrong way. There are my beliefs on the capabilities of people and then there's the reality of the US healthcare environment. Education to me is important but the vast majority of what's learned is learned on the job for the most part and anyone can learn anything by working at it enough. An established group with a vested interest in any particular field has the typical superiority complex and doesn't like to hear this and I see the same theme repeated in every business I'm involved in.

- Brokers against realtors, realtors against non-realtor agents, all of these groups against nonlicensed people acting pro se
- white American construction and tree service guys against central American immigrants in the same fields
- licensed plumbers and electricians against unlicensed ones
- neurosurgeons against pain docs
- the examples i mentioned in my previous post
- now that I'm being "forced" to make my farm profitable I'm starting to see it here too

-------

We can discuss the above if you'd like but whether or not I'm right about it is irrelevant and separate from what's happening in healthcare. The reality is that most patients don't care or notice the letters after your name. The best analogy to explain this is when you walk onto an airplane. You don't know or even think about the educational background or credentials that the pilot and flight crew have. You just trust in the system. That's how most patients see us. We're probably judged mostly by the first visit and by word of mouth more than anything else.

So on one side, most patients don't think about our educational background and on the other side, you have the payers and the government. Both are going to focus on reducing costs and if someone is willing to provide the same service as you for a lower cost you better be able to compete with that.

If I were to spend the time and money opening up a business I would want to consider all of these options.

_____

On another note, you seem to be pretty staunch on the far right, which is cool but it seems that you're advocating for more government involvement and protectionism of your interests which would seem to contradict the typical right-wing belief system. It also seems that you're not advocating for a free market which also seems to be a contradiction. Why not let the free market decide who the best pain provider is?

I think your idea of a free market is a little skewed. In almost every industry we have standardization, licensure, and other protocols in place to ensure that whoever is providing a service is adequately trained and competent. this serves as a safeguard for the general public. It has nothing to do with socialism vs capitalism although I can understand the confusion

what you're suggesting is to completely upend the current system of training and checks and balances which has been in place for the last century. Why not restructure medical school instead of developing numerous off shoot wanna be "medical" training programs that have very little standardization, adequate training or education. You're certainly not thinking about the patient. As others have stated above, the intent of midlevels was never to replace physicians.

Interestingly, I've never heard you take a stance on anything except this. Of all things to speak up for it's midlevel FPA? Strange coming from a physician 🤔

I highly recommend you read "Patients at Risk” by Physicians for Patient Protection. As someone who is typically open to both sides of the argument, I look forward to your thoughts after reading it

 

[Agast]

I hear all of that, but if radiographic guidance is poor, isnt that why sensory/motor testing exists? Trust me I respect the possibility of a nerve injury, but 3 in a year? C’mon. Thats clear negligence. Thats clearly somebody who doesnt understand the anatomy or the technique of the procedure.

Or a form of sociopathy where he simply does not care to adjust his trajectory when he misses his mark

Anecdotally I know someone who allegedly regularly wet taps their cervical ESI. That is not a knowledge deficiency. That is a lack of caring.

 

[bedrock]

Or a form of sociopathy where he simply does not care to adjust his trajectory when he misses his mark

Anecdotally I know someone who allegedly regularly wet taps their cervical ESI. That is not a knowledge deficiency. That is a lack of caring.

There are definitely docs and pas who just don’t care. I don’t know how they can sleep at night.

 

[powermd]

There are definitely docs and pas who just don’t care. I don’t know how they can sleep at night.

Not caring might have something to do with it. An ex-partner of mine had all the complications we ever saw in the group over ten years. Clearly wasn't affected by it. Great guy to hang out with, but lacked something in the give a **** department.

 

[Ducttape]

I hear all of that, but if radiographic guidance is poor, isnt that why sensory/motor testing exists? Trust me I respect the possibility of a nerve injury, but 3 in a year? C’mon. Thats clear negligence. Thats clearly somebody who doesnt understand the anatomy or the technique of the procedure.

yes, 3 a year paints a much different picture.

one of negligence, poor training, focus on financial renumeration, or a combination of the 3.

 

[Pain Applicant1]

I think your idea of a free market is a little skewed. In almost every industry we have standardization, licensure, and other protocols in place to ensure that whoever is providing a service is adequately trained and competent. this serves as a safeguard for the general public. It has nothing to do with socialism vs capitalism although I can understand the confusion

what you're suggesting is to completely upend the current system of training and checks and balances which has been in place for the last century. Why not restructure medical school instead of developing numerous off shoot wanna be "medical" training programs that have very little standardization, adequate training or education. You're certainly not thinking about the patient. As others have stated above, the intent of midlevels was never to replace physicians.

