Lawsuit Alleges Practicing Physicians Block New Residency Program

[2021Doctor]

OrthoSC torpedoed residency program to maintain Myrtle Beach monopoly, lawsuit alleges
BY DAVID WEISSMAN UPDATED NOVEMBER 22, 2021 12:16 PM

A potentially prosperous orthopedic surgery residency program was shut down due to threats by a group of Myrtle Beach-area doctors who “did not want to be training their competition,” according to the former director of that program. Dr. Scott Duncan, a longtime orthopedic surgeon who was tasked with starting the graduate medical education program at Grand Strand Regional Medical Center, filed a lawsuit last week against his now-former employer and OrthoSC alleging illegal interference and civil conspiracy, among other claims. HCA Healthcare, the parent company of Grand Strand Regional Medical Center, recruited Duncan in 2017 from Boston, Massachusetts, where he was serving as chairman of the orthopedic surgery department for Boston Medical Center, to start and serve as director of a new residency program, the suit states.

But after OrthoSC was given a deadline to decide, one of its executive board members, Dr. Gene Massey, sent an email to the president of HCA’s Southeast Atlantic division threatening to pull all of their surgical cases from Grand Strand Regional Medical Center to one of their competitor’s hospitals if the residency program continued, Duncan alleges. “Massey also stated and represented to (the HCA division president) words to the effect that Defendant OrthoSC and its member doctors ‘did not want to be training their competition’ and that the GME program threatened Defendant OrthoSC’s monopoly in the relevant market in Myrtle Beach, Conway, and Murrells Inlet,” the complaint reads.

Read more at: https://www.myrtlebeachonline.com/news/local/article255930641.html#storylink=cpy

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[VA Hopeful Dr]

I'm not sure Myrtle Beach is busy enough for the programs it has much less something like Ortho.

 

[DarkHorizon]

Of course HCA wanted to increase the supply of orthopods. I’m glad that the group stood their ground and killed the program.

 

[Osminog]

Many doctors care far, far more about maintaining their monopoly power than they do about increasing patients' access to healthcare services. Some of these doctors can be found on this forum, sadly.

 

[VA Hopeful Dr]

Many doctors care far, far more about maintaining their monopoly power than they do about increasing patients' access to healthcare services. Some of these doctors can be found on this forum, sadly.

I'm not aware of an orthopedic shortage. I have never worked anywhere where it took more than 2 weeks for non-urgent Ortho referrals and more than 2 days for uncomplicated fractures.

This is in smaller areas in SC for context.

The question that needs to be asked before opening a new progr should be: do we need this?

Primary care? Definitely. Cardiology? Not really.

Endocrinology? Yes. Ortho? Not so much.

 

[DarkHorizon]

Many doctors care far, far more about maintaining their monopoly power than they do about increasing patients' access to healthcare services. Some of these doctors can be found on this forum, sadly.

Come back in 5-10 years and read what you just wrote.

 

[Osminog]

I'm not aware of an orthopedic shortage. I have never worked anywhere where it took more than 2 weeks for non-urgent Ortho referrals and more than 2 days for uncomplicated fractures.

This is in smaller areas in SC for context.

The question that needs to be asked before opening a new progr should be: do we need this?

Primary care? Definitely. Cardiology? Not really.

Endocrinology? Yes. Ortho? Not so much.

I'm sorry to hear that you're not aware of a shortage of orthopedic surgeons—or the inflated costs (and doctors' paychecks) that naturally stem from undersupply of medical care, disproportionally hurting socioeconomically disadvantaged patients. I hope that you eventually become more aware of what's actually going on so you can contribute to adult discussions on this topic, instead of just thoughtlessly thumbing-down others' posts.

"Do we need this?" you ask. Who exactly is "we"? Are you talking about established medical professionals? If so, then you're already approaching the issue from the wrong angle. The real question is whether it would benefit patients or not, and the answer is yes; it would benefit patients to have greater access to affordable healthcare, including orthopedic services. Also, as you're probably aware, there are many highly qualified applicants who don't match orthopedic surgery every cycle (either due to an unsuccessful application cycle or weeding themselves out through self-selection) and more residency spots would help more medical students achieve their dreams.

Read the article in the original post. Why were the established orthopedic surgeons worried about "training [their] competition"? If there isn't any room for additional orthopedic surgeons in their community, then why would the established surgeons think that future residents would eventually serve as their competition? If all of the community's orthopedic patients are being promptly seen and cared for by the current surgeons and there are no additional patients in need, then why would the established surgeons be worried about an influx of more surgeons?

Come back in 5-10 years and read what you just wrote.

I doubt that anything will happen in 5-10 years that will inspire me to stop prioritizing patient care over the thickness of my wallet.

