Are locums rates really declining?

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Actually, there's increasing evidence that we don't know when people are going to die and that it's fairly hard to predict. Retrospectoscope is always 20/20. Ashley Shreves has done some great work on this.

Great work on what? Cost of end-of-life care, prediction of end-of-life, or the retrospectoscope being 20/20? Is this a person that I should know? If so, I must admit my ignorance here.

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Great work on what? Cost of end-of-life care, prediction of end-of-life, or the retrospectoscope being 20/20? Is this a person that I should know? If so, I must admit my ignorance here.

Predicting when people will die. She's an EM doc who did a HPM fellowship.
 
What about the risk of medicare for all? Or NHS style system? Or healthcare becomes VA run? The VA pays 180/hr for ED work. Politics and the rabbled mass of voters who want free everything is a huge risk to all of us

VA docs also arent worked to death and have 100% tort protection. They have a federally funded retirement. Im not saying less money in salary is a great thing, but If you worked for the govt and got paid 180/hr and only saw 1 pt/hr and could never get sued, its possible many may be happier.

Im not advocating for a federalized system, I still prefer to make as much as I can in a job I enjoy, but my point is, I dont think a complete federal takeover making us all VA workers would be the end of the world either.
 
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The less I get paid, the slower I work. I have a skillset that will always be in demand. If I get paid $60/hr in a socialist takeover of heslthcare (i dont believe thats coming) we’ll all unionize like good socialists and see 0.5/hr and collectively bargain for ridiculous benefits.

I just refuse to believe the doom and gloom of physicians. I grew up dirt poor, and I make way more money than I ever imagined. First I honestly dont believe a socialist healthcare takeover will ever happen. The Democrats had the presidency and both houses of congress, and still had to barter within their own party to get healthcare legislation passed that wasnt anywhere close to a socialized system. And even if by some crazy chain of events we had a complete nationalized system get passed and my salary went down tomorrow, I certainly wouldnt be thrilled, but Id also be just fine and better off than 90% of society.

Worst case scenario (which again just isnt going to happen)... Im still a physician. Im still making way more money than I ever thought I would have.
 
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VA docs also arent worked to death and have 100% tort protection. They have a federally funded retirement. Im not saying less money in salary is a great thing, but If you worked for the govt and got paid 180/hr and only saw 1 pt/hr and could never get sued, its possible many may be happier.

Im not advocating for a federalized system, I still prefer to make as much as I can in a job I enjoy, but my point is, I dont think a complete federal takeover making us all VA workers would be the end of the world either.

Agreed. It seems like the UK, Canada, and Australia actually pay their docs fairly similarly. Sure, the UK quotes $75 an hour...but they can't get EM docs for that when GPs earn the same- they have to resort to highly paid locums, and even that's a stretch. And in Australia and the UK attending coverage at night is scant, if it exists at all, so they can pay a bit less. With nurses in the US earning up into the mid six figures in California and midlevels earning six figures, either you get rid of docs or you have to pay us reasonably. PAs and NPs and their online degrees will basically sink in the ER without docs to supervise, so I don't think they are the death knell.

The biggest threat I see is the endless expansion of CMG residency slots and grads with insane student loans that will take any job with any conditions.
 
I'm not sure if it's 80%, but I think the point is being missed: a large portion of CMS expenditures are made during the last year of a person's life, and a lot of it is made on care that is futile. Like you, I've seen various statistics, and whether it's 20% or 60%, it doesn't matter. Futile care is futile care, and it's costly.
There’s a huge difference between care made in the last year of one’a life and “futile” care. Given the age of Medicare patients, it’s not exactly surprising that not a small amount of it goes into caring for an individual one year before he/she dies. If someone has a stemi and gets a stent then dies a few months later from another heart attack, then would you argue that the person should never have gotten the stent? Or all dialysis spending should be stopped since the costs are added up one year prior to the persons death? Should we deny expensive chemotherapy to Medicare patients with stage 4 cancer since they’ll likely die within a year? Truly “futile” care, which you would likely describe as the 90 year old patient with multiple comorbidities in the ICU for months, is likely not a very high percentage of this spending... though it would be nearly impossible to calculate due to the lack of a concrete definition for what constitutes “futile” care.

I just find it curious that people are ignoring the elephant in the room (cost fixing) and just focus on what is largely a nebulous and likely overblown concept of futile health care. And ultimately I understand the sentiment since I’ve had the same thoughts back when I did my icu rotations, but a close examination of the data just doesn’t support this argument.
 
There’s a huge difference between care made in the last year of one’a life and “futile” care. Given the age of Medicare patients, it’s not exactly surprising that not a small amount of it goes into caring for an individual one year before he/she dies. If someone has a stemi and gets a stent then dies a few months later from another heart attack, then would you argue that the person should never have gotten the stent? Or all dialysis spending should be stopped since the costs are added up one year prior to the persons death? Should we deny expensive chemotherapy to Medicare patients with stage 4 cancer since they’ll likely die within a year? Truly “futile” care, which you would likely describe as the 90 year old patient with multiple comorbidities in the ICU for months, is likely not a very high percentage of this spending... though it would be nearly impossible to calculate due to the lack of a concrete definition for what constitutes “futile” care.

