looking into the devil's eyes

Started by MSmentor018
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That document itself needs to be found and posted online in its entirety, its author identified if any of this is real...


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bravotwozero said:
That document itself needs to be found and posted online in its entirety, its author identified if any of this is real...


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Click to expand...

I read this article when it came out. It is indeed a powerful fable with loads of truth to it and we're in a constant battle with admin to create a tolerable work environment that offers good patient care.

While there's no easy fix for all the issues raised by the article, the single best tool I've found to make things better is to frame my concerns in the interest of patient safety.

Admin will try to belittle you and push you around but once the issue of safety is brought up they tend to retreat (other subjects that catch the attention of suits include patient satisfaction, EMTALA, and hospital finances). Sure, they'd love to steamroll you but they'd love even more to avoid a bad patient outcome that can be clearly tied to their actions. For example--and hypothetically, of course--if I have a sick patient who needs to be admitted but admin gets involved because the "the patient would be a re-admit" then I explain why outpatient care isn't safe. If they still don't back down and we can't find a solution I think is safe for the patient then I let them know I'll be documenting why and I won't be discharging the patient from the ED until a safe solution is found. I document this just like you would with a belligerent patient, just state facts not emotions.

Could this get me fired?
Possibly.

Do I care?
Absolutely not.

Amidst all the bull**** we deal with on a daily basis, when I think back to why I went into medicine it was to provide good care and feel good about my work. At the end of the day, admin will not take that away from me. I can get a dozen jobs tomorrow and places still exist where doctors are actually appreciated and listened to. Admin needs us FAR more than we need them. If I was pushed to see more than 2pt/hr at a site with any acuity I'd quit immediately. Forced to work with incompetent staff who don't want/won't allow themselves to be better at their job? I'm gone. I want my patients to get what they need (enough time with me, good nursing care, clean facilities, etc) and I've worked too hard and have too great a desire for a decent workplace to put up with anything less.
 
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Blame the hospital administrators all you want. Blame the executives, health insurance companies, etc. We can keep acting like we (read: physicians) are victims and hope that somebody listens to our whining in the comments section on a blog. It's a joke. We won't get any support from the general public because we are interpreted as being "well off", which is absurd because a lot of what we are upset about is how hospital regulations affects patient care. When it comes to instituting real change and doing the right thing for patients and physicians (and preserving the doctor/patient relationship) nobody is really doing anything substantial. Where is the AMA on getting our backs on this? Regulations and red tape on physicians has only gotten worse over the years. Where is ACEP on this issue? They are in the pockets of the community groups instead of advocating for its constituents. It's an embarrassment.

We have had ZERO advocacy amongst physicians for these types of issues. While the American Nursing Association is going to war to get independent practice rights for NPs, physicians just roll over and take it. I know that isn't what this thread is about, but it's just another example of how we pretend like we are still the indestructible entity that we have been for generations without really voicing our disapproval and offering up better solutions.

We are physicians and we are valued members of the healthcare team. If we don't show up to work, that's a big problem for the hospital administrators (I am NOT advocating that we strike, so please don't misinterpret that). But rather I'm trying to illustrate that we have a voice for ourselves and for our patients. Too many physicians I've met are very happy (in EM in particular) being a slave for a CMG and being placated with a nice little paycheck because they hit their RVUs. The issue is much bigger than that, we need to protect our profession and do what's right for our patients.
 
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This should be read by every medical student looking at different residencies... And they should use this information to chose a field that will allow them to avoid hospital based medicine.
 
Seriously, though, I don't know that a lot of medical students are taking in to account the effect of both the corporate practice of medicine and Obamacare on their future careers. For example, the toxic combination of EMTALA and Medicaid expansion on EM.
 
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MSmentor018 said:
absolutely the most accurate and F@#ked up thing about our profession today. I posted on FB emdocs but had to share with everyone here

How hospitals discourage doctors: A step by step guide
Click to expand...

Ahh...I love this one. I remember this post from when it came out. A great post from Gunderman on KevinMD. I think (not totally sure) that it turned out to be fictional, but there's so much truth to it, it doesn't matter.

Man...KevinMD. Lol. I haven't checked that place in years. Remember when I used to put stuff on there?

Lol [emoji24]
 
Medicaid expansion actually increases revenue for docs and EDs in area where you have a crappy payor mix - you're guaranteed to get more revenue from medicaid patients then you are from self pay, which is invariably $0.


