The AI CEO

Started by circleK
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circleK

circleK

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AI is sloshing in money but much of it is a circle jerk. I have a young relative who just took a leave of absence from college to join an AI startup. The startup uses AI to recruit engineers for um….other AI companies. Their goal is to be acquired by a larger more established AI recruiting company or to be acquired by a behemoth professional networking site and be killed. The irony is that the founders did not use AI to find, recruit, and hire my relative. They met him at a poker game. Even the AI guys are cynical about AI. They just want to mine the mother lode and exit but boomer CEOs like Dr Katz are buying the pitch.
 
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circleK said:
Great rebuttal to a certain NY healthcare system CEO who recently spoke of replacing certain physicians with AI:

www.linkedin.com

The AI CEO: Why Dr. Mitchell Katz Should Replace Himself Before He Replaces Radiologists

By Waseem Ullah, MD | Healthcare Leadership & Policy Last week, Dr. Mitchell Katz, CEO of NYC Health + Hospitals, stood before a Crain’s New York Business audience and made a declaration disguised as a dilemma.
www.linkedin.com www.linkedin.com
Click to expand...

This made the most sense.

When I saw Katz's statement about wanting to replace radiologists, I thought why wouldn't you just replace the horde of useless Vice presidents etc even the CEO position.

Your typical hospital administrator is low IQ with an online MBA. Not exactly hard to replace that brainpower with minimal liability.
 
The only way I'd want to invest in AI is to invest in non-AI companies using it for nefarious and dystopian purposes, because odds are that's all it's going to be good for in our lifetimes.

For example defense contractors making autonomous weapon systems, companies that specialize in surveillance and intrusive data mining, customer service companies that specialize in denying actual customer service, social media companies looking for more effective and personalized ragebait, porn sites specializing in celebrity deepfakes.

Maybe with a side of the chip/hardware companies making the shovels for this gold rush ...
 
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AI can’t ever replace the human factor

Isnt that what high frequency Wall Street trading based on computer algorithms except when the system gets overloaded. They are f’d.
 
CopaceticOne said:
Just think of the millions of dollars saved by not having to pay C-suite B-school salaries & severance packages
Click to expand...
My old hospital system faced some financial issues a few years ago and trimmed 30 administrative positions, saving $10million/yr. We really didn't notice the difference with those people gone. The CEO then bemoaned that he fired all of those people, only to have the doctors request increased financial support and compensation almost equal to the amount saved (at least half of that was my group requesting a bigger stipend to deal with the skyrocketing costs of CRNAs and the demands for more late locations).
 
psychbender said:
My old hospital system faced some financial issues a few years ago and trimmed 30 administrative positions, saving $10million/yr. We really didn't notice the difference with those people gone. The CEO then bemoaned that he fired all of those people, only to have the doctors request increased financial support and compensation almost equal to the amount saved (at least half of that was my group requesting a bigger stipend to deal with the skyrocketing costs of CRNAs and the demands for more late locations).
Click to expand...

Yeah how horrible it is to hire more of the people who bring the money in
 
We have too many of everything in the USA. That includes health care providers.

There are so many unnecessary “elective” procedures being done after 5pm at most hospitals.

I got a doc out at 7am Monday morning and who was called in at 330am for a “closed” fracture for the elbow which turned open. Patient wanted to be transferred downtown to real trauma facility closer to his house. But the surgeon (I’m sure with the hospital’s backing) didn’t want to transfer the patient.

The staff has 30 min to get in setup the room etc. so why the f start non emergency surgery at 422 in the morning. It can easily wait to 730am.

Because surgeons are incentivized for rvu at the hospitals. This hospital grosses so much money. It’s a cough cough non profit 501c hospital.

So the hospital doesn’t care if it’s paying an anesthesia doc 57k for the week to cover beeper. It’s insane. I obviously grab some of that cash myself. Lol 😂. I ain’t complaining They capture 20k in facility fees just for a 10 min carpal tunnel. Employed surgeon gets to bill for $500. Anesthesia $1200. They don’t give a crap having to kick back anesthesia hard cash. They do fake complain about anesthesias costs. But we all know how the game is played out.

So my point is I’ve given up trying to care how to save the system money. As long as hospitals are racking up millions or even billions in facility fees. That more than pays the bills.
 
