No competition allowed here! Non-competes are back, baby!

[GravelRider]

---

Members don't see this ad.

As expected, the non-compete ban has been delayed by preliminary injunction, with expected conversion to permanent injunction on August 30, 2024.

Federal Court Enjoins Federal Trade Commission’s Rule Prohibiting Non-Competition Agreements (US)

In January 2023, the U.S. Federal Trade Commission (FTC) proposed a sweeping rule that, with limited exceptions (such as for highly compensated executives

www.employmentlawworldview.com

Y’all can keep arguing about which Presidential candidate is more senile while the institutions in this country continue to chip away at individual rights…like the right to earn the best wages for your skills.

 

[aneftp]

Be careful what you wish for. If you give power to the FTC. They can rule unilaterally to give mid levels including PA and ARNP unlimited independent practice due to the fair practice due to the collision of the board of medicine in all states.

I see more things into this than others.

 

[GravelRider]

Be careful what you wish for. If you give power to the FTC. They can rule unilaterally to give mid levels including PA and ARNP unlimited independent practice due to the fair practice due to the collision of the board of medicine in all states.

I see more things into this than others.

I’ve been a proponent of midlevel independence for years. It’s simple principles of capitalism. It also seems naive to think that in an environment of deregulation, corporations are going to be champions of providing the safest and best medical care possible when the temptation to provide the cheapest exists.

 

[TeslaCoil]

Just one more reason for doctors to just leave medicine altogether. As if it wasn't already happening in droves. Private equity and “big medicine” just want to keep us all enslaved, and for peanuts.

 

[aneftp]

I’ve been a proponent of midlevel independence for years. It’s simple principles of capitalism. It also seems naive to think that in an environment of deregulation, corporations are going to be champions of providing the safest and best medical care possible when the temptation to provide the cheapest exists.

Issue is once the public realizes who actually keeps the billing. That mid levels aren’t cheaper.

If mid levels kept their billing. Do u really think the public would go to them if they don’t see a lower medical bill?

The Hospitals and corporations are just taking a bigger profit using mid levels as we all know.

Like what’s the point of using a arnp gi specialist if u are paying out of pocket and getting charged the same?

 

[ambiturner]

Issue is once the public realizes who actually keeps the billing. That mid levels aren’t cheaper.

If mid levels kept their billing. Do u really think the public would go to them if they don’t see a lower medical bill?

The Hospitals and corporations are just taking a bigger profit using mid levels as we all know.

Like what’s the point of using a arnp gi specialist if u are paying out of pocket and getting charged the same?

Suppose the public are given the option of colonoscopy with the MD GI for full price or the APRN endoscopist with 15 alphabet soup certifications for a 15% discount. By accepting the discount you also must acknowledge the possibility of a slightly higher rate of false negative endoscopy (read: no monster lawsuits).

What percent of people do you think would go with the APRN? My guess is it would exceed 50%.

 

[ambiturner]

Oh and to the topic - as an anesthesiologist don’t sign a contract with a noncompete that could in any way lock you out of surrounding groups you might consider. Ask them to take it out of the contract or pick another job. If noncompetes make the jobs less competitive then employers will have to either change or pay a premium.

 

[aneftp]

Suppose the public are given the option of colonoscopy with the MD GI for full price or the APRN endoscopist with 15 alphabet soup certifications for a 15% discount. By accepting the discount you also must acknowledge the possibility of a slightly higher rate of false negative endoscopy (read: no monster lawsuits).

What percent of people do you think would go with the APRN? My guess is it would exceed 50%.

Arnp make 50% or even 70% less than Gi docs

15% won’t sway the public

Now a 50% discount. People would start thinking about it but arnp would need to find an arnp surgeon to handle any complications.

Like my plastics buddies won’t handle any complications done by another doc.

 

[nimbus]

Suppose the public are given the option of colonoscopy with the MD GI for full price or the APRN endoscopist with 15 alphabet soup certifications for a 15% discount. By accepting the discount you also must acknowledge the possibility of a slightly higher rate of false negative endoscopy (read: no monster lawsuits).

What percent of people do you think would go with the APRN? My guess is it would exceed 50%.

