Med Econ: Turning Tide for Independent MD's?

[drusso]

"Beyond an ardent desire to practice medicine without worrying about meeting an employers’ quotas, all of these recently liberated doctors have something else in common: the certainty that they are at the forefront of the new trend in medicine."

Employed vs independent doctors: Numbers don't tell the whole story

Why independence is not a thing of the past. Rather, it is the future of medicine.

www.medicaleconomics.com

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[hyperalgesia]

"This adds up. According to a 2019 report from Merritt Hawkins, hospitals make on average $2.4 million a year net for every doctor they employ. "

WTF???

 

[drusso]

"This adds up. According to a 2019 report from Merritt Hawkins, hospitals make on average $2.4 million a year net for every doctor they employ. "

WTF???

During the ACA/Obama-era so many struggling independent MD/DO’s fell for slick talking hospital administrators luring them with “magic beans” of $600K salaries, $75/RVU, and promises of 60 minute ESI’s in the HOPD. Those contracts are resetting and doctors are realizing trading their professionalism for money was a sugar high not in their long-term best interests. Price transparency and site neutral payment policies are pulling the rug out from under them. The administrators have moved on, but the doctors are left holding the bag. New boss, same as the old boss...

 

[Ligament]

During the ACA/Obama-era so many struggling independent MD/DO’s fell for slick talking hospital administrators luring them with “magic beans” of $600K salaries, $75/RVU, and promises of 60 minute ESI’s in the HOPD. Those contracts are resetting and doctors are realizing trading their professionalism for money was a sugar high not in their long-term best interests. Price transparency and site neutral payment policies are pulling the rug out from under them. The administrators have moved on, but the doctors are left holding the bag. New boss, same as the old boss...

That era is still happening, but I suspect we are past the peak "invasion" of hospitals destroying private practice through assimilation. They will continue to try, of course.

 

[bronx43]

"This adds up. According to a 2019 report from Merritt Hawkins, hospitals make on average $2.4 million a year net for every doctor they employ. "

WTF???

I’m sure this is counting total revenue generated from ancillaries, facility/OR fees, billing, etc.

Basically I suspect they’re simply dividing total profit by number of employed physicians.

 

[drusso]

I’m sure this is counting total revenue generated from ancillaries, facility/OR fees, billing, etc.

Basically I suspect they’re simply dividing total profit by number of employed physicians.

Absolutely, it is. It's a f*cking racket. How would you like it if someone was making $2.4million of what you do and what you generate and only sharing less than 15% of that with you? Is 85/15 a fair split?

 

[Doctodd]

Absolutely, it is. It's a f*cking racket. How would you like it if someone was making $2.4million of what you do and what you generate and only sharing less than 15% of that with you? Is 85/15 a fair split?

That sounds like capitalism.....until you factor in that the hospital lobbied to make the private doctor’s reimbursement less to “persuade” him into working for the hospital.

 

[Doctodd]

This statement is startling.....

“The average net revenue generated by all physicians included in the survey ($2,378,727) is up from $1,560,688 in 2016, an increase of 52%.”

 

[Disciple]

No progressive responses, so I’ll play devil’s advocate.

It’s all worth it right? Right?! If a small proportion of the population is able to get health insurance (albeit bad insurance) that otherwise couldn’t?

 

[hyperalgesia]

That sounds like capitalism.....until you factor in that the hospital lobbied to make the private doctor’s reimbursement less to “persuade” him into working for the hospital.

Crony capitalism. Closer to Socialism than free market capitalism.

 

[deleted993114]

During the ACA/Obama-era so many struggling independent MD/DO’s fell for slick talking hospital administrators luring them with “magic beans” of $600K salaries, $75/RVU, and promises of 60 minute ESI’s in the HOPD. Those contracts are resetting and doctors are realizing trading their professionalism for money was a sugar high not in their long-term best interests. Price transparency and site neutral payment policies are pulling the rug out from under them. The administrators have moved on, but the doctors are left holding the bag. New boss, same as the old boss...

I don't know- I've ran my own practice and paid overhead for 28 years. I guess at this stage of the game, "selling out" is somewhat appealing.

I really don't care if someone else makes money off me- I really don't care. I would imagine they would not pay a good salary if they weren't making money off the docs.

