Final senate bill to lower compensation by 40% - all hands on deck - please call your Senators/Reps

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nimbus said:
Both CMG’s and insurance companies claiming victimhood.:rofl:



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Congress is debating multiple proposals that would protect patients from surprise medical bills. But the physician staffing industry is pushing back.
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Funny thing is United Health Care makes more profit ($12B) than Blackstone (TH owner) and KKR (Envision owner) make in REVENUE per year. United Health makes more Revenue than every emergency physician group combined. Overall, health insurers make more money ($750B) than all doctors combined ($700B).

If this bill passes, it will gift $25 B to insurers, and guess what, we'll be paying for it. So...play nice with all EM groups, b/c if this passes, we'll all be working for hospitals or CMG's in 10 yrs
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sum dude said:
Here's the breakdown (simplified numbers, but pretty close to average numbers):
25% your patients pay nothing
25% pay Medicaid, which for a level 5 reimbursement is like $80
25% pay Medicare, which for a level 5 is $170
25% are commercial payers.

Where do you guys think we get paid those wonderful numbers people like to boast on this very forum? In the US, EMTALA is funded by commercial payors. Insurances decided they've had enough, now want to remove that. They want to pay us at Median In-Network rates, which basically means you'll have to take whatever the rate falls to after 10 years. Congress CBO predicts that to save $20-25 Billion.

So to recap, 75% of patients you see reimburse less than your hourly, and Congress wants to cut your pay (and all PEAR--path, em, anesthesia, radiology) by $20-25Billion next 10 years.

This is a pretty big F&$ing deal. Doctors need to learn about how they make their wages and learn to defend them or their going to be taken to the cleaners over the next 10 years.
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Yeah, but I also can't help but think that we wouldn't be in this state if we didn't have 8 administrators to 1 physician.
I don't have any hard numbers or sources, but I don't think anywhere else in the world has this burden of parasites.
 
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I sent the email and got a response from my state’s senator. Got the generic “thanks, but it’s unacceptable so many patients have had to deal with this instead of focusing on basic human health care”. Essentially, “I don’t give a f*** if you don’t like what’s happening”
 
namethatsmell said:
I have to maintain some anonymity. But it's 9-5, no nights, no weekends, no holidays. I have time off to eat lunch, am never rushed to complete a task, almost always get out on time, and never take work home with me.

There are too many possibilities to list, but you'll find many options discussed if you search on this forum and on the EM docs and Physician Nonclinical Career (and other similar groups) on Facebook.
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Boo bad answer. I think you can be more specific and maintain your anonymity (which I respect)
 
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thegenius said:
Boo bad answer. I think you can be more specific and maintain your anonymity (which I respect)
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I always just assume that the people who post that they’ve found their unicorn non-EM side gig but won’t say what it is are doing something either frankly unethical or somewhat embarrassing like shady cosmetic practices involving lasers or Botox, prescribing amphetamine derivatives for weight loss, concierge practice that involves an unsurprising amount of treating chronic pain and anxiety in the worried wealthy or something along those lines. Would be happy to learn that I’m wrong.
 
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The public support of this type of bill is too high. I would be shocked if this isn’t pushed through sooner or later.

Same goes for hospital price transparency.
At the end of the day, the public simply doesn’t have any sympathy for “greedy doctors.“
 
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They'll give a **** after the fact when the hospitals they depend on close.
bronx43 said:
The public support of this type of bill is too high. I would be shocked if this isn’t pushed through sooner or later.

Same goes for hospital price transparency.
At the end of the day, the public simply doesn’t have any sympathy for “greedy doctors.“
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TooMuchResearch said:
They'll give a **** after the fact when the hospitals they depend on close.
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Once hospitals go down en masse, the federal government will sweep in and acquire them/fund them enough to stay open. And so goes the slide into socialized healthcare.
 
