"I'm A Doctor: Corporate Greed Is Killing Your ER"

[Groove]

---

Members don't see this ad.

 

[WhatJobDoIPick]

Only about 25 years too late

 

[RuralEDDoc]

Better late than never. Fix this problem and then we can fix boarding and homelessness 🦄

 

[southerndoc]

Please see this thread: Justice Department Seeks Input on Private Equity Involvement in Healthcare

I almost merged the threads but left them separate. Please submit your comments to the DoJ for their antitrust investigation. Now is your chance to make your voice known. Don't pass it up!

 

[Boatswain2PA]

No mention of USUCKS....

 

[RustedFox]

No way to anonymously submit data?

 

[ShockIndex]

I’ve seen a couple of threads on this website discussing the corporate practice of medicine and private equity influence. As usual, I come to provide a contrarian perspective for your consideration.

It’s not that I disagree with the prevailing sentiment that the corporate practice of medicine is bad and needs reform - this is undeniable. I have concerns with the target of everyone’s ire and perhaps your methods.

As bad as players like TeamHeath and EMP/USACS are, I submit they are not the biggest nor most immediate threat to your longevity in this career. Private equity-back EM jobs are only 25% of the employers; you often have other options. Ladies and gentlemen of the jury, I submit that the private “nonprofit” healthcare system is a more immediate threat to your profession, and we need to make sure that actions taken to weaken private equity do not feed the gorilla in the china shop. The growth of these private and semi-public systems are a cancer, a true pustule on the ass of healthcare, that is quickly absorbing all manner of physician practices. Last I checked, they now control about 40% of healthcare jobs and show no signs of slowing down. Trust me, they behave nothing like a non-profit charity, and are as tuned into profiteering as any private equity firm. They use every anti-trust trick in the book such as physician non-compete clauses, certificate of need requirements, eminent domain, etc. to undercut competition, drive down physician salaries, and grow. Their CEOs pull salaries that you would expect to see at a major bank.

My fear is that any federal regulations that weaken these private equity groups will further strengthen the grip of private non-profits. Take a look at what happened with Atrium Heath and USACS. Atrium has quickly grown from a regional heath system, Carolinas Heath, to a national super-system with hospitals across the Southeast and Midwest. While it touts itself as a non-profit, Atrium has notoriously sued patients and physicians, engaged in deceptive billing, and vigorously lobbied politicians at all levels. When Atrium replaced USACS last month, they didn’t replace them with a SDG - they are expanding their own hospital employee group. This is nothing more than effectively eliminating yet another employer in the region and stifling competition. As much as USACS sucks, losing yet another potential employer in the Charlotte region will eventually suck more. Why? Because Atrium will control a significant portion of the EM jobs not just in Charlotte, but as far away as Winston Salem, Greensboro, High Point, and beyond.

My concern with the methods used to bring about reform are far less pressing. I appreciate that the government is often the most expedient means to bring about needed change. However, the US health system, if nothing else, seems to be the poster child for unintended consequences when Uncle Sam get deeply involved.

 

[RustedFox]

Private equity-back EM jobs are only 25% of the employers; you often have other options.

This doesn't pass the sniff test.

 

[ShockIndex]

This doesn't pass the sniff test.

Simply click on the video link in the original post and fast forward to the 5:30 mark. There is no need for you to be sniffing anything.

 

[RustedFox]

Simply click on the video link in the original post and fast forward to the 5:30 mark. There is no need for you to be sniffing anything.

Doesn't mean they're correct either, amigo.
25% seems too low.

 

[ShockIndex]

Doesn't mean they're correct either, amigo.
25% seems too low.

A quick perusal of multiple sources cite the same statistic: 50% of EM jobs are tied to a CMG.

Corporate Control of Emergency Departments - A Growing Monster? - JournalFeed

Spoon FeedThere is undeniable corporate influence in the practice of emergency medicine, and this could cause problems for patients or for those of us who care for them. We need to thoughtfully consider this. SourceCorporate Control of Emergency Departments: Dangers from the Growing Monster. J...

journalfeed.org

Welcome to the Emergency Room. A Wall Street Honcho Will Decide Your Treatment.