You always have a "boss" of some type. When a part of a multi-specialty clinic, the board is your "boss". As a hospital employee, the CEO is your "boss", but in some of these situations, there is a general contract with a multi-specialty clinic. When an independent, your "boss" is your referral base and the insurers.

It seems as though the trend is actually being a part of a larger healthcare system, due to high overhead costs and declining reimbursement in a office based setting. Who knows- it's hard to predict the future and I am sure that there are very marked regional differences with regard to what system is the best for providers.

 

[drusso]

I don't know- I've ran my own practice and paid overhead for 28 years. I guess at this stage of the game, "selling out" is somewhat appealing.

I really don't care if someone else makes money off me- I really don't care. I would imagine they would not pay a good salary if they weren't making money off the docs.

You always have a "boss" of some type. When a part of a multi-specialty clinic, the board is your "boss". As a hospital employee, the CEO is your "boss", but in some of these situations, there is a general contract with a multi-specialty clinic. When an independent, your "boss" is your referral base and the insurers.

It seems as though the trend is actually being a part of a larger healthcare system, due to high overhead costs and declining reimbursement in a office based setting. Who knows- it's hard to predict the future and I am sure that there are very marked regional differences with regard to what system is the best for providers.

A few years ago I attended a regional health care leadership event and ran into a former hospital administrator who left the industry for real estate but was still consulting a little. I asked him point blank, "Do hospital admins F*ck with doctors on purpose?" His answer was a resounding YES. They do it intentionally to keep an edge and keep MD/DO's feeling powerless.

This should be required reading Day 1 of medical school:

How To Discourage a Doctor

By RICHARD GUNDERMAN, MD Not accustomed to visiting hospital executive suites, I took my seat in the waiting room somewhat warily. Seated across from me was a handsome man in a well-tailored three-piece suit, whose thoroughly professional appearance made me – in my rumpled white coat, sheaves...

thehealthcareblog.com

 

[bronx43]

I don't know- I've ran my own practice and paid overhead for 28 years. I guess at this stage of the game, "selling out" is somewhat appealing.

I really don't care if someone else makes money off me- I really don't care. I would imagine they would not pay a good salary if they weren't making money off the docs.

You always have a "boss" of some type. When a part of a multi-specialty clinic, the board is your "boss". As a hospital employee, the CEO is your "boss", but in some of these situations, there is a general contract with a multi-specialty clinic. When an independent, your "boss" is your referral base and the insurers.

It seems as though the trend is actually being a part of a larger healthcare system, due to high overhead costs and declining reimbursement in a office based setting. Who knows- it's hard to predict the future and I am sure that there are very marked regional differences with regard to what system is the best for providers.

There’s a huge difference between a hospital suit being your boss and your referral base being your boss. The only boss you should have is your referring docs and your patients... that’s a reality of life. The same goes for Jeff Bezos - his customers are his boss.

Being owned by a MBA in a suit due to government giving them an unfair advantage is what we all have a problem with.

 

[blockstar]

Its much easier for a practitioner or generalist to cowboy it in his own practice than work for a hospital. This thread could easily be paired with another thread discussing non pain fellowship trained providers doing procedures. 99 times out of 100 a hospital is going to prefer advertising a "board certified fellowship trained doctor" rather than saying hey we got an advanced practice nurse real cheap we can do a bunch of procedures on you. Maybe this goes on in rural areas where there are no board cert fellowship trained docs available but in the two major metro areas Ive been major health systems hire board cert fellowship trained pain docs and some nps see consults. Only in the ascs and borderline "hospitals" have I seen non fellowship trained docs doing pain procedures and only ONCE have I heard of a midlevel running a pain clinic.

 

[deleted993114]

There’s a huge difference between a hospital suit being your boss and your referral base being your boss. The only boss you should have is your referring docs and your patients... that’s a reality of life. The same goes for Jeff Bezos - his customers are his boss.

Being owned by a MBA in a suit due to government giving them an unfair advantage is what we all have a problem with.

That is true. Having never been employed by a hospital system or an admin, I have never experienced anything but being in an office setting. However, regardless of where we are, the grass is always greener and there will always be some BS to deal with. It will just be different kids of BS.