Interestingly, I've never heard you take a stance on anything except this. Of all things to speak up for it's midlevel FPA? Strange coming from a physician 🤔

I highly recommend you read "Patients at Risk” by Physicians for Patient Protection. As someone who is typically open to both sides of the argument, I look forward to your thoughts after reading it

I'm going to assume if I read that book it will give the side from the physician's perspective. I'm also going to assume I can find other books and studies supporting the other side. It doesn't matter either way and I'm not taking a strong stand on this.

What I'm predicting is how the future of medicine will play out and from the examples listed above it seems like my thoughts are right. The future doesn't care about my or your opinion or anyone's anecdotes in here. I would prepare myself accordingly.

 

[TeslaCoil]

I'm going to assume if I read that book it will give the side from the physician's perspective. I'm also going to assume I can find other books and studies supporting the other side. It doesn't matter either way and I'm not taking a strong stand on this.

What I'm predicting is how the future of medicine will play out and from the examples listed above it seems like my thoughts are right. The future doesn't care about my or your opinion or anyone's anecdotes in here. I would prepare myself accordingly.

I predict the future of medicine will be different from what you think its going to be. 😂

 

[Pain Applicant1]

I think your idea of a free market is a little skewed. In almost every industry we have standardization, licensure, and other protocols in place to ensure that whoever is providing a service is adequately trained and competent. this serves as a safeguard for the general public. It has nothing to do with socialism vs capitalism although I can understand the confusion

what you're suggesting is to completely upend the current system of training and checks and balances which has been in place for the last century. Why not restructure medical school instead of developing numerous off shoot wanna be "medical" training programs that have very little standardization, adequate training or education. You're certainly not thinking about the patient. As others have stated above, the intent of midlevels was never to replace physicians.

Interestingly, I've never heard you take a stance on anything except this. Of all things to speak up for it's midlevel FPA? Strange coming from a physician 🤔

I highly recommend you read "Patients at Risk” by Physicians for Patient Protection. As someone who is typically open to both sides of the argument, I look forward to your thoughts after reading it

Oh btw, I agree with you about restructuring medicine. It's the only way it can survive close to its current form. It's nice to learn everything about everything but it's not practical or efficient. It's an outdated luxury in today's environment.

Also, I try to take many stances on emotionally charged issues and I've worked hard to provoke fights with many of you. Take that back. Now you've offended me, lol!!

 

[Welcome123]

Absolutely not.
This is an interesting thread.
From a business perspective it is great. Take a lower cost employee and have them do what a higher cost employee can do. My question is where is the line? why stop at fluoro guided joint injections? Go to spinal injections and then might as well do more complex operative cases, such as discography and fusions?
In fact, why pay a pilot to fly the plane? Just train the stewardess (air hostess).
The sarcasm should be clear to anyone reading this. So should the inappropriate role you are trying to put a PA in. Regardless of the extra monies generated.
A 25 year old MBA reading this may actually take it seriously and from a financial perspectives it would be a clear decision and business model to run saving practices and Hospitals an enormous sum.
The PA NP or non physician should be assisting doing routine follow ups, med refills on stable patients not doing your procedures.
Complications and liability will still be directed to whatever idiot is agreeing to “supervise “
Unfortunately, this is already becoming reality in some private practices and hospitals

 

[Pain Applicant1]

Absolutely not.
This is an interesting thread.
From a business perspective it is great. Take a lower cost employee and have them do what a higher cost employee can do. My question is where is the line? why stop at fluoro guided joint injections? Go to spinal injections and then might as well do more complex operative cases, such as discography and fusions?
In fact, why pay a pilot to fly the plane? Just train the stewardess (air hostess).
The sarcasm should be clear to anyone reading this. So should the inappropriate role you are trying to put a PA in. Regardless of the extra monies generated.
A 25 year old MBA reading this may actually take it seriously and from a financial perspectives it would be a clear decision and business model to run saving practices and Hospitals an enormous sum.
The PA NP or non physician should be assisting doing routine follow ups, med refills on stable patients not doing your procedures.
Complications and liability will still be directed to whatever idiot is agreeing to “supervise “
Unfortunately, this is already becoming reality in some private practices and hospitals

If there's a difference in outcome then the burden is on you to prove it so you can justify a higher pay standard. Either that or if I'm the business owner you have to prove to me that marketing your MD will generate more revenue for my company. If none of the above applies, why would I pay someone more?