Doctors and medical experts say private equity firms and profiteering corporations are putting American lives at risk and compromising the practice of medicine.

www.ineteconomics.org

However, not all CMGs are backed by private equity; about half are. Hence the 25%.

Do you have any sources to support your keen sniffer, paisano?

(See what I did there…Italian)

 

[RustedFox]

A quick perusal of multiple sources cite the same statistic: 50% of EM jobs are tied to a CMG.

Corporate Control of Emergency Departments - A Growing Monster? - JournalFeed

Spoon FeedThere is undeniable corporate influence in the practice of emergency medicine, and this could cause problems for patients or for those of us who care for them. We need to thoughtfully consider this. SourceCorporate Control of Emergency Departments: Dangers from the Growing Monster. J...

journalfeed.org

Welcome to the Emergency Room. A Wall Street Honcho Will Decide Your Treatment.

Doctors and medical experts say private equity firms and profiteering corporations are putting American lives at risk and compromising the practice of medicine.

www.ineteconomics.org

However, not all CMGs are backed by private equity; about half are. Hence the 25%.

Do you have any sources to support your keen sniffer, paisano?

(See what I did there…Italian)

I see my mistake. I'm conflating CMG and PE. But can you blame me?

I smell tacos.

 

[WhatJobDoIPick]

I’ve seen a couple of threads on this website discussing the corporate practice of medicine and private equity influence. As usual, I come to provide a contrarian perspective for your consideration.

It’s not that I disagree with the prevailing sentiment that the corporate practice of medicine is bad and needs reform - this is undeniable. I have concerns with the target of everyone’s ire and perhaps your methods.

As bad as players like TeamHeath and EMP/USACS are, I submit they are not the biggest nor most immediate threat to your longevity in this career. Private equity-back EM jobs are only 25% of the employers; you often have other options. Ladies and gentlemen of the jury, I submit that the private “nonprofit” healthcare system is a more immediate threat to your profession, and we need to make sure that actions taken to weaken private equity do not feed the gorilla in the china shop. The growth of these private and semi-public systems are a cancer, a true pustule on the ass of healthcare, that is quickly absorbing all manner of physician practices. Last I checked, they now control about 40% of healthcare jobs and show no signs of slowing down. Trust me, they behave nothing like a non-profit charity, and are as tuned into profiteering as any private equity firm. They use every anti-trust trick in the book such as physician non-compete clauses, certificate of need requirements, eminent domain, etc. to undercut competition, drive down physician salaries, and grow. Their CEOs pull salaries that you would expect to see at a major bank.

My fear is that any federal regulations that weaken these private equity groups will further strengthen the grip of private non-profits. Take a look at what happened with Atrium Heath and USACS. Atrium has quickly grown from a regional heath system, Carolinas Heath, to a national super-system with hospitals across the Southeast and Midwest. While it touts itself as a non-profit, Atrium has notoriously sued patients and physicians, engaged in deceptive billing, and vigorously lobbied politicians at all levels. When Atrium replaced USACS last month, they didn’t replace them with a SDG - they are expanding their own hospital employee group. This is nothing more than effectively eliminating yet another employer in the region and stifling competition. As much as USACS sucks, losing yet another potential employer in the Charlotte region will eventually suck more. Why? Because Atrium will control a significant portion of the EM jobs not just in Charlotte, but as far away as Winston Salem, Greensboro, High Point, and beyond.

My concern with the methods used to bring about reform are far less pressing. I appreciate that the government is often the most expedient means to bring about needed change. However, the US health system, if nothing else, seems to be the poster child for unintended consequences when Uncle Sam get deeply involved.

Non-profit status for health systems is a scam.

The "profits" are never returned to the physicians and nurses who helped generate them.

Instead you have a middle management bloat of "physician leaders" who command clinical salaries to sit in meetings.

 

[Arcan57]

Both private equity and the current non-profit hospital "systems" run off the same B-school model of continuous unending growth being the main and only point of existing. The only difference is that non-profits get a head start due to lighter tax burden and private equity can still make money even as their over extended house of cards collapses. This growth over everything mindset is why we get so little value out of the money we put into healthcare. It doesn't get reinvested into quality care, it goes into buying up land, smaller hospitals, and big executives.

