Hospital Administrators Are Not Always Honest

Guest post by John Di Saia, MD

Hospital administrators have an agenda that's not always aligned with yours.

I used to do emergency work at a hospital in a large chain. It was hardy profitable and became less so over time. When I moved an hour away I sought to limit my emergency exposure for obvious reasons. The hospital administration cited sections of the Bylaws and Rules and Regulations that mandated that surgical specialists take call. This was specified for Plastic Surgery and Orthopedics.

Later and entirely by accident, I found out that the Orthopedists were being paid to take this emergency call by the same administration that was citing those hospital documents. Essentially they were being paid to take call from 15 minutes away whereas I was required to take call for free from four times the distance. Needless to say I dropped that hospital after briefly entertaining legal action. So soon after my divorce I hardly wanted to enrich another attorney. They are much smarter about getting paid than physicians are. I did inform a contact at the local newspaper who passed on the story stating that the public doesn't really care if a doctor gets screwed over. I found that a bit amusing.

As the story evolved I extended my practice up the street not so far away and something similar almost happened again. This time the administration in my new acute care hospital sought to get into an arrangement with me to take call. They were very quick to stipulate that this arrangement was to be secret. It was to involve some kind of payment from the hospital. The thought left a bad taste in my mouth. Emergency call is a loser. I just stopped taking it.

The moral of this story is that you should not expect hospital administrators to be honorable people. Entering into any kind of business arrangement with them especially a secret one is liable to be unfair, unjust or just plain illegal. You might want to avoid that.

About: John DiSaia MD is a plastic surgeon and blogger who also writes at Medical Spa MD.

Physicians In Transition: Learning To Bounce Back

Overcoming setbacks to succeed in your career and in life

If we’ve learned anything from history, it’s that nobody goes through life unscathed—no matter how rich, how smart, how talented, or how fortunate they may be.  One way or another, we can all relate to the raw emotion that strikes people when they are knocked down. 

Perhaps you’ve been fired.  Or you’ve been side-stepped for the promotion you wanted.  Maybe you reached for a golden opportunity—and did not get the nod.  Perhaps you’ve finally made it to the top—don’t like what you see—and you want out.    

These sorts of things may be setbacks—but they are only permanent if you allow them to be.  We can let the negative overcome us—and those around us—or we can plot a course to “bounce back” to make a life transition.  

First, know that you are not the first, worst, or only.  Others have been where you are, and they’re doing just fine now.  But it took some time and effort.

Tips and Action Steps

Evaluate, come to grips with what has happened
Acknowledge the event, but don’t be limited by it.  Learn from experience.  Let your emotions run their course, and then focus on starting to bounce back with a positive attitude.  Take stock of what has happened, and be prepared to attack your transition

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Non Clinical Revenue Generation

Guest post by Jordan Grumet MD

Although I mostly expound on the trials and tribulations of practicing medicine, for a guest post, I decided to write about being a small businessman. 

Running a successful private practice can be both difficult and time consuming.  With the recent passage of health care reform, many physicians fear the security of their current income streams.  As primary care doctors, we face the ultimate catch twenty two.  The better job we do, the less outpatient visits and hospitalizations are necessary, the less money that flows through our doors.  Talk about perverse incentives!  Many have thrown their hands up in the air and joined the local hospital or medical group.  For some of us though, the loss of personal freedom is a major concern.  

So what is the burgeoning physician/entrepreneur to do?  How do we continue to be captain of a ship that faces a tsunami of change?  For me, the simple answer lies in maximizing non clinical revenue generation.  

Over the years, I have established myself as a medical expert, nursing home director, and writer.  Each of these activities provides consulting fees that are more lucrative than patient visits, require little or no overhead, and develop new personal goals and interests.By diversifying my skill set, I have created a more stable and enjoyable practice environment.  Furthermore, my time spent in the clinic is more concentrated and busier than ever.  I no longer need to try to actively recruit new patients.

There are many different nonclinical revenue streams available to physicians.  Besides those mentioned above, there are opportunities with pharma, chart review, and biotech to name a few.  Either way, I no longer worry about the traffic through my exam room door.  Most importantly, I am able to practice parsimonious, appropriate care and still bring home a salary that I'm proud of.  

And I learn something new each day.

About: Jordan is an Internal Medicine physician practicing in Highland Park, Illinois. He blogs at In My Humble Opinion.

Effects Of Changes In The Medicare Physician Fee System

Guest post by John Di Saia MD

Relatively newly practicing physicians may not know that the Medicare physician payment system changed pretty substantially in the early nineties. This was by design.

The perception of those who designed this new system was that certain services were overpaid and others underpaid. It likely had much more to do with ratcheting down the costs of health care. As physician fees constitute only 10-20% of the entire equation, the wisdom of concentrating on physician’s fees to change the system is perhaps questionable. This is what was done nevertheless.

A cornerstone philosophy of the new system was that procedure-based specialties were overpaid. The physician fee system prior to this was based on usual and customary fees. This newer one based payments on a model that paid for a service at a uniform rate regardless of who performed it. While this seems fair on the surface, it had predictable effects.

Why would a surgeon with much higher overhead remove a lump in a patient if the new payment system put the procedure in a revenue negative position? The practice of surgeons removing certain lumps gave way to family practice and dermatology physicians removing many of them. These were the only specialties that under the newer system could turn a profit doing so.

The Medicare fee schedule economically regulates procedures in medicine. It also indirectly fed the growth of cosmetic medicine and surgery as this was the escape hatch many practitioners sought as the Medicare boom feel upon us. Surgeons interested in turning a profit quickly figured on what paid adequately and more importantly on what did not. As my grandfather told me as a young child, everyone needs to make a living. It is perhaps unfortunate that doctors do not discuss these matters with patients when telling them why they cannot offer a service. Is it really ever wrong to tell your patients the truth?

About: John Di Saia MD is a board-certified Plastic Surgeon and formerly (he didn't re-certify) a board certified General Surgeon as well. He also serves on the California Medical Board's Expert Reviewer Program reviewing cases of proposed negligence in the field. He blogs at CosmeticSurgeryTruth.com and is a Contributing Author to Medical Spa MD.

ExpedMed 2012 Brochure Available Now

Our 2012 ExpedMed brochure is now available.

If you're interested in learning more about the exciting CME activities offered by ExpedMed in the coming months, clink Here to download a pdf version of the brochure.

ExpedMed is a leading Expedition Medicine and Wilderness Medicine CME company.  In addition to the annual ExpedMed washington, DC conference, ExpedMed leads CME adventure trips to some of the most unique and remote places on earth.  

Average 2011 Physician Income By Specialty

Average physician incomes by specialties for 2011

ZDoggMD Les Misérables

Lovers of medical musicals rejoice! We're finally turning our talents to music outside of rap.

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