Disposable, Replaceable Doctors

Certainly, none of us are surprised by this, are we?  While health care CEO’s hide in their well-stocked bunkers  the same people who always do the work, put up with annually added, idiotic mandates and constraints on their abilities, show up…and do all the work again.  

Most ER’s are staffed by companies that contract with hospitals, and those latter two entities are losing money due to the suspension of elective medical work.  While the nation goes through a great viral clench and millions are out of work, the doctors and nurses expected to deal with all of this are often working harder…and now for less.

Alteon Health announced “that the company would be reducing hours for clinicians, cutting pay for administrative employees by 20%, and suspending 401(k) matches, bonuses and paid time off… [indicating] that the measures were temporary but didn’t know how long they would last.”

The company is changing their physicians to an hourly rate, and expects to start cutting hours. 

Emergency staffing company TeamHealth, “said its employees would not be affected. ‘We are not instituting any reduction in pay or benefits.  This is despite incurring significant cost for staffing in anticipation of surging volumes, costs related to quarantined and sick physicians, and costs for PPE as we work hard to protect our clinicians from the virus.’”  (TeamHealth certainly worked hard in canning employee Dr. Ming Lin for criticizing their customer hospital PeaceHealth St. Joseph Medical Center over not having adequate screening and PPE support available).

Other hospital systems are starting to suspend retirement benefits, or short employed physicians accrued pay, citing hard times throughout the health system.  While I realize that the small retailor facing bankruptcy over this panic will have little sympathy for an employed doctor not keeping up with his 401K contributions, that same individual expects that physician to ready, willing, and available if he gets sick, whatever the contagious risks.  I might even understand the corporate concerns to a point, if I thought the rest of the hierarchy was taking a haircut.  Are your frontline people really the ones you want trim?

Of course, the answer is “yes.”  It’s sad to read, “’We all feel pretty crestfallen,’ another ER doctor employed by Alteon said in a text message. ‘I did expect support from our administrators, and this certainly doesn’t feel like that.’”  In this age of core measures and Press Ganey scores, why would any physician ever think any health corporation would have their back?

The truth is that physicians are still seen, and will be viewed after this upheaval, as commodities, disposable and replaceable.  Those who own their own practices might mitigate it somewhat, but only DPC docs will be truly immune.  The rest of us should eschew expectations.

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Pat Conrad MD

Pat Conrad is a full-time rural ER doc on the Florida Gulf Coast. After serving as a carrier naval flight officer, he graduated from the University of Florida College of Medicine, and the Tallahassee Family Medicine residency program. His commentary has appeared in Medical Economics and at AuthenticMedicine.com . Conrad’s work stresses individual freedom and autonomy as the crucial foundation for medical excellence, is wary of all collective solutions, and recognizes that the vast majority of poisonous snakebites are concurrent with alcohol consumption. 

  10 comments for “Disposable, Replaceable Doctors

  1. arf
    April 8, 2020 at 8:13 pm

    “I think it’s time for our nation to enlist our medical personnel on a national basis,” the mayor said at a coronavirus briefing. “We don’t have the same kind of draft we used to have, but we’re going to have to create something new right now at this moment in history to enlist all available medical personnel around the country, and I mean civilians. Anyone with medical training anywhere in the country who can be spared by their city, their town, their state to come to the front.”
    https://www.pbs.org/newshour/health/nyc-mayor-urges-national-enlistment-program-for-doctors

    “……..Anyone with medical training anywhere in the country who can be spared by their city, their town, their state………..”
    Notice, no mention of “spared” by their wives, their husbands, their mothers, their fathers, their children.

    • Mamadoc
      April 9, 2020 at 1:37 pm

      Hell let’s just draft the NPs. And the administrators

  2. arf
    April 8, 2020 at 7:12 pm

    Did anyone read about NYC Mayor deBlasio urging a physician draft?
    https://www.pbs.org/newshour/health/nyc-mayor-urges-national-enlistment-program-for-doctors
    https://www.ny1.com/nyc/all-boroughs/coronavirus/2020/04/03/health-care-worker-draft-needed-to-supply-medical-personnel–de-blasio-says
    Actually, doctors, nurses, probably respiratory herapists, who knows how many others.
    Let it sink in, this is what they actually think of you.

    Oh, and to remind you, they actually did that in Canada, back in 2002

    They’ve talked about doing that, in a pandemic.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2817323/

    But in 2002, Quebec drafted doctors, simply because they could not find doctors to work in rural Emergency Departments. And that wasn’t a national emergency or pandemic. These rural Emergency Departments were not staffed because of political decisions of the Canadian and Quebec government.

    In other words, draft the doctors, reports of mounties showing up at doctors houses and bringing them to these hospitals back then…….to make up for the shortcomings of politicians.

    https://www.cmaj.ca/content/167/5/530.1

    I regret to say it, but the “hero doctors” (and nurses, etc.) will be thrown away like trash when this all blows over.

    The dumpster picture is, unfortunately, quite appropriate.

    • Benjamin Van Raalte
      April 8, 2020 at 7:23 pm

      Very interesting since de Blasio as mayor of New York City supervises the transit authority which had one worker no college degree required make almost $400,000 with overtime last year. Does that mean if he conscripts doctors We can demand to unionize just like the transit workers and for the same hours and effort get $400,000 a year plus a $200,000 a year lifetime pension. Oh, and to equal the hours the average government worker puts in their career, we will probably be retired by age 40 on the full pension.