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If this passes then physician's need to quit but that won't happen Ive been calling but calls are <<<money
 
bronx43 said:
The public support of this type of bill is too high. I would be shocked if this isn’t pushed through sooner or later.

Same goes for hospital price transparency.
At the end of the day, the public simply doesn’t have any sympathy for “greedy doctors.“
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Something will pass, but what passes is huge. If it's benchmarking, we're screwed. If it's IDR, nothing much changes.
 
thegenius said:
Boo bad answer. I think you can be more specific and maintain your anonymity (which I respect)
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DrDrummer said:
I always just assume that the people who post that they’ve found their unicorn non-EM side gig but won’t say what it is are doing something either frankly unethical or somewhat embarrassing like shady cosmetic practices involving lasers or Botox, prescribing amphetamine derivatives for weight loss, concierge practice that involves an unsurprising amount of treating chronic pain and anxiety in the worried wealthy or something along those lines. Would be happy to learn that I’m wrong.
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C'mon, certainly you two can lay on better peer pressure than this.

And regarding the bolded statement: I always just assume that people who make snide, tacit, backhanded attempts to smear and shame others in order to get what they want may have limited social intelligence and potentially borderline personalities. Would be happy to learn that I'm wrong. While I'm a bit disappointed in myself for dignifying your comment with a response...for the sake of decorum I'll add that what I'm doing couldn't be further from what you describe.

What I'm doing outside the ED is nothing special in the sense that anybody capable of becoming an EM doc can do it...or the laundry list of other options. The hardest steps are doing some soul searching for what kind of work makes you happy, trusting yourself, and then going for it. My only intention of posting on this is to let people who feel trapped in the ED know that they are not trapped unless they let themselves be trapped.

So, on that note, I give up. One of the two pics below shows the job I have:


Screen Shot 2019-12-12 at 4.13.19 PM.png
Screen Shot 2019-12-12 at 4.12.01 PM.png
 
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Before we get TOO off the rails...it looks like House Ways and Means has countered with a bill putting arbitration for all bills back on the table: Ways and Means Committee announces rival surprise medical billing fix

Intercameral squabbling is good for us. The insurance companies and the Senators they've purchased are eager to ram this thing through, any delay gives time for the greater public to become aware of just how many hospitals this thing could close.
 
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namethatsmell said:
Sadly, this represents one of the best hopes for our field if conditions get worse. A mass exodus of well-trained EM docs, and the resulting fallout, is one of the few things that will get everybody's attention.
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good luck. It’s hard enough getting 10 docs in a single group to agree on anything. Imagine getting every ED doc to cooperate and leave the specialty!

there are almost double the amount of residents in training in some states as there were 3 years ago (looking at you florida). These extra docs will happily take those spots to pay off their hundreds of thousands in student loans.

organization is tough
 
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How did we lose sooooo much self control over our own livelihoods... it’s embarrassing that for as intelligent as we like to think of ourselves... we are also the biggest idiots I’ve ever encountered!!! When people are indoctrinated in college and then go to Med school and are taught that physicians should be indentured servants and that there is no finance or business/dollars in medicine, we then let the lawyers and the midlevels and the politicians, and the corporations pick and pick and pick away out our livelihoods and dictate to us what we need to do!!!!.... something needs to happen and happen soon or medicine as we know it is going to be non existent at the turn of the next decade. (Rant over)
 
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We let them? When were we in control to begin with?


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HoosierdaddyO said:
How did we lose sooooo much self control over our own livelihoods... it’s embarrassing that for as intelligent as we like to think of ourselves... we are also the biggest idiots I’ve ever encountered!!! When people are indoctrinated in college and then go to Med school and are taught that physicians should be indentured servants and that there is no finance or business/dollars in medicine, we then let the lawyers and the midlevels and the politicians, and the corporations pick and pick and pick away out our livelihoods and dictate to us what we need to do!!!!.... something needs to happen and happen soon or medicine as we know it is going to be non existent at the turn of the next decade. (Rant over)
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To be fair, we still haven't screwed ourselves over as badly as lawyers, who in theory are the people who actually make all the rules to begin with.

