Seattle Hospital Fires all its Anesthesiologists

[militarymd]

Not quite. Hospital PRIVILEGES are usually at the discretion of the medical staff. The EXCLUSIVE CONTRACT for anesthesia services is usually at the discretion of the hospital administration. So "joe blow" can get privileges, but no right to do cases, even if the surgeons are willing.

Depending on the deal a majority of the anesthesiologists may remain in a new corporate structure. Most likely with the hospital's bought and paid for chief.

"joe blow" will do cases if it is in the best interest of the CEO...

---

Members don't see this ad.

 

[nedflanders]

On the contrary, he is making the specialty stronger....taking over and getting rid of poor performers who are also greedy money mongers.....

He's paid me the same as he paid himself from the day I started my professional association with him....

No, again...you are wrong. Your mentor is the greedy money mongerer who is driving down compensation for the rest. He is underbidding like you said, but by underbidding that extra profit is going somewhere (i.e. back to the hospital or to the CEO)...meanwhile he's making a buck by repeatedly doing this and hiring peons to do the work (i.e. AMC). At least this is what your original post described. What this does in essence is drive down everyone's compensation (not just the poor performers).

 

[g3pro]

militarymd, there is something that general surgeons will never forgive themselves for: some surgeons didn't care to get compensation for "complications" that came months after a surgery, and then insurance companies/medicare subsequently removed payment for post-op complication visits across the board. They lost a huge source of revenue by giving over-arching powers an inch to dictate what they will pay out.

You get insurance companies and hospitals to treat some people as peons, and it trickles down to everyone else, to the detriment of everyone.

It's game theory, and in this day and age it's the doctors who are getting played.

Underbidding is dangerous to the economic realities in medicine. Fighting against underbidding is not money-grabbing, it is ensuring that doctors are fairly compensated for the work they put in. Doctors who take the positions of the anesthesiologists who were de-contracted and who also take on-call hours for free sets a bad precedent. Medicine is different than other service fields because physicians are dealing with huge powers, which have vested interests in making doctors get paid as little as possible.

 

[johankriek]

He's paid me the same as he paid himself from the day I started my professional association with him....

HA HA HA .. thats hilarious. If you believe that one you are really more stupid than i already know you are. This mentor dude is playing you like a bad fiddle

 

[militarymd]

No, again...you are wrong. Your mentor is the greedy money mongerer who is driving down compensation for the rest. He is underbidding like you said, but by underbidding that extra profit is going somewhere (i.e. back to the hospital or to the CEO)...meanwhile he's making a buck by repeatedly doing this and hiring peons to do the work (i.e. AMC). At least this is what your original post described. What this does in essence is drive down everyone's compensation (not just the poor performers).

No, I'm afraid that I AM right...although the term "underbid" is not an accurate term.

If you are expecting to take a job where you get a "subsidy" from the hospital, then you can "underbid"....but WHY do you need a subsidy from the hospital?

A lot of practices DON'T get subsidies....Subsidies are used by hospital to entice anesthesia groups to do a better job at providing services....WHY I ask do some groups need a subsidy and others don't?

UT doesn't get any subsidies where he practicies....No one is going to "underbid" him.

So I ask ..why do these guys in Seattle need "extra" money to get them to do the job that UT does without "extra" money in Dallas.

Why is it that UT bills for his services and calls it a day....and these guys in Seattle bills for their services AND asks for more money from the hospital?

One doe not drive down the doller paid per UNIT by insurance companies by "underbiding" the hospital.

 

[militarymd]

I am on my own however i dont think i have the most ideal situation.. My situation is really day to day.. I am not guaranteed cases but i do manage to do stay at least moderately busy

HA HA HA .. thats hilarious. If you believe that one you are really more stupid than i already know you are. This mentor dude is playing you like a bad fiddle

You can call me stupid if you like, but I feel that I AM in "the most ideal situation" as opposed to yours.

 

[Khalid]

johankriek,

Would you possibly describe a "day in your life" as you have in previous posts. While I think you're a good guy, I'm not sure a typical day practicing like yourself would appeal to many. I admire your entrepreneurial stance, but the lack of security and economic instability you deal with is incredible to me.

Anyway, I think it might be instructive to some of the residents on the board...

