Slate Article

[Aquaman29]

Slate Article - what do current attending and residents think?

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[southerndoc]

I read somewhere that part of the Biden agenda was to try to eliminate independent contractors with most jobs.

 

[WildEMDoc]

I read somewhere that part of the Biden agenda was to try to eliminate independent contractors with most jobs.

interesting, I wonder how feasible that would be. Obviously he wouldn't be doing it for the physicians benefit but I could see it really helping people who are working for uber/etc

 

[southerndoc]

Plan to Strengthen Organized Labor and Collective Bargaining | Joe Biden

Strong unions built the American middle class. That's why Joe Biden has an extensive plan for strengthening organized labor and collective bargaining.

joebiden.com

• Aggressively pursue employers who violate labor laws, participate in wage theft, or cheat on their taxes by intentionally misclassifying employees as independent contractors. As president, Biden will put a stop to employers intentionally misclassifying their employees as independent contractors. He will enact legislation that makes worker misclassification a substantive violation of law under all federal labor, employment, and tax laws with additional penalties beyond those imposed for other violations. And, he will build on efforts by the Obama-Biden Administration to drive an aggressive, all-hands-on-deck enforcement effort that will dramatically reduce worker misclassification. He will direct the U.S. Department of Labor to engage in meaningful, collaborative enforcement partnerships, including with the National Labor Relations Board (NLRB), the Equal Employment Opportunity Commission, the Internal Revenue Service, the Justice Department, and state tax, unemployment insurance, and labor agencies. And, while Trump has weakened enforcement by sabotaging the enforcement agencies and slashing their investigator corps, Biden will fund a dramatic increase in the number of investigators in labor and employment enforcement agencies to facilitate a large anti-misclassification effort.

 

[Apollyon]

I used to read Slate all the time, but the beginning of the end was Matthew Yglesias. Bloggers are useless - speaking with unearned authority. I mean, the weakest form of evidence is "expert opinion". Non-expert opinion is virtually worthless. Now, Slate is just too left - like too much salt on your food, or sugar in your coffee, I just can't tolerate it. As the saying goes, "It's good to have an open mind, but not so open that your brains fall out".

 

[Rekt]

I read somewhere that part of the Biden agenda was to try to eliminate independent contractors with most jobs.

The only thing happening under Biden will be the rise of NPP independent practice.

 

[TwistedTea]

The only thing happening under Biden will be the rise of NPP independent practice.

At least if he pays our loans off we can quit and do something besides medicine 😂

 

[Rekt]

At least if he pays our loans off we can quit and do something besides medicine 😂

You already know all physicians and probably residents would be excluded. Anyway, it looks like at most 10k, which is essentially nothing in regards to medical school debt.

 

[TwistedTea]

You already know all physicians and probably residents would be excluded. Anyway, it looks like at most 10k, which is essentially nothing in regards to medical school debt.

Yeah it would only apply to those who got degrees that are worth less than the paper they are printed on.

 

[turkeyjerky]

The only thing happening under Biden will be the rise of NPP independent practice.

Like the past 4 years have been good on this regard? Where's my malpractice reform? (Not that I actually diagree with your point, I just don't think is a dem vs repub thing)

I don't really see the W2 vs 1099 debate having much of an effect on us. (Envision, TH, Apollo et al can employ docs via either mechanism). I think it would be a definite plus to get rid of CMGs and go to primarily hospital employed practice (both being far inferior to owning your job via a SDG). Hospital admin is obviously not our ally, but at least they have some responsibility to ensure a reasonable environment, as well as affording some workplace protections.

 

[deleted941485]

Slate Article

How do we get out of this alive without everyone having to do three fellowships and a post doc to get a job?

Bigger question Who do ER docs really work for?

 

[Rekt]

Like the past 4 years have been good on this regard? Where's my malpractice reform? (Not that I actually diagree with your point, I just don't think is a dem vs repub thing)

I don't really see the W2 vs 1099 debate having much of an effect on us. (Envision, TH, Apollo et al can employ docs via either mechanism). I think it would be a definite plus to get rid of CMGs and go to primarily hospital employed practice (both being far inferior to owning your job via a SDG). Hospital admin is obviously not our ally, but at least they have some responsibility to ensure a reasonable environment, as well as affording some workplace protections.

