NYT: Hospitals Get Bailed Out While Independent MD's Struggle

[drusso]

Doctors Without Patients: ‘Our Waiting Rooms Are Like Ghost Towns’ (Published 2020)

As visits plummet because of the coronavirus, small physician practices are struggling to survive.

www.nytimes.com

“Here’s the scary thing — as these practices start to break down and go bankrupt, we could have more consolidation among the health care systems,” Dr. Crow said. That concerns health economists, who say the steady rise in costs is linked to the clout these big hospital networks wield with private insurers to charge high prices.

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[hyperalgesia]

I think this is true in a lot of industries - culling the weak - or in this case, the disadvantaged.

 

[deleted993114]

Doctors Without Patients: ‘Our Waiting Rooms Are Like Ghost Towns’ (Published 2020)

As visits plummet because of the coronavirus, small physician practices are struggling to survive.

www.nytimes.com

“Here’s the scary thing — as these practices start to break down and go bankrupt, we could have more consolidation among the health care systems,” Dr. Crow said. That concerns health economists, who say the steady rise in costs is linked to the clout these big hospital networks wield with private insurers to charge high prices.

I thought this may happen as a result of the coronavirus.

Of course, there are advantages and disadvantages to being an employed physician, which are probably more appealing the closer you are to retirement. I like being an employee, as I have zero personal financial concerns with the practice. That being said, they could fire me at any time, which I am okay with.

Those practice groups that "sell" to hospital systems may be a little surprised to find out that they use your own revenues to "pay you off" over a 7 year period. In effect, they get your practice for free, using your own revenues to "pay" you. There is rarely, if ever, a big check written and you just quit- that's not the way it works. Usually you are obligated to continue working there for 5-7 more years.

Make no mistake of it, these guys are not idiots and are not in the practice of giving money away.

 

[drusso]

I thought this may happen as a result of the coronavirus.

Of course, there are advantages and disadvantages to being an employed physician, which are probably more appealing the closer you are to retirement. I like being an employee, as I have zero personal financial concerns with the practice. That being said, they could fire me at any time, which I am okay with.

Those practice groups that "sell" to hospital systems may be a little surprised to find out that they use your own revenues to "pay you off" over a 7 year period. In effect, they get your practice for free, using your own revenues to "pay" you. There is rarely, if ever, a big check written and you just quit- that's not the way it works. Usually you are obligated to continue working there for 5-7 more years.

Make no mistake of it, these guys are not idiots and are not in the practice of giving money away.

Absolutely correct!

"The Cake is a Lie." There is no pot of gold at the end of the hospital-employed MD rainbow. And, an institution can't love you back. Once you can no longer turn a trick on generating SOS and facility fees, they will cut off the RVU pellets and kick you to the curb like a used-up plaything. Moreover, often the people you seal the deal with won't be around in 2-3 years when your contract comes up for renewal. Add on to that non-compete clauses, corona-triggers clauses, claw-backs, forced arbitration, gag-orders, etc and they've got a plethora of ways to stick a hot poker up the backside for misbehaving or otherwise being "disruptive."

 

[lobelsteve]

Absolutely correct!

"The Cake is a Lie." There is no pot of gold at the end of the hospital-employed MD rainbow. And, an institution can't love you back. Once you can no longer turn a trick on generating SOS and facility fees, they will cut off the RVU pellets and kick you to the curb like a used-up plaything. Moreover, often the people you seal the deal with won't be around in 2-3 years when your contract comes up for renewal. Add on to that non-compete clauses, corona-triggers clauses, claw-backs, forced arbitration, gag-orders, etc and they've got a plethora of ways to stick a hot poker up the backside for misbehaving or otherwise being "disruptive."

I feel sorry for all those suckers.

 

[drusso]

I feel sorry for all those suckers.

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

 

[SSdoc33]

Your posts are not informative.... they are a cry for help. Trying to tear down hospitals and hospital based practice to make up for your insecurity in your own professional (or personal) life.

I can say this bc i have been listening to this drivel for 10 years.


Also, you have posted that Gunderman article at least 3 times. Get some new material.

