Why would hospitals be greedy like that? Many other industries reward their employees. Who would continue in medicine if things went down like this?
And also, do you think all specialties are at risk of this, or certain more than others?
Your first question: My opinion is that greed is universal, and the love of power (lust for power) and the love of money (lust for money) are the roots of evil. There are centuries of data to support this.
Your second question: I don't know. I suspect that the primary specialties, at least initially are more at risk, but once the primaries are on board, then the specialists may be coerced as the institution lets the specialists know that they now control the referral base, and if they want to keep getting referrals from the primaries, they'll hop on board too.
Thus endeth the gospel.
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Detailed thoughts on how they might pull this off/have pulled it off.
Two schools of thought on the first question: School A: labor is labor, get it as cheap as you can get away with to maximize profits. And pay not one red cent more than you must to keep that labor doing the work. Physicians are labor, and due to a wide variety of archaic but still enforceable anti-trust constraints unable to pool together to further their own interests. The way they get around this is "group practices" either single or multi-specialty which gives some leverage and bargaining strength. It also frees us from having to watch our own backs which is becoming increasingly difficult. In this model, hospitals will look at the revenue sources and seek to maximize them by keeping docs happy that are able to pull referrals, keep patients within the "system" and shift patient care patterns away from competing enterprises.
School B: As you suggest, some industries reward their employees. Well and good. As an employer, my philosophy is more along your lines, and I have happy, productive and efficient employees who work hard for me when they must, and we share the rewards. They are loyal, turnover is very low, and will do darn near anything for me when the going gets rough. It works for me (and for them), but then I earn less than I would with the school A model. The economic theory here is that I do what is best for me, but also what is best for the group. We all gain.
The School A group thinks it has enough power to maximize its personal gain by being a sweat shop and as long as they can attract labor willing to accept their terms, they survive. It may be a J-1 waiver populated group, but they will experience turnover as soon as their waivers turn into green cards. It is largely irrelevant what other industries do or do not do, and even within those industries, both schools are represented. Here the employer does what is best for the employer which works in the shorter term and they maximize next quarter's profits (or surpluses if you are a not-for-profit). Ultimately the price will be paid by them, but by that time the execs will have moved on to other fertile ground, and taken their bonuses.
Here's an example: Hospital A in the big city has fallen on hard times. The city population is shrinking due to a loss of job base, and increasing crime. Hospital A is cash rich, but is running on its reserves. It looks about and sees the small outer ring Hospital B with a good cash flow. It changes its name to System A. Hospital B has just purchased its local physician multi-group specialty and now controls the referral base surrounding it. Not a large population compared to System A, but respectable, and with a solid revenue stream.
System A (only composed of Hospital A) approaches Hospital B and offers to allow Hospital B to join the System and use its "resources" to help expand its market and make more money. In exchange, System will provide billing, purchasing, advice, marketing experts, shared efficiencies in labs, etc, and a good time (and profit) will be had by all. Hospital B sees System and its flagship hospital, a pre-eminent institution (which has guarded well its troubles from the world) and joins System and all is good.
Except that System now has access to revenue stream data, cost/expense, patient flow data and is now able to see where Hospital B is making its money, expand its product lines (a lucrative lab test it can add), "merge" that function into its lab and then tell Hospital B that the System can provide that service and since they're in the System they must abandon their own lab test but they can keep the revenue minus the costs of the test as established by the System. But Hospital B still has the equipment, the personnel, and the overhead, which eventually must be cut. And when Hospital B is sending all its revenue to the System it will be cut and Hospital B now has less ability to support itself until it becomes insolvent and is abandoned or absorbed by the System. Its docs, and the formerly happy family are now unwilling adoptees of the System and the System is now free to dictate terms. Like it or lump it, and by the way, if you leave, you've got a non-complete with not just Hospital B, but the System which covers both Hospital A and Hospital B (and Hospitals C, D, and E which we've just bought too).
Perhaps I'm a cynic, but I've seen this happen too many times. It is far more likely to happen in a major city with an affluent suburban ring environment, but out-burbs are not immune.
) For other fields, anesthesia, derm, etc, the salaries are also in the 400k+. Either they are fake posts or I'm thinking that salaries are pretty decent for hospital employed positions. No? Am I missing something here? I don't see what's so bad about working in a hospital setting for these types of salaries.
