ER physician pay cut at Beth Israel Deaconess

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alpinism said:
You guys really want to get depressed one of my ER PA friends just got offered a position at one of the NYC Health public hospitals with a well known EM residency for 225/hr moonlighting shifts. The same place is currently paying faculty 215/hr for moonlighting shifts.
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I don't blame admin or the PA. This fault lies at the feet of the EM docs who are willing to sacrifice blood for this risk. If I was a PA, I wouldn't even take $215/hr.

That is one hard shift and dangerous putting fires out left and right. People stacked in the hallway. No way am I coming in.
 
I was on the conference call mentioned by BravoTwoZero.
Lie after lie after lie.

You know, at a time where grandmas are spending their social security checks on fabric and are taking to their sewing machines by the hundreds to bang out masks for everyone, and others are donating whatever they can... these corporate jackholes are making sure that their bonuses are intact.

There's a special place in hell for that kind of nonsense.


 
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alpinism said:
You guys really want to get depressed one of my ER PA friends just got offered a position at one of the NYC Health public hospitals with a well known EM residency for 225/hr moonlighting shifts. The same place is currently paying faculty 215/hr for moonlighting shifts.
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Maybe we suck at negotiating? The ER faculty can use this as leverage to their advantage.
They think we are stupid docs and we continue to behave that way.
 
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Porfirio said:
What did they say?
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First, there were lots of pictures of families and good deeds and other fluff.
Then, there was nonsensical chatter and buzzwords about "caring".
Next, there was :10 minutes of how the economy is just unprecedented and how this affects revenue.
Finally, they said: "Hard decisions will have to be made, so we'll have to let you know in the coming days how much we'll have to steal from you."

There was mention of the "sacrifices" made by executives. I wanted to post a link to Birdstrike's post in the live chat box to call them on their lies.
 
RustedFox said:
First, there were lots of pictures of families and good deeds and other fluff.
Then, there was nonsensical chatter and buzzwords about "caring".
Next, there was :10 minutes of how the economy is just unprecedented and how this affects revenue.
Finally, they said: "Hard decisions will have to be made, so we'll have to let you know in the coming days how much we'll have to steal from you."

There was mention of the "sacrifices" made by executives. I wanted to post a link to Birdstrike's post in the live chat box to call them on their lies.
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If revenues go down by 20%, would you agree to a 20% paycut for every employee of a company? Executive and laborer alike?
 
HCA has already closed down a bunch of their freestanding EDs so I would think that’s already a fair amount of envision docs who are out of a job. To do a significant payout on top of that would be brutal.

At least APP or any of their sites hasn’t canned anyone yet.


Sent from my iPhone using Tapatalk
 
thegenius said:
If revenues go down by 20%, would you agree to a 20% paycut for every employee of a company? Executive and laborer alike?
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No.
Ethically, the last ones to be touched should be the rank and file docs.
Without us, there is no "Company".

I've said it before, and it bears repeating:

The same "lean" model that the suits apply to us, needs to also apply to them.
Right now, its not even close to equal, so I want my thumb on the other end of the scale.
 
Someone explain the math to me:
--the stimulus bill includes at least $100 billion in payments to hospitals
--health insurance premiums are set to go up 40% next year
--supposedly, much provided care is either at or below cost, hence decreased volumes really shouldn't hurt that much
--for some reason, we're all going to be drafted and sent to work as slave labor for for-profit hospitals?

Anyone else think this cuts are just pure-opportunism and mostly driven by decreases in stock market and private equity valuations?
 
turkeyjerky said:
Someone explain the math to me:
--the stimulus bill includes at least $100 billion in payments to hospitals
--health insurance premiums are set to go up 40% next year
--supposedly, much provided care is either at or below cost, hence decreased volumes really shouldn't hurt that much
--for some reason, we're all going to be drafted and sent to work as slave labor for for-profit hospitals?

Anyone else think this cuts are just pure-opportunism and mostly driven by decreases in stock market and private equity valuations?
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100 billion to hospitals. Do I have the math right? That would be 100 million to 1000 hospitals? That would seem to more than make up for cost of losing elective cases for a few months and even paying the docs premium for the no pays. Or lets go by patient. Say 1 million COVID patients get hospitalized. Thats what, 100,000 per patient? They should be able to get by on that.
 
