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The 145% Markup: Why Catholic Systems Are Buying Your Practice
Dynasty 3: The Cross-Market Consolidators
dutchrojas.substack.com
They’re not buying your practice because they need doctors.
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dutchrojas.substack.com
of course.
healthcare in the US is 100% capitalism. we get what we want.
healthcare in the US is 100% capitalism. we get what we want.
My daughter's "woke" high school AP Economics teacher assigned her class an essay on society's passive acceptance of economic inequity. After a long conversation with me, she turned in this...she's thinking about pre-med.
Example of Passive Acceptance of Structural Economic Inequity
A clear example of passive acceptance of structural economic inequity occurs in hospital-employed physician compensation. Large hospital systems often impose artificial caps on physician pay and productivity, limiting earnings regardless of the revenue physicians generate. Although these caps suppress physician income and violate competitive market principles, most employed physicians accept them rather than challenge the system.
This acceptance is rooted in structural conditions rather than individual preference. Medical training socializes physicians to tolerate hierarchy, delay rewards, and accept unequal power relationships. By the time physicians enter employment, they are accustomed to being told what compensation is “reasonable” and are reluctant to challenge institutional authority. As a result, inequitable compensation structures are normalized rather than questioned.
Additionally, physicians often prioritize income stability and risk reduction over maximizing earnings. Hospitals offer guaranteed salaries, benefits, and administrative protection in exchange for capped productivity and limited autonomy. For many physicians, the certainty of employment outweighs the uncertain gains of resisting compensation limits, even when those limits reduce long-run earnings.
Unequal sharing of information further reinforces acceptance. Hospitals control access to revenue data, facility fees, contribution margins, and cross-subsidization across departments. Physicians typically see only simplified productivity metrics, such as work relative value units (RVUs), without complete insight into the profits their labor generates. This lack of transparency prevents physicians from accurately assessing whether compensation is equitable.
High exit costs also discourage resistance. Leaving employment may require rebuilding referral networks, losing benefits, navigating non-compete clauses, or assuming business risk. Because hospital administrators understand these barriers, they can maintain compensation caps knowing that many physicians are unwilling or unable to exit the system.
Finally, social and professional pressures discourage high productivity. Physicians who exceed expected output may be criticized for disrupting workflows or raising compliance concerns. Over time, the system rewards conformity rather than efficiency, reinforcing acceptance of compensation limits.
In conclusion, hospital-employed physicians passively accept structurally inequitable compensation because training, risk aversion, information asymmetry, high exit costs, and professional norms reduce resistance. Although the system suppresses physician earnings and weakens market competition, its design makes compliance appear safer and easier than opposition, allowing inequity to persist.
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This will undoubtedly end up being discussed in the teachers' staff room...
You mean you talked to your daughter about some topics to include and she punched it into chatGPT with possibly some light editing....
I am a huge proponent of reverting back to blue book, in person administration of all essay writing assignments. ChatGPT makes essay assignments utterly pointless otherwise.
Apples and trees.
Agreed. This isn't poorly written but it completely fails to address the assigned question. If her teacher is super "woke" as stated, she might get away with a tangential answer. That said, I don't know how well a paper complaining about physician compensation will resonate with that sort of person.
It's got clear flags of ChatGPT generated to some extent. Sorry to burst your bubble drusso.
Chat GPT often has the "in conclusion" thing at the end and then to rehash the topics in a one liner...in fact when I punched a similar prompt into chatGPT it gave me an "in conclusion" paragraph that looked pretty similar right at the end.
It also loves this style of multiple small paragraphs of a few sentences each.
I could get almost exact similar sentences from Chat GPT with a prompt that included these specific subjects. For example:
OP: "Hospitals control access to revenue data, facility fees, contribution margins, and cross-subsidization across departments. Physicians typically see only simplified productivity metrics, such as work relative value units (RVUs), without complete insight into the profits their labor generates. This lack of transparency prevents physicians from accurately assessing whether compensation is equitable.
Mine: "Hospitals possess detailed knowledge of revenue streams, downstream profits, and cost allocation, while employed physicians typically see only narrow productivity metrics such as RVUs. Without transparency into how clinical labor generates institutional revenue beyond salary formulas, physicians lack the information necessary to assess or challenge inequitable compensation structures."
Her other essay was on "Why teachers shouldn't use AI detectors to evaluate student work."
All the essay assignments are now proctored "in-class" assignments for AP classes. They get to make an outline at home but have to write the essay in class. Spell check and stripped down version of grammarly allowed. Otherwise, no AI permitted. They all use tablets, and teachers can monitor keystrokes.
Interesting times...
I've noticed that kids are learning to write like AI. It's becoming the new "Trans-Atlantic" regional dialect of our time
lol except the difference is it's an actual way to structure content not an accent
drusso idk what to tell you bud just look at how similar the actual content and structure is. ChatGPT isn't sourcing off high school essays. I wouldn't be surprised if she punched it into ChatGPT and semi-memorized it before having to write the essay in class but it's way too similar to not have any AI input at all.
Want to see another example when I just punch in "write a 350 word essay with the topic of Passive Acceptance of Structural Economic Inequity regarding hospital employed physician compensation with subtopics of deferred gratification, risk aversion, information asymmetry, high exit costs and professional norms." It literally comes up with the same first sentence for the last section.
Yours: Additionally, physicians often prioritize income stability and risk reduction over maximizing earnings. Hospitals offer guaranteed salaries, benefits, and administrative protection in exchange for capped productivity and limited autonomy. For many physicians, the certainty of employment outweighs the uncertain gains of resisting compensation limits, even when those limits reduce long-run earnings.