 

[Hippocrates II]

I'm sorry to hear that you're not aware of a shortage of orthopedic surgeons—or the inflated costs (and doctors' paychecks) that naturally stem from undersupply of medical care, disproportionally hurting socioeconomically disadvantaged patients. I hope that you eventually become more aware of what's actually going on so you can contribute to adult discussions on this topic, instead of just thoughtlessly thumbing-down others' posts.

"Do we need this?" you ask. Who exactly is "we"? Are you talking about established medical professionals? If so, then you're already approaching the issue from the wrong angle. The real question is whether it would benefit patients or not, and the answer is yes; it would benefit patients to have greater access to affordable healthcare, including orthopedic services. Also, as you're probably aware, there are many highly qualified applicants who don't match orthopedic surgery every cycle (either due to an unsuccessful application cycle or weeding themselves out through self-selection) and more residency spots would help more medical students achieve their dreams.

Read the article in the original post. Why were the established orthopedic surgeons worried about "training [their] competition"? If there isn't any room for additional orthopedic surgeons in their community, then why would the established surgeons think that future residents would eventually serve as their competition? If all of the community's orthopedic patients are being promptly seen and cared for by the current surgeons and there are no additional patients in need, then why would the established surgeons be worried about an influx of more surgeons?




I doubt that anything will happen in 5-10 years that will inspire me to stop prioritizing patient care over the thickness of my wallet.

Because HCA is definitely going to shaft their newly trained orthos with salary cuts, and then pass those savings onto patients, right?

Er, wait...

 

[DarkHorizon]

I'm sorry to hear that you're not aware of a shortage of orthopedic surgeons—or the inflated costs (and doctors' paychecks) that naturally stem from undersupply of medical care, disproportionally hurting socioeconomically disadvantaged patients. I hope that you eventually become more aware of what's actually going on so you can contribute to adult discussions on this topic, instead of just thoughtlessly thumbing-down others' posts.

"Do we need this?" you ask. Who exactly is "we"? Are you talking about established medical professionals? If so, then you're already approaching the issue from the wrong angle. The real question is whether it would benefit patients or not, and the answer is yes; it would benefit patients to have greater access to affordable healthcare, including orthopedic services. Also, as you're probably aware, there are many highly qualified applicants who don't match orthopedic surgery every cycle (either due to an unsuccessful application cycle or weeding themselves out through self-selection) and more residency spots would help more medical students achieve their dreams.

Read the article in the original post. Why were the established orthopedic surgeons worried about "training [their] competition"? If there isn't any room for additional orthopedic surgeons in their community, then why would the established surgeons think that future residents would eventually serve as their competition? If all of the community's orthopedic patients are being promptly seen and cared for by the current surgeons and there are no additional patients in need, then why would the established surgeons be worried about an influx of more surgeons?




I doubt that anything will happen in 5-10 years that will inspire me to stop prioritizing patient care over the thickness of my wallet.

So HCA, out of everyone, has the best interest of patients in mind while starting a new program? I refer you to EM forum to see how they have decimated their field. I admire your idealism, but your post is full of naiveness on almost every point.

 

[VA Hopeful Dr]

I'm sorry to hear that you're not aware of a shortage of orthopedic surgeons—or the inflated costs (and doctors' paychecks) that naturally stem from undersupply of medical care, disproportionally hurting socioeconomically disadvantaged patients. I hope that you eventually become more aware of what's actually going on so you can contribute to adult discussions on this topic, instead of just thoughtlessly thumbing-down others' posts.

"Do we need this?" you ask. Who exactly is "we"? Are you talking about established medical professionals? If so, then you're already approaching the issue from the wrong angle. The real question is whether it would benefit patients or not, and the answer is yes; it would benefit patients to have greater access to affordable healthcare, including orthopedic services. Also, as you're probably aware, there are many highly qualified applicants who don't match orthopedic surgery every cycle (either due to an unsuccessful application cycle or weeding themselves out through self-selection) and more residency spots would help more medical students achieve their dreams.

Read the article in the original post. Why were the established orthopedic surgeons worried about "training [their] competition"? If there isn't any room for additional orthopedic surgeons in their community, then why would the established surgeons think that future residents would eventually serve as their competition? If all of the community's orthopedic patients are being promptly seen and cared for by the current surgeons and there are no additional patients in need, then why would the established surgeons be worried about an influx of more surgeons?




I doubt that anything will happen in 5-10 years that will inspire me to stop prioritizing patient care over the thickness of my wallet.

So your uncalled for condescension aside, lots of issues with this.

First, Merritt Hawkins and the AAMC both have conflicts of interest when it comes to physician workforce so you'll forgive me if I don't take their word for it.

