NY Times Article: Doctors And Nurses Are Ethical, Hospital Administrators Exploit That To Make Money

[Birdstrike]

Not sure if anyone posted this yet, but the author nails it on the head that the business of health care depends on exploiting the food will and ethics of physician and nurses. The only thing I disagree with is that hospital administrators do it inadvertently. I think they are very smart, know exactly what they are doing and do it willfully and calculatingly. I think they view physician good will ethical commitment to their patients as a resource like any other, that can be manipulated to maximize profits.


“The Business of Health Care Depends On Exploiting Doctors And Nurses”

Opinion | The Business of Health Care Depends on Exploiting Doctors and Nurses (Published 2019)

One resource seems infinite and free: the professionalism of caregivers.

www.nytimes.com

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Members don't see this ad.

 

[Lawpy]

I think i saw this in the Lounge. In any case, i hate administrators. I think they're actively hurting the profession and endangering patient care with their singular focus of reaping huge profits.

 

[GeneralVeers]

Not sure if anyone posted this yet, but the author nails it on the head that the business of health care depends on exploiting the food will and ethics of physician and nurses. The only thing I disagree with is that hospital administrators do it inadvertently. I think they are very smart, know exactly what they are doing and do it willfully and calculatingly. I think they view physician good will ethical commitment to their patients as a resource like any other, that can be manipulated to maximize profits.


“The Business of Health Care Depends On Exploiting Doctors And Nurses”

Opinion | The Business of Health Care Depends on Exploiting Doctors and Nurses (Published 2019)

One resource seems infinite and free: the professionalism of caregivers.

www.nytimes.com

Not sure we needed an article to tell us this. It's self-evident in all their behaviors. Once you know their game, it's easy to manipulate them back when you couch everything in "quality" and "reimbursement" terms.

 

[deleted547339]

Not sure we needed an article to tell us this. It's self-evident in all their behaviors. Once you know their game, it's easy to manipulate them back when you couch everything in "quality" and "reimbursement" terms.

Agreed. Similarly, “patient safety” is one of the few terms that gets a rapid response. I think that’s just for fear of getting sued.

 

[scummie]

Some excellent quotes from the article:

“From 1975 to 2010, the number of health care administrators increased 3,200 percent. There are now roughly 10 administrators for every doctor. If we converted even half of those salary lines to additional nurses and doctors, we might have enough clinical staff members to handle the work.”

“In a factory, if 30 percent more items were suddenly dropped onto an assembly line, the process would grind to a halt. Imagine a plumber or a lawyer doing 30 percent more work without billing for it. But in health care there is a wondrous elasticity — you can keep adding work and magically it all somehow gets done.”

“If doctors and nurses clocked out when their paid hours were finished, the effect on patients would be calamitous. Doctors and nurses know this, which is why they don’t shirk. The system knows it, too, and takes advantage.”

 

[Brigade4Radiant]

10 admins per doctor who have no liability but gain all the profit. Yeah medicine is heading in a great direction.

 

[p1acebo]

10 admins per doctor who have no liability but gain all the profit. Yeah medicine is heading in a great direction.

Not to mention contribute essentially nothing to patient care.

 

[GeneralVeers]

Not to mention contribute essentially nothing to patient care.

Not to mention contribute essentially nothing to patient care.

But who's going to make the powerpoint presentation with slides showing our monthly "metrics" and how we rank with other facilities in the "region"?

 

[gro2001]

Not sure we needed an article to tell us this. It's self-evident in all their behaviors. Once you know their game, it's easy to manipulate them back when you couch everything in "quality" and "reimbursement" terms.

Doctors certainly won't find anything shocking in this article. I think it may be interesting to the lay public though.

 

[scummie]

So how do we protect our turf and get less administrators?

 

[RustedFox]

When I started at my first job after residency, it was common for all of us to stay 1 hour or so after the shift for a smooth handoff, and to clean-up simple stuff. We billed for that hour, and got paid for that hour. We all did it happily.

Then, our volume grew, and it became common for us to be called 1-2 hours prior to the scheduled start of our shift to help out with volume to "keep the times down". This was billed as "Surge Pay", and we were paid 1.5x for that hour or two. We all did it happily.

