Duke toxicity

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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.
 
2Fast2Des said:
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.
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While the hospital CEO and executives pull their fat bonuses. This is corporate medicine stomping out physicians.
 
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.
 
nimbus said:
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.
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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.
 
nimbus said:
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.
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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
 
coffeebythelake said:
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
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coffeebythelake said:
While the hospital CEO and executives pull their fat bonuses. This is corporate medicine stomping out physicians.
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Not sure what the big deal
Is here. Duke U owns all the hospitals, all the research equipment, staffs the nurses

Most academic centers employ all of their physicians, now Duke wants to do so in a traditional way.

They’re saying we own your research equipment. You want to do research here, you have to be an employee. Actually seems fair to me.

Sorry for those CDC folks but come on, you are at one of the 10 largest academic health systems in the country. You take a job there, guess what, you are at Dukes whim

Sounds to me the Duke Anes team crying over spilled milk because their salaries likely to drop and be similar to MGh or something.

Too bad. You don’t like it, leave go work for private practice
 
“This is consistent with the organizational model used by our peer institutions across the country and aligns with our need to simplify the management of relationships with key research funding organizations,” Klotman wrote.
“We believe this will lead to greater operational efficiency, a better patient experience, the ability to recruit and retain top talent, and enhancements in community health,” he wrote in an email.

What a bunch of S***. I always thought things like this violated stark regulations
 
Howard888 said:
Sounds to me the Duke Anes team crying over spilled milk because their salaries likely to drop and be similar to MGh or something.
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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.
 
Mman said:
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.
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I worked in a similar model with split salary between a physician group and academic center. Worked out fine there at least
 
Interesting issue...

On the one hand I'm creeped out by Duke's weird corporate-speak about "alignment" and "peer institutions". On the other hand, it is a tough to justify complicated employment model.

I know of some academic centers that employ this hybrid model and it's a total mess - weird super partners and a ponzi scheme that exploits the young within what should be a fair academic environment. I know of others where this works out great - fantastic democratic physician led management with nice lifestyle.

Duke is a behemoth and they'll ultimately win. There's no way around it. I'll still root for the physicians to get what they can out of the deal though!
 
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.
 
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
 
GassYous said:
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
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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
 
Howard888 said:
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
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Also heard that the work environment is bad for new anesthesiologists. CRNAs constantly wanting to do more and more. They will do things like not call you for a spinal and try to muddle through it themselves or deal with a complication and you won't know about it until you hear the stat call overhead. Think their years of experience means more than your training. If you speak out they band against you and complain.

I never worked there. But know people who have.
 
Mman said:
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.
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During my brief foray into academics that seemed to be the norm.

A small salary from the medical school for academic activities or being department chair or residency program director.

Then a clinical salary from the physician practice corporation.

If you did research and had salary support another check from the research corporation.

Then if you were an athletic team physician a check from the athletic department.

I am pretty sure one of the neurosurgeons hit the superfecta.
 
Howard888 said:
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.
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That explains why PDC board members folded and gave away the farm rather than pursue another fate for their 90yo practice. That’s also in line with what the lawsuit claims, that Duke is out to destroy PDC. They probably felt their were no other possible outcomes like a sale to Duke or to PE at a higher valuation. Also I don’t think the lawsuit is claiming PDC is worth $1bil but that their annual revenue is $1bil and they’ll probably claim an even higher valuation.

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.
 
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YOU WILL BE ASSIMILATED. RESISTANCE IS FUTILE.
 
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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2Fast2Des said:
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.
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That is correct. This is what they paid the politicians for. Consolidation. Terrible for consumers, doctors and employees
 
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.
 
nimbus said:
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.
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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.
 
WholeLottaGame7 said:
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.
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I’m sure they’ll try to recruit as many people as possible from PDC to DFP. I’m sure most would like to stay. Hopefully PDC doesn’t have or enforce a noncompete agreement but that’s the only leverage they have.
 
IMGASMD said:
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.
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Cleveland Clinic is the largest employer in Ohio with over 100,000 employees. Healthcare is 18% of GDP in the USA so it’s not surprising that big hospital systems are major employers. Retail is 19%. Tech is about 10%. Auto is 3-3.5%.
 