 

[WorkNoteEmergency]

I’m with you Shockindex and also smell the same bad funk as RustedFox. I’d be interested to know what percentage of ED visits is covered by that 25% PE backed CMG, I suspect it is much higher than 25% but the corporate profit taking model now covers a huge majority. Except for a brief unhappy stint with USACS, I spent my ED career hospital employed in a small “not for profit” system and watched the physician group morph from a small, competitively paid (and happy), clinically excellent 3 specialty group into a massive top heavy ****show. It all ended with the retirement of the CEO who founded the system and it has since been victimized by a string of administrators who are looking to make the jump to a bigger job and operate under the fear of being bought out and downsized. In the era of free money, the hospital bought up private practices like a hoarder making the rounds of yard sales and is now faced with debt service on this spending spree. You need a scorecard now to keep track of all the vice presidents and which ones work for the hospital and which ones work for the physicians group. The non profits take their dues from the for profits, they cut our pay to “fair market value” using the CMG dominated region 90 miles away as the market and now seem content despite all the open shifts as long as the code strokes get called for every dizzy little old lady and all the boxes are checked on the sepsis bundle order set.

 

[HemeOncHopeful19]

Non-profit status for health systems is a scam.

The "profits" are never returned to the physicians and nurses who helped generate them.

Instead you have a middle management bloat of "physician leaders" who command clinical salaries to sit in meetings.

Many of those middle management types are former nurses though.

I interviewed for a job the other day and more of my interview day (outside of the dinner) was spent with former nurses now in “chief of xyz operations” roles than actual physicians.

At this point the non-profit megasystems are basically impossible to beat. If you go to the Wikipedia page for any small to medium sized city in the United States 90% of the time the local hospital will be the #1 employer in the area (occasionally it will be #2 or #3). Good luck getting the representatives/senators from that area to start legislating against them.

 

[Birdstrike]

I submit that the private “nonprofit” healthcare system is a more immediate threat to your profession

I agree and I've said this on this for for more than a decade. Any time I've tried to explain to other physicians that "non-profit" hospital systems are as much "for profit" and as greedy as any other health system, they just argue with me, never gaining understanding. It's incredibly easy for them to take massive amounts of money, redirect and rename them with accounting such that profits are no longer "profits."

What was a "profit" is now available for CEO bonuses.

What was "profit" is now available for more administrators.

What was "profit" is now "reinvestment" for a new hospital, more administrators, more CEO/CFO salaries and more money to in whatever self-serving accounting bucket they want, to wash the stain of "profit" away.

For profit and non-profit are identical from the standpoint of directing money away from physicians, staff and patient care, without restraint.

If you don't believe me that no hospital in existence is truly not-for-profit, show me one that is "for-losses"?

You can't find one. They each want to make as much money as possible and will find every way possible to make sure as much money goes to administrators and anyone who isn't a part of the staff-patient relationship, as possible.

Non-profits are way worse than private equity for doctors. At least private equity will give you several multiples of your share value for your practice. And at least they won't lie to you and falsely claim they don't care about enriching themselves, which is exactly what the "non-profit" people will do.

 

[WhatJobDoIPick]

I agree and I've said this on this for for more than a decade. Any time I've tried to explain to other physicians that "non-profit" hospital systems are as much "for profit" and as greedy as any other health system, they just argue with me, never gaining understanding. It's incredibly easy for them to take massive amounts of money, redirect and rename them with accounting such that profits are no longer "profits."

What was a "profit" is now available for CEO bonuses.

What was "profit" is now available for more administrators.

What was "profit" is now "reinvestment" for a new hospital, more administrators, more CEO/CFO salaries and more money to in whatever self-serving accounting bucket they want, to wash the stain of "profit" away.

For profit and non-profit are identical from the standpoint of directing money away from physicians, staff and patient care, without restraint.

If you don't believe me that no hospital in existence is truly not-for-profit, show me one that is "for-losses"?