Vast majority of patients are very unsophisticated medical consumers. They’re swayed by yelp reviews and marketing. Most people don’t have any medical insight and don’t choose their own specialists. It likely depends on where they are referred, who’s on the insurance panel, and how long it takes to get an appointment. Skill and training of the “provider” is way down the list and very difficult for laypeople to parse.

 

[Onefellswoop87]

Suppose the public are given the option of colonoscopy with the MD GI for full price or the APRN endoscopist with 15 alphabet soup certifications for a 15% discount. By accepting the discount you also must acknowledge the possibility of a slightly higher rate of false negative endoscopy (read: no monster lawsuits).

What percent of people do you think would go with the APRN? My guess is it would exceed 50%.

An informed consent paperwork isn’t worth the paper it’s printed on if the patient claims in court they didn’t understand the medical jargon printed on it and they didn’t get the procedure they thought they signed up for.
I’m skeptical that average Joe will scientifically and legally understand false negative rate that their “informed consent” will hold up. And no mid-level will write on a consent “let me take care of you, ignore the statistically worse results cause you’ll get a discount”

 

[MTGas2B]

Issue is once the public realizes who actually keeps the billing. That mid levels aren’t cheaper.

If mid levels kept their billing. Do u really think the public would go to them if they don’t see a lower medical bill?

The Hospitals and corporations are just taking a bigger profit using mid levels as we all know.

Like what’s the point of using a arnp gi specialist if u are paying out of pocket and getting charged the same?

As reimbursement keeps declining/stagnating the billing will matter less and less. "Savings" will come from what the vertically integrated health system has the give up to subsidize the providers' salaries. My $0.02

 

[aneftp]

As reimbursement keeps declining/stagnating the billing will matter less and less. "Savings" will come from what the vertically integrated health system has the give up to subsidize the providers' salaries. My $0.02

Hospitals profit more using mid levels for these reasons
1. Mid levels order more tests

Since hospitals employ more “providers”. This ordering more test (stress tests, radiology tests, labs etc). In a weird way it adds to their profit margin due to over ordering of tests

2. The facility fees matters way more to the hospital than the provider fees generates.

3. So better to have more mid levels and increase profit margin unless mid levels (crnas) demand equal salary

 

[ambiturner]

An informed consent paperwork isn’t worth the paper it’s printed on if the patient claims in court they didn’t understand the medical jargon printed on it and they didn’t get the procedure they thought they signed up for.
I’m skeptical that average Joe will scientifically and legally understand false negative rate that their “informed consent” will hold up. And no mid-level will write on a consent “let me take care of you, ignore the statistically worse results cause you’ll get a discount”

Change the terms to whatever you want - let’s say there’s an AANA style study that shows the APRN endoscopist is ‘noninferior’. You can have your screening colonoscopy for X discount with the APRN, what’s the number that makes people jump? I mean I buy the generic Tylenol if it saves me even 5%.

 

[aneftp]

Change the terms to whatever you want - let’s say there’s an AANA style study that shows the APRN endoscopist is ‘noninferior’. You can have your screening colonoscopy for X discount with the APRN, what’s the number that makes people jump? I mean I buy the generic Tylenol if it saves me even 5%.

Procedures are easy for 80% of the population to learn. The key word is to learn. Like teacher a monkey to do things once they lean the technique and anatomy.

Especially with video cameras,

I can be “comfortable “ with an omfs resident by month 3 of anesthesia covering him or her for standard anesthesia case. Image them “learning “ on the job for 2 years while “out in practice”. One can get pretty competent doing regular anesthesia

So if someone does 100 colonoscopy. I will reckon they feel comfortable. Than they can learn on the job the next two years while out in practice

 

[deleted1183938]

Change the terms to whatever you want - let’s say there’s an AANA style study that shows the APRN endoscopist is ‘noninferior’. You can have your screening colonoscopy for X discount with the APRN, what’s the number that makes people jump? I mean I buy the generic Tylenol if it saves me even 5%.

Except Generic Tylenol does not come with a higher chance of maiming or killing you. It was still formulated by scientists. Not wannabe scientists.