I don't think this is unique to doctors, and I never particularly thought that I or most other doctors were that intelligent in the first place (for Nassim Taleb's definition of intelligence, which is basically just the ability to survive and sustainably prosper and is very different from the ability to do well on tests or imitate your teachers). What may be unique to us is that what is actually needed to provide good patient care, ie what most of us care about first, is very different than what is needed to make money. At the end of the day, my experience is that the suits do not really give a damn about patient care, so they have a lot more degrees of freedom than we do here.

I don't have any good solution to these problems. Ultimately, I think the best thing for most patients would be to learn enough about basic healthcare to stop coming to the ER so much for stupid stuff and also realize that they won't live forever and doctors are not magicians. That would take most of the money out of this bloated system, so the suits would lose interest and doctors would naturally take back control. Unfortunately, this would have the side effect that most ER docs would lose our jobs because if patients wised up, we wouldn't be able to see enough of them to survive, at least in multiple-coverage shops.

In short, money inevitably attracts sociopaths.
 
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HoosierdaddyO said:
How did we lose sooooo much self control over our own livelihoods... it’s embarrassing that for as intelligent as we like to think of ourselves... we are also the biggest idiots I’ve ever encountered!!! When people are indoctrinated in college and then go to Med school and are taught that physicians should be indentured servants and that there is no finance or business/dollars in medicine, we then let the lawyers and the midlevels and the politicians, and the corporations pick and pick and pick away out our livelihoods and dictate to us what we need to do!!!!.... something needs to happen and happen soon or medicine as we know it is going to be non existent at the turn of the next decade. (Rant over)
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Dude. This is a direct consequence of having a third payer system for decades. If people themselves paid for health care, like we do everything else in life: lawyers, electricians, real estate agents, prostitutes, astrophysicists, etc...we wouldn’t have all these insane regulations. There would be some, but not this many.

It makes complete sense to me - if i were the federal government or a major insurer, and we set aside 1.5T in money to pay health care costs...and every frickin year the true amount paid exceeds the budgeted amount....and every year it gets worse....of course I would put in laws and regulations to curb payments. Same thing for insurers.

There is no reason to click on 35 buttons per chart and document 10 ROS and do this and that other than to deny payments.

If people paid for their doctors...and only used insurance for catastrophic coverage (and BTW I don’t consider a traumatic ACL rupture or getting Lung cancer after decades of smoking an emergency) then all the quality would be built into the system itself and be, more or less, self governing and regulating.

The health care system we have now is utterly ridiculous and it will probably never change. Only minor changes will occur. That’s my prediction.
 
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thegenius said:
Dude. This is a direct consequence of having a third payer system for decades. If people themselves paid for health care, like we do everything else in life: lawyers, electricians, real estate agents, prostitutes, astrophysicists, etc...we wouldn’t have all these insane regulations. There would be some, but not this many.

It makes complete sense to me - if i were the federal government or a major insurer, and we set aside 1.5T in money to pay health care costs...and every frickin year the true amount paid exceeds the budgeted amount....and every year it gets worse....of course I would put in laws and regulations to curb payments. Same thing for insurers.

There is no reason to click on 35 buttons per chart and document 10 ROS and do this and that other than to deny payments.

If people paid for their doctors...and only used insurance for catastrophic coverage (and BTW I don’t consider a traumatic ACL rupture or getting Lung cancer after decades of smoking an emergency) then all the quality would be built into the system itself and be, more or less, self governing and regulating.

The health care system we have now is utterly ridiculous and it will probably never change. Only minor changes will occur. That’s my prediction.
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Agree that this would be a better system on average. Especially if combined with better baseline education about how to manage basic medical problems at home. Also agree it will never happen because of too many vested interests and too much money in the current system.

