Practicing without Residency

[BobBarker]

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I live in a rural state. My mentor as an undergrad was an older GP who had been in practice for 25 years. Initially, he went into practice with his brother who was also a GP. They each had only completed internship. His brother liked surgery and he liked anesthesia. So his brother operated and he provided the anesthesia for his cases. They also delivered babies and did c sections under general. I always thought this was interesting seeing how this was the early 1980s, really not that long ago. In my state there are still many FM docs who do general surgery. Don't know of anybody doing something similar for anesthesia. The practice sounds so strange but was once very common.

 

[BLADEMDA]

I live in a rural state. My mentor as an undergrad was an older GP who had been in practice for 25 years. Initially, he went into practice with his brother who was also a GP. They each had only completed internship. His brother liked surgery and he liked anesthesia. So his brother operated and he provided the anesthesia for his cases. They also delivered babies and did c sections under general. I always thought this was interesting seeing how this was the early 1980s, really not that long ago. In my state there are still many FM docs who do general surgery. Don't know of anybody doing something similar for anesthesia. The practice sounds so strange but was once very common.

Good luck getting privileges or reimbursement from insurance companies. These days Board Eligibility and even Certification are essential for success in 99 percent of practices.

 

[oldguy55]

On my first day of residency (early '80s) I arrived to find my attending was a former GP. I thought I recognized his name. It turns out he had taken out my tonsils around 1960.

So, a GP who did surgery at one time, then trained to do anesthesia. I have no idea what sort of "residency" he might have done.

 

[deleted126335]

It was still out there in an at least one rural hospital that I know as late as 2009. Might still be for all I know.

 

[BLADEMDA]

It was still out there in an at least one rural hospital that I know as late as 2009. Might still be for all I know.

Almost all of these individuals are over the age of 65 with the vast majority in their mid 70s or more. That day has come and gone for Anesthesiology.


Another scenario in rural hospitals is an FMG who did an Anesthesiology Residency in his/her home country but only an internship year in the USA. Yet, this person practices Anesthesiology as state licensure used to be just one year of post graduate training. Again, this is not very common any longer and not something any recent Anesthesiology graduate will likely encounter.

 

[Idiopathic]

its all about what a hospital will hire you and give you privileges for. technically all you need is a medical license, if a small town cant find boarded physicians to staff their needs, they can cetrtainly find licensed docs to do the same. reimbursement will be an issue, and i imagine malpractice coverage will be challenging, but if the hospital is in serious need, anything is possible.

 

[mille125]

I live in a rural state. My mentor as an undergrad was an older GP who had been in practice for 25 years. Initially, he went into practice with his brother who was also a GP. They each had only completed internship. His brother liked surgery and he liked anesthesia. So his brother operated and he provided the anesthesia for his cases. They also delivered babies and did c sections under general. I always thought this was interesting seeing how this was the early 1980s, really not that long ago. In my state there are still many FM docs who do general surgery. Don't know of anybody doing something similar for anesthesia. The practice sounds so strange but was once very common.

Not a real viable option today for all of the reasons previously quoted...cant get insurance, cant get on panels, cant be hospital privileges (mainly because of the first two issues)...

 

[leaverus]

i wonder what the complication rates for these non-formally trained "anesthesiologists" are. did they learn on the job??

 

[92122]

"Another scenario in rural hospitals is an FMG who did an Anesthesiology Residency in his/her home country but only an internship year in the USA. Yet, this person practices Anesthesiology as state licensure used to be just one year of post graduate training. Again, this is not very common any longer and not something any recent Anesthesiology graduate will likely encounter."

I work with a gentleman who trained in Anesthesiology in South Africa and practiced there for many years. Later, he came to the US and did a one-year fellowship. Granted, your post discusses someone doing an internship, but there are certainly people out there who are working here having done only one year of USPGME.

 

[AlmostJesus]

I know of at least one place in ND that the a couple of the FPs do lap chole's and lap appys along with c-sections. Hospital in the middle of nowhere with only 1 surgeon (that only does open procedures), so the doctors trained with the surgeons to do enough cases that the hospital granted them privileges. They are still able to get malpractice coverage although it is very spendy.
Its a matter of acceptable risk I guess. The people in these areas are willing to take a higher risk of complications in order to avoid having to travel long distances for these procedures.

 

[45408]

I know of at least one place in ND that the a couple of the FPs do lap chole's and lap appys along with c-sections. Hospital in the middle of nowhere with only 1 surgeon (that only does open procedures), so the doctors trained with the surgeons to do enough cases that the hospital granted them privileges. They are still able to get malpractice coverage although it is very spendy.
Its a matter of acceptable risk I guess. The people in these areas are willing to take a higher risk of complications in order to avoid having to travel long distances for these procedures.

I saw an FP do a C-section once, in a major city. He had done a one year fellowship that enabled him to do that, I think.

It was terrifying for me, as a student. The post-op management was even worse.

 

[MTGas2B]

FPs doing rural anesthesia is a model uses in some parts of Canada I've heard. From what I understand it's a somewhat formalized process.


On the iPhone

 

[deleted59964]

FPs doing rural anesthesia is a model uses in some parts of Canada I've heard. From what I understand it's a somewhat formalized process.


On the iPhone

GPs (FPs) give anaesthetics here in australia too.
mostly simple stuff in rural locations - but not always.
they do 12months training to become GP anaesthetists.
this is our model for meeting need in a very geographically isolated country that does not have nurse anaesthetists.

 

[sevo85288]

Newsflash: The year is 2012, not 1960. That is IMPOSSIBLE today in 99% of places.

 

[Sergio99]

This is exactly how CRNAs came into existence, because there weren't enough anesthesiologists to fill the needs of the population. The same thing happens in underserved rural areas, and anybody daring and arrogant enough to think he knows as much as an anesthesiologist, will do some sort of anesthetic act if the local hospital allows him.

The only way to end this situation is what I have always said about solving the CRNA problem: training more anesthesiologists. Restricting entrance into our field does not work te same way it does for neurosurgeons and ophthalmologists, because they don't have CRNAs competing with them.

 

[gasattack3]

This is exactly how CRNAs came into existence, because there weren't enough anesthesiologists to fill the needs of the population. The same thing happens in underserved rural areas, and anybody daring and arrogant enough to think he knows as much as an anesthesiologist, will do some sort of anesthetic act if the local hospital allows him.

The only way to end this situation is what I have always said about solving the CRNA problem: training more anesthesiologists. Restricting entrance into our field does not work te same way it does for neurosurgeons and ophthalmologists, because they don't have CRNAs competing with them.

Or we should intensify/further support the development of new AA schools. At least we'll have a non-hostile partner then.

 

[rsgillmd]

I saw an FP do a C-section once, in a major city. He had done a one year fellowship that enabled him to do that, I think.

It was terrifying for me, as a student. The post-op management was even worse.

I can give you the exact opposite experience. FP docs in my institution can do C/S unsupervised and don't seem to be particularly scary intra-partum or post-partum. Of course they use good judgment and get OB/GYN backup or transfer care to the obstetricians in cases where they are not comfortable/trained.

 

[deleted59964]

Newsflash: The year is 2012, not 1960. That is IMPOSSIBLE today in 99% of places.

Newsflash : the Quote button is your friend. What is IMPOSSIBLE today in 99% of places?