Vote-how many prefer MD/DO only practice?

[ctsicu]

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Me!!

 

[Direct Laryngoscopy]

Seems like it will become a thing of the past, especially in desirable cities.

We've lost a foothold in our specialty, to the point where it has been dumbdowned and anyone can do it. I do think the pendulum will swing our way in the future, as we are peri operative physicians and not OR technicians. Patients will require pre and post management, a service that mid levels cannot provide (at least competently IMHO). In general, the new generation of anesthesiologists (myself included 😀 )are a lil bit more proactive and protective of our specialty, and hopefully will contribute to PAC and fight for what's best for our patients. But I have no clue, I have a positively realistic outlook on life in general. Maybe consigliere, maceo, et al are right and the specialty is doomed 🙁

I know I went off on a tangent, but to answer your question, yes I'm all for all physician practice

I-Phone technology

 

[Consigliere]

Me. Very difficult to find, though. It is rarer than a jetpropilot post that doesn't use bolds and different font sizes.

 

[saratoga733]

luckily i'm currently at a md/do only practice. surprisingly mostly at the institution's insistence... for 2 reasons mainly: our surgical colleagues appreciate our level of care and also we deal with a highly entitled pt population. could we make more dough utilizing nurses? yes, but thankfully the institution culture (at least for now) will not allow us to shoot ourselves in the foot!

btw, at my prior gig i use to insist on taking the code/airway pager from the crna when i did my overnights because i discovered that i actually slept BETTER not having to worry about their foolishness.

 

[sevoflurane]

Patients will require pre and post management, a service that mid levels cannot provide (at least competently IMHO).

So you don't think there is a place for intra-operative management?

pre, INTRA and post-operative management my friend.

Ohh... the things I've seen from some CRNA's is pretty scary!

This is how my friends CEA went:

30 minutes after the carotid was clamped, he comes in to give a break to his CRNA and sees a pressure of 85/50.

MD: "Why is the BP so low?"

CRNA: "Because I don't want to cause a hemorragic stroke to the non-clamped side. All that blood pressure can cause it to burst"

MD: "😱 "

There are great CRNA's out there... but there is a big population (especially the newly minted ones) that don't know what they don't know.
Some of their logic is downright dangerous. They need INTRAOPERATIVE supervison.


MD ONLY. I don't want to be responsible for that type of care when I'm running 4 rooms. Sorry, I'll pass.

 

[stonemd]

I would go nuts sitting thru 16 cataracts a day. I prefer to see all patients preop, attend all inductions, do all nerve blocks, spend more time in OR when problems arise, follow patients in PACU - while supervising CRNAs, and then doing occasional late cases. Worked locum tenens in 25 practices over 3 years under a large variety of situations before settling into this group practice 20+ years ago.

Afixing a large target to my chest and waiting for incoming.

 

[Consigliere]

Seems like it will become a thing of the past, especially in desirable cities.

We've lost a foothold in our specialty, to the point where it has been dumbdowned and anyone can do it. I do think the pendulum will swing our way in the future, as we are peri operative physicians and not OR technicians. Patients will require pre and post management, a service that mid levels cannot provide (at least competently IMHO). In general, the new generation of anesthesiologists (myself included 😀 )are a lil bit more proactive and protective of our specialty, and hopefully will contribute to PAC and fight for what's best for our patients. But I have no clue, I have a positively realistic outlook on life in general. Maybe consigliere, maceo, et al are right and the specialty is doomed 🙁

I know I went off on a tangent, but to answer your question, yes I'm all for all physician practice

I-Phone technology

Just watch. 2018 ----> "ologists" will be making $150-175k per annum.

 

[stonemd]

Just think of the money we will save in taxes!

 

[OB1🤙]

I am very, very happy in my all-MD practice.

I am very, very happy that I don't have to worry about somebody else injuring my patient.

I am very, very happy that our hospitals and surgeons value the services we provide as physicians.

 

[24858]

i used to be in an all md practice but the hospital demanded we hire crnas to improve room time turnovers or they would hire sheridan to come in and take over, as sheridan promised 8 min run turnover times. so we hired crnas, i prefer all md/do, but that may be slowly a thing of the past unfortunately. i also prefer 1099 style practice as well.

 

[imfrankie]

I've never really known anesthesiologists to be rate limiting in room turnover.

 

[Mman]

There are great CRNA's out there... but there is a big population (especially the newly minted ones) that don't know what they don't know.
Some of their logic is downright dangerous. They need INTRAOPERATIVE supervison.


MD ONLY. I don't want to be responsible for that type of care when I'm running 4 rooms. Sorry, I'll pass.

And that's why you work in a job where they are your employees and not hospital employees. Then you can fire the dumb ones (or not even hire them in the first place) and only keep the good ones. It's really quite simple.

 

[HollATme]

Just think of the money we will save in taxes!

🙄

 

[HollATme]

Just watch. 2018 ----> "ologists" will be making $150-175k per annum.

150-175?

i doubt it, but if you're right, it'll be a sad day.

 

[Mman]

150-175?

i doubt it, but if you're right, it'll be a sad day.

you are correct that it isn't happening. Even in completely socialized systems, they earn more than that.

 

[sevoflurane]

And that's why you work in a job where they are your employees and not hospital employees. Then you can fire the dumb ones (or not even hire them in the first place) and only keep the good ones. It's really quite simple.

Correct. Unfortunately, some MD(notAs) don't have that choice.
I know of far too many groups (both PP and hospital employed) where the structure is such that the CRNA's are owned by either the hospital or some other outside source (management companies).
As this trend continues, your ability to fire the "dumb ones" becomes not so simple.
All the while your malpractice risk becomes very unfavorable.

We are lucky to work in a PP setting with complete control of the way we carry out anesthesia services. Patients do better.
Some MDs are not so lucky.