But any thoughts on how your system would handle, eg, sicklers and lupus-ers and other young and chronically ill people who couldn't afford the massive care needed to keep them healthy out of pocket? If you say "those people can be publicly funded", how does one decide who gets funded and avoid perpetuating regulatory capture and mission creep in that system?
 
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hundreddaysoff said:
Agree that this would be a better system on average. Especially if combined with better baseline education about how to manage basic medical problems at home. Also agree it will never happen because of too many vested interests and too much money in the current system.

But any thoughts on how your system would handle, eg, sicklers and lupus-ers and other young and chronically ill people who couldn't afford the massive care needed to keep them healthy out of pocket? If you say "those people can be publicly funded", how does one decide who gets funded and avoid perpetuating regulatory capture and mission creep in that system?
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I don't have a good answer for your very legitimate question / constructive criticism.

I mentioned above that we pay lawyers, accountants, engineers, prostitutues, etc. Why can't we do that for medicine?

One reason is that it is possible in life to never have the need to hire a lawyer, accountant, an engineer, or a prostitute. Or if you do - you might only need them once or twice. So if it costs you $3-5K to get any one of those, and you do it a few times in your life, well then you understand how expensive it is and modify your life as much as possible to try to avoid needing them. As a result you try live a lawful life, minimize your economic complexities to need an accountant, buy a reputable car and house to avoid needing a regular engineer, and finding a partner to wham-bam without having to pay him/her - perhaps in the form of marriage or just a partner with benefits.

However It is probably unlikely, if not impossible, to live your entire life without needing a doctor. You might be able to for the first 40-60 years, but people these days live to be 80 years old, the body slowly breaks down and organs slowly stop working. Unless you are willing to let nature take it's course, you will need help to keep yourself alive. So hey, if you are willing to die from an MI at 52 yrs, old, or not get treated and have severe heart failure and a miserable life for the next 3-4 years, and willing to sit at home hypoxic and in respiratory distress and feeling like you are going to die, want to die, and die like that....then I'm for that. But most people are going to say "s%@t...my chest really hurts and there is a hospital close by...so let them fix me and I'll live another 25 years of living."

So unlike an accountant or lawyer, you are probably going to need a physician in your life many times. Now the next question is who should pay for it? I still think in that situation that you should pay for your own doctor. I think it's fine to get catastrophic "real" insurance. I know there are some countries (and I think Malaysia or the Phillipines are one) where the government "gives" or deposits money into a federal health care fund for you to use only on health care. But you don't have to use it, and you can bequeath it to your children. So some older adults near the end of their life won't use their health care and die sooner than they should, and give their money to their children. But what happens in those countries if you are young and exhaust your supply of money? Do they let you rot and die in the street? Or do you stay in the hospital and the govt picks up the tab until are healthy enough to be discharged? I don't know.

And my desire to have people pay for more of their health care is problematic for the reasons you stated above. I don't know what to do about those people with chronic disease. Frankly, probably the right thing to do on a national / international level, for the sake of our world and to live in a sustainable world at peace with nature, is to let them die. If a lion is born with an autoimmune disease, it dies. If a fly is born without a wing, it dies. It a bird develops marfans and has an aortic dissection, it dies. We feel though that everybody single person has the right to life. And that can be taken to an extreme too. We feel that not only are people allowed to live, but if it takes 4 other people FULL TIME to care for them their entire life, then that's legitimate. It's kind of a ridiculous position, isn't it?

There are about 1.4M wildebeest in the world. They all roam free. Imagine if 400,000 of them stay in one place, protect, and take care of 100,000 infirmed and physically disabled wildebeest? And the other 1M go out and roam free?

So I don't have a good answer for those sicklers and lupus and chronic pain patients. My answer is not a popular one.
 
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hundreddaysoff said:
Agree that this would be a better system on average. Especially if combined with better baseline education about how to manage basic medical problems at home. Also agree it will never happen because of too many vested interests and too much money in the current system.

