Fired Over Patient Sat and Metrics

[Birdstrike]

(Edit: I have no specific involvement of the parties involved in the cited article, and no specific knowledge of the events as stated. The opinions and statements below are made in general and do not have any direct application to the groups, physicians or parties involved.)


"NEW BEDFORD — St. Luke's Hospital switched emergency room contractors today, introducing the Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center.

Poor patient satisfaction ratings caused St. Luke's to cut short the contract for the previous company, St. Luke's Emergency Associates (SLEA).

St. Luke's Hospital, part of the Southcoast Health System, already has a relationship with Deaconess through a rotating residency program, so the hospital and the community will be familiar, officials said.

"They have come to know and understand our community and its emergency medicine needs," said Linda Bodenmann, chief operating officer at St. Luke's.

She called it a "natural fit."

The chief of emergency medicine at Harvard/Beth Israel, Dr. Richard Wolfe, said in a statement that "One of our missions is to ensure that board-certified emergency physicians oversee the care of emergency patients. This is critically important in a busy, high-acuity (high severity) department like St. Luke's."

The new contractor took over the department at 7 a.m., said Bodenmann. It went so smoothly that "you would never have known," she said.

All of the physicians from the previous contract have either moved on to other positions elsewhere or have remained at St. Luke's, as long as they are board certified or board eligible, Bodenmann said.

"We used to allow exceptions, but with the increasing acuity and business of the emergency room and our goal of ensuring high-quality care" the hospital raised the bar, she said.

With more than 80,000 patients per year, long wait times were the biggest problem in the past, she added. The hospital will continue to monitor patient satisfaction through letters, phone calls and other surveys, Bodenmann said.

Dr. Jennifer Pope, an emergency room physician at Beth Israel/Deaconess, is the new chairwoman of emergency medicine at St. Luke's. She is in the process of moving to SouthCoast, Bodenmann said.

She extended an olive branch to SLEA, saying "I want to also say thanks and express gratitude to the former group for all the years of services they provided."".

http://t.southcoasttoday.com/apps/pbcs.dll/article?AID=/20130116/NEWS/130119907&template=tabletart

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[The White Coat Investor]

You though I was just pointless ranting again on the "Actual Emergencies" thread over patient sats and metrics? Think again.


"NEW BEDFORD — St. Luke's Hospital switched emergency room contractors today, introducing the Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center.

Poor patient satisfaction ratings caused St. Luke's to cut short the contract for the previous company, St. Luke's Emergency Associates (SLEA).

St. Luke's Hospital, part of the Southcoast Health System, already has a relationship with Deaconess through a rotating residency program, so the hospital and the community will be familiar, officials said.

"They have come to know and understand our community and its emergency medicine needs," said Linda Bodenmann, chief operating officer at St. Luke's.

She called it a "natural fit."

The chief of emergency medicine at Harvard/Beth Israel, Dr. Richard Wolfe, said in a statement that "One of our missions is to ensure that board-certified emergency physicians oversee the care of emergency patients. This is critically important in a busy, high-acuity (high severity) department like St. Luke's."

The new contractor took over the department at 7 a.m., said Bodenmann. It went so smoothly that "you would never have known," she said.

All of the physicians from the previous contract have either moved on to other positions elsewhere or have remained at St. Luke's, as long as they are board certified or board eligible, Bodenmann said.

"We used to allow exceptions, but with the increasing acuity and business of the emergency room and our goal of ensuring high-quality care" the hospital raised the bar, she said.

With more than 80,000 patients per year, long wait times were the biggest problem in the past, she added. The hospital will continue to monitor patient satisfaction through letters, phone calls and other surveys, Bodenmann said.

Dr. Jennifer Pope, an emergency room physician at Beth Israel/Deaconess, is the new chairwoman of emergency medicine at St. Luke's. She is in the process of moving to SouthCoast, Bodenmann said.

She extended an olive branch to SLEA, saying "I want to also say thanks and express gratitude to the former group for all the years of services they provided."".

http://t.southcoasttoday.com/apps/pbcs.dll/article?AID=/20130116/NEWS/130119907&template=tabletart






"Moved to other positions" or "remained"? Yeah, either you accept a pay cut or you are fired. Or, maybe you are just fired.