Yeah rise was inappropriate terminology. I think completion is more accurate. NPs will get close to 50 states I'm sure. PAs will rename themselves to something completely silly and probably get close to 50 as well.

Clueless ivory tower docs will continue to deliver LLPs over on a silver platter.

CMGs will continue to takeover what's left.

You're right, it's a bipartisan issue, against physicians, that is. Whoever wins we lose.

Same old, same old, but the wells are drying up.

 

[Spikebd]

You already know all physicians and probably residents would be excluded. Anyway, it looks like at most 10k, which is essentially nothing in regards to medical school debt.

If they’re going to slash our salaries let’s at least all get our loans repaid. Young doctors won’t have the chance to earn as much as older docs with Medicare for all.

 

[deleted941485]

Plan to Strengthen Organized Labor and Collective Bargaining | Joe Biden

Strong unions built the American middle class. That's why Joe Biden has an extensive plan for strengthening organized labor and collective bargaining.

joebiden.com

Somehow

If they’re going to slash our salaries let’s at least all get our loans repaid. Young doctors won’t have the chance to earn as much as older docs with Medicare for all.

This is why I dont get why young docs bother voting. When you become a doctor stop voting. No one cares how hard you work or if you save peoples lives or not. Medicare hates you and so does a good chunk of the US population. Think about that the next time you're coding a Boomer at 2 in the morning. the fact of the matter is it increasingly isnt worth the time or aggravation. The only thing the bean counters can count on is that you will still show up for work anyway and do a good job because theres no where else for you to go.

 

[Birdstrike]

It’s used to be that we as doctors worked for our patients. In solo or small private practices, the only person that could fire you was your patient. That gave us a tremendous amount of job security and control. If you had 1,000 patients you had 1,000 “bosses.”” If a patient “fired” you, by leaving the practice and switching doctors, you were still whole, or at a least 999/1,000th whole until you got another patient to replace them.

It’s not like that anymore for most physicians. By allowing businessmen to come between us and the patient, we have much less job security, autonomy and control. The trade off has been the ability to shed the aspect of running a business to employers, since doing that has gotten more complicated and difficult.

Some specialties have retained more that independence and control than others. I’m not there’s any easy road going back, at this point. Certainly any greater amount of autonomy and job security you can achieve for yourself, the better.

 

[deleted941485]

It’s used to be that we as doctors worked for our patients. In solo or small private practices, the only person that could fire you was your patient. That gave us a tremendous amount of job security and control. If you had 1,000 patients you had 1,000 “bosses.”” If a patient “fired” you, by leaving the practice and switching doctors, you were still whole, or at a least 999/1,000th whole until you got another patient to replace them.

It’s not like that anymore for most physicians. By allowing businessmen to come between us and the patient, we have much less job security, autonomy and control. The trade off has been the ability to shed the aspect of running a business to employers, since doing that has gotten more complicated and difficult.

Some specialties have retained more that independence and control than others. I’m not there’s any going back, at this point.

Needlessly more complicated and difficult.

 

[deleted547339]

I think the general public is not aware of the plight of EM. I think articles like this help.

 

[GeneralVeers]

The push to get rid of IC and make everyone W2 has its roots in money and politics (of course). In CA it was driven by labor unions who wanted to force Gig economy people to become union members. It's also driven by outdated industries like the taxi companies who want to protect their extortionist, and archaic business models. They got defeated by the ballot measure in CA, and in NV by Uber's money.

I prefer IC actually. I get more control over write-offs, business expenses, and where I put my retirement funds.

As for being a hospital employee, I've said it before: You are not more protected, and the new boss is just as bad as the old boss.

 

[RustedFox]

The push to get rid of IC and make everyone W2 has its roots in money and politics (of course). In CA it was driven by labor unions who wanted to force Gig economy people to become union members. It's also driven by outdated industries like the taxi companies who want to protect their extortionist, and archaic business models. They got defeated by the ballot measure in CA, and in NV by Uber's money.

I prefer IC actually. I get more control over write-offs, business expenses, and where I put my retirement funds.

As for being a hospital employee, I've said it before: You are not more protected, and the new boss is just as bad as the old boss.

I was waiting for this post.

