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The Moral Crisis of Americas Doctors.The corporatization of health care.
1.[u] “The Moral Crisis of Americas Doctors.[/u] [size=”2″]The corporatization of health care has changed the practice of medicine, causing many physicians to feel alienated from their work.” [/size]
nytimes.com
Great article NYT magazine section, google it. So accurate and well reported.
2. I went to a dermatologist recently; which has been bought out by a PE group. What a sweat shop since the sale. Tons of extenders with the dermatologist running around. Medical care seemed OK, but 30 years of that for a young dermatologist? I thought Derm was a cushy deal, no more I guess. Took a nice OP practice and made it an “efficient” turd.
3. Recently caught up with an old friend from college. He owns his own PE firm. Wealthy beyond imagination. Part of his portfolio are numerous dental practices. He truly is perplexed why so many medical/dental practice sell out, but was willing to make money off their backs.
4. Recently caught up with an old radiologist friend, also in PP. We are both preretirement discussing volumes; 30 years of this?
Medicine overall seems bleak. We are forgoing control of our practices to others who treat us like assembly line workers.
In many ways I have seen the enemy, and it is us.
The beatings will continue until moral improves… 30 years of this?
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60 Replies
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I think that era is over. PE got so much easy cash thanks to Fed ZIRP policy. JPowell aint dropping rates anytime soon.
Watch age of easy money Frontline episode.
PE in medicine will likely survive but in a very wounded form.
Hospitals and Insurance companies are a bigger threat than PE now. Look at Optum. United health is half a trillion dollar company wtf.
My daughter wants to go to medical school and I told her to go for it but to a cushy specialty and dont worry about the money aspect too much.
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PE def does not help but this all started with managed care/consolidation of commercial payers (think there are like 5 major ones that cover majority of US directly/indirectly), and CMS budget neutrality (eg. death by a thousand cuts). Remove PE and these forces are still decimating medicine. Despite some action/chatter from our advocacy groups/AMA, I do not see CMS fundamentally changing, and clearly commercial payers have infinite more power than physicians, so race to the bottom. One glimmer of hope is hospital subsidization but HC system/hospital administrators are usually the last to realize this so who knows.
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You did not link the articles:
[link=https://www.nytimes.com/2023/06/15/magazine/doctors-moral-crises.html?unlocked_article_code=nSNz5ymvATbQ3Z8Lh1L1hunOc22Sc6mBvQ9WZHc9eHhk58-icO04S9-HUrtIYfB5ZnNrXGbfWs-OKwL7cYCV54h5Mebek8a5x-PtdqUz8cyVAkXo8eAx6fe3AuwUk08FJq4AfNee0R0wPk4fxHDT-bricXjRzJMItFOTAtq2zRJvYvg7mvGpquHbFNdl3Xs9H4YsusdTsHUzuPrz9-QxIDWvnl2frRC1nath4mzFHyT4VzNNeV4zYeAOtFjCaPiQBEXCSjZKvnZ9LcFbMPxJ9OAGVZRbrq6ACDXQ4kZdGJEuMSyKhtKKDqyZFDSLZxoIK3XIvsv24o8W9YltuW8&smid=url-share]https://www.nytimes.com/2…uW8&smid=url-share[/link]
and:
[link=https://www.statnews.com/2018/07/26/physicians-not-burning-out-they-are-suffering-moral-injury/]https://www.statnews.com/2018/07/26/physicians-not-burning-out-they-are-suffering-moral-injury/[/link]-
Republicans getting their way
And just you wait because whats coming next is science going out the window so these idiot home- schooling conspiracy types and anti vaxxers can create more Hydroxychloroquine and ivermectins so we can base our care on our political beliefs
Look at this board if some of these arseholes had their way thats where we would be
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The patients are suffering and the doctors care enough to be depressed, overwhelmed and leaving traditional practice. Who would have thought that?
I guess we need to spend more non physicians to come on here and bash the “rich” doctors for causing this mess.-
How many radiology physicians are actually on these forums?
