There is a reason Obamacare included clauses no more physician owned hospitals.
There is a reason Obamacare included clauses no more physician owned hospitals.
Physician-Owned Hospitals | CMS
Section 1877(d) of the Social Security Act (the Act) sets forth exceptions to the physician self-referral law’s referral and billing prohibitions that are related to ownership or investment interests held by a physician (or an immediate family member of a physician) in an entity that furnishes...www.cms.gov
They claim “stark law” anti kick backs with docs self referral
Yet you can’t help but laugh when hospital own physician practices and kick back referrals to themselves. Just different lipstick on the same referral tactics.
“Alignment”
“Strategic partnerships” lol
I did a SIJ neurotomy when I was doing pain
It's not necessarily "slowly getting leverage" but can result in a much more instantaneous response of hospital kicking out the group the moment they ask for a stipend. I know because it happened in another hospital across town. Group asked for a stipend last year to stay competitive with surging market pay rates that were resulting in them not being able to recruit as their billing collections were not enough to offer competitive salaries vs the market. Hospital laughed and said "if we are going to pay you we might as well employ you". They then refused contract renewal with the group and sought to employ their own anesthesiologists. Their jaws about hit the floor when they couldn't recruit a single person either and they scrambled to bring in locums staffing for $400/hr. They ended up bleeding themselves dry paying locums to try and keep the ORs running and to this day are staffing with locums and cannot hire an anesthesiologist to save their life. If they had not been so arrogant and out of touch with the market they could have kept the private group offering superior coverage for far less money.
It's kind of funny/sad that this has happened so often that I feel like I know this hospital, but it could also be one of many similar situations across the nation. Is this the one with Sound?
Where did the members of that group go?
Its because the locums pay comes from a different pool.
Thanks for the article. I was surprised that otherwise well educated reporters had no idea that there's fewer residency spots than eligible physicians. Overall it was sympathetic to physicians which is a refreshing change.
The number of anesthesiology residency slots has doubled in over 20-25 years. It used to be around 1000 slots. Now it’s 2000 slots.
lcme.org
Yeah some young lady went to one of those California new med schools who tried to TikTok her way in to plastic surgeon residency and didn’t match. Feel bad forIn California alone there are 4 new LCME schools, Kaiser, CUSM (Prem Reddy), Charles R Drew, and California Northstate. And there are many new osteopathic schools nationwide.
Looks like there are 4 newer schools in Florida too.
Here’s the official list:
Accredited U.S. Programs | LCME
Which one was this? The one in New Mexico?
Isn’t part of the increase just getting back to baseline of the early 90’s of around 1300-1400? The huge fall off the cliff portion of 1996 had a lead up in 1995 and a very slow recovery that took about 6-7 years before getting back to baseline. It was after that when we saw very gradual increases in residency positions accomplished by expansion of existing programs and creation of new programs. So, if the current number is around 1900, it is still an increase but I would say the increase is above the 1300-1400 older early 1990s baseline and not the 1000 baseline you discussed, which was likely still in the long recovery process from when the bottom fell out in 1996. In 1995, the number of US grads that chose anesthesiology in the NRMP dropped to around 600, from almost 1400 the year before. There were 43 US grads matched in anesthesiology through the NRMP in 1996- many spots eventually filled through scramble; the numbers ~doubled for the next three years to ~85 in 1997–> ~160 in 1998 –> ~350 in 1999. I believe it took about 7 years to really recover completely.
I graduated early 90s. The market was **** for new grads starting 93-94. I mean it absolutely hit a wall. Word got back to the med students, so they stopped going into the field. Remember, at this time there were a few thousand more residency slots than US grads. So there were alternatives to anesthesia. Programs that historically matched 30 med students a year had ZERO matches. Those residents did a ton of work. Suddenly, there were ads for 20-30 MDs or CRNAs in the journals for a single academic hospital system. Under employed fresh grads and recent grads took thee jobs for a few years till the excess was burned off circa 2000. Suddenly no excess of bodies and no residents in the pipeline. The early-mid 00s were very good years.
No one is going to keep salaries high and work hours low out of the goodness of their heart. Both of these things are a constant push/pull based on market dynamics.
Yes. But will this drive people out of anesthesia residency and we then end up having a shortage of docs working more? I don’t expect salaries to remain high but fear us being worked more and more. Thus I live frugal for years. Can’t get time back. Don’t get how old guys think working 50+ per week is normal. Or worse when they did 60-70
It was not that good. Maybe I didn't get out enough, but, The only people I know who made that type of money were lucky enough to be in an area with an excellent payor mix or were exploiting senior partners or supervised more than four rooms or did pain in their own facility.
A lot of private practices lack transparency. It comes down to what am I getting per hour. And for the youngins, it’s about personal time and work doesn’t define them. I just don’t think hospital systems care about the well being in the long run. It’s probably still slightly better than an AMC which is like a devilish senior partner hiding the books.
