Those of you in Florida should oppose this autonomous mid-level thread.

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Won't happen. On to the next one....
 
This is Florida House Speaker Jose Oliva's biggest remaining goal (nurse independent practice). The house passed it last year, and will probably pass it again this year. It's going to hit a dead end in a much more physician-friendly Senate. If it were to miraculously pass both chambers, it will meet the cold hard tip of our Governor's veto pen.

The interests that are fighting for it will continue fighting for it. Both sides are extremely powerful and well funded, but they have to have three stars align (house, senate, governor) to make it happen, and I just don't see it happening anytime soon in this state. That won't stop them from trying, though. Lobbyists gotta eat too.

PieOHmy said:
How do you know?
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Endee said:
This is Florida House Speaker Jose Oliva's biggest remaining goal (nurse independent practice). The house passed it last year, and will probably pass it again this year. It's going to hit a dead end in a much more physician-friendly Senate. If it were to miraculously pass both chambers, it will meet the cold hard tip of our Governor's veto pen.

The interests that are fighting for it will continue fighting for it. Both sides are extremely powerful and well funded, but they have to have three stars align (house, senate, governor) to make it happen, and I just don't see it happening anytime soon in this state. That won't stop them from trying, though. Lobbyists gotta eat too.
Click to expand...
Some day the three may align.

On the other hand, I personally support CRNA independence. They become so vocal and bold is partly because physicians shield them from liabilities. Once they are on their own, the hospitals will think twice to hire them.
 
Consigliere said:
You are either very naive, inexperienced, or a combination of both. Hospitals will think twice about hiring YOU, you overpaid tube monkey.
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Why so harsh? I am in an opt out state. Most of the pp practices are MD only. Back in tri state area, non opt out, mostly crna supervisions.
 
narcotics999 said:
Why so harsh? I am in an opt out state. Most of the pp practices are MD only. Back in tri state area, non opt out, mostly crna supervisions.
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It wasn't a direct attack on you; merely emphasizing how administrators view all anesthesiologists. Sorry fella.
 
nimbus said:
For those practicing in supervision or collaborative models, beware the curbside by a midlevel.

www.ama-assn.org

More physicians being sued by patients they’ve never treated

Do doctors ever have “legal duty of care” in such cases? An AMA education session explored the issue.
www.ama-assn.org www.ama-assn.org

Minnesota Medical Association - MN Supreme Court Rules Physician-Patient Relationship is Not Necessary to Sue Docs for Malpractice

www.mnmed.org www.mnmed.org
Click to expand...
The hospitalist told the NP not to admit a septic pt... sounds like they didn’t see the pt, review vitals or labs... they have some culpability here. Wouldn’t just pin this on the midlevel...
 
MoMoGesiologist said:
The hospitalist told the NP not to admit a septic pt... sounds like they didn’t see the pt, review vitals or labs... they have some culpability here. Wouldn’t just pin this on the midlevel...
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Yeah it was all done over the phone. The hospitalist made the decision without ever seeing the patient or reviewing the chart. Maybe this is standard operating procedure in the brave new world. Quasi independent NP who doesn’t have hospital admitting privileges. Shouldn’t the midlevel who actually saw and examined the patient be making the decision and send the patient to the ER if they felt the patient was actually sick?
 
nimbus said:
Yeah it was all done over the phone. The hospitalist made the decision without ever seeing the patient or reviewing the chart. Maybe this is standard operating procedure in the brave new world. Quasi independent NP who doesn’t have hospital admitting privileges. Shouldn’t the midlevel who actually saw and examined the patient be making the decision and send the patient to the ER if they felt the patient was actually sick?
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This is eerily similar to some situations I came across on 3rd year rotations. Literally worked with NPs 75% of the shifts in the rural ED, which was probably some sort of accreditation violation. The NPs had to call the on-call family med doc to admit or "consult" a telemedicine doc if they wanted to admit or transfer. 9/10 conversations were "yeah, sure, go ahead and admit/transfer" but 1/10 was a gross misinterpretation/miscommunication regarding the patient's clinical picture that led to some...concerning decisions. I'm all for physician extenders/APPs/midlevels/whatever under the appropriate circumstances. Running a couple of rooms in a fast track/urgent care where they have a doc available to SEE the patients? Sure. Nearly anything else? It's a no from me, dawg.

Work in an area where it's really hard to get docs? Better beef up the recruiting department or pony up for a telemedicine service that can SEE the patient at the bare minimum, rather than hire someone with an online diploma wanting to play doctor for a weekend.
 
narcotics999 said:
Some day the three may align.

On the other hand, I personally support CRNA independence. They become so vocal and bold is partly because physicians shield them from liabilities. Once they are on their own, the hospitals will think twice to hire them.
Click to expand...
Nope. U aren’t seeing the big pic.
Docs will be around but stuck doing the bigger higher risk case.
It’s call selection bias. Crnas will take all the bread and bother. Hospitals know it.
Anything risky hospitals or surgeons may question gets punted to docs are more tertiary care places.

It’s as plain as day.
 
aneftp said:
Nope. U aren’t seeing the big pic.
Docs will be around but stuck doing the bigger higher risk case.
It’s call selection bias. Crnas will take all the bread and bother. Hospitals know it.
Anything risky hospitals or surgeons may question gets punted to docs are more tertiary care places.

It’s as plain as day.
Click to expand...


I imagine this is what the militant CRNAs out west are fighting for. After the big VA decision that docs have to be involved with anesthetics it shuts down the idea of CRNAs running Anesthesiology departments at hospitals doing major cases. These guys are telling stories of CRNAs independently doing hearts and livers, reading TEEs, running pain clinics when really they probably have contracts with small ASCs doing fast turnover cases like cataracts cashing big checks for high volume, GI centers, plastic surgery offices, etc. Follow the money...
 
narcotics999 said:
Why so harsh? I am in an opt out state. Most of the pp practices are MD only. Back in tri state area, non opt out, mostly crna supervisions.
Click to expand...

