"How Private Equity Is Ruining American Health Care."

[Redpancreas]

I disagree. I think nurses deserve high salaries. The extent is debatable.

Nurses do all the following:

1.) Start IVs, draw blood in urgent settings. Some physicians can do this, but not all are willing/able to. Phlebotomists only come qAM and oftentimes mess up.
2.) Serve as a human in the otherwise automated medical world we have developed. We order labs and there's a glitch. Who realizes it? The nurse who then makes the right decision. We order fluids and lasix on a HF patient. Who realizes it?
3.) Communicate with the patients on our behalf. When patients are upset with their care, nurses know their patients extremely well and can communicate 90% of the care plan and know when to contact a physician.
4.) Serve as our eyes and ears. They are always the first to detect when things are off.

Nurses have technical skills:

1.) They have structured clinical skills evaluations before they're allowed to place lines, carry their own patients, etc. These supercised clinical evaluations are way more robust than what we have in medical school.
2.) Nurses have several standardized protocols and knowledge about different hospital hardware that most IM residents still don't know even after they graduate residency.

Seeing a lot of downvotes for this and I think the bolded is the area of contention. I can give examples if needed.

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[Lem0nz]

Seeing a lot of downvotes for this and I think the bolded is the area of contention. I can give examples if needed.

I can count the number of residents I have met on one single hand who can make an IV stop saying air in line and start actually working again (hitting silence doesn't count). It is not selective to IM. Anesthesia doesn't count.

Hint: They were all former nurses. XD

 

[sunshinefl]

I can count the number of residents I have met on one single hand who can make an IV stop saying air in line and start actually working again (hitting silence doesn't count). It is not selective to IM. Anesthesia doesn't count.

Hint: They were all former nurses. XD

Okay but they’re two different jobs???

 

[Redpancreas]

Okay but they’re two different jobs???

Exactly. I was replying to this:

"The bloat is the 100k salary for a nurse who has a bachelors degree and whose skills are not that technical.. You. And there are nothing but nurses around . Not to mention the salaries of other support staff that dont even treat or talk to patients. And last but not least, all the administrators who are utterly useless, who everything they try to engineer makes things worse.."

 

[sunshinefl]

Exactly. I was replying to this:

"The bloat is the 100k salary for a nurse who has a bachelors degree and whose skills are not that technical.. You. And there are nothing but nurses around . Not to mention the salaries of other support staff that dont even treat or talk to patients. And last but not least, all the administrators who are utterly useless, who everything they try to engineer makes things worse.."

Oh yeah I disagree with that for sure. They are skilled professionals of nursing. Just also saying doctor doesn’t equal nurse + something else.

 

[Aheadbyacentury]

I can count the number of residents I have met on one single hand who can make an IV stop saying air in line and start actually working again (hitting silence doesn't count). It is not selective to IM. Anesthesia doesn't count.

Hint: They were all former nurses. XD

umm,, are you saying that clearing a line of air is somehow rocket science.. CMON dude. Are you even in medicine?

 

[Lem0nz]

umm,, are you saying that clearing a line of air is somehow rocket science.. CMON dude. Are you even in medicine?

No, I'm saying 99/100 residents don't know how to program an Alaris pump. My subtext was not rocket science either. Can you even read?

 

[Aheadbyacentury]

No, I'm saying 99/100 residents don't know how to program an Alaris pump. My subtext was not rocket science either. Can you even read?

Again, is programming an Alaris pump rocket science?

 

[Lem0nz]

Again, is programming an Alaris pump rocket science?

You know what man, you're right. Let's drop the salary of nurses about 50k because they definitely aren't worth it, what they do isn't rocket science.

When they ALL start working like unionized NYC nurses and say they refuse to draw labs and run the IVs and dump it on your residents, you can explain to them that "man, it isn't rocket science, just go get it done, we can't control them. Don't be such a bitch about it."

Your residents gonna love that. Make sure someone youtubes it when they tell you to eff off and go do it yourself because you're the tool who thinks a nurse has no value.

Like... I can't. How did you become an attending physician?

 

[Redpancreas]

Again, is programming an Alaris pump rocket science?