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Good question. No idea. I do know that the non physicians like to point out how we make too much money, as if that’s the cause of out of control health care costs.
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The answer to “making too much money” is “it depends,” on your specialty for example. Family physicians and pediatricians for example are hardly making healthcare unaffordable for patients. However, if you’re not arguing defensively, it’s much more than that considering that hospital CEO’s are often mentioned as making millions of $, how providers, like hospitals & hospital systems can charge insane non-standard prices for common procedures, how investors push for ever more profits.
The point of the articles is about PE’s and investors pushing costs and profits putting many doctors on a treadmill to see as many patients possible in a short time defined as “efficiency.” Healthcare is not often about “efficiency” and green shades, it’s about patient care.
Read the articles!-
A short podcast on the issue of “Moral Crisis of America’s Doctors,”
[link=https://www.wnycstudios.org/podcasts/bl/segments/moral-crisis-doctors-working-americas-corporatized-health-care]https://www.wnycstudios.org/podcasts/bl/segments/moral-crisis-doctors-working-americas-corporatized-health-care[/link]-
When you have physicians like Scott atlas the crazy Nigerians, Americas frontline doctors etc what do you think will happen to public perception
Its no wonder there is a moral crisis
We have met the enemy and it is us
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Damn evil republicans
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It is a nice article, and I think the term moral crisis well describes what doctors and other healthcare workers are dealing with.
That being said I dont think the general public cares. PE will continue to decimate medicine to line its pockets and throw enough chump change at politicians to let them continue. There was another good article about PE I read recently that describes it as heads I win, tails you lose. In other words while PE ventures may fail in every way, those who are at the top of the PE world always win financially and never get punished.
The only way PE leaves Medicine is once there is no more blood to extract from the stone. And honestly at that point I really dont think there will be much left to salvage.
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In order to get PE out or at least greatly reduced in ability to make profits, the industry, healthcare, will require a bit more in regulations for the benefit of patients.
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Or complete socialized medical system.
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Yes Frumi. I read the articles. You have no idea what the point is because you are not a doctor. My only point is; it is not the doctors fault costs are so high. Never was. They are the solution. Doctors making more is the solution.
Yes, PE needs to go and on that front regulations would help. However, we only have ourselves to blame for selling out.
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Quote from Thread Enhancer
Yes Frumi. I read the articles. [b]You have no idea what the point is because you are not a doctor. [/b]My only point is; it is not the doctors fault costs are so high. Never was. They are the solution. Doctors making more is the solution.
Yes, PE needs to go and on that front regulations would help. However, we only have ourselves to blame for selling out.
Is this true? If so what is Frumi’s connection to our field? -
Quote from jd4540
Quote from Thread Enhancer
Yes Frumi. I read the articles. [b]You have no idea what the point is because you are not a doctor. [/b]My only point is; it is not the doctors fault costs are so high. Never was. They are the solution. Doctors making more is the solution.
Yes, PE needs to go and on that front regulations would help. However, we only have ourselves to blame for selling out.
Is this true? If so what is Frumi’s connection to our field?
Yes it is true. I have no idea why he chose to come on here and taunt radiologists with his outsider’s opinion. It’s especially troubling when all he has are straw man arguments. I have not seen one person, even his Dem teammates come to his side on the actual substance of his arguments. They do love to get behind him to bash the right wing nut jobs though. -
Quote from Thread Enhancer
Quote from jd4540
Quote from Thread Enhancer
Yes Frumi. I read the articles. [b]You have no idea what the point is because you are not a doctor. [/b]My only point is; it is not the doctors fault costs are so high. Never was. They are the solution. Doctors making more is the solution.
Yes, PE needs to go and on that front regulations would help. However, we only have ourselves to blame for selling out.
Is this true? If so what is Frumi’s connection to our field?
Yes it is true. I have no idea why he chose to come on here and taunt radiologists with his outsider’s opinion. It’s especially troubling when all he has are straw man arguments. I have not seen one person, even his Dem teammates come to his side on the actual substance of his arguments. They do love to get behind him to bash the right wing nut jobs though.