Second, training more physicians of any type is a multifactorial issue. First and most importantly: can we adequately train more? Can existing programs expand without the quality of their graduates suffering? Do brand new programs offer sufficient training so that their graduates are of acceptable quality? If the quality goes down then even if the patients end up saving money I would not call that a fair trade. Second, if you pay the pysicians less, who keeps the money that used to go to them? As another poster noted, it's almost never the patient. EM and anesthesiology can attest to that. Third, ortho and neurosurgery in particular (they're all surgical fields have this issue to various degrees) have a large disconnect between the surgeons fees and all of the other fees. For example, for Medicare and orthopedic surgeon will receive around $1,300 for a total knee replacement. The total amount that Medicare will pay the hospital for that is around $13,000. So your surgeon fee is around 10% of the total cost. So total cost is $14,300 now. Cut the surgeon fee by 50% and the cost goes down to $13,650. Not a huge difference there.

 

[DOVinciRobot]

Good for them. HCA is a disease. Anyone who thinks any of these types of programs will decrease costs to the patient is engaging in delusional thinking. Physicians being paid a fair wage for the high risk and highly valuable service they provide is not the reason patients get gouged, despite whatever these healthcare conglomerates claim.

 

[Obnoxious Dad]

I'm sorry to hear that you're not aware of a shortage of orthopedic surgeons—or the inflated costs (and doctors' paychecks) that naturally stem from undersupply of medical care, disproportionally hurting socioeconomically disadvantaged patients. I hope that you eventually become more aware of what's actually going on so you can contribute to adult discussions on this topic, instead of just thoughtlessly thumbing-down others' posts.

"Do we need this?" you ask. Who exactly is "we"? Are you talking about established medical professionals? If so, then you're already approaching the issue from the wrong angle. The real question is whether it would benefit patients or not, and the answer is yes; it would benefit patients to have greater access to affordable healthcare, including orthopedic services. Also, as you're probably aware, there are many highly qualified applicants who don't match orthopedic surgery every cycle (either due to an unsuccessful application cycle or weeding themselves out through self-selection) and more residency spots would help more medical students achieve their dreams.

Read the article in the original post. Why were the established orthopedic surgeons worried about "training [their] competition"? If there isn't any room for additional orthopedic surgeons in their community, then why would the established surgeons think that future residents would eventually serve as their competition? If all of the community's orthopedic patients are being promptly seen and cared for by the current surgeons and there are no additional patients in need, then why would the established surgeons be worried about an influx of more surgeons?




I doubt that anything will happen in 5-10 years that will inspire me to stop prioritizing patient care over the thickness of my wallet.

This post times 10,000. Medicine, nursing and dentistry are cartels. They remind anyone, with a knowledge of history and economics, of the guilds of Florence. Their professional associations have done their level best to minimize internal and external competition. The closure of 1,250 hospital- based nursing diploma programs, the Flexner Report, the struggle by the dental profession against the licensure and employment of dental therapists, and obscenely high medical school tuition are just a few of many examples of this behavior.

Anybody who believes that the salaries of orthopedic surgeons have no impact on the price of orthopedic care is a fool. Sure, there might be a delay between the time salaries fall and prices fall but a change in salaries, higher or lower, will eventually impact the price of care.

 

[Wordead]

This post times 10,000. Medicine, nursing and dentistry are cartels. They remind anyone, with a knowledge of history and economics, of the guilds of Florence. Their professional associations have done their level best to minimize internal and external competition. The closure of 1,250 hospital- based nursing diploma programs, the Flexner Report, the struggle by the dental profession against the licensure and employment of dental therapists, and obscenely high medical school tuition are just a few of many examples of this behavior.

Anybody who believes that the salaries of orthopedic surgeons have no impact on the price of orthopedic care is a fool. Sure, there might be a delay between the time salaries fall and prices fall but a change in salaries, higher or lower, will eventually impact the price of care.

The disconnect here seems to be that you and the med student think that if there were say 10000 more ortho residency spots in the country that the end effect would be lower price of care and maintained quality of care.

Which everyone else thinks is dumb. Supremely naïve.

 

[Obnoxious Dad]

The disconnect here seems to be that you and the med student think that if there were say 10000 more ortho residency spots in the country that the end effect would be lower price of care and maintained quality of care.

Which everyone else thinks is dumb. Supremely naïve.

They think it's naive because most of the people on SDN have never cracked an economics book.

 

[Wordead]

They think it's naive because most of the people on SDN have never cracked an economics book.

Im glad economists have fixed healthcare oh wow if we had only known about supply and demand curves from your econ 101 class we could have fixed this years ago. Im glad it's such a simple topic.

 

[0ncogene]

This post times 10,000. Medicine, nursing and dentistry are cartels. They remind anyone, with a knowledge of history and economics, of the guilds of Florence. Their professional associations have done their level best to minimize internal and external competition. The closure of 1,250 hospital- based nursing diploma programs, the Flexner Report, the struggle by the dental profession against the licensure and employment of dental therapists, and obscenely high medical school tuition are just a few of many examples of this behavior.