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bravotwozero said:
Medicaid expansion actually increases revenue for docs and EDs in area where you have a crappy payor mix - you're guaranteed to get more revenue from medicaid patients then you are from self pay, which is invariably $0.


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which brings more money back into the hospital, who bargains with the insurance co, who buys america's debt and is very powerful, who then buys the lawyers not to have tort reform, so now you order a ton and viola' more money back into the hospital
 
MSmentor018 said:
which brings more money back into the hospital, who bargains with the insurance co, who buys america's debt and is very powerful, who then buys the lawyers not to have tort reform, so now you order a ton and viola' more money back into the hospital
Click to expand...

It always comes back to the money.

The #1 priority of emergency departments in 2017 is to make money for hospitals.
 
Old_Mil said:
This should be read by every medical student looking at different residencies... And they should use this information to chose a field that will allow them to avoid hospital based medicine.
Click to expand...

Like what specific specialties? There is doom and gloom on every forum. I would genuinely love to hear your opinions on alternatives to EM and Anesthesia. I sense that by the time I graduate residency/fellowship, it will be nearly impossible to avoid hospital based medicine.
 
PS2020 said:
Like what specific specialties? There is doom and gloom on every forum. I would genuinely love to hear your opinions on alternatives to EM and Anesthesia. I sense that by the time I graduate residency/fellowship, it will be nearly impossible to avoid hospital based medicine.
Click to expand...
Dermatology
 
PS2020 said:
Like what specific specialties? There is doom and gloom on every forum. I would genuinely love to hear your opinions on alternatives to EM and Anesthesia. I sense that by the time I graduate residency/fellowship, it will be nearly impossible to avoid hospital based medicine.
Click to expand...

Plastics, Derm, concierge primary care, aesthetic derm/med spa by (insert specialty), weight loss med, weight loss surgery...

alas not a lot of hope for soley EM trained guys, (aesthetic derm/med spa has no specialty pre req). I have been searching for a way out of hospital based practice. I do not have the local need and capital to fund a full-on UC. Free standings are a marked entity with an uncertain future and not even available in my state.
According to all the resources I have looked at, cash-based UCs/convenient cares have a 0% survival and end up with the high overhead of insurance-based on short order.
 
LaBusqueda said:
Plastics, Derm, concierge primary care, aesthetic derm/med spa by (insert specialty), weight loss med, weight loss surgery...

alas not a lot of hope for soley EM trained guys, (aesthetic derm/med spa has no specialty pre req). I have been searching for a way out of hospital based practice. I do not have the local need and capital to fund a full-on UC. Free standings are a marked entity with an uncertain future and not even available in my state.
According to all the resources I have looked at, cash-based UCs/convenient cares have a 0% survival and end up with the high overhead of insurance-based on short order.
Click to expand...

Well that sucks for me. Zero interest in derm. I don't even want to mention aesthetics or.. med spa? Concierge primary care is also horrifying. The lucrative part of plastics is cosmetic surg - that is not for me. Pretty much everyone at my school who does plastics also takes a year off, so that is a big no no. Looks like I don't have that many options.

Regarding your second point, when do you recon all those new UCs will close down then? I don't see why they would keep opening up more and more of them, year after year, if they are not so profitable. Maybe it is region specific?
 
PS2020 said:
Regarding your second point, when do you recon all those new UCs will close down then? I don't see why they would keep opening up more and more of them, year after year, if they are not so profitable. Maybe it is region specific?
Click to expand...

UCs are opening like wild, but take Insurance's.
Most-all (based on reading I've done) that start as cash only/direct Pay, etc end up taking insurance eventually.



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PS2020 said:
Well that sucks for me. Zero interest in derm. I don't even want to mention aesthetics or.. med spa? Concierge primary care is also horrifying. The lucrative part of plastics is cosmetic surg - that is not for me. Pretty much everyone at my school who does plastics also takes a year off, so that is a big no no. Looks like I don't have that many options.

Regarding your second point, when do you recon all those new UCs will close down then? I don't see why they would keep opening up more and more of them, year after year, if they are not so profitable. Maybe it is region specific?
Click to expand...

Can also do expert witness consultancy and independent medical examiner to evaluate disability claims as an EM doc.


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