Some examples cited above are, umm, a bit off. Do you honestly think an NP or PA can't do a TPI over a lung field? How long would that take to learn and how does medical school training prepare you better for this procedure?

Don't worry btw, no MBA is wasting time reading this thread and my opinion is completely worthless anyway, it has absolutely no impact on how healthcare will evolve in the US.


Also, I'm curious about your thoughts on the following:

Training non-physicians as neurosurgeons in sub-Saharan Africa

The surgical gap in sub-Saharan Africa is a huge problem. Some countries are tackling it by training non-physicians as surgeons - including neurosurgeons. And the results have not been bad. But is it a silver bullet? Adrian Burton investigates.

www.thelancet.com

A comparison of clinical officers with medical doctors on outcomes of caesarean section in the developing world: meta-analysis of controlled studies

Objective To review the effectiveness and safety of clinical officers (healthcare providers trained to perform tasks usually undertaken by doctors) carrying out caesarean section in developing countries compared with doctors. Design Systematic review with meta-analysis. Data sources Medline...

www.bmj.com

Surgical Task-Shifting in a Low-Resource Setting: Outcomes After Major Surgery Performed by Nonphysician Clinicians in Tanzania - World Journal of Surgery

Background Little is known about the breadth and quality of nonobstetric surgical care delivered by nonphysician clinicians (NPCs) in low-resource settings. We aimed to document the scope of NPC surgical practice and characterize outcomes after major surgery performed by nonphysicians in...

link.springer.com

 

[SpineandWine]

If there's a difference in outcome then the burden is on you to prove it so you can justify a higher pay standard. Either that or if I'm the business owner you have to prove to me that marketing your MD will generate more revenue for my company. If none of the above applies, why would I pay someone more?

Some examples cited above are, umm, a bit off. Do you honestly think an NP or PA can't do a TPI over a lung field? How long would that take to learn and how does medical school training prepare you better for this procedure?

Don't worry btw, no MBA is wasting time reading this thread and my opinion is completely worthless anyway, it has absolutely no impact on how healthcare will evolve in the US.


Also, I'm curious about your thoughts on the following:

Training non-physicians as neurosurgeons in sub-Saharan Africa

The surgical gap in sub-Saharan Africa is a huge problem. Some countries are tackling it by training non-physicians as surgeons - including neurosurgeons. And the results have not been bad. But is it a silver bullet? Adrian Burton investigates.

www.thelancet.com

A comparison of clinical officers with medical doctors on outcomes of caesarean section in the developing world: meta-analysis of controlled studies

Objective To review the effectiveness and safety of clinical officers (healthcare providers trained to perform tasks usually undertaken by doctors) carrying out caesarean section in developing countries compared with doctors. Design Systematic review with meta-analysis. Data sources Medline...

www.bmj.com

Surgical Task-Shifting in a Low-Resource Setting: Outcomes After Major Surgery Performed by Nonphysician Clinicians in Tanzania - World Journal of Surgery

Background Little is known about the breadth and quality of nonobstetric surgical care delivered by nonphysician clinicians (NPCs) in low-resource settings. We aimed to document the scope of NPC surgical practice and characterize outcomes after major surgery performed by nonphysicians in...

link.springer.com

The question id ask then is does training matter at all?
Can I get my MAs to see patients/work them up? Especially if I train them well.

 

[Pain Applicant1]

The question id ask then is does training matter at all?
Can I get my MAs to see patients/work them up? Especially if I train them well.

It does but I'm not the one to draw those lines. Don't worry, if you don't think my prediction is right then there's nothing to worry about it. That's how I see things but I have no crystal ball.

I don't feel threatened by mid-levels and I don't worry about competition from them but I do have an arch-enemy ----> The insurance companies.

I think I figured out a way to get back at them. I may start recording my phone conversations with them stating at the beginning of the call that this call may be recorded as they do to me.

Maybe I can then post one of the very frustrating calls, redacted of course, on social media to show what happens with billing from a doctor's perspective. I remember several years ago someone did this when he tried to cancel his cable. He actually stirred up a lot of media attention for this and caused a change in their policies.

