This why physicians are burning out...

[drusso]

http://www.kevinmd.com/blog/2015/03/this-is-why-physicians-burning-out.html

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[willabeast]

Docs losing control bit by bit is a bummer. but...i would be retiring anyway in 5 months, having started medical school in 1975 i feel like i am ready to see what else the world has to offer. i was OK with a lot of admin decisions, and some of them turned out to be smart ones, and the $$ is good, but it is so irritating to have someone tell me i need to be in my clinic seeing patients 15 minutes after finishing my last case at the hospital. would i retire because i was irritated? i doubt it. i am retiring because i have a huge bucket list, and need the time and health to finish it. and so will the rest of the boomers if they are honest with themselves.

“The mass of men lead lives of quiet desperation. What is called resignation is confirmed desperation. From the desperate city you go into the desperate country, and have to console yourself with the bravery of minks and muskrats. A stereotyped but unconscious despair is concealed even under what are called the games and amusements of mankind. There is no play in them, for this comes after work. But it is a characteristic of wisdom not to do desperate things.” HDT

 

[drusso]

MD/DO's *LET* the loss of control happen. And, if they wanted to, they could make it stop.

 

[NJPAIN]

MD/DO's *LET* the loss of control happen. And, if they wanted to, they could make it stop.

I agree 100%. Instead of sticking together and presenting a united front we cut each other's throats for an extra nickle. This happened first in hospital based specialties like anesthesiology where we accepted peanuts for our work just to beat our fellow physicians out of contracts. Other professionals would not have let this happen.

 

[Papa Lou]

You guys have to stop the bs. Always saying doctors are at each other's throats. Complete bs. It's competition in business and it happens in every industry. It's economics and probably unavoidable in most circumstances. All the negativity saying doctors cut each other's throats is what's wrong. We don't run a monopoly and there is no conspiracy against the community and that's why there's competition amongst people in our business and that's it. If you want to treat it like its "not a business" I'm sure the hospital CEOs can give you a hand with that.

 

[lonelobo]

You guys have to stop the bs. Always saying doctors are at each other's throats. Complete bs. It's competition in business and it happens in every industry. It's economics and probably unavoidable in most circumstances. All the negativity saying doctors cut each other's throats is what's wrong. We don't run a monopoly and there is no conspiracy against the community and that's why there's competition amongst people in our business and that's it. If you want to treat it like its "not a business" I'm sure the hospital CEOs can give you a hand with that.

Competition is good
Doctors screwing other Docs is not good( Docs who hire new associates promising Partnership, then letting go)
Docs hiring J1 Visas working them like residents for 3 years then repeat.
Not sure how long you have been in practice Papa, but I have seen how doctors screw one another for their own benefit and have even experienced it myself.
Getting Docs to agree is like herding cats

 

[Papa Lou]

Competition is good
Doctors screwing other Docs is not good( Docs who hire new associates promising Partnership, then letting go)
Docs hiring J1 Visas working them like residents for 3 years then repeat.
Not sure how long you have been in practice Papa, but I have seen how doctors screw one another for their own benefit and have even experienced it myself.
Getting Docs to agree is like herding cats

Ok and how are other businesses any different? It's the same in every business esp where the profit margin is high. Business is profit driven and emotionless. We should all aspire to a higher moral ground in business but you could argue in its purest sense good business is sociopathic.

I'm not making excuses btw. I abhor all people who manipulate and use others solely for their own good. But I understand where they're coming from. Still we should torch them.

And yes I've been run through enough times too

 

[willabeast]

I hope we shall crush in its birth the aristocracy of our monied corporations which dare already to challenge our government to a trial by strength, and bid defiance to the laws of our country.
Thomas Jefferson

 

[SSdoc33]

Ok and how are other businesses any different? It's the same in every business esp where the profit margin is high. Business is profit driven and emotionless. We should all aspire to a higher moral ground in business but you could argue in its purest sense good business is sociopathic.

I'm not making excuses btw. I abhor all people who manipulate and use others solely for their own good. But I understand where they're coming from. Still we should torch them.

And yes I've been run through enough times too

there is a clear conflict of interest between doing your job as a doc and making a lot of money as a doc here in america. sure, there is a middle ground, but to put your head in the sand and not acknowledge the problem is pure ingnorance.

we are not selling widgets here.

 

[Papa Lou]

You've made no point that I can see there. Everyone sees the conflict of interest. Yet nobody here would agree to let the businessmen take the stress off our shoulders so we can stick purely to practicing medicine.

And if you have a business, and you take pride in the services you offer, it's still a moral dilemma, even if you're selling widgets. I would think conflicts of interest and bias are inherent interests of any business. Healthcare is held to a higher moral standard. But if you want to continue down that road then everyone should be less upset about corporations taking over "our business."

In any case, I was talking about doctors screwing other doctors and you seem to be talking about doctors and their patients.

 

[drusso]

there is a clear conflict of interest between doing your job as a doc and making a lot of money as a doc here in america. sure, there is a middle ground, but to put your head in the sand and not acknowledge the problem is pure ingnorance.

we are not selling widgets here.

