Advice from an attending radiologist

[vm26]

What do you guys think about residencies in terms of preparing people. I've read stories where people say the higher ranked academic programs actually prepare you worse for real world radiology

Hard to say as "real world radiology" (and healthcare) are changing. Right now with fee-for-service, reading high-volume is the name of the game and therefore one could argue that less-competitive efficient private-practice type community programs would be ideal. By the time you are practicing however things may be very different.

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[PL198]

When would a time been where the academic programs would have been better? I envision PP radiology as essentially always being relatively quick compared to some prestigious big name residency where they'd have you sit there for forever pouring over the details of an image to the nth degree. I'm not sure of a model where the academic way would better prepare you, unless there was some sort of ultra high scrutiny, high stakes practice w/ low volume.

 

[shark2000]

Some people can not be fast, no matter which program they do their residency at as we talked about it.

For a person who can be fast and IS WILLING to be fast, improving speed is not difficult. You will become faster as you go through the first 6 months to one year of your private practice. So even if you were trained at a big academic program where you spent half an hour on each CXR, if you are WILLING to improve yourself, you can become fast in 6 months.

However, the comprehensive training, subspecialty teaching and complexity of cases that you see in big referral centers, are things that can not be easily achieved once you are out of training. You can not easily learn it in the first 6 months of your private practice. Some people may argue that you don't see such complex cases in private practice and they are wrong. You see them but with much less frequency and you don't get to follow them because they are referred once they are diagnosed. In fact, a lot of sub-specialist clinicians are really dependent on radiology in community for complex cases because they don't deal with uncommon entities day in and day out, unlike sub-specialist clinicians in the academic centers.

Choosing a private-practice community program over a big academic center because it makes you a faster radiologist isn't a right thing to do. Once you finish training, you can pick up the speed in a few months, can easily get rid of the minutia that are emphasized in academics and yet enjoy the comprehensive training that you had during residency and can be the "guy-to-go" for tough and complex cases.

Nevertheless, many radiology programs give you very good to excellent training. Though I personally believe you have more educational opportunities at a big academic center, I have seen some excellent radiologist who did their training in low tier radiology programs. Most of it depends on how much time and energy you put into it. Learning is an ongoing process and because you had better USMLE scores 15 years ago (and went to a big program ), does not make you a better radiologist now 10-12 years into practice.

If you are a type-A OCD radiologist, you can not become fast no matter where you do your training. Even if you try hard and become fast for a few months of call during residency, sooner or later your OCD personality will overcome and you will go back to your "natural you" which makes you look at the liver for 12 times to make sure that you don't miss a 2 mm hypo-density and you talk about it for 2 sentences.

Also if you are not willing to be fast because you are lazy, it doesn't matter where you did your training. You will resign from your pp job or you will stay in the same job, but become a constant-complainer esp on auntminnie about the horrible world of private practice.

This field was a good fit for lazy personalities in 80s and 90s and somehow early 2000s. The pace was slow and the hours were short. Unfortunately, this "stigma" has stayed with radiology. Right now, esp private practice radiology is the exact opposite. The pace of work is faster than most other fields and the hours are long. It is not like sitting in a quiet room and drinking coffer and looking at some images. It is cranking through thousands of images constantly nonstop for 10-12 hours a day. Need a lot of attention and mental work.

If you are lazy or you don't want to work hard, don't choose this field. If you don't want to work nights, evenings or weekends don't choose this field. It used to be different. But these days, the options are limited. You don't choose your job, the job will choose you. "This is what we have for you. 60+ hours per week with Q3 weekends. Don't want it, we give it to the next person". Finding an academic job or a VA job is very hard. Don't look at your radiology rotation at your medical school and think you will sit in the attending chair in 10 years. No, you will be someone in community who work hard. You will make good money, but there will not be a way to work less and make less. It will be either hard work and good money or no work and no money. Nothing in between. It is not like PCPs who can work 2 or 6 days a week. It is more like surgery that you have to work Full+ time or no work.