Crabbygas said:
100 billion to hospitals. Do I have the math right? That would be 100 million to 1000 hospitals? That would seem to more than make up for cost of losing elective cases for a few months and even paying the docs premium for the no pays. Or lets go by patient. Say 1 million COVID patients get hospitalized. Thats what, 100,000 per patient? They should be able to get by on that.
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The people doing the heavy lifting here won’t see much of anything.

The potential lawsuits however will go on for years. Not medical malpractice mind you. But hospital workers that were given inadequate protection and ultimately died, non COVID patients that had no choice but to seek healthcare and got exposed and ended up in the icu because of it, hospital vendors, mask companies rushing production and making a defective product, the list goes on and on...
 
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GeneralVeers said:
That's completely reasonable, however it has to include 20% cut to stock options and bonuses for executives, not just salary.
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It's not reasonable at all. Physicians provide actual value. We are the engine that drives healthcare. Without us there is no care.

Envision on the other hand provides nothing except for unnecessary overhead costs. They, in the truest form of the word "literal", are literally not necessary at all. They provide nothing except for a business opportunity for themselves. They exist for the sake of their own existence. They exist because they realized that if they could raise the capital to interject themselves into their position, the financial math would work out in their favor by providing a steady stream of money that would far outweigh the initial investment costs. They are the definition of a parasite.

So no, a 20% cut across the board doesnt make sense. Envision should be cut 100% and physicians can take whatever natural paycut happens when demand is reduced.
 
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Dr.McNinja said:
www.bloombergquint.com

KKR-Backed Envision Withholds Doctor Pay as Routine Care Slows

KKR-Backed Envision Withholds Doctor Pay as Routine Care Slows
www.bloombergquint.com www.bloombergquint.com
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Porfirio said:
I don’t know what to say...
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Here is the most important part of the article @Dr.McNinja linked:


Envision carries more than $7 billion of debt amassed through what was, according to data compiled by Bloomberg, the third-largest health-care leveraged buyout ever.
Copyright © BloombergQuint

Envision is a big black hole for KKR in which they are pouring money. At some point, investors will start cutting their losses. This could get interesting real quick.
 
erdoc00 said:
Envision should be cut 100% and physicians can take whatever natural paycut happens when demand is reduced.
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Are physicians prepared to take on the cost and responsibilities of coding, compliance, malpractice, etc.? Let’s not kid ourselves, there was once an era of DSGs. That era passed for a reason. Are we prepared to bring it back, or are we going to flock to hospitals (the big non-profit types)?

This pandemic is an interesting wake-up to doctors. Perhaps it will expose the liquidity provided by these private equity groups as an illusion? They giveth and they taketh away.

I don’t have the answer but it’s a helluva question.
 
Doctors are empaths. Private Equity businessmen are narcissists. Do you doubt for one second that the executives at KKR have any issue with royally ****ing over doctors? They are motivated by money. That is their sole purpose in life. The only way this gets better is for physicians to collectively grow some balls, stop working for PE, stop selling to PE and put the effort into building/maintaining a practice. It’s truly unbelievable that medicine has been taken over by a debt Ponzi scheme.

“The Business of Medicine” needs to be mandatory core curriculum for med schools and residents. An eye-opening number are clueless about where paychecks come from.
 
I'm optimistic our democratic group survives the current revenue...issue. At least we don't carry debt.
ShockIndex said:
Are physicians prepared to take on the cost and responsibilities of coding, compliance, malpractice, etc.? Let’s not kid ourselves, there was once an era of DSGs. That era passed for a reason. Are we prepared to bring it back, or are we going to flock to hospitals (the big non-profit types)?

This pandemic is an interesting wake-up to doctors. Perhaps it will expose the liquidity provided by these private equity groups as an illusion? They giveth and they taketh away.

I don’t have the answer but it’s a helluva question.
Click to expand...
 
Kuratz said:
Doctors are empaths. Private Equity businessmen are narcissists. Do you doubt for one second that the executives at KKR have any issue with royally ****ing over doctors? They are motivated by money. That is their sole purpose in life. The only way this gets better is for physicians to collectively grow some balls, stop working for PE, stop selling to PE and put the effort into building/maintaining a practice. It’s truly unbelievable that medicine has been taken over by a debt Ponzi scheme.