 

[medicine2wallstreet]

Change the terms to whatever you want - let’s say there’s an AANA style study that shows the APRN endoscopist is ‘noninferior’. You can have your screening colonoscopy for X discount with the APRN, what’s the number that makes people jump? I mean I buy the generic Tylenol if it saves me even 5%.

I don't even understand this post Jesus.

 

[USCTrojan11]

Procedures are easy for 80% of the population to learn. The key word is to learn. Like teacher a monkey to do things once they lean the technique and anatomy.

Especially with video cameras,

I can be “comfortable “ with an omfs resident by month 3 of anesthesia covering him or her for standard anesthesia case. Image them “learning “ on the job for 2 years while “out in practice”. One can get pretty competent doing regular anesthesia

So if someone does 100 colonoscopy. I will reckon they feel comfortable. Than they can learn on the job the next two years while out in practice

Major difference between doing something and understanding it.

I've taught a lot of AA and CRNA students to do a central line. They do it fine and with enough proficiency. However, when you ask them while floating a swan where the catheter is, they can't tell you what the route or even understand what the tracings mean. Had an M&M where the "expert" cRNA of 25 years who "practices independently" but joined our ACT model for some reason, had wedged/inflated/ruptured a hepatic vein leading to massive bleeding all the while faking understanding the waveforms and "teaching" them to his sRNA student before MTP was started.

Same here, anyone can stick a scope up a hole and drive it. Very different to understand the nuance and what is abnormal, when to biopsy, what kind of biopsy to take. That involves known the patients demographic, what they are at risk for, what is can't miss diagnosis etc.

 

[Arch Guillotti]

I've taught a lot of AA and CRNA students to do a central line.

🙄🙄🙄

 

[dabears505]

Major difference between doing something and understanding it.

I've taught a lot of AA and CRNA students to do a central line. They do it fine and with enough proficiency. However, when you ask them while floating a swan where the catheter is, they can't tell you what the route or even understand what the tracings mean. Had an M&M where the "expert" cRNA of 25 years who "practices independently" but joined our ACT model for some reason, had wedged/inflated/ruptured a hepatic vein leading to massive bleeding all the while faking understanding the waveforms and "teaching" them to his sRNA student before MTP was started.

Same here, anyone can stick a scope up a hole and drive it. Very different to understand the nuance and what is abnormal, when to biopsy, what kind of biopsy to take. That involves known the patients demographic, what they are at risk for, what is can't miss diagnosis etc.

Where was the md during this?

 

[medicine2wallstreet]

🙄🙄🙄

Nurse practitioners do central lines in the ICU all the time you goon.

 

[Iso4ane]

I’ve never taught a CRNA/AA student how to do a line. I like doing lines. I already miss enough opportunities because I have to teach residents.

 

[deleted1130227]

Nurse practitioners do central lines in the ICU all the time you goon.

They do. But Anesthesia has the most acrimonious relationship between its APPs and other specialties. Those ****s see themselves as interchangeable from us...or interchangeable but for skill in technical procedures. More than enough reason to deny them training in those procedures.

 

[GravelRider]

Major difference between doing something and understanding it.

Do you think the hospitals, corporations, or private equity folks employing us and all the other “providers” care at all about that? Between that and the non-competes, healthcare labor (you) is nothing more than a commodity.

 

[ProRealDoc]

Just one more reason for doctors to just leave medicine altogether. As if it wasn't already happening in droves. Private equity and “big medicine” just want to keep us all enslaved, and for peanuts.

 

[Maz777]

Be careful what you wish for. If you give power to the FTC. They can rule unilaterally to give mid levels including PA and ARNP unlimited independent practice due to the fair practice due to the collision of the board of medicine in all states.

I see more things into this than others.

That would be excellent. No more supervision!

 

[Maz777]

Major difference between doing something and understanding it.

I've taught a lot of AA and CRNA students to do a central line. They do it fine and with enough proficiency. However, when you ask them while floating a swan where the catheter is, they can't tell you what the route or even understand what the tracings mean. Had an M&M where the "expert" cRNA of 25 years who "practices independently" but joined our ACT model for some reason, had wedged/inflated/ruptured a hepatic vein leading to massive bleeding all the while faking understanding the waveforms and "teaching" them to his sRNA student before MTP was started.