Obviously not. This all started because I had the gall to point out oftentimes residents don't know patient hardware (lines, tubes, etc.) that well. Nurses have to for their job in addition to a bunch of other things. It's a pretty technical job. They do that in addition to a lot of other small things. Are these skills rocket science? No...the same can be said about reading a CBC and BMP in the morning and figuring out what they mean. In addition, the job's stressful and they're hearing it from their supervisors, residents, attendings, nurse managers, patient families, etc. I just think they deserve high compensation. Maybe that's 80K instead of 100K.

 

[GastriqueGraffin]

I don’t even understand what this conversation has devolved into. Everyone is worth whatever they are willing to accept for the job. We don’t (yet) live in a centrally planned economy that assigns a $ to a profession.

 

[Aheadbyacentury]

the job's stressful and they're hearing it from their supervisors, residents, attendings, nurse managers, patient families, etc. I just think they deserve high compensation. Maybe that's 80K instead of 100K.

Lots of jobs are stressful. Stress is not a barometer of how much you should get paid.

 

[NicMouse64]

Lots of jobs are stressful. Stress is not a barometer of how much you should get paid.

The word "should", I think SHOULD be taken out of the conversation about compensation. What something should pay and what they do are very rarely alligned.

 

[ChiDO]

The problem is hospitals are too big. Too much administration. If done correctly, I think PE could be very lucrative.

We run a 7 or physician owned ASC, multispecialty and we have 1 manager/ceo/admin/etc. The place runs flawlessly, we bonus all the staff yearly based on our success and everyone wants to work there. Out staff turns rooms over quickly, we can do addon cases at 6 am or 6pm without issues.

Furthermore, PE can help by bringing tech to billing, pre-certification and other parts of the business. We use a PE backed billing company that uses AI to find and sort through claims that are expiring, expedite precert, and decrease AR. Basically, they're finding 10-20% extra $$"that would just be written off and expired.

I do agree that selling out to PE is the bad version of PE and a huge mistake. Losing control or screwing over junior partners for a golden parachute is sad.

 

[Lawpy]

The problem is hospitals are too big. Too much administration. If done correctly, I think PE could be very lucrative.

We run a 7 or physician owned ASC, multispecialty and we have 1 manager/ceo/admin/etc. The place runs flawlessly, we bonus all the staff yearly based on our success and everyone wants to work there. Out staff turns rooms over quickly, we can do addon cases at 6 am or 6pm without issues.

Furthermore, PE can help by bringing tech to billing, pre-certification and other parts of the business. We use a PE backed billing company that uses AI to find and sort through claims that are expiring, expedite precert, and decrease AR. Basically, they're finding 10-20% extra $$"that would just be written off and expired.

I do agree that selling out to PE is the bad version of PE and a huge mistake. Losing control or screwing over junior partners for a golden parachute is sad.

I think a lot of doctors aren't business savvy

 

[Neopolymath]

I think a lot of doctors aren't business savvy

Most physicians are not business savvy and many of them don't have personal finance skills either (this is slowly changing) and an alarming number have deficiencies in basic life skills, frankly.

Mix that with a bunch of woke med students graduating who don't want to do the work to retain control of their practice (and field) and you have the perfect storm for PE takeover.

The ones who want to do as little as possible make it even harder for those that do because of consolidation.

 

[Splenda88]

Most physicians are not business savvy and many of them don't have personal finance skills either (this is slowly changing) and an alarming number have deficiencies in basic life skills, frankly.

Mix that with a bunch of woke med students graduating who don't want to do the work to retain control of their practice (and field) and you have the perfect storm for PE takeover.

The ones who want to do as little as possible make it even harder for those that do because of consolidation.

I think most physicians will take the plunge when every PE is like Envision or Teamhealth. I myself did not want to get into (or learn) the business side of medicine and it did not take me long to realize that in order to have a fulfilling career in medicine, I need to stay far away from PE.

I am not even an attending yet and I am already working on a plan to have my own practice after 2 yrs of being an attending.

 

[Crayola227]

Seeing a lot of downvotes for this and I think the bolded is the area of contention. I can give examples if needed.

For me it was the statement above that one.

 

[sunshinefl]

For me it was the statement above that one.

Oh ha I skipped over that one. Yeah I can say 100% that’s not accurate. And again, I was an RN before I was a doctor (eek! First time I said that!)

 

[Redpancreas]

Oh ha I skipped over that one. Yeah I can say 100% that’s not accurate. And again, I was an RN before I was a doctor (eek! First time I said that!)

