I don't like having pay based on door-to-doc and LWBS, LOS, etc. Much of the factors involved in these things are beyond the control of the physician/physician group ...
That's right. Here's what always drove me insane about that. For people that model hospital and EDs after a Walmart or fast food mentality, they sure don't ever seem to want to respond in the same way that such a business would to similar problems. As far as staffing goes, it drove me insane that every day I walked into the ED, I knew at some point there would be a patient surge, the wait room would fill up, and for a while the placed would be slammed. Almost every day. There was no surprise value there. Yet, every day, when this occurred admin would freak out, like it was a big shocker, as if someone had just spotted big foot or unexpectedly isolated a case of Ebola virus at the nursing station.
Why can't I take 30 min (most shifts) to rest my brain with a meal break like the rest of humanity, while working one of the most stressful jobs there is?
"We're slammed. This never happend before."
Why do I have to work more shifts, more nights, and be more sleepy-groggy than I signed up for?
"We're slammed. This never happend before."
Rather than doing the obvious, expanding capacity, adding staff, nurses, doctor coverage, rooms, techs, etc, they would expect everyone to buy into the frenetic panic as if it was their first day shadowing in the ED. I know extra resources cost money, and there are certificate of need issues that slow down efforts to expand, and providers are hard to find, but the concept of EDs being "slammed" by non-emergencies is not new. Rather than taking real steps to meet the needs of the problem, they look for tokens and buzzwords such as "provider in triage" or "improve greet times" where resources are put one place, and just short another.
If you're going to survive in EM, you have to decide either you're going to
1-Ignore the manufactured sense of panic of "wow we're slammed, this never happened before. Run around like you're a chicken with your headul cut of for this and almost every shift the next 30 years," and block it out, which I think is next to impossible nowadays, with jobs and contracts being threatened over patient sat and throughput times, or
2- Buy into the panic, that every level 2 work note needs to be treated with the urgency of a 3-yr-old impending cardiac arrest, and risk emotional exhaustion, or
3-Opt out. Opt out could mean leave the ED setting in some form (without necessarily leaving the specialty or Medicine in general). Or more commonly you'll see people jump at something like a directorship, or something else that allows them to reduce shifts and throw other troops into the line of fire. Often times such people refuse to admit they just wanted out of the grinder, because doing so, would either undercut their message of wanted to get you to jump into combat or, they feel they'd be stigmatized with having the "Bigshot" stamp on the white coat replaced with a "Burn Out" stamp. Opting out coil also mean contractually refusing to work over a certain amount of hours/shifts, but could risk being replaced.
Maybe not all EDs are this way, but I've worked in enough it seemed to be a common theme. Staff things bare bones and pray that everyone buys into the theme that a wait room full of (> 2/3) walking-well is a "crisis," never happened before and that there is no solution but for you to always run faster. Hope that there's more young bucks, PAs and new recruits to fill the revolving door of those who "burnout" or wise up. This is all done with ZERO focus on physician wellness, physician "satisfaction" (patient satisfaction is the only golden goose, because it lays golden eggs) and solving the actual problems with resources from the administrator year-end cash-bonus fund. The only solution are "keep turning the crankshaft boys" and keep that goose laying those eggs.
The real crisis will occur if and when they just can't find anyone to buy into it anymore.
Solution: Think for yourself, and don't drink the Kool Aid.
http://mobile.nytimes.com/2014/05/1...ries-are-not-the-big-cost.html?_r=0&referrer=
"Medicine’s Top Earners Are Not the M.D.s
THOUGH the recent release of Medicare’s physician payments cast a spotlight on the millions of dollarrs paid to some specialists, there is a startling secret behind America’s health care hierarchy: Physicians, the most highly trained members in the industry’s work force, are on average right in the middle of the compensation pack.
That is because the biggest bucks are currently earned not through the delivery of care, but from overseeing the business of medicine.
The base pay of insurance executives, hospital executives and even hospital administrators often far outstrips doctors’ salaries, according to an analysis performed for The New York Times by Compdata Surveys: $584,000 on average for an insurance chief executive officer, $386,000 for a hospital C.E.O. and $237,000 for a hospital administrator, compared with $306,000 for a surgeon and $185,000 for a general doctor.