This is not a life-style field. period.

 

[bcovert]

I have been in practice since 2003 and find this to be accurate information. Head CT now pays 40 dollars medicare and MR brain without pays 75. Ultrasound abdomen complete pays 40. Plain films pay 7-11 dollars per case. Overhead is getting higher as it is with all specialties. 10% billing costs, 5-10k year CME/licensure expense, 25k malpractice expense.

I am working 9 hour shifts and q3 weekends doing 12 hour shifts with 8 weeks vacation. It is too much work. Most rads are burning the candle at both ends. No one can read much more than 100 cases per day mixed modality and not burn out.

I am monitoring the primary care jobs and seeing 200k+ jobs with no weekends and vacation time on top. Per hour that is a better deal than I am getting.

 

[IJL]

What exactly do you mean by "q3 weekends"

 

[PL198]

I have been in practice since 2003 and find this to be accurate information. Head CT now pays 40 dollars medicare and MR brain without pays 75. Ultrasound abdomen complete pays 40. Plain films pay 7-11 dollars per case. Overhead is getting higher as it is with all specialties. 10% billing costs, 5-10k year CME/licensure expense, 25k malpractice expense.

I am working 9 hour shifts and q3 weekends doing 12 hour shifts with 8 weeks vacation. It is too much work. Most rads are burning the candle at both ends. No one can read much more than 100 cases per day mixed modality and not burn out.

I am monitoring the primary care jobs and seeing 200k+ jobs with no weekends and vacation time on top. Per hour that is a better deal than I am getting.

not when that PCP doesn't have a job in 10 years because they're all midlevels

 

[vm26]

What exactly do you mean by "q3 weekends"

working every third weekend which btw is pretty rough particularly if the shifts are 12 hrs

 

[meister]

What a joke, $7 to take on unlimited liability. Our system is ******.

 

[bcovert]

not when that PCP doesn't have a job in 10 years because they're all midlevels

I agree. Mid levels will have a negative impact on primary care as they work for 60-100k. This will keep primary care salaries low. With lower incomes Mid levels also spend more time with patients which will give the midlevels an advantage. Medical knowledge and medical outcomes are not something the government or patients can judge.

Half of the studies I read are ordered by midlevels. Hospitals love midlevels. I expect midlevels to compete in ER and Hospitalist markets too.

 

[PL198]

I agree. Mid levels will have a negative impact on primary care as they work for 60-100k. This will keep primary care salaries low. With lower incomes Mid levels also spend more time with patients which will give the midlevels an advantage. Medical knowledge and medical outcomes are not something the government or patients can judge.

Half of the studies I read are ordered by midlevels. Hospitals love midlevels. I expect midlevels to compete in ER and Hospitalist markets too.

Any estimates on 5 years ago what percentage of your studies were from midlevels? Just curious

 

[shark2000]

Midlevels are exponentially increasing in number. Their obtain more and more responsibility over time. It takes only 4 years to train a midlevel in contrast to an MD which almost takes 3 times.
Also when it comes to obtaining more responsibility they have multiple winning cards. They don't have a lot to lose. They are supported by many physicians that see them as a temporary productivity boost. We as physicians are generally not smart enough and are so egocentric that we don't see the long term consequences of events. Most important thing is the great support that midlevels have from the insurance companies and the hospitals since they save lots of money.

I get lots of studies from midlevels probably something about 40% of all my referrals and their share is increasing rapidly. They have lower threshold to order lab tests and imaging studies. However still the cost of midlevel visit+imaging study seems to be less that PCP+specialist visit+less number of imaging studies and this is only correct if the specialist is not aggressive to do more procedures or does not own his own MRI scanner.

 

[RadsonRads]

Midlevels are exponentially increasing in number. Their obtain more and more responsibility over time. It takes only 4 years to train a midlevel in contrast to an MD which almost takes 3 times.
Also when it comes to obtaining more responsibility they have multiple winning cards. They don't have a lot to lose. They are supported by many physicians that see them as a temporary productivity boost. We as physicians are generally not smart enough and are so egocentric that we don't see the long term consequences of events. Most important thing is the great support that midlevels have from the insurance companies and the hospitals since they save lots of money.