Then, they stopped paying us "Surge Pay", and asked us to be available 1-2 hours prior to the scheduled start of every shift to assist with "seasonal volume". A lot of us didn't do that. I didn't unless I was going to get paid "surge pay".

Then, it became "if you're not available 1-2 hours prior to the scheduled start of your shift, you will have to justify why you are not available" failing to do so, you were called "not a team player" and had to have a face-to-face meeting with the local suits.

I'm so glad I quit that job. That's HCA/Envision, folks!

 

[RustedFox]

Oh! Forgot this detail;

When we asked why "Surge Pay" was no longer being offered, the answer that we got was: "regional budget constraints and shortfalls".

Right? Like, its not my fault that your regional administrators can't steal more money. If they stole LESS money, maybe the boat wouldn't be rocked so much?

I've said it before, and it bears repeating: the day that you hang up your scrubs and trade in your stethoscope for a pair of loafers... you lose all your credibility. I love it when MS 1-2'ers post on here saying something like: "I'm interested in administration; how can I make myself more marketable for [whatever]?"

I want to metaphorically punch every poster that says something like that in their virtual mouth.

If you've ever been punched in the mouth before, you know what I mean. It stings. You bleed. You're mad. But one thing is for sure: you shut that mouth, fast.

We need LESS "chiefs" and MORE "indians". You didn't go to medical school to b!tch out and go admin after your pre-clin years.

If you did... then you should hang your head in shame and never hold the title of "physician".

 

[DrStephenStrange]

So how do we protect our turf and get less administrators?

Open your own private practice!

 

[RustedFox]

Open your own private practice!

Uhmm.... yeah, amigo. - We don't do that here in the world of EM.
Unless you're talking about forming a nascent SDG, in which case... that's a different thread altogether.

 

[Hercules]

I get the general discontent with the suits, but i think you have to differentiate between the necessary and the extraneous ones.

I think a lot of these large CMG’s have a heft helping of extraneous suits that are just leeches feeding off your labor.

On the other hand hospitals have to have suits as most hospitals are businesses and they won’t run by themselves. These suits tend to perform necessary functions that most doctors are both uninterested in and unqualified to perform.

 

[Lawpy]

When I started at my first job after residency, it was common for all of us to stay 1 hour or so after the shift for a smooth handoff, and to clean-up simple stuff. We billed for that hour, and got paid for that hour. We all did it happily.

Then, our volume grew, and it became common for us to be called 1-2 hours prior to the scheduled start of our shift to help out with volume to "keep the times down". This was billed as "Surge Pay", and we were paid 1.5x for that hour or two. We all did it happily.

Then, they stopped paying us "Surge Pay", and asked us to be available 1-2 hours prior to the scheduled start of every shift to assist with "seasonal volume". A lot of us didn't do that. I didn't unless I was going to get paid "surge pay".

Then, it became "if you're not available 1-2 hours prior to the scheduled start of your shift, you will have to justify why you are not available" failing to do so, you were called "not a team player" and had to have a face-to-face meeting with the local suits.

I'm so glad I quit that job. That's HCA/Envision, folks!

That really stinks. Another example how administrators make physicians' lives worse by ruining everything.

 

[RustedFox]

I get the general discontent with the suits, but i think you have to differentiate between the necessary and the extraneous ones.

I think a lot of these large CMG’s have a heft helping of extraneous suits that are just leeches feeding off your labor.

On the other hand hospitals have to have suits as most hospitals are businesses and they won’t run by themselves. These suits tend to perform necessary functions that most doctors are both uninterested in and unqualified to perform.

I getchoo, man - but when you're HCA-Envision... there's a lot of fat to cut. Maybe if they did the right thing, they wouldn't be gold-medal winners in "whistleblower lawsuits"

 

[MechEDoc]

Then, it became "if you're not available 1-2 hours prior to the scheduled start of your shift, you will have to justify why you are not available" failing to do so, you were called "not a team player" and had to have a face-to-face meeting with the local suits.