There is truth to this. Take a look at California. One of the oldest opt-out states. The greatest number of physician only practices in the US. # of unemployed anesthesiologists - zero.
 
Zekchar said:
There is truth to this. Take a look at California. One of the oldest opt-out states. The greatest number of physician only practices in the US. # of unemployed anesthesiologists - zero.
Click to expand...
But ok. Seriously, how many anesthesiologists, that are competent, that want to work are actually out of work? For like a period of time longer than the three months it takes to get credentialed? We are in demand everywhere last I checked. Lots of locums available everywhere. Everywhere.
 
Zekchar said:
There is truth to this. Take a look at California. One of the oldest opt-out states. The greatest number of physician only practices in the US. # of unemployed anesthesiologists - zero.
Click to expand...
California is not one of the oldest opt out states. The terminator made it opt out when he was governor. The reason for opt out was due to rural areas in California not the major cities where MD only anesthesia was the norm and is still the norm.
 
BLADEMDA said:
California is not one of the oldest opt out states. The terminator made it opt out when he was governor. The reason for opt out was due to rural areas in California not the major cities where MD only anesthesia was the norm and is still the norm.
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So if MD only anesthesia is the norm, and still the norm, why the opt out. Seems like docs wanted to go where no one wanted to go.
Makes no sense to me other than the nurses put money in someone’s pocket.
 
BLADEMDA said:
California is not one of the oldest opt out states. The terminator made it opt out when he was governor. The reason for opt out was due to rural areas in California not the major cities where MD only anesthesia was the norm and is still the norm.
Click to expand...

Perhaps my timeline is off. I thought it was longer back, but the point still stands no? Cali has the greatest amount of physician only anesthesia despite being very high risk to physicians due to no tort reform and lots of lawsuits. How do we reconcile those two things? If the opt-out gives the CRNAs and hospital admins so much power over anesthesiologist only practices, why aren't all the desirable jobs in the major cities CRNA only?
 
Zekchar said:
Cali has the greatest amount of physician only anesthesia despite being very high risk to physicians due to no tort reform and lots of lawsuits.
Click to expand...

Can you please make an effort to educate yourself before you post nonsense like this. CA actually has very strong tort reform, and our low malpractice premiums are evidence of that. All you do is completely discredit yourself when you post things like this that are completely false.
 
Zekchar said:
Perhaps my timeline is off. I thought it was longer back, but the point still stands no? Cali has the greatest amount of physician only anesthesia despite being very high risk to physicians due to no tort reform and lots of lawsuits. How do we reconcile those two things? If the opt-out gives the CRNAs and hospital admins so much power over anesthesiologist only practices, why aren't all the desirable jobs in the major cities CRNA only?
Click to expand...
Physicians are cheaper in parts of California. See Valley Presbyterian Anesthesiology job (Los Angeles)
Anesthesiologist working 1099 at $28-30/unit with call in LA. no overtime pay.
vs. CRNA working for the state (low paying probably) as w-2 with full benefits and pension doing 3 12's a week no nights no weekends no holidays at 200-240k base in LA with OT pay in addition. Standard pension is 2.5% of the highest salary times the number of years worked.

Edited to add link UC is handing out generous pensions, and students are paying the price with higher tuition

1579910353783.png
 
Last edited:
mmag said:
Physicians are cheaper in parts of California. See Valley Presbyterian Anesthesiology job (Los Angeles)
Anesthesiologist working 1099 for at $28-30/unit working 1099 with call in LA. no overtime pay
vs. CRNA working for the state (low paying probably) as w-2 with full benefits and pension doing 3 12's a week no nights no weekends no holidays at 200-240k base in LA with OT pay in addition. Standard pension is 2.5% of the highest salary times the number of years worked.

Edited to add link UC is handing out generous pensions, and students are paying the price with higher tuition

View attachment 293659
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Shocking to see. I had no idea. This certainly is an eye-opener for me ... and I'm sure many others as well.
 
nimbus said:
For those practicing in supervision or collaborative models, beware the curbside by a midlevel.

www.ama-assn.org

More physicians being sued by patients they’ve never treated

Do doctors ever have “legal duty of care” in such cases? An AMA education session explored the issue.
www.ama-assn.org www.ama-assn.org

Minnesota Medical Association - MN Supreme Court Rules Physician-Patient Relationship is Not Necessary to Sue Docs for Malpractice

www.mnmed.org www.mnmed.org
Click to expand...


Yes, but my midlevels where I'm in fellowship actually quote in their notes, "curb sided xyz, they said abc." I told my new PAs that actually listen, absolutely never do this. The person that does this also happens to be our weakest NP and most obnoxious.
 
jthedestroyr said:
Yes, but my midlevels where I'm in fellowship actually quote in their notes, "curb sided xyz, they said abc." I told my new PAs that actually listen, absolutely never do this. The person that does this also happens to be our weakest NP and most obnoxious.
Click to expand...

Lol as if that will hold up in court. The doc can say "no i didnt. can you prove otherwise?" Same reason I lmao when I see 'MD Aware' in nursing notes and they say its to "cover themselves."
 
jthedestroyr said:
Yes, but my midlevels where I'm in fellowship actually quote in their notes, "curb sided xyz, they said abc." I told my new PAs that actually listen, absolutely never do this. The person that does this also happens to be our weakest NP and most obnoxious.
Click to expand...
Maybe you are at the same place I went to. Sounds familiar.
 
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