I get lots of studies from midlevels probably something about 40% of all my referrals and their share is increasing rapidly. They have lower threshold to order lab tests and imaging studies. However still the cost of midlevel visit+imaging study seems to be less that PCP+specialist visit+less number of imaging studies and this is only correct if the specialist is not aggressive to do more procedures or does not own his own MRI scanner.

Out of curiosity, would you say that the lower cost to hire midlevels is negated by the amount of unneeded imaging/labs that they order on a daily basis? I've never actually thought of this until now...

 

[Gadofosveset]

Out of curiosity, would you say that the lower cost to hire midlevels is negated by the amount of unneeded imaging/labs that they order on a daily basis? I've never actually thought of this until now...

They'll just end up hiring more midlevels and then reimbursements will be cut for the increased number of studies they order.

 

[IJL]

There is a zero percent chance that I'll be working q3 weekends. Whatever it takes.

 

[shark2000]

Out of curiosity, would you say that the lower cost to hire midlevels is negated by the amount of unneeded imaging/labs that they order on a daily basis? I've never actually thought of this until now...

Still not. Midlevel visit + more imaging is still less expensive that PCP+Specialist+ imaging study+ possible procedures.

There are lots of confounding factors. For example, some specialists own their own MRI scanner and in fact order more studies than midlevels (was studies in the past and published). Some specialists have very low threshold for doing procedures (for example spine surgery, gallbladder surgery, hysterectomy, stent placement,... ).

 

[bcovert]

There is a zero percent chance that I'll be working q3 weekends. Whatever it takes.

Never say never. You would not want to know how low you would go if the vicissitudes of life called for it.

Desperate times call for desperate measure...... a platitude but true.

What is the next best alternative for a radiologist? Unskilled labor? Walmart greeter? Even elementary school teachers need to be certified. You need to be board certified to do primary care.

Extreme specialization has its risks.

 

[IJL]

Never say never. You would not want to know how low you would go if the vicissitudes of life called for it.

Desperate times call for desperate measure...... a platitude but true.

What is the next best alternative for a radiologist? Unskilled labor? Walmart greeter? Even elementary school teachers need to be certified. You need to be board certified to do primary care.

Extreme specialization has its risks.

PP radiologists that I have spoken to around my region usually work 5-10 weekends a year. I haven't heard of q3 anywhere - not doubting that it exists though.

 

[bcovert]

PP radiologists that I have spoken to around my region usually work 5-10 weekends a year. I haven't heard of q3 anywhere - not doubting that it exists though.

Can't speak for all groups but q3 weekends exists in my current job in a major Florida city as well as my prior job in a Texas major city. It used to be one in 5 or 6 before the bottom dropped out in radiology.

 

[PL198]

it's going to be cyclical. just in a downturn right now

 

[meister]

There are q3 weekend starting job offers around here.

 

[Etorphine]

this thread saved me from making a major life mistake

 

[shark2000]

PP radiologists that I have spoken to around my region usually work 5-10 weekends a year. I haven't heard of q3 anywhere - not doubting that it exists though.

It is very variable but not uncommon to work Q 3 weekends. If you are a junior in the group, you will cover more weekends than the average people in the group. So if the norm in your region is 5-10 weekends, most likely the new people work more than that which is Q3 to Q4 weekends.
The same for night coverage. More and more groups are taking back their nights. So be ready to work nights and evening.

I am pretty sure that there are many groups out there that have their own night person. Also there are many groups out there that have less than Q4 weekends. There are many groups that have ... weeks of vacation, .... But may not be in the location that you want or in the subspecialty that you like. So especially if you look into desirable locations, you have to be flexible.