“The Business of Medicine” needs to be mandatory core curriculum for med schools and residents. An eye-opening number are clueless about where paychecks come from.
Click to expand...
Truth
 
ShockIndex said:
Are physicians prepared to take on the cost and responsibilities of coding, compliance, malpractice, etc.?
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Some are, most aren’t. I’m a shareholder and on the board of directors of a 100% physician-owned, 40+ provider group, which puts me in the minority. You don’t have to do all the business work, you just have to be good at finding others who will. It has it’s ups and downs but is better than being at the mercy of sociopathic parasites who would struggle to take a bandaid out of its wrapper.
 
Kuratz said:
Doctors are empaths. Private Equity businessmen are narcissists. Do you doubt for one second that the executives at KKR have any issue with royally ****ing over doctors? They are motivated by money. That is their sole purpose in life. The only way this gets better is for physicians to collectively grow some balls, stop working for PE, stop selling to PE and put the effort into building/maintaining a practice. It’s truly unbelievable that medicine has been taken over by a debt Ponzi scheme.
Click to expand...

Well, most of us would, but at the end of the day, the only way to work in a hospital based specialty is to be available 24/7, or be part of a bigger group. If you don't have 20 friends with which to make a group, you can't take over the contract, so you have to work for them and then have a clause in your contract saying you can't take over for it.
 
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erdoc00 said:
It's not reasonable at all. Physicians provide actual value. We are the engine that drives healthcare. Without us there is no care.


So no, a 20% cut across the board doesnt make sense. Envision should be cut 100% and physicians can take whatever natural paycut happens when demand is reduced.
Click to expand...

I'm suggesting this from the standpoint of understanding the reality that CMGs are here to stay, and are now an evil we have to live with. Saying that they should fire many non-productive admins and corporate types is not a realistic demand. They won't do it. They view doctors as an expense from whom they can squeeze every last dollar.
 
GeneralVeers said:
I'm suggesting this from the standpoint of understanding the reality that CMGs are here to stay, and are now an evil we have to live with. Saying that they should fire many non-productive admins and corporate types is not a realistic demand. They won't do it. They view doctors as an expense from whom they can squeeze every last dollar.
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Why can't the CMGs wither up and die, in your opinion?

I'm not arguing; I'm trying to analyze the battle plans in this Droid to find a weakness.
 
RustedFox said:
Why can't the CMGs wither up and die, in your opinion?

I'm not arguing; I'm trying to analyze the battle plans in this Droid to find a weakness.
Click to expand...

I'd have no problem with that, but what comes next? Physicians have proven inept at managing their own business, and protecting their long-term interests. To become a hospital employee just presents a lot of the same problem with administrative bloat.
 
GeneralVeers said:
I'd have no problem with that, but what comes next? Physicians have proven inept at managing their own business, and protecting their long-term interests. To become a hospital employee just presents a lot of the same problem with administrative bloat.
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I get that; but why are you dismissing the potential for a SDG rebirth?
 
RustedFox said:
Why can't the CMGs wither up and die, in your opinion?

I'm not arguing; I'm trying to analyze the battle plans in this Droid to find a weakness.
Click to expand...
The Droid doesn't wither up and die on it's own. Something has to defeat it. CMGs will flourish until something more ruthless and efficient takes its place. Is that you?
 
GeneralVeers said:
I'd have no problem with that, but what comes next? Physicians have proven inept at managing their own business, and protecting their long-term interests. To become a hospital employee just presents a lot of the same problem with administrative bloat.
Click to expand...

Part of the reason, I reckon, is that we spend so much damn time clicking on buttons and filling out forms - along with doing the thing that actually matters (e.g. patient care) that we are too exhausted to run a business so to speak. All of these buttons we click and form we fill out are unnecessary and consume tremendous time.

Running a doctor business (especially ER) is theoretically, and in reality, not difficult.
 
Birdstrike said:
The Droid doesn't wither up and die on it's own. Something has to defeat it. CMGs will flourish until something more ruthless and efficient takes its place. Is that you?
Click to expand...

The problem is that we forget where CMGs come from. They didn't spring up overnight. They were birthed by expansion and consolidation of SDGs and once they had become big enough, they stopped being physician-run and turned into a giant cancer on our specialty. Even if we hit the reset button and went back to all-SDGs, this would likely happen again and even faster next time.
 