Mman said:
we have too few doctors and too few nurses and too few scrub techs and too few of many other health care professions
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Depends how you see things. Physician or health care shortage often times is artificially created.

Like I said over utilization of healthcare services

I’d like some European doc to chime in and ask how many elective case they do after 5pm or how many elective schedule cs they do at 6am. These are artificiallly created unnecessary procedures that create “shortage “
 
Mman said:
we have too few doctors and too few nurses and too few scrub techs and too few of many other health care professions
Click to expand...
with the currrent system yes

with an efficient system where not everyone is up all night competing in different hospitals for this elbow case, maybe we are more appropriately staffed
 
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aneftp said:
I’d like some European doc to chime in and ask how many elective case they do after 5pm or how many elective schedule cs they do at 6am. These are artificiallly created unnecessary procedures that create “shortage “
Click to expand...

The EU has significantly more physicians per capita than the United States
 
Hospitals want us to do these bull**** cases at 2AM. They feel that if they're paying people to be on call, those minions might as well be working. (They'll say something else to our faces, but this is the economic efficiency they want. Their dream is 24/7 OR utilization.)

Also from their perspective ... if some garbage case gets done at 1 AM that patient can often be discharged that same day. If they get punted to the day's add-on list, maybe those cases get done at 4 or 5 PM after the elective stuff, and that patient spends the night. And hospital stay length is the mother of all metrics to our PowerPoint-obsessed overlords. Bundled payments = move the meat out ASAP.
 
pgg said:
Hospitals want us to do these bull**** cases at 2AM. They feel that if they're paying people to be on call, those minions might as well be working. (They'll say something else to our faces, but this is the economic efficiency they want. Their dream is 24/7 OR utilization.)

Also from their perspective ... if some garbage case gets done at 1 AM that patient can often be discharged that same day. If they get punted to the day's add-on list, maybe those cases get done at 4 or 5 PM after the elective stuff, and that patient spends the night. And hospital stay length is the mother of all metrics to our PowerPoint-obsessed overlords. Bundled payments = move the meat out ASAP.
Click to expand...
Several years ago, my hospital closed, and they were discussing moving all of us (hospital employees) over to a much smaller facility that they also owned, which was already staffed by a private group. They discussed with us and the surgeons at both facilities moving to a system of 8-hr blocks throughout the day. They honestly pitched that a room could go to general surgery 0700-1500, then have Gyn have the 1500-2300 block, then have the remaining 8 hours for call cases. This other facility wasn't a big trauma center, it was a 4 OR (plus cysto, 2 endo, and L&D) place in rural PA.

Sometimes, the admin does say the quiet part out loud
 
pgg said:
Hospitals want us to do these bull**** cases at 2AM. They feel that if they're paying people to be on call, those minions might as well be working. (They'll say something else to our faces, but this is the economic efficiency they want. Their dream is 24/7 OR utilization.)

Also from their perspective ... if some garbage case gets done at 1 AM that patient can often be discharged that same day. If they get punted to the day's add-on list, maybe those cases get done at 4 or 5 PM after the elective stuff, and that patient spends the night. And hospital stay length is the mother of all metrics to our PowerPoint-obsessed overlords. Bundled payments = move the meat out ASAP.
Click to expand...
but why dont they just pay that same staff to do that same case during the day?

They can work the day shift instead. Same number of cases done overall.

I think there should be one designated hospital open at night within a certain mile radius.

Not the best for business, but best for the docs and the patients.

It could be a place with a very competent ICU, ER, night OR staff that is used to these off hours and high acuity cases.

No more of these small places trying to hang onto kids and very sick people without the resources.

When I took call as a resident I worked literally all night, if not in the OR then in the ICU, OB, there was always stuff going on.

As an attending in a smaller hospital the game is how much sleep do I get... why dont they just send everything to the big places where they are more prepared up all night anyways? Maybe one day
 
Hoya11 said:
but why dont they just pay that same staff to do that same case during the day?

They can work the day shift instead. Same number of cases done overall.
Click to expand...

The ORs are full all day every day.

It's actually kind of sad to see services like podiatry be treated like redheaded stepchildren because they don't get enough block time and always wind up doing their cases in the cracks of the schedule or as add-ons at the end of the day.

