Where does the care team model predominate?

[objdoc]

... and where does it not?

The Northeastern US seems to run on the care-team (supervision) model... same goes for the South... Is it less common in the West? It seems like we must sit our own cases in Dallas, Phoenix, Las Vegas...

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[core0]

... and where does it not?

The Northeastern US seems to run on the care-team (supervision) model... same goes for the South... Is it less common in the West? It seems like we must sit our own cases in Dallas, Phoenix, Las Vegas...

Urban Colorado (if there is such a thing) seems to have very few ACT areas. Mostly GYN surg and stuff nobody wants such as OB night call (well and Kaiser).

David Carpenter, PA-C

 

[VolatileAgent]

if you mean the traditional crna supervised by anesthesiologist (vs. crna working alone or anesthesiologist working alone), then the ACT model actually happens everywhere in some way, shape, or form... except for BFE.

in BFE, there exists an "anything goes" mentality. i would never send anyone to one of those places for elective surgery... maybe except milmd.

so, where exactly is BFE? pick any hospital that you can draw a 50 mile radius around that has less than 50,000 total people in that area. that's BFE. you don't want to live there. no one wants to live there. no one cares about living there. i worked with a guy a few years back who was in BFE, maine, and he was the only anesthesiologist for the entire hospital. he was on call 24/7/365. i kid you not. (they had to get a locums when he wanted to take vacation.)

in BFE, if you want to work you're on your own. no one's got your back. no one comes when you say "help". maybe that's where some see themselves happy, to which i'd say "good luck" and "better you than me".

 

[militarymd]

The fat smelly guy has to open his mouth again.........

You will find MD only practices in locations where the practice revenue is high enough.

You will find CRNA only practices where High and Mighty Fat Smelly guys think it is below them to live there.

 

[militarymd]

............. you don't want to live there. no one wants to live there. no one cares about living there. i..... .

Them people are worth less than regular citizens of the United States.

They might as well just die now.....They obviously are worthless.....so worthless that only a lowly CRNA can do anesthesia for them.....

Worthy citizens of the US live in places where Fat Smelly guys would want to live...so they can have Fat Smelly guys put them to sleep.

 

[VolatileAgent]

Them people are worth less than regular citizens of the United States.

They might as well just die now.....They obviously are worthless.....so worthless that only a lowly CRNA can do anesthesia for them.....

wow, that's pretty brazen. i was speaking more about the fact that you don't really have any back-up if something goes wrong. but, then again, you'd have everyone here believe that nothing ever goes wrong in your cases because you are the perfect anesthetist (note, you've already made it abundantly clear you're nothing more than a technician, so don't split hairs on that term).

i guess you're going to be relocating your practice to such an area. after all, they deserve a guy like you. we all know how much you like underserved areas and patients that are unable to pay. so, is this a change of heart, sweetie?

i'm looking forward to hearing about your resigning your current practice and moving to such an area then. or, can i just call you a total hypocrite right now?

 

[militarymd]

wow, that's pretty brazen. i was speaking more about the fact that you don't really have any back-up if something goes wrong. but, then again, you'd have everyone here believe that nothing ever goes wrong in your cases because you are the perfect anesthetist (note, you've already made it abundantly clear you're nothing more than a technician, so don't split hairs on that term).

I have no problems with being a "perfect anesthetist"....because I'm pretty damn good at being an anesthetist......and I'm the VERY FIRST physician to admit that 99.99% of what I do in the OR is being an "anesthetist".

I really only function as a Consultant in Anesthesiology with Special Qualifications in Critical Care Mediicine almost solely outside of the OR.....

unfortunately....despite all your smelly bravado.......you only function as someone who is under instruction.....

 

[VolatileAgent]

I have no problems with being a "perfect anesthetist"....because I'm pretty damn good at being an anesthetist......and I'm the VERY FIRST physician to admit that 99.99% of what I do in the OR is being an "anesthetist".

(and, boys and girls, humility appears to be his strong suit.)

by the way: sarcasm, learn the concept, recognize it.

 

[swpm]

i would never send anyone to one of those places for elective surgery... maybe except milmd.

Once again, for the record, let's all note exactly who threw the first rock to get today's pissing match started.

 

[johankriek]

... and where does it not?

The Northeastern US seems to run on the care-team (supervision) model... same goes for the South... Is it less common in the West? It seems like we must sit our own cases in Dallas, Phoenix, Las Vegas...

depends where you are.. there are plenty of places that are all MD in the northeast..

 

[The_Sensei]

if you mean the traditional crna supervised by anesthesiologist (vs. crna working alone or anesthesiologist working alone), then the ACT model actually happens everywhere in some way, shape, or form... except for BFE.

WRONG! Most of North Jersey is anesthesiologists only and is most definitely NOT BFE. Do your homework....since you haven't, I'll give you the first clue - google Hackensack Medical Center and see how many CRNAs they have.........

