Regular day in PP land

[pd4emergence]

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So this was my day case wise yesterday. I was the last guy to leave other than the call guy. I left about 8 pm but was only there today for a short time (left about 0830).

CABG
Nephrectomy for renal cell cancer (surgeons quit after 500 cc's blood loss after seeing enough of the tumor to know they could not resect it)
ACF
ACF
lumber interbody fusion
post cervical fusion/decompression
Breast reduction
cysto/bladder tumor fulguration
forearm av fistula/vas cath
permacath
declot av fistula
2 C sections
Da Vinci prostatectomy
bilateral mastectomy
2 labor epidurals at the end of the day

I probably missed 1 or 2 but can't remember offhand what they were. It was a moderately busy day (some are busier, some are slower). It was nice having the CABG and the prostatectomy b/c those were relatively long cases and those rooms did not turn over as much. As you can tell, I pretty much only do supervision. It turned out to be a pretty good day, I had good CRNA's in my rooms nearly all day. No complications, no post op issues, everybody lived. I really do enjoy what I do. At 8 pm, I left it to the call guy who had 3 rooms going and more to follow. I went home knowing that I would have a pretty short day today and looking forward to spending some time with my wife and kids and looking forward to some mountain bike time later in the day. Just thought I would share.

 

[urge]

So this was my day case wise yesterday. I was the last guy to leave other than the call guy. I left about 8 pm but was only there today for a short time (left about 0830).

CABG
Nephrectomy for renal cell cancer (surgeons quit after 500 cc's blood loss after seeing enough of the tumor to know they could not resect it)
ACF
ACF
lumber interbody fusion
post cervical fusion/decompression
Breast reduction
cysto/bladder tumor fulguration
forearm av fistula/vas cath
permacath
declot av fistula
2 C sections
Da Vinci prostatectomy
bilateral mastectomy
2 labor epidurals at the end of the day

I probably missed 1 or 2

Wow, that's a lot of cases. Supervision, not direction, right? How many rooms do you supervise at a time?

What is an ACF?

Do you want to know how many cases I did today? 2- A 6 hr ACDF and a 4 hr pancreatectomy. I bet both of them were medicare.

 

[militarymd]

My day (I was on call)

All Medical Direction :

- 4 TKA (1 was a revision) : 2 with fem/sciatic nerve blocks...2 with femoral only
3 of them were lma ga and one was a spinal.

at 2200 3 of 4 had no pain....1 had "annoy knee sensation".

- cysto / stone extraction

- 2 penile prosthesis.

- 3 portacaths
- 3 lap choles
- 1 total hip revision
- plastics - lesion excisions
- plastics - hematoma excision
- 1 laboring epidural
- 1 orif of ankle
- + a few others I can't remember.

went to bed at 2100..

 

[zippy2u]

ACF= anterior cervical fusion. ----Zip

 

[pd4emergence]

Wow, that's a lot of cases. Supervision, not direction, right? How many rooms do you supervise at a time?

What is an ACF?

Do you want to know how many cases I did today? 2- A 6 hr ACDF and a 4 hr pancreatectomy. I bet both of them were medicare.

I should have said medical direction. I never have more than 4 rooms. Zippy's right ACF=ant. cervical fusion. Our payor mix is not the best either. After doing all of those cases I think the grand total for my group was about 18 dollars (one or two cases I think I had to pay to do). At least everybody did well.

 

[jetproppilot]

I should have said medical direction. I never have more than 4 rooms. Zippy's right ACF=ant. cervical fusion. Our payor mix is not the best either. After doing all of those cases I think the grand total for my group was about 18 dollars (one or two cases I think I had to pay to do). At least everybody did well.

Nice to see our busy day.

BTW, those DaVinci prostates are pretty cool.....but make sure you have a buncha anesthesia records!!! I hope they get shorter.