Anybody who believes that the salaries of orthopedic surgeons have no impact on the price of orthopedic care is a fool. Sure, there might be a delay between the time salaries fall and prices fall but a change in salaries, higher or lower, will eventually impact the price of care.

This has been discussed over and over again at this year's annual AAOS and AAHKS meeting (yes, there is bias). As @VA Hopeful Dr have said, surgeon's fee for an orthopedic procedure is only a small portion of the overall cost. As presented at the recent AAHKS meeting in Dallas, TX, although Medicare reimbursement to hospitals have increased slightly over the years for a knee replacement, reimbursement for surgeon's fee have decreased.

I do not think decreasing the salary of orthopedic surgeons will make any significant impact on the cost of orthopedic care. And this can be applied to all specialties. Same reason why decreasing the salary of critical care surgeons will not significantly improve the cost of ICU care.

 

[Obnoxious Dad]

Im glad economists have fixed healthcare oh wow if we had only known about supply and demand curves from your econ 101 class we could have fixed this years ago. Im glad it's such a simple topic.

Economists didn't "fix" the cost of care politicians did.

 

[Hippocrates II]

This post times 10,000. Medicine, nursing and dentistry are cartels. They remind anyone, with a knowledge of history and economics, of the guilds of Florence. Their professional associations have done their level best to minimize internal and external competition. The closure of 1,250 hospital- based nursing diploma programs, the Flexner Report, the struggle by the dental profession against the licensure and employment of dental therapists, and obscenely high medical school tuition are just a few of many examples of this behavior.

Anybody who believes that the salaries of orthopedic surgeons have no impact on the price of orthopedic care is a fool. Sure, there might be a delay between the time salaries fall and prices fall but a change in salaries, higher or lower, will eventually impact the price of care.

I'm not even sure what to tell you if you think HCA is the one in the driver's seat trying to lower healthcare costs for patients by expanding programs. Just lol all around there.

Healthcare costs are a racket, but you're clearly angry at the wrong people.

 

[Obnoxious Dad]

This has been discussed over and over again at this year's annual AAOS and AAHKS meeting (yes, there is bias). As @VA Hopeful Dr have said, surgeon's fee for an orthopedic procedure is only a small portion of the overall cost. As presented at the recent AAHKS meeting in Dallas, TX, although Medicare reimbursement to hospitals have increased slightly over the years for a knee replacement, reimbursement for surgeon's fee have decreased.

I do not think decreasing the salary of orthopedic surgeons will make any significant impact on the cost of orthopedic care. And this can be applied to all specialties. Same reason why decreasing the salary of critical care surgeons will not significantly improve the cost of ICU care.

Part of the problem here is the utter lack of cost transparency. Everything is supposedly just a "small portion" of the cost. The fact that Americans pay about 50% more than Canadians for the common market basket of patented pharmaceuticals amounts to approximately $100 billion per year is just 2.5% of the total health care bill but it all hurts.

 

[DarkHorizon]

This post times 10,000. Medicine, nursing and dentistry are cartels. They remind anyone, with a knowledge of history and economics, of the guilds of Florence. Their professional associations have done their level best to minimize internal and external competition. The closure of 1,250 hospital- based nursing diploma programs, the Flexner Report, the struggle by the dental profession against the licensure and employment of dental therapists, and obscenely high medical school tuition are just a few of many examples of this behavior.

Anybody who believes that the salaries of orthopedic surgeons have no impact on the price of orthopedic care is a fool. Sure, there might be a delay between the time salaries fall and prices fall but a change in salaries, higher or lower, will eventually impact the price of care.

Is this a serious post? Are you even a physician? HCA is a for-profit organization with a terrible business model and has been fined by the government for Medicare fraud. Do you really believe that they have patients best interest in mind while starting new programs? This new program surely wouldn’t have undercut existing surgeons in the area.

You speak of Orthopedic surgeons salaries, what about hospital admin salaries? Who keeps track of that? I work for a non-profit health system and our CEO took a 3 million pay raise this year, to have “navigated us through COVId”. Our chief nursing officer is paid more than the highest paid physician in the system. The assistants to the CEO, who are all lawyers btw, are on average paid more than an average orthopod. WhT value do they bring in? I can’t even get a hold of anyone in the admin after 4pm. Physicians in our system are paid roughly 25th-40th percentile per unit of their work on national salary surveys, while our administrators are paid in 90th plus percentile. Yet, you blame physicians for price gouging and creating monopolies. Remember, patients come to see the physicians, not administrators. American healthcare has a ton of problems, physician salaries is not even in the top 10.