 

[Tenesma]

#1 the CEO would never fire the anesthesiologists unless he had a back-up plan ALREADY in mind

#2 a lot of services that physicians provide that aren't paid for should be subsidized by the hospital.... most hospitals understand that and will provide directorships/stipends to cover those services... the hospitals do it for other specialties as well

#3 you cannot expect any hospital to pay $2million to subsidize salaries... if salaries are low it is for 3 reasons
A - under-productivity
B - too much overhead
c - bad insurance contracts

those are not things the hospital has any control over since this is an independent anesthesia group...

this is a problem with anesthesia where services are replaceable... anesthesia is not bringing in the bucks to the hospital... same goes for radiology and for pathology - these 3 groups are at the mercy of the hospital... those specialties that do bring in money will get treated very differently by the CEO (Gastro, Ortho)...

what the anesthesia group should have done is probably gotten rid of a few anesthesiologists and they would have seen their vacation time go from 10 weeks to 7 weeks but their salary would have gone up...

 

[nedflanders]

No, I'm afraid that I AM right...although the term "underbid" is not an accurate term.

If you are expecting to take a job where you get a "subsidy" from the hospital, then you can "underbid"....but WHY do you need a subsidy from the hospital?

A lot of practices DON'T get subsidies....Subsidies are used by hospital to entice anesthesia groups to do a better job at providing services....WHY I ask do some groups need a subsidy and others don't?

UT doesn't get any subsidies where he practicies....No one is going to "underbid" him.

So I ask ..why do these guys in Seattle need "extra" money to get them to do the job that UT does without "extra" money in Dallas.

Why is it that UT bills for his services and calls it a day....and these guys in Seattle bills for their services AND asks for more money from the hospital?

One doe not drive down the doller paid per UNIT by insurance companies by "underbiding" the hospital.

Military again I'll repeat, you're wrong and part of the problem. So now you say when you said "underbid" that was the wrong term. Whatever you want to call it. Here's why subsidies are important for anesthesiolgists. Say for example, a hospital wants to get Level 1 status. For being that level 1 status, the state gives the hospital a HUGE amount of money per year. That money can then be used in a variety of ways - it can go into the pocket of the hospital, or part of it can be used to pay to have a trauma surgeon and anesthesiologist in house. Many of these hospitals don't have a trauma each and every day. And many of these trauma patients are uninsured. Meaning the anesthesiologist doesn't get a dime. But, by instituting a subsidy (i.e. paying for an anesthesiologist to be inhouse, it knocks down that burden). Same thing goes for OB. Some hospitals are filled with Medicaid patients on their OB floor. Again the liability/lack of compensation makes performing an epidural essentially worthless. Say a hospital with low volume wants to sell itself has having an anesthesiologist on hand 24 hours a day to perform your labor epidural. If there is maybe 1 or 2 a night, does it make sense for the anesthesia group to subsidize itself by making the anesthesiologist in house. Doesn't make much business sense does it? You may be in a particular situation where your hospital is busy at night, you have great insurance patients, etc but subsidies exist for a reason and by having your "mentor" "underbid" to eliminate the subsidy hurts everyone. If you are a consultant type specialty the hospital and the hospital wants to provide or make available those specialty type services 24 hours a day, they should pay for that right. Why should the insurance company "subsidize" your night work/availability by paying you a unit value during the day. To repeat, emergencies at night at most hospitals are often non-paying customers where you get little money and assume all the liability. Radiologists get paid by the hospital for performing radiologic services at night. Even he ortho surgeon at home gets a grand for being "oncall."

I have an MBA and if you don't get the above, I can dumb it down even more. Also, learn to realize when you may be wrong instead of always being so defensive "I AM RIGHT."

 

[militarymd]