I'm not trying to scare you, EM hopefuls. I just want you to be prepared, so you can have a plan.

Ha ha....captured!

Contracts can be lost at any time. It seems a big issue with this group and with many others is the lack of board certified docs. If you're in a big city, don't expect to be able to get a job in an ED without a board certification. If you're in an ED job now without board certification, don't be surprised when the issue comes up. It is coming up now in smaller and smaller towns all the time. If you want to be an emergency doc, go to an emergency medicine residency and pass the emergency medicine boards. Going through the backdoor may cause you some complications later.

All that said, that's probably just the excuse being used to move this group of docs out for another. Most of these decisions are about money. Get rid of the private group, bring in employees, and take a slice of their income.

 

[Birdstrike]

All that said, that's probably just the excuse being used to move this group of docs out for another. Most of these decisions are about money. Get rid of the private group, bring in employees, and take a slice of their income.

(Edit: I have no specific involvement of the parties involved in the cited article, and no specific knowledge of the events as stated. The opinions and statements below are made in general and do not have any direct application to the groups, physicians or parties involved.)






Ding, ding, ding! We have a winner.

If it was about board certification they simply would not have renewed the contract of those with ABEM certification. Instead they fired everyone, including those with board certification, is how I read the article. Then they hired some back. Could it be those who accepted a sizable pay cut?

If they were interested in paying competitive in the first place, you have to wonder why they couldn't get board certified EPs to begin with.







"I'm just sittin' here watchin' the wheels go 'round and 'round. I really love to watch them roll" - Watching the Wheels, John Lennon

 

[Arcan57]

Ding, ding, ding! We have a winner.

If it was about board certification they simply would not have renewed the contract of those with ABEM certification. Instead they fired everyone, including those with board certification, is how I read the article. Then they hired some back. Could it be those who accepted a sizable pay cut?

If they were interested in paying competitive in the first place, you have to wonder why they couldn't get board certified EPs to begin with.

Recruiting is difficult (especially for small groups) and depending who was in power within the group it may not have been politically feasible to force out the non-ABEM folk. So assuming that was an option is tenuous at best. And I'm somewhat confused that you believe the group was fired because they wanted to pay the docs less but that the previous group was also underpaying? I just came from a city where the average salary was $300k+ and where there was a comical inability to recruit residency trained docs. So while this may have been a transparent money grab, it's far more likely they had a fair number of non-ABEM folks who had crappy productivity and the local group couldn't/wouldn't address the issue.

 

[southerndoc]

Here's hoping that any doc or group that is "fired" for poor patient satisfaction sue, and sue for a lot.

Reasons why patient satisfaction shouldn't be used to terminate physicians or groups:

1. It's not statistically valid,

2. There is a sample bias (the most pleased patients are often the ones admitted, which aren't sampled),

3. The patient's selected also tend to return surveys more when they're unhappy than when they're happy,

4. It encourages physicians to not practice evidence-based medicine,

5. It encourages physicians to overprescribe controlled substances,

6. It costs healthcare systems hundreds of millions of dollars annually that could be spent actually providing quality patient care instead of trying to get by with the minimum number of nurses/doctors and just appear to provide quality care.

I will say this: if I ever get fired for bad surveys, I will sue. I hope anyone who gets fired sues. It's one thing if you're downright ugly to patients, but the surveys could have an 80% satisfaction rate and you're in the 1st percentile.

 

[deleted109597]

Recruiting is difficult (especially for small groups) and depending who was in power within the group it may not have been politically feasible to force out the non-ABEM folk. So assuming that was an option is tenuous at best. And I'm somewhat confused that you believe the group was fired because they wanted to pay the docs less but that the previous group was also underpaying? I just came from a city where the average salary was $300k+ and where there was a comical inability to recruit residency trained docs. So while this may have been a transparent money grab, it's far more likely they had a fair number of non-ABEM folks who had crappy productivity and the local group couldn't/wouldn't address the issue.