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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)
 
Howard888 said:
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)
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I thought the PDC was every physician at Duke in every specialty
 
Months of tension between Duke University, Duke University Health System and a private group of physicians who work at both have surfaced in a lawsuit. The lawsuit claims Duke University and Duke Health have conspired to undermine the physicians group and force or coerce its members to work for Duke. It says Duke is essentially trying to acquire the 90-year-old private company, comprised of 1,850 physicians, without paying for it. The result of becoming Duke employees, the suit says, is that the physicians would lose their independence and would likely be paid less for more work in the future. A spokesman for Duke said the lawsuit “has no basis in fact or law” and that Duke will vigorously fight it. The suit was filed in Durham County Superior Court late Monday by Dr. Eugene Moretti, an anesthesiologist and critical care specialist, on behalf of the Private Diagnostic Clinic. Founded in 1931, the PDC is a for-profit company that employs doctors who work, teach and do research at Duke University and its medical facilities. End of Year Sale Unlimited digital access - $4 for 4 months CLAIM OFFER The lawsuit says Duke has tried for years to take over the PDC but that the two sides could not agree on terms. It says Duke has now changed strategies and begun to “pursue unlawful ways of destroying the PDC to take over its business and goodwill.” Last winter, Dr. Mary E. Klotman, dean of Duke’s medical school, announced the formation of Duke Faculty Practice, an alternative to the PDC controlled by Duke. Transitioning to the new practice was optional, Klotman wrote in a memo to faculty, except for those in clinical departments who do research. They have until July 2022 to join. “This is consistent with the organizational model used by our peer institutions across the country and aligns with our need to simplify the management of relationships with key research funding organizations,” Klotman wrote. The shift would mean the PDC would lose 400 doctors, according to the lawsuit, threatening its existence “by draining the physicians group of its most important asset: its members.” But Michael Schoenfeld, Duke’s chief communications officer, said Duke and the PDC have been in talks over how to better work together and align their missions. Schoenfeld said Duke has simply proposed that faculty physicians who are already employed by Duke for education and research become full-time Duke employees for their clinical practice as well. Today’s top headlines Sign up for the Afternoon Update and get the day’s biggest stories in your inbox. SIGN UP This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. “We believe this will lead to greater operational efficiency, a better patient experience, the ability to recruit and retain top talent, and enhancements in community health,” he wrote in an email. “The lawsuit filed by Dr. Moretti, who is not a representative of PDC leadership, is an attempt to obstruct these discussions about alignment and impede Duke’s ability to provide the highest-quality health care services to our patients.” Complicating the relationship between the PDC and Duke is that the PDC’s leaders hold similar positions in the medical school. The chair of the school’s psychiatry department, for example, heads the same department at the PDC and serves on its governing board. The suit claims that despite serving on the PDC’s board, five doctors planned to move their medical school departments from the PDC to the new physicians group formed by Duke. It says one of them, Dr. Anthony Joseph Viera, followed through, transferring the PDC’s Department of Family Medicine and Community Health to Duke last summer, in violation, the suit says, of his fiduciary duties to the physicians group. WHAT IS THE PRIVATE PHYSICIANS GROUP WORTH? The lawsuit says the PDC’s board as a whole has not looked out for the interests of its members. It says the board hired two law firms to advise it on Duke’s takeover attempt, then worked to avoid sharing the conclusions of one of those firms with PDC members. A memo from the firm was leaked to a PDC message board, the lawsuit says. The suit quotes an unnamed lawyer for the New York firm Epstein Becker & Green who said it appeared Duke was pressing some members of PDC’s board to dissolve the practice, against the best interests of the group. It said by luring or coercing doctors to join its physician practice, Duke was essentially trying to acquire the PDC. “It seems clear that one of Duke’s overarching objectives here is to terminate PDC by taking over substantially all of PDC’s assets and operations,” the suit quotes from the memo. “Viewed from that perspective, the Duke Employment Offers — if accepted by all or substantially all of PDC’s Physicians — would amount to Duke acquiring PDC for a purchase price of $0.” The suit says the PDC hired three firms to determine the value of the private physicians group, and that one of them concluded that it was somewhere between $750 million and $1.1 billion. Finally, the suit says Duke further undermined the PDC in October when Dr. Eugene Washington, Chancellor for Health Affairs and president and CEO of the health system, terminated the agreement Duke and the PDC have operated under since 1972. The agreement, which has been renewed annually since 1976, includes a clause that says Duke “recognizes the separate and independent status of the PDC and agrees not to interfere in its organization and operations to the extent that such organization and operations relate to the private practice of medicine.” In his termination letter, Washington said threatened litigation about the relationship between Duke and the PDC had been based “upon an unfortunate misinterpretation” of that clause, according to the lawsuit. The letter also said Duke had “no intention of taking steps to undermine the PDC or to compromise its continued existence.” The lawsuit argues that requiring doctors who do research at Duke to leave the group does just that. OTHER PHYSICIANS COULD JOIN LAWSUIT Moretti is suing Duke on his own but on behalf of the company. In late August, his attorney, Erica Harris, wrote to the PDC board urging it to file suit to protect the group’s interests. In an interview Tuesday, Harris, who is based in Houston, said a committee created by the board agrees Moretti’s claims have merit but has not yet decided whether to sue. She said he decided to go ahead on his own. “It would seem that the other PDC members are concerned about their careers,” Harris said. “Dr. Moretti is an older gentleman who is passionate about what he has devoted his life and much of his career to, and he’s willing to stand up against Duke.” Other physicians or the PDC itself could join or intervene in the lawsuit, Harris said. “We’re just the first one to file,” she said. Harris said Moretti is not seeking any direct compensation for himself, other than attorneys fees. The suit seeks unspecified damages for the PDC. It’s not clear how the outcome of this battle between Duke and a large private group of physicians would affect patients. Harris said keeping the PDC independent would prevent further consolidation in the health care industry that can potentially lead to fewer choices and higher prices. “In addition, many people would hear about an old institution that has worked independently and worked to build Duke and then Duke turns around and when they can’t buy it or agree to business terms to merge with it, Duke uses its power to basically force the dissolution of the entity or destroy it,” she said. “I think that’s a compelling story that people might care about even if it doesn’t affect their pocket book.”