 

[vm26]

this thread saved me from making a major life mistake

haha...unfort no one has a crystal ball, as a med student it is hard to predict what your chosen field will look like 4-7 years down the road

 

[PL198]

I still feel like large amounts of these gripes are coming from people in hotspot locations. I don't give a crap about working in NYC or LA or any other major metro area. I'm curious if there are any PP guys in BFE or relatively (lets say an hour+ from major metro) and what their hours are like.

 

[vm26]

I still feel like large amounts of these gripes are coming from people in hotspot locations. I don't give a crap about working in NYC or LA or any other major metro area. I'm curious if there are any PP guys in BFE or relatively (lets say an hour+ from major metro) and what their hours are like.

Worked about 3 hrs from major city/international airport and had to do q3wkends (12 hr shifts) which was very rough. Typical workday was 8am-7pm-ish with lunch at work station, good times indeed bc I have a passion for the work!

 

[colbgw02]

.

 

[Zweihander]

We just had someone leave my PP most likely because it was "too busy." In reality I don't consider it any busier than most PP. ~60-80 x rays, 20 US, 20 mammos on one day, 10-15 MRI, 8-12 CTs the other day (i.e. person reading CT/MRI is only responsible for reading CT/MRI, while person B reading the other stuff is only responsible for xr, us, mammos. I think this person had unrealistic expectations of PP and would have been better suited for VA job or a different field.

Holy crap I would love my life if my workload was like this!

 

[shark2000]

haha...unfort no one has a crystal ball, as a med student it is hard to predict what your chosen field will look like 4-7 years down the road

Totally agree. You never know.

My girlfriend is a cardiologist. I was talking with some of her friends recently. One of them mentioned that when he was an internal medicine resident 10 years ago, everybody used to say that GI is a dead end field and cards will be in high demand. The exact opposite happened.

A colleague of mine switched from general surgery to radiology in late 70s. Everybody told him that he was making the biggest mistake of his life. "Radiology will be a dead field in a few years". That is what he heard multiple times. He entered radiology, he enjoyed the best years of radiology. He had a relatively good life style and now his savings and retirement package is better than most surgeons out there (if money is important to you).

If someone claims that they can predict even 10 years from now, they are wrong at best.

 

[Baller MD]

I have been in practice since 2003 and find this to be accurate information. Head CT now pays 40 dollars medicare and MR brain without pays 75. Ultrasound abdomen complete pays 40. Plain films pay 7-11 dollars per case. Overhead is getting higher as it is with all specialties. 10% billing costs, 5-10k year CME/licensure expense, 25k malpractice expense.

I am working 9 hour shifts and q3 weekends doing 12 hour shifts with 8 weeks vacation. It is too much work. Most rads are burning the candle at both ends. No one can read much more than 100 cases per day mixed modality and not burn out.

I am monitoring the primary care jobs and seeing 200k+ jobs with no weekends and vacation time on top. Per hour that is a better deal than I am getting.

Wow.

 

[PL198]

Totally agree. You never know.

My girlfriend is a cardiologist. I was talking with some of her friends recently. One of them mentioned that when he was an internal medicine resident 10 years ago, everybody used to say that GI is a dead end field and cards will be in high demand. The exact opposite happened.

A colleague of mine switched from general surgery to radiology in late 70s. Everybody told him that he was making the biggest mistake of his life. "Radiology will be a dead field in a few years". That is what he heard multiple times. He entered radiology, he enjoyed the best years of radiology. He had a relatively good life style and now his savings and retirement package is better than most surgeons out there (if money is important to you).

If someone claims that they can predict even 10 years from now, they are wrong at best.

that's why I'm doubling down on rads now. it's like buying low. I think opposing the group think is one of the best plays someone can make.

 

[bcovert]

The big thing now is reimbursing rads less than medicare for wRVU. For the neophytes out there the Medicare RVU is broken up into work, practice expense, and malpractice expense. Hand x-ray pays .15 wRVU. At 29 dollars per wRVU which is more than many telerad groups pay that's a whopping 4 dollars and 45 cents. LOL

Head CT without wRVU 1.1*29=31.9 dollars.