Military again I'll repeat, you're wrong and part of the problem. So now you say when you said "underbid" that was the wrong term. Whatever you want to call it. Here's why subsidies are important for anesthesiolgists. Say for example, a hospital wants to get Level 1 status. For being that level 1 status, the state gives the hospital a HUGE amount of money per year. That money can then be used in a variety of ways - it can go into the pocket of the hospital, or part of it can be used to pay to have a trauma surgeon and anesthesiologist in house. Many of these hospitals don't have a trauma each and every day. And many of these trauma patients are uninsured. Meaning the anesthesiologist doesn't get a dime. But, by instituting a subsidy (i.e. paying for an anesthesiologist to be inhouse, it knocks down that burden). Same thing goes for OB. Some hospitals are filled with Medicaid patients on their OB floor. Again the liability/lack of compensation makes performing an epidural essentially worthless. Say a hospital with low volume wants to sell itself has having an anesthesiologist on hand 24 hours a day to perform your labor epidural. If there is maybe 1 or 2 a night, does it make sense for the anesthesia group to subsidize itself by making the anesthesiologist in house. Doesn't make much business sense does it? You may be in a particular situation where your hospital is busy at night, you have great insurance patients, etc but subsidies exist for a reason and by having your "mentor" "underbid" to eliminate the subsidy hurts everyone. If you are a consultant type specialty the hospital and the hospital wants to provide or make available those specialty type services 24 hours a day, they should pay for that right. Why should the insurance company "subsidize" your night work/availability by paying you a unit value during the day. To repeat, emergencies at night at most hospitals are often non-paying customers where you get little money and assume all the liability. Radiologists get paid by the hospital for performing radiologic services at night. Even he ortho surgeon at home gets a grand for being "oncall."

I have an MBA and if you don't get the above, I can dumb it down even more. Also, learn to realize when you may be wrong instead of always being so defensive "I AM RIGHT."

ok then.....you're right...and some day my mentor (who has a MBA from Stanford) will "UNDERBID" you....to the detriment of our specialty.

 

[militarymd]

Military again I'll repeat, you're wrong and part of the problem. So now you say when you said "underbid" that was the wrong term. Whatever you want to call it. Here's why subsidies are important for anesthesiolgists. Say for example, a hospital wants to get Level 1 status. For being that level 1 status, the state gives the hospital a HUGE amount of money per year. That money can then be used in a variety of ways - it can go into the pocket of the hospital, or part of it can be used to pay to have a trauma surgeon and anesthesiologist in house. Many of these hospitals don't have a trauma each and every day. And many of these trauma patients are uninsured. Meaning the anesthesiologist doesn't get a dime. But, by instituting a subsidy (i.e. paying for an anesthesiologist to be inhouse, it knocks down that burden). Same thing goes for OB. Some hospitals are filled with Medicaid patients on their OB floor. Again the liability/lack of compensation makes performing an epidural essentially worthless. Say a hospital with low volume wants to sell itself has having an anesthesiologist on hand 24 hours a day to perform your labor epidural. If there is maybe 1 or 2 a night, does it make sense for the anesthesia group to subsidize itself by making the anesthesiologist in house. Doesn't make much business sense does it? You may be in a particular situation where your hospital is busy at night, you have great insurance patients, etc but subsidies exist for a reason and by having your "mentor" "underbid" to eliminate the subsidy hurts everyone. If you are a consultant type specialty the hospital and the hospital wants to provide or make available those specialty type services 24 hours a day, they should pay for that right. Why should the insurance company "subsidize" your night work/availability by paying you a unit value during the day. To repeat, emergencies at night at most hospitals are often non-paying customers where you get little money and assume all the liability. Radiologists get paid by the hospital for performing radiologic services at night. Even he ortho surgeon at home gets a grand for being "oncall."

I have an MBA and if you don't get the above, I can dumb it down even more. Also, learn to realize when you may be wrong instead of always being so defensive "I AM RIGHT."

I hear and deal with everything you're talking about on a daily basis....I just happen to disagree with you........

People can ONLY get underbid IF there are "other" people WILLING to do the job for less. It's called competition.....

How can you say that COMPETITION makes our specialty weaker?

I thought competition makes things stronger?

 

[dhb]

People can ONLY get underbid IF there are "other" people WILLING to do the job for less. It's called competition.....

There's a billion chinese (no pun intended) willing to do your job for much less, don't know if it would make anesthesiology stronger...

 

[militarymd]

There's a billion chinese (no pun intended) willing to do your job for much less, don't know if it would make anesthesiology stronger...

So the BILLION dollar question?

Does competition make our field stronger or weaker?

 

[dhb]

competition is good but not when it's financially motivated: doing things cheaper is certainly not a quality criteria; is that a Rolex your sporting?

 

[jwk]

competition is good but not when it's financially motivated: doing things cheaper is certainly not a quality criteria; is that a Rolex your sporting?

Competition is always financially motivated, is it not?

 

[militarymd]

Competition is always financially motivated, is it not?

beat me to it.

