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Shady as f***. Muscling to acquire an independent $1billion faculty practice for free. I’m glad this anesthesia/intensivist stood up against them and hope he prevails.
Just another private group being gobbled up by Big Healthcare conglomerate... That's the theme these days, hospital system wants zero competition and to take all the revenue. All the newly employed docs get low pay, more work, and zero control.
This is what “Physician executives” do. Play both sides so that no matter what the outcome they still win. Duke has always been this way.The most interesting part of this story is how the board of PDC betrayed their own members because the had dual allegiances to both Duke and PDC. But that’s how these things happen.
The most interesting part of this story is how the board of PDC betrayed their own members because the had dual allegiances to both Duke and PDC. But that’s how these things happen.
Clear conflict of interest. Do they not have a fiduciary duty? PDC should kick out those physicians, and direct their lawsuit to both Duke and those individuals conspiring with them
While the hospital CEO and executives pull their fat bonuses. This is corporate medicine stomping out physicians.
That is the point. Eventually, there wont be any pvt practiceToo bad. You don’t like it, leave go work for private practice
Plenty leftThat is the point. Eventually, there wont be any pvt practice
Sounds to me the Duke Anes team crying over spilled milk because their salaries likely to drop and be similar to MGh or something.
A long time ago I interviewed and was offered a job at Duke (before I decided academics wasn't for me) and I could never quite understand their job offer. The salary from Duke itself was like $20K per year and the rest came from the PDC (including benefits). The told me it was nothing to worry about just a way to separate physician reimbursement from the medical center yada yada yada. I never took the offer but still found it odd.
But MGH was paying more back then, and I suspect they still do.
Regional is horrible. They pay new people badly, give them worse schedules and dump on them at the end of the day. You'll be covering up to 8 crna rooms as people leave. No thanks
Wow-had heard similar but wasn’t sure-well there you go-no wonder Anesthesia leading the suit. Regional doesn’t want its ponzi super partner scheme to die
During my brief foray into academics that seemed to be the norm.A long time ago I interviewed and was offered a job at Duke (before I decided academics wasn't for me) and I could never quite understand their job offer. The salary from Duke itself was like $20K per year and the rest came from the PDC (including benefits). The told me it was nothing to worry about just a way to separate physician reimbursement from the medical center yada yada yada. I never took the offer but still found it odd.
But MGH was paying more back then, and I suspect they still do.
100% on how these hybrid models can go either way-ponzi or democratic. I’m not sure how the PDC at Duke works, but I will say that Regional anesthesia, or Dukes community group has a reputation in the southeast as a super partner, “ponzi” model. Not sure how accurate the reputation is but I do know they have had high turnover.
But doesn’t really matter if it is the more high functioning democratic model. Duke U will win this either way. Your practice is worth nothing if you do not control the revenue aspects. Not only does Duke U own all the facilities and research equipment but they employ all the nurses, PAs, CRNAs, NPS, etc. Now that primary care joined Duke U they control patient referrals too.
The PDC is not worth 1 billion. Anesthesia, ER, Radiology largely do not bring patients to the hospital. They are ancillary non revenue generating services. While it might be unadvisable and a pain to replace a lot of physicians, Duke can with those specialties and not lose patients. Particularly since they already control the CRNAs and other ancillary staff. Add to the fact RDU top 10 place to live right now and it’s even easier to replace.
So PDC loses family med, anyone doing research, can replace Anes, ED, and Rads if they want-that leaves just crumbles of a PDC that won’t survive
Duke wins this battle quickly. PDC is wasting money on lawyers.
If you work at Duke, you should have known that this was always a possibility.
So what "efficiencies" did they "advise"?Beware if your hospital system engages these guys. Also don’t agree to help pay their fees. It’s like paying your own assassins.
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So what "efficiencies" did they "advise"?
That is correct. This is what they paid the politicians for. Consolidation. Terrible for consumers, doctors and employeesJust another private group being gobbled up by Big Healthcare conglomerate... That's the theme these days, hospital system wants zero competition and to take all the revenue. All the newly employed docs get low pay, more work, and zero control.