I agree. I've seen some hourly rates that are astronomical, and they can't hire people to fill the holes they've already got, much less make more holes in the schedule by forcing people out.
Comically, some of the non-EM trained folk actually get better PG, because they're more likely to prescribe antibiotics to treat viral illness, give pain medicines, order more CTs, etc.

 

[Socrates25]

The insistence of board certification is happening across all specialties. I think it is quite absurd.

Yes, they only want "board certified" EM docs but I bet they'd hire a midlevel with their sham "board certification" in a heartbeat.

Same deal with narcotics. We're going to make all the doctors take extra "training" to script them yet the NP fresh out of school with 1/5th the clinical training of an MD gets to script schedule IIs with no oversight. That makes sense.

 

[deleted109597]

What state require extra training for Schedule II?
Texas requires special prescriptions, but conveniently, I just don't buy them. Patients can ask me for schedule II meds, but tough ****.

 

[Birdstrike]

Recruiting is difficult (especially for small groups) and depending who was in power within the group it may not have been politically feasible to force out the non-ABEM folk. So assuming that was an option is tenuous at best. And I'm somewhat confused that you believe the group was fired because they wanted to pay the docs less but that the previous group was also underpaying? I just came from a city where the average salary was $300k+ and where there was a comical inability to recruit residency trained docs. So while this may have been a transparent money grab, it's far more likely they had a fair number of non-ABEM folks who had crappy productivity and the local group couldn't/wouldn't address the issue.

(Edit: I have no specific involvement of the parties involved in the cited article, and no specific knowledge of the events as stated. The opinions and statements below are made in general and do not have any direct application to the groups, physicians or parties involved.)


First of all, I have no sympathy for a hospital that has a "comical inability" to recruit quality doctors. Give me break. Pay more! Offer better benefits! Sweeten the deal! Am I so stupid that a hospital CEO doesn't know the laws of supply and demand. Keep sweetening the pot, and you'll get a hire. $300,000? Why not more? Offer a stipend to your EM group. Is this a hospital with zero profits last year to sweeten the pot? Absolutely not. If they were losing money, they'd board up the place. Make no mistake about it. You're dealing with people who spent as much time reading books on business, deal making and schmoozing as you did MCAT, USMLE and boards. Don't be fooled. Their hands are not tied. They don't want to pay more. Make the guys who we do have in the pit pick up the slack. That's cheaper.

Despite frequently having "loss of contract" hung over my head, I've never personally gotten the hatchet. Somehow, I dodged that bullet. But I've worked with several guys who have, and I've made some observations. In each case they were ABEM certified, experienced and either solid, even exceptional docs. None of them were jerks to patients. In some cases, they had to move their families, due to not being rehired, not wanting to be rehired, or non-competes. I've heard of many cases where recently fired doctors were hired back to the hospital that just forced them out. I've never heard of anyone being hired back on by a hospital that just fired them for more money or a better deal. It just doesn't make sense, that one gets fired, then gets a raise, or even the same deal from the boss that just fired them. Just think of it logically: You're a hospital CEO, the EM group you've got isn't making you happy. Sure, some of the docs are pretty good, but overall, you're not happy with them, for whatever reason. You're forced to fire the group as a whole. A few from the group you just fired ask to be rehired. Let's face it. They are desperate. They're out of a job. They've got a house payment to make. Realistically you know they'd probably see twice the patients for 30% less, just just to avoid having a month with $0 for a paycheck. So you give them a raise just to be nice?

Now, could it be that they want to pay the same, or even more money, for a better quality group, ie, board certified, more productive, etc? Sure, it's possible. I've just never heard of it happening that way. Because, there's plenty of contract management groups that will offer all that for cheaper than most small groups, becaue they can do it cheaper with economies of scale, efficiency, flying "fire fighters" in, etc. If they do pay more for a new group, they sure as hell are going to want something in return, like much greater patients per hour, much better Press-Ganey, etc.

So, you are speculating. I am speculating. What we need is someone with first hand knowledge of the situation to chime in. Maybe one of the ones who was fired, would be disgruntled enough to speak out online. We'll see.