      • arf
        April 8, 2020 at 8:04 pm

        Some physicians really did unionize, in the Seattle/Tacoma area. A subset of Multicare doctors – Multicare is one of several “big box” operations with million-dollar executive salaries and physicians are a revolving door, they work a short time, get disgusted and quit.

        If I worked for Multicare, I’d join the union in a heartbeat.
        https://www.uapd.com/category/tacoma/
        https://www.uapd.com/multicare/

  3. Jesse L Belville Jr,PA-C
    April 8, 2020 at 6:05 pm

    Hello,Hello, Earth calling MD’s /DO’s..
    Nursing has been after you FOR YEARS.. PA’s are now out of self defense,or else we will both be replaced by NP’s..
    When I started as a PA-C in August 1976, MD’s / DO’s ran it all. But they did not fight or do the politics to keep it all and take the Responsibility to Maintain CONTROL of Modern American Medicine.
    I am a Physician Assistant: My job is to do 70 to 90% of what my supervising Physician does,I handle routine stuff and He/she does the complicated multidisease people who medical history is a nightmare!!! That is what I signed up for..
    Guess what,All those Admin types used me as a cheap MD/DO not a PA under supervision. Used me Abused me and tossed me away to get someone cheaper with less experience.. Now its happening to YOU..
    Get organized in Every state, Buy those politicians, and get your Medical system BACK.. Otherwise you become just another Employee to be used ,abused and discarded.. I do not want Parity with you. I do not have Pre Med 4 yrs, Med school 4 yrs and 3 to 5 years of residency. I have a BS and 43 plus years experience. I had 6 years experience as a #1) combat Medic for 19 months in Vietnam, 4 yrs total as army medic,3 yrs as nursing Tech at Surgical ICU at Johns Hopkins hospital, 2 yrs as ER nursing Tech while in PA school.. Many graduates or PA school today have 4yrs of college,2 yrs PA school and no prior clinical experience. Will need 3 to 5 years of supervised practice to avoid killing someone.. NP’s get their 4 yr BS maybe get RN experience and can do a Masters or PHD program on line and go hang out a shingle .. Not a good idea. They have problems. I have seen them. so have all you Very sad. No PA or NP has the same smarts as an MD, Needs to be better. Who will lead it??

  4. arf
    April 8, 2020 at 5:49 pm

    So much for the “hero doctors”.

    This is why doctors need to unionize. As much as I hate to say it, there’s not much choice.

    Junior doctors want to live in the big city, and I understand it. Thing is, far more often than in my generation, physicians are two-career couples, where the spouse’s employment is not portable. At the risk of a sexism accusation I suppose, I would say that’s even more common with women physicians, who are now, to my reading, a slight majority of graduates nowadays. I think my class was 25% women.

  5. Jesse L Belville Jr,PA-C
    April 8, 2020 at 1:04 pm

    AS a long time employee/Physician Assistant-Certified, welcome to the ranks of employees. No team spirit,no Loyality from supervising MD’s, Admin people accountants or fellow staff.. EVERYTHING IS A BUSINESS MODEL,including Medicine. All the platitudes is all bullshit.
    I do what I do as a Primary Care,ER,Family Practice PA-C because I care about it. It is My job,Chosen Profession. I do it because I love what I do every day. Every day as a PA-C I go in Harms way,flu,TB, tropical diseases,Malaria, Hansens disease/leprosy, Strep, staph infections. Corona virus is just an add on to what is already out there.Routine part of my life/job. I do my Job for ME. It pays well,sometimes the hours Suck but I love it.
    Along the way I have seen saviors and Killers. crooks and a few good guys. I do this because I want to and I am fairly decent at it. I am always learning,sometimes I have the privilege of helping one person at a time get thru some nasty crap. I am Honored I could help. Cause I do this FOR ME. I get as much as I give. It has been my honor and privilege to be of service. Can you say the same? Feel abused? Stop complaining and go do your job,stop your abuser,come up with a better way. All you brilliant MD’s and DO’s.. Quit whining and get cracking. Your life,Your profession. Make it Better,not just for You, but for those you SERVE???? Oh forgot about them? Yeah I thought so.

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  6. Benjamin Van Raalte
    April 8, 2020 at 12:39 pm

    Private-equity investors have increasingly acquired doctors’ practices in recent years, according to a study published in February in JAMA.. This means the senior partner MDs took the money and ran. So we only have ourselves to blame. The doctors that sold the practice and cashed out, and the younger doctors that didnt thumb their noses at places that only hired them. These are usually the desirable areas, that the younger doctors had to live rather than go elsewhere. Once the companies got critical mass, then they kept going as they had the majority of jobs. But this would not have happened without senior doctors that cashed in, and junior doctors who were insistent on living in a big city.

    • Kay Victor Adamczak
      April 8, 2020 at 5:39 pm

      Brought to you by the self-same people who have replaced qualified PHYSICIANS with lesser qualified NP’s and PA’s all in the name of the almighty dollar!
      That patients are in jeopardy is of little consequence!
      Continue to allow the various State Legislatures to be lobbied by the AAPA and the AANP for independent practice without a peep from the AMA and other medical societies and you’ll be abused even more.

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