It's going to be a lot trickier than a private group buyout. Trying to replace the entire Duke anesthesia department would be an absolute nightmare and a ****show to boot, not to mention the residency program. They will reach some sort of financial agreement to keep people where they are, but what that will look like is anybody's guess.This illustrates that the regional hospital systems have all the power and and physician groups are essentially powerless against them.
This is reminiscent of how Atrium kicked out Mednax after Mednax paid big bucks for Southeast Anesthesiology Consultants.
It's going to be a lot trickier than a private group buyout. Trying to replace the entire Duke anesthesia department would be an absolute nightmare and a ****show to boot, not to mention the residency program. They will reach some sort of financial agreement to keep people where they are, but what that will look like is anybody's guess.
Saw a picture the other day, titled the biggest employer for each state. IIRC, there are 14 states which Walmart takes the win. In CT, it was Yale Health. In PA it was UPMC.
I thought that was very interesting.
Duke won’t have to replace all the PDC Anes. Likely, at least half the faculty do research as Duke a big research dept. they’ll join Duke U. Others will stay because they don’t want to change jobs. Maybe Duke U has to replace 20% tops. They already have the CRNAs. This is a done deal. Not sure why the PDC wasting time (oh yeah because if the pyramid/ponzi scheme suggested by others maybe? But that’s just in Anes-or do other specialties do it to)
Could you copy/paste the article? it seems to be behind a paywall//registerwallShady as f***. Muscling to acquire an independent $1billion faculty practice for free. I’m glad this anesthesia/intensivist stood up against them and hope he prevails.
Could you copy/paste the article? it seems to be behind a paywall//registerwall
It is. Some of other specialties have already left the PDC and joined the DFP. Anesthesia one of the primary ones fighting and an anesthesiologist was the lawsuit. It’s funny because Anesthesia probably has one of the weakest positions of all the specialties. Reliant on research if work at Duke U, reliant on a Ponzi scheme if work in community. CRNAs employed by Duke. Game over.I thought the PDC was every physician at Duke in every specialty
I am actually surprised by how negatively this is perceived.
Even if the private practice IS a Ponzi scheme, are we saying there is ZERO value in the private practice? Why is Duke so aggressively trying to obtain a zero value business? Are we really happy all working for one company? What happened to competition begets progress? Are we again all agreeing there’s no space for PP in the future, especially within some of these huge health care systems?
This is an academic center. Not a private or even not for profit hospital. This is not private practice unless Duke wanted to allow that. They don’t. Game over. UNC is right down the road. They are academic. Everyone is a state employee. That is UNCs choice.
Duke now wants everyone to be a Duke employee. They own the facilities, all the physical assets including the big one-research, employ the ancillary staff and nurses, med school. Med school donations. But again the big one is they control the assets and the BRAND.
It is academic center. Employing everyone is not an uncommon model. It’s Duke taking the risk to employ everyone. The PDC is only worth the revenue it brings in. Anes, Rad, ED don’t bring in revenue. Cardiology and Surgery do, hence why they should be driving this not Anes. Add the ponzi aspect…..well you’re not going to get support here. You choose to work at Duke you should expect to FOR Duke
This is an academic center. Not a private or even not for profit hospital
Wow..hope this was sarcastic. No patient chooses a hospital or surgeon for the Anesthesia, ED, or Radiology (IR being the lone exception). You get your revenue because of the surgeon or hospital.How does anes not bring in revenue? My collections say otherwise.
Your mindset is horrible. Without us none of the hospitals make any money. Sure, they come for the surgeon. But without us it literally cannot happen.Wow..hope this was sarcastic. No patient chooses a hospital or surgeon for the Anesthesia, ED, or Radiology (IR being the lone exception). You get your revenue because of the surgeon or hospital.
If you can replace these folks smoothly (there is the crux-almost impossible to do) then the hospital loses little to no revenue as these depts don’t bring in revenue.
