MUSC physician payment changes

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More non-physicians making all the decisions. How in the world did this stupid profession allow such parasitic dirtbags to run their lives is just beyond comprehension.

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arent most systems RVU based already? a combination of base salary plus location plus malpractice multiplied by output
 
I wouldn't get livid. I would get on 2 weeks notice. The way the CEO alludes to underproducing/low production makes me queasy.

At the MUSC Board of Trustees meeting Thursday, Medical University Hospital CEO Pat Cawley acknowledged that some doctors are nervous about the changes.

"High producers," Cawley said, who are meeting their goals won't be penalized, but doctors who have not been the most "clinically productive" are "going to have a tough time."

"Everybody has to be accountable to this clinical productivity," he said.
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SouthernSurgeon said:
Yeah I mean this with all sincerity MUSC has been mentally on my "wish list" for programs i would look at for a job.

I love Charleston and their new surgery chair had been making a big push to expand their research footprint and make the department more academic. This would, at face value at least, torpedo that effort.
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For all the "death of PP" threads and complaints on SDN, the slow decline of academic medicine programs doesn't see the same amount of deserved complaints. I didn't even pretend to have interest in staying at my residency program because of the combination of the hassles that some of our hardest working faculty got due to low RVUs, a department chair that no one seems to have a clue why he still has his job, and my friend getting a salary offer the previous year that was flat out insulting.

I'd have otherwise loved to stay. I love the faculty who are still there, and the junior residents who keep coming in are always top notch to teach and work with. But my current base salary is 50% higher than what they offered a graduating resident the year before me with a lower RVU burden (though I've gotten a couple raises since I started, but they were due to new funding sources and not anything to do with merit or seniority).
 
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SouthernSurgeon said:
Yeah I mean this with all sincerity MUSC has been mentally on my "wish list" for programs i would look at for a job.

I love Charleston and their new surgery chair had been making a big push to expand their research footprint and make the department more academic. This would, at face value at least, torpedo that effort.
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I can't claim to know much about the inner workings of MUSC (though we do need more academic strength here in SC), but I do like Charleston quite a bit too
 
Additionally, I would worry that this continue to push would sacrifice education in the name of productivity.

Where I train in dermatology, during the last two years of residency the hospital administration was pushing very hard to increase the number of patients and clinic hours worked by everyone, including residents. It doesn't matter that an academic institution attracts more complicated cases, and precepting with attendings on complex medical derm patients takes time.

It's all about quantity, quality has no place in the discussion anymore.
 
username456789 said:
Additionally, I would worry that this continue to push would sacrifice education in the name of productivity.

Where I train in dermatology, during the last two years of residency the hospital administration was pushing very hard to increase the number of patients and clinic hours worked by everyone, including residents. It doesn't matter that an academic institution attracts more complicated cases, and precepting with attendings on complex medical derm patients takes time.

It's all about quantity, quality has no place in the discussion anymore.
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That's disgustingly sad. I thought residents were there to learn, and not to churn out cases? (paging @madjack, @therestofthecrewthatlovestobeslavelabor).
 
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Giovanotto said:
That's disgustingly sad. I thought residents where there to learn, and not to churn out cases? (paging @madjack, @therestofthecrewthatlovestobeslavelabor).
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Yes, one place that puts emphasis on productivity totally invalidates all of post graduate medical education.
 
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Reason number 1293812948147 why we need physicians unions.
 
VA Hopeful Dr said:
No, we really don't.

If you're an MUSC doc and this really pisses you off, then leave. Its pretty simple and doctors are always in demand.
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No they're not. Look at pathology.
 
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I predict that most of these MUSC physicians will bi-tch and complain but they will nevertheless stay at their current jobs. Typical pansy physician behavior.
 
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VA Hopeful Dr said:
No, we really don't.

If you're an MUSC doc and this really pisses you off, then leave. Its pretty simple and doctors are always in demand.
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Being in demand doesn't negate the need for a union...
 