Hoya11 said:
I think there should be one designated hospital open at night within a certain mile radius.

Not the best for business, but best for the docs and the patients.
Click to expand...

That's what the whole certificate of need process is supposed to manage.

Hoya11 said:
It could be a place with a very competent ICU, ER, night OR staff that is used to these off hours and high acuity cases.

No more of these small places trying to hang onto kids and very sick people without the resources.

When I took call as a resident I worked literally all night, if not in the OR then in the ICU, OB, there was always stuff going on.

As an attending in a smaller hospital the game is how much sleep do I get... why dont they just send everything to the big places where they are more prepared up all night anyways? Maybe one day
Click to expand...

The small terrible places can be profitable for the health care system because as critical access hospitals they get reimbursed by the state for their actual costs as opposed to the usual garbage Medicare rates.


We've got a community hospital that should have its ORs closed. They won't. Even as inefficient as it is, it somehow makes money. I suppose it's maybe at some risk because of the BBB but for now we're stuck with it.
 
pgg said:
The ORs are full all day every day.

It's actually kind of sad to see services like podiatry be treated like redheaded stepchildren because they don't get enough block time and always wind up doing their cases in the cracks of the schedule or as add-ons at the end of the day.
Click to expand...
Some of that is by design for the podiatrists, though. They don't really make money on the cases they do in the hospital, so fill their day with clinic and cases at ASCs where they own shares. I know at least of few of those guys won't do cases earlier if a room is available, because they want to finish clinic, go home for dinner, then come to the hospital to deal with the quick toe amp or I&D.

I think the really problematic OR was closed before you came. We would regularly drive for an hour to get there only to find that the six or eight colonoscopies was reduced to just two, or maybe one in the morning, followed by an ankle or SCS generator in the early afternoon (and no, they "couldn't" get the patient in earlier). Ultimately, it wasn't the horrible inefficiency that forced the closure (although the system CEO was complaining about that), but rather their complete inability to fix issues with their blood bank.

They did have one ER doc whose notes were always a trip to read when accepting ICU admissions. Once during covid, he wrote about a patient who, "unfortunately subscribed to a fringe belief regarding the use of certain veterinary medicines in lieu of evidence-based treatments, and now presents with the consequences of his actions."
 
psychbender said:
Several years ago, my hospital closed, and they were discussing moving all of us (hospital employees) over to a much smaller facility that they also owned, which was already staffed by a private group. They discussed with us and the surgeons at both facilities moving to a system of 8-hr blocks throughout the day. They honestly pitched that a room could go to general surgery 0700-1500, then have Gyn have the 1500-2300 block, then have the remaining 8 hours for call cases. This other facility wasn't a big trauma center, it was a 4 OR (plus cysto, 2 endo, and L&D) place in rural PA.

Sometimes, the admin does say the quiet part out loud
Click to expand...

I’m not in leadership for my group, and here’s why. The obvious response to this is ‘no problem, just ensure you (the admin pitching the idea) is in house for all surgery blocks in case administrative issues arise that they’d need to help resolve. We can even move all meetings to 1-2am.’
 
AI models have gotten hospitals to think and not pay for anesthesia in house coverage

Dude just texted me too risky at busy downtown hospital where one doc is expected to cover ob and or at the same time.

And if there is a stat cs that’s needed. He’s suppose to be calling the backup anesthesia doc in if he’s stuck in the Or

Ai models tell admin the risk of this happening is 3-4 x a year and it’s too costly to have a crna or doc in house at the same time.

That’s ai for you. We all know admin used information from Or utilization and figure how to maximize profits.

Imagine being the backup doc having to rush in. Or the solo doc there in the or.

Too much stress.
 
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psychbender said:
Several years ago, my hospital closed, and they were discussing moving all of us (hospital employees) over to a much smaller facility that they also owned, which was already staffed by a private group. They discussed with us and the surgeons at both facilities moving to a system of 8-hr blocks throughout the day. They honestly pitched that a room could go to general surgery 0700-1500, then have Gyn have the 1500-2300 block, then have the remaining 8 hours for call cases. This other facility wasn't a big trauma center, it was a 4 OR (plus cysto, 2 endo, and L&D) place in rural PA.

