Cynics step back

[Algiatrist]

Good morning all,

I thought I would put this out to the forum to get the populaces' opinions on the matter (God save me). I work in a very small private practice in a very small community in a very small state. Just me (Interventional Pain) and a Neurosurgeon.

We do just fine, but in our state the writing is on the wall. The two super-huge hospital groups are gobbling up everything around. We had a heart-to-heart the other day and the neurosurgeon, who is 58 (not old), is thinking of selling and working for the hospital.

I'm mixed on the whole situation. The hospital has asked me on numerous occasions to come work for them, and re-vamp their pain management program, and start a hospital run out-patient pain management clinic.

Therefore, I'm trying to be as objective as I can about this, and my main question is:

WHAT ARE TRULY THE PROS AND CONS ABOUT WORKING AS A HOSPITAL EMPLOYEE?

Discuss.

No throwing things.

---

Members don't see this ad.

 

[drusso]

You become an employee which means that you'll be under the "direction and control" of your employer.

The hospital will lie to you--make promises that they can't keep--and generally only notify you about things on a "need to know basis." They will court you and woo you and then f*ck you. You will be subjugating your autonomy, judgment, and to some degree your professionalism to people who are less educated, less motivated, and less accountable than you. To get anything done you'll have to navigate a maze of committees, managers, fiefdoms, and politics. You'll be thrown into situations with veteran "institutionalized" workers whose priorities mostly center on day-to-day survival and counting down to their retirement date. You'll be expected to get along with these kind of people and if there's a problem, the classic rejoinder will be "Well, Dr. So-and-so just hasn't aligned with the mission--he or she is not integrated."

I wouldn't approach the question by asking "what are they pro's and con's to being hospital employed?" I would consider how much valuable it is to remain self-employed in a society that is increasingly eschewing ownership values; how much work have you put into building a successful enterprise; how much you value your autonomy...the barriers to STARTING a private practice are very high and getting higher every day. I would hold on to what you've got and recruit a new neurosurgeon or interventionist. I would build a better mouse-trap. I would be entrepreneurial and industrious.

Further, why be an "employee?" If the hospital wants to work with you--ask to be a vendor to them, ask for an exclusive business services agreement, ask for a medical director stipend/independent contractor arrangement and have them 1099 you. But, do not, under any circumstances, castrate yourself and just become employed...

 

[SSdoc33]

ING a private practice are very high and getting higher every day. I would hold on to what you've got and recruit a new neurosurgeo

there are obviously good points here. however, not all docs that are employed become eunuchs. the picture painted above is one end of the hospital employee spectrum.

working as a hospital employee:

cons:
-less autonomy
-more regulations
-may need to compromise some of your ethics
-lack of transparency in the finances. nobody will be able to tell you where your revenues go, who much goes to nurses, what the supplies cost, etc.
-less control. much less control
-likely restrictive covenant in your contract

pros:
-less administrative work / less hassle
-more stability
-generally more stable hours
-better retirement options and benefits (hospitals have a 403b, which is an extra 17K you can put away tax-free on top of the standard 401k. also, some have a 457 plan, which adds another 17k). also, there is generally more CME money, legal plans, disability and life insurance (you'd still need more), dental plans, etc.
-built-in referral base
-less stress
-easier to just leave when you want. no major financial investment, you can just up and quit if you want



money could go either way depending on your typical situation. you CAN fight city hall, but at some point, it may not be worth it. you are not "weak" if you want to work for a hospital, but if you like to control all the ins and outs of your practice, then PP is the way to go.

 

[101N]

How has your relationship with the hospital staff/admin been over the years? As in PP, it depends upon the individual personalities involved.

 

[drusso]

How has your relationship with the hospital staff/admin been over the years? As in PP, it depends upon the individual personalities involved.

Don't be their employee. Be a vendor to them.

 

[emd123]

I guaran-effing-tee you that they will treat you like (highly paid) hourly help, because that's what you will be. It can work, but give up forever on feeling remotely important, respected or anything but an utterly replaceable cog in a large machine.