Birdstrike said:
The Droid doesn't wither up and die on it's own. Something has to defeat it. CMGs will flourish until something more ruthless and efficient takes its place. Is that you?
Click to expand...

I think he wants to launch rockets down a very small tube into the CMG machine with Darth CMG bearing down on his tail. He would like a spectacular explosion.
 
GeneralVeers said:
The problem is that we forget where CMGs come from. They didn't spring up overnight. They were birthed by expansion and consolidation of SDGs and once they had become big enough, they stopped being physician-run and turned into a giant cancer on our specialty. Even if we hit the reset button and went back to all-SDGs, this would likely happen again and even faster next time.
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Right. How do keep the cycle from repeating?

Other than individual docs refusing to work for groups big enough that it’s leadership has lost touch with the frontline docs, I’m not sure.

Otherwise, you’re right. What’s to stop born-again SDGs from getting greedy and selling out to consolidation and increasing size, once again?

The only think I can think of, is individual docs in all specialties placing a value on independence as opposed to dependence, when they search for opportunities.
 
GeneralVeers said:
The problem is that we forget where CMGs come from. They didn't spring up overnight. They were birthed by expansion and consolidation of SDGs and once they had become big enough, they stopped being physician-run and turned into a giant cancer on our specialty. Even if we hit the reset button and went back to all-SDGs, this would likely happen again and even faster next time.
Click to expand...
Until physicians are willing to take drastic action, in ways they never thought they would, there is little hope for change. But once physicians get angry enough to go nuclear, then there's all the hope in the world. Because until then, the businessmen know they out-ruthless us by a factor of 10:1. Get angry or get bent.
 
@GeneralVeers
Birdstrike said:
Until physicians are willing to take drastic action, in ways they never thought they would, there is little hope for change. But once physicians get angry enough to go nuclear, then there's all the hope in the world. Because until then, the businessmen know they out-ruthless us by a factor of 10:1. Get angry or get bent.
Click to expand...
Right now, doctors like to complain about being others pawns, but they aren't willing to pay the price for success in that realm.

"If you want success, find out the price then pay it." - Scott Adams
 
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Kuratz said:
Doctors are empaths. Private Equity businessmen are narcissists. Do you doubt for one second that the executives at KKR have any issue with royally ****ing over doctors? They are motivated by money. That is their sole purpose in life. The only way this gets better is for physicians to collectively grow some balls, stop working for PE, stop selling to PE and put the effort into building/maintaining a practice. It’s truly unbelievable that medicine has been taken over by a debt Ponzi scheme.

“The Business of Medicine” needs to be mandatory core curriculum for med schools and residents. An eye-opening number are clueless about where paychecks come from.
Click to expand...

The fact that that so many of us, myself included, sold our souls by massively overprescribing opiates in our never ending quest for “5” on a survey makes me think that you may be overplaying the empathy hand just a little. Hell, there was a time that I gave into demands for dilaudid for migraines and Tussenex for colds out of fear of a single survey that could cost me a couple of thousand dollars in monthly incentive. That, and the fact that so many of us were willing to get into bed with CMGs in the first place to keep a salary that was in line with our perceived self-worth...again, myself included.

Are doctors better than divorce attorneys and used car salesmen? On average, yes by a lot. But, we respond to economic pressures at some point.
 
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Lets not all forget (at least I suspect) that the real reason for CMG proliferation was hospital admin selling out their longstanding SDGs. Remember NinerNiner999's thread on this (that he never finished, sadly).

I can be wrong; but I reckon that if it weren't for greedy butthole C-suiters, that SDGs would still be in more abundance.
 
miacomet said:
Another article on a staffing agency cutting a physician's pay: Overwhelmed Hospitals Face a New Crisis: Staffing Firms Are Cutting Their Doctors’ Hours and Pay — ProPublica
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This is one of the more comprehensive summations that I have seen about it. I hate that this is happening to Emergency Medicine. ED docs and PAs/NPs are on the front lines of this insanity and our money is being compromised while we simultaneously risk our lives. Meanwhile the staffing companies are trying to reassure you that as soon as things get busy again they will call you back but get bothered when you say you will be looking elsewhere and may not be available. It definitely makes me mad and sad at the same time. My exit from Emergency Medicine may come sooner than I planned at this rate.
 
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