Two anesthesiologists murdered

[pgg]

on quick internet search some police academy courses are as short as 19 weeks while San Diego is 6 months and LAPD is 6-9 months. of course they go into probation periods afterward where they work the streets. I found a firearms course in California that literally says on the site "We will take you from not having any experience with a firearm, to a Concealed Carry Advanced Level Shooter in 2 days. Shooting made easy."

2.....Days

This makes me profoundly uncomfortable too. But so do lots of foolish things that stupid or reckless people do. We can start that discussion with lousy drivers, who kill 30K+ people per year (including thousands of children), and injure millions more. And car driving isn't even a civil right. 16 year old kids get drivers licenses every day with minimal time/investment. That bar is pretty low.


I don't know what the best answer is, and I'm not totally opposed to some training and proficiency requirements for gun owners.

The problem is that when such things are proposed, they're always thinly veiled attempts to make gun ownership and carry an expensive, onerous process that will discourage people from exercising the right. Especially if they're poor, and/or live in urban areas where zoning and other restrictions have made it all but impossible to operate a gun store or shooting range. An indoor pistol range takes a tiny amount of space. Can you guess how many exist in New York City, population 8.4 million?

As for the cost (fees, time) we've been down this road repeatedly over the last 80+ years. The 1934 National Firearms Act got it all started - it slapped a $200 tax (over $3000 in today's dollars) on the purchase of certain types of firearms and firearm parts/accessories. Clearly nothing more than a cynical attempt to reserve firearm ownership to the wealthy. Shrouded in lies about how the law was needed to protect the public from itself.

Additionally, licensing for firearm ownership or carry creates a de facto registry of firearm owners in the process. Since registration always (always ... always) eventually leads to confiscation, I really can't agree to any more licensing or regulation.

The bottom line is I basically trust all Americans who haven't been proven untrustworthy in a criminal court, and I'm happy to see them exercise all of their civil rights, particularly speech, religion, assembly, keep/bear arms, and refusal of unwarranted government searches or other intrusions. If this means some untrustworthy or generally untrained/incompetent people are armed, I accept that risk. Living is dangerous. Living free is more dangerous, but worth the risk.

This is just one more reflection of my fundamental difference with the Democratic party: they think people need to be protected from themselves, and the state is the agent to do it, and I don't.


There are strong parallels between Democratic attempts at gun control and Republican attempts to outlaw abortion.

When a Republican says women should be required to have an ultrasound prior to an abortion, he's pretending that he cares about her and just wants her to have comprehensive medical care and more information. What he really wants is to make abortions costly, inconvenient, and more emotionally treacherous for women. It's a deliberate, cynical, manipulative, incremental tactic aimed at his obvious but unspoken goal: an eventual complete ban of all abortions.

When a Democrat says gun owners should be required to have more training, he's pretending that he cares about people and just wants gun owners to be safer and better trained. What he really wants to to make gun ownership costly, inconvenient, and easily tracked by the government. It's a deliberate, cynical, manipulative, incremental tactic aimed at his obvious but unspoken goal: an eventual complete ban of all guns.

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[DrCommonSense]

In what universe or part of the country does this happen?

I've been in practice for over 20 years and NEVER done a TKR on a nonambulatory nursing home patient. Same with back fusions. We don't do them on old people. The patients are almost always in their 40-60s. My entire career has been in California. Maybe the gatekeepers are appropriately tougher out here.

Dunno I have worked throughout the MidWest and South (plus a few NE cities) and have seen this CONSTANTLY. This is PARTICULARLY common in competitive markets where surgeons are fighting to maintain income due to falling reimbursement rates.

Are you seriously trying to pretend most TKR and fusions aren't done on >60 year olds?

More Americans Getting Knees Replaced, And at Younger Ages



Median age for TKR was 66 in 2010 and 69 in 2010. Granted, they are INCREASING surgeries on younger people as well, however, the vast majority are in OLDER patients with MANY comorbid conditions.

Please don't tell me you don't ROUTINELY see OBESE, diabetic, etc patients who are >65 that are getting TKRs.

Maybe California is totally different than most of the rest of the country but im pretty skeptical about that. I highly doubt the median age is far lower in Cali.

Here is the BMJ article that confirms mostly TKR are NOT cost effective: Impact of total knee replacement practice: cost effectiveness analysis of data from the Osteoarthritis Initiative | The BMJ

Do you really want me to get into the tons of studies on arthroscopy procedures?