No surprise, some TeamHealth sites in AZ would call their docs 45-60 minutes before their shift start and tell them to show up 1-2 hours late is the ED was slow at that movement in an attempt to save a few bucks. The docs started leaving their phones off before shift start.

I worked a CMG evil site for a few shifts. They wanted day->day->night->afternoon->morning->night->day->night as a rotation, sometimes with less than six hours of down time between shifts. Back and forth regarding the schedule. "It's unsafe, I won't work it" / "work it!" The boss man thought he solved his schedule issue by screaming at me on the phone and threatening come and get me unless I worked according to their wishes. They found themselves with 18 hours to find a new physician at a bumf*ck IVDU center of excellence.

F-them and their private equity. I hope they are haunted by the patients that they have hurt.

 

[MechEDoc]

you were called "not a team player" and had to have a face-to-face meeting with the local suits.

To adapt from Charles de Gaulle and Lord Palmerston: A physician has no friends, only interests.

• Lawsuits? You're on your own.
• Subpoena? You're on your own.
• Patient complaints? You find yourself answering to idiots and explaining normal actions that don't warrant an explanation.
• Nurse got her feelings hurt? Don't point out their failures, it hurts their feelings.
• Contract change? Best of luck. Here's a new contract. We've dumped 1/2 the doctors and you'll have to sign off on charts that PAs and NPs (that you didn't hire, can't fire, and you'd better not hurt their feelings). The suits get the money, you get the liability.
• Patient volume slow last week? We've reduced your hours but upped the PAs and NPs.
• Lacking equipment? Be a team player.
• Management failed to find a physician for the next shift? They'll lean on you with false threats like "patient abandonment", and "reporting to the board" in an attempt to coerce you to stay.

Management and myself are not friends and will never be. We are not on the same team. We have common interests at times and often work well together, but there are boundaries to the relationship.

* Charles de Gaulle - No nation has friends only interests.
* Lord Palmerston - “England has no eternal friends, England has no perpetual enemies, England has only eternal and perpetual interests.”

 

[hundreddaysoff]

When I started at my first job after residency, it was common for all of us to stay 1 hour or so after the shift for a smooth handoff, and to clean-up simple stuff. We billed for that hour, and got paid for that hour. We all did it happily.

Then, our volume grew, and it became common for us to be called 1-2 hours prior to the scheduled start of our shift to help out with volume to "keep the times down". This was billed as "Surge Pay", and we were paid 1.5x for that hour or two. We all did it happily.

Then, they stopped paying us "Surge Pay", and asked us to be available 1-2 hours prior to the scheduled start of every shift to assist with "seasonal volume". A lot of us didn't do that. I didn't unless I was going to get paid "surge pay".

Then, it became "if you're not available 1-2 hours prior to the scheduled start of your shift, you will have to justify why you are not available" failing to do so, you were called "not a team player" and had to have a face-to-face meeting with the local suits.

I'm so glad I quit that job. That's HCA/Envision, folks!

Y'know, I thought HCA was pretty OK at first but I'm starting to dislike them. And based on your Envision stories, TH seems to be less proactively evil than Envision but still bends over backward not to fight HCA's evil. The more you get to know these behemoths, the less you like them.

Eg: the other night at my FSED, an unusually enterprising admin walks in at midnight to administer a fire drill to us. This involves her pulling the fire alarm and everyone meeting up at the RN station. Don't ask me why the RN station rather than walking to their nearest exit like we learned in elementary school.

And but what's the first thing she does when she walks in?

Yells at the RNs that having food, drink, cell phones, and computers at the RN station is a fire hazard.

Me: "Wait, why is that a fire hazard?"

Admin: "Well, the drinks could spill on a power cord, and that could start a fire."

Me: [mouth opening and closing]

I don't find this evil so much for its effect on myself; I can tolerate just about anything for $275/h for a couple years. It's what I signed up for. I find this evil because my (technically HCA's) RNs, some of the most talented in the city, my friends who I hang out with 12 hours a day several times a week, are getting paid just $30/h to take this crap. I hope they quit, but I also hope they don't quit because they're so good at their jobs and bringing in new ones who would eat this BS would probably be less talented and make my and my patients' lives a bit harder.