Thanks for sharing. 👍

 

[Coastie]

I should have said medical direction. I never have more than 4 rooms. Zippy's right ACF=ant. cervical fusion. Our payor mix is not the best either. After doing all of those cases I think the grand total for my group was about 18 dollars (one or two cases I think I had to pay to do). At least everybody did well.

Pay to do a couple...

Yikes.

 

[maceo]

My day (I was on call)

All Medical Direction :

- 4 TKA (1 was a revision) : 2 with fem/sciatic nerve blocks...2 with femoral only
3 of them were lma ga and one was a spinal.

at 2200 3 of 4 had no pain....1 had "annoy knee sensation".

- cysto / stone extraction

- 2 penile prosthesis.

- 3 portacaths
- 3 lap choles
- 1 total hip revision
- plastics - lesion excisions
- plastics - hematoma excision
- 1 laboring epidural
- 1 orif of ankle
- + a few others I can't remember.

went to bed at 2100..

i hope you are getting paid handsomely

 

[jetproppilot]

i hope you are getting paid handsomely

He is.

 

[Planktonmd]

Wow, that's a lot of cases. Supervision, not direction, right? How many rooms do you supervise at a time?

What is an ACF?

Do you want to know how many cases I did today? 2- A 6 hr ACDF and a 4 hr pancreatectomy. I bet both of them were medicare.

You work in an academic place don't you?
So, you were directing 1 room the whole day?

 

[cfdavid]

My day (I was on call)

All Medical Direction :

- 4 TKA (1 was a revision) : 2 with fem/sciatic nerve blocks...2 with femoral only
3 of them were lma ga and one was a spinal.

at 2200 3 of 4 had no pain....1 had "annoy knee sensation".

- cysto / stone extraction

- 2 penile prosthesis.

- 3 portacaths
- 3 lap choles
- 1 total hip revision
- plastics - lesion excisions
- plastics - hematoma excision
- 1 laboring epidural
- 1 orif of ankle
- + a few others I can't remember.

went to bed at 2100..

Mil, you didn't tell us you put JET under!!!! LOL LOL

j.k. JPP!

 

[pd4emergence]

Nice to see our busy day.

BTW, those DaVinci prostates are pretty cool.....but make sure you have a buncha anesthesia records!!! I hope they get shorter.

Thanks for sharing. 👍

DaVinci prostatecomies are the way to go. Over the past few years I have seen our uro guys get better and better. Now instead of 6 hours +, it seems most get done in about 4 hrs. I still see the occasional 6 hour Davinci but if it was me, I'd take that over the alternative any day.

 

[militarymd]

DaVinci prostatecomies are the way to go. Over the past few years I have seen our uro guys get better and better. Now instead of 6 hours +, it seems most get done in about 4 hrs. I still see the occasional 6 hour Davinci but if it was me, I'd take that over the alternative any day.

we have a urologist who can do an open one in less than one hour...with less than 100 cc of blood loss....and patients go home the next day....

I doubt the robot is going to do much for him.

 

[IceDoc]

DaVinci prostatecomies are the way to go. Over the past few years I have seen our uro guys get better and better. Now instead of 6 hours +, it seems most get done in about 4 hrs. I still see the occasional 6 hour Davinci but if it was me, I'd take that over the alternative any day.

One of our guys (at an academic center no less) can reliably do 2 before 1pm or earlier.

 

[Tenesma]

i don't think the data on better outcomes is all that accurate - at least in france they think the world of robot assisted lap prost.

if you have an excellent surgeon, then the risks of urinary incontinence and erectile dysfunction (which are the 2 big concerns on patients' minds) are probably the same whether davinci or not...

a surgeon who takes 6 hours to do an ACDF in private practice should have his operating privileges taken away unless it was a C6-7 level on a 550 lbs patient with all of their fat rolled up in their neck or unless it was a revision, hardware removal, with tons of scar tissue or unless it was in a patient with previous radical neck dissection with significant radiation contracture...

my guys do their ACDF in under 1 hour...

 

[urge]

You work in an academic place don't you?
So, you were directing 1 room the whole day?

2 rooms. One case in each. I was exhausted. Left around 2pm.