Also, who do you think makes the high dosage narcotic patients? How many of them were fused out the wazoo whereby they are now sitting on tons of morphine?

Spinal Fusion Surgery Provides Worse Outcomes in Workers' Compensation Patients

Here is an Ohio workman's compensation study showing fusion patients are on far higher narcotic medications and RTW is lower compared to people managed conservatively.

Where do you think many of these narcotic trainwrecks come from? From what I see in the "pain" clinic, most people on very high dosages have gotten MULTIPLE fusion procedures that probably cost >500K in total and are sitting on >80 morphine equivalents.

The same patient who was on 3 Norcos per day before surgery QUICKLY increases to Oxycontin, Fentanyl or Morphine after having a fusion on a ROUTINE basis.

What are you going to do with them? Put them on Tylenol and Ibuprofen with some Neurontin?

When I was in residency, I was under the illusion that these fusion patients were "fixed" after surgery as well. I remember routine losses of blood >500cc on "multi level fusion" surgeries on patients who were significantly overweight, diabetic, etc. Hell, all I had to worry about was getting them to the PACU successfully and recovered from anesthesia. That was the end of my dealing with them.

You realize the chain reaction that develops with the vast majority of fusion surgeries, particularly in younger active patients?

So lets not kid ourselves here.

 

[narcusprince]

This makes me profoundly uncomfortable too. But so do lots of foolish things that stupid or reckless people do. We can start that discussion with lousy drivers, who kill 30K+ people per year (including thousands of children), and injure millions more. And car driving isn't even a civil right. 16 year old kids get drivers licenses every day with minimal time/investment. That bar is pretty low.


I don't know what the best answer is, and I'm not totally opposed to some training and proficiency requirements for gun owners.

The problem is that when such things are proposed, they're always thinly veiled attempts to make gun ownership and carry an expensive, onerous process that will discourage people from exercising the right. Especially if they're poor, and/or live in urban areas where zoning and other restrictions have made it all but impossible to operate a gun store or shooting range. An indoor pistol range takes a tiny amount of space. Can you guess how many exist in New York City, population 8.4 million?

As for the cost (fees, time) we've been down this road repeatedly over the last 80+ years. The 1934 National Firearms Act got it all started - it slapped a $200 tax (over $3000 in today's dollars) on the purchase of certain types of firearms and firearm parts/accessories. Clearly nothing more than a cynical attempt to reserve firearm ownership to the wealthy. Shrouded in lies about how the law was needed to protect the public from itself.

Additionally, licensing for firearm ownership or carry creates a de facto registry of firearm owners in the process. Since registration always (always ... always) eventually leads to confiscation, I really can't agree to any more licensing or regulation.

The bottom line is I basically trust all Americans who haven't been proven untrustworthy in a criminal court, and I'm happy to see them exercise all of their civil rights, particularly speech, religion, assembly, keep/bear arms, and refusal of unwarranted government searches or other intrusions. If this means some untrustworthy or generally untrained/incompetent people are armed, I accept that risk. Living is dangerous. Living free is more dangerous, but worth the risk.

This is just one more reflection of my fundamental difference with the Democratic party: they think people need to be protected from themselves, and the state is the agent to do it, and I don't.


There are strong parallels between Democratic attempts at gun control and Republican attempts to outlaw abortion.

When a Republican says women should be required to have an ultrasound prior to an abortion, he's pretending that he cares about her and just wants her to have comprehensive medical care and more information. What he really wants is to make abortions costly, inconvenient, and more emotionally treacherous for women. It's a deliberate, cynical, manipulative, incremental tactic aimed at his obvious but unspoken goal: an eventual complete ban of all abortions.

When a Democrat says gun owners should be required to have more training, he's pretending that he cares about people and just wants gun owners to be safer and better trained. What he really wants to to make gun ownership costly, inconvenient, and easily tracked by the government. It's a deliberate, cynical, manipulative, incremental tactic aimed at his obvious but unspoken goal: an eventual complete ban of all guns.

I propose that firearm education start in high school throughout the entire United States as part of a civics class. The high school years we have so much un-necessary education. We should train our children to be comfortable around weapons similar to how Russian kids get educated on firearms. Where teachers can educate their students on the physical items of the gun, as well as educate them on proper use, and discuss superlative cases where firearms used by legal owners.

 

[DrCommonSense]

This makes me profoundly uncomfortable too. But so do lots of foolish things that stupid or reckless people do. We can start that discussion with lousy drivers, who kill 30K+ people per year (including thousands of children), and injure millions more. And car driving isn't even a civil right. 16 year old kids get drivers licenses every day with minimal time/investment. That bar is pretty low.