I've been there. And now I'm independent. It may ultimately be that I have no choice but to go back to this arrangement, but I would only do it if absolutely needed for career survival. Not for a few promised extra dollars, fears of the future, or any other lick-and-a-promise.

At the Hosp I used to work at, they'd bring docs in, lie to them about this, that, and everything, and then tell them, "Tough sh¡t. If you don't like it, leave." If the docs didn't jump when told to jump, and beg when told to beg, they just canned 'em, without remorse. Or at the end of the year they'd get, "Sorry, we're unable to renew you contract."

If you think working for your patients sucks, go try working for some post-MBA bean counter whose next bonus depends on finding a way for you not to get yours.

My question to you is, "Do you need to sell out to survive, or are you considering it only out of fear, trends, or a sales pitch?"

 

[powermd]

There is another option.

Lease your practice to the hospital, and be employed with a clear option to sever ties if either party is unhappy.
You will still own your practice, but can now bill at HOPD rates. Negotiate for a higher salary or more vacation time.

If they ask why you are pursuing this option, give them a laundry list of all the reasons physicians hate hospital employment. Explain that the hospital needs to have an incentive to keep you satisfied with the deal. Once they own everything, it's game over.

 

[SSdoc33]

There is another option.

Lease your practice to the hospital, and be employed with a clear option to sever ties if either party is unhappy.
You will still own your practice, but can now bill at HOPD rates. Negotiate for a higher salary or more vacation time.

If they ask why you are pursuing this option, give them a laundry list of all the reasons physicians hate hospital employment. Explain that the hospital needs to have an incentive to keep you satisfied with the deal. Once they own everything, it's game over.

if the hospital owns all the referring docs and can hire anyone do do what you do (quality is not important in the CEO's mind), then why would they agree to this?

 

[powermd]

if the hospital owns all the referring docs and can hire anyone do do what you do (quality is not important in the CEO's mind), then why would they agree to this?

An existing practice is a known quantity. The docs have established patient relationships, and relationships with referring doctors. There is a history of attractive revenues and carefully managed expenses. All they need to do is put their rubber stamp on the place, minimize interference, and it's a cash machine for the hospital from day one. Plus with a lease there is minimal up front cost. If reimbursements go south, they may not want to own the practice and can easily end the lease.

If they choose instead to start their own pain practice they need to make space available, renovate, buy equipment, hire staff, including recruiting physicians to what sounds like BFE, then fight with an existing group in town to squash their referrals. Finally, they need to figure out how to run a pain practice efficiently. The guys they recruit may have no clue how to make pain work from a business point of view. Perhaps the CEO is a jerk with a lot of energy for this, but it would be way easier to to just lease the existing pain practice, hire the docs and call it a day.

 

[willabeast]

You become an employee which means that you'll be under the "direction and control" of your employer.

The hospital will lie to you--make promises that they can't keep--and generally only notify you about things on a "need to know basis." They will court you and woo you and then f*ck you. You will be subjugating your autonomy, judgment, and to some degree your professionalism to people who are less educated, less motivated, and less accountable than you. To get anything done you'll have to navigate a maze of committees, managers, fiefdoms, and politics. You'll be thrown into situations with veteran "institutionalized" workers whose priorities mostly center on day-to-day survival and counting down to their retirement date. You'll be expected to get along with these kind of people and if there's a problem, the classic rejoinder will be "Well, Dr. So-and-so just hasn't aligned with the mission--he or she is not integrated."

I wouldn't approach the question by asking "what are they pro's and con's to being hospital employed?" I would consider how much valuable it is to remain self-employed in a society that is increasingly eschewing ownership values; how much work have you put into building a successful enterprise; how much you value your autonomy...the barriers to STARTING a private practice are very high and getting higher every day. I would hold on to what you've got and recruit a new neurosurgeon or interventionist. I would build a better mouse-trap. I would be entrepreneurial and industrious.