Same here, anyone can stick a scope up a hole and drive it. Very different to understand the nuance and what is abnormal, when to biopsy, what kind of biopsy to take. That involves known the patients demographic, what they are at risk for, what is can't miss diagnosis etc.

Why are you teaching AA students and SRNAs? Let the AAs and CRNAs "teach" them. And why the heck would you ever let one do a central line on one of your patients?

 

[Southpaw]

Nurse practitioners do central lines in the ICU all the time you goon.

I know I’m feeding the troll as you’re already a master of all things anesthesia, but until the AANA drops their anti-anesthesiologist (the physician kind) agenda I don’t blame anyone for not wanting to train SRNAs. That said there appear to be plenty of anesthesiologists and other physicians more than happy to train them in procedures.

 

[medicine2wallstreet]

I know I’m feeding the troll as you’re already a master of all things anesthesia, but until the AANA drops their anti-anesthesiologist (the physician kind) agenda I don’t blame anyone for not wanting to train SRNAs. That said there appear to be plenty of anesthesiologists and other physicians more than happy to train them in procedures.

Look I'm not carrying the pale for nurses or anesthesia techs in terms of scope of practice and supervision. But let's not kid ourselves that having them do central lines is some sort of breach of practice. PAs take down the saphenous vein in every single cabg I've done.

 

[Dr. Anonymouss]

The way I see it is if mid-levels were to get complete independence then our healthcare system will move to a tiered system. The wealthy, or those that are willing to pay more, will have physicians provide their care. On the other hand, the rest of the public will have the opportunity to seek care from mid-levels at a cheaper rate. This already happens in the rest of the world, just in a different way. In Brazil, everyone is provided free healthcare at public hospitals, yet private hospitals exist for those willing to pay and roughly 25% of Brazil's population, or 50 million people, have private insurance. It can be argued that this occurs because the public hospitals in brazil have long wait times and surgeries can take up to years, but I would also venture out and assume that the best doctors work in this sector because the earning potential is much higher. There are plenty of people who are willing to pay for the knowledge and expertise of a physician as opposed to saving a buck going with a mid-level. This doesn't worry me the slightest.

 

[deleted1183938]

Look I'm not carrying the pale for nurses or anesthesia techs in terms of scope of practice and supervision. But let's not kid ourselves that having them do central lines is some sort of breach of practice. PAs take down the saphenous vein in every single cabg I've done.

Carrying the pale? What’s this mean?

 

[deleted1183938]

The way I see it is if mid-levels were to get complete independence then our healthcare system will move to a tiered system. The wealthy, or those that are willing to pay more, will have physicians provide their care. On the other hand, the rest of the public will have the opportunity to seek care from mid-levels at a cheaper rate. This already happens in the rest of the world, just in a different way. In Brazil, everyone is provided free healthcare at public hospitals, yet private hospitals exist for those willing to pay and roughly 25% of Brazil's population, or 50 million people, have private insurance. It can be argued that this occurs because the public hospitals in brazil have long wait times and surgeries can take up to years, but I would also venture out and assume that the best doctors work in this sector because the earning potential is much higher. There are plenty of people who are willing to pay for the knowledge and expertise of a physician as opposed to saving a buck going with a mid-level. This doesn't worry me the slightest.

In these systems doctors tend to work both Private and Public systems. The best can be found at either or is my understanding. They do some time serving the public and then extra time workijf in Private to make extra income.

And at the end of the day, their two tiered system does not involve NPPs. It’s all Physician. So it’s not an even comparison.

 

[Dr. Anonymouss]

In these systems doctors tend to work both Private and Public systems. The best can be found at either or is my understanding. They do some time serving the public and then extra time workijf in Private to make extra income.

And at the end of the day, their two tiered system does not involve NPPs. It’s all Physician. So it’s not an even comparison.

I was trying to show that there are still a lot of people willing to pay more for better healthcare. I hypothesize that the same will hold true if there was ever direct competition between physicians and midlevels.