How so? From my understanding there’s a dedicated period of time where they’re literally next to a senior nurse and they learn every little thing the nurse does on a shift. Then they are tested multiple times with someone holding a clipboard with a standard checklist. Their clinical experience starts right away. In terms of medical education, I don’t see why we need two years of didactic education much of which is unrelated to clinical medicine before touching a patient. We can still have all those didactic components but integrate have them while a student is on their clerkship.

 

[PikminOC]

Most physicians are not business savvy and many of them don't have personal finance skills either (this is slowly changing) and an alarming number have deficiencies in basic life skills, frankly.

Mix that with a bunch of woke med students graduating who don't want to do the work to retain control of their practice (and field) and you have the perfect storm for PE takeover.

The ones who want to do as little as possible make it even harder for those that do because of consolidation.

New students are being indoctrinated to be providers. The pump has nothing to do with medical expertise.

And this is the med student forum. They will learn all the negative stuff about medicine at some point and the level of responsibility. Let them be Pollyanna for now.

It is unprofessional to strike and harm patients via strike.

 

[PikminOC]

Oh ha I skipped over that one. Yeah I can say 100% that’s not accurate. And again, I was an RN before I was a doctor (eek! First time I said that!)

Have you completed your osteopathic school all the step exams and residency?

 

[Lawpy]

Have you completed your osteopathic school all the step exams and residency?

I think you're restricting a doctor to mean attending even though med school graduates are doctors

 

[PikminOC]

I think you're restricting a doctor to mean attending even though med school graduates are doctors

I am asking a question

 

[PikminOC]

I think you're restricting a doctor to mean attending even though med school graduates are doctors

Chiropractors and psychologist are doctors too. So what

 

[Redpancreas]

Have you completed your osteopathic school all the step exams and residency?

You two actually have similar views on NPPs tbh. To answer the question I think this poster is has done about half of the above.

 

[Redpancreas]

Chiropractors and psychologist are doctors too. So what

Chiropractors are not doctors, but massage therapists. Psychologists are doctorates and shouldn’t use that term in a clinical setting. What’s your beef with psychologists? They go through a 5 year school, internship, and often time residencies and a large majority don’t Rx medications or want to.

 

[PikminOC]

Chiropractors are not doctors, but massage therapists. Psychologists are doctorates and shouldn’t use that term in a clinical setting. What’s your beef with psychologists? They go through a 5 year school, internship, and often time residencies and a large majority don’t Rx medications or want to.

It's not a beef with either. Just explaining other people who are doctors. And psychologists do use the term in a clinical why shouldn't they? Chiros are doctors too. Dentists are too.

 

[sunshinefl]

How so? From my understanding there’s a dedicated period of time where they’re literally next to a senior nurse and they learn every little thing the nurse does on a shift.

Never happened at my school at least. (Plus not sure how you’re arguing that shadowing as you’re describing here would be better?) Edit: maybe you’re talking about how at the very end of the program you have like a 4 week period to work 12 shifts with a nurse preceptor you’re assigned to. It was more akin to a resident/med student relationship but nursing wise. Like you aren’t shadowing, or just having someone pop in 20 mins a day to chalkboard talk, more like when you are a med student and go see patients on your own and then kinda go over it with your resident, and then see the patient together sometimes, and then work on charting side by side.

Then they are tested multiple times with someone holding a clipboard with a standard checklist.

Well for a few things yes. I also had that in medical school though.

Their clinical experience starts right away. In terms of medical education, I don’t see why we need two years of didactic education much of which is unrelated to clinical medicine before touching a patient. We can still have all those didactic components but integrate have them while a student is on their clerkship.

Well this is one thing I go back and forth on. I did think for nursing school that having didactic and clinical concurrent the whole time was better, and kind of missed that in med school. But, medicine is more cognitive work than technical skills (ignoring procedural specialties but that’s in residency more so. I’m talking about foundational medicine.) I don’t know how exactly that could work for medical school. My school did have us go to primary care office 1/2 day every 2 weeks, so that’s something. And I can still remember distinct things that I learned during M1 from that experience. Maybe if that was like a whole day a week during preclinical years? Not sure.

But anyway, by saying “they do clinical the whole time” in nursing school, yes part of the week. But you might have classroom days mon, tues, thurs and clinical days wed, fri. It’s not like nurses spend more time in clinical training just because it’s mixed into the whole time. And then you also lose continuity of patients/cases/learning because you’re jumping back and forth. And whatever you’re learning in the classroom may or may not even correlate to the clinical experience.