Further, why be an "employee?" If the hospital wants to work with you--ask to be a vendor to them, ask for an exclusive business services agreement, ask for a medical director stipend/independent contractor arrangement and have them 1099 you. But, do not, under any circumstances, castrate yourself and just become employed...

i have worked PP for 5 years, employee for 20+ years. All of the above is true. but there are some docs who thrive in the above situation. so i think you have to figure out what sort of system you fit best in.
here is the question to ask yourself. is it more important that my patients love/respect me or my fellow docs love/respect me. i think how you answer this question will determine your future happiness as self employed versus employee.
everybody has to serve someone - either management or the patients. take your pick.

 

[drusso]

there are obviously good points here. however, not all docs that are employed become eunuchs. the picture painted above is one end of the hospital employee spectrum.

working as a hospital employee:

cons:
-less autonomy
-more regulations
-may need to compromise some of your ethics
-lack of transparency in the finances. nobody will be able to tell you where your revenues go, who much goes to nurses, what the supplies cost, etc.
-less control. much less control
-likely restrictive covenant in your contract

pros:
-less administrative work / less hassle
-more stability
-generally more stable hours
-better retirement options and benefits (hospitals have a 403b, which is an extra 17K you can put away tax-free on top of the standard 401k. also, some have a 457 plan, which adds another 17k). also, there is generally more CME money, legal plans, disability and life insurance (you'd still need more), dental plans, etc.
-built-in referral base
-less stress
-easier to just leave when you want. no major financial investment, you can just up and quit if you want

money could go either way depending on your typical situation. you CAN fight city hall, but at some point, it may not be worth it. you are not "weak" if you want to work for a hospital, but if you like to control all the ins and outs of your practice, then PP is the way to go.

Many of those "fringe" benefits can be customized and emulated more cheaply in private practice. Plus, you get some access to retirement and financial planning tactics that would of reach for you as a hospital employee--ie a cash balance plan, etc. Moreover, when you're paying for your own fringes you can rationally evaluate their true worth--just how valuable is that comprehensive vision plan? Or, would you rather pocket the extra money for yourself? Can't do that with a "take or leave it" pre-structured, employee benefit package.

Ever wonder how much those expensive hospital-employed, union-style fringes contribute to driving up the cost of health care??

 

[Ducttape]

3/4 of what drusso says about hospital employed physicians is inflammatory hyperbole. clearly he has great resentment against hospital employed practice that goes beyond a factual basis and somehow there is some deep damage to his psyche... maybe he wanted to be hired but got rejected...

i will not tout that hospital based practices are all fine and dandy. they are not. but then again, neither is PP. at least in one practice, financial decisions are not the major determinant of who you see, what you do, and where you do it.

admin does not make decisions on how to treat, unless, well, see below. they may make decisions on who to treat based on which insurances are accepted, but physicians can have a huge say.

if you are PP, you are forced to make multiple decisions on what you do, how you do it ($ in), how much it costs($ out), how you can cut costs($ out), who you have to kiss arse to keep referrals ($ out), staff to fire ($ out) minimal staff needed to keep clinic running ($ in). you get the point. you have to be all about finances, and $$$ drives the bottom line. it becomes extraordinarily easy to say "okay, ill give you a few vics/oxys/percs if you get this ESI/TF/RFA", for example.

if you decide to go hospital based, many of the things that drusso and others may very well happen - if you allow it. the classic example that drusso is touting is the hospital based doc that clocks in, clocks out, passively does what hospital admin tells them, then yes you will be pushed around. but if you make money, take an interest in the finances, actively work to expand the practice, the fact you dont have to worry about finances and can worry only about taking care of patients is a huge bonus.

but you have to have an interest in working with those who are financially less well off, and lower class population - who may be less demanding and complaining than the rich self-indulgent. when they do well, they are very grateful, and i dont care what PP say - getting a Medicaid/SSD patient back to work is satisfaction that is almost unmatched by any other clinical experience.


ultimately, i personally believe that the choice as to whether one goes private or hospital based needs to be based on how much financial acumen and interest one has. if you are a businessman first and foremost, do not go hospital based, and open your own practice. if you have that acumen and gene, then dont put yourself in the situation of getting frustrated by admin that are assuming that role for you.