More power to the local ortho group for protecting their turf and standing up. I will side with physicians everyday of the week before any administrator.

 

[Chelsea FC]

I know they are significant barriers and its totally specialty-specific but I'm surprised more docs don't try and go private? That was a huge selling point when deciding what field I would settle in.

 

[Osminog]

Is this a serious post? Are you even a physician? HCA is a for-profit organization with a terrible business model and has been fined by the government for Medicare fraud. Do you really believe that they have patients best interest in mind while starting new programs? This new program surely wouldn’t have undercut existing surgeons in the area.

You speak of Orthopedic surgeons salaries, what about hospital admin salaries? Who keeps track of that? I work for a non-profit health system and our CEO took a 3 million pay raise this year, to have “navigated us through COVId”. Our chief nursing officer is paid more than the highest paid physician in the system. The assistants to the CEO, who are all lawyers btw, are on average paid more than an average orthopod. WhT value do they bring in? I can’t even get a hold of anyone in the admin after 4pm. Physicians in our system are paid roughly 25th-40th percentile per unit of their work on national salary surveys, while our administrators are paid in 90th plus percentile. Yet, you blame physicians for price gouging and creating monopolies. Remember, patients come to see the physicians, not administrators. American healthcare has a ton of problems, physician salaries is not even in the top 10.

More power to the local ortho group for protecting their turf and standing up. I will side with physicians everyday of the week before any administrator.

The bashing of HCA in some of the posts here is just a red herring. The physicians in the article aren’t taking a stand on the basis of HCA’s “terrible business model” or past legal liabilities. They’re explicitly taking a stand because they don’t want competitors. In other words, they want to continue to artificially limit patients’ options for their own financial gain. There’s no reason at all to think that they would be supportive of a potential residency program that were started by, say, a non-profit. They simply don’t want more orthopedic surgeons around to treat patients.

Regarding the topic of salaries: The artificially high salaries of American physicians are merely a symptom of a more serious underlying problem: the monopolization of healthcare services. And the physicians who are fighting for continued monopolization in order to keep their salaries artificially high (e.g., the physicians in the article) are contributing to this problem. Nobody here is saying that physician salaries in and of themselves are a “top 10” problem.

 

[DarkHorizon]

The bashing of HCA in some of the posts here is just a red herring. The physicians in the article aren’t taking a stand on the basis of HCA’s “terrible business model” or past legal liabilities. They’re explicitly taking a stand because they don’t want competitors. In other words, they want to continue to artificially limit patients’ options for their own financial gain. There’s no reason at all to think that they would be supportive of a potential residency program that were started by, say, a non-profit. They simply don’t want more orthopedic surgeons around to treat patients.

Regarding the topic of salaries: The artificially high salaries of American physicians are merely a symptom of a more serious underlying problem: the monopolization of healthcare services. And the physicians who are fighting for continued monopolization in order to keep their salaries artificially high (e.g., the physicians in the article) are contributing to this problem. Nobody here is saying that physician salaries in and of themselves are a “top 10” problem.

I’m sure any board certified or board eligible orthopedic surgeon can start up a shop/group and provide Ortho services. There’s nothing existing group can do to stop them. HCA starting a program is more nefarious. It’s a way for them to control referrals, surgeries, and supply of orthopedic surgeons in the area. In essence, they would eventually strong arm the existing group in either joining HCA, or run them out of town. See it happen all the time. And if you think that it’ll somehow benefit the patients locally, you’re sorely mistaken. Do you really believe that patients get billed less for seeing hospital employed physicians than PP physicians? Doubt there’s any shortage of Orthopods in the area.

 

[Osminog]

Im glad economists have fixed healthcare oh wow if we had only known about supply and demand curves from your econ 101 class we could have fixed this years ago. Im glad it's such a simple topic.

The issue isn’t so much that complicated, highly technical nuances invalidate basic laws of economics in the context of healthcare… You have to realize that economists aren’t in charge of policy-making. If they were, we wouldn’t have tariffs anymore, since a majority of economists on both sides of the political aisle are opposed to them. Alas, the theatre of populist politics often overshadows expert opinion.

 

[7331poas]

The issue isn’t so much that complicated, highly technical nuances invalidate basic laws of economics in the context of healthcare… You have to realize that economists aren’t in charge of policy-making. If they were, we wouldn’t have tariffs anymore, since a majority of economists on both sides of the political aisle are opposed to them. Alas, the theatre of populist politics often overshadows expert opinion.

I agree that medicine is a cartel in a certain sense given that physician societies artificially inflate their own salaries and limit the supply of graduating physicians.

However to offer a different perspective: Becoming a doctor takes over a decade of training. If doctors were paid their actual market value, there is no way any American would pursue training (unless they were rich).