I don't know what the best answer is, and I'm not totally opposed to some training and proficiency requirements for gun owners.

The problem is that when such things are proposed, they're always thinly veiled attempts to make gun ownership and carry an expensive, onerous process that will discourage people from exercising the right. Especially if they're poor, and/or live in urban areas where zoning and other restrictions have made it all but impossible to operate a gun store or shooting range. An indoor pistol range takes a tiny amount of space. Can you guess how many exist in New York City, population 8.4 million?

As for the cost (fees, time) we've been down this road repeatedly over the last 80+ years. The 1934 National Firearms Act got it all started - it slapped a $200 tax (over $3000 in today's dollars) on the purchase of certain types of firearms and firearm parts/accessories. Clearly nothing more than a cynical attempt to reserve firearm ownership to the wealthy. Shrouded in lies about how the law was needed to protect the public from itself.

Additionally, licensing for firearm ownership or carry creates a de facto registry of firearm owners in the process. Since registration always (always ... always) eventually leads to confiscation, I really can't agree to any more licensing or regulation.

The bottom line is I basically trust all Americans who haven't been proven untrustworthy in a criminal court, and I'm happy to see them exercise all of their civil rights, particularly speech, religion, assembly, keep/bear arms, and refusal of unwarranted government searches or other intrusions. If this means some untrustworthy or generally untrained/incompetent people are armed, I accept that risk. Living is dangerous. Living free is more dangerous, but worth the risk.

This is just one more reflection of my fundamental difference with the Democratic party: they think people need to be protected from themselves, and the state is the agent to do it, and I don't.


There are strong parallels between Democratic attempts at gun control and Republican attempts to outlaw abortion.

When a Republican says women should be required to have an ultrasound prior to an abortion, he's pretending that he cares about her and just wants her to have comprehensive medical care and more information. What he really wants is to make abortions costly, inconvenient, and more emotionally treacherous for women. It's a deliberate, cynical, manipulative, incremental tactic aimed at his obvious but unspoken goal: an eventual complete ban of all abortions.

When a Democrat says gun owners should be required to have more training, he's pretending that he cares about people and just wants gun owners to be safer and better trained. What he really wants to to make gun ownership costly, inconvenient, and easily tracked by the government. It's a deliberate, cynical, manipulative, incremental tactic aimed at his obvious but unspoken goal: an eventual complete ban of all guns.

I agree with this.

However, the analogy at the end is flawed. The republican OPENLY admits that he/she would like to ban abortion mostly when he puts that restrictions onto it.

Democrats try to pretend they aren't trying to ban guns.

 

[pgg]

I propose that firearm education start in high school throughout the entire United States as part of a civics class. The high school years we have so much un-necessary education. We should train our children to be comfortable around weapons similar to how Russian kids get educated on firearms. Where teachers can educate their students on the physical items of the gun, as well as educate them on proper use, and discuss superlative cases where firearms used by legal owners.

It used to be that way. My high school had a smallbore shooting team, and PE had a block of shooting, only a few years before I attended.

And this wasn't in Texas. It was a San Francisco suburb.

 

[Twiggidy]

Boy Scouts even teach you to shoot

 

[nimbus]

Dunno I have worked throughout the MidWest and South (plus a few NE cities) and have seen this CONSTANTLY. This is PARTICULARLY common in competitive markets where surgeons are fighting to maintain income due to falling reimbursement rates.

Are you seriously trying to pretend most TKR and fusions aren't done on >60 year olds?

More Americans Getting Knees Replaced, And at Younger Ages



Median age for TKR was 66 in 2010 and 69 in 2010. Granted, they are INCREASING surgeries on younger people as well, however, the vast majority are in OLDER patients with MANY comorbid conditions.

Please don't tell me you don't ROUTINELY see OBESE, diabetic, etc patients who are >65 that are getting TKRs.

Maybe California is totally different than most of the rest of the country but im pretty skeptical about that. I highly doubt the median age is far lower in Cali.

Here is the BMJ article that confirms mostly TKR are NOT cost effective: Impact of total knee replacement practice: cost effectiveness analysis of data from the Osteoarthritis Initiative | The BMJ

Do you really want me to get into the tons of studies on arthroscopy procedures?

Also, who do you think makes the high dosage narcotic patients? How many of them were fused out the wazoo whereby they are now sitting on tons of morphine?