 

[hyperalgesia]

I think you have to be flexible and there are sometimes arrangements that can/should be made with a hospital. But you definitely have to assume the hospital will screw you when they get the chance.

Also, a slow death is pretty much inevitable. Just talk to guys who have been employed at hospital for a long time. They speak in monotone as they recite the employee motto; "ICARE: Inginuity, Compassion, Accommodation, Responsiveness, Empathy". They do this after completing the mandatory "Meaningful Use Training Module" and the annual "Privacy Compliance Module" and all the other modules.

At some point, the doc-ployee is indistinguishable from all the other -ployees.

You get the idea...

 

[drusso]

3/4 of what drusso says about hospital employed physicians is inflammatory hyperbole. clearly he has great resentment against hospital employed practice that goes beyond a factual basis and somehow there is some deep damage to his psyche... maybe he wanted to be hired but got rejected...

It's not personal, Duct. If your gig is working out for you, that's great. But, people need to hear the other side. I've had *three* conversations this week (and it's only Tuesday) with people wanting to LEAVE hospital-employed positions. Why? "They didn't give me what they promised." The administration lied." "I have no control." The list goes on and on. I've personally sat in local and regional meetings and heard hospital "leadership" (I prefer Idiocracy) refer to employed MD's as "Sheeple," "Lazy," "Unmotivated." I've seen hospitals use the peer review process and medical licensing boards as tools of coercion to silence "trouble-makers." Others on this Board will attest to the same.

But, I'll lay my biases down plain and clear: It is my conviction that working for a hospital subsidizes inefficiency and corruption in our health care system. The reason they want to **EMPLOY** (as opposed to collaborate, partner, form joint ventures, etc) MD's is because the hospital makes money off of them. They want CONTROL. This money, in turn, subsidizes inflated hospital administrator compensation. The shell game they play is all about the site of service differential...they're masters of the "the vig," "the juice," "the take" in health care. The casino (hospital) always wins. All made possible by economically exploiting the labor of the employed MD.

Look at these ridiculous Administrator salaries for a local hospital in my area--a small po-dunk hospital in rural Oregon:

Mid-Columbia Medical Center (MCMC) CEO, $674,235

#MCMC VP of Medical Affairs, $344,492

#MCMC CFO and VP of Finance, $259,099

#MCMC VP – Chief Nursing Officer, $204,773

http://www.thedalleschronicle.com/news/2015/mar/27/shining-light-many-local-salaries/

How is this possible? Maybe because they're smart, talented, industrious stewards of resources who care about serving the underserved? No. They're shrewd, cut-throat, savvy operators. They know the game and they know how to extract profit from other's work. What's most disgusting is that this "Admin team" starts its entry-level PCP-MD's at....140K (total comp value approx $200K). Do you know what a typical MD in their system produces in terms of revenue? Almost $800K. Do the math. Look at the admin salaries.

Hospitals Administrators are brokers of "information asymmetry." They don't want MD's to know what they know. And, they know how to make money off you...Pimps and Hoes...

My general advice is the following: If the hospital wants to do business with you--seek an arrangement where you are on an equal footing--where you can CONTROL the information and scope of work. MD/DO's are, in my view, members of a privileged, ancient, and sacred caste of society. We are better than them--not by birth, but by achievement. Don't hand over your balls and subjugate yourself to someone who couldn't even figure out how apply to medical school---let alone get in.

 

[Louisville04]

I think you have to be flexible and there are sometimes arrangements that can/should be made with a hospital. But you definitely have to assume the hospital will screw you when they get the chance.

Also, a slow death is pretty much inevitable. Just talk to guys who have been employed at hospital for a long time. They speak in monotone as they recite the employee motto; "ICARE: Inginuity, Compassion, Accommodation, Responsiveness, Empathy". They do this after completing the mandatory "Meaningful Use Training Module" and the annual "Privacy Compliance Module" and all the other modules.

At some point, the doc-ployee is indistinguishable from all the other -ployees.