As far as board certification, I think it should be required where possible. I worked my tail off for mine, so I agree with a tough stance on that. But go back and read that article. There were board certified docs in that group, too. I find it very, very hard to believe that after getting fired along with their group, and rehired from a position of zero leverage, that they made out the same or better. I could be wrong, but if so, I'd be very, very surprised. If anyone here has lost their contract, then been rehired back at no loss, please educate me.

What it really comes down to is this:


We deserve better




.

 

[Haemr Head]

Good concerns but in the case of New Bedford, you might want to collect just a bit of data before leaping to conclusions. The new group offered jobs to everyone who had worked there and wanted the work, but was restricted to only board certified physicians. The new practice plan ensures that you get the income you generate and vote on the admin costs annually. Unlike the previous group, the new group is a democratic, open book practice, not hospital employed or a single contract holder. The new group was asked, at very short notice, to come in and save what was left of the practice as most of the precious physicians had fled to the local competitors because of disagreements with those holding the contract. No one, including the hospital or the new group can exploit the income of the MDs with the new practice plan. Easy enough to check. Pick up the phone and call any of the EM physicians who work there and transited from the old to the new system. Or speak to those who left. Or any physician at BIDMC about how it works.

 

[Haemr Head]

Or better yet, call about a job since there are a few positions still opened, if you want to see what is really happening. But you really should be boarded to work in a 90,000 patient/year high acuity ED.

I still agree 100% about the dangers of patient sat, the risk of hospitals, contract holders, and megagroups, exploiting EM physicians, and all the dangers that we face. But some of us are fighting back by spreading democratic practices and building high quality groups to block those risks. Not a whole lot of megagroups in the Bay State because they cant compete effectively with a democratic model.

 

[Birdstrike]

Good concerns but in the case of New Bedford, you might want to collect just a bit of data before leaping to conclusions. The new group offered jobs to everyone who had worked there and wanted the work, but was restricted to only board certified physicians. The new practice plan ensures that you get the income you generate and vote on the admin costs annually. Unlike the previous group, the new group is a democratic, open book practice, not hospital employed or a single contract holder. The new group was asked, at very short notice, to come in and save what was left of the practice as most of the precious physicians had fled to the local competitors because of disagreements with those holding the contract. No one, including the hospital or the new group can exploit the income of the MDs with the new practice plan. Easy enough to check. Pick up the phone and call any of the EM physicians who work there and transited from the old to the new system. Or speak to those who left. Or any physician at BIDMC about how it works.

(Edit: I have no specific involvement of the parties involved in the cited article, and no specific knowledge of the events as stated. The opinions and statements below are made in general and do not have any direct application to the groups, physicians or parties involved.)


If I cold call that ER and ask about their pay and contract, no one is going to tell me anything. Please post contract specifics (pay, benefits, expected patient per hour, patient sat policies, metrics expectations, etc) before and after these doctors were fired and rehired. All I know is what the article said, that they were fired over patient satisfaction surveys and metrics, and that makes me suspicious. Hey, if you can show me the docs made out well on the deal, I'm happy.

 

[la gringa]

Here's hoping that any doc or group that is "fired" for poor patient satisfaction sue, and sue for a lot.

Reasons why patient satisfaction shouldn't be used to terminate physicians or groups:

1. It's not statistically valid,

2. There is a sample bias (the most pleased patients are often the ones admitted, which aren't sampled),

3. The patient's selected also tend to return surveys more when they're unhappy than when they're happy,

4. It encourages physicians to not practice evidence-based medicine,

5. It encourages physicians to overprescribe controlled substances,

6. It costs healthcare systems hundreds of millions of dollars annually that could be spent actually providing quality patient care instead of trying to get by with the minimum number of nurses/doctors and just appear to provide quality care.