 

[Pades]

Love my MD-only practice. Never expected to have as much support and respect as an anesthesiologist after my experience in residency and reading others' experiences on this forum the past 10 years. Surgeons love working with us as opposed to the other groups in town, and the nursing support is unbelievable. Also for all the usual reasons as stated by others here. I don't know if it can last forever but I am riding it as long as I can. I have 15 cataracts to do tomorrow and that seems like a wonderful way to spend a Thursday 🙂

 

[Consigliere]

Love my MD-only practice. Never expected to have as much support and respect as an anesthesiologist after my experience in residency and reading others' experiences on this forum the past 10 years. Surgeons love working with us as opposed to the other groups in town, and the nursing support is unbelievable. Also for all the usual reasons as stated by others here. I don't know if it can last forever but I am riding it as long as I can. I have 15 cataracts to do tomorrow and that seems like a wonderful way to spend a Thursday 🙂

Hmmm. That seems like my version of hell.

 

[ctsicu]

This is a news flash for you nurse trolls: we don't want you!!

 

[jetproppilot]

Me. Very difficult to find, though. It is rarer than a jetpropilot post that doesn't use bolds and different font sizes.

GOOD ONE DUDE

 

[saratoga733]

Hmmm. That seems like my version of hell.

4 base units x 2 time units (30 mins) = 6 units for typical case

6 * 15 = 90 units for the day

depending on how well you do with collections that's a nice take home anyway you cut it.

what's not to like?!

 

[Consigliere]

4 base units x 2 time units (30 mins) = 6 units for typical case

6 * 15 = 90 units for the day

depending on how well you do with collections that's a nice take home anyway you cut it.

what's not to like?!

Ummmmmm......sitting in a room charting vitals and giving 1-2 mg of Versed all day.

 

[Pades]

Ummmmmm......sitting in a room charting vitals and give 1-2 mg of Versed all day.

No question I would go crazy and my brain would likely atrophy from lack of stimulation if I had to do this every day, but once every couple weeks is a nice break. My point with this being and MD-only practice related thread is that I have no other rooms or people to worry about, and while it may get a little boring, it does make for a good billing day and there are worse ways to make money...

 

[B-Bone]

I work in a primarily supervisory practice where I sit my own cases maybe once every other week or so (although twice this week). It is usually a nice relaxing break from the chaos of running around, doing blocks, labor epidurals, lines, preops, etc. I specifically hate cataracts though. I did a day of them on monday, and what I hate is the fact that the folks are old and tend to have a bunch of medical problems and wading through their medical record takes forever, especially given the fact that nothing I find in the record will change my anesthetic at all. I swear, even if someone were having a STEMI in preop, I would tell the surgeon to quick get it done while we waited for the cath lab to get ready.

 

[Mman]

4 base units x 2 time units (30 mins) = 6 units for typical case

6 * 15 = 90 units for the day

depending on how well you do with collections that's a nice take home anyway you cut it.

what's not to like?!

The fact it's probably 98% Medicare or Medicaid between the old folks and the diabetic dialysis patients.

Because I don't know what you collect for those cases, but for us it isn't much. In fact it's about the least profitable thing we do aside from complex peds cases which are intensive and mostly medicaid.

 

[saratoga733]

The fact it's probably 98% Medicare or Medicaid between the old folks and the diabetic dialysis patients.

Because I don't know what you collect for those cases, but for us it isn't much. In fact it's about the least profitable thing we do aside from complex peds cases which are intensive and mostly medicaid.

well i suppose 'profitability' depends on whether you blend your units. fortunately, my group does.

 

[Mman]

well i suppose 'profitability' depends on whether you blend your units. fortunately, my group does.

yes, fortunately, because the cases themselves are not a profitable ordeal. We have actually gotten most of our surgeons to do them without us under straight local anesthetic since they aren't doing retrobulbar blocks anyways so patients don't mind.

 

[Pades]

yes, fortunately, because the cases themselves are not a profitable ordeal. We have actually gotten most of our surgeons to do them without us under straight local anesthetic since they aren't doing retrobulbar blocks anyways so patients don't mind.

Very true. Our hospital is certainly losing money by us being there in these cases. But for now, individually it is profitable since generally more units = more $$ regardless of what the hospital is reimbursed from the patient. I certainly wouldn't miss these lines if our surgeons decided to all go straight local, but right now it doesn't hurt our group to be doing them.

 

[saratoga733]

yes, fortunately, because the cases themselves are not a profitable ordeal. We have actually gotten most of our surgeons to do them without us under straight local anesthetic since they aren't doing retrobulbar blocks anyways so patients don't mind.

The way we see it, we have to cover these ORs anyway. Who has the luxury of saying on Tuesdays we will plan on not covering OR 5 because that is Dr. Eyes' block time. Worse case reimbursement scenario for a busy cataract day is still around 2k. We appreciate the business and say thank you.

 

[88845]

i used to be in an all md practice but the hospital demanded we hire crnas to improve room time turnovers or they would hire sheridan to come in and take over, as sheridan promised 8 min run turnover times. so we hired crnas, i prefer all md/do, but that may be slowly a thing of the past unfortunately. i also prefer 1099 style practice as well.

I've never really known anesthesiologists to be rate limiting in room turnover.

Apathetic orderlies and O.R. staff swing-shift changes kill turnover time, in my experience. I've never known anesthesia to not keep the turnover pace going unless pre-op is slammed.

 

[24858]

I agree Tachyon, try to convince hospital administrators of that when Sheridan is coming in during your contract renegotiations promising they can speed up turnovers to 8 minutes or less. Luckily for our group the surgeons wanted us to stay and enjoyed getting a drink or toast between cases. Our room turnover times are consistently below the national average but no where near 8 minutes.