You get the idea...

I just completed that module this morning. It actually stands for Integrity, Commitment, Advocacy , Respect, Excellence

 

[hyperalgesia]

I just completed that module this morning. It actually stands for Integrity, Commitment, Advocacy , Respect, Excellence

I'm sure it stands for the other thing somewhere

 

[Algiatrist]

Thanks for all the feedback. To answer one persons comment,

I've never had any issue with the hospital folks. They've been pretty good to our practice thus far. Helped out with marketing in the beginning, etc. I even do a few consults for them here and there and if a patient comes to their surgical unit who needs a pump to be managed.

Again, the hospital is asking specifically for an outpatient pain management clinic, i.e.- Medicaid/Medicare driven most likely. (The PCP's and ER docs in the area will think I'm sent from heaven above-and crazy!)

But, I like the idea of the Medical Director stipend (what's fair? 100K/year?) I can create their out-patient clinic, operate as its Medical Director, oversee the 3-4 NP's who staff it, but don't actually become employed by the hospital.

In return, all procedures have to be done in my office suite. See, I'm trying to conceive a hybrid position where I give the hospital what they want (an outpatient haven to send their chronic pain patients with crap insurance), but not become their employee.

 

[dunecat]

I also work in a small town (different field). In my opinion, you would want to get your foot in the door. A $100k stipend could help, but I can assume that that is probably peanuts compared to how your practice does; I don't believe that should be a sticking point.

As for the hospital allowing all procedures to be done in your suite - that's the catcher in my opinion. If they were to allow that, I'd imagine that they are very desperate; however, it's hard to believe that a hospital system would be okay with that.

 

[101N]

I've done hybrids before. Just be aware that the volume of patients coming from the 'system' can easily swamp your PP. Moreover, the referred patients from the ED and PMD's within the system
will be overwhelmingly medicare and medicaid.

In retrospect, my biggest value to the system when I've done the hybrid has been doing the heavy lifting no fun stuff like saying no to drug seekers, introducing a structured refill clinic, offering UDS/SDS, and off loading the ED and PCPs from their demanding, entitled, CNP patients. This is where the big need is, not procedures. Anticipate that, and put a number on it..

 

[drusso]

I've done hybrids before. Just be aware that the volume of patients coming from the 'system' can easily swamp your PP. Moreover, the referred patients from the ED and PMD's within the system
will be overwhelmingly medicare and medicaid.

In retrospect, my biggest value to the system when I've done the hybrid has been doing the heavy lifting no fun stuff like saying no to drug seekers, introducing a structured refill clinic, offering UDS/SDS, and off loading the ED and PCPs from their demanding, entitled, CNP patients. This is where the big need is, not procedures. Anticipate that, and put a number on it..

And, that's work that no one wants to pay for...that our system doesn't see as valuable nor important...it's too cognitive. It's also soul-sucking, high burn-out work. When I've proposed pro-formas for that work...and bench-marked them as a percentage of *the hospital's* net operating income....all services included--UDS, behavioral health, pharmacy, plus imputed saving added back from events that did not occur (ED admissions for over-doses, etc)...they just blankly stare at me...and ask why I don't be employed by them...I think that 1% of $40 million in net operating income is a bargain for that work...

Rinse, lather, repeat...

 

[powermd]

In return, all procedures have to be done in my office suite. See, I'm trying to conceive a hybrid position where I give the hospital what they want (an outpatient haven to send their chronic pain patients with crap insurance), but not become their employee.

Interesting idea, but I can't see a hospital biting on that. The whole point in doing business with you will be to take advantage of HOPD rates and get a big piece of your procedure income. If you lease your practice and become an employee, you could get a medical directorship (more likely $75k, if they allow it at all for a one guy pain practice) AND higher and more stable base/bonus income.

 

[hyperalgesia]

I can't imagine any hospital deal without taking advantage of HOPD (procedures on hospital campus). The hospital adds a lot of overhead (admin, inefficiency, compliance) and poor payers so you have to make up for that somehow. There's just not enough money on the table.