Its a fact that American laws prohibit foreign doctors from competing in our labor markets. Its a fact that other countries pay their doctors dramatically less than doctors are paid here in the USA. Therefore, it is logical that doctors from third world countries would gladly come to the United States to work for salaries less than 60k. Doctors in third world countries are paid less than even nurses here in the US. Why wouldn't Regional Medical Center recruit from Cuba instead of MGH Transplant Surgery Graduate?

That leaves my final point, why would any American college graduate train to become a doctor so they would make an equivalent salary to a physician who works in Cuba? The answer is simple, no one would except for a very very small number.

If we really opened our labor markets in the way you are suggesting, no one would enter the field of medicine from US medical schools.

 

[VA Hopeful Dr]

Part of the problem here is the utter lack of cost transparency. Everything is supposedly just a "small portion" of the cost. The fact that Americans pay about 50% more than Canadians for the common market basket of patented pharmaceuticals amounts to approximately $100 billion per year is just 2.5% of the total health care bill but it all hurts.

Nope. Medicare rates for physicians and hospitals are very easy to find. I did it with less than 90 seconds of Googling.

Why bring drug costs into this particular thread?

 

[Obnoxious Dad]

Is this a serious post? Are you even a physician? HCA is a for-profit organization with a terrible business model and has been fined by the government for Medicare fraud. Do you really believe that they have patients best interest in mind while starting new programs? This new program surely wouldn’t have undercut existing surgeons in the area.

You speak of Orthopedic surgeons salaries, what about hospital admin salaries? Who keeps track of that? I work for a non-profit health system and our CEO took a 3 million pay raise this year, to have “navigated us through COVId”. Our chief nursing officer is paid more than the highest paid physician in the system. The assistants to the CEO, who are all lawyers btw, are on average paid more than an average orthopod. WhT value do they bring in? I can’t even get a hold of anyone in the admin after 4pm. Physicians in our system are paid roughly 25th-40th percentile per unit of their work on national salary surveys, while our administrators are paid in 90th plus percentile. Yet, you blame physicians for price gouging and creating monopolies. Remember, patients come to see the physicians, not administrators. American healthcare has a ton of problems, physician salaries is not even in the top 10.

More power to the local ortho group for protecting their turf and standing up. I will side with physicians everyday of the week before any administrator.

I'm not a physician. My kid is.

If you're working in a system that's as bad as you claim, maybe you should get another job.

The salaries of your administrative leeches are buttressed by the lack of competition among physicians. The anticompetitive practices of the healthcare professions make it easier for health care managers to corner the market, administer prices and pass the gouging up to themselves.

 

[Candidate2017]

Many doctors care far, far more about maintaining their monopoly power than they do about increasing patients' access to healthcare services. Some of these doctors can be found on this forum, sadly.

Newsflash: the ability to practice IS a state granted monopoly. For good reason. Used to be anyone could put up a shingle and claim to be a doctor, which society is now moving back towards.

But don't worry comrade. When you get into residency your hospital CEO, program, attendings, midlevels, and nurses will definitely be happy to utilize you and your fancy privileged medical degree to the maximum to increase patient access to healthcare. Days, nights, weekends, holidays. You may even have to ignore the 80 hour work week limit. Or you might be pulled off your training rotations and thrown into COVID wards without proper equipment. Because patient care and... reasons.

It'll be ok as long as you don't find out how much the attendings, program, and hospital are making off of you. Eh, screw it. Here you go: everyone is making millions off you (in this order: CEO >>>>> program >> med school > dept chair > attendings) and you will be deployed like a rented mule to the highest bidder and/or to do tasks no one else wants to do.

Anyway, this thread reminds me of 17 year olds discussing economics but have never worked a job in their life.

 

[Candidate2017]

I'm not a physician. My kid is.

If you're working in a system that's as bad as you claim, maybe you should get another job.

The salaries of your administrative leeches are buttressed by the lack of competition among physicians. The anticompetitive practices of the healthcare professions make it easier for health care managers to corner the market, administer prices and pass the gouging up to themselves.

User name checks out.

BTW I fully welcome competition in my field. It really helps to have a bunch of NP run clinics to which I can refer people who have self-proclaimed "adult ADHD".

 

[Spine MD]

I'm not sure Myrtle Beach is busy enough for the programs it has much less something like Ortho.

It’s plenty busy. Been there recently? Also no “academic” presence until MUSC for ortho. Elective procedures flourish in SC these days. Residents would get their trauma fill May-Sept every year and still have to ship some out.

However, just because MB could sustain it doesn’t mean they should. HCA has earned its murky rep fair and square. OrthoSC is a bustling practice and it makes sense they wouldn’t want to train more orthos to do more elective procedures and have trainees stick around once they realize they can make money and have a high QOL in a low COL region.