 

[Birdstrike]

Y'know, I thought HCA was pretty OK at first but I'm starting to dislike them. And based on your Envision stories, TH seems to be less proactively evil than Envision but still bends over backward not to fight HCA's evil. The more you get to know these behemoths, the less you like them.

Eg: the other night at my FSED, an unusually enterprising admin walks in at midnight to administer a fire drill to us. This involves her pulling the fire alarm and everyone meeting up at the RN station. Don't ask me why the RN station rather than walking to their nearest exit like we learned in elementary school.

And but what's the first thing she does when she walks in?

Yells at the RNs that having food, drink, cell phones, and computers at the RN station is a fire hazard.

Me: "Wait, why is that a fire hazard?"

Admin: "Well, the drinks could spill on a power cord, and that could start a fire."

Me: [mouth opening and closing]

I don't find this evil so much for its effect on myself; I can tolerate just about anything for $275/h for a couple years. It's what I signed up for. I find this evil because my (technically HCA's) RNs, some of the most talented in the city, my friends who I hang out with 12 hours a day several times a week, are getting paid just $30/h to take this crap. I hope they quit, but I also hope they don't quit because they're so good at their jobs and bringing in new ones who would eat this BS would probably be less talented and make my and my patients' lives a bit harder.

Never forget this: Anytime administration does something that seems mindbogglingly stupid, they usually aren't doing something stupid. It's usually a cover for them and those above them to make more money.

One of my faves was when the admins made us start locking up water bottles and antibiotic ointment in the locked med machine "cuz H2O and petroleum jelly are medicines and psych patients could take large amounts orally and die."

Your first reaction is, "They can't be stupid." Then you realize they're not, they're just lying.

They've simply determined they could make more money by creating a barrier to using these items, because nurses were giving patients a few packets of antibiotic ointment to take home and the more expensive sterile water was sometimes being used when tap water could suffice. They'll rarely tell you the truth when the truth is, "We're doing this so we can make more money." They're taught, "Always tell docs and nurses everything is for 'patient care' and they'll suck it right up." And it works.

The next time admin makes some seemingly insane policy decision, ask yourself, "How can this be traced back to them making more money?" Usually it can. When you start to think in these terms things come into much better focus.

 

[Birdstrike]

Y'know, I thought HCA was pretty OK at first but I'm starting to dislike them. And based on your Envision stories, TH seems to be less proactively evil than Envision but still bends over backward not to fight HCA's evil. The more you get to know these behemoths, the less you like them.

Eg: the other night at my FSED, an unusually enterprising admin walks in at midnight to administer a fire drill to us. This involves her pulling the fire alarm and everyone meeting up at the RN station. Don't ask me why the RN station rather than walking to their nearest exit like we learned in elementary school.

And but what's the first thing she does when she walks in?

Yells at the RNs that having food, drink, cell phones, and computers at the RN station is a fire hazard.

Me: "Wait, why is that a fire hazard?"

Admin: "Well, the drinks could spill on a power cord, and that could start a fire."

Me: [mouth opening and closing]

I don't find this evil so much for its effect on myself; I can tolerate just about anything for $275/h for a couple years. It's what I signed up for. I find this evil because my (technically HCA's) RNs, some of the most talented in the city, my friends who I hang out with 12 hours a day several times a week, are getting paid just $30/h to take this crap. I hope they quit, but I also hope they don't quit because they're so good at their jobs and bringing in new ones who would eat this BS would probably be less talented and make my and my patients' lives a bit harder.

Admins Don't Do Stupid or Patient Care, They Only Do Money

Let’s apply the rule:

The above has nothing to do with any fire hazards. When this admin walked through, she saw food, drinks and cell phones. To an admin that doesn't mean "fire." It means "laziness, loss of productivity" and "you could be working harder" and "don't you dare ever ask for raise again or complain about being 'too busy' or 'overwhelmed.’”