I tend to agree although 1.2m seems a stretch in a group where everyone was equal. I knew of some groups 2005-2015 making 650ish (not inflation adjusted) working 55ish. Good hospital stipend. Fair groups. Sold out.
Agree it’s partially true. They will work if the rate is worth it for 50-60h weekly. Others want to work with flexibility. Either way, the sacrifice has to be worth it beyond just being a doctor.
5-10 years ago CRNAs were blamed for wages not raising as quickly as other MDs. I guess the last 5 years their rising wages have also helped raise ours.
We are younger and we aren't all about $$$$.
One will always be in demand with Bariatric Surgery in this country.
What did the insurance pay? This country's healthcare needs an overhaul.
6800
Bariatric surgery only boomed when it got approved by Medicare that was. In mid 2000s.
mexicobariatriccenter.com
Bariatric surgery only boomed when it got approved by Medicare that was. In mid 2000s.
Than private insurers started approved more. And obviously advances in surgery especially with gastric sleeve becoming more and more popular where it dominant type of weight loss surgery over the original gastric bypass.
I would never use the word “always” though
like open heart and valve surgeries were booming up to the early 2000s. Than it went down even with patient population grew. Because cardiologist started doing more invasive procedures that drove down many open heart procedures. Now most cv surgeons are hospital employed because revenue stream is so uneven. Before most were private.
With fda just now approving weight loss wegovy for cholesterol control this week. This likely will blow up the door to force private insurers to cover those drugs. Those drugs will likely become the standard weight loss vs invasive surgeries. There are non fda. Approved GI procedures that my friend had in Mexico.
Gastric Balloon in Mexico
In the Gastric Balloon procedure, a balloon is inflated in the stomach to temporarily decrease the stomach capacity/volume and induce weight loss. The goal of this procedure is to be somewhere in between major weight loss surgery and dieting/exercise. The gastric balloon works best with a...
It’s very effective. She lost 50 pounds in 9 months. Flew back to get it removed. On ozempic and lost another 40 pounds. So she went from 215 down to 125 without invasive gastric sleeve which most have been doing
Ballon from
Seems to me that continuing "current prices" is not a "reasonable assumption".
Why don't we just give Lily and Novo Nordisk one of these:“Right now, Medicaid spends a relatively modest amount — roughly $3 billion — on these treatments because federal government health insurance plans generally cover them only for those with Type 2 diabetes. But the government may have a hard time limiting access, given how beneficial they may be for a broader set of people. The savings generated from treating obesity sooner generate a host of health benefits, including reducing the likelihood of someone suffering deadly conditions like heart failure, coronary artery disease and stroke. Restricting the usage of GLP-1s will become extremely difficult to defend because that is not in the public interest.
We have estimated the costs and savings for state public insurance programs, health insurance exchange subsidies and U.S. taxpayers from making this class of drugs more broadly available. Under reasonable assumptions and at current prices, making this class of drugs available to all obese Americans could eventually cost over $1 trillion per year. That exceeds the savings to the government from reduced diabetes incidence and other health care costs from excess weight by $800 billion annually.
This is a staggering sum. It is almost as much as the government spends on the entireMedicare program and almost one-fifth of the entire amount America spends on health care.“
Opinion | The Miracle Weight-Loss Drug Is Also a Major Budgetary Threat
Ozempic threatens to bust the national budget. That may finally force the government to address the problem of overly expensive medical treatments.www.nytimes.com
Indeed. We use a compounding pharmacy to get a 3 month supply at full strength semaglutide for $250 for patients right now. Even those that have insurance coverage can't get it because the starter doses aren't being made because of their inability to keep up with supply yet they go after the compounding pharmacies to choke that supply as well. Totally ridiculous situation --cms should negotiate a reasonable price ( eg 300/month) and be done with it.
Just split the 4mg ozempic pen dose into 8 weeks.
canadianinsulin.com
250/3 months is 85/month via a compounding pharmacy, that's really damn cheap at a full 2.4 mg dose weekly.Just split the 4mg ozempic pen dose into 8 weeks.
18 clicks is 0.25mg
36 clicks 0.5mg
54 clicks .75 mg
72 clicks 1mg
Most people trying to lose weight don’t need to go above 0.5mg
Use a coupon to get it around $500. That’s 2 month supply. With one ozempic 4mg pen
Or buy online pharmacy
Buy Ozempic (Semaglutide) Pens From Canada Online - CDI
Ozempic (Semaglutide) Pens are injectable medical devices for the management of blood sugar levels. The Ozempic pen contains hormones similar to the naturally occurring compound in the body. Ozempic helps control blood glucose and aid in improving insulin sensitivity.
U can buy the insulin /ozempic pen needles for $8 for 100 needles on Amazon.
No need for these compounding pharmacy clinics. Then prey on dumb public and take the cash. Can’t blame them. But the Public can get the real drug for the same price.