But any thoughts on how your system would handle, eg, sicklers and lupus-ers and other young and chronically ill people who couldn't afford the massive care needed to keep them healthy out of pocket? If you say "those people can be publicly funded", how does one decide who gets funded and avoid perpetuating regulatory capture and mission creep in that system?
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Part of the problem is that our own professional society thinks there is no significant waste in the ED, and that only 3-5% of ED visits could be avoided. To get to this number, they will cite studies such as this one (Only 3.3 Percent of ER Visits are "Avoidable") where a visit was deemed unavoidable if it resulted in any test being ordered or treatment being given. In other words, go to the ED for sore throat and that visit was unavoidable if they gave you a Motrin.

Let that sink in for a second. Why should politicians listen to professional societies like ACEP that pedal such flawed logic that is clearly aimed at keeping the gravy train running. I’m not saying that half of all ED visits are unavoidable. However, the number is more than 5%, definitely significant, and needs to be addressed.

As for a system that directs resources to those with significant need, you create a point system. Having SLE, ESRD, AML, ALS, T21, etc. gives you a boat load of points. Having 4 babies from 4 different guys...not so much.
 
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Yes I definitely understand that ACEP wants to justify their own constitutients' needs. But I agree 3% is ridiculously low. That study is bogus. I think about 15% of all visits don't even have to see a doctor at all, ever. They can just stay home. Another 15-25% could easily see their PCP within 1 week with absolutely no bad outcome. I'd say about 25% need some sort of intervention (or testing) urgently / emergently (within 24 hours) and the remaining are appropriate ER visits, even though not all of them would end up being emergencies.

Remember the national average for admitting patients is about 11% from the ER give or take a few percent.
 
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ShockIndex said:
Part of the problem is that our own professional society thinks there is no significant waste in the ED, and that only 3-5% of ED visits could be avoided. To get to this number, they will cite studies such as this one (Only 3.3 Percent of ER Visits are "Avoidable") where a visit was deemed unavoidable if it resulted in any test being ordered or treatment being given. In other words, go to the ED for sore throat and that visit was unavoidable if they gave you a Motrin.

Let that sink in for a second. Why should politicians listen to professional societies like ACEP that pedal such flawed logic that is clearly aimed at keeping the gravy train running. I’m not saying that half of all ED visits are unavoidable. However, the number is more than 5%, definitely significant, and needs to be addressed.
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The vast majority of legislators could care less whether it's 3.3% or 50% of ER visits are unnecessary. What they're concerned about are the unnecessary visits being billed as level 5's. They're more concerned about the dollars spent total, billing excessively for basic services (sore throat gets a $1100 bill for a strep swab when a PCP charges only $75), and private equity-backed CMG's purposefully remaining out-of-network so they can bill the full amount instead of negotiated rates which are usually >50% less than full billing price.
 
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southerndoc said:
The vast majority of legislators could care less whether it's 3.3% or 50% of ER visits are unnecessary. What they're concerned about are the unnecessary visits being billed as level 5's. They're more concerned about the dollars spent total, billing excessively for basic services (sore throat gets a $1100 bill for a strep swab when a PCP charges only $75), and private equity-backed CMG's purposefully remaining out-of-network so they can bill the full amount instead of negotiated rates which are usually >50% less than full billing price.
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Nobody would care about anything at all if a $1100 bill could be cut to $75. That is more than a 10 fold difference in savings.
Our health care budget would go from 3T/year to 300B/year.

That would be an astounding difference.

Yes we have multiple problems, charging exorbitant rates for minor things AND abusing services that you don't have to pay for.



The truly sad part of all of this is the following.

The American Health Care System has bloated a fantastically significant amount largely due to administrators. There has only been a slight increase in the corresponding number of physicians and their pay.