Sometimes, the admin does say the quiet part out loud
Click to expand...
It never ceases to amaze me that the low revenue surgeons put up with this. Imagine being a general surgeon with actual urgent cases being told you can’t start operating until 3 pm every day because the PITA (but lucrative) joint surgeon needs 2-3 rooms. Then that guy goes home and sleeps in his bed while you do cases until 11 pm. I would be questioning my life choices every day.
 
ambiturner said:
It never ceases to amaze me that the low revenue surgeons put up with this. Imagine being a general surgeon with actual urgent cases being told you can’t start operating until 3 pm every day because the PITA (but lucrative) joint surgeon needs 2-3 rooms. Then that guy goes home and sleeps in his bed while you do cases until 11 pm. I would be questioning my life choices every day.
Click to expand...
No, no, no, you don't understand, that general surgeon gets to sleep in every day! Just think of how much he can get done on his own, since his OR block doesn't start until 1500!

Or, even better, he can do a full clinic day, THEN go operate. Two days for the price of one (and then the same thing the next day, and the next...)!

--Admin, probably
 
Aneftp is right about over utilization- we wouldn’t do half the joints that we do if Americans could keep their bmi under 40…. And how many fistulas, amputations, and I and Ds could we avoid if people could just control their diets. How many car wrecks with drinking and driving or using drugs….
this is why we can’t have nice things like health care for all…. No one in charge (government, health insurance companies, etc) will call the patients out. Put the fork down, get off your ass and go for a walk and wave at the neighbors while you’re at it.
Stop doing illicit drugs…. Lots of what I see is preventable lifestyle illness- it annoys me when there are real patients with real issues to take care of.
 
psychbender said:
Some of that is by design for the podiatrists, though. They don't really make money on the cases they do in the hospital, so fill their day with clinic and cases at ASCs where they own shares. I know at least of few of those guys won't do cases earlier if a room is available, because they want to finish clinic, go home for dinner, then come to the hospital to deal with the quick toe amp or I&D.

I think the really problematic OR was closed before you came. We would regularly drive for an hour to get there only to find that the six or eight colonoscopies was reduced to just two, or maybe one in the morning, followed by an ankle or SCS generator in the early afternoon (and no, they "couldn't" get the patient in earlier). Ultimately, it wasn't the horrible inefficiency that forced the closure (although the system CEO was complaining about that), but rather their complete inability to fix issues with their blood bank.

They did have one ER doc whose notes were always a trip to read when accepting ICU admissions. Once during covid, he wrote about a patient who, "unfortunately subscribed to a fringe belief regarding the use of certain veterinary medicines in lieu of evidence-based treatments, and now presents with the consequences of his actions."
Click to expand...


Yep podiatry “block” time has always started at 5pm.
 
amyl said:
Aneftp is right about over utilization- we wouldn’t do half the joints that we do if Americans could keep their bmi under 40…. And how many fistulas, amputations, and I and Ds could we avoid if people could just control their diets. How many car wrecks with drinking and driving or using drugs….
this is why we can’t have nice things like health care for all…. No one in charge (government, health insurance companies, etc) will call the patients out. Put the fork down, get off your ass and go for a walk and wave at the neighbors while you’re at it.
Stop doing illicit drugs…. Lots of what I see is preventable lifestyle illness- it annoys me when there are real patients with real issues to take care of.
Click to expand...


Hey!! You’re talking about my bread n butter!
 
amyl said:
Aneftp is right about over utilization- we wouldn’t do half the joints that we do if Americans could keep their bmi under 40…. And how many fistulas, amputations, and I and Ds could we avoid if people could just control their diets. How many car wrecks with drinking and driving or using drugs….
this is why we can’t have nice things like health care for all…. No one in charge (government, health insurance companies, etc) will call the patients out. Put the fork down, get off your ass and go for a walk and wave at the neighbors while you’re at it.
Stop doing illicit drugs…. Lots of what I see is preventable lifestyle illness- it annoys me when there are real patients with real issues to take care of.
Click to expand...

I feel called out
 
Too many peanut gallery pencil pushers in 'management' and administrative roles which ultimately have to bearing on patient care are advocating for AI. Article did a good job of essentially saying 'put your feet to the fire first' and honestly we need a stronger attitude of this - because we know exactly from what level the AI proponents will be coming from.
 
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