Guess the government has removed me from my hallowed position among the one percenters!

 

[Etorphine]

Totally agree. You never know.

My girlfriend is a cardiologist. I was talking with some of her friends recently. One of them mentioned that when he was an internal medicine resident 10 years ago, everybody used to say that GI is a dead end field and cards will be in high demand. The exact opposite happened.

A colleague of mine switched from general surgery to radiology in late 70s. Everybody told him that he was making the biggest mistake of his life. "Radiology will be a dead field in a few years". That is what he heard multiple times. He entered radiology, he enjoyed the best years of radiology. He had a relatively good life style and now his savings and retirement package is better than most surgeons out there (if money is important to you).

If someone claims that they can predict even 10 years from now, they are wrong at best.

You have more experience with the topic than I, but I sense there are large market forces in place now that take a uniquely long time to change. IE # of slots (which have effects 6-7 yrs down the road), current workforce saturation, overall downward trend in reimbursement and virtually no incentive to increase in the future even being discussed, high liability rate, night shift expectations, could go on. I just don't see many of these problems changing for a while, if ever. IE like trying to steer an aircraft carrier. Banking on it getting better with no concrete plan in place - and immediate momentum in the opposite direction - seems risky. I like the idea of being a visual diagnostician all day, but at a certain point it doesn't seem worth it.

 

[PL198]

the only thing that honestly concerns me about rads is the fellowship loophole. I still don't understand how it hasn't been fixed.

 

[shark2000]

The big thing now is reimbursing rads less than medicare for wRVU. For the neophytes out there the Medicare RVU is broken up into work, practice expense, and malpractice expense. Hand x-ray pays .15 wRVU. At 29 dollars per wRVU which is more than many telerad groups pay that's a whopping 4 dollars and 45 cents. LOL

Head CT without wRVU 1.1*29=31.9 dollars.

Guess the government has removed me from my hallowed position among the one percenters!

But it is the same for all medicine. You have two options: Work for yourself or work for somebody else. Why do you think many physician private practices are taken over by hospitals? Why do you think internists prefer to work as a hospitalist than opening their own office? I hear some scary stories around me like a practice with 60 years of history has been sold to the hospital, . ..

We as physicians are terrible when it comes to business. In summary, in the last 40 yeas our reimbursement per unit of work has gone down constantly (office visit, surgery, image interpretation, ....). The expenses has gone up (inflation, EMR versus paper chart for example, ... ). We have tried to fill the gap by working more and more. But we have reached a breaking point. Now most practices can not pay for their expenses and are doomed to be sold to the hospital. Simple math.

Hospital employment may seem fine at first. Right now you may see some perks and bonuses because the hospital system wants to win the competition against the private practices and attract good physicians. 10 years down the road when the last private practices vanish from the market, the only available jobs will be mega-hospital systems. Then they will be able to dictate whatever they want. Good times!!!

If you are a premed student go to another field. Medicine is over-rated.

 

[shark2000]

the only thing that honestly concerns me about rads is the fellowship loophole. I still don't understand how it hasn't been fixed.

Last year only 7 people got board certified in this way. The year before it was about 40-50. Though I think it should be terminated and the number of residency spots should be decreased, its effect is not significant.

 

[shark2000]

You have more experience with the topic than I, but I sense there are large market forces in place now that take a uniquely long time to change. IE # of slots (which have effects 6-7 yrs down the road), current workforce saturation, overall downward trend in reimbursement and virtually no incentive to increase in the future even being discussed, high liability rate, night shift expectations, could go on. I just don't see many of these problems changing for a while, if ever. IE like trying to steer an aircraft carrier. Banking on it getting better with no concrete plan in place - and immediate momentum in the opposite direction - seems risky. I like the idea of being a visual diagnostician all day, but at a certain point it doesn't seem worth it.