 

[ambiturner]

I know I’m feeding the troll as you’re already a master of all things anesthesia, but until the AANA drops their anti-anesthesiologist (the physician kind) agenda I don’t blame anyone for not wanting to train SRNAs. That said there appear to be plenty of anesthesiologists and other physicians more than happy to train them in procedures.

There are plenty of academic practices where the senior MD leadership more or less forces the junior MDs to participate in this. It makes their lives easier by appeasing the CRNAs, meaning less headache running the ORs, and then the admin MDs can do even less clinical work because they don’t have to do procedures. Some people are willing to relocate over this but most just bow their heads and take it.

 

[Maz777]

There are plenty of academic practices where the senior MD leadership more or less forces the junior MDs to participate in this. It makes their lives easier by appeasing the CRNAs, meaning less headache running the ORs, and then the admin MDs can do even less clinical work because they don’t have to do procedures. Some people are willing to relocate over this but most just bow their heads and take it.

Bingo. That's the goal of many in academics. How can I kiss the appropriate arse and climb the ladder by minimizing how much clinical work I actually do? How can I sit in my office, sign a few charts, and become Vice Chair of something completely made up that no one needs?

 

[TeslaCoil]

Mmk. Can anybody actually talk about what the thread is supposed to be about?? Non-compete ban getting put on pause? Does nobody care?

 

[abolt18]

Mmk. Can anybody actually talk about what the thread is supposed to be about?? Non-compete ban getting put on pause? Does nobody care?

I think everyone saw it as inevitable so it doesn't feel like news.

I think that if nothing else, the FTC pushing this is going to give extra momentum to help states push through similar legislation and make the FTC ruling unimportant in those states.

Our state managed to push the through legislation last year making non-competes invalid for PCPs (but only for contracts signed 2023 and beyond). A big step in the right direction and likely to get it for all of medicine within a couple years.

 

[TeslaCoil]

I think everyone saw it as inevitable so it doesn't feel like news.

I think that if nothing else, the FTC pushing this is going to give an extra momentum to help states push through similar legislation through and make the FTC ruling unimportant in those states.

Our state managed to push the through legislation last year making non-competes invalid for PCPs (but only for contracts signed 2023 and beyond). A big step in the right direction and likely to get it for all of medicine within a couple years.

I feel completely trapped. Hate my current practice. There is another practice in town trying to recruit me. Thought this was my ticket out and Im so pissed it didnt hold up.

 

[GravelRider]

I feel completely trapped. Hate my current practice. There is another practice in town trying to recruit me. Thought this was my ticket out and Im so pissed it didnt hold up.

If you are truly miserable, it may be worth it to set up a meeting with a lawyer to find out if your non-compete is enforceable and the likelihood of you winning if your current employer decides to try to enforce it after you leave. If the non-compete is overly restrictive then it might actually be better if you decide to fight it. You should also consider setting up a meeting with your current employer and tell them you are miserable. Ask them not to enforce the non-compete or do something to make you less miserable in your current job. Having people who are unhappy at work is not good for overall morale. You may be able to buy out your non-compete for a reasonable amount. Ask for that amount as a sign on bonus at the new job.

Also, examine your contract. If your employer has breached the contract in any way (extra call, less money, less vacation, etc.), it would nullify your non-compete if you quit.

If you are miserable and feel trapped, definitely don’t wait for legislation or the FTC to solve it. Start making plans now under the assumption that nothing will change in the near future (it won’t). Do locums if you have to.

 

[TeslaCoil]

If you are truly miserable, it may be worth it to set up a meeting with a lawyer to find out if your non-compete is enforceable and the likelihood of you winning if your current employer decides to try to enforce it after you leave. If the non-compete is overly restrictive then it might actually be better if you decide to fight it. You should also consider setting up a meeting with your current employer and tell them you are miserable. Ask them not to enforce the non-compete or do something to make you less miserable in your current job. Having people who are unhappy at work is not good for overall morale. You may be able to buy out your non-compete for a reasonable amount. Ask for that amount as a sign on bonus at the new job.

Also, examine your contract. If your employer has breached the contract in any way (extra call, less money, less vacation, etc.), it would nullify your non-compete if you quit.

