Re: Here Comes Another Nail in the Coffin

[Guest guest]

Hey ,

I'd like to not be offended, but you're making it really hard. Of course I'm not doing bypass surgery -- never had a surgical rotation. I hope you aren't doing it either, since, although you had a rotation, you certainly don't have any experience doing cardiac bypass surgery, appendectomies, knee replacements, or any other kind of surgery -- since you're not a surgeon.

But I do have many years experience providing very excellent full primary care services, with hundreds of very happy, satisfied patients with excellent outcomes.

Our training may be different, but that doesn't mean I don't know what I'm doing.

Deanna, FNP-BC

Here Comes Another Nail in the Coffin

Hey folks,

Just as has been predicted and even trended here are the states taking the cheap way out of the Primary Care Shortage... Instead of supporting and saving primary care, less relagate it to an new lower level care provider than all the other specialties. I would love to see the outrage if NP's were allowed to do bi-pass surgery and total Knee replacements, heck even good old apendectomies without supervision. I wonder how much a a multi-step PIA their level of board re-cert is if at all too??? Goodness knows the AAFP just shot itself in the foot with this entire module thing that even intelligent doctors and the PM's like myself have trouble figuring out or understanding...

As I have said before on other topics: Read 'em and weep boys, read 'em and weep....

http://rr.com/news/topic/article/rr/9020/10954291/Doctor_shortage_28_states_may_expand_nurses_role/1

[Guest guest]

OK, this is a good time to remind everyone on the listserve that SARCASM AND HUMOR DOES NOT ALWAYS TRANSLATE WELL OVER THE INTERNET. There are no visual cues to indicate when a person is making a joke. Case in point: Marty's previous pun about whether or not to charge for death pronouncement: I don't think you should charge for this service. Of course, that would make it a dead giveaway...Get it? Dead. Give away? :-pAnyways, please remember the basic rules of netiquette, and that we have people of all stripes on this listserve, including physicians, nurses, physician's assistants, billers, spouses, office managers, vendors, computer programmers, policy wonks and even non-medical related people. Let's be respectful to each other. Thanks! SetoSouth Pasadena, CA

Hey ,

I'd like to not be offended, but you're making it really hard. Of course I'm not doing bypass surgery -- never had a surgical rotation. I hope you aren't doing it either, since, although you had a rotation, you certainly don't have any experience doing cardiac bypass surgery, appendectomies, knee replacements, or any other kind of surgery -- since you're not a surgeon.

But I do have many years experience providing very excellent full primary care services, with hundreds of very happy, satisfied patients with excellent outcomes.

Our training may be different, but that doesn't mean I don't know what I'm doing.

Deanna, FNP-BC

Here Comes Another Nail in the Coffin

Hey folks,

Just as has been predicted and even trended here are the states taking the cheap way out of the Primary Care Shortage... Instead of supporting and saving primary care, less relagate it to an new lower level care provider than all the other specialties. I would love to see the outrage if NP's were allowed to do bi-pass surgery and total Knee replacements, heck even good old apendectomies without supervision. I wonder how much a a multi-step PIA their level of board re-cert is if at all too??? Goodness knows the AAFP just shot itself in the foot with this entire module thing that even intelligent doctors and the PM's like myself have trouble figuring out or understanding...

As I have said before on other topics: Read 'em and weep boys, read 'em and weep....

http://rr.com/news/topic/article/rr/9020/10954291/Doctor_shortage_28_states_may_expand_nurses_role/1

[Guest guest]

From Drain, That's okay . I have 18 years of college and as far as I can tell it only amounts to another form of a communication disorder. And, frankly, if it helped the health care problem, I wouldn't care if they licensed my dog to practice medicine. The problem is that all this will not solve the problems. As long as we hire people to run our health care system who are those who believe the goal is to make as much money as they can, we will be having poor management. Peace... Joanne Holland, DVM/MD

[Guest guest]

I'm not sure which one of Atul Gawande's books it was in, but he describes the specialist hospital that only does inguinal hernia repairs, and has the best success rate in the country.  And they don't use trained surgeons, just family docs trained specifically only to do herniorraphies.

Hey folks,

    Just as has been predicted and even trended here are the states taking the cheap way out of the Primary Care Shortage... Instead of supporting and saving primary care, less relagate it to an new lower level care provider than all the other specialties. I would love to see the outrage if NP's were allowed to do bi-pass surgery and total Knee replacements, heck even good old apendectomies without supervision. I wonder how much a a multi-step PIA their level of board re-cert is if at all too??? Goodness knows the AAFP just shot itself in the foot with this entire module thing that even intelligent doctors and the PM's like myself have trouble figuring out or understanding...