Spinal Fusion Surgery Provides Worse Outcomes in Workers' Compensation Patients

Here is an Ohio workman's compensation study showing fusion patients are on far higher narcotic medications and RTW is lower compared to people managed conservatively.

Where do you think many of these narcotic trainwrecks come from? From what I see in the "pain" clinic, most people on very high dosages have gotten MULTIPLE fusion procedures that probably cost >500K in total and are sitting on >80 morphine equivalents.

The same patient who was on 3 Norcos per day before surgery QUICKLY increases to Oxycontin, Fentanyl or Morphine after having a fusion on a ROUTINE basis.

What are you going to do with them? Put them on Tylenol and Ibuprofen with some Neurontin?

When I was in residency, I was under the illusion that these fusion patients were "fixed" after surgery as well. I remember routine losses of blood >500cc on "multi level fusion" surgeries on patients who were significantly overweight, diabetic, etc. Hell, all I had to worry about was getting them to the PACU successfully and recovered from anesthesia. That was the end of my dealing with them.

You realize the chain reaction that develops with the vast majority of fusion surgeries, particularly in younger active patients?

So lets not kid ourselves here.

No we have many older joint patients but they are active. NEVER from a nursing home.

The back fusion patients are younger, middle aged. I can't remember the last time I did one in a patient over 70.

I'm not kidding.

 

[InfinitiPSI]

Since registration always (always ... always) eventually leads to confiscation, I really can't agree to any more licensing or regulation.

While I realize once a list is established, it cannot simply vanish. Where is the proof this would happen? Even if in a parallel situation, where a formation of a list did lead to confiscation, how can you be so sure it would happen with guns?

It would appear, that all gun owners are worried and scared it would be confiscated. But isn't that how everything works these days. Governments, Hierarchies, Sales. Fear is the best motivator, and primes people to make decisions based on perceived fears, instead of reason, and likelihoods.

We can't even get healthcare legislation passed without a huge fight, watered down, often has to be linked to another bill for the opposing party to vote for it. How can you so firmly believe that the federal or state governments would ever come close to pass legislation against the second amendment. Its almost as unlikely as repealing the 1st amendment. In my opinion the fear of a registry, and confiscation appears far-fetched.

 

[pgg]

While I realize once a list is established, it cannot simply vanish. Where is the proof this would happen?

I'll leave the historical instances to you as an exercise.

But it happened to me in California just a few years ago. I had three registered rifles on the assault weapon ban list. A Colt AR15 and two Armalite AR10s. And then a new attorney general took office (Kamela Harris) and the DOJ declined to renew the permit. They told me to take the rifles to a police station to turn them in, destroy them, sell them (it's impossible to sell a registered AW in CA because transfers are illegal), or remove it from the state. Fortunately I had a brother in Arizona who could store it for me.

I was on active duty in the military and had been ordered to go to California. I couldn't just choose not to live there.

California had (has) a registry and has used it to force people to surrender or get rid of firearms in the last few years. It happened to me. Think about that for a few minutes and then tell me not to worry.

 

[DrCommonSense]

No we have many older joint patients but they are active. NEVER from a nursing home.

The back fusion patients are younger, middle aged. I can't remember the last time I did one in a patient over 70.

I'm not kidding.

Thats ok but didn't you read the Ohio workman's compensation case whereby the younger patients who got fusions were on higher dosages of narcotics and lower RTW? The huge fusions that are done on a consistent basis is where alot of the higher dosage narcotic patients are formed. When these guys arrive to the pain clinic after a 3 level lumbar fusion with hardware where they complain of "severe pain throughout the spine", do you think a few Mobic and Neurontin pills are going to cut it for them?

Also, with the older TKR patients, if they are fully healthy, have a good weight, few comorbidities (no smoking, diabetes, etc), then they could be argued to be good candidates.

However, in the grand scheme of America, how many >65 year old people with OA of the knees are there out of the total TKR population? You have to be kidding if its >10% of the patients total.

Clearly, the BMJ article using data throughout the country confirms the vast majority don't meet that criteria for surgery.

 

[Ipassgas]

I think Narcusprince has a good idea. It'll never happen, but a good idea.

I'll continue to derail a 2 anesthesiologists murdered story into a gun thread (we are REALLY good at that).

I believe right now there exist 3 groups: John Waynes (Zimmerman), well informed and rational (PGG), and the negligently uninformed (Congresspersons Feinstein, de Leon, DeGette).