We are doing well if you look into it from business standpoint. I can argue no other fields could really survive all these cuts. Still our salaries are more than most physicians.

Reimbursement cut happens to all fields, but it happened more to radiology in the last 6-7 years. I think though it will also happen in the future, it won't be more than other fields.

Liability is in the middle of most fields. I have an article about it somewhere in my archive that showed it is about the average.

Nigh shifts yes. It will stay forever. The field has changed to a 24/7 field and will stay like this forever. Won't go back. If you don't want to work nights, do something else.

Not a life-style field anymore and it won't change.

Most of what you say would be right if the field were static. The field is technology driven and will change over time rapidly, unlike many other fields. For example, ophtho revenue is heavily dependent on cataract surgery. Once the reimbursement for cataract surgery was cut siginificantly in mid 80s, ophtho salaries dropped significantly and never recovered. On the other hand, in mid 80s reimbursement for Xray dropped significantly ( also radiologists lost cardiac cath turf). Not only radiology workload and salaries didn't drop, but also it increased because of advancement in other areas.
This year CMS decided to pay for low dose chest CT for lung cancer screening in heavy smokers. It is not yet well established, but translates into 3 million/year more CTs which is slightly less than the total number of cardiac stress tests done in the US annually. Also CMS approved reimbursement for screening breast tomosynthesis. Though it will not pay significantly more per case, giving its large volume the total workload and revenue will be huge.

So, I personally don't think that we will be out of job or our reimbursement will go down in the future. Our field will remain well paid. However, we will get busier. This is not and will not be a life-style field. In the future, we will have to work even harder. If you like it, then do it and it will be rewarding but you will work your a$$ off.

 

[PL198]

Last year only 7 people got board certified in this way. The year before it was about 40-50. Though I think it should be terminated and the number of residency spots should be decreased, its effect is not significant.

I didn't know it was that small of an effect. thanks

 

[bcovert]

Radiology night work is more like ER night work. You are basically working constantly all night long.

 

[bcovert]

It is still possible and probable to make 300k per year as a rad. If this will persist in the future no one knows. Radiology is a risky trade. 380k puts one in the top 1% at least in 2012. I used to make much more than 380k.

 

[bcovert]

According to an analysis of tax returns by Jon Bakija of Williams College and two others, 16% of the top 1% were in medical professions and 8% were lawyers: shares that have changed little between 1979 and 2005, the latest year the authors examined (see chart) . The most striking shift has been the growth of financial occupations, from just under 8% of the wealthy in 1979 to 13.9% in 2005. Their representation within the top 0.1% is even more pronounced: 18%, up from 11% in 1979.

 

[bcovert]

The managerial/executive class are exerting their power and shifting resources from physicians who are busy day and night saving lives and stamping out disease.

 

[shark2000]

The managerial/executive class are exerting their power and shifting resources from physicians who are busy day and night saving lives and stamping out disease.

They have already taken over the business aspect of medicine. Not uncommon for hospital CEOs to make 2-3 millions, though their baseline salary may be 200-300K. And they are smart enough to only report their base salary in many surveys and hide their 2.5 million bonus.
If I talk about insurance companies all of us will get a big headache, so let's just stop here.

 

[Baller MD]

They have already taken over the business aspect of medicine. Not uncommon for hospital CEOs to make 2-3 millions, though their baseline salary may be 200-300K. And they are smart enough to only report their base salary in many surveys and hide their 2.5 million bonus.
If I talk about insurance companies all of us will get a big headache, so let's just stop here.

Is it true that this is the case only for certain fields? Psychiatry and derm seems to be able to survive on an outpatient basis.

 

[bronx43]

They have already taken over the business aspect of medicine. Not uncommon for hospital CEOs to make 2-3 millions, though their baseline salary may be 200-300K. And they are smart enough to only report their base salary in many surveys and hide their 2.5 million bonus.
If I talk about insurance companies all of us will get a big headache, so let's just stop here.

