The Real Enemy

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The exodus is almost complete.  More and more doctors are jumping on the bandwagon of hospital employment.  Here is some info from a recent New York Times article:

Last year, 64 percent of job offers filled through Merritt Hawkins, one of the nation’s leading physician placement firms, involved hospital employment, compared with only 11 percent in 2004. The firm anticipates a rise to 75 percent in the next two years.

There is an old saying that “power tends to corrupt and absolute power corrupts absolutely”.  The consequences of the unhealthy physician-hospital marriage can be very bad for patients.  As the article states, the increase in prices and “facility fees” are just two that quickly come to mind.

But I know the deal.  I was there.  I worked between two hospitals for over fifteen years.   The administrators who that ran them had a warped view of everything, including the Golden Rule.  You know, those that have the gold make the rules.  Administrators treat doctors as a commodity when doctors are salaried.  That is just business.  So if you join you immediately become their bitch.  There, I said it.

After all my battles on this site with the NP/PA militant LELTs, I still know who the real enemy is.  One of my friends (family doc) recently went on an interview for a hospital sponsored job.  During the visit she was asked in front of few members of the hospital’s brass what and how she was getting paid.  She explained that she is on what is called a work RVU system (a system, by the way, completely bastardized by administrators as a way to pay doctors).  When she gave them the dollar per RVU she was getting, one female administrator responded:

“And how long have you been overpaid?”

Overpaid? That dollar per RVU amount my friend was getting paid had NOT changed in 15 years?  And what does an administrator generate for the hospital?  Nada.

Remember, if a doctor went missing for a DAY, there would be chaos in the office.  If this administrator was missing for a month, no one would hardly notice.

 

A Collaborative Work From Some of the Writers at Authentic Medicine

These editorials are from some of the writers here at Authentic Medicine. The opinions expressed by these authors do not necessarily purport to reflect the opinions or views of other writers of this blog. Each collaborative work may, in fact, be from different authors.

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13 Responses

  1. Chuck Davis says:

    KOM and All…Prior, present and evolving circumstances seem to dictate that WE must take RADICAL actions to remain sane and continue in the practice of our passion! I was a union man in the fishing industry to get to med school. As distasteful as it seems, We NEED organization and a collective voice. As “independent” as we Drs. think we are, the endangered species list now includes the classical free wheeling physician ( more so the subspecies PCP!) I’m sure there are other aggressive tacks to take that others wiser than I could suggest. So discouraging, I’m otherwise at a loss!

  2. Stella Fitzgibbons MD says:

    Doug, please add a note or two about the “patient satisfaction ratings” that are proposed as part of “quality” evaluations for hospitals. I worked once at a big hospital that was so hung up on patient satisfaction that all the local sociopaths and drug-seekers were onto them. “But, Ms. Demerol, if we increase your dose or frequency you’re at risk for respiratory suppression” often produced a call to the Patient Advocacy office, where a complaint was recorded that went into the doctor’s file. Too many of those and you got a summons to the chief of service’s office; more than that and your privileges would not be renewed next year.

  3. Bridget Reidy MD says:

    OK, that worked. This comment is worth trying to repost.

    The title says it all, The Real Enemy, and I’m glad the focus is back on that. There was a comment a few weeks ago that’s germaine to this topic and it’s been literally haunting me. Someone posted that he had to discharge patients on a statin if the admitting diagnosis was vascular, no exceptions. So a frail elder admitted for medication induced fluctuation in level of consciousness (called a TIA in most places I’ve worked) has to go home on maximum dose statin.

    It’s one thing to get paid very little per RVU, cause that can happen in private practice too if you do things that aren’t valued on that scale. It’s one thing to ignore your patients needs to go after the PFP cause that’s going on in the private practice too. But to allow your non doctor boss to tell you what to prescribe in every case – that CEO should honestly be reported to the Board for practicing without a license! How can we convince our colleagues that there are just certain lines that can’t be crossed or it IS the end of medicine? Will we ever sacrifice our incomes to stand up for what is right? Or are we bound to the inevitable from not doing that long ago.
    I have left jobs in ways that make my employment prospects worse, more than once, rather than commit fraud or tolerate a system so abusive to me I can’t provide good patient care. I have the debt and periods of unemployment and underemployment to prove it, and could stand no more. I have now given up and gone to Canada. Somebody left behind has got to stand up. I truly think a strike is needed in that hospital.

    • tad hominem says:

      I am afraid that the tipping point was reached several years ago. Your friend’s failure to object to and / or walk out confirms my fear. The “big money” people, insurance companies and hospitals, have enough in common to cooperate to squeeze out all other players,oh, sorry, I mean “stakeholders” and enough $$ to buy the influence they need to come out on top.

  4. Bridget Reidy MD says:

    Doug your website has cut off my left margin and I have to guess where the email goes and where my name goes.

  5. Russell B. says:

    Please tell me your friend got up and walked out.

    • Doug Farrago says:

      No and she regrets not doing just that. I think it caught her so off guard.

    • Bridget Reidy MD says:

      All I see above this box are three boxes, no asterixes to know which are required, or instructions of which one is name and which is email and which is optional. When I get it wrong it erases my whole post, saying “a valid email address is required”. Even if I scroll all the way up or all the way down I never see a left-right scroll bar for getting the left side of the window, where presumably the asterixes and what to put in each box are supposed to be.

  6. Pat says:

    I’ve been instinctively anti-union my entire adult life; now, I can’t wait for this whole mess to hurry up and end in frank socialism, complete with a national doctors’ union. Then I’ll show you the true meaning of lazy.

  7. Fred Powell says:

    Great points. A lot of docs paint themselves into a corner with financial obligations and that gives the suits the upper hand, when they know you are very unlikely to walk.

  8. Randy says:

    I am surprised the whole concept of a facility fee has lasted this long without the government questioning it. In essence it can double what I charge for a visit in my office (I’m a solo FP), purely because the location is attached to a hospital. This makes no sense at all and should be a prime target for cutting costs.

    I am coming to the conclusion that for whatever reason the government prefers all doctors should be salaried and work for hospitals or large corporations. The Cleveland Clinic and Mayo models were touted during the run-up to the ACA passage, and the continual adding on of more quality and meaningful use requirements almost requires a large group or hospital with departments dedicated to deciphering them.

    Ultimately this is a wasteful mindset.

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