The truth: She saw signs of what she perceived as sub-maximal productivity and translated that into, "Why am I even paying them what we're paying them? We're losing money on them. Labor costs are too high. We should probably decrease staffing by 20% and they're asking for a raise. My boss could be making more money. I could be making more money!”

The lie was: "This is a fire hazard and you better not do these things or a fire will start and patients will burn up."

 

[GeneralVeers]

The lie was: "This is a fire hazard and you better not do these things or a fire will start and patients will burn up."

The other reason they do this at HCA is to keep the employees off balance. By having middle nurse managers enforce tiny, irrelevant rules, the employees live in fear. They are so worried about being caught in this or that tiny infraction that they don't think about the bigger picture, bring up actual patient care concerns or complain.

My last HCA literally had a "no lights off" policy because they caught an employee taking a nap one day. From then on they told the nurses "anyone who turns off EVEN ONE LIGHT WILL BE FIRED!"

I usually dim the lights around midnight on night shift, but thanks to HCA I had to leave the fluorescent panels blazing brighter than a supernova until the end of my shift. If I even tried to touch the light switch the nurses would scream, and tell me not to do it or they would get fired.

 

[Birdstrike]

The other reason they do this at HCA is to keep the employees off balance. By having middle nurse managers enforce tiny, irrelevant rules, the employees live in fear. They are so worried about being caught in this or that tiny infraction that they don't think about the bigger picture, bring up actual patient care concerns or complain.

My last HCA literally had a "no lights off" policy because they caught an employee taking a nap one day. From then on they told the nurses "anyone who turns off EVEN ONE LIGHT WILL BE FIRED!"

I usually dim the lights around midnight on night shift, but thanks to HCA I had to leave the fluorescent panels blazing brighter than a supernova until the end of my shift. If I even tried to touch the light switch the nurses would scream, and tell me not to do it or they would get fired.

This might shock the uninitiated. I doubt it will surprise anyone seasoned:

I used to work at this site where the docs also covered a much smaller ED but the nurses didn't go back and forth. The smaller ED was seen as more desirable by the nurses because of the lower acuity and volume and the older (and higher paid) nurses with more seniority would eventually settle there. Every couple of years administration would suddenly change policy and start forcing the older nurses go back and forth between sites. Inevitably this would cause a few of the older, more skilled nurses to quit. Then short time later, they'd reverse the policy back to how it had been. They did this more than once over several years and it was frustrating losing some of the best nurses for no good reason.

One day, I asked out of frustration, why they did this every few years when it obviously caused many of the best, most skilled nurses to quit, only to have the policy reversed a few weeks later. I was told they "do it every few years to shake the old dead wood out of the tree," meaning to force the older nurses to quit so they could replace them with less skilled, cheaper new grads, since firing them for that reason would put them at risk for being sued for age discrimination.

 

[Sushirolls]

Oh! Forgot this detail;

When we asked why "Surge Pay" was no longer being offered, the answer that we got was: "regional budget constraints and shortfalls".

Right? Like, its not my fault that your regional administrators can't steal more money. If they stole LESS money, maybe the boat wouldn't be rocked so much?

I've said it before, and it bears repeating: the day that you hang up your scrubs and trade in your stethoscope for a pair of loafers... you lose all your credibility. I love it when MS 1-2'ers post on here saying something like: "I'm interested in administration; how can I make myself more marketable for [whatever]?"

I want to metaphorically punch every poster that says something like that in their virtual mouth.

If you've ever been punched in the mouth before, you know what I mean. It stings. You bleed. You're mad. But one thing is for sure: you shut that mouth, fast.

We need LESS "chiefs" and MORE "indians". You didn't go to medical school to b!tch out and go admin after your pre-clin years.

If you did... then you should hang your head in shame and never hold the title of "physician".

The issue isn't with physicians taking on admin roles.

We need more physicians in admin, and in policy, and in politics. But those who do trade for loafers, need to still by physician minded. This is the real issue, that those who do tend to drink the kool aid. They themselves have more suits above them and should they be a real advocate, an admin we'd all admire, they would quickly be replaced for various reasons. So thus the paradox, of physician admin who can still advocate without getting replaced...