Take a way a popular surgeon or cardiologist-millions can be lost.
Duke will get the majority of PDC to join because of research so they won’t have to replace all, maybe just a small fraction. This won’t last much longer
Completely disagree. You overestimate your value. I agree with what you say..which is why you have to continuously spend money to demonstrate your value. Have eras programs, good outcomes etc. But ultimately Anes is much more replaceable than a surgeon or Cardiologist who brings patients in. All the more reason to make yourself less replaceable as much as you can as you point out. However the best way to do that is employ the CRNAs. Much much harder to replace 150 CRNAs and 80 MDs than just 80 MDs.Your mindset is horrible. Without us none of the hospitals make any money. Sure, they come for the surgeon. But without us it literally cannot happen.
I mean - even for stuff where they don't technically need anesthesia the surgeons/hospitals want us. I still think it's odd the cataract surgeons want us for MAC, yet even they can't seemingly do without us. And that's small potatoes - you want a trauma center, a transplant program, a heart center, a peds center, an outpatient surgery center, a smooth running endo suite- you want almost anything significant and you need us. You need to fix your mindset.
Some hospitals thought they could just dump "anesthesia" and find new "anesthesia". That never ends well. Dump a well seated anesthesia group outright and you'll loose tens of millions in facility fee revenue.
Completely disagree. You overestimate your value. I agree with what you say..which is why you have to continuously spend money to demonstrate your value. Have eras programs, good outcomes etc. But ultimately Anes is much more replaceable than a surgeon or Cardiologist who brings patients in. All the more reason to make yourself less replaceable as much as you can as you point out. However the best way to do that is employ the CRNAs. Much much harder to replace 150 CRNAs and 80 MDs than just 80 MDs.
In this case you don’t have to replace any CRNAs and likely 20-30 MDs tops. Duke won’t lose any revenue.
Do the things you talk of. Provide great care. Do cost saving anesthesia. But don’t fool yourself. Ultimately this is about manpower. If you don’t control it, you are replaceable with little cost to the facility. Atrium had some bad outcomes, but they didn’t lose money. Now things are stable there. We are all replaceable if the hospital system is motivated enough. Takes the surgeons threatening to leave if you really want action,
Completely disagree. You overestimate your value. I agree with what you say..which is why you have to continuously spend money to demonstrate your value. Have eras programs, good outcomes etc. But ultimately Anes is much more replaceable than a surgeon or Cardiologist who brings patients in. All the more reason to make yourself less replaceable as much as you can as you point out. However the best way to do that is employ the CRNAs. Much much harder to replace 150 CRNAs and 80 MDs than just 80 MDs.
In this case you don’t have to replace any CRNAs and likely 20-30 MDs tops. Duke won’t lose any revenue.
Do the things you talk of. Provide great care. Do cost saving anesthesia. But don’t fool yourself. Ultimately this is about manpower. If you don’t control it, you are replaceable with little cost to the facility. Atrium had some bad outcomes, but they didn’t lose money. Now things are stable there. We are all replaceable if the hospital system is motivated enough. Takes the surgeons threatening to leave if you really want action,
Non-profit orgs are often the most corrupt. All you gotta do is zero out the balance sheet at the end to be called a non-profit.... not that hard to do. Duke is a POS.
I agree with @Howard888. While the transition can be costly and painful, it has been shown over and over that even large anesthesia groups can be replaced and business return to normal after a year or 2. For whatever reason, probably money and control, Duke unilaterally decided to replace PDC with DFP and they will more than likely succeed.
What is the public going to do about it? Absolutely nothing. Duke is a monopoly in Durham, they have been for years. There was a private facility in Durham about 20 years ago but Duke bought it. The public will still show up at Duke for all their various maladies, hands outstretched begging to be saved.I don’t disagree with you. The public should know these big health care system is being run like a business. They are big business!
Why isn’t there some antitrust law being broken somewhere? How’s this good for the public? It’s not.