 

[militarymd]

competition is good but not when it's financially motivated: doing things cheaper is certainly not a quality criteria; is that a Rolex your sporting?

Yes, a Sea-Dweller....and if one Authorized Dealer sold it for less than another and provided better customer service, then I would go to that particular AD to purchase my Sea-Dweller....and probably for a lot of other things that a jeweller offers.

 

[militarymd]

Thought some more about this....

I guess the question boils down to whether we think competition makes us stronger or weaker...

What does everyone say about that?

And IF there are folks willing to do the same that you are doing for less.....are we supposed to say that those people ARE NOT allowed to work?

Seems almost like the Immigration debate.

 

[nociceptor]

You guys make me laugh. In a good way.

It is good to see a spirited debate about the future of GASWORKS

Bravo for keeping it friendly but directed.

/I'll be selling popcorn to other onlookers

 

[Tenesma]

competition does not make the specialty stronger... nor does it make it weaker... it really has no significant impact on the specialty of anesthesia

competition does have an impact on business models of the practice of anesthesia...

for example, an anesthesia group tells the CEO that they can provide more services with less headaches than they are in effect underbidding --- but it doesn't mean that the service will be equal or superior - and frequently when you are cutting corners to underbid the service is usually inferior...

look at walmart did with mom-pop stores... they effectively wiped out mom-pop stores by underbidding and selling cheap chinese crap - did that competition improve the market? it definitely brought cheaper goods (with lead and other toxins)

 

[militarymd]

competition does not make the specialty stronger... nor does it make it weaker... it really has no significant impact on the specialty of anesthesia

competition does have an impact on business models of the practice of anesthesia...

for example, an anesthesia group tells the CEO that they can provide more services with less headaches than they are in effect underbidding --- but it doesn't mean that the service will be equal or superior - and frequently when you are cutting corners to underbid the service is usually inferior...

look at walmart did with mom-pop stores... they effectively wiped out mom-pop stores by underbidding and selling cheap chinese crap - did that competition improve the market? it definitely brought cheaper goods (with lead and other toxins)

Once we leave the hallowed halls of academia, the "business" aspect is a major component of practicing medicine....like it or not....that's just the way the cookie crumbles.

The model exists because of numerous reasons.....most of which is outside the control of most of us....we can only try to survive and thrive or wither in it.

As for Walmart...no one held a gun to anyone's head to go and shop there. Walmart CRUSHED mom & pop because that's what EVERYONE wanted.

As for the toxic Chinese crap...that's not Walmart's fault.......It's China's fault for not meeting their obligations.

If China is going to continue with their toxic products, then Walmart will go somewhere else....while continuing to keep their cost down...

 

[Noyac]

There will always be competition.

It will always be good.

The only thing is that finances come into play and the cheaper product will win out until things are obviously not equal any longer and quality declines. Then the decision will be whether to stick with the cheaper model or go with the quality product. Its just like the MD vs crna issue. We will all be under bid by crna's if they are allowed to practice independently. Then the hospital/employers will need to decide what it is they value more.

Or we can continue to under bid each other as in Mil's partners case (not getting personal here Mil, I know there are plenty of other anesthesiologist willing to under bid the next) until we undercut down to the cost of a crna. Then the decision is a no brainer.

 

[johankriek]

?

Seems almost like the Immigration debate.

If you ask me they should ship you out on the next boat to wherever you came from..

Competition improves quality.

Just look at the services we get on cell phones and the competition that exists in that market. just one minor example of how competition is positive. It just makes life suck for all involved when you are constantly waking up and competing. Just ask the board of verizon att apple t mobile etc etc

 

[drccw]

#1 the CEO would never fire the anesthesiologists unless he had a back-up plan ALREADY in mind

1. Back-up plan- contracting with a new" group... who had a grand total of 3 anesthesiologists... not a great plan...

#2 a lot of services that physicians provide that aren't paid for should be subsidized by the hospital.... most hospitals understand that and will provide directorships/stipends to cover those services... the hospitals do it for other specialties as well

agree. the ob production is enough to warrant 24 hour coverage but they provide it.

#3 you cannot expect any hospital to pay $2million to subsidize salaries... if salaries are low it is for 3 reasons
A - under-productivity
B - too much overhead
c - bad insurance contracts

those are not things the hospital has any control over since this is an independent anesthesia group...