Maybe the hospital could pay you based solely on RVUs after they set up the clinic to your specs... You would be a contractor.

 

[emd123]

I just completed that module this morning. It actually stands for Integrity, Commitment, Advocacy , Respect, Excellence

Lol. Are you serious? Lmao

 

[Louisville04]

Lol. Are you serious? Lmao

Yep. It's a VA. When a patient NO SHOWS, you have some time to kill.

 

[Ducttape]

In retrospect, my biggest value to the system when I've done the hybrid has been doing the heavy lifting no fun stuff like saying no to drug seekers, introducing a structured refill clinic, offering UDS/SDS, and off loading the ED and PCPs from their demanding, entitled, CNP patients. This is where the big need is, not procedures. Anticipate that, and put a number on it..

And, that's work that no one wants to pay for...that our system doesn't see as valuable nor important...it's too cognitive. It's also soul-sucking, high burn-out work. When I've proposed pro-formas for that work...and bench-marked them as a percentage of *the hospital's* net operating income....all services included--UDS, behavioral health, pharmacy, plus imputed saving added back from events that did not occur (ED admissions for over-doses, etc)...they just blankly stare at me...and ask why I don't be employed by them...I think that 1% of $40 million in net operating income is a bargain for that work...

that was essentially my "selling" point towards taking over my current employment. it might be soul sucking, but no more so than rotating hours of ER, with disgruntled patients...

 

[101N]

Hang in

 

[emd123]

that was essentially my "selling" point towards taking over my current employment. it might be soul sucking, but no more so than rotating hours of ER, with disgruntled patients...

Now THATS 100% true.

 

[Disciple]

And, that's work that no one wants to pay for...that our system doesn't see as valuable nor important...it's too cognitive. It's also soul-sucking, high burn-out work. When I've proposed pro-formas for that work...and bench-marked them as a percentage of *the hospital's* net operating income....all services included--UDS, behavioral health, pharmacy, plus imputed saving added back from events that did not occur (ED admissions for over-doses, etc)...they just blankly stare at me...and ask why I don't be employed by them...I think that 1% of $40 million in net operating income is a bargain for that work...

Rinse, lather, repeat...

They don't see the value because their objectives are not aligned with yours. I would guess that that hospital's counter proposal would be that you offload the ER and PCPs (as you stated), and properly monitor the patients (UDS and state PDMP), but are liberal with opioid prescribing (keeps patient satisfaction scores high), rarely discontinue meds or discharge patients (give 3rd, 4th and 5th chances), and are aggressive with procedures (performed in the hospital or their ASC). They would expect you to deliver on savings from "events that did not occur" by taking on a dual role as a pseudo Psychiatrist/psychologist, manning a weekend/afterhours crisis hotline. They might even give you a midlevel to help with the "emergency" pain add-on appointments and weekend call, if you're producing enough. What you're able to negotiate would be dependent on whether or not they can find a new graduate willing to take a non-competitive offer.

Is there a term for prematurely jaded and cynical?

Not surprisingly, systems like Kaiser are more receptive to, or have models similar to the one you've described, as they function as both insurer and provider of services.

 

[Disciple]

In return, all procedures have to be done in my office suite. See, I'm trying to conceive a hybrid position where I give the hospital what they want (an outpatient haven to send their chronic pain patients with crap insurance), but not become their employee.

Two factors influencing whether or not the hospital may negotiate in good faith:

1. Whether or not they think they can crush your existing practice.
2. Whether or not they think they will be able to hire a new graduate, or physician from outside the community.

 

[Disciple]

How is this possible? Maybe because they're smart, talented, industrious stewards of resources who care about serving the underserved? No. They're shrewd, cut-throat, savvy operators. They know the game and they know how to extract profit from other's work. What's most disgusting is that this "Admin team" starts its entry-level PCP-MD's at....140K (total comp value approx $200K). Do you know what a typical MD in their system produces in terms of revenue? Almost $800K. Do the math. Look at the admin salaries.

