Doctors Take On Schwarzenegger in California. For Real !

And plastic surgery patients would probably be the first to be affected, since they generally have the fewest health issues.  But WLS plastics is a different deal, as we all know.

Here's the story:

http://drlomonaco.blogspot.com/2010/02/doctors-vs-schwarzene gger-in-california.html

and more at:

http://www.healthleadersmedia.com/content/PHY-245956/Doctors -Sue-To-Stop-Unsupervised-Nurse-Anesthetists-from-Administer ing-Anesthesia.html

What would YOU want as a patient ?

I would have posted this question/comment on the blog, but I'm not an erudite person, so I'm afraid of posting my blather on someone else's public space.

Not sure I know enough to formulate the right question -- I'm guessing this is going to become a follow-the-money issue, no?  In states with largely inaccessible and remote rural populations, is it possible that a move like this makes surgical care more accessible?   California does have regions like this . . .   So if there are regions that are underserved by anesthesiologists (are there, in this state?) perhaps nurse anesthetists unhampered by direct supervision would provide a great service (though no, I would not accept that for myself or my family).

And I'm baffled ... the nurse anesthetists who care for your patients .... during procedures, are they under YOUR supervision, since you're the surgeon ... or are they under the supervision of a physician anesthesiologist?

I'm very confused about this, and very concerned.

Here is a major problem in our neck of the woods:  In a major urban area that is heavily served by major metropolitan hospitals, the outlying areas are served almost entirely by providers who are subpar in a lot of respects.  I know that's not nice, but it's true.  (I'm happily floating along under my anonymous moniker right now.)  Let's just say that in a big city like Los Angeles, the cream of the medical crop does not rise to, say, San Pedro.  Or even Torrance.  Or Santa Clarita.

All of these smaller suburbs are big enough to adequately staff good-sized hospitals.  They are still close enough to the big city to attract physicians of all disciplines ... Really, no shortage of anesthesiologists in this state.  Our problem is frequently that physicians do not want to go to more remote areas because of the poor compensation and the long commute.  And in general the lower the recognized skill of the practitioner, the less money s/he can command for services so that person winds up being more available to go farther afield  ...and  the quality of service tends to decline rapidly in proportion to distance from the big cities.

With this proposed change, I'm thinking the idea is to reduce government compensation for anesthesia services -- and in the process eroding the care.  Is that what this is about?

My apologies for rambling.  If I understood this better, my question would have been shorter.

 

Valid points.  Although, truthfully, the situation is far worse in many other places, such as the state of Alaska (another place I lived).  I lived in Anchorage and saw a lot people fly or drive into Anchorage for medical services because they couldn't get them in more remote areas, including Fairbanks!  And even more people leaving Alaska for Washington state for bariatric and plastic surgery because they weren't satisfied with the local alternatives.

Are you the same doctor I see on Big Medicine?

Underserved areas are a different story, and it is there that nurse midwives and anesthetists play a more important role.

California has no shortage of anesthesiologists, and it is the state's Medical Board that addresses the needs in underserved counties.  And they were left out of this process, apparantly.

Today, with telemedicine, it is possible to have a doctor involved in a patient's care.  There are many alternatives that still preserve patient safety.  But a blanket law like this is dumb, and will result in abuse by institutions who want to cut costs.

In my cases, the supervisor is the staff anesthesiologist.  I do not feel a surgeon is capable of monitoring anesthesia and doing the case at the same time.  Also, I see a big potential for conflict of interest where a doc (who owns and profits form the sugery center) is also the one assessing and clearing patients for surgery.

Yes, I am the PS on Big Medicine.  Thinking of doing my own show at this point, as I ahve so many interesting patients and I do not understand the "process" out there in L.A.

I would LOVE to watch your show. Since I am now in the maintenance phase of my weight loss journey, I find myself less interested in the surgical aspects of WLS than in the reconstructive process involved. Last night's episode was a rerun of the time Garth put a band on his former teacher and then told that other lady she could not have surgery at their clinic since she was too poor to afford aftercare and maintenance. You were the only interesting part of that episode. Let us know when your show will start.  

I do not feel a surgeon is capable of monitoring anesthesia and doing the case at the same time. 

Absolutely.  It's dangerous, no matter how brilliant the surgeon may be.  There is a Los Angeles/Torrance case going on here of a plastic surgeon who chose to lipo and monitor the anethesia himself.  The patient did not survive.

I agree that nurses are more vigilant.  Of course, I'm a nurse!  lol.  I don't, however, believe that it is in the best interest of patient care that the "crusty old physicians" go away.  I wouldn't feel comfortable being the patient having surgery if there were no anesthesiologist available.  The surgeon fixes my problem, but the anesthesiologist keeps me alive! 

Kathie

Agreed, Kathie.  I always mention when introducing patients to my anesthesia provider "here is the person who will put you off to sleep AND wake you up."  

Gotta say that last part !

I too would LOVE to watch the show! Im so looking forward to my surgery with you on March 16th (and scared to absolute death, but that's beside the point *grin*)
Where/when can I see Big Medicine and do let me know when a new show comes about!

I also think it's a great thing that you have your seperate people doing their jobs so that each can focus on just one important aspect of the surgeries. I too, think it would be taken advantage of and possibly compromise safety to take that out of the hands it's currently in.

Im talking with another photographer friend of mine currently and discussing the idea of possibly offering a DEEP discount to your WLS patients post plastics for a Boudoir Session. Nothing like a boudoir session to show you how sexy you are in your new body - Right!?