Sign of things to come?

[ProRealDoc]

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A non-surgeon's role in gallbladder surgery | Ahmed Ezzat posted on the topic | LinkedIn

Every UK surgeon/ trainee must watch this. A Non-Surgeon has been performing complex gallbladder surgery. I explain in detail in my video @DrMishMash the published scope of work for Surgical Care Practitioners by The Royal College of Surgeons of England. They only need 18 months of post...

www.linkedin.com

 

[smq123]

A non-surgeon's role in gallbladder surgery | Ahmed Ezzat posted on the topic | LinkedIn

Every UK surgeon/ trainee must watch this. A Non-Surgeon has been performing complex gallbladder surgery. I explain in detail in my video @DrMishMash the published scope of work for Surgical Care Practitioners by The Royal College of Surgeons of England. They only need 18 months of post...

www.linkedin.com

Can someone translate that into American physician-ese?

 

[Smurfette]

Can someone translate that into American physician-ese?

I think the gist is that NPs and PTs (!!) can do surgery with an attending "available" but not in the OR, if they do a 2 year masters program. Sounds like a bad idea. Aside from the doing surgery factor, I don't understand the UK system and think lumping PTs in a group with what sounds like our NP equivalent is weird.

 

[Neurodelic]

Sounds like exactly what they do in anesthesiology (have 1 physician supervising multiple nurses/assistants in multiple ORs). Why should this be any more concerning?

 

[akwho]

There is a reason all the wealthy British people private pay for surgery or fly out of the country for it. British government doing their best drive public healthcare into the ground. As an aside this is likely what would happen in the U.S. with a single payer system. Large wait lists, push to use the cheapest widgets possible (PA/NP) despite the cost to the average patient's health. The wealthy would still pay top dollar for surgeon expertise and quicker service.

‘My GP suggested it’: Britons explain why they went private for surgery

As it emerges that private hospitals are treating a record number of people, patients tell their stories

www.theguardian.com

 

[Dr.LeoSpaceman]

Things to come? This is basically where we are at now.

Generally speaking, PAs, NPs and residents can perform portions of the operation as long as the surgeon is present for the "critical portions". What are those critical portions? Well, probably depends on who you ask and what procedure you're talking about. Though I think most surgeons would have some agreement on what those are.

So the question is, are we going to get to a point where APPs could perform something like a cholecystectomy with someone only being "available" and not present? I mean, I guess we could...but the surgeon would have to be pretty cavalier with considerations regarding their own liability.

Also, despite the comments on the video, that amount of training is seemingly similar to what you'd expect in a mid-level resident. So makes sense that the scope could be similar to that of residents (at least as it relates to the operating room). In other words, given two years of intensive training, could I teach someone to accomplish the technical aspects of a straightforward laparoscopic cholecystectomy. Yes, I'm pretty sure I could. Could I train them to deal with the full scope of dealing with appropriate workup and management (pre/intra/post-op) of biliary pathology? No, certainly not. Which is still what should separate APPs and surgeons in this example. And also why residency takes longer.

So if you want to start considering why we may have to train people to take roles of mid-level residents, perhaps it's because the work has to be done by someone.

 

[dozitgetchahi]

Sounds like exactly what they do in anesthesiology (have 1 physician supervising multiple nurses/assistants in multiple ORs). Why should this be any more concerning?

Because surgeons like to think that what they do is so special that nobody else can do it (and they should be paid way more than other types of physicians for it).

Don’t get me wrong - I’m not in favor of midlevel care. At all. I think we’re already seeing how bad the proliferation of midlevel care has been for American patients.

BUT

If the rest of us in medicine have to put up with watching midlevels invade our respective specialties, I’m not sure why surgeons should be magically excluded from that. Or why surgeons should be magically paid way more then non-procedural docs for their work.

But I digress.

 

[Dr.LeoSpaceman]

Because surgeons like to think that what they do is so special that nobody else can do it (and they should be paid way more than other types of physicians for it).

There is a fundamental difference when it comes to complex procedural endeavors. The fact that they require literally thousands of micro decisions over the course of a case in order to obtain the ideal result, generally with little ability to stop and consult a collaborating physician, makes it unique. Then there is the issue that I touch on above--and which most surgeons would likely agree--being able to operate, while demanding, isn't even the most important part of the gig.

Its also not unique to surgery. It's shared by a variety of other subspecialties as well. Interventional cards, advanced GI endo, IR, etc.

This is in contrast to anesthesiology, where there is perhaps more opportunity to safely put things on "cruise control" and delegate more straightforward portions of the case to someone else. Though we could argue about whether you're still making tradeoffs vs. having an anesthesiologist there the whole time. I suspect you are, but the NNT is likely higher when it comes to realizing a net benefit to patients (particularly when costs are considered).

It's not like the Surgical Illuminati are out there pulling strings to minimize the impact of midlevels in comparison to other areas of medicine. There are actually structural reasons why it's less prone to mid-level creep. Doesn't mean it can't/won't happen, of course.

I won't touch on the compensation aspect, particularly because you're painting with a broad brush. There are plenty of specialties that are compensated better than some surgical disciplines.

 

[anonperson]

What is it with non physicians wanting to be physicians while taking every short cut possible?

I could train someone to do a hysterectomy/c section etc just like we could train someone to do an appendectomy or cholecystectomy etc. That's what residency is for. Not some twisted situation where we have a PA/NP who will just do choles, another group who will just do hysterectomies etc .

Give me a break.

Anesthesia as a specialty was really dumb to let the CRNA horse out of the barn. A mix of greed and also their own success. Modern day anesthesia is safe because of the protocols/work that prior physicians worked to create. Someone came by and decided to exploit that safety unfortunately.

There are plenty of non surgical specialists making a ton. You see the numbers getting thrown around for heme once? Non invasive cardiology is also doing exceptionally well also.

 

[operaman]

Selfishly not a fan of midlevels making inroads here, but also pragmatic enough to realize there are many procedures that could easily be done by a technician with adequate training. Anything we let interns and pgy2s do could probably be done by non physicians. Doesn’t mean we should, but it doesn’t seem so outside the realm of possibility.

I wonder more about the supply/demand issues in the UK where this is a viable solution. I’m also in a very high need area, but even more scarce than surgeons are OR blocks. I struggle at times to get two rooms for myself, much less to supervise a mid level. I think OR space is generally hard to come by most places, so adding a bunch of non-surgeon operators doesn’t really address the key limiting factor in many markets. Is the NHS just sitting on oodles of unused OR time such that expanding the number of operators makes sense?

 

[Apollyon]

I recall someone telling me that surgeons aren't there for routine choles and appys. They are there when there's a carcinoid or a retrocecal. It usually isn't, but, when it is, it's everything. And, if you are a surgeon that hasn't found something on opening that you didn't see on imaging, you haven't operated enough.

For clarity, I am not a surgeon. I just listen when people talk.

 

[operaman]

I recall someone telling me that surgeons aren't there for routine choles and appys. They are there when there's a carcinoid or a retrocecal. It usually isn't, but, when it is, it's everything. And, if you are a surgeon that hasn't found something on opening that you didn't see on imaging, you haven't operated enough.

For clarity, I am not a surgeon. I just listen when people talk.

Yeah if you’ve never felt lost in a neck/ear/<insert body part here> then you just haven’t done enough yet.

It can be unexpectedly humbling at times.