 

    As I have said before on other topics: Read 'em and weep boys, read 'em and weep....

 

 

http://rr.com/news/topic/article/rr/9020/10954291/Doctor_shortage_28_states_may_expand_nurses_role/1

-- Graham Chiuhttp://www.compkarori.co.nz:8090/Synapse - the use from anywhere EMR.

[Guest guest]

It is scary to hear talk of making healthcare more cost-effective by using NPs

for primary care. If I become more cost effective, that is big business talk

for " less money for you. " So the NPs in Washington and Oregon (and elsewhere)who

have enjoyed the legislation that allows equal pay in primary care, get ready to

take a pay cut. We have been outed -- we don't have a medical degree and we are

nurses so we know how to put our big girl (boy) pants on and wade through this

mountain of paperwork, preauths, billing and who knows what else, for less pay

and recognition than our medical colleagues. SCARY! (for so many reasons, not

just the money)

If I had spent most of m 20s in medical school and most of my life paying it

off, I would be totally pissed off... sorry you are just not " cost-effective... "

Sorry for the rant -- I just came back from book club and we had it out about a

great novel " The Help " (highly recommend), and is a bad (good) influence on

me. I am kind of a fan of 's because I have read many of your AC posts.

You are almost up to and status IMHO, and I am not a stalker...ask

and ... just a NP trying to do right by myself and my patients.

a Garrido, ARNP

16 months IMP and going strong!

www.villagefamilyclinic.com

>

> From Drain,

>

>       That's okay .  I have 18 years of college and as far as I can tell

it only amounts to another form of a communication disorder.  And, frankly, if

it helped the health care problem, I wouldn't care if they licensed my dog to

practice medicine.  The problem is that all this will not solve the problems.  

As long as we hire people to run our health care system who are those who

believe the goal is to make as much money as they can, we will be having poor

management. 

>                    Peace...

>                             Joanne Holland, DVM/MD

>

[Guest guest]

Not clear if primary care docs doing surgeries.http://www.shouldice.com/The Medical Staff

Ram K. Singal,   MB,   BS,   FRCSC,  FACS

Earle Byrnes Shouldice,  MD

A. ,  MB,  BS,   FRCSC,

  FACS

Chin K. Chan, BS(Hon),  MD,  CM,   CSPQ,  DABS,  FRCSC

T. Sang,  MD

Slater,  MD

Rasheed. A. Affifi,  MB,  ChB,  FRCSC

N. Ross,  MD

Palmer,  MD,  FRCSC

Kalman,  MD,  FRCSC,  FACS

Claude J. Burul,  MD,  FRCSC

Cassim T. Degani,  MB,   BS,  MS,  FRCSC,  FACS

Alberto G. de la Rocha,  MD,   FRCSC,  FACS

http://en.wikipedia.org/wiki/Shouldice_Hernia_CentreShouldice Hernia Centre is a hospital in Thornhill, Ontario, Canada, that is known for its specialization in external abdominal hernia operations. Shouldice uses a technique developed during World

War II by Dr.

Earle Shouldice. Their ten full-time surgeons perform over 7500 hemiorrhapies each year. The facility, which looks much like a mansion, is purposely comfortable, featuring a 23-acre (9.3 ha) property. The centre is owned by Shouldice

Hospital Limited.

The facility was subject of a 1983 business case by the Harvard Business School. Written by professor Heskett,

the report is currently the school's fourth-best-selling business case,

selling nearly 260,000 copies. Twenty thousand students at 500 universities worldwide read about the centre annually, as part of their curriculum.

Shouldice launched a website in 1995. Over 300,000 visit the site each year; each year 1300 operations are scheduled online, and close to 10,000 emails requesting information are received.Surgery

Shouldice doctors take 35–40 minutes. Local anesthesia is used in surgeries, instead of general anesthesia, as the second is unnecessary in hernia surgeries, and the first is both safer and cheaper. The procedure most commonly used at Shouldice uses no surgical mesh.