I find this really surprising and on a certain level feel duped, particularly given the many posts regarding CMS/HC policies in the US. The assumption here (unless clearly stated like Dicom or Corbett) is that you are a physician and a radiologist. An outsider is entitled to their opinion on HC but personally I simply view them differently. They have no clue what we all went through with respect to education/training and have no clue of the day-to-day grind and challenges that we face as rads. -
Hes been at it a lot longer than us. I imagine he was transparent at one point but those days are long gone.
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Quote from Thread Enhancer
Hes been at it a lot longer than us. I imagine he was transparent at one point but those days are long gone.
To each their own but pretty perplexing. -
“There’s two specialties in particular which I think going forward we don’t need as many as we have. Top of my hit list, and they hate it when I say it- radiologists, it’s electronic guys, it’s up in the ether guys, we are going to have a spot market in 2030. You’re just going to put it out there and people who are pre-certified are going to read it and the price for radiology is going to go through the floor. So that’s one area I don’t think we need so many.” Ezekiel Emanuel
Literally none of this even makes sense. The fact that radiology is now digital does not make it more simple- if anything more complex. Commodifying the field is now being attempted by PE but not to improve healthcare delivery- to enrich a small segment of wealthy investors. Subjecting healthcare delivery to more “market forces” isn’t going to improve healthcare delivery, it will just enrich a small segment of wealthy investors.
I wonder if this individual has much practice experience. He went to Exeter and Harvard, IM at Beth Israel and oncology at Dana Farber. I expect more with this kind of pedigree.
CV-
[link=http://www.tsim.org.tw/article/A95/abstract/12-morning/Rm102/CV_Ezekiel-J.Emanuel.pdf]http://www.tsim.org.tw/ar…_Ezekiel-J.Emanuel.pdf[/link] -
When did the term “moral crisis” become popularized. It is one of the dumber things IMO to say that doctors aren’t happy because of “moral injury”. If a doctor isn’t happy it is because they are either overworked, underpaid, or both. To dress it up in fancy language to try and take the moral highground is silly.
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Radiology is a job. Those who think its more are setting themselves up for disappointment. Administrators and other suits will abuse those who think its more than a job.
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Guess no one wants to mention the crazy rise in healthcare administrators, pointless metrics, and the total take over of our institutions by big Pharma?
Chiro is over there bashing cheap drugs while praising big pharma vaccines/mandates based on lies and extolling the virtues of socialism. You are on, what, your 6th booster now? -
Wtf are you babbling about you stupid Fck
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Please don’t assault me in the Denny’s parking lot Chiro, I have people that depend on me.
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“okay uh and we could go on and on, Kaiser has rolled out tele dermatology right. You go to the dermatologist, they look at you, and they say, yeah, cortisone cream. No matter what it is cortisone cream right? so you can take a picture of it send it to the dermatologist and say cortisone cream uh increased productivity 50% among dermatologists.
We could go down the list there are lots and lots of places where we’re going to be much more efficient. There is the fact that lots of what we do as doctors doesn’t require an md the four years of medical school the three years of training any subspecialty training that we have
That what’s called task shifting shifting, the provision of care to people who are sometimes better capable than we are of doing things and letting them work to their highest level of licensure. -That’s happening everywhere.” -ZekeDoesn’t like Derms either
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Quote from drad123
“okay uh and we could go on and on, Kaiser has rolled out tele dermatology right. You go to the dermatologist, they look at you, and they say, yeah, cortisone cream. No matter what it is cortisone cream right? so you can take a picture of it send it to the dermatologist and say cortisone cream uh increased productivity 50% among dermatologists.