 

[drusso]

Your posts are not informative.... they are a cry for help. Trying to tear down hospitals and hospital based practice to make up for your insecurity in your own professional (or personal) life.

I can say this bc i have been listening to this drivel for 10 years.


Also, you have posted that Gunderman article at least 3 times. Get some new material.

 

[lobelsteve]

It’s not just that he keeps posting the same old stuff, he continues to get it wrong.
Ymmv.

 

[10KHertz]

The comprehensive private pain practices will be fine. The pill mills will probably be fine as well(unfortunately). The hospital pain centers around me weren’t efficient or comprehensive prior to Covid 19. Not sure how they will compete post pandemic ...
I worry more about post pandemic/recession poverty and inability to pay deductibles and copays (remember 2009?).

 

[SSdoc33]

better

 

[drusso]

It’s not just that he keeps posting the same old stuff, he continues to get it wrong.
Ymmv.

I don't begrudge anyone making rational choices in their own best interests. I just champion contrarian points of view. Hospital employment is a relatively new phenomenon in health care. All of the doctors I knew growing up were independent.

 

[deleted993114]

Absolutely correct!

"The Cake is a Lie." There is no pot of gold at the end of the hospital-employed MD rainbow. And, an institution can't love you back. Once you can no longer turn a trick on generating SOS and facility fees, they will cut off the RVU pellets and kick you to the curb like a used-up plaything. Moreover, often the people you seal the deal with won't be around in 2-3 years when your contract comes up for renewal. Add on to that non-compete clauses, corona-triggers clauses, claw-backs, forced arbitration, gag-orders, etc and they've got a plethora of ways to stick a hot poker up the backside for misbehaving or otherwise being "disruptive."

Wow- I feel like an orphaned waif out in the world on my own now- kind of like "Le Miserable"

Well...………………………. if I was fired or let go at the end of my contract, I really wouldn't care. I would just retire to my farm and be a bum. I talk with the CEO fairly often and have a good relationship with her (being married for over 30 years, I am used to being bossed around by women). However, I am not under a delusion that if the clinic was no longer generating a bucket of revenue, I would certainly be booted (that would make economic sense).

From what I have read on this site, it appears MANY providers have had an adversarial relationship with their employers. I don't. I live/work in a middle sized market which is somewhat isolated, so they need pain providers. That being said, admins are charged with keeping their facility economically stable (even if not for profit) and may whack a provider who is performing well simply for budget considerations. I understand the economics of medicine and would not take it personally.

There are advantages and disadvantages to every type of practice and one needs to choose what is best for them. I am a guy who has no problem taking orders from others and being told what to do, so being employed is okay for me. When I was younger and more opinionated about what I did, perhaps that would not have been a good fit. However, today, if they asked me to wash cars for the morning, I would be up for it, as I really don't care what I do.

PS- that hot poker treatment sounds really unpleasant and I would like to avoid that, if possible.

 

[drusso]

Wow- I feel like an orphaned waif out in the world on my own now- kind of like "Le Miserable"

Well...………………………. if I was fired or let go at the end of my contract, I really wouldn't care. I would just retire to my farm and be a bum. I talk with the CEO fairly often and have a good relationship with her (being married for over 30 years, I am used to being bossed around by women). However, I am not under a delusion that if the clinic was no longer generating a bucket of revenue, I would certainly be booted (that would make economic sense).

From what I have read on this site, it appears MANY providers have had an adversarial relationship with their employers. I don't. I live/work in a middle sized market which is somewhat isolated, so they need pain providers. That being said, admins are charged with keeping their facility economically stable (even if not for profit) and may whack a provider who is performing well simply for budget considerations. I understand the economics of medicine and would not take it personally.

There are advantages and disadvantages to every type of practice and one needs to choose what is best for them. I am a guy who has no problem taking orders from others and being told what to do, so being employed is okay for me. When I was younger and more opinionated about what I did, perhaps that would not have been a good fit. However, today, if they asked me to wash cars for the morning, I would be up for it, as I really don't care what I do.

PS- that hot poker treatment sounds really unpleasant and I would like to avoid that, if possible.