2 million is a place to start.. not to end the negotiation.. the payer mix of NW isnt great... that'll be another area that some hospitals have chosen to pay subsidies

this is a problem with anesthesia where services are replaceable... anesthesia is not bringing in the bucks to the hospital... same goes for radiology and for pathology - these 3 groups are at the mercy of the hospital... those specialties that do bring in money will get treated very differently by the CEO (Gastro, Ortho)...

OR's closed= no bucks for hospital. replaceing 17 anesthesiolgists is tough.... there are very few anesthetia providers willing to go into that hospital now (though I am sure CRNAs would love to get a foothold in..-> this could be the first significant area that the CRNA's work outside of academia in Seattle)

 

[g3pro]

Just wait until CRNAs "underbid" all MDAs and the hospital administration/medicare is stupid enough to employ them instead of the MDAs. Have fun then.

Good business sense.

 

[deleted126335]

.

 

[militarymd]

This went through my mind as I was doing my workout this morning....

Why are we bugging the hospitals to pay us for the "free" services????

Why aren't we bugging the government or other 3 rd party payers to pay us for the "free" services?

Obviously the hospitals are getting paid for the "free" services by the payors....so why are we bugging the middleman....and not the ultimate payors....the government?

 

[coprolalia]

This went through my mind as I was doing my workout this morning....

Why are we bugging the hospitals to pay us for the "free" services????

Why aren't we bugging the government or other 3 rd party payers to pay us for the "free" services?

Obviously the hospitals are getting paid for the "free" services by the payors....so why are we bugging the middleman....and not the ultimate payors....the government?

What "free" services? Coverage (24-hr) for OB? Curious what you are talking about here.

-copro

 

[militarymd]

What "free" services? Coverage (24-hr) for OB? Curious what you are talking about here.

-copro

All the stuff that everyone is clamoring about "Not getting paid for"

 

[cchoukal]

In the case of 24 hour OB coverage in less-busy hospitals, I suspect we (the royal we; I'm a resident) are bugging the hospitals and not the government is because it is the hospitals that have a vested interest in the service. The government derives no benefit from our mere presence. The hospital, on the other hand, appears to be the one requesting the service, and also the one benefiting from it (I think it was nedflanders who posted hospitals advertising 24-hour coverage for epidurals or something like that).

 

[coprolalia]

In the case of 24 hour OB coverage in less-busy hospitals, I suspect we (the royal we; I'm a resident) are bugging the hospitals and not the government is because it is the hospitals that have a vested interest in the service. The government derives no benefit from our mere presence. The hospital, on the other hand, appears to be the one requesting the service, and also the one benefiting from it (I think it was nedflanders who posted hospitals advertising 24-hour coverage for epidurals or something like that).

Well, this is the issue, I believe. The hospital wants the coverage without assuring that the patients will be there. And, without the patients, you can't bill for the service. This means that the anesthesia practice willl have to "volunteer" to cover this service, and dedicate manpower, to provide it whether or not they get reimbursed.

The problem arises with coverage. If you expect someone to be there right away, then you have to provide some sort of incentive if the work doesn't show up. "Call pay" is pretty typical for most people who are required to be available if/when a service is needed. EMTs get it. Nurses get it. A whole host of ancillary services get it, and not just in the medical world. Why should an anesthesiology practice be any different... if this is actually what we're talking about?

-copro

 

[Tenesma]

competition benefits the consumer.... it doesn't benefit anesthesia as a field (unless it is competition in research) and it doesn't benefit anesthesia business models...

you still haven't explained how it would benefit anesthesia the field or anesthesia as a business...

the only way to compete is to provide more service for cheaper costs --- and if everybody keeps on competing you will end up with cheap service - and when it is a plastic toy no big deal - but when it is medical care you may be compromising on what our accepted standards of care.

 

[militarymd]

competition benefits the consumer.... it doesn't benefit anesthesia as a field (unless it is competition in research) and it doesn't benefit anesthesia business models...

you still haven't explained how it would benefit anesthesia the field or anesthesia as a business...

the only way to compete is to provide more service for cheaper costs --- and if everybody keeps on competing you will end up with cheap service - and when it is a plastic toy no big deal - but when it is medical care you may be compromising on what our accepted standards of care.