Now...to save health care $$$ we are going to end up reducing physician compensation instead of getting rid of the bloat (administrators). So we continue to employ all of these nonesense administrators who deny reimbursements, and reduce physician pay.
 
So how is this for an idea. I bet it's terrible and I'm going to throw it out there.

I got this idea after reading the first few lines from
ShockIndex said:
To get to this number, they will cite studies such as this one (Only 3.3 Percent of ER Visits are "Avoidable") where a visit was deemed unavoidable if it
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One way to employ ER's with psychiatrists, full time, is to give the psychiatrists most, or all of the RVU's generated by the ER physician for non-medically complicated psychiatric patients. The presumption here is if we had more emergency psychiatrists available then psych patients wouldn't clog up ED being treated by ED physicians who basically don't care about them. Plus psych patients would get better care.

Current model:
ER doctor sees psych patient. ER doctor spends 2 minutes in the room to make sure their behavior isn't medical. Orders some labs that 95% of the time will end up normal or non-emergent. Pt gets medically cleared, calls psychistrist, SW, or crisis center. Bills CPT 99285, which is 4.89 RVUs (~$150 dollars). Pt then waits 12-36 hours in the ED getting placed or dispoed. During that time any medical or psychiatric problem that occurs is managed by the ED doc. If a psychiatrist comes to the ED for a consult, they get paid a consultation fee which I don't know how much it is, but it isn't that much. But psychiatrists do little to no mgmt of psych pts in the ER (at least where I work).

New model:
ER doctor sees psych patient (same). ER doctor spends 2 minutes in teh room to make sure their behavior isn't medical (same). Orders some labs that will end up normal or non-emergent (same). ER doctor calls psychiatrist and "transitions" the patient to him/her, and the ER doctor no longer takes care of the patient at all unless there is a medical problem (different). The pt may still be drunk, high, etc. But it's no longer in the hands of the ER doctor. If the psych patient acts out, the psych doctor has to order the meds. If transfer paperwork needs to be filled out, psych does it. If the crisis center or inpatient psych unit wants more testing done, they have to go through psych. med reconciliation occurs by psych. psych puts in all orders, including discharge / transfer orders. Visit is still billed for CPT 99285, which is 4.89 RVUs (~$150). Because the psych doc is doing most of the work, like > 90% of it, then they get the majority if not all of the money. Psych doc gets $130-150 dollars of it.

The advantage of the new model is that ER doctors which really know little to nothing about psych stuff never really get involved with those patients. Maybe the hospital pays the ER doc a fixed-rate stipend for every psych patient they screen so the ER doc gets something. But the psych doctor takes care of everything, and the patient gets to see a psychiatrist on an emergency basis which is undoubtely better than seeing the ER doctor. The patient wins, the psych doctor wins, and the ER doctor wins in one sense that we don't have to take care of that stuff anymore. The ER doc might lose a little bit of money, but patients get much better care.

The whole point of doing this model is that psych doctors will get better compensated to actually work in the ER.
 
For me, the issue with psych patients wasn’t an issue of effort-intensive management. The issue was the that they typically boarded in the ED for hours to days, and scare the piss out of the old lady in the adjacent room.

At one place I worked, we did our medical screening exam and sent them over to the psych ED for dispo. It was wonderful.
 
ShockIndex said:
For me, the issue with psych patients wasn’t an issue of effort-intensive management. The issue was the that they typically boarded in the ED for hours to days, and scare the piss out of the old lady in the adjacent room.

At one place I worked, we did our medical screening exam and sent them over to the psych ED for dispo. It was wonderful.
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Well you kind of have to have the volume to do my plan above. Won't work if you only see 5-10 psych pts / day. But if you see 1.5/hr it might work
 
So in NY, their surprise billing law is that an outside arbitrator picks what the patient has to pay, while in California it is basically the average. The NY bill passed in 2014.

Isn’t this what is basically being argued at with this law but just nationally?