Your age and experience have brought you wisdom. I take a lot of flack for trying to "corrupt the youth" into independence and being masters of their own destiny. I'm committed to it because Doctors are some of the smartest people I know. The fact that many EMERGE from their training so willing to subjugate themselves to the will of 2.8 GPA sociology majors and night-school health care MBA graduates who run hospitals is no accident: It is a result of indoctrination into a particular way of thinking that has taken hold in medical schools and academic training institutions--a collectivist orientation toward labor and care.

There is nothing wrong with accepting one's place in a hierarchy. Still, the only place I feel comfortable in hierarchies is at or near the top. Many others are like me. They should know that they have options.

Besides, it's a victory for me if I annoy @SSdoc33...it brings me joy.

 

[SSdoc33]

Your age and experience have brought you wisdom. I take a lot of flack for trying to "corrupt the youth" into independence and being masters of their own destiny. I'm committed to it because Doctors are some of the smartest people I know. The fact that many EMERGE from their training so willing to subjugate themselves to the will of 2.8 GPA sociology majors and night-school health care MBA graduates who run hospitals is no accident: It is a result of indoctrination into a particular way of thinking that has taken hold in medical schools and academic training institutions--a collectivist orientation toward labor and care.

There is nothing wrong with accepting one's place in a hierarchy. Still, the only place I feel comfortable in hierarchies is at or near the top. Many others are like me. They should know that they have options.

Besides, it's a victory for me if I annoy @SSdoc33...it brings me joy.

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[hyperalgesia]

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

If you could get a similar perspective from inside a health insurance board room, you would get a similar nausea. These are your bosses, the insurance execs. They pay your salary and you do as your told.

I just don't think there's any value to getting into people's heads. Many are human scum. We do what we do because we enjoy it and want to make a difference. The world burns around us with injustice. We choose what to focus on.

 

[deleted993114]

Your age and experience have brought you wisdom. I take a lot of flack for trying to "corrupt the youth" into independence and being masters of their own destiny. I'm committed to it because Doctors are some of the smartest people I know. The fact that many EMERGE from their training so willing to subjugate themselves to the will of 2.8 GPA sociology majors and night-school health care MBA graduates who run hospitals is no accident: It is a result of indoctrination into a particular way of thinking that has taken hold in medical schools and academic training institutions--a collectivist orientation toward labor and care.

There is nothing wrong with accepting one's place in a hierarchy. Still, the only place I feel comfortable in hierarchies is at or near the top. Many others are like me. They should know that they have options.

Besides, it's a victory for me if I annoy @SSdoc33...it brings me joy.

Well...…………………… I don't mind being at the bottom of the power hierarchy at all and don't want to run anything. If they tell me to mop the floors, I would certainly do so and look at it like an additional skill to put on my resume (those power floor buffing machines are pretty fun).

As nearly all doctors are from the top of their high school and college classes, they are used to being academic "top dogs". However, having grown up low income, I am used to having toothless, uneducated guys telling me what to do and being amazed at how stupid I was. I actually learn a lot more by observing those in a position of power and incorporating some of their tactics which are effective. Heck- that's how I learned to build stone and brick structures, lay hardwood floors, frame, pour concrete, and to roof. I do all that stuff myself today for fun.

Indian...……………………….. not chief.

 

[hyperalgesia]

Well...…………………… I don't mind being at the bottom of the power hierarchy at all and don't want to run anything. If they tell me to mop the floors, I would certainly do so and look at it like an additional skill to put on my resume (those power floor buffing machines are pretty fun).

As nearly all doctors are from the top of their high school and college classes, they are used to being academic "top dogs". However, having grown up low income, I am used to having toothless, uneducated guys telling me what to do and being amazed at how stupid I was. I actually learn a lot more by observing those in a position of power and incorporating some of their tactics which are effective. Heck- that's how I learned to build stone and brick structures, lay hardwood floors, frame, pour concrete, and to roof. I do all that stuff myself today for fun.

Indian...……………………….. not chief.

Sounds like you've fully exited the rat race, as we all eventually will. The sooner the better.