So you're going to tell a fellow anesthesiologist that he can't work because he's willing to provide "free" services? like sitting around a hospital and waiting for an epidural to do?

 

[Tenesma]

i am confused by your last question...

and as far as the CEO having a back-up plan - we obviously don't know the whole story...

the surgeons would have been in an UPROAR if they couldn't get their cases done --- and the hospital would have had a huge financial loss if cases weren't going to happen... so i bet you that the CEO (and who knows - maybe in collusion with the surgeons) had a back up plan for this show-down.

 

[nedflanders]

So you're going to tell a fellow anesthesiologist that he can't work because he's willing to provide "free" services? like sitting around a hospital and waiting for an epidural to do?

Really Millitary? Do you know how hospitals work? Do you know how other specialties are paid? Like I said, at most hospitals, the number of epidurals at night don't justify an FTE. Same thing with the emergent case at night (often without insurance). The dynamics change at an extremely busy hospital. Sure, the desperate anesthesiologist can sit at the hospital all night (at the hospitals request) and maybe perform an epidural or two but is it worth it for the anesthesiolgists' time? Is it worth it not having that individual work the next day and losing that FTE because he is "post call" and therefore the group having to hire another individual to cover the continual "post call" days. So by doing what you're saying, you are driving up your costs and lowering your salary...Taking that a step further, if your mentor "mentors" anymore people like you, or specialty will further decline in compensation.

 

[militarymd]

Really Millitary? Do you know how hospitals work? Do you know how other specialties are paid? Like I said, at most hospitals, the number of epidurals at night don't justify an FTE. Same thing with the emergent case at night (often without insurance). The dynamics change at an extremely busy hospital. Sure, the desperate anesthesiologist can sit at the hospital all night (at the hospitals request) and maybe perform an epidural or two but is it worth it for the anesthesiolgists' time? Is it worth it not having that individual work the next day and losing that FTE because he is "post call" and therefore the group having to hire another individual to cover the continual "post call" days. So by doing what you're saying, you are driving up your costs and lowering your salary...Taking that a step further, if your mentor "mentors" anymore people like you, or specialty will further decline in compensation.

Unfortunately I am only too familiar with all the issues that you are addressing.

My question to you...or to anyone else for that matter, who has issue with competition.

Compensation will decline if there are people who are willing to work for less while providing the same services....

And there are plenty of them around....otherwise how can groups get "fired"?

How is a hospital able to send a RFP out and have people answer?

Bottomline...there will be anesthesiologists who will be willing to work for less...especially with the glut of them being trained right now...

So I ask again....are we going to NOT let them work? ...not certified them? what?

Because if you don't hire them to dilute your income, someone else will.......at a lower cost perhaps...and they will come gunning for the folks who are "costing" more.

 

[nedflanders]

This went through my mind as I was doing my workout this morning....

Why are we bugging the hospitals to pay us for the "free" services????

Why aren't we bugging the government or other 3 rd party payers to pay us for the "free" services?

Obviously the hospitals are getting paid for the "free" services by the payors....so why are we bugging the middleman....and not the ultimate payors....the government?

Maybe you shouldn't think while working out. This makes no sense. What does this have to do with a 3rd party payer or the government. The hospital is the one requesting us to sit there. Our contract is with the hospital. Why should a 3rd party payer pay us to sit there, are we going to have an anesthesiolgist for just Aetna patients, and another one for UnitedHealth patients...and the insurers are going to advertise their plans by saying we have an Aetna anesthesiolgist at X Hospital 24 hours, choose our plan??? No, the hospital is the one advertising the availability of services. Getting to the government side, states/counties do subsidize hospitals for offering the services (like Level 1 Status) because they know that it is a public health need, and know the hospitals will have to pay "on call" salary to multiple specialties (Trauma Surgeon, Radiologist, etc, etc.).

 

[nedflanders]

Unfortunately I am only too familiar with all the issues that you are addressing.

My question to you...or to anyone else for that matter, who has issue with competition.

Compensation will decline if there are people who are willing to work for less while providing the same services....

And there are plenty of them around....otherwise how can groups get "fired"?

How is a hospital able to send a RFP out and have people answer?

Bottomline...there will be anesthesiologists who will be willing to work for less...especially with the glut of them being trained right now...

So I ask again....are we going to NOT let them work? ...not certified them? what?