I will say this: if I ever get fired for bad surveys, I will sue. I hope anyone who gets fired sues. It's one thing if you're downright ugly to patients, but the surveys could have an 80% satisfaction rate and you're in the 1st percentile.

can't comment on 1 in an informed manner
totally agree with you on point 2
haven't seen point 3 to be so prevalent
in my experience - the art marrying medicine and patient satisfaction is in how you sell points 4 and 5.

in 3.5 years i personally have NEVER had a patient complaint or negative survey related to failure to rx controlled subs or abx. i DO, however, spend more TIME explaining expected course, a plan, and rationale... just one gringa doc's experience, but i think that concerns over cont subs and rx's are overemphasized.

there are studies out there on pt's expectations... can't look them up right now but they say that we are poor at judging what a pt wants i/r/t things like abx.

 

[Haemr Head]

Contract specifics:

Faculty member selects number of clinical hours. Based on the hours selected, using payer mix, the pretty good contracts negotiated as part of a large system, hourly volume, initial salary is set based on projected revenue generated factoring in benefits and admin costs. Income generated above that number is all back to the attending as a quarterly bonus. The admin costs are decided by the group. annually to cover time spent in hospital committees, scheduling, QI, at 150/h for an admin hour. The hospital does not subsidize the practice or take money from the group. The rest of the system provides an interest free loan for the start up but does not capitalize of the income generated by the MDs. You do not get handouts from the hospital and you do live off your professional billing so it works better for those that are fast and document well.

I haven't heard the exact specifics but it is roughly $300,000 with an additional 27% benefit package for 32-34 clinical hours/week. And no one gets in trouble for speaking their mind internally or externally. The moonlighting rate is $250/h.

Now, before insulting another group in public, and if you still have trouble believing this, don't you think you should try and get a little independent data on your own or do you always believe what you don't read in the press.

 

[Haemr Head]

Sorry not to fully answer your questions, there are no patient/h metrics, minimum sat scores or any other type of nonsense. Since patient sat is driven mainly by inpatient access and nursing, hardly seems logical. Those issues are fixed by good systems and aligning incentives, not by threatening providers with report cards.

 

[deleted109597]

I'm with Birdstrike. Something strikes me as odd about that being their new salary.
It is drastically higher than any of the stats published for the region.

If it is as good as Haemr is saying it is, then good for the few that got "hired back" at a higher salary.

 

[Haemr Head]

Actually, that salary is similar to others in the BIDMC network at 32h/week. It is the same deal at BID Milton and St Vs. Its pretty much the reason that an ED like St Luke's can be staffed at very short notice. BIDMC itself is lower when you start, because there are only 18 clinical hours/week, the rest being dedicated to academic work. Agree those community BID sites are higher than the rest of the state, but when you actually pay the MDs what they make and keep admin costs down to a minimum, good things happen. Different practice models produce different results. If you work for a hospital or a single contract holder, or in any system with closed books, expect to make less.

In the last months at St Luke's, the former group was desperate to hold on to the few remaining full timers as people were leaving in droves. They started offering hourly rates that were very high so it is true that moonlighting rate and bonuses might have dropped in the immediate transition as income was directly tied to revenue. However, many of the providers who left started to return and the rest of the EM physicians in the BID network filled the gap. They are recruiting at present to fill the remaining slots for July.

I suppose paranoia is a healthy frame of mind in EM but anyone can call the new director, Jen Pope, and ask about what a job would pay since there are still positions for July. Once a practice like this fills, there is usually very little turn over. Or ask Mike Burns at St V or Paul Paganelli at Milton about jobs since both practices have record growths and may be looking as well.

Sometimes, good things do happen.

 

[Birdstrike]

Actually, that salary is similar to others in the BIDMC network at 32h/week. It is the same deal at BID Milton and St Vs. Its pretty much the reason that an ED like St Luke's can be staffed at very short notice. BIDMC itself is lower when you start, because there are only 18 clinical hours/week, the rest being dedicated to academic work. Agree those community BID sites are higher than the rest of the state, but when you actually pay the MDs what they make and keep admin costs down to a minimum, good things happen. Different practice models produce different results. If you work for a hospital or a single contract holder, or in any system with closed books, expect to make less.