And those numbers almost certainly understate the payment gap, since top executives frequently earn the bulk of their income in nonsalary compensation. In a deal that is not unusual in the industry, Mark T. Bertolini, the chief executive of Aetna, earned a salary of about $977,000 in 2012 but a total compensation package of over $36 million, the bulk of it from stocks vested and options he exercised that year. Likewise, Ronald J. Del Mauro, a former president of Barnabas Health, a midsize health system in New Jersey, earned a salary of just $28,000 in 2012, the year he retired, but total compensation of $21.7 million.
The proliferation of high earners in the medical business and administration ranks adds to the United States’ $2.7 trillion health care bill and stands in stark contrast with other developed countries, where top-ranked hospitals have only skeleton administrative staffs and where health care workers are generally paid less. And many experts say it’s bad value for health care dollars.
“At large hospitals there are senior V.P.s, V.P.s of this, that and the other,” said Cathy Schoen, senior vice president for policy, research and evaluation at the Commonwealth Fund, a New York-based foundation that focuses on health care. “Each one of them is paid more than before, and more than in any other country.”
She added, “The pay for the top five or 10 executives at insurers is pretty astounding — way more than a highly trained surgeon.”
She said that executive salaries in health care “increased hugely in the ‘90s” and that the trend has continued. For example, in addition to Mr. Del Mauro’s $21.7 million package, Barnabas Health listed more than 20 vice presidents who earned over $350,000 on its latest available tax return; the new chief executive earned about $3 million. Data released by Medicare show that Barnabas Health’s hospitals bill more than twice the national average for many procedures. (In 2006, the hospital paid one of the largest Medicare fines ever to settle fraud charges brought by federal prosecutors.)
Hospitals and insurers maintain that large pay packages are necessary to attract top executives who have the expertise needed to cope with the complex structure of American health care, where hospitals and insurers undertake hundreds of negotiations to set prices.
Ellen Greene, a spokeswoman for Barnabas Health, said Mr. Del Mauro’s retirement package was “a function of over four decades of service and reflects his exceptional legacy.” Nearly $14 million was a cumulative payout from a deferred retirement plan, she said, and the remainder included base compensation, a bonus and an incentive plan
Ms. Greene also said Barnabas’s compensation program follows I.R.S. rules and is established by an executive compensation committee with “guidance from a nationally recognized compensation consultant.”
In many areas, the health care industry is home to the top earning executives in the nonprofit sector.
And studies suggest that administrative costs make up 20 to 30 percent of the United States health care bill, far higher than in any other country. American insurers, meanwhile, spent $606 per person on administrative costs, more than twice as much as in any other developed country and more than three times as much as many, according to a study by the Commonwealth Fund.
As a result of the system’s complexity, there are many jobs descriptions for positions that often don’t exist elsewhere: medical coders, claims adjusters, medical device brokers, drug purchasers — not to mention the “navigators” created by the Affordable Care Act.
Among doctors, there is growing frustration over the army of businesspeople around them and the impact of administrative costs, which are reflected in inflated charges for medical services.
“Most doctors want to do well by their patients,” said Dr. Abeel A. Mangi, a cardiothoracic surgeon at the Yale School of Medicine, who is teaming up with a group at the Yale School of Management to better evaluate cost and outcomes in his department. “Other constituents, such as device manufacturers, pharmaceutical companies and even hospital administrators, may not necessarily have that perspective.”
Doctors are beginning to push back: Last month, 75 doctors in northern Wisconsin took out an advertisement in The Wisconsin State Journal demanding widespread health reforms to lower prices, including penalizing hospitals for overbuilding and requiring that 95 percent of insurance premiums be used on medical care. The movement was ignited when a surgeon, Dr. Hans Rechsteiner, discovered that a brief outpatient appendectomy he had performed for a fee of $1,700 generated over $12,000 in hospital bills, including $6,500 for operating room and recovery room charges.
It’s worth noting that the health care industry is staffed by some of the lowest as well as highest paid professionals in any business. The average staff nurse is paid about $61,000 a year, and an emergency medical technician earns just about minimum wage, for a yearly income of $27,000, according to the Compdata analysis. Many medics work two or three jobs to make ends meet.
“It’s stressful, dirty, hard work, and the burnout rate is high,” said Tom McNulty, a 19-year-old college student who volunteers for an ambulance corps outside Rochester. Though he finds it fulfilling, he said he would not make it a career: “Financially, it’s not feasible.”
Elisabeth Rosenthal is a reporter for The New York Times who is writing a series about the cost of health care, “Paying Till It Hurts.”
Correction: May 18, 2014
An earlier version of the headline for this article was revised to more precisely capture the principal insight offered by the news analysis."