Hospitals Administrators are brokers of "information asymmetry." They don't want MD's to know what they know. And, they know how to make money off you...Pimps and Hoes...

My general advice is the following: If the hospital wants to do business with you--seek an arrangement where you are on an equal footing--where you can CONTROL the information and scope of work. MD/DO's are, in my view, members of a privileged, ancient, and sacred caste of society. We are better than them--not by birth, but by achievement. Don't hand over your balls and subjugate yourself to someone who couldn't even figure out how apply to medical school---let alone get in.

I've had these conversations many times with pain doctors/surgeons in my community. Basically, we have no leverage in negotiations. Worse in competitive geographic regions.

Would love to see an organization of physician executives whose primary mission is to return the stewardship of American Healthcare to physicians. Foundation to help physicians with business and leadership training, business school, etc. Requirement to serve as an officer, or on the board of directors would be a x% of time currently spent in clinical medical practice.

 

[drusso]

But, I like the idea of the Medical Director stipend (what's fair? 100K/year?) I can create their out-patient clinic, operate as its Medical Director, oversee the 3-4 NP's who staff it, but don't actually become employed by the hospital.

In return, all procedures have to be done in my office suite. See, I'm trying to conceive a hybrid position where I give the hospital what they want (an outpatient haven to send their chronic pain patients with crap insurance), but not become their employee.

The only way to rationally structure this kind of arrangement is to "gain share" with the hospital. In other words, look at how much money the problem is costing them and offer to sell your services as a vendor to fix it for a % of the revenue it will bring it or they will save. They will be appalled that you (lowly MD or DO) would dare approach a negotiation with them in such a manner...yet every other management consultation contract, IT vendor, or fiancial services contract they enter into is structured EXACTLY that way...

Ponder this: Why do you think hospital adminstrators have such an aversion to negotiating with physicians this way, but the aversion doesn't exist when they are dealing with other kinds of professional sevice vendors (IT, Finance, Human Resources, etc)...most hospitals are more than happy to outsource their IT, human resources, and many other management (UR, CQI, etc) services...what on earth could be driving the bias????

 

[deleted682700]

The hospitals hire a consulting firm run by a guy who has three operating room nurses to improve the case load and volume and we're happy to pay them 120,000$. This consultants have no clue. But they sold the idea to the CEO who bought into it. Now the consultants come in and they are going to interview,ie, get the ideas from doctors , nurses and then type into a 100 page document and give it to the CEO. It doesn't matter to the CEO because it's other people's money.

 

[deleted682700]

Why would you want to work for a hospital. The insurance companies are driving bussiness out to surgery centers and medical offices. In fact that is why after practicing anesthesia for 15 years, I am planning to go back and see if I can learn and do pain management.
The hospitals just think they own your soul.

 

[emd123]

Why would you want to work for a hospital. The insurance companies are driving bussiness out to surgery centers and medical offices. In fact that is why after practicing anesthesia for 15 years, I am planning to go back and see if I can learn and do pain management.
The hospitals just think they own your soul.

Quoted for truth

 

[Disciple]

The only way to rationally structure this kind of arrangement is to "gain share" with the hospital. In other words, look at how much money the problem is costing them and offer to sell your services as a vendor to fix it for a % of the revenue it will bring it or they will save. They will be appalled that you (lowly MD or DO) would dare approach a negotiation with them in such a manner...yet every other management consultation contract, IT vendor, or fiancial services contract they enter into is structured EXACTLY that way...

Ponder this: Why do you think hospital adminstrators have such an aversion to negotiating with physicians this way, but the aversion doesn't exist when they are dealing with other kinds of professional sevice vendors (IT, Finance, Human Resources, etc)...most hospitals are more than happy to outsource their IT, human resources, and many other management (UR, CQI, etc) services...what on earth could be driving the bias????

The bias is that their experience shows them that physicians are profit centers and can be taken advantage of. Especially, individual physicians with little business acumen. In the other examples of vendors, a service is being provided, and possibly some savings realized, but the hospital is usually dealing with a larger entity and doesn't actively profit off of the vendor. It's simpler. They look at the vendor's service track record and go with the best deal.