We could go down the list there are lots and lots of places where we’re going to be much more efficient. There is the fact that lots of what we do as doctors doesn’t require an md the four years of medical school the three years of training any subspecialty training that we have
That what’s called task shifting shifting, the provision of care to people who are sometimes better capable than we are of doing things and letting them work to their highest level of licensure. -That’s happening everywhere.” -ZekeDoesn’t like Derms either
The five laws of dermatology:
[ol][*]If it’s wet, dry it. [*]If it’s dry, wet it. [*]If neither of those work, use steroids. [*]If you know what it is, don’t touch it. [*]If you don’t know what it is, FOR GOD’S SAKE DON’T TOUCH IT! [/ol] -
Ezekeil is a weird dude.
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Good thing is he is irrelevant basically.
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Quote from jd4540
Quote from Thread Enhancer
Quote from jd4540
Quote from Thread Enhancer
Yes Frumi. I read the articles. [b]You have no idea what the point is because you are not a doctor. [/b]My only point is; it is not the doctors fault costs are so high. Never was. They are the solution. Doctors making more is the solution.
Yes, PE needs to go and on that front regulations would help. However, we only have ourselves to blame for selling out.
Is this true? If so what is Frumi’s connection to our field?
Yes it is true. I have no idea why he chose to come on here and taunt radiologists with his outsider’s opinion. It’s especially troubling when all he has are straw man arguments. I have not seen one person, even his Dem teammates come to his side on the actual substance of his arguments. They do love to get behind him to bash the right wing nut jobs though.
I find this really surprising and on a certain level feel duped, particularly given the many posts regarding CMS/HC policies in the US. The assumption here (unless clearly stated like Dicom or Corbett) is that you are a physician and a radiologist. An outsider is entitled to their opinion on HC but personally I simply view them differently. They have no clue what we all went through with respect to education/training and have no clue of the day-to-day grind and challenges that we face as rads.
I have no idea what you 2 think you are arguing here.
The question is who is or are your champions in either party in Congress who agree CMS payments are too low for rads or any other specialty. That includes the meager reimbursements to primary care & pediatricians in this time of cutting spending. You need Congress to improve reimbursements, but who is arguing for increased payments? The argument is about how Medicare is running out of funding in 5 years now so increasing payments is not part of most arguments now. The results so far have been less of a reimbursement haircut than originally proposed, not increased spending for physician pay.
[link=https://www.washingtontimes.com/news/2023/jun/14/republicans-push-kevin-mccarthy-address-social-sec/]https://www.washingtontimes.com/news/2023/jun/14/republicans-push-kevin-mccarthy-address-social-sec/[/link]
[link=https://www.cbo.gov/topics/health-care]https://www.cbo.gov/topics/health-care[/link]Spending on federal health care programs is growing rapidly, driven by both rising enrollmentstemming from the aging of the population and expansions of federal programsand rising health care spending per enrollee. CBO prepares projections of federal health care spending under current law and analyzes proposals that would change federal health care policies.
[link=https://jamanetwork.com/journals/jama/fullarticle/2806637]https://jamanetwork.com/journals/jama/fullarticle/2806637[/link]
In the meantime PEs and their influence are where in your arguments? -
Quote from xraygiggles
Or complete socialized medical system.
That’s also the funny thing. At this point, a lot of docs would just take the guaranteed pay for much less work and stress, organize and say, “Give the patients what they want.” Haha, which means, worse care. But hey, the .gov can give you a card that says “free coverage” … right? -
Exactly
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Radiology can learn a lot from the success and struggles of PE in different areas of medicine.
We are expensive and highly skilled labor. Our power comes from leverage over the owners of capital. What leverage do we have? A shortage and strong job market. Also, a lack of “extenders” and other noctors in Radiology.
If Radiology continues to protect these things, by preventing flooding of the Rad market by labor, we should continue to do well and PE backed Rads will be around but not a big threat to take over the field.
Of course the big unknown here is AI and its impact on Rads. Right now, AI is nowhere near a threat to Rads however.
ER screwed because the field is being flooded by physician labor (HCA et al ER training programs) and noctors. Double whammy.
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Still think this dates back way before PE arrived on the scene. CMS cuts/managed care combo. Its likely in part why partners sold to PE, they became sick of never-ending cuts, BS administrative micromanaging etc and wanted a way out
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Maybe PE should of gave money to hospital admin or funded radiology residency programs instead of trying to buy off radiologists.