I have 2 I'm working on now. A stim trial and an SIJ injection. I have written documentation for prior auth for both and they're still denying them. It's been countless hours on the phone already. I wish I was more charismatic and had social media skills to make it effective.

 

[SpineandWine]

It does but I'm not the one to draw those lines. Don't worry, if you don't think my prediction is right then there's nothing to worry about it. That's how I see things but I have no crystal ball.

I don't feel threatened by mid-levels and I don't worry about competition from them but I do have an arch-enemy ----> The insurance companies.

I think I figured out a way to get back at them. I may start recording my phone conversations with them stating at the beginning of the call that this call may be recorded as they do to me.

Maybe I can then post one of the very frustrating calls, redacted of course, on social media to show what happens with billing from a doctor's perspective. I remember several years ago someone did this when he tried to cancel his cable. He actually stirred up a lot of media attention for this and caused a change in their policies.

I have 2 I'm working on now. A stim trial and an SIJ injection. I have written documentation for prior auth for both and they're still denying them. It's been countless hours on the phone already. I wish I was more charismatic and had social media skills to make it effective.

Honestly, not to get too political but universal healthcare will be what does it for all medicine- then everyone will get Medicaid/Medicare billing

 

[Pain Applicant1]

Honestly, not to get too political but universal healthcare will be what does it for all medicine- then everyone will get Medicaid/Medicare billing

I'm not really for or against something like this but I know other people have strong opinions on this.

The one positive I see is that it would put the commercial payers out of business. Unfortunately, I think the executives from these same companies would probably end up helping to run the universal plan and getting a nice salary to do so so it would probably only really adversely affect the lower-tiered people. I don't think fighting the battle against the payers is something I can win. Grrrrrrr!!

 

[buddababa]

for prior auths for anything, start sending them an invoice for your time

 

[lobelsteve]

Word in Kansas is that there is CRNA's doing SCS trials and looking for pain docs to do implants.
If true, we need to find out name of company supporting that and boycott them.

 

[SpineandWine]

Word in Kansas is that there is CRNA's doing SCS trials and looking for pain docs to do implants.
If true, we need to find out name of company supporting that and boycott them.

I wonder if there is a pain doc signing off on this.
Agree with boycott

 

[Agast]

Word in Kansas is that there is CRNA's doing SCS trials and looking for pain docs to do implants.
If true, we need to find out name of company supporting that and boycott them.

They will say “it’s the surgery center making the purchase, we have no control over who uses it”

That’s the response I got from Coolief when CRNAs were marketing it

 

[lobelsteve]

They will say “it’s the surgery center making the purchase, we have no control over who uses it”

That’s the response I got from Coolief when CRNAs were marketing it

BS used to sell leads to a nearby chiro clinic. DC ordered scs trials to be done by locum pmr doc in chiro office. No plans for implant if successful. When rep came to my office I told her to get the eff out.

If companies say crap like that, tell them to eff off.

 

[Espn123]

BS used to sell leads to a nearby chiro clinic. DC ordered scs trials to be done by locum pmr doc in chiro office. No plans for implant if successful. When rep came to my office I told her to get the eff out.

If companies say crap like that, tell them to eff off.

Will you please let us know which company it is if anyone finds out?

 

[Welcome123]

If there's a difference in outcome then the burden is on you to prove it so you can justify a higher pay standard. Either that or if I'm the business owner you have to prove to me that marketing your MD will generate more revenue for my company. If none of the above applies, why would I pay someone more?

Some examples cited above are, umm, a bit off. Do you honestly think an NP or PA can't do a TPI over a lung field? How long would that take to learn and how does medical school training prepare you better for this procedure?

Don't worry btw, no MBA is wasting time reading this thread and my opinion is completely worthless anyway, it has absolutely no impact on how healthcare will evolve in the US.