 

[VolatileAgent]

WRONG! Most of North Jersey is anesthesiologists only and is most definitely NOT BFE. Do your homework....since you haven't, I'll give you the first clue - google Hackensack Medical Center and see how many CRNAs they have.........

in some way, shape, or form. we are talking regions of the country, not specific hospital systems. i can name several hospitals systems in my immediate area that are md/do-only anesthesiologist. that's not what we were talking about.

read more carefully. and don't be so pedantic.

 

[VolatileAgent]

p.s. and an anesthesiologist backing-up another anesthesiologist, at least in my book, constitutes a "team".

 

[objdoc]

Gents - sorry to see the thread go this way...

It seems to me that someone not set on any specific location will have a tough time navigating the anesthesiology job market. Conditions appear greatly different depending on location... it would be nice to share some insights without name calling...

 

[Noyac]

I've had enough of the back and forth insults b/w VA, Mil and others. Just about every thread now degrades to this crap. This is my request that you two stop and everyone else that gets involved as well. I don't care who started it.

VA in my opinion, you are wrong about your BFE scenario. You for one know the makeup of my practice and should realize the inaccuracy of your comments.

objdoc, I find that the ACT model works well in groups of substantial size. That means groups that have enough anesthesiologists to spread out the call burden (usually 6 or more MD's). If there are only 4 or less MD's then they carry a large call burden. Thats not to say that these groups don't exist but that is their choice and usually they accept this burden in order to maintain a financial level that they are comfortable with. And because their call is usually beign for the most part. For example, we have 6 MD's in my group and 0 crna's. This is the choice of the hospital the surgeons and the anesthesiologists that are currently here. We could hire 3 crna's for the price of one more MD. That means there is one less person to take call. But nonetheless we are getting large enough to consider this model now.

 

[VolatileAgent]

i don't think of your part of colorado as BFE, noy. also, i've stipulated to the md/do-only model, which is not the "classic" ACT model.

and, as for your other comments, well... certain people who are notoriously antagonistic and seem to post here at least daily appear to derive way too much pleasure and self-esteem from their perception as the "forum bully". that's all i'm reacting to. i just picture the junior-high-chess-nerd who got beat up a lot and is now trying to overcompensate, and i'll keep calling it when i see it.

 

[The_Sensei]

p.s. and an anesthesiologist backing-up another anesthesiologist, at least in my book, constitutes a "team".

Right.......in "your" book 🙄

 

[EtherMD]

ACT model means MD/DO Anesthesiologist supervising CRNA's/AA's.
This model predominates where payer mixes are high in Medicare, Medicaid and No-Pay.

The "solo" MD/DO model predominates in areas where the payer mix is more than 50% private insurance.

These are just guidelines and not rules.

 

[johankriek]

. We could hire 3 crna's for the price of one more MD. .

dude,


dont you dare hire a crna. are you out of your mind? have you not been following things on here.. what have we been trying to tell you? DO NOT DO IT>.


and for your information... crnas get paid 150-170K. not exactly chump change for 40 hours a week and lunch everyday..

Just hire another anesthesiologist.

 

[VolatileAgent]

Right.......in "your" book 🙄

yeah, well mine and the ASA's...

http://www.asahq.org/Newsletters/1996/06_96/Article2.htm

 

[Noyac]

dude,


dont you dare hire a crna. are you out of your mind? have you not been following things on here.. what have we been trying to tell you? DO NOT DO IT>.


and for your information... crnas get paid 150-170K. not exactly chump change for 40 hours a week and lunch every
Just hire another anesthesiologist.

Yeah, what was i thinking? Thank you johan for bringing me to my senses. I must have been out of my mind. 🙄

 

[VolatileAgent]

Yeah, what was i thinking? Thank you johan for bringing me to my senses. I must have been out of my mind. 🙄

i've said it before, and i'll say it again, in many practices it makes sense to hire crna's. the practice i'm starting at has a fair share (and is looking to hire more). they are primarily used in deep-sedation cases and bread-and-butter in the ACT model. you have to be able to book them about at about 70-80% into cases in order to make money, though. so, if you're predominately doing a lot of sedation cases (endoscopy, MRI, etc) then it might make sense.

hiring crna's into your group is a sound financial decision many ways around, if you can make it work. fact is, many practices cannot. personally, i'd like to see the situation in the future where crna's are exclusively hired by groups. it's all about control of resources, and this would help to ensure that. i would never recommend an anesthesiologist work for a crna-run group, though.

 

[The_Sensei]

and here's one you might...

http://www.biggestloserclub.com/

Thanks, dork........My BMI is normal. I understand that YOU may benefit from the program, however. Shall I give the producers a call? Perhaps a bitter, know-it-all, aging anesthesia resident would be a unique profile they'd consider! Hmmmmmmm.......