 

[nimbus]

Many doctors care far, far more about maintaining their monopoly power than they do about increasing patients' access to healthcare services. Some of these doctors can be found on this forum, sadly.

These are private practice doctors who like to do their own cases. If they like to train residents and want to teach, they would be in academics. Why should they be forced to change jobs? Some people like to teach and some don’t.

 

[dnyal]

Come back in 5-10 years and read what you just wrote.

I now understand the increasing number of hours of volunteering and humanitarian work that medical schools require applicants. I guess some will never be screened out.

 

[nimbus]

I now understand the increasing number of hours of volunteering and humanitarian work that medical schools require applicants. I guess some will never be screened out.

I think you have more impact if do humanitarian and volunteer work after you finish medical training. I’ve been volunteering for over 15 years. It’s funny that the vast majority of medical school faculty don’t do ANY volunteer work or community service even though they expect it from their applicants. Incredible hypocrisy. At your medical school interviews ask your interviewers about their volunteer experiences and how it influenced them…lol

 

[DarkHorizon]

I now understand the increasing number of hours of volunteering and humanitarian work that medical schools require applicants. I guess some will never be screened out.

Of course a pre med would say that.

 

[VA Hopeful Dr]

It’s plenty busy. Been there recently? Also no “academic” presence until MUSC for ortho. Elective procedures flourish in SC these days. Residents would get their trauma fill May-Sept every year and still have to ship some out.

However, just because MB could sustain it doesn’t mean they should. HCA has earned its murky rep fair and square. OrthoSC is a bustling practice and it makes sense they wouldn’t want to train more orthos to do more elective procedures and have trainees stick around once they realize they can make money and have a high QOL in a low COL region.

I'm a native of SC and still live here.

I'm going by size of hospital (Grand Strand is significantly smaller than MUSC and Prisma Upstate and Midlands, the places that have Ortho already).

Catchment area, I use MSA as a rough measure. Columbia, Charleston, and Greenville are all significantly larger by that measure.

 

[Lawpy]

Becoming a doctor takes over a decade of training. If doctors were paid their actual market value, there is no way any American would pursue training (unless they were rich).

Rich people are overwhelmingly making up med school classes. Med school admissions is pretty hostile to middle class and average Americans (and also to lower SES groups despite their claims to the contrary)

The situation wouldn’t change if physicians are suddenly paid their market value

 

[Lawpy]

I now understand the increasing number of hours of volunteering and humanitarian work that medical schools require applicants. I guess some will never be screened out.

This is an absurd post. Premed volunteering is overwhelmingly exploitative and insincere for the sake of checking a box, and is quite frankly the biggest mistake med school admissions is making. True value of volunteering is one that is actually done genuinely, which is rare in premed level but can be more popular in attending level

 

[7331poas]

Rich people are overwhelmingly making up med school classes. Med school admissions is pretty hostile to middle class and average Americans (and also to lower SES groups despite their claims to the contrary)

The situation wouldn’t change if physicians are suddenly paid their market value

Thats because rich people can afford to enter medical school due to barriers of entry. If you polled poor people today there would be plenty lining up to accept an admission.

 

[ACSurgeon]

How do you define “market value” for physicians?

Why does an investment banker make as much as they do? Why is that their “market value”

Why do hospital administrators make what they make?

When someone sacrifices their 20’s and 30’s to train in a pressure cooker environment with little room for error or breaks and finally learn a skill set they can work with to heal humans, what do you think is a fair price for the sacrifice and for their unique skill?

A physician bills 2-3 million dollars worth a year and gets paid a small fraction of that. If employed, the physician earns his/her employer a ton more more in the way of labs, imaging studies, having patients staying in the hospital, procedure/OR fees and much more. So I ask again, how do you define market value?

 

[Matthew9Thirtyfive]

This is an absurd post. Premed volunteering is overwhelmingly exploitative and insincere for the sake of checking a box, and is quite frankly the biggest mistake med school admissions is making. True value of volunteering is one that is actually done genuinely, which is rare in premed level but can be more popular in attending level

Might be selection bias due to the nature of my school’s student body, but a sizable portion of my class volunteers very genuinely and did prior to med school. So it does happen.

 

[nimbus]

Might be selection bias due to the nature of my school’s student body, but a sizable portion of my class volunteers very genuinely and did prior to med school. So it does happen.

How about your attendings? Director of admissions?

 

[Neopolymath]

They think it's naive because most of the people on SDN have never cracked an economics book.

One of my bachelor's is in econ. It's dumb. Great, glad we cleared that hurdle in the argument.

 

[operaman]

Major props to the group for standing up to this. There is a massive conflict of interest when you have a for-profit hospital starting a training program for one of their highest earning specialties. It doesn’t take a rocket scientist to see that their long term plan is to hire their own fresh grads at lower market rates and gradually displace the established group in favor of an employed model where they will keep a larger share of the revenues down the road.