I don’t see why the outside arbitrator is a bad idea. In NY it seems like costs have gone down, and the arbitrator chooses a fee to pay the hospital/DOCTOR on the high end. Yeah inevitably physician salaries go down a tiny bit, but the patients really benefit here in something they can’t really control.
 
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scoopdaboop said:
So in NY, their surprise billing law is that an outside arbitrator picks what the patient has to pay, while in California it is basically the average. The NY bill passed in 2014.

Isn’t this what is basically being argued at with this law but just nationally?

I don’t see why the outside arbitrator is a bad idea. In NY it seems like costs have gone down, and the arbitrator chooses a fee to pay the hospital/provider on the high end. Yeah inevitably physician salaries go down a tiny bit, but the patients really benefit here in something they can’t really control.
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Stop saying provider

I didn’t go to provider school
 
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scoopdaboop said:
So in NY, their surprise billing law is that an outside arbitrator picks what the patient has to pay, while in California it is basically the average. The NY bill passed in 2014.

Isn’t this what is basically being argued at with this law but just nationally?

I don’t see why the outside arbitrator is a bad idea. In NY it seems like costs have gone down, and the arbitrator chooses a fee to pay the hospital/provider on the high end. Yeah inevitably physician salaries go down a tiny bit, but the patients really benefit here in something they can’t really control.
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The Alexander bill limits arbitration for amounts >$750. That's very few of the EM bills as the median in-network rate is a lot less than that. It also limits arbitration to one per 90 day period. Basically, arbitration doesn't exist for the vast majority of EM bills under the Alexander plan.
 
southerndoc said:
The Alexander bill limits arbitration for amounts >$750. That's very few of the EM bills as the median in-network rate is a lot less than that. It also limits arbitration to one per 90 day period. Basically, arbitration doesn't exist for the vast majority of EM bills under the Alexander plan.
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Right. But the ways and means committe introduced their own way of resolving disputes, and it seems it's akin to that of NY, although it isn't outlined very well.
 
The arbiter is going to be one busy person, arbitrating over all of the disputed claims. Will probably be 10's of millions of claims.


It's so complicated - if anyone is going to be shafted it should be the burgeoning group of administrators at these health care companies (and the executive salaries) who offer basically nothing to the delivery of health care. Patient's shouldn't be screwed, and doctors shouldn't be screwed. Everybody else should though.

Who here thinks doctors make too much money? I think their salaries (except for some of the very high end NSG, Ortho, and Derm) are ridiculous, but making $250K - $500K / a year is about right for all the crap we have to go through.
 
Lets say this passes or some version close. What is a realistic timeframe on pay cut? 10% in year 1, 20% year 2? Im sure itll trickle down to the rest of the hospital over time as well, so I am guessing my ICU pay is gonna tank as well? Just trying to prepare for the worst at this point.
 
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sylvanthus said:
Lets say this passes or some version close. What is a realistic timeframe on pay cut? 10% in year 1, 20% year 2? Im sure itll trickle down to the rest of the hospital over time as well, so I am guessing my ICU pay is gonna tank as well? Just trying to prepare for the worst at this point.
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Hard to tell. NY and California already have similar bills like this. Just look at their salaries there. It seems California pays slightly more than NY. California has it set where the average is what is paid to the doc. In NY, an arbitrator decides what is paid.
 
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scoopdaboop said:
Hard to tell. NY and California already have similar bills like this. Just look at their salaries there. It seems California pays slightly more than NY. California has it set where the average is what is paid to the doc. In NY, an arbitrator decides what is paid.
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Personally I'd be satisfied with (not thrilled about) coastal CA pay for the next 10 years as long as this new national bill wouldn't decrease it any further.
 
scoopdaboop said:
Hard to tell. NY and California already have similar bills like this. Just look at their salaries there. It seems California pays slightly more than NY. California has it set where the average is what is paid to the doc. In NY, an arbitrator decides what is paid.
Click to expand...

what is that salary?
 
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