No. of Recommendations: 6
Manlobbi had mentioned this board as a refuge for posts of possible general interest that didn't seem to fit anywhere else, i.e. a land of Off Topic Posts
In that spirit: a little over a year ago, my sister wondered why there was such a physician turnover at her clinic. Looking for something else this morning, I found my response:
A few things
One: when corp medicine is in charge of physician recruiting, pay, benefits: on a human level it's usually someone in the junior VP level who calls the shots. His motivation is moving up the corporate ladder, or a diagonal transfer (over, and up one level) to another health care firm. To that person, medical providers are fungible: a board certified ER doc is the same as another board certified ER doc.
Patient care? That's solely up to the docs. The law says so. His hands are tied. Now, if that's all, I have another meeting..
If ER doc Jones voices objections to...anything, it's just easiest to tell Jones his services are no longer necessary, and to clear out his desk to make room for ER doc Smith
Conversely, when docs own(ed) and ran the practices, they had a high interest in collegiality, retention, keeping partners happy. You know, a smoothly oiled, professional machine with mutual respect and the shared goal of optimal patient care
Consider other ripple effects. Here's a flash bulletin: once you look up from the goddamed spreadsheet, MD specialists are not fungible. Real life (hypothetical, ahem) example: you think it's in Jane Doe's best interest to go to a craniotomy, but it's admittedly a judgment call. You call the local nsgy practice and say, this is doctor givesashit. Who's on call for new consults? When the receptionist/whoever says, today it's Dr Hatesoperatingoncancerpatients, you say: thanks, calling for a friend, I'll check back tomorrow when Dr Iseeyourpointletsdothis is on call. But if the neurosurgeon is some newby...you don't know to do that. And when the neurologist AND pathologist AND the radiologist AND the horses they all rode in on are people you've spoken with 0-3 times...Dr Givesashit is sorely tempted to look around to see if he can't find a medical Galt's Gulch somewhere, anywhere (you're a 1960s librul, so I don't have to hyperlink)
And, when your esteemed colleague - a brilliant, plainspoken, committed doc who advocates for her patients is...gone suddenly, then you can: a) also go somewhere else b) say kcfu it, I'll just do my job and what happens happens. After a period of shaking the gold out of the pan, don't complain because what you have is suddenly all sand.
I've known of more than one doc who has thrown up his hands at trying to make things better, and is running out the thread.
Next: Mr MBA Spreadsheet goes to attract a new doc whose market value is X, in exchange for Y hours of work seeing Z number of patients. He offers 1.3X year, guaranteed, for three years while Dr Newby "builds her practice" (insert eyeroll here. Dr N will be assuming the chaff and/or the still-warm chair of someone who threw up their hands and quit). After three years, you're paid on production, of course, Dr N. How much is that? Well, typically about X. Subject to shipping, handling, delivery fees of course.
Four years later:
Dr N is earning X (less 23% in mumblemumble, or 0.77X), is seeing Z patients, and is spending 1.4Y hours in doing it due to all the new requirements developed by people who don't have clinics. She is told that to earn X she'll have to see 1.3Z patients (and of course work 1.7Y hours...call it 78.5 hours/week, or more when Dr ThatsitIquit stands up one day and stalks out).
She is on her sixth MA since starting, there is no longer any RN in the building, and the schedulers mispronounce her first name. Which is not how she is to be referred to in front of the patients. And the exam table in room 4 is still broken
She has already been flagged as prolly need to replace as she's asked re her income. So one complaint about anything in 2) and...you get the idea.
I could go on. BTW: You're fungible too.
-- sutton
(Perhaps a Land of Off Topic Rants?)