Read more at: https://www.newsobserver.com/news/local/article256761697.html#storylink=cpy

Best I can do right now. Have some junk ads in the middle. Skip them.
 
Mman said:
I thought the PDC was every physician at Duke in every specialty
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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.

Surgery or Cardiology has a much better posture. Surprised they aren’t leasing this
 
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?

Then I will also put this out here. Since I don’t know how to post a poll.
What kind of practice then would most of the members want to be in?
Private Practice?
AMC?
Academic?
Hospital employee?
None of the choices?
Combinations of the choices?
Have you experienced one or the other? And actually changed your mind? Are you too worried to change your job?
 
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IMGASMD said:
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?
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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
 
Howard888 said:
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
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How does anes not bring in revenue? My collections say otherwise.
 
Howard888 said:
This is an academic center. Not a private or even not for profit hospital
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Duke is a private university. I assume the hospital is also private, even though it is academic in the sense of having residents and fellows.
 
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.
 
GassYous said:
How does anes not bring in revenue? My collections say otherwise.
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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
 
Howard888 said:
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
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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.
 
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kidthor said:
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.
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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,
 
Howard888 said:
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,
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Well as a profession we systematically underestimate our value. If we had the long game irreplaceable mindset collectively it would help us all... rather than the sad weak sit in the office please don't fire me because all I do is push 20ml of this, 2ml of that, 5ml of that, and watch a CRNA put the tube in, then have coffee mindset.

Plenty of hospitals are desperate for manpower, academic shops included. The nurses are playing this perfectly - I respect them for it. We are not collectively playing the long game well (or the short game for that matter).
 
Howard888 said:
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,
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Riiiight that's why you have amcs and huge hospital systems throwing 500k at people these days. Because we are valueless and replaceable.
 
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.
 
nimbus said:
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.
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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.
 
IMGASMD said:
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.
Click to expand...
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.

And as far as anti-trust laws, if there are laws being broken you have to have a justice department interested in trying to figure it out. The “justice system“ favors the rich and connected, Except in certain cases where the people who run the system decide it will be useful to placate the public by sending up a sacrificial lamb.
 
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