Have you completed your osteopathic school all the step exams and residency?

I have just graduated so yes I have completed osteopathic medical school, level 1, level 2, step 1, step 2. I have not take comlex 3 or step 3 or completed residency, which I start in a month.

I never said I was an attending, so I’m not sure what your point is.

but even without having completed residency I could compare going through nursing school and medical school and say that statement was not correct. Completing residency training will only add to the disparity in the direction of my point.

 

[Redpancreas]

It's not a beef with either. Just explaining other people who are doctors. And psychologists do use the term in a clinical why shouldn't they? Chiros are doctors too. Dentists are too.

Dentists yes in their clinical setting. Podiatrists absolutely in any clinical setting. Chiropractors are not doctors. Psychologists are professionals (doctorate degree holders). I suppose I am biased because my partner is a psychologist who eventually wants to prescribe medications.

Chiropractors do not make evidence based diagnoses, and in many instances, delay medical care for back pain. Their technique is a combination of massage therapy. Their manipulations are basically OMM but a shot gun approach.

Never happened at my school at least. (Plus not sure how you’re arguing that shadowing as you’re describing here would be better?)

Well for a few things yes. I also had that in medical school though.

Well this is one thing I go back and forth on. I did think for nursing school that having didactic and clinical concurrent the whole time was better, and kind of missed that in med school. But, medicine is more cognitive work than technical skills (ignoring procedural specialties but that’s in residency more so. I’m talking about foundational medicine.) I don’t know how exactly that could work for medical school. My school did have us go to primary care office 1/2 day every 2 weeks, so that’s something. And I can still remember distinct things that I learned during M1 from that experience. Maybe if that was like a whole day a week during preclinical years? Not sure.

But anyway, by saying “they do clinical the whole time” in nursing school, yes part of the week. But you might have classroom days mon, tues, thurs and clinical days wed, fri. It’s not like nurses spend more time in clinical training just because it’s mixed into the whole time. And then you also lose continuity of patients/cases/learning because you’re jumping back and forth. And whatever you’re learning in the classroom may or may not even correlate to the clinical experience.

Thank you for this. This is an opinion I was looking for for a while.

 

[Crayola227]

Have you completed your osteopathic school all the step exams and residency?

You don't have to complete residency to be called a physician or by the honorific doctor. Completion of osteopathic or allopathic med school is all.

 

[Crayola227]

Chiropractors and psychologist are doctors too. So what

But no one said they are physicians. No one said they were doctors of medicine.

 

[Crayola227]

You two actually have similar views on NPPs tbh. To answer the question I think this poster is has done about half of the above.

They are my friend and they have completed all their graduation requirements and taken the oath, they said this in another thread on SDN. The graduation ceremony already took place. They also matched and have packed for residency.

Not directed at you, but there is no reason to be rude to a fellow physician over the simple fact they are a physician.

 

[Redpancreas]

They are my friend and they have completed all their graduation requirements and taken the oath, they said this in another thread on SDN. The graduation ceremony already took place. They also matched and have packed for residency.

Not directed at you, but there is no reason to be rude to a fellow physician over the simple fact they are a physician.

I like him/her too even though they own the most dislikes for my posts from midlevel threads and C/O 2021 group for some comments I made but I look forward to reading his/her opinions when she posts them. I was just answering the question semi-anonymously. I know more about him/her from past threads than I posted above and he/she has provided me with emotional support too in the past.
Edit: missed the not directed at me.

 

[Crayola227]

I have no issue with most doctors of chiropractic but the ones I have worked with in my neck of the woods are fairly good with what they do promoting basic wellness/addressing lifestyle like diet, smoking cessation, exercise. Musculoskeletal medicine is notoriously difficult to address, there's a lot we don't know and a lot of studies need done. I haven't seen them delay treatment for back pain but that's because usually people do see a regular MD before they see a chiropractor. But I see a role for manual manipulation in treatment of some kinds of pain, but I'm sort of a maverick among MDs for how much I am an ally of a very specific kind of chiropractic practice.

But it's no skin off my back that doctors of dentistry, psychology, or chiropractic are called as such. It's usually obvious when you interact with them what domain it is that they're doctor of. Calling doctors of jurisprudence doctor feels a little silly.

Doctor Nurses are a real issue because of the sphere they work in. And I hate when NPs and PAs are called doctor because that's just flat out wrong.