If you are miserable and feel trapped, definitely don’t wait for legislation or the FTC to solve it. Start making plans now under the assumption that nothing will change in the near future (it won’t). Do locums if you have to.

Doing that this week.

 

[pgg]

Doing that this week.

Please let us know what happens.

 

[abolt18]

Doing that this week.

I have a close friend that recently left his employer in January (academic employer with non-compete). He was one of many, and majority of them violated their non-compete without any consequence, finding jobs in town. University didn't come after any of them at all.

 

[deleted1130227]

Doing that this week.

make sure that they are familiar with the local players and history of enforcement.

 

[GravelRider]

I have a close friend that recently left his employer in January (academic employer with non-compete). He was one of many, and majority of them violated their non-compete without any consequence, finding jobs in town. University didn't come after any of them at all.

Yet…

I know someone who violated a non-compete. The first letter telling them of the plans to enforce it arrived about 8 months later. This person ended up fighting it and winning, but it was almost 2 years before it was all resolved.

 

[aneftp]

The way I see it is if mid-levels were to get complete independence then our healthcare system will move to a tiered system. The wealthy, or those that are willing to pay more, will have physicians provide their care. On the other hand, the rest of the public will have the opportunity to seek care from mid-levels at a cheaper rate. This already happens in the rest of the world, just in a different way. In Brazil, everyone is provided free healthcare at public hospitals, yet private hospitals exist for those willing to pay and roughly 25% of Brazil's population, or 50 million people, have private insurance. It can be argued that this occurs because the public hospitals in brazil have long wait times and surgeries can take up to years, but I would also venture out and assume that the best doctors work in this sector because the earning potential is much higher. There are plenty of people who are willing to pay for the knowledge and expertise of a physician as opposed to saving a buck going with a mid-level. This doesn't worry me the slightest.

Issue in anesthesia is likely 90% of procedures can be safely done with almost any competent crna. Now crnas will say they can do 100% of cases safely. I would disagree.

Being humble. I don’t even know if I can do 100% of cases myself. Maybe. 98-99%. But not 100%

Anyone who says they can do 100% is either a superstar or simply arrogant.

Some arrogant crnas simply can’t recognize their own limitations and those are the most dangerous ones.

 

[MirrorTodd]

Issue in anesthesia is likely 90% of procedures can be safely done with almost any competent crna. Now crnas will say they can do 100% of cases safely. I would disagree.

Being humble. I don’t even know if I can do 100% of cases myself. Maybe. 98-99%. But not 100%

Anyone who says they can do 100% is either a superstar or simply arrogant.

Some arrogant crnas simply can’t recognize their own limitations and those are the most dangerous ones.

Even if you can, there are random issues that pop up that can't always be accounted for.

 

[IlDestriero]

Doing that this week.

They might let you go. We had a few very competent, but very unhappy, people leave and everyone was better for it. They drag morale down across the board. They leave and everyone wins. Go here, go there, just go. Negotiate your exit. If you give them the notice they want, or maybe even a bit more, and they might not care to enforce the non compete. That might keep you there much longer poisoning the well.

 

[TeslaCoil]

They might let you go. We had a few very competent, but very unhappy, people leave and everyone was better for it. They drag morale down across the board. They leave and everyone wins. Go here, go there, just go. Negotiate your exit. If you give them the notice they want, or maybe even a bit more, and they might not care to enforce the non compete. That might keep you there much longer poisoning the well.

Me poisoning the well? Thats hilarious. Im not a partner and Im billing 2.6 million per year before overhead. My take-home is sickeningly small for how much work I do. Im the one who is poisoned.

 

[Arch Guillotti]

Me poisoning the well? Thats hilarious. Im not a partner and Im billing 2.6 million per year before overhead. My take-home is sickeningly small for how much work I do. Im the one who is poisoned.

How do you know this info?

 

[abolt18]

Me poisoning the well? Thats hilarious. Im not a partner and Im billing 2.6 million per year before overhead. My take-home is sickeningly small for how much work I do. Im the one who is poisoned.

That's billing, but what are collections for that billing?

 

[Onefellswoop87]

That's billing, but what are collections for that billing?