You can't find one. They each want to make as much money as possible and will find every way possible to make sure as much money goes to administrators and anyone who isn't a part of the staff-patient relationship, as possible.

Non-profits are way worse than private equity for doctors. At least private equity will give you several multiples of your share value for your practice. And at least they won't lie to you and falsely claim they don't care about enriching themselves, which is exactly what the "non-profit" people will do.

The worst is when the "non profit" hides behind a veil of "academics"

 

[Rekt]

Shock index. You’re just wrong unfortunately. In EM (aren’t you CCM?) PE is about 70% of EM jobs or more.

 

[ShockIndex]

Shock index. You’re just wrong unfortunately. In EM (aren’t you CCM?) PE is about 70% of EM jobs or more.

This is a good resource for the current EM employer landscape, Notice that private equity staffs 1319 of the 5705 (23.1%) EDs in the US. Heath systems staff 34% and non-equity backed partnerships about 40%. The rest are things like the VA.

State of the US Emergency Medicine Employer Market, Sept. 2023

Analysis based on Ivy Clinicians data.

emworkforce.substack.com

 

[always.chillin]

Last I heard, St John is a Teamhealth site with residents. Probably high volumes, high stress, mediocre pay. Probably high burnout. Probably frequent wellness meetings. Maybe it's time to just quit and do locums and actually enjoy life. So much local locums within an hour. 70k/month for 20 10-hour shifts at 1.5 pph. Sometimes it all feels like a dream until you see the checks.

 

[alpinism]

This is a good resource for the current EM employer landscape, Notice that private equity staffs 1319 of the 5705 (23.1%) EDs in the US. Heath systems staff 34% and non-equity backed partnerships about 40%. The rest are things like the VA.

State of the US Emergency Medicine Employer Market, Sept. 2023

Analysis based on Ivy Clinicians data.

emworkforce.substack.com

I'm not sure how accurate that dataset is since many of those groups listed as non PE owned are still PE backed like USACS and ECP for instance.

In that case its more like 33% for each of the 3 group types which seems to be more accurate in my opinion.

 

[BoardingDoc]

Last I heard, St John is a Teamhealth site with residents. Probably high volumes, high stress, mediocre pay. Probably high burnout. Probably frequent wellness meetings. Maybe it's time to just quit and do locums and actually enjoy life. So much local locums within an hour. 70k/month for 20 10-hour shifts at 1.5 pph. Sometimes it all feels like a dream until you see the checks.

You're seeing lots of locums @ $350/hr around you? That seems surprising, particularly at the 1.5 pph volume you posit.

 

[always.chillin]

You're seeing lots of locums @ $350/hr around you? That seems surprising, particularly at the 1.5 pph volume you posit.

Yeah, multiple sites. Can be higher or lower depending on which company you use. I've thought of quitting my full time job.

 

[RustedFox]

I worked last night at the main site.
That "hate for every patient" feeling is back.

I do a great job of faking it.
I work at the freestanding tonight.
Maybe it will be better.
Probably not.

I need a vacation.

 

[RustedFox]

I worked last night at the main site.
That "hate for every patient" feeling is back.

I do a great job of faking it.
I work at the freestanding tonight.
Maybe it will be better.
Probably not.

I need a vacation.

UPDATE:

EM is great when you don't see patients.

 

[CoolDoc1729]

UPDATE:

EM is great when you don't see patients.

We opened our FSED the same week covid reached our state …. Lots of shifts I saw 2-5 in 12 hours .. at first I just brought cme but then I started bringing crafts and stuff .. good gig! Now that place sees 60-80/d though so no more cricut at the desk

 

[Kryptocoin]

.......
At this point the non-profit megasystems are basically impossible to beat. If you go to the Wikipedia page for any small to medium sized city in the United States 90% of the time the local hospital will be the #1 employer in the area (occasionally it will be #2 or #3). Good luck getting the representatives/senators from that area to start legislating against them.

This is where the DOJ has to step in and breakup the monopoly. Google, Apple,....next stop mega health-systems? Unlike Mayo Clinic that does not accept Medicare, these hospitals are dependent on Medicare and so can be easily brought to heel.