These days, It's **NOT** a conflict of interest to make money taking care of patients...so as long as only large hospitals, academic centers, government supported ACO's, and employed MD's do it. Then it's called a "confluence" of interest...But, when private practitioners do the same, for some reason the relationships are framed in a "conflictual" way...

http://jama.jamanetwork.com/article.aspx?articleid=2444293

Confluence, Not Conflict of Interest Name Change Necessary
Anne R. Cappola, MD, ScM1,2; Garret A. FitzGerald, MD, FRS1
[+] Author Affiliations
JAMA. 2015;314(17):1791-1792. doi:10.1001/jama.2015.12020.
Text Size: A A A

This Viewpoint discusses themes that emerged at the recent Institute for Translational Medicine and Therapeutics international meeting on conflict of interest.

The primary interest of the biomedical scientific endeavor is to benefit patients and society. Frequently, this primary interest coincides with secondary interests, most commonly financial in nature, at the interface of the investigator’s relationship with a private sponsor, typically a drug or device company or, increasingly, venture capital firms. Academia and the public have become sensitive to how such a secondary interest might be unduly influential, biasing the interpretation of results, exposing patients to harm, and damaging the reputation of an institution and investigator. This concern has prompted efforts to minimize or “manage” such “conflicts of interest” resulting in a plethora of policies at both the local and national level. Although these policies are often developed in reaction to a limited number of investigators, once introduced, they apply to all. Given the broad array of stakeholders, the diversity of approaches, and the concern that such policies might restrain innovation and delay translation of basic discoveries to clinical benefit, the Institute for Translational Medicine and Therapeutics at the University of Pennsylvania recently convened an international meeting on conflict of interest.1 Several themes emerged.

 

[SSdoc33]

These days, It's **NOT** a conflict of interest to make money taking care of patients...so as long as only large hospitals, academic centers, government supported ACO's, and employed MD's do it. Then it's called a "confluence" of interest...But, when private practitioners do the same, for some reason the relationships are framed in a "conflictual" way...

http://jama.jamanetwork.com/article.aspx?articleid=2444293

Confluence, Not Conflict of Interest Name Change Necessary
Anne R. Cappola, MD, ScM1,2; Garret A. FitzGerald, MD, FRS1
[+] Author Affiliations
JAMA. 2015;314(17):1791-1792. doi:10.1001/jama.2015.12020.
Text Size: A A A

This Viewpoint discusses themes that emerged at the recent Institute for Translational Medicine and Therapeutics international meeting on conflict of interest.

The primary interest of the biomedical scientific endeavor is to benefit patients and society. Frequently, this primary interest coincides with secondary interests, most commonly financial in nature, at the interface of the investigator’s relationship with a private sponsor, typically a drug or device company or, increasingly, venture capital firms. Academia and the public have become sensitive to how such a secondary interest might be unduly influential, biasing the interpretation of results, exposing patients to harm, and damaging the reputation of an institution and investigator. This concern has prompted efforts to minimize or “manage” such “conflicts of interest” resulting in a plethora of policies at both the local and national level. Although these policies are often developed in reaction to a limited number of investigators, once introduced, they apply to all. Given the broad array of stakeholders, the diversity of approaches, and the concern that such policies might restrain innovation and delay translation of basic discoveries to clinical benefit, the Institute for Translational Medicine and Therapeutics at the University of Pennsylvania recently convened an international meeting on conflict of interest.1 Several themes emerged.

it is completely unfair that hospital administrators somehow get shielded from scrutiny when it comes to making money at the expense of patients. no doubt.

 

[SSdoc33]

You've made no point that I can see there. Everyone sees the conflict of interest. Yet nobody here would agree to let the businessmen take the stress off our shoulders so we can stick purely to practicing medicine.

And if you have a business, and you take pride in the services you offer, it's still a moral dilemma, even if you're selling widgets. I would think conflicts of interest and bias are inherent interests of any business. Healthcare is held to a higher moral standard. But if you want to continue down that road then everyone should be less upset about corporations taking over "our business."

In any case, I was talking about doctors screwing other doctors and you seem to be talking about doctors and their patients.

your point is well taken. but you have to acknowledge the difference is selling a computer and selling a service/procedure which can actually harm someone. once can always make the argument that to make a lot of money, you have to screw over somebody (the poor, the gullible, your slave labor, etc). but when you offer a FMS patient an ESI, MBB, RF, and SIJ injections, it is great for your bank account, but bad for their back. thats not the same as spending 50 bucks on a pair of pants.