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Quote from drad123
Maybe PE should of gave money to hospital admin or funded radiology residency programs instead of trying to buy off radiologists.
Funding of residency programs has worked well with ER, they’ve over expanded and have flooded the field with physician ER docs and also routinely incorporate cheaper mid-level labor.
If medicine was relatively unchanged from its “golden age”, the trend of selling to PE would simply not make sense for PP groups
At times it seems these CMS cuts are simply a plan to fully gut PP and making all docs employees. -
Quote from jd4540
At times it seems these CMS cuts are simply a plan to fully gut PP and making all docs employees.
Occam’s Razor.
Radiologists aren’t the or a primary cause America has the most expensive system in the world but CMS is a primary cost to government for healthcare. It’s very visible to everyone and an easy target for those opposed to government participation as already being too expensive.
It’s about keeping expenses down.
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Keeping individual RVU values and conversion factors down does not decrease expenses. It increases them.
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The way to actually keep expenses down is listen to the radiologists who are consultants and can limit wasteful imaging.
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But thats too difficult so people that dont understand economics do it the Frumi way and continue the race to the bottom on individual reimbursement all the while promising no limits on use.
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The problem is that decisions are being made by too many people who are not physicians and are completely out of touch.
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Didn’t you read Ezekiel Emanuel’s article in JAMA?
The expenses are due to physician greed and lying.
OK, he didn’t say lying. He said physician’s “inaccuracies, distortions, and false statements”.
Why is that guy so obsessed with libeling and slandering doctors?
[link=https://jamanetwork.com/journals/jama/fullarticle/2806638]https://jamanetwork.com/j…ma/fullarticle/2806638[/link] -
Emanuel’s article aside, legislating for more CMS reimbursement for physicians is not exactly a winning political issue, period.Family health and pediatricians can’t even gen an improvement in reimbursement, why would radiologists & other specialists get ahead of the line? Political reality, consider how the ACA was portrayed for a decade now by 1 party. Who is going to stick their neck out arguing physicians need more $ considering the expense of American healthcare overall being the most expensive in the world? You think politicians much less layperson understand the issues? More Socialism for physicians to earn more $?
Nah. Not in this political climate where discussing healthcare costs reality will get you marked a fool or a Socialist. -
Sounds like he is suggesting replacing one broken system with another…
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Again
We have met the enemy
And it is us
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Emanuel must be a republican
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On the up side, Zeke is going to kill himself in a few years
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Quote from dergon
On the up side, Zeke is going to kill himself in a few years
This is funniest in that, when he doesn’t, he becomes the spit and image of all of you guys – mandates for others, not for you. No integrity. No principle. Just power trips.
And for that, I thank him. The sad truth is that the other people are so deceived, bought off, or so stupid (or all of the above) that they can’t even recognize this and eschew leftism in general. -
Quote from Frumious
Emanuel’s article aside, legislating for more CMS reimbursement for physicians is not exactly a winning political issue, period.Family health and pediatricians can’t even gen an improvement in reimbursement, why would radiologists & other specialists get ahead of the line? Political reality, consider how the ACA was portrayed for a decade now by 1 party. Who is going to stick their neck out arguing physicians need more $ considering the expense of American healthcare overall being the most expensive in the world? You think politicians much less layperson understand the issues? More Socialism for physicians to earn more $?
Nah. Not in this political climate where discussing healthcare costs reality will get you marked a fool or a Socialist.
Its not more CMS reimbursement that is necessary. There has been plenty of that since it was first implemented. It merely needs to be allocated better. The knee jerk reaction of cutting the price per click has been a disaster. -
Quote from Thread Enhancer
Quote from Frumious
Emanuel’s article aside, legislating for more CMS reimbursement for physicians is not exactly a winning political issue, period.Family health and pediatricians can’t even gen an improvement in reimbursement, why would radiologists & other specialists get ahead of the line? Political reality, consider how the ACA was portrayed for a decade now by 1 party. Who is going to stick their neck out arguing physicians need more $ considering the expense of American healthcare overall being the most expensive in the world? You think politicians much less layperson understand the issues? More Socialism for physicians to earn more $?