 

[Birdstrike]

So thus the paradox, of physician admin who can still advocate without getting replaced...

That's correct. It's a difficult if not impossible straddle. At the end of the day, those higher up the administrative ladder are going to demand they (admin) are served as opposed to paying someone to serve a group with different demands (physicians). As long as the goals of admin and physicians are aligned, all is well. When they're not, it's the physicians' demands that are going to suffer.

Admins also know doctors have a lot of leverage but are afraid to use it because we will put up with a lot of crap to maintain our income.

 

[IMGASMD]

The issue isn't with physicians taking on admin roles.

We need more physicians in admin, and in policy, and in politics. But those who do trade for loafers, need to still by physician minded. This is the real issue, that those who do tend to drink the kool aid. They themselves have more suits above them and should they be a real advocate, an admin we'd all admire, they would quickly be replaced for various reasons. So thus the paradox, of physician admin who can still advocate without getting replaced...

I was once talking to an older nurse about similar issue. The conclusion was when the doctors stop running the hospital, we already gave our power away. Most of the MBA, MPH will never see this side of medicine. But the same can be said about “this generation” of doctors. The ones who “needs” work life balance or only “shift work”.

With bean counters trying to extract every last ounce of productive from us, I would probably start looking for a “shift work” job or demand more balance in my life too. (This is from IM and anesthesia prospectives though)...

 

[Brigade4Radiant]

Executives control money saying physicians shouldn’t be admins is saying you need to dedicate yourself to a burnout profession.

 

[RustedFox]

Executives control money saying physicians shouldn’t be admins is saying you need to dedicate yourself to a burnout profession.

Not necessarily.
We need:

(1.) ...less "chiefs" and more "indians". That is; these 9-4pm with an hour and a half for a catered lunch admins need to do more work and not expand the bloat.
(2.) ... for the existing admins to act ethically and do the right thing, instead of finding new and creative ways to steal money (i.e. - create a metric, crack the whip, collect your bonus)

We could have both of those things without driving MS1-2s into an "admin track".

 

[Birdstrike]

I think admins view physician salaries as form of hush money. Although they'd love to pay us $1 per year if they could, they know if they keep us fat and happy, they can do whatever they want to us and although we'll complain, we won't take any real action for fear of risking our lifestyles.

 

[Sushirolls]

As a non-EM person, my proposed solution for EM is consolidation of EM docs, forming a like minded EM medical group. Quit/strike, and then form an LLC to undertake the care at that hospital as a unified voice.

Granted some hospitals will fight viciously, and have non-competes, etc. So, to incorporate and separate from the local hospital system medical group may be difficult. Thus, another layer of complexity would be to coordinate with another similar sized hospital ED group, and essentially play musical chairs to run down the non-compete clauses clock. They form a group, swoop in to take over your contracts, and you do the same. All docs gets displaced for 1, 2, 3 years, then magically each group swaps back at same time. Logistical nightmare for all, but best chance EM docs stand to improve their bureaucracy blight at a local level.

I've seen OB do this 'move as flock' without being their own medical group.
I've seen this in an anesthesiology group that grew to take over several hospitals and peripheral sites.

 

[IMGASMD]

As a non-EM person, my proposed solution for EM is consolidation of EM docs, forming a like minded EM medical group. Quit/strike, and then form an LLC to undertake the care at that hospital as a unified voice.

Granted some hospitals will fight viciously, and have non-competes, etc. So, to incorporate and separate from the local hospital system medical group may be difficult. Thus, another layer of complexity would be to coordinate with another similar sized hospital ED group, and essentially play musical chairs to run down the non-compete clauses clock. They form a group, swoop in to take over your contracts, and you do the same. All docs gets displaced for 1, 2, 3 years, then magically each group swaps back at same time. Logistical nightmare for all, but best chance EM docs stand to improve their bureaucracy blight at a local level.

I've seen OB do this 'move as flock' without being their own medical group.
I've seen this in an anesthesiology group that grew to take over several hospitals and peripheral sites.

Lots of coordination. Mostly, lots of trust. And while you’re doing this, a national group may come in, game over.