 

[NJPAIN]

From my point of view; as someone in practice (academic then private) for 23 years, the problem is devaluating my knowledge, my expertise, my years of training, my caring, etc. I am being told that if I want to make a decent living in this “business” I need to produce numbers and not results. I need to see 50 patients a days, do 30 procedures a week. The only way I can see 50 patients a day is by seriously limiting how long I listen to a patient’s problem and how thoroughly I examine, document and formulate a treatment plan. I can also improve my productivity by hiring people junior to me, working them like dogs and paying them like monkeys – in a way that I would not want to be treated myself. That’s fine if you are making pants. Who cares if the pocket is accidently sewed shut? Doesn’t work well when dealing with someone’s health. You get sued for a screw up. No one sues Wrangler for crappy jeans. Same thing applies to procedures. If I have to do 30 a week to get by there will be a strong incentive for me to do them when they are not needed. Then when I have a complication someone will be all over me claiming that the complication was unacceptable because the procedure was unnecessary. QUALITY healthcare by QUALIFIED and CARING providers cannot come cheap. You get what you pay for. You pay peanuts and you get monkeys. There are more monkeys in healthcare than I have ever seen in my lifetime.

 

[lobelsteve]

Fast, good, or cheap. Pick any two. But all 3 are not possible.

 

[nvrsumr]

Fast, good, or cheap. Pick any two. But all 3 are not possible.

I know you have an office based procedure suite. Compared to asc/hospital you can have all 3

 

[Disciple]

Politically, I don't think there's much we can do at this point about reimbursement rates.

Our specialty societies should be focusing on giving input towards defining specialty specific "quality measures", while we still have the chance to do so.

If we're successful, we can lower our stress about high volume/substandard care, and spend our free time on focusing on other endeavors.

 

[NJPAIN]

In other words - just turn the wrench on the assembly line and don't expect fulfillment at work. Would not be that tough to swallow if I anticipated making a boat load of money and being protected from the liability of substandard care. I don't expect either.

 

[Stim4me]

lots of complaining above... so what's the most meaningful fix? single payer system, capitalistic health care reform, malpractice reform? I don't recall my predecessors complaining about health care as much as we do. Personally, I ultimately think the over reach of governmental programs is the issues.

 

[Disciple]

In other words - just turn the wrench on the assembly line and don't expect fulfillment at work. Would not be that tough to swallow if I anticipated making a boat load of money and being protected from the liability of substandard care. I don't expect either.

What I'm saying is that we've already lost when it comes to increasing reimbursement, per service.

How many times have you heard from CMS, regarding moving away from fee for service? They've already set a timeline for transition.

The best we can do is assert our opinion as to what constitutes "quality" in our specialty, and hope that somebody listens. Even better if we have data to back it up.

At first it was about cutting costs upfront, decreasing reimbursements, etc. Now, they (the government/payors) want better value for their dollar as well.

Why? Because the masses need to feel like they've been given something of value, have improved access, etc.

In the private sector, the closed health systems want to keep costs down, but also need to provide service, good enough to keep patients from signing up with the rival system one suburb over.

 

[hyperalgesia]

lots of complaining above... so what's the most meaningful fix? single payer system, capitalistic health care reform, malpractice reform? I don't recall my predecessors complaining about health care as much as we do. Personally, I ultimately think the over reach of governmental programs is the issues.

My solution would be to out-liberal the liberals and have a VA-type model for everyone at a very basic level. That is, federally employed docs in federally owned clinics and hospitals. I would expect extended wait periods and highly regulated care. The benefit would be the emancipation of true free market healthcare. Seniors could get old-school insurance plans that would pay for their healthcare in a true private marketplace. IMO Medicare has had a pernicious effect on our healthcare and our economy.

 

[Stim4me]

My solution would be to out-liberal the liberals and have a VA-type model for everyone at a very basic level. That is, federally employed docs in federally owned clinics and hospitals. I would expect extended wait periods and highly regulated care. The benefit would be the emancipation of true free market healthcare. Seniors could get old-school insurance plans that would pay for their healthcare in a true private marketplace. IMO Medicare has had a pernicious effect on our healthcare and our economy.

You just described the current parallel system in Europe... I agree, let hillary win and go to a single payer system. I'll take the cream of the crop insurances and retire early...

 

[hyperalgesia]

You just described the current parallel system in Europe... I agree, let hillary win and go to a single payer system. I'll take the cream of the crop insurances and retire early...

I really don't support "single payer", which to me means expanding Medicare and continuing to throw OPM at capitalism and hoping to get the same efficiency as you would with free market capitalism. Single payer to me will eventually lead to all docs becoming meaningful use drones and getting peanuts, while watching bureaucrats run wild in a monopoly/crony capitalist system. In other words, Hillary's America. I think that if you want socialized healthcare, which seems to be what most people want, you have to contain it and you should take care not to disrupt the free market (much less try to put a saddle on it).

We are all basically federal employees now, dancing to the tune of Medicare, and this is gonna get way worse and I think all Americans will suffer immensely. Having a completely encapsulated and limited system, with all services provided within a strict budget, all employed and completely managed by the federal govt, would remove the definition of CE (covered entity), HITECH, HIPAA, PQRS, MU, MIPS, and the rest of the foul odor from our profession.

I've given up on the idea of removing the Fed from healthcare. Now I just want to quarantine it.