Most surgeries at Shouldice involve sewing muscle layers together in overlap. The specific technique is often referred to as the Shouldice operation or the Canadian operationTrivia

A season one episode of Monk featured the Shouldice grounds in exterior shots.Shouldice was used as the White House in the movie: Murder at 1600.A scene from Dawn of the Dead (2004 film)

was supposed to be filmed on the grounds in August 2003, but was cancelled because of poor weather conditions and the Northeast Blackout of 2003. Locke, MD

 

I'm not sure which one of Atul Gawande's books it was in, but he describes the specialist hospital that only does inguinal hernia repairs, and has the best success rate in the country.  And they don't use trained surgeons, just family docs trained specifically only to do herniorraphies.

[Guest guest]

Forgot to mention....FRCSC stands for Fellow of the Royal College of Surgeons of CanadaLooks like most have this designation except for...Earle Byrnes Shouldice,  MD

T. Sang,  MD Slater,  MD

N. Ross,  MD

No time to see what their credentials are, but there you go. Locke, MD

The Medical Staff

Ram K. Singal,   MB,   BS,   FRCSC,  FACS

Earle Byrnes Shouldice,  MD

A. ,  MB,  BS,   FRCSC,

  FACS

Chin K. Chan, BS(Hon),  MD,  CM,   CSPQ,  DABS,  FRCSC

T. Sang,  MD

Slater,  MD

Rasheed. A. Affifi,  MB,  ChB,  FRCSC

N. Ross,  MD

Palmer,  MD,  FRCSC

Kalman,  MD,  FRCSC,  FACS

Claude J. Burul,  MD,  FRCSC

Cassim T. Degani,  MB,   BS,  MS,  FRCSC,  FACS

Alberto G. de la Rocha,  MD,   FRCSC,  FACS

[Guest guest]

This link says Dr. Sang is a former family physician. SetoSouth Pasadena, CA

Forgot to mention....FRCSC stands for Fellow of the Royal College of Surgeons of CanadaLooks like most have this designation except for...Earle Byrnes Shouldice, MD

T. Sang, MD Slater, MD

N. Ross, MD

No time to see what their credentials are, but there you go. Locke, MD

The Medical Staff

Ram K. Singal, MB, BS, FRCSC, FACS

Earle Byrnes Shouldice, MD

A. , MB, BS, FRCSC,

FACS

Chin K. Chan, BS(Hon), MD, CM, CSPQ, DABS, FRCSC

T. Sang, MD

Slater, MD

Rasheed. A. Affifi, MB, ChB, FRCSC

N. Ross, MD

Palmer, MD, FRCSC

Kalman, MD, FRCSC, FACS

Claude J. Burul, MD, FRCSC

Cassim T. Degani, MB, BS, MS, FRCSC, FACS

Alberto G. de la Rocha, MD, FRCSC, FACS

[Guest guest]

Nice find, .Of course, can one every be a " former " Family Doc?Wonder if he went on to get more surgical training or if he is still a Family Doc - just doing hernia surgery?Cheers

Locke, MD

 

This link says Dr. Sang is a former family physician.

SetoSouth Pasadena, CA

 

Forgot to mention....FRCSC stands for Fellow of the Royal College of Surgeons of CanadaLooks like most have this designation except for...Earle Byrnes Shouldice,  MD

T. Sang,  MD Slater,  MD

N. Ross,  MD

No time to see what their credentials are, but there you go. Locke, MD

The Medical Staff

Ram K. Singal,   MB,   BS,   FRCSC,  FACS

Earle Byrnes Shouldice,  MD

A. ,  MB,  BS,   FRCSC,

  FACS

Chin K. Chan, BS(Hon),  MD,  CM,   CSPQ,  DABS,  FRCSC

T. Sang,  MD

Slater,  MD

Rasheed. A. Affifi,  MB,  ChB,  FRCSC

N. Ross,  MD

Palmer,  MD,  FRCSC

Kalman,  MD,  FRCSC,  FACS

Claude J. Burul,  MD,  FRCSC

Cassim T. Degani,  MB,   BS,  MS,  FRCSC,  FACS

Alberto G. de la Rocha,  MD,   FRCSC,  FACS

[Guest guest]

ROCK STAR!

>

> uh- what exactly IS my status a? offlist perhaps I am fragile.

> -Jean

>

> > your AC posts. You are almost up to and status IMHO, and I am

> > not a stalker...ask and ... just a NP trying to do right by myself

> > and my patients.

> >

> > a Garrido, ARNP

> > 16 months IMP and going strong!

> > www.villagefamilyclinic.com

> >

> > -

> >

> > --

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