Because if you don't hire them to dilute your income, someone else will.......at a lower cost perhaps...and they will come gunning for the folks who are "costing" more.

Which gets back to my original point, that you and your mentor are part of the problem - your undercutting leading to lower incomes for all (which you vehemently denied). More people like you and your mentor, further deteriorate our specialty. Or we can have stong groups, strong leadership, alignment with hospital boards, and anesthesiologists (and residents coming out) demanding fair compensation or we're going to have Seattle over and over again. Why? Because the hospital board feels they can get someone like you over there to take a fee as essentially an AMC and hire employees at a lower cost. You get $, the rest get screwed by having lower salaries....but eventually this model will change as well as the hospital gives you less and less a fee for managing and the lower salaries become the norm across the board.

Now back to subsidies which this conversation was transitioned to, what don't you get about that?

 

[militarymd]

Which gets back to my original point, that you and your mentor are part of the problem - your undercutting leading to lower incomes for all (which you vehemently denied). More people like you and your mentor, further deteriorate our specialty. Or we can have stong groups, strong leadership, alignment with hospital boards, and anesthesiologists (and residents coming out) demanding fair compensation or we're going to have Seattle over and over again. Why? Because the hospital board feels they can get someone like you over there to take a fee as essentially an AMC and hire employees at a lower cost. You get $, the rest get screwed by having lower salaries....but eventually this model will change as well as the hospital gives you less and less a fee for managing and the lower salaries become the norm across the board.

Now back to subsidies which this conversation was transitioned to, what don't you get about that?

First...all members of my group gets paid the same for the same work...there's NO skimming from the top...you don't have to believe that if you don't want, but FAIRNESS is a concept that my senior has always advocated and which I agree with....THE reason that I have aligned myself with him professionally.

Second....So..you're saying that someone like me should NOT be allowed to work because I'm willing to work more for less...and am happy with it...I was happy with the 100,000 bucks a year I made after 11 years in the Navy.

Third....What are you going to say when in 5 years ALL these new grads who are recently trained in all the new and advanced stuff are willing to work for 170,000 a year...(I see some of them posting that already)....

Are you going to tell them that " NO, YOU CANNOT work for only 170,000 a year....you HAVE to make 400,000.....or make NOTHING at all because we're not going to hire you"??

 

[militarymd]

Maybe you shouldn't think while working out. This makes no sense. What does this have to do with a 3rd party payer or the government. The hospital is the one requesting us to sit there. Our contract is with the hospital. Why should a 3rd party payer pay us to sit there, are we going to have an anesthesiolgist for just Aetna patients, and another one for UnitedHealth patients...and the insurers are going to advertise their plans by saying we have an Aetna anesthesiolgist at X Hospital 24 hours, choose our plan??? No, the hospital is the one advertising the availability of services. Getting to the government side, states/counties do subsidize hospitals for offering the services (like Level 1 Status) because they know that it is a public health need, and know the hospitals will have to pay "on call" salary to multiple specialties (Trauma Surgeon, Radiologist, etc, etc.).

It's not that it's makes no sense...it's just another point of view or paradigm

 

[militarymd]

Which gets back to my original point, that you and your mentor are part of the problem - your undercutting leading to lower incomes for all (which you vehemently denied). More people like you and your mentor, further deteriorate our specialty. Or we can have stong groups, strong leadership, alignment with hospital boards, and anesthesiologists (and residents coming out) demanding fair compensation or we're going to have Seattle over and over again. Why? Because the hospital board feels they can get someone like you over there to take a fee as essentially an AMC and hire employees at a lower cost. You get $, the rest get screwed by having lower salaries....but eventually this model will change as well as the hospital gives you less and less a fee for managing and the lower salaries become the norm across the board.

Now back to subsidies which this conversation was transitioned to, what don't you get about that?

I understand subsidies as well as the next guy who's got to negotiate for one.

So...back to my question....What do you tell the guy who's willing AND happy to work for LESS subsidy than you think is appropriate?

 

[racerx]

So...back to my question....What do you tell the guy who's willing AND happy to work for LESS subsidy than you think is appropriate?

Tell him to talk with the "mentor", Thuggybear, MD:

He has some kick-a$$ scrubs, don't you think? Bought and paid for by selling the profession to the lowest bidder. All in the course of destroying it for any future MDAs.