I just find it curious that people are ignoring the elephant in the room (cost fixing) and just focus on what is largely a nebulous and likely overblown concept of futile health care. And ultimately I understand the sentiment since I’ve had the same thoughts back when I did my icu rotations, but a close examination of the data just doesn’t support this argument.
“We” shouldn’t be paying for any of it
 
The rates in my specialty are ridiculously low and I think one of the main reasons is as physicians we take these offers so they continue to low ball us. When I asked one of the recruiters why he was quoting such a crazy low number he said hey there are four other physicians that are willing to take it at this number. :(
What are you doing? Path?
 
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“We” shouldn’t be paying for any of it
Dude, you're a one trick pony, so, if you're going to drive-by post, well, you can't. You have to put a LOT more meat on those bones, when you make a statement such as you did. If you are going to post such things, you're going to have to show your work.
 
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Please do not lump PA education in with NP online classes.

We have both as students in our department, and while I agree the PA students are better, I have seen huge decline in PA competence over the last few years. Many new, for-profit schools with questionable admissions standards have opened, and they are frankly churning out crap. Seems like PA education is really declining.
 
Dude, you're a one trick pony, so, if you're going to drive-by post, well, you can't. You have to put a LOT more meat on those bones, when you make a statement such as you did. If you are going to post such things, you're going to have to show your work.
There should be no govt liability for people’s medical care. People can have all the care that either they can pay for or someone voluntarily donates to them.

If you have a specifc question I would be fine to discuss it
 
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I think it's pretty easy to identify futile care:

1. Demented and bed bound? Guess what....comfort measures only, no feeding tubes, broad-spectrum antibiotics for sepsis, intubation, or ICU stays regardless of what family wants.
2. Dialysis in non-compliant people. Don't want to show up for your dialysis chair appointments? Well tough luck
3. Chemotherapy for extensive and INCURABLE cancers in patients over 70.
4. No transport of hospice patients to the ED, regardless of what family says
 
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The medical care not paid for by the patient.

You are right, and ultimately "cost sharing" is what will make vast decreases in the cost of all medical care possible. All patients should pay out of pocket for routine health management, and then a co-pay for outpatient labs, radiology studies, and specialist visits and hospitalizations. Force hospitals and clinics to publish up-front price lists so patients can shop around for the best price. The best example is probably GoodRX. This has led to competition among pharmacies to provide lower prices, as consumers can easily search pharmacies and get up-front pricing. The cost for many prescription drugs has dropped enormously since GoodRX.

Ultimately the most ethical form of medical rationing is when patients ration their own care based on cost/benefit.
 
There should be no govt liability for people’s medical care. People can have all the care that either they can pay for or someone voluntarily donates to them.

If you have a specifc question I would be fine to discuss it
No, I do not desire to - again - repeat what has been discussed, by you, over, and over, and over, and over again, now, many times.

I get it, although I do not know if others are aware: you're a ***** to the wall libertarian. Your opinion is that government should not pay for medical care. Now, that's done.

Are you doing EM, or some other specialty?
 
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I think it's pretty easy to identify futile care:

1. Demented and bed bound? Guess what....comfort measures only, no feeding tubes, broad-spectrum antibiotics for sepsis, intubation, or ICU stays regardless of what family wants.
2. Dialysis in non-compliant people. Don't want to show up for your dialysis chair appointments? Well tough luck
3. Chemotherapy for extensive and INCURABLE cancers in patients over 70.
4. No transport of hospice patients to the ED, regardless of what family says

And what percent of Medicare spending is this exactly?
 
No, I do not desire to - again - repeat what has been discussed, by you, over, and over, and over, and over again, now, many times.

I get it, although I do not know if others are aware: you're a ***** to the wall libertarian. Your opinion is that government should not pay for medical care. Now, that's done.

Are you doing EM, or some other specialty?
I get it, we disagree
 
No, we don't. I haven't given my position. I just wonder if you troll around SDN (in the sense of fishing, not living under a bridge and causing trouble) just looking for this question, to pop in and give your opinion.
The tone here is unnecessary. If you want to have a civil exchange at some point, let me know
 
And what percent of Medicare spending is this exactly?

No one knows. Everyone has a different definition of "futile care". I personally don't think there should be any cancer care, dialysis, stroke care, or cardiac care for anyone over 80. I'm sure most would disagree.

Put me on the Death Panel and I will save $Trillions
 
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I'd heard/read that 50% of Medicare dollars are spent in the last 6 months of life. There was no mention of futility in there.

This could be calculated, but it would be retrospective, only.

Good luck telling family: "We can't give your relative X treatment because it's futile". Simply wouldn't fly. There's no way to do a prospective cost analysis due to ethical issues.
 
Good luck telling family: "We can't give your relative X treatment because it's futile". Simply wouldn't fly. There's no way to do a prospective cost analysis due to ethical issues.
I don't know how you inferred that from my post. As I said, it's a retrospective analysis. I didn't mention prospective analysis.
 
I don't know how you inferred that from my post. As I said, it's a retrospective analysis. I didn't mention prospective analysis.

Are you going to use retrospective data to deny care to patients going forward? My point is that you will never get buy-in from families.
 
Great work on what? Cost of end-of-life care, prediction of end-of-life, or the retrospectoscope being 20/20? Is this a person that I should know? If so, I must admit my ignorance here.
She was married to the most (or second most) infamous doctor in EM history, David Newman.
 
Also, Keep it professional in here guys. There can be a discussion about end of life care without it becoming angry I would hope.
 
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Hi, Everyone. As a friendly remind, please check your timesheet for locum company very carefully.
I found that Locumtenens.com repetitively miscalculated my reimbursement even the timesheet was reported correctly. They had to correct it since I had strong evidence. I almost believe that they did it on purposely.
 
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