 

[Crayola227]

I like him/her too even though they own the most dislikes for my posts from midlevel threads and C/O 2021 group for some comments I made but I look forward to reading his/her opinions when she posts them. I was just answering the question semi-anonymously. I know more about him/her from past threads than I posted above and he/she has provided me with emotional support too in the past.
Edit: missed the not directed at me.

To be fair I edited it in probably after you replied.

 

[Splenda88]

Chiropractors are not doctors, but massage therapists. Psychologists are doctorates and shouldn’t use that term in a clinical setting. What’s your beef with psychologists? They go through a 5 year school, internship, and often time residencies and a large majority don’t Rx medications or want to.

Do you have a significant other who is a psychologist?

 

[Redpancreas]

Do you have a significant other who is a psychologist?

maybe...

 

[Lem0nz]

I feel like this thread is off topic. So, something something private equity.

Or if we aren't going to talk about that how about we circle back to the murder at least...

 

[Crayola227]

I feel like this thread is off topic. So, something something private equity.

Or if we aren't going to talk about that how about we circle back to the murder at least...

It's not murder. It's just the way that physicians work in a rush is very, very, bad for patients and there's nothing controversial about that, doctors know this. All kinds of great stats on the fact a physician spends like an average of 3 min prescribing a new medication. And then abysmal compliance rates.

That's one example of the industry crush physicians are subject to.

 

[arjusmc]

I think a lot of doctors aren't business savvy

Truthfully, a lot of doctors aren't good at anything but medicine.

 

[arjusmc]

But no one said they are physicians. No one said they were doctors of medicine.

Chiros say they are physicians. I don't agree, but their pts are normalized to the thought of it. It blurs the lines.

 

[Splenda88]

Only Physicians, dentists, podiatrists, (maybe optometrists) should be allowed to call themselves doctors in healthcare settings.

 

[Captain_Falcon]

Only Physicians, dentists, podiatrists, (maybe optometrists) should be allowed to call themselves doctors in healthcare settings.

Definitely not optometrists, agreed with the rest

 

[Cranjis McBasketball]

Definitely not optometrists, agreed with the rest

Just curious: why dentists yes but optometrists no? Arent they both a 4 year education with similar training structures?

 

[Captain_Falcon]

Just curious: why dentists yes but optometrists no? Arent they both a 4 year education with similar training structures?

The training is wide and variable, and the degree of things missed regularly is dangerous to people's health. Speaking from personal family experience.

Dental school has far greater standards for admissions as well. I'm not sure how many total O.D. schools there are but when you have other far better trained individuals in the same field that actually manage medical conditions (insert gen ophtho and all sub specialties) you cannot be called doctor in my eyes.

Dentists do a full blown residency, I don't believe optometrists have that kind of extensive training.

 

[Rekt]

The training is wide and variable, and the degree of things missed regularly is dangerous to people's health. Speaking from personal family experience.

Dental school has far greater standards for admissions as well. I'm not sure how many total O.D. schools there are but when you have other far better trained individuals in the same field that actually manage medical conditions (insert gen ophtho and all sub specialties) you cannot be called doctor in my eyes.

Dentists do a full blown residency, I don't believe optometrists have that kind of extensive training.

They're also pushing for surgeries they're incapable of understanding, performing safely or even doing correctly. They have ophto in a tight spot because every ophto that fights them is at significant risk of losing a chunk of their referral volume.

It's very simple to me. The only people that are physicians are MD, DO, MBBS. That's it.

A podiatrist is a podiatrist. A dentist is a dentist. Optometrist is an optometrist.

 

[Splenda88]

They're also pushing for surgeries they're incapable of understanding, performing safely or even doing correctly. They have ophto in a tight spot because every ophto that fights them is at significant risk of losing a chunk of their referral volume.

It's very simple to me. The only people that are physicians are MD, DO, MBBS. That's it.

A podiatrist is a podiatrist. A dentist is a dentist. Optometrist is an optometrist.

It's true that dentists (DDS/DMD) and podiatrists (DPM) are not physicians but I think it's ok for them to refer themselves as doctors in healthcare settings.

 

[PikminOC]

But no one said they are physicians. No one said they were doctors of medicine.

In Illinois chiropractors are considered physicians.

 

[Crayola227]

In Illinois chiropractors are considered physicians.

I stand corrected. Weird. I disagree with calling them physicians.