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Will be interesting to see how it all plays out. I'm especially curious as to the details given how MUSC structures its physician compensation already. A simple search of public records shows that most faculty receive compensation from 2 sources - the university, and a separate 501(c)3 called University Medical Associates which is governed solely by the MUSC physicians themselves (at least according to the last year they were required to file). Searching someone's salary on the state database returns some laughably paltry numbers, so clearly that isn't counting the UMA compensation. Is this change only applying to the institutional side of things, or are both UMA and the hospital authority both changing to an RVU system? Can't imagine it's both if everyone is so "livid" yet UMA is an MD-governed entity.

My guess is that many will find their daily routine and compensation essentially unchanged, at least at first. In addition to a non-compete (questionably enforceable), other hospitals in the area already base compensation on an RVU model, so it's not like there's anywhere locally they can go that's much different. On the other hand, I think you'd be hard pressed to work academic physicians like private practice physicians while still paying them like academic ones. Fields with an especially large academic-private pay gap may see more of an exodus.

Not sure what I think about the whole union thing. Certainly not an option for MUSC docs. Like all states which find themselves near the bottom of education rankings and near the top of opiate prescriptions, SC is a right to work state. Even if it weren't, I can't imagine physicians striking at an academic center that's the only tertiary care center for hundreds of miles. Seems like it would just end up hurting the patients while administration would keep moving along unscathed.

On the other hand, some people publicly challenging the non-compete and winning....now THAT could be a game changer.
 
VA Hopeful Dr said:
Uhh, it kinda does
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With all due respect, that makes 0 sense. The landscape of american medicine has changed drastically in the last few decades and physicians are nowhere near the helm of the changes. Who's supposed to be offering physician input and leadership at this time? The AMA? Lets be serious.

There's got to be a way for physicians to unionize and actually direct change (or form a solid PAC instead) without being labeled as spoiled brats. It doesn't make one immune to changes, but certainly can lead to larger impact. It's hard to put a label on what physicians think since there are as many opinions as there are specialties, but there has got to be some common ground through it all, even if only regional.

The 'oh this wont really ever have an effect on me' trope is going to be played out pretty soon, especially if changes like this start having a domino effect. Nurses have been extremely successful using patients to act as surrogates and physicians should learn from them to do as much.
 
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ridethecliche said:
With all due respect, that makes 0 sense. The landscape of american medicine has changed drastically in the last few decades and physicians are nowhere near the helm of the changes. Who's supposed to be offering physician input and leadership at this time? The AMA? Lets be serious.

There's got to be a way for physicians to unionize and actually direct change (or form a solid PAC instead) without being labeled as spoiled brats. It doesn't make one immune to changes, but certainly can lead to larger impact. It's hard to put a label on what physicians think since there are as many opinions as there are specialties, but there has got to be some common ground through it all, even if only regional.

The 'oh this wont really ever have an effect on me' trope is going to be played out pretty soon, especially if changes like this start having a domino effect. Nurses have been extremely successful using patients to act as surrogates and physicians should learn from them to do as much.
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Unions are traditionally used when workers are mistreated and/or there is a massive power differential between workers and management. Neither of those apply to us.

First, with a few exceptions, the job market for physicians is still insanely good. If you aren't being treated like you want to be, then you can very easily find a new job that treats you better. The ability to leave a job is very powerful because it forces administration to find a replacement (which is very expensive) and get someone to do your job temporarily while they find said replacement - either with locums (very expensive) or by having other existing doctors pick up the slack which results in markedly increased wait times. There is a reason that hospitals are spending so much effort on physician retention and why on the whole our salaries do increase yearly.

Second, physicians actually do have a fair bit of power even beyond that. Its not universally true, but on the whole if we present our viewpoints calmly and with sound reasoning we are usually listened to. We may not always get what we'd like, but I've found that this approach will at least get an explanation as to why something is the way it is.

Now let me ask you something: what would you like a physician union to do? What battles do you think we need to fight, win, and risk pissing off the public over? After all, unions are only effective because of the threat of a strike and the general public will not be sympathetic to a bunch of doctors going on strike.
 
as a pathologist, i use what i learned in medical school every day. if i wanted to practice primary care, i would have become a nurse.
 
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VA Hopeful Dr said:
Unions are traditionally used when workers are mistreated and/or there is a massive power differential between workers and management. Neither of those apply to us.