The first group is generally dangerous to themselves and others, and perhaps, maybe, possibly, with a bit of general demystification in a large group setting, they won't be so awed by the amazing power of gun powder. I think they're alost cause though.

The second group doesn't need school based education, because they'll get it on their own or through work (military, police, etc).

The last group, could really benefit. A family member tried to lecture me on firearms and how bad they are. Assault weapons are clearly extra bad, because they're black. And use huge bullets. And nobody should ever possess more than 3 bullets. Etc.
Finally I gave them a 5.56 round to hold. Once they realized it wouldn't spontaneously destroy a 3 mile radius, they figured it was for a child's rifle, like a 22LR cricket. It wasn't possible it could be anything else, because it was so small.

I tried to explain it was for one of those murderous black rifles or for a mini 14. And asked why the ruger is ok, but the same bullet in an AR is so scary? I didn't get a coherent answer. I never tried to get justification on the single digit bullet limit.

Just as a huge percentage (politicians and citizens) of this third group can't discuss or argue the issues competently, because they have no idea what's being discussed or how to engage the second group (PGG). They lack the vocabulary and understanding. All they know are "feelings".

Maybe mandatory school classes would at least get everyone speaking the same language.

 

[InfinitiPSI]

I'll leave the historical instances to you as an exercise.

But it happened to me in California just a few years ago. I had three registered rifles on the assault weapon ban list. A Colt AR15 and two Armalite AR10s. And then a new attorney general took office (Kamela Harris) and the DOJ declined to renew the permit. They told me to take the rifles to a police station to turn them in, destroy them, sell them (it's impossible to sell a registered AW in CA because transfers are illegal), or remove it from the state. Fortunately I had a brother in Arizona who could store it for me.

I was on active duty in the military and had been ordered to go to California. I couldn't just choose not to live there.

California had (has) a registry and has used it to force people to surrender or get rid of firearms in the last few years. It happened to me. Think about that for a few minutes and then tell me not to worry.

Well, I learn something new everyday. I can see your point clearly now.

 

[nimbus]

Thats ok but didn't you read the Ohio workman's compensation case whereby the younger patients who got fusions were on higher dosages of narcotics and lower RTW? The huge fusions that are done on a consistent basis is where alot of the higher dosage narcotic patients are formed. When these guys arrive to the pain clinic after a 3 level lumbar fusion with hardware where they complain of "severe pain throughout the spine", do you think a few Mobic and Neurontin pills are going to cut it for them?

Also, with the older TKR patients, if they are fully healthy, have a good weight, few comorbidities (no smoking, diabetes, etc), then they could be argued to be good candidates.

However, in the grand scheme of America, how many >65 year old people with OA of the knees are there out of the total TKR population? You have to be kidding if its >10% of the patients total.

Clearly, the BMJ article using data throughout the country confirms the vast majority don't meet that criteria for surgery.

We are getting different patient populations.

Vast majority of our fusions are 1level ALIFs for spondylolisthesis. Often with posterior decompression. We almost never do 3level fusions except on trauma patients.

As for total joints, like I said we never do them in nonambulatory patients. My own partners, nurses and surgeons have had fantastic results with their knees and hips. They all say they should have done it sooner. I also see many patients coming back for the 2nd side. It's not a BS operation. It works.

 

[dhb]

It's not a BS operation. It works.

In the right patient which, imho is less and less frequent (but maybe not where you practice).

 

[Hoya11]

We are getting different patient populations.

Vast majority of our fusions are 1level ALIFs for spondylolisthesis. Often with posterior decompression. We almost never do 3level fusions except on trauma patients.

As for total joints, like I said we never do them in nonambulatory patients. My own partners, nurses and surgeons have had fantastic results with their knees and hips. They all say they should have done it sooner. I also see many patients coming back for the 2nd side. It's not a BS operation. It works.

Of course it works. I have seen lots and lots of successful Total Joint Replacements in people 60-70 even 80. People wish they did it sooner.

The idea that these surgeries "dont work" or "arent cost effective" (they do cost money yes) is hard to understand, like most of his posts.

 

[BLADEMDA]

Of course it works. I have seen lots and lots of successful Total Joint Replacements in people 60-70 even 80. People wish they did it sooner.

The idea that these surgeries "dont work" or "arent cost effective" (they do cost money yes) is hard to understand, like most of his posts.

In my neck of the woods the average (yes, average) age for a total joint replacement is around 75. These patients are all ambulatory but almost all are ASA 3 and ASA 4.
Typically, there are at least several patients in their mid 80's having total joint replacements each week.