 

[ACSurgeon]

Major props to the group for standing up to this. There is a massive conflict of interest when you have a for-profit hospital starting a training program for one of their highest earning specialties. It doesn’t take a rocket scientist to see that their long term plan is to hire their own fresh grads at lower market rates and gradually displace the established group in favor of an employed model where they will keep a larger share of the revenues down the road.

That and physicians are always shackled with non-competes, yet all of a sudden a physician group is evil if they want to play by the same rules that are placed on them.

 

[Osminog]

One of my bachelor's is in econ. It's dumb. Great, glad we cleared that hurdle in the argument.

Very impressive.

Sir Angus Deaton received the 2015 Nobel Prize in Economics. His wife, Anne Case, is also an accomplished economist and works alongside him in Princeton's economics department. Here's what they had to say on this matter in an article they co-wrote (emphasis mine):

How is it possible that Americans pay so much and get so little? The money is certainly going somewhere. What is waste to a patient is income to a provider. The industry is not very good at promoting health, but it excels at promoting wealth among health care providers, including some successful private physicians who operate profitable practices. Physicians are the largest single occupation among the top 1% of incomes. The industry also delivers vast sums to the owners and executives of pharmaceutical companies, to medical-device manufacturers, to insurers and to large, ever more monopolistic hospitals. Much of the difference in costs compared with those of other countries comes from vastly higher prices. American doctors get paid almost twice as much as the average doctor in other wealthy countries. The effect on costs is limited because the U.S. also has fewer doctors per capita—physician-led groups have been effective in holding salaries up by holding down the number of places in medical schools, and by excluding well-qualified foreign doctors.

If only Drs. Deaton and Case had enrolled in your undergrad econ courses. Maybe then they'd know that the concerns above are "dumb" and unworthy of our attention.

 

[Matthew9Thirtyfive]

How about your attendings? Director of admissions?

There are a LOT of attendings lol. I know some of them volunteer for stuff, including humanitarian missions.

 

[DarkHorizon]

Very impressive.

Sir Angus Deaton received the 2015 Nobel Prize in Economics. His wife, Anne Case, is also an accomplished economist and works alongside him in Princeton's economics department. Here's what they had to say on this matter in an article they co-wrote (emphasis mine):



If only Drs. Deaton and Case had enrolled in your undergrad econ courses. Maybe then they'd know that the concerns above are "dumb" and unworthy of our attention.

That’s just like his opinion man.

Healthcare protectionism, especially physician protectionism, is much more robust in Canada and much of Western Europe, your healthcare utopia. Try getting a license there and practice. 25 percent of the US physicians are foreign grads.

 

[VA Hopeful Dr]

Very impressive.

Sir Angus Deaton received the 2015 Nobel Prize in Economics. His wife, Anne Case, is also an accomplished economist and works alongside him in Princeton's economics department. Here's what they had to say on this matter in an article they co-wrote (emphasis mine):



If only Drs. Deaton and Case had enrolled in your undergrad econ courses. Maybe then they'd know that the concerns above are "dumb" and unworthy of our attention.

You realize physician salaries are usually just under 10% of healthcare spending right?

 

[Osminog]

That’s just like his opinion man.

Healthcare protectionism, especially physician protectionism, is much more robust in Canada and much of Western Europe, your healthcare utopia. Try getting a license there and practice. 25 percent of the US physicians are foreign grads.

The US has a much higher disease burden than any wealthy European country or Canada... and yet look at the number of practicing physicians per capita. Is this not telling?

We have a lot of FMGs for the simple reason that we have too few medical school spots relative to residency spots. We don't produce enough medical school graduates domestically to fill our residency programs and create future practicing physicians in the US, so we have to depend on international talent to get by. Many other developed countries produce a close-to-adequate supply of physicians through their domestic medical schools, so they have less of a dependence on migrant doctors; it's not because they're "protectionist."

 

[7331poas]

How do you define “market value” for physicians?

Why does an investment banker make as much as they do? Why is that their “market value”

Why do hospital administrators make what they make?

When someone sacrifices their 20’s and 30’s to train in a pressure cooker environment with little room for error or breaks and finally learn a skill set they can work with to heal humans, what do you think is a fair price for the sacrifice and for their unique skill?

A physician bills 2-3 million dollars worth a year and gets paid a small fraction of that. If employed, the physician earns his/her employer a ton more more in the way of labs, imaging studies, having patients staying in the hospital, procedure/OR fees and much more. So I ask again, how do you define market value?

Market value is what the market will pay you for your service. The problem here is that physicians have created a cartel where foreign doctors are barred from competing on the labor market. Where we artificially limit residency positions to prop up salaries for doctors already in attendinghood.