 

[zippy2u]

Urge, exhausted after 2 measley cases? Try 35 cases over 8 hrs in 5 separate rooms. I'll put you on that supervisional merry-go-round and you won't even have the time to smell your own farts. Serious ASC coinage--makin' them dinosaur hospitals bleed and scream fo' mercy. Get some of dat! Regards, ---Zip

 

[urge]

I was being sarcastic.


I have a question now. If you are supervising, do you even have to talk to the pts? Or, is it more like a "call me if **** hits the fan" otherwise I'll be in my office?

 

[pd4emergence]

i don't think the data on better outcomes is all that accurate - at least in france they think the world of robot assisted lap prost.

if you have an excellent surgeon, then the risks of urinary incontinence and erectile dysfunction (which are the 2 big concerns on patients' minds) are probably the same whether davinci or not...

a surgeon who takes 6 hours to do an ACDF in private practice should have his operating privileges taken away unless it was a C6-7 level on a 550 lbs patient with all of their fat rolled up in their neck or unless it was a revision, hardware removal, with tons of scar tissue or unless it was in a patient with previous radical neck dissection with significant radiation contracture...

my guys do their ACDF in under 1 hour...

There are only a hand full of surgeons I have run across that I would classify as excellent. Sure, for excellent surgeons it probably doesn't matter robot vs. open vs. whatever. For the rest of them, I am happy to see them use the robot b/c I don't have to worry about the 500-1L blood loss I used to see with the old retropubic approach. Long term outcome I don't know but these guys are regularly leaving the hospital within a day or two with some discomfort but nothing like I used to see with the RPP.

 

[Jeff05]

surgeon at my institution does robot 'states in about 2 hours - skin to skin.
usually we can do 4 robots from 7-4pm...

 

[jwk]

Nice to see our busy day.

BTW, those DaVinci prostates are pretty cool.....but make sure you have a buncha anesthesia records!!! I hope they get shorter.

Thanks for sharing. 👍

Huge learning curve on the Davinci's - our experienced guys are now in the 2-3 hour range, but they were 8hrs + early on.

Everything I'm reading and seeing indicates that the Davinci prostates seem to do better with nerve preservation as well as continence - we've seen several urologists have their own prostatectomies done this way.

That being said, the prostates are the only procedure I see a clearcut advantage (don't know about hearts). We're seeing Davinci hysterectomies and BSO's - the only advantage is big $$$ for the surgeon, hospital, and supplier of the Davinci instrumentation, which adds $15k to the cost of the procedure.

 

[jetproppilot]

Mil, you didn't tell us you put JET under!!!! LOL LOL

j.k. JPP!

 

[drccw]

It seems that there is quite a big learning curve with the RObot- but once they get over the hump the doctors are relatively zippy enough... of course one of the big hurdles also is nursing support. if you;ve got a good team, who is really used to setting thee cases up then things are good- if it takes your nurses an hour and a half to set up you're hosed...

 

[gasping81]

I saw some of those posts, and if I interpret the statements with military time right, then you guys normally spend 12 hrs/day at work.

That is quite a lot if you throw in call every 4 days or so. I don't see how that beats FP or IM except that you can tube someone to shut em up and the pay. Well, the pay is only good for now, and I am sure it will suck in 5 years relatively.

Anybody out there working 40-50 hours in low-key practice with people making less but larger group meaning less call? When does it become unrealistic to do this? How many MDs and/or CRNAs?

 

[Gas]

I saw some of those posts, and if I interpret the statements with military time right, then you guys normally spend 12 hrs/day at work.

That is quite a lot if you throw in call every 4 days or so. I don't see how that beats FP or IM except that you can tube someone to shut em up and the pay. Well, the pay is only good for now, and I am sure it will suck in 5 years relatively.

Anybody out there working 40-50 hours in low-key practice with people making less but larger group meaning less call? When does it become unrealistic to do this? How many MDs and/or CRNAs?