In the last months at St Luke's, the former group was desperate to hold on to the few remaining full timers as people were leaving in droves. They started offering hourly rates that were very high so it is true that moonlighting rate and bonuses might have dropped in the immediate transition as income was directly tied to revenue. However, many of the providers who left started to return and the rest of the EM physicians in the BID network filled the gap. They are recruiting at present to fill the remaining slots for July.

I suppose paranoia is a healthy frame of mind in EM but anyone can call the new director, Jen Pope, and ask about what a job would pay since there are still positions for July. Once a practice like this fills, there is usually very little turn over. Or ask Mike Burns at St V or Paul Paganelli at Milton about jobs since both practices have record growths and may be looking as well.

Sometimes, good things do happen.

(Edit: I have no specific involvement of the parties involved in the cited article, and no specific knowledge of the events as stated. The opinions and statements below are made in general and do not have any direct application to the groups, physicians or parties involved.)


When I read about a group of ER doctors getting fired over metrics and patient sat, it bothers me. Like I wrote above, I was speculating about the rest, and I will not speculate any more. If they truly are being hired back with a better deal then that's great.

 

[EctopicFetus]

We all know the truth. It isnt gonna be better. One of two things happened the bigger academic group sold them on some bs and they used this as an excise. It isnt rare for academic groups to staff some community hospitals to allow their docs to make a little more money since academics in a lot of ways doesnt pay great.

 

[Haemr Head]

Wanna bet?

 

[Janders]

Man, you guys made me dust off my password to log in...

What the big man says is true. He's the boss of the network. He likes democratic open book groups. He gets what he wants.

The way the BI model works, either at a community or an academic site, as he points out above:
You contract for, say, 1500 hours.
They know that should pay (pulling # out my arse) $275,000, based on estimates at your location.

So that is what you get.

THEN every quarter, they reconcile ALL of your revenue. Subtract out your overhead (set democratically by your group) and you get to keep any extra that you EARNED.

i.e. the hospital doesn't take a cut. The administrators don't take any extra cut over what you voted them to get.

The overhead rate is low. The billings are ALL yours. The policies are democratic. It is run by doctors. Yes, we doctors occasionally have to pay lip service to things like press-gainey, quality markers, core measures, and whatever. But that is certainly driven by the individual hospital setting you are in, NOT by the ED group.

Anyway, there are a lot of models for EM groups. If you want to be a hospital employee, there are plenty of jobs. If you want to join a private group with closed books that one day once you (maybe) make partner you get to see, there are plenty of jobs. If you want a democratic open-book from day one group... this is a job for you.

I do think the initial article above doesn't, of course, give you any of the important details about this transition.

 

[EctopicFetus]

Wanna bet?

Whats the bet? BTW I assure you the academic folk arent making out as well as community docs.. If not for money why would BIDMC take over this contract?

Discuss..

 

[EctopicFetus]

I do think the initial article above doesn't, of course, give you any of the important details about this transition.

Help us out..

 

[Janders]

Help us out..

I think I've given you all the details you'd need about the new groups organization and financial set up, but ask if you have more questions.

As far as the reasons for the transition, I can't say I know all the dirt. From what I understand, the old group was having issues with physician retention for a variety of reasons, and some type of disagreements with the hospital. They were given notice that the hospital was cancelling their contract. BI had a long-standing relationship with that ER (sending residents there, some attendings moonlit there), and for a time helped shore up the staffing with moonlighters, but once the old group ceased to function, offered their services creating a new democratic group, retaining those from the old group that wanted to stay (versus allowing, say, a MegaGroup to come in and take over the contract).

Slightly different than showing up unannounced and low-balling the contract, or such.

I am absolutely sure there is more to it, and different sides of the story, but that is really all I know.

Certainly if I DIDN'T have inside knowledge, reading that article would make me think that the old group was forced out due soley to being unboarded press-gainey flunkers... which I agree is scary. I don't like PG. I still read the weekly comments I get from PG, but I don't like it!

 

[Arcan57]

I think I've given you all the details you'd need about the new groups organization and financial set up, but ask if you have more questions.