It's the two headed dragon that is dominating the health care industry - and ultimately what is largely responsible for the unsustainability. Insurance companies get the brunt of the public hate, since they are the interface between the patient and the payment of their care. However, the large healthcare corporations are equally (if not more) responsible. Not only are the CEOs making 7 figures, but it isn't uncommon for profitable hospitals to have billions of cash reserve. The big system in my area can survive for 1.5-2 years without any revenue inflow, and their operating costs are easily 700+ million annually, so you do the math.

 

[bronx43]

Is it true that this is the case only for certain fields? Psychiatry and derm seems to be able to survive on an outpatient basis.

It's easiest for those fields, but it's technically possible for any field. The problem comes when the services you provide require high overhead. Compare what is needed for a psychiatrist (small room and prescription pad) vs an interventional cardiologist (cath lab, personnel, supplies, recovery room, etc).

 

[PL198]

It's the two headed dragon that is dominating the health care industry - and ultimately what is largely responsible for the unsustainability. Insurance companies get the brunt of the public hate, since they are the interface between the patient and the payment of their care. However, the large healthcare corporations are equally (if not more) responsible. Not only are the CEOs making 7 figures, but it isn't uncommon for profitable hospitals to have billions of cash reserve. The big system in my area can survive for 1.5-2 years without any revenue inflow, and their operating costs are easily 700+ million annually, so you do the math.

My problem is that you automatically see a CEO making 7 figures as wrong. I agree there's a lot of pork in big medicine but criticizing executives for their salaries is the exact same thing as a layperson looking at an article and going " why does a doctor get paid 200k on avg? that's way too much."

I think a lot of physicians struggle with the fact that in terms of bringing value to the table, they aren't the apex being. I don't really see how having a cash reserve is a bad thing as that would indicate they are relatively lean?

 

[bronx43]

My problem is that you automatically see a CEO making 7 figures as wrong. I agree there's a lot of pork in big medicine but criticizing executives for their salaries is the exact same thing as a layperson looking at an article and going " why does a doctor get paid 200k on avg? that's way too much."

I think a lot of physicians struggle with the fact that in terms of bringing value to the table, they aren't the apex being. I don't really see how having a cash reserve is a bad thing as that would indicate they are relatively lean?

Did I say it was automatically wrong? Wrong or right in the context of what you're referring to is a philosophical question. I lean libertarian and would be the last person to make such a claim given a free market (which it's not). I'm simply pointing out that the health care system is unsustainable largely due to the reasons stated - that costs are too high when compared to similar services in other countries due to extraction of resources via the insurance companies and the healthcare corporations. Despite certain sophistries, the amount of health care services provided is actually not that different compared to other countries. The salaries and bonuses of the executive level administrators are simply a reflection of such - not a sole data point to be taken at face value.
Make no mistake that these trends are products of political decrees, as prior to the advent of large HMOs and HC corporations, medicine was not nearly as centralized. Consolidation of providers and managed care were supposed to be the key to cost containment, but that obviously didn't happen. Reimbursements were then cut heavily for independent practices, while hospital reimbursement went up - ultimately leading to selling of practices en masse, while hospital systems saw large increases in market share. The bottom line is that productivity and efficiency did not increase with these changes, and hospital CEOs do not actually create or add value in a vacuum outside of the artificial manipulations of central planning. Physicians, however, do add value, and there would obviously be no health care without health care providers.
Can there be 7 figure CEOs in a completely free market (fantasy scenario)? Yes, but it would be proportional to an overall smaller market, which would be sustainable.