I average 35-40 hours/week (not including home call - roughly about 20 hours/week) with q8 call. Salary here is quite good for the work we do. Reason is that it is not the most desirable place to live, but it suits me due to proximity of family. 8 MDs, 9 CRNAs, 10 ORs to cover. We are currently recruiting too.

I don't think our pay will "suck" in 5 years. And if it does, don't think IM and FP are immune.

 

[pd4emergence]

I saw some of those posts, and if I interpret the statements with military time right, then you guys normally spend 12 hrs/day at work.

That is quite a lot if you throw in call every 4 days or so. I don't see how that beats FP or IM except that you can tube someone to shut em up and the pay. Well, the pay is only good for now, and I am sure it will suck in 5 years relatively.

Anybody out there working 40-50 hours in low-key practice with people making less but larger group meaning less call? When does it become unrealistic to do this? How many MDs and/or CRNAs?

I average 50-60 hours a week. I honestly don't think that is too bad for a physician. You mention FP and IM like they are an 8-5 job. The ones I know spend 10 hours in clinic seeing 40 patients a day and then have to go to the hopital for rounds. They don't get paid nearly what they should. I looked back at your posts, looks like you are, or want to be a PMR resident. You know, I have never really understood what it is a PMR doctor does. I at least have the decency not to bash what it is you want to do. If you don't like anesthesiology that's ok there are other things you can do. There is actually a whole other world out there besides medicine. The thing is all residencies suck, it doesn't really matter what you are doing, sooner or later it gets better but with your attitude my guess is it will never be better for you. By the way, if you apply for a pain fellowship in a few years make sure and bring a copy of this post.

 

[gasping81]

Remember, most don't consider anesthesiologists to be doctors as well. So I wouldn't go to far about dogging other hidden specialties like rads, PMR, etc. Take what you want from my comment, but please no George Bush talk.

 

[177983]

Remember, most don't consider anesthesiologists to be doctors as well. So I wouldn't go to far about dogging other hidden specialties like rads, PMR, etc. Take what you want from my comment, but please no George Bush talk.

Gasping, I believe you are taking umbrage where none is really merited. I don't think PD4 was ever implying that PMR docs aren't doing "doctorly" things. Also, the reference to GW is lost on me...

 

[jeesapeesa]

Wow, that's a lot of cases. Supervision, not direction, right? How many rooms do you supervise at a time?

What is an ACF?

Do you want to know how many cases I did today? 2- A 6 hr ACDF and a 4 hr pancreatectomy. I bet both of them were medicare.

you mentioned supervision vs. direction. what's the difference between the two? and what will be the more prevalent trend in say....10 years?

 

[jetproppilot]

Remember, most don't consider anesthesiologists to be doctors as well.

ITS ALL GOOD, DUDE.


Jet pulls the Yukon XL monsta truck ever-so-gingerly into the Bank of America driveup and puts the beast into park. He climbs nearly out of the window, hanging way outta the truck, and grabs the cylinder shaped tube. One more glance at the piece of paper that monetarily represents a months work.

"Jesus," Jet mutters.

Jet laughs aloud, shakes his head, then buries the tube in the tunnel that carries all the benjamins on that one piece of paper into his account. He uses a pen to reach the SEND button.

Its still a good gig.

Even if you don't think I'm a real doctor.

 

[deleted126335]

.

 

[pd4emergence]

Remember, most don't consider anesthesiologists to be doctors as well. So I wouldn't go to far about dogging other hidden specialties like rads, PMR, etc. Take what you want from my comment, but please no George Bush talk.

I wasn't saying anything bad about PMR. I said that I really don't know what they do. Not that they weren't "real" doctors but that I really have no idea what they do in their day to day practice. You don't seem to understand what it is that an anesthesiologist does. Maybe you should not post flippant remarks about just getting the tube in. Your sense of entitlement is almost as annoying as your whining posts. Suck it up, finish a residency in something or find something else to do, just remember it's not all about you and your current state of happiness. Good luck in your future endeavors.