 

[Sushirolls]

Trust indeed, but the more doctors have been burned by admin/hospitals in their careers the greater the likelihood of success and it only takes a few vocal champions to help cheer lead the change. Not all need buy in for the plan, just a critical mass. As an outsider, I believe EM has a culture of people more likely to implement and see this thru.

 

[scummie]

Trust indeed, but the more doctors have been burned by admin/hospitals in their careers the greater the likelihood of success and it only takes a few vocal champions to help cheer lead the change. Not all need buy in for the plan, just a critical mass. As an outsider, I believe EM has a culture of people more likely to implement and see this thru.

The problem is getting this critical mass organized. I can see why people argue for the “get involved with ACEP committees approach” to advocate for change. Let’s unionize and go on strike. Oh wait, jk, that will never happen.

 

[hundreddaysoff]

"do it every few years to shake the old dead wood out of the tree"

Yes, this RN deadwood theory rings true as a reason for the no-food firedrill BS. Of course, Veers' lighting reign of terror experience is related.

Our pt census is way down and at our main, the charge nurse regularly sends half our nursing staff home 4--5h early. Gets annoying when the odd wake-up stroke, legit sepsis, or other actual emergency comes in at the 6AM rush and I only have 2 RNs left.

The insidious genius of this is that it doesn't even require any conscious lying or other intentional evil by Commissar Firedrill Bureaucrat! She just needs to follow the orders from above, regurgitate all over us the BS fed to her by the big evil, and look forward to that Christmas bonus she'll get for preventing ER fires by banning all personal objects at the RN station.

I kind of want to shake the hand of the jerk who came up with this system. I wonder if they were related to Arthur Sackler.

I also wonder why our nurses' union isn't preventing this stuff, as our RNs are all unionized.

 

[miacomet]

I think admins view physician salaries as form of hush money. Although they'd love to pay us $1 per year if they could, they know if they keep us fat and happy, they can do whatever they want to us and although we'll complain, we won't take any real action for fear of risking our lifestyles.

We don't really get paid that much considering our education and, at least in EM, our liability and stress. And in EM there is most definitely downward salary pressure.

 

[GonnaBeADoc2222]

We don't really get paid that much considering our education and, at least in EM, our liability and stress. And in EM there is most definitely downward salary pressure.

I think we get paid pretty fine considering the length of our training. We are one of the highest if not the highest (hourly) paid specialists. If I worked 20 days / month I would get paid 600K+, obviously I don't do this.

I have however started to think about what rate below which I would absolutely not walk into an ED, no matter how nice the shop and how low the volume. I think that number is about $170/hr. Below this I think I would probably stop doing any kind of traditional full time ER work, maybe do a few 24 hour shifts in BF per month, be a full time dad, and rely on my wife's income.

 

[miacomet]

I think we get paid pretty fine considering the length of our training. We are one of the highest if not the highest (hourly) paid specialists. If I worked 20 days / month I would get paid 600K+, obviously I don't do this.

I have however started to think about what rate below which I would absolutely not walk into an ED, no matter how nice the shop and how low the volume. I think that number is about $170/hr. Below this I think I would probably stop doing any kind of traditional full time ER work, maybe do a few 24 hour shifts in BF per month, be a full time dad, and rely on my wife's income.

I know NPs making $150 an hour and nurses making over $100 an hour.
Software engineers can make 250k a few years out of undergrad.
Wall Street can make millions.
None of these people has half our training, none works overnights, and they work fewer weekends. Sure you "could" make 600k, but you don't, and you can't, really, because most EM docs switch schedules so it's pretty hard to make 600k a year.
If you like being an EM doc (or other doc), great, but the pay is not great considering the training, stress, and circadian issues.
Be an owner, not an employee, and start earning at 21, not 28.