Also, I'm curious about your thoughts on the following:

Training non-physicians as neurosurgeons in sub-Saharan Africa

The surgical gap in sub-Saharan Africa is a huge problem. Some countries are tackling it by training non-physicians as surgeons - including neurosurgeons. And the results have not been bad. But is it a silver bullet? Adrian Burton investigates.

www.thelancet.com

A comparison of clinical officers with medical doctors on outcomes of caesarean section in the developing world: meta-analysis of controlled studies

Objective To review the effectiveness and safety of clinical officers (healthcare providers trained to perform tasks usually undertaken by doctors) carrying out caesarean section in developing countries compared with doctors. Design Systematic review with meta-analysis. Data sources Medline...

www.bmj.com

Surgical Task-Shifting in a Low-Resource Setting: Outcomes After Major Surgery Performed by Nonphysician Clinicians in Tanzania - World Journal of Surgery

Background Little is known about the breadth and quality of nonobstetric surgical care delivered by nonphysician clinicians (NPCs) in low-resource settings. We aimed to document the scope of NPC surgical practice and characterize outcomes after major surgery performed by nonphysicians in...

link.springer.com

“if there is a difference in outcome then the burden is on you to prove it so you can justify a higher pay standard” Good point
The issues are where is the line?
Neurosurgery in sub-saharan Africa-I see your point, but it just isn’t applicable to the standard of care we set in America
Regardless-the future will be increased practice scope or creep from mid-levels.
We as pain docs don’t need to encourage or support it
Arguably, pain docs are creeping into spine surgery and it is unlikely many spine surgeons are in support

 

[Welcome123]

“if there is a difference in outcome then the burden is on you to prove it so you can justify a higher pay standard” Good point
The issues are where is the line?
Neurosurgery in sub-saharan Africa-I see your point, but it just isn’t applicable to the standard of care we set in America
Regardless-the future will be increased practice scope or creep from mid-levels.
We as pain docs don’t need to encourage or support it
Arguably, pain docs are creeping into spine surgery and it is unlikely many spine surgeons are in support

Actually, never mind all that scope creep talk
ChatGPT for the win

 

[buddababa]

Word in Kansas is that there is CRNA's doing SCS trials and looking for pain docs to do implants.
If true, we need to find out name of company supporting that and boycott them.

im nearby, tell me more information - i want to shut this down asap

 

[lobelsteve]

Hoping to get more info shortly.

 

[DrMDAware]

for prior auths for anything, start sending them an invoice for your time

I don’t know why there isn’t a movement towards this. Seriously.

When I tell the bean counters I can’t see more patients because I’m doing a peer to peer or prior auth they don’t get it.

Same thing with patients.

Not sure the mechanisms behind sending them an invoice though

 

[SSdoc33]

how about this:

Emailing Your Doctor May Carry a Fee

To Nina McCollum, Cleveland Clinic’s decision to begin billing for some email correspondence between patients and doctors “was a slap in the face.” She has relied on electronic communications to help care for her ailing 80-year-old mother, Penny Cooke, who is in need of specialized psychiatric...

news.yahoo.com

 

[Pain Applicant1]

for prior auths for anything, start sending them an invoice for your time

I don’t know why there isn’t a movement towards this. Seriously.

When I tell the bean counters I can’t see more patients because I’m doing a peer to peer or prior auth they don’t get it.

Same thing with patients.

Not sure the mechanisms behind sending them an invoice though

Attrition warfare: a military strategy consisting of belligerent attempts to win a war by wearing down the enemy to the point of collapse through continuous losses

No way is the above not their policy: Multilevel administrative hurdles, consistent phone disconnections, dozens of minutes exhausted trying to reach a live person, having to voice enter patient and other "pertinent" information through an automated system prior to a live connection, many times the automated system does not recognize what you're saying - these are just a few of their many tactics.

 

[mid|ine]

Your insurance contract will not allow you to invoice them for your time. I will only do P2P with a patient in the office and bill for the time it takes.

 

[bedrock]

how about this:

Emailing Your Doctor May Carry a Fee

To Nina McCollum, Cleveland Clinic’s decision to begin billing for some email correspondence between patients and doctors “was a slap in the face.” She has relied on electronic communications to help care for her ailing 80-year-old mother, Penny Cooke, who is in need of specialized psychiatric...

news.yahoo.com

Not sure why patients feel entitled to using a physician time for free.
They wouldn’t expect this from a lawyer who spent far less time on their education.

I’ll never do email with patients. If they call my office about something and it will take more than 30 seconds for me to deal with it, they have to come in for an appointment.

 

[bedrock]

Your insurance contract will not allow you to invoice them for your time. I will only do P2P with a patient in the office and bill for the time it takes.

Agree. I do the same. I’m not going to fight with their insurance company for free. The patient choose the cheapest plan and so this is what happens.

For that visit I bill for time , but if my staff has to do a lot of legwork I include that in the time. “Coordination of care”

Insurance companies are being cheap so I ensure they pay an extra $100 for putting me through this hassle.