Nah. Not in this political climate where discussing healthcare costs reality will get you marked a fool or a Socialist.
Its not more CMS reimbursement that is necessary. There has been plenty of that since it was first implemented. It merely needs to be allocated better. The knee jerk reaction of cutting the price per click has been a disaster.
The zero sums game + lack of adjustment for inflation (which hospitals receive annually) is simply no longer working. When you take inflation into account, our reimbursement is down around 50% from 2000. Thats not reasonable or sustainable…There is a physician shortage with a large % currently working that are beyond retirement age (according to Dan for radiology its was around 25%?). Burn-out, which increased volumes/RVU demands contributes to, is a real phenomenon. Everything from medical education to the cost of medical malpractice has increased yet we are supposed to be ok with the downward spiral of reimbursement. It’s ok for techs, RNs/PAs and other HC workers to get raises yet physicians are not allowed to unless they kill themselves with increased volume. There is a breaking point and I think we are just about there. -
Quote from Frumious
Emanuel’s article aside, legislating for more CMS reimbursement for physicians is not exactly a winning political issue, period.Family health and pediatricians can’t even gen an improvement in reimbursement, why would radiologists & other specialists get ahead of the line? Political reality, consider how the ACA was portrayed for a decade now by 1 party. Who is going to stick their neck out arguing physicians need more $ considering the expense of American healthcare overall being the most expensive in the world? You think politicians much less layperson understand the issues? More Socialism for physicians to earn more $?
Nah. Not in this political climate where discussing healthcare costs reality will get you marked a fool or a Socialist.
I suppose the AMA has stuck out their neck already. Last year they launched a recovery plan for Americas physicians which includes CMS payment reform (for all physicians, not just specialists). I’ve received/sent out numerous call to action emails from them regarding this issue. -
Quote from sandeep panga
Didn’t you read Ezekiel Emanuel’s article in JAMA?
The expenses are due to physician greed and lying.
OK, he didn’t say lying. He said physician’s “inaccuracies, distortions, and false statements”.
Why is that guy so obsessed with libeling and slandering doctors?
[link=https://jamanetwork.com/journals/jama/fullarticle/2806638]https://jamanetwork.com/j…ma/fullarticle/2806638[/link]
That guy is such a freakin clown…he really despises rads and anesthesia if I recall correctly… -
Didnt he also say radiologists would be replaced by AI in a relatively short period
Do I remember that correctly?
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Quote from Chirorad84
Didnt he also say radiologists would be replaced by AI in a relatively short period
Do I remember that correctly?
There’s some footage from 2014 where he states that “top of his hit list” are rads and anesthesia for decreasing training spots. “Its up in the ethers” or something like that when refer to rads. Supposing he referring to AI when he mentions this and the year 2030. Skip to 30:45
[link=https://www.youtube.com/watch?v=-McgKf_CrrI]https://www.youtube.com/watch?v=-McgKf_CrrI[/link]
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Frumi is probably med school or rads dropout and lives on a commune where they have a team of wokesters who scrape all the liberal news sites to spam this forum with nonsense
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Like they say, you can’t fix stupid.
He’s the type Solzhenitsyn met in the gulags that couldn’t believe the esteemed leader had sent him there after all those years of “service.”
Sad stuff. -
Quote from xraygiggles
Damn evil republicans
The guy is just a brainless repeater of things. Zero thought, which of course is how you become a marxist in the first place. -
The return of Private practice is the solution. Decentralization of healthcare is the solution. Price transparency and real price info is the solution. patient centered care is the solution. Decoupling insurance from employment is the solution. Physician lead care is the solution. Breakup of hospital monopolies and insurance monopolies is the solution.
All the things that will never happen because too many depend on the grift.
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