 

[ShockIndex]

This is where the DOJ has to step in and breakup the monopoly. Google, Apple,....next stop mega health-systems? Unlike Mayo Clinic that does not accept Medicare, these hospitals are dependent on Medicare and so can be easily brought to heel.

Just a couple of clarifications. First, my understanding is that the Mayo Clinic does participate in traditional Medicare (aka Original Medicare, Medicare A and B, etc.).

Insurance frequently asked questions - Mayo Clinic

www.mayoclinic.org

Does Mayo Clinic take Medicare? » Mayo Clinic Connect

For those of us who live in the U.S., this is a complicated issue. Whether or not Mayo Clinic takes Medicare comes up frequently. The[…]

connect.mayoclinic.org

On the other hand, many of the Medicare Advantage plans are no longer covered on some or all of the Mayo campuses. However, this is far cry from the claim that Mayo “doesn’t accept Medicare,” and to the best of my knowledge, Mayo is still beholden to all of the requirements and reporting of Medicare participation.

I mention this because this thread seems to have a bunch of errors, oversimplifications, and outright misstatements floating around in it. A big oversimplification and misstatement is the notion that these large, private/public non-profits can be easily brought to heel by the DOJ. The DOJ’s Anti-Trust Division follows specific guidelines and policies that are shaped by federal law. Large healthcare systems employ armies of lawyers, some with prior experience working for DOJ and DOC, whose job it is to help the system grow within federal law. I’ll refer back to the example of Atrium Health as the behemoth in the China shop that has massively expanded across the country despite swatting away various anti-trust claims from the DOJ, NC government, and media. Ironically, Atrium likes to fall back on its founding charter as a quasi-government entity (ie Mecklenburg Hospital Authority) when skirting anti-trust accusations. Regardless, look at how fluidly Atrium absorbed Wake Forest Baptist Health system to control 1/3 the healthcare delivery in NC (a benchmark for state and federal anti-trust scrutiny), and then pivoted to form a “strategic partnership” with Aurora/Advocate Health in the mid-West…that is conveniently headquartered in Charlotte…with Atrium’s CEO at the helm.

Bottom line, the DOJ has not saved physicians from themselves in the past, and is not going to save us tomorrow. Such thinking is as much false hope as it is an abdication in our own actions that brought us here. Part of this is a problem of our own making because we have surrendered our autonomy out of financial and personal expediency. Getting that back is going to take a pound of flesh from our collective hides. My hat is off to the doctors who are paying that debt, sometimes by leaving medicine all together, and told the mega systems to f-off in the process.

 

[EctopicFetus]

Simply click on the video link in the original post and fast forward to the 5:30 mark. There is no need for you to be sniffing anything.

They don’t count usacs which is PE and the 2nd largest employer. Excluding VA/IHS real numbers are 40-45% employed, 40-45% PE and 10-15% sdgs which would include Vituity. Very regional including some major cities with no sdgs.

This is all pre APP.

 

[EctopicFetus]

One other very important thing which seems to get conflated is an ED is not just an ED. Some ED that sees 5000 patients a year that might be hospital employed is not the same as a UA site seeing 80,000 but if we do it just by the count of number of hospitals it works itself out. I would venture to guess with some data I’ve seen previously, that if you do it by volume of patients excuse, much heavier to the private equity backed and non-employed spots.

 

[MechEDoc]

Yeah, multiple sites. Can be higher or lower depending on which company you use. I've thought of quitting my full time job.

Where are you seeing $350/hr?

 

[cyanide12345678]

Yeah, multiple sites. Can be higher or lower depending on which company you use. I've thought of quitting my full time job.

Yeah I’m starting to see 300-350/hr too.

Though it’s sometimes even better to call directly and set up a prn agreement yourself.

I had a locums company contact me regarding what sounded like the kind of rural gigs i like - 8000 annual volume. I asked for $300/hr plus travel and malpractice for 3 shifts per month. They got back to me saying that was too high for 3 shifts and weren’t even going to present me to the company.

I called the company directly and they were so excited to sign me up prn for the same hourly rate.

Now i just gotta decrease my w2 shifts lol. I’ve never seen anything close to 300/hr for that volume.