I have been inspired by Mil's position as the poster boy for the profession. From now on my motto will be, 'Screw the future, as long as I get mine before the bottom falls out!' I just hope there is some semblance of the profession left by the time I get there.

 

[flashgordon]

So if a group underbids other groups, won't that lower the threshold of how much the hospital will pay future groups that work with them? i.e. You will work for $5 instead of $8. Now that the hospital knows docs will work for $5, why the hell would they ever pay the next doc any higher? If you continue to underbid more and more hospitals, won't that eventually affect everyone's pay? The future docs (us) will be working for $3. It sounds like you are putting the power in the hospital's hands and cheapening our profession.

Anesthesiologists of last few decades (i.e. the lounge lizards) have not fought hard enough to protect the future of our specialty. They whored it out to nurses to fatten their paychecks and what did we get? Some nurses doing interventional pain. Smooth move!

Where are the hard working people?? I'm sick of seeing students go into this specialty for the lifestyle/pay. i.e. WTF is the thread about working ONE day a week all about?? You better have a good reason for this...

Should we do fellowships? Uhh....**** yea we should. The new generation needs to step it up and quit being *******. End rant.

 

[Tenesma]

you can find people who work for less --- i mean look at what happened in Manhattan (where the cost of living is astronomical) but you can't find an anesthesia job for over 200k (unless you got connections at Lennox or HSS)... the reason: you have tons of people who want to stay in the city, compounded by tons of FMGs who are happy making any type of salary, all cutting each others achilles just to get a job...

again this works out well for the consumer (from a price point of view) and well for the hospital -

again mil your point about competition doesn't make sense - we agree that it helps the health care consumer by lowering costs but how does competition help us as anesthesiologists other than seeing our income chiseled away.

 

[cchoukal]

you can find people who work for less --- i mean look at what happened in Manhattan (where the cost of living is astronomical) but you can't find an anesthesia job for over 200k (unless you got connections at Lennox or HSS)... the reason: you have tons of people who want to stay in the city, compounded by tons of FMGs who are happy making any type of salary, all cutting each others achilles just to get a job...

again this works out well for the consumer (from a price point of view) and well for the hospital -

again mil your point about competition doesn't make sense - we agree that it helps the health care consumer by lowering costs but how does competition help us as anesthesiologists other than seeing our income chiseled away.

by "health care consumer," I hope you mean hospital executives and health "insurance" companies. I doubt any of these savings ever get passed onto the patients.

 

[militarymd]

you can find people who work for less --- i mean look at what happened in Manhattan (where the cost of living is astronomical) but you can't find an anesthesia job for over 200k (unless you got connections at Lennox or HSS)... the reason: you have tons of people who want to stay in the city, compounded by tons of FMGs who are happy making any type of salary, all cutting each others achilles just to get a job...

again this works out well for the consumer (from a price point of view) and well for the hospital -

again mil your point about competition doesn't make sense - we agree that it helps the health care consumer by lowering costs but how does competition help us as anesthesiologists other than seeing our income chiseled away.

Makes you learn how to do more with less....

 

[deleted126335]

.

 

[Tenesma]

so competition teaches you how to do more for less...

well, i can agree that you can cut costs by using less anesthetic gas and less zofran - and maybe if you are really disgusting you can re-use ET tubes after wiping them with an alcohol wipe...

how does it help the practice of anesthesia or the business of anesthesia?

it may force you to become more efficient if you have large overhead - otherwise it looks like i am going to have to tell you what competition really means

it means an anesthesiologist is going to have to work more hours and take on more risks for less pay --- if that is good for our field then this sucks...

 

[militarymd]

so competition teaches you how to do more for less...

well, i can agree that you can cut costs by using less anesthetic gas and less zofran - and maybe if you are really disgusting you can re-use ET tubes after wiping them with an alcohol wipe...

how does it help the practice of anesthesia or the business of anesthesia?

it may force you to become more efficient if you have large overhead - otherwise it looks like i am going to have to tell you what competition really means

it means an anesthesiologist is going to have to work more hours and take on more risks for less pay --- if that is good for our field then this sucks...

that's right ....it sucks...compensation has been steadily dropping over the last 30 years while work hours have been going up...and the trend will continue....

This will force our specialty to have only strong (mentally and/or likely physically), harder working folks....many will disagree, but I think that makes our specialty stronger....

 

[cchoukal]

Stronger to what end?