 

[Brigade4Radiant]

Worth W-2 employees you pay a lot in tax.
There was a group that employed physicians as a W-2 a few years ago. You were required to be on call without getting paid for it because as an employee they can determine your hours. They would also have for one case that were loaded with fees to take your money.

You also got taxed out the wazoo

 

[Mad Jack]

I used to read Slate all the time, but the beginning of the end was Matthew Yglesias. Bloggers are useless - speaking with unearned authority. I mean, the weakest form of evidence is "expert opinion". Non-expert opinion is virtually worthless. Now, Slate is just too left - like too much salt on your food, or sugar in your coffee, I just can't tolerate it. As the saying goes, "It's good to have an open mind, but not so open that your brains fall out".

This is politics. It's... Basically just an area where people have opinions. Even on the economic side of things, experts base their views more on dogma than fact.

 

[deleted547339]

The push to get rid of IC and make everyone W2 has its roots in money and politics (of course). In CA it was driven by labor unions who wanted to force Gig economy people to become union members. It's also driven by outdated industries like the taxi companies who want to protect their extortionist, and archaic business models. They got defeated by the ballot measure in CA, and in NV by Uber's money.

I prefer IC actually. I get more control over write-offs, business expenses, and where I put my retirement funds.

As for being a hospital employee, I've said it before: You are not more protected, and the new boss is just as bad as the old boss.

That’s simply not true. Being a hospital employee is better than a CMG. Yes, it’s not as good as a well functioning SDG, but I would rather be able to knock on my bosses door, pass him in the cafeteria and admit patients to him than have it be some suit in Manhattan.

 

[GeneralVeers]

That’s simply not true. Being a hospital employee is better than a CMG. Yes, it’s not as good as a well functioning SDG, but I would rather be able to knock on my bosses door, pass him in the cafeteria and admit patients to him than have it be some suit in Manhattan.

My N=1 experience showed that overall this wasn't true. The ED staffing did seem to be better, however we reported directly to nurse-managers and administrators. Our medical director was a figurehead who had no control over staffing levels. We had no control over the NPs as they were employed directly by the hospital, and we couldn't make them work faster, or see patients within their scope. This was a large, tertiary-care referral center with teaching programs.

 

[RustedFox]

My N=1 experience showed that overall this wasn't true. The ED staffing did seem to be better, however we reported directly to nurse-managers and administrators. Our medical director was a figurehead who had no control over staffing levels. We had no control over the NPs as they were employed directly by the hospital, and we couldn't make them work faster, or see patients within their scope. This was a large, tertiary-care referral center with teaching programs.

I was waiting for this post.

 

[p1acebo]

My N=1 experience showed that overall this wasn't true. The ED staffing did seem to be better, however we reported directly to nurse-managers and administrators. Our medical director was a figurehead who had no control over staffing levels. We had no control over the NPs as they were employed directly by the hospital, and we couldn't make them work faster, or see patients within their scope. This was a large, tertiary-care referral center with teaching programs.

That sounds like a bad experience unfortunately. I have an N=2, working at two different institutions that were both hospital employed. In both cases the director listened to complaints we have had, and represented us well. At my current institution we even had changes in staffing and shift staggering simply based on our input. I think results may vary for sure but I’m willing to bet in most cases a hospital employed model has the potential for the department directors and hospitals to have more ownership in their physicians.

 

[GeneralVeers]

That sounds like a bad experience unfortunately. I have an N=2, working at two different institutions that were both hospital employed. In both cases the director listened to complaints we have had, and represented us well. At my current institution we even had changes in staffing and shift staggering simply based on our input. I think results may vary for sure but I’m willing to bet in most cases a hospital employed model has the potential for the department directors and hospitals to have more ownership in their physicians.

I'm glad you had a good experience. I'd be hesitant to every work in a hospital-employed job again. I'm not saying they are worse. In every situation there are tradeoffs, but in the end the results are similar.

 

[SeekerOfTheTree]

That sounds like a bad experience unfortunately. I have an N=2, working at two different institutions that were both hospital employed. In both cases the director listened to complaints we have had, and represented us well. At my current institution we even had changes in staffing and shift staggering simply based on our input. I think results may vary for sure but I’m willing to bet in most cases a hospital employed model has the potential for the department directors and hospitals to have more ownership in their physicians.