 

[Uranium678]

It should be no surprise that businesses act like businesses. Admin has to make money, it’s their main job. Now that money is tied to “quality and metrics” they are concerned with that. Physicians in general are just cogs in a big money wheel. Hospitals sell doctor services for the most part. We are the widgets that people pay big money to use. I think physicians in admin is a good thing. Anyone read this article or seen these numbers

Doctors bring in a lot of money for hospitals

It's much more than those doctors receive in salary.

www.axios.com

EM is not there but its not hard to assume we would also bring a lot in

 

[TooMuchResearch]

It should be no surprise that businesses act like businesses. Admin has to make money, it’s their main job. Now that money is tied to “quality and metrics” they are concerned with that. Physicians in general are just cogs in a big money wheel. Hospitals sell doctor services for the most part. We are the widgets that people pay big money to use. I think physicians in admin is a good thing. Anyone read this article or seen these numbers

Doctors bring in a lot of money for hospitals

It's much more than those doctors receive in salary.

www.axios.com

EM is not there but its not hard to assume we would also bring a lot in

I'm not sure about some of those numbers

 

[Brigade4Radiant]

I'm not sure about some of those numbers

Why not? There is a reason why there are 10 admins per 1 physician.

There is and will always be a good amount of money in healthcare

 

[TooMuchResearch]

Why not? There is a reason why there are 10 admins per 1 physician.

There is and will always be a good amount of money in healthcare

Primary care brings in $2m revenue?

 

[VA Hopeful Dr]

Primary care brings in $2m revenue?

Yep

Employed Physicians Create Almost $2.4M a Year in Hospital Revenue | TechTarget

A new report shows employed physicians are a major driver of hospital revenue, with specialists and primary care doctors generating $2.5 million and $2.1 million a year, respectively.

revcycleintelligence.com

 

[MechEDoc]

Yep

Employed Physicians Create Almost $2.4M a Year in Hospital Revenue | TechTarget

A new report shows employed physicians are a major driver of hospital revenue, with specialists and primary care doctors generating $2.5 million and $2.1 million a year, respectively.

revcycleintelligence.com

What does EM bring in?

 

[VA Hopeful Dr]

What does EM bring in?

No clue

 

[Brigade4Radiant]

Primary care brings in $2m revenue?

Yeah referrals and such they are the gate keepers

What does EM bring in?

It’s hard to answer because the money goes to the staffing company that’s why hospitals treat you like an easily replaceable cog. Versus Neurology and Cardiology they will bow down and the CEO knows them.

To see how a hospital sees you see HCA they have a staffing company for a vital service they advertise unethical door to doc and have EMCare do their bidding because they need to contract.

 

[TooMuchResearch]

Yeah referrals and such they are the gate keepers



It’s hard to answer because the money goes to the staffing company that’s why hospitals treat you like an easily replaceable cog. Versus Neurology and Cardiology they will bow down and the CEO knows them.

To see how a hospital sees you see HCA they have a staffing company for a vital service they advertise unethical door to doc and have EMCare do their bidding because they need to contract.

Shouldn't be that hard to answer if anyone has easy access to their books.

 

[Brigade4Radiant]

Shouldn't be that hard to answer if anyone has easy access to their books.

Well you see you have to be super mega partner to have access at a lot of SDG. Most CMG keep their books closed so you can be ignorant of how much you are really worth.

 

[GeneralVeers]

Well you see you have to be super mega partner to have access at a lot of SDG. Most CMG keep their books closed so you can be ignorant of how much you are really worth.

When one of my friends go ahold of EMP's(now USACS) real books for our site, we found they were taking 47% off the top right to Ohio. Needless to see the higher ups were annoyed, but it was still fun throwing it back at them whenever they'd complain about decreasing reimbursement.

 

[TooMuchResearch]

Well you see you have to be super mega partner to have access at a lot of SDG. Most CMG keep their books closed so you can be ignorant of how much you are really worth.

I actually don't have access as I'm not a partner. Our group only has one level of shareholder and a non-predatory partnership track. Unless my friends that are shareholders are blowing smoke, they make about 30% more than me. Our biggest practice expenses are office staff and probably office rental along with outsourced coding and billing. Where is that thread about what we're really worth? Since everything in the corporation is paid out annually, and the partners make some of their money off us underlings and midlevels, I think each partner must not bring in much more than they take home.