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Dumb question, why doesn't ortho learn blocks themselves in their residency training and then do blocks on their own patients for their cases?
why doesnt ortho do blocks themselves?
- Thread starter icecoldstar
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Combination of things, but most likely money.
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wouldn't it make sense to do them cuz blocks takes less than 3 min and it would be easy money for them?
D
deleted162650
Why do you want to give up that revenue stream?
I think it boils down to training more than anything. Blocks aren’t part of their residency curriculum.
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Many reasons
1) They have enough to do and learn in residency without having to learn someone else's job. They won't even spend time learning management of basic things for their patients like bp or diabetes control. These are guys with 250s, 260s and were rockstars in medical school
2) Surgeons don't get paid a separate fee for blocks. Payers consider pain control as part of surgical fee for a procedure. Whether they do local infiltration with a needle at the site or pick up an ultrasound, they get paid the same. So why bother? The supplies and the ultrasound cost money and it's a lot quicker for them to just place some lido with epi at the site.
3) Blocks take 3 minutes because we as anesthesiologists are good at them. We do a lot, we know the anatomy well and use needles and ultrasounds routinely. But watch someone doing them for the first time. In residency, our ortho residents didn't want us to place blocks because some of our attendings would spend half an hour going up and down the leg with the ultrasound "to really get a good sense of the anatomy". Then the ortho residents will take 5 hours to do a case that should take 45 minutes. I get it, they are learning too but serious double standard.
4) We do our blocks well. They generally provide good pain relief for the patient and there is a lower infection risk as we place the local under sterile conditions away from the surgical site. Same reason why we do the lines instead of the surgeons even though they are completely capable of placing a cvl.
1) They have enough to do and learn in residency without having to learn someone else's job. They won't even spend time learning management of basic things for their patients like bp or diabetes control. These are guys with 250s, 260s and were rockstars in medical school
2) Surgeons don't get paid a separate fee for blocks. Payers consider pain control as part of surgical fee for a procedure. Whether they do local infiltration with a needle at the site or pick up an ultrasound, they get paid the same. So why bother? The supplies and the ultrasound cost money and it's a lot quicker for them to just place some lido with epi at the site.
3) Blocks take 3 minutes because we as anesthesiologists are good at them. We do a lot, we know the anatomy well and use needles and ultrasounds routinely. But watch someone doing them for the first time. In residency, our ortho residents didn't want us to place blocks because some of our attendings would spend half an hour going up and down the leg with the ultrasound "to really get a good sense of the anatomy". Then the ortho residents will take 5 hours to do a case that should take 45 minutes. I get it, they are learning too but serious double standard.
4) We do our blocks well. They generally provide good pain relief for the patient and there is a lower infection risk as we place the local under sterile conditions away from the surgical site. Same reason why we do the lines instead of the surgeons even though they are completely capable of placing a cvl.
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Have you ever seen a surgeon put in a central line in the OR? Talk about a production. If ortho did their own blocks they'd have reps and special devices... and they'd still blame anesthesia for some random surgical complication.
That said, podiatrists do pretty awesome ankle blocks.
That said, podiatrists do pretty awesome ankle blocks.
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Half that patient population wouldn't feel the surgery regardless of block.
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One of the places I've worked had an ortho fellow consistently place FI blocks in ER when doing a #NOF consult if he felt ER/anaesthesia were crap or taking too long. They were honestly better than ER's ****ty US-guided FI/fem/whatever blocks that never worked. He also used to do a few ankle blocks.
I preferred his blocks to ER/some of my colleagues.
I preferred his blocks to ER/some of my colleagues.
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What everyone said above ^, I can't remember the last time I worked an ortho case that used ultrasound
Had a general surgeon with anesthesia family, would do his own tap block with Touhy and a ton of dilute under direct visualization in his ex-laps, they were great blocks.
Had a general surgeon with anesthesia family, would do his own tap block with Touhy and a ton of dilute under direct visualization in his ex-laps, they were great blocks.
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Where I am (with ****ty unit value) a fascia iliaca pays about 150.
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How good are they at managing intravascular .5% bupi?
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They're great - that sounds like a blame anesthesia problem.
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Part of regional block training involves managing complications of regional blocks, including LAST. Managing LAST involves practicing medicine. This last part is a no-go for meaty cheesy ortho boys.