I have worked as an IC, in a SDG, and now hospital employed. I have loved my hospital employed W2 job the most. We have direct control over who we hire/fire. We also have direct control over staffing and our mid-levels. Great support. I would never go back. My 403 match has been great as well.

Doing write offs was fun for the first 2 years and then became super stressful for me. I am glad to be done with it. Writing off a car lease was nice but my current gig is very nice. In our position we had no hours cut, no furloughs, no layoffs during the covid surge and even got a bonus. I know it varies for hospital employed positions but mine is pretty great.

 

[cyanide12345678]

I had promised myself that i would never become a w2 again and here i am having signed a w2 agreement to become hospital employed.

I will certainly miss my 199a deduction, 57k solo 401k contribution, mileage deduction, and lots of other random deductions. They add up pretty quickly.

 

[sylvanthus]

I had it good this past year but not so much anymore. A W-2 for benefits (matching 401k, 457, health insurance, etc) and also a IC job for all the other tax perks. Now I cant find hours for the IC job. Ah well maybe later in the year....

 

[thegenius]

Plan to Strengthen Organized Labor and Collective Bargaining | Joe Biden

Strong unions built the American middle class. That's why Joe Biden has an extensive plan for strengthening organized labor and collective bargaining.

joebiden.com

That's all fine and dandy...but if it works against the companies they will just band together and re-write the laws.

AKA California Proposition 22 - Uber, Lyft, and DoorDash all pitched in 150-200 million dollars and just rewrote the labor laws in CA.

 

[WilcoWorld]

That sounds like a bad experience unfortunately. I have an N=2, working at two different institutions that were both hospital employed. In both cases the director listened to complaints we have had, and represented us well. At my current institution we even had changes in staffing and shift staggering simply based on our input. I think results may vary for sure but I’m willing to bet in most cases a hospital employed model has the potential for the department directors and hospitals to have more ownership in their physicians.

My experience is similar to yours.

 

[hundreddaysoff]

My N=1 experience showed that overall this wasn't true. The ED staffing did seem to be better, however we reported directly to nurse-managers and administrators. Our medical director was a figurehead who had no control over staffing levels. We had no control over the NPs as they were employed directly by the hospital, and we couldn't make them work faster, or see patients within their scope. This was a large, tertiary-care referral center with teaching programs.

My experience as well at a large community hospital where I recently moonlit that effectively employs all its docs. Effectively reported to RNs, figurehead medical director, etc.

This was also, of course, my experience working for TeamHealth/HCA.

Others' experiences may be different. That's OK. Bottom line for me is, if we're all just rolling the dice on this issue, I'd rather stay IC so I can save some tax money.

<rant>
I suspect what really matters is not who your boss is on paper, but rather how rentier/business-class oriented your organization is philosophically. Since political trends over the past 40 years have (with all the best of intentions of course!) favored the rentier class and their worldview* (vs doctors or any other workers who do/make real stuff), we should fully expect it will seep into nonprofit and hospital-employed models.

Tangentially, I suspect that the general rise of stupid JCAHO/Press-Ganey/government rules and metrics is also fundamentally due to the rise of this rentier/MBA class and misapplication of fine-sounding but naive business school ideas in order to make a buck.

*great read about this general trend that is orthogonal to your political party: _Econned_ by Yves Smith
</rant>

 

[bravotwozero]

Anyone know what kind of problems, tax wise, you can run into if you have both a w-2 and a 1099 IC job? Is this going to lower the amount of money I can put in a solo 401k?

Also, do you end up getting double taxed on social security, both from your 1099 and w-2, even though there's a cap on it?

 

[GeneralVeers]

Anyone know what kind of problems, tax wise, you can run into if you have both a w-2 and a 1099 IC job? Is this going to lower the amount of money I can put in a solo 401k?

Also, do you end up getting double taxed on social security, both from your 1099 and w-2, even though there's a cap on it?

I've had this setup for some time.

1. You can contribute the IRS maximum to a retirement plan. I do the employer deduction at my W2 and contribute the maximum allowable for that tax year to my employer 401K. The remaining amount I contribute to my SEP -IRA, up to 25% of 1099 income

2. No. The SS amount is the same regardless.