As far as the reasons for the transition, I can't say I know all the dirt. From what I understand, the old group was having issues with physician retention for a variety of reasons, and some type of disagreements with the hospital. They were given notice that the hospital was cancelling their contract. BI had a long-standing relationship with that ER (sending residents there, some attendings moonlit there), and for a time helped shore up the staffing with moonlighters, but once the old group ceased to function, offered their services creating a new democratic group, retaining those from the old group that wanted to stay (versus allowing, say, a MegaGroup to come in and take over the contract).

Slightly different than showing up unannounced and low-balling the contract, or such.

I am absolutely sure there is more to it, and different sides of the story, but that is really all I know.

Certainly if I DIDN'T have inside knowledge, reading that article would make me think that the old group was forced out due soley to being unboarded press-gainey flunkers... which I agree is scary. I don't like PG. I still read the weekly comments I get from PG, but I don't like it!

Unboarded PG flunkers are on the way out and groups with a high percentage (say 30%?)of them in areas with competition are going to lose their contracts. Being slow and pissing off patients isn't acceptable in 2013. While I don't agree with using PG as a criteria for termination, customer service is a critical action for an EP and a doc that is continuously generating valid patient complaints should expect to lose their job. Likewise, I don't have a lot of sympathy for the docs that are paid hourly and are seeing 1.2-1.4 pph and order million dollar work-ups on every patient and are claiming that they're being pressured into practicing unsafely when confronted with how far their practice pattern is from the norm.

 

[Birdstrike]

Unboarded PG flunkers are on the way out and groups with a high percentage (say 30%?)of them in areas with competition are going to lose their contracts. Being slow and pissing off patients isn't acceptable in 2013. While I don't agree with using PG as a criteria for termination, customer service is a critical action for an EP and a doc that is continuously generating valid patient complaints should expect to lose their job. Likewise, I don't have a lot of sympathy for the docs that are paid hourly and are seeing 1.2-1.4 pph and order million dollar work-ups on every patient and are claiming that they're being pressured into practicing unsafely when confronted with how far their practice pattern is from the norm.

Agree. The key word is valid.

 

[Birdstrike]

Also, if your ED is at max capacity with a waiting room log-jam, increasing satisfaction to drive more patients into a packed waiting room is futile. I never understood it. Sure, if you have an empty waiting room, that's one thing, but most EDs are at or near max capacity. So obsessing about patient sat to attract more patients without increasing capacity is pointless and does nothing, but create longer wait times which the staff are then flogged for, torturing them for no gain to anyone. Now, if they are under performing (1.2-1.4 pph) that's one thing, but how many EM groups, ABEM boarded or not, are averaging only 1.2-1.4 pph? Does such a place exist?

That being said, with increased burdens, such as EMR, physician order entry, continued medicolegal requirements, increased acuity, boarding patients, are the days 1.2 patient per hour EDs coming?

 

[EctopicFetus]

to Haemr and Janders..

Ill keep my opinions simple.. I am all for true democratic groups. If the original group was some dude payng people crap and keeping all the profits then I am happy they are gone. If BIDMC offers some great deal thats great too.

While I may be an idealist I would hope only 2 systems existed. An academic (resident staffed) group and private democratic group. Any other staffing model I find to be highly unfair. Perhaps this is naive but I think people profiting off of our labor besides us is wrong.

 

[WilcoWorld]

Also, if your ED is at max capacity with a waiting room log-jam, increasing satisfaction to drive more patients into a packed waiting room is futile.

This is simple, true, and it would make an administrator's head explode like a Star Trek robot presented with a paradox.

Gosh, I'd like to see that.

 

[deleted65604]

Any other staffing model I find to be highly unfair. Perhaps this is naive but I think people profiting off of our labor besides us is wrong.

Is it wrong for the Chevrolet Company to profit off the labor of factory workers? Is it wrong for a farmer to profit off the labor of field workers? Is is wrong for the owner of a McDonald's company to profit from the labor of fast-food workers?

If a company decides to take on the herculean task of obtaining a contract, recruiting physicians, billing, etc., then they are certainly due the just rewards of their sacrifice. The same applies to a store owner who makes a huge investment, gives blood, sweat and tears in order to get a well-functioning restaurant up and running... that owner has the right to profit off that investment.