Would be interested to see if negotiations would proceed any differently between a hypothetical vendor (silent physician owner) with RN admin staff and figure head CEO.

Aren't some anesthesia management companies partially physician owned?

Would love to have a strong physician executive/business organization that could provide support to solo physicians and small groups in these types of endeavors.

 

[deleted682700]

Physician executives turn against their colleagues once they taste the power of the administration. They in fact may be dangerous because they have half knowledge and half truth if they are not from your speciality.
It's all about the green back.

 

[drusso]

The bias is that their experience shows them that physicians are profit centers and can be taken advantage of. Especially, individual physicians with little business acumen. In the other examples of vendors, a service is being provided, and possibly some savings realized, but the hospital is usually dealing with a larger entity and doesn't actively profit off of the vendor. It's simpler. They look at the vendor's service track record and go with the best deal.

Would be interested to see if negotiations would proceed any differently between a hypothetical vendor (silent physician owner) with RN admin staff and figure head CEO.

Aren't some anesthesia management companies partially physician owned?

Would love to have a strong physician executive/business organization that could provide support to solo physicians and small groups in these types of endeavors.

Many anesthesia management companies, Emergency Medicine groups (EmCare), and radiology groups are structured this way...

https://www.emcare.com/ABOUT/LEADERSHIP

 

[miamidoc2b]

Don't sell out. Hang onto your balls and make sure you have a good, experienced attorney in your corner.

If they want you, they will work with you. If they don't really care, then get ready for a possible ****storm, but hang onto your balls.

 

[Disciple]

Physician executives turn against their colleagues once they taste the power of the administration. They in fact may be dangerous because they have half knowledge and half truth if they are not from your speciality.
It's all about the green back.

True,

Medical directors of UR vendors, large insurers, large medical groups, etc. can act in the same manner as hospitals.

Is it possible to have a business organization that backs the "little guy"? I don't know.

After all, most physicians who get MBAs do so for the purpose of holding upper level positions in corporations that are unfriendly to independent medical practice.

 

[hyperalgesia]

The only way to rationally structure this kind of arrangement is to "gain share" with the hospital. In other words, look at how much money the problem is costing them and offer to sell your services as a vendor to fix it for a % of the revenue it will bring it or they will save. They will be appalled that you (lowly MD or DO) would dare approach a negotiation with them in such a manner...yet every other management consultation contract, IT vendor, or fiancial services contract they enter into is structured EXACTLY that way...

Ponder this: Why do you think hospital adminstrators have such an aversion to negotiating with physicians this way, but the aversion doesn't exist when they are dealing with other kinds of professional sevice vendors (IT, Finance, Human Resources, etc)...most hospitals are more than happy to outsource their IT, human resources, and many other management (UR, CQI, etc) services...what on earth could be driving the bias????

So true! However, in their defense (sort of), I think they constantly feel like idiots around doctors and are attempting to compensate. Nothing else can really explain the contempt that seeps from their pores when you make a simple and equitable proposal.

 

[drusso]

So true! However, in their defense (sort of), I think they constantly feel like idiots around doctors and are attempting to compensate. Nothing else can really explain the contempt that seeps from their pores when you make a simple and equitable proposal.

I don't think they feel like idiots at all. I think that they look at doctors as something to make money off--not equal parties in a transaction.

 

[Disciple]

Many anesthesia management companies, Emergency Medicine groups (EmCare), and radiology groups are structured this way...

https://www.emcare.com/ABOUT/LEADERSHIP

At that point, you're not much different than the hospital.

 

[emd123]

Many anesthesia management companies, Emergency Medicine groups (EmCare), and radiology groups are structured this way...

https://www.emcare.com/ABOUT/LEADERSHIP

They are, but at least in EM, they're publicly traded and the allowed physician portion of ownership is minuscule. It's essentially equivalent to being employed by a hospital if you're employed by a contract management group. In fact, it can be worse, in the sense that you're serving two masters, your contract group bosses and the hospital administration bosses both who are putting the screws to you.