 

[bcovert]

Did I say it was automatically wrong? Wrong or right in the context of what you're referring to is a philosophical question. I lean libertarian and would be the last person to make such a claim given a free market (which it's not). I'm simply pointing out that the health care system is unsustainable largely due to the reasons stated - that costs are too high when compared to similar services in other countries due to extraction of resources via the insurance companies and the healthcare corporations. Despite certain sophistries, the amount of health care services provided is actually not that different compared to other countries. The salaries and bonuses of the executive level administrators are simply a reflection of such - not a sole data point to be taken at face value.
Make no mistake that these trends are products of political decrees, as prior to the advent of large HMOs and HC corporations, medicine was not nearly as centralized. Consolidation of providers and managed care were supposed to be the key to cost containment, but that obviously didn't happen. Reimbursements were then cut heavily for independent practices, while hospital reimbursement went up - ultimately leading to selling of practices en masse, while hospital systems saw large increases in market share. The bottom line is that productivity and efficiency did not increase with these changes, and hospital CEOs do not actually create or add value in a vacuum outside of the artificial manipulations of central planning. Physicians, however, do add value, and there would obviously be no health care without health care providers.
Can there be 7 figure CEOs in a completely free market (fantasy scenario)? Yes, but it would be proportional to an overall smaller market, which would be sustainable.

I agree with most of what bronx43 said. We are bearing witness the one of the largest corporate takeovers in history. John D. Rockefeller eat your heart out wherever you are! Wealth is a power law function of monopoly power. On the flip side physicians didn't do a great job when they where given carte blache by the government and insurance companies.

 

[shark2000]

Did I say it was automatically wrong? Wrong or right in the context of what you're referring to is a philosophical question. I lean libertarian and would be the last person to make such a claim given a free market (which it's not). I'm simply pointing out that the health care system is unsustainable largely due to the reasons stated - that costs are too high when compared to similar services in other countries due to extraction of resources via the insurance companies and the healthcare corporations. Despite certain sophistries, the amount of health care services provided is actually not that different compared to other countries. The salaries and bonuses of the executive level administrators are simply a reflection of such - not a sole data point to be taken at face value.
Make no mistake that these trends are products of political decrees, as prior to the advent of large HMOs and HC corporations, medicine was not nearly as centralized. Consolidation of providers and managed care were supposed to be the key to cost containment, but that obviously didn't happen. Reimbursements were then cut heavily for independent practices, while hospital reimbursement went up - ultimately leading to selling of practices en masse, while hospital systems saw large increases in market share. The bottom line is that productivity and efficiency did not increase with these changes, and hospital CEOs do not actually create or add value in a vacuum outside of the artificial manipulations of central planning. Physicians, however, do add value, and there would obviously be no health care without health care providers.
Can there be 7 figure CEOs in a completely free market (fantasy scenario)? Yes, but it would be proportional to an overall smaller market, which would be sustainable.

I also agree with almost all of what bronx43 said. Very smart analysis of the situation.

"Artificial manipulation" resulted in artificial added value by hospital CEOs. This is one of the best explanations I've heard about what happened in the last 5 years. If you work in private practice you exactly feel this statement. Again nice job bronx43.

Hospitals and big corporates have taken over medicine. period. They did it under the cover of "decreasing cost". I agree that the former system was not sustainable, but the current system is neither. The only thing that has been done is changing one "non-sustainable" system to "another non-sustainable". The cost of the system has not decreased. The money has been shifted from the "real workers" in the system to the "middle men".

Just FYI, the total compensation of the hospital CEO in one of the hospitals that we cover was over 4 million last year. The same hospital hires a pediatrician for 150-170K.

 

[vm26]

I also agree with almost all of what bronx43 said. Very smart analysis of the situation.

"Artificial manipulation" resulted in artificial added value by hospital CEOs. This is one of the best explanations I've heard about what happened in the last 5 years. If you work in private practice you exactly feel this statement. Again nice job bronx43.

Hospitals and big corporates have taken over medicine. period. They did it under the cover of "decreasing cost". I agree that the former system was not sustainable, but the current system is neither. The only thing that has been done is changing one "non-sustainable" system to "another non-sustainable". The cost of the system has not decreased. The money has been shifted from the "real workers" in the system to the "middle men".

Just FYI, the total compensation of the hospital CEO in one of the hospitals that we cover was over 4 million last year. The same hospital hires a pediatrician for 150-170K.

Any thoughts on how to buck this trend?