I for one have no intention at this point in my life of putting up a second mortgage on my home in order to raise capital to start a private, democratic group. I will happily show up to work, put in my hours and then go home. I don't care if we lose the contract, I'd work for whoever got the contract next.

The vilification of corporations is simple-minded and smacks of anti-capitalism. I have been on the partnership in a "democratic group". It was pure hell and there was far more manipulation of employees than I currently experience as an employee of a mega-staffing corporation.

The only "right" an employee has is to dictate the terms of the initial contract. After that, the employee can go elsewhere to work if they feel they aren't getting market-value compensation for their labors.

 

[Arcan57]

If a company decides to take on the herculean task of obtaining a contract, recruiting physicians, billing, etc., then they are certainly due the just rewards of their sacrifice. The same applies to a store owner who makes a huge investment, gives blood, sweat and tears in order to get a well-functioning restaurant up and running... that owner has the right to profit off that investment.

This. The lag time between obtaining a contract and being at full revenue is substantial and whoever gets the contract is having to float between 3 and 6 mos of physician salary and administrative overhead, and that's assuming that you aren't going to have to pay sign on bonuses to get your docs. The CMGs obviously have a large war-chest that facilitates this, but most new private groups are going to have people that are putting in money up-front and are going to expect to have a return on their investment. Nobody's going to plop down their own money and go through the risk of acquiring a contract without some reward over and above what they'll make working shifts. Now if you can get a group of docs together and they split the start-up costs then that's great, but what do they do when they need to hire new docs? Hence things like partnership tracks or buy-ins. However as the actual costs for the new docs become fuzzier with the start-up costs in the long-ago, I'm sure it becomes tempting to start skimming off the new hires and you get the abusive situations that can crop up even in "democratic" groups.

 

[EctopicFetus]

Response in bold

Jarabacoa;13613820]Is it wrong for the Chevrolet Company to profit off the labor of factory workers? Is it wrong for a farmer to profit off the labor of field workers? Is is wrong for the owner of a McDonald's company to profit from the labor of fast-food workers? I this your comparison is false. the laborer at Chevrolet only puts on the tire. The ED doc does all the work (patient care) everything else can and is (in the CMGs case) outsourced.

If a company decides to take on the herculean task of obtaining a contract, recruiting physicians, billing, etc., then they are certainly due the just rewards of their sacrifice. The same applies to a store owner who makes a huge investment, gives blood, sweat and tears in order to get a well-functioning restaurant up and running... that owner has the right to profit off that investment. There is no sacrifice. Obtaining a contract in a lot of ways is just promising a bunch of things to the hospital. Billing can and usually is outsourced. The CMGs dont give up blood sweat and tears. Thats the EP who is getting "raped" by business people.

I for one have no intention at this point in my life of putting up a second mortgage on my home in order to raise capital to start a private, democratic group. I will happily show up to work, put in my hours and then go home. I don't care if we lose the contract, I'd work for whoever got the contract next. Dont. Get a business loan. It is easy to pay back. Curious if you could earn 25% more would you still feel this way? Especially knowing you could control your day to day much more? you would limit physician burnout (going into admin is one of the long list)

The vilification of corporations is simple-minded and smacks of anti-capitalism. I have been on the partnership in a "democratic group". It was pure hell and there was far more manipulation of employees than I currently experience as an employee of a mega-staffing corporation. Its far from simple minded. The corporate practice of medicine is bad for your patients. Perhaps your dem group wasnt all that democratic. Perhaps its not for everyone. I concede that. I just despise these guys profiteering off the work of my colleagues. I may see it simply cause my job is good. The corporations in EM are leeches IMO. They provide no tangible benefit.

The only "right" an employee has is to dictate the terms of the initial contract. After that, the employee can go elsewhere to work if they feel they aren't getting market-value compensation for their labors. I agree. its just that the current market is artificially suppressed by these guys. Whatever makes you guys happy. Its not an issue for me. I believe as long as you know what you are signing up for it all fair. Like you said if you hate it then quit. about 50% of new grads do within 2 years of taking that 1st job.[/QUOTE]