As for lumbar fusions the age range is 35-90 at my facility. Each week there are plenty of patients in their 70's and early 80's getting their backs fused.

 

[DrCommonSense]

We are getting different patient populations.

Vast majority of our fusions are 1level ALIFs for spondylolisthesis. Often with posterior decompression. We almost never do 3level fusions except on trauma patients.

As for total joints, like I said we never do them in nonambulatory patients. My own partners, nurses and surgeons have had fantastic results with their knees and hips. They all say they should have done it sooner. I also see many patients coming back for the 2nd side. It's not a BS operation. It works.

Cool story but on a population level I just posted two studies that this is ROUTINE.

BMJ confirms the GOOD majority of TKR are "cost ineffective" due to being done on older ages, high comorbid states (diabetes, obesity, smoking, etc), high costs of surgery, etc.

Ohio Workman's compensation plus a BILLION other studies confirm that RTW levels are LOWER in fusion patients and narcotic usage postop are GREATLY increased.

Are you seriously trying to argue that even one level lumbar fusions on younger patients don't "cascade" in the future whereby they need redo fusions and extension of the fusions in the future?

The national literature show a large re-fusion rate for patients who TYPICALLY need another fusion in 5-10 years. You must have some magic fusion patients that isn't showing up in the literature.

NEJM just published ANOTHER article comparing fusion to simple laminectomy surgery and didn't find any difference for stenosis.


So when a guy like Hoya does the anesthesia for these fusion cases, he basically ADDING to the opioid crisis considering the LIKELY outcome of these cases, so to pretend you are not contributing to the narcotic crisis is laughable.

Who do you think become the trainwrecks at the "pain clinic" after the surgeons are done with these patients?

The surgeon after doing their fusions will place the patient on some narcotic medications and refer the patient to "pain" to "manage the chronic narcotics" because "they don't do that" just throwing it off on another provider. If the pain guy doesn't manage it, the PCP will be writing HIGH dosages of narcotics for these patients.

Sorry to break that to you but thats the real world RESULTS of these patients in general.

All I know is I saw these "trainwreck" patients in ALL the bigger cities I've practiced in as well as the South/MidWest, so its not like its a localized problem.

 

[DrCommonSense]

Of course it works. I have seen lots and lots of successful Total Joint Replacements in people 60-70 even 80. People wish they did it sooner.

The idea that these surgeries "dont work" or "arent cost effective" (they do cost money yes) is hard to understand, like most of his posts.

Not hard to understand at all for BMJ, Ohio workman's comp studies, etc.

Its "hard to understand" because you financially benefit from it regardless of outcomes while pretending to be a "moral" person while contributing to the opioid crisis by helping to facilitate fusion surgeries.

Who do you think manages these patients after they become train wrecks?

TKR (best ortho procedure in terms of evidence) ONLY has evidence in severe OA patients who are ambulatory without obesity, smoking, geriatric age, etc. The census data through the country shows that the vast majority of these surgeries are done on patients who FALL OUTSIDE of the literature evidence.

There is zero evidence for most arthroscopic surgeries (no better than sham), labral surgeries for shoulder (NEJM just published article saying sham procedure is equal to labral shoulder surgeries), etc.

Prostectomy surgeries for early CA (>96% of the surgeries done are for this indication) have just been proven to NOT decrease mortality for patients EVEN past the 10 year mark but increase morbidity significantly including incontinence and impotence (not to mention anesthesia effects on geriatric patients exposed for HOURS at a time for these).

You going to demand to avoid doing anesthesia for any of these ineffective surgeries or the ones contributing to the "opioid" crisis considering you are a "moral man" that wants to avoid it?

Yeah thought so. Your "morality" is very selective apparently when it affects your pocketbook.

Lets not kid ourselves here.

As long as you do anesthesia for those large fusion cases, you are no better than the "narcs for injections" pain doc you condemn considering the train wrecks you are going to leave behind for either a PCP or pain doc to manage. In fact, you are worse in most ways considering you are making them into narcotic train wrecks AND exposing them to huge morbidity/mortality risks with anesthesia risks.

As long as you do anesthesia for the litany of procedures that has been show to be ineffective, you are worse than the pain guy who does procedures for money on people he knows won't benefit considering the anesthesia/morbidity risks you are exposing the patients to for YOUR financial gain.

I know this might make you angry and you won't "understand" my VERY clear argument but its fact.