High exit costs also discourage resistance. Leaving employment may require rebuilding referral networks, losing benefits, navigating non-compete clauses, or assuming business risk. Because hospital administrators understand these barriers, they can maintain compensation caps knowing that many physicians are unwilling or unable to exit the system.
Mine: Risk aversion further reinforces passivity. Physicians often prioritize income stability, predictable schedules, and institutional backing over potentially disruptive efforts to renegotiate compensation or pursue independent practice. Given the high personal and professional stakes—malpractice exposure, credentialing hurdles, and family obligations—many physicians rationally avoid actions that could jeopardize perceived security, even if long-term earnings suffer.
High exit costs also discourage resistance. Leaving a hospital system may require relocation, rebuilding referral networks, forfeiting benefits, or navigating non-compete clauses. These barriers make exit an unattractive option, effectively binding physicians to existing compensation arrangements.
True story.
A group of students, including my daughter, was implicated in an academic scandal involving the unauthorized use of AI. It seems odd that only a particular group of students, who all happen to know each other, would be targeted and accused of scholastic dishonesty. What the accusing teacher didn't realize was that all work, including keystrokes, is tracked in Google Classroom, whether the activity occurs on or off-campus.
So, my daughter and her peers appeared before the school Honor Code committee for their required punishment, listened to the accusations, and reviewed the evidence. The evidence rested on the fact that the charging teacher used a non-district-approved "AI-detector" application to screen student work and automatically awarded a zero grade for any submission that "fell out" of the algorithm.
But...my daughter asked, "Did you check the document versioning history?" Blank stares looked back. The charging teacher didn't realize that Google Classroom has automatic versioning history. Teachers can literally track every keystroke a student makes in producing their work product or assignment. The teacher went back and checked the versioning history. No large "cut and paste" activities were detected that would be consistent with plagiarism from other sources. The grade was amended to a 95. Case dismissed.
If you have school-age kids, recognize that these tools and checkers are out there. Also, remember that educators are not immune to bias and ideological warfare.
......I'm sorry you're in denial that your kid is using ChatGPT on the reg for her schoolwork. Did it ever occur to you that she could have ChatGPT pulled up somewhere else and literally just type the output without copy/pasting anything? I guess it didn't occur to the administrators.
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Yeah, that's happened too. One kid had his AirPods synced to his Apple watch and basically "took dictation" for the whole assignment. So, now, the kids have to put their electronics in "jail" in these metallic shielding mesh pouches at the start of class...
I'm mostly alarmed by the assigned topic of "society's passive acceptance of economic inequity". This is why we have full grown adults still falling for socialist propaganda.
My essay would paint the "passive acceptance" as a zen like state of virtuous non judgement and contrast it with the turbulent chaos of jealous social justice warriors.
My essay would paint the "passive acceptance" as a zen like state of virtuous non judgement and contrast it with the turbulent chaos of jealous social justice warriors.
what were the consequences for the teacher pray tell
Triple secret probation.
That is not very encouraging
There were no consequences his kid used ChatGPT and got away with it lol. Just like she did with the original answer above, he just refuses to believe it.
Did you not see the part where the cool slick students somehow made the old teachers think the only way they could have gotten their answers from ChatGPT is if they directly copied and pasted it into Google Docs instead of doing the prompt on their phone, changing a few words and typing it all in?
Without a clear explanation for why a "particular group of students, who all happen to know each other, would be targeted and accused of scholastic dishonesty"....probably cause they were all doing the same stuff 🤣 It's the old getting your buddy to write an essay for you trick but on a macro level.
@drusso were Joe and Fatima’s kids ensnared in this liberal teachers union witch hunt?
As a matter of fact, their oldest daughter was implicated in the scandal, but emerged with her reputation unscathed.
As you might recall, Joe was among the earliest cash-outs from Microsoft in the mid-1990s, having lost faith in Bill's and Paul's vision for the future, and subsequently parlayed that small fortune into a sustainable, diversified revenue stream in real estate, agribusiness, alternative energy, and crypto. As he describes it, "It started well when Bill and Paul were in the office every day, but soon the core products began to steadily shift from user-focused tools into platforms optimized for lock-in, data extraction, and recurring revenue. Features are increasingly bundled, defaults are harder to change, and customers are nudged toward subscriptions, cloud dependence, and cross-product integration whether they want it or not."
He really became a bit of a tech Luddite, believing that what's happening to tech more generally is a harbinger of doom regarding the cooptation of human culture by AI. Joe has it on pretty good authority that the Internet, social media, and now AI are basically tools to strip society of privacy rights and intellectual property, and that they are the first steps toward a tech-enabled dystopian society where Silicon Valley tech bro's rule us. His kids were the last in the neighborhood to get smartphones, and he explicitly forbade any of them from having TikTok, Instagram, etc. His daughter's defense was, "Have you met my Dad? He barely lets me use the Internet. I would have no idea how to use Chat." At the end of the day, ironically, it was tech's incursion into student privacy that proved their innocence. Societies that surrender privacy in the name of safety often discover too late that the only thing truly protected is power. And that, sometimes, the absence of data is the most substantial proof of innocence.
Thanks for asking.
That makes sense @drusso. Paul’s mother, Faye, won all around girl at my high school in 1940 in a landslide. Lots of peculiarities in the election were noted and ignored by the powers that be. And here we are today. Really makes one think.