First, with a few exceptions, the job market for physicians is still insanely good. If you aren't being treated like you want to be, then you can very easily find a new job that treats you better. The ability to leave a job is very powerful because it forces administration to find a replacement (which is very expensive) and get someone to do your job temporarily while they find said replacement - either with locums (very expensive) or by having other existing doctors pick up the slack which results in markedly increased wait times. There is a reason that hospitals are spending so much effort on physician retention and why on the whole our salaries do increase yearly.

Second, physicians actually do have a fair bit of power even beyond that. Its not universally true, but on the whole if we present our viewpoints calmly and with sound reasoning we are usually listened to. We may not always get what we'd like, but I've found that this approach will at least get an explanation as to why something is the way it is.

Now let me ask you something: what would you like a physician union to do? What battles do you think we need to fight, win, and risk pissing off the public over? After all, unions are only effective because of the threat of a strike and the general public will not be sympathetic to a bunch of doctors going on strike.
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If a physicians union builds and presents itself in a way that it wants to ensure that doctors get to spend time with their patients and to ensure that they would fight against schemes such as the one discussed here to ensure that quality of patient care wasn't replaced by an assembly line mentality, then I think the public would rally behind that. Who you make the 'enemy' is completely based on how good you are with getting your message across. Americans right now hate insurance and they hate big business lets call it the 'insurance/hospital industrial complex' because that's what my liberal arts education makes me think is a reasonable term for it...

Yeah, physicians can't strike, but I don't think nurses have really done so recently have they? I know the Brigham in Boston has a nursing union since I used to go there for meetings back in the day. It earns them bargaining power.

The public has an us vs them mentality against physicians because they see doctors as the reason their bills are so high. With the change in the landscape of care, that's changing.

You don't have to threaten a strike. You just have to have a common front to earn public favor. Show the people you're working for them and their best interest. Most often, that lines up with the best interest of the future of physicians too.

I'm pretty sure that everyone thinks that doctors work really hard but are still overpaid. Just more public education regarding the cost to become a physician would do wonders to change the mindset. Then add in more crap about how much administration etc costs and where the patients money actually goes and you have something going. There's already a push back with colleges since folks are starting to catch on that education is suffering and administration is booming.

I know much of what I said is probably naive, but hell, I'm a second year. I just know it's frustrating to me that there isn't any sort of decent physician advocacy agency. I think the AMA is kind of meh...

If the solution is more local groups, or state wide groups since there are difference by state, then so be it, but there's no unified physician presence from what I've seen and that troubles me.

Pathman1000 said:
Im just defensive because im about to get replaced by a pigeon
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Crypto got you too, huh?
 
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ridethecliche said:
If a physicians union builds and presents itself in a way that it wants to ensure that doctors get to spend time with their patients and to ensure that they would fight against schemes such as the one discussed here to ensure that quality of patient care wasn't replaced by an assembly line mentality, then I think the public would rally behind that. Who you make the 'enemy' is completely based on how good you are with getting your message across. Americans right now hate insurance and they hate big business lets call it the 'insurance/hospital industrial complex' because that's what my liberal arts education makes me think is a reasonable term for it...

Yeah, physicians can't strike, but I don't think nurses have really done so recently have they? I know the Brigham in Boston has a nursing union since I used to go there for meetings back in the day. It earns them bargaining power.

The public has an us vs them mentality against physicians because they see doctors as the reason their bills are so high. With the change in the landscape of care, that's changing.

You don't have to threaten a strike. You just have to have a common front to earn public favor. Show the people you're working for them and their best interest. Most often, that lines up with the best interest of the future of physicians too.

I'm pretty sure that everyone thinks that doctors work really hard but are still overpaid. Just more public education regarding the cost to become a physician would do wonders to change the mindset. Then add in more crap about how much administration etc costs and where the patients money actually goes and you have something going. There's already a push back with colleges since folks are starting to catch on that education is suffering and administration is booming.

I know much of what I said is probably naive, but hell, I'm a second year. I just know it's frustrating to me that there isn't any sort of decent physician advocacy agency. I think the AMA is kind of meh...

If the solution is more local groups, or state wide groups since there are difference by state, then so be it, but there's no unified physician presence from what I've seen and that troubles me.



Crypto got you too, huh?
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So a few easy points first. Educating the public about our education, loans, hours, whatever won't help. Think about it: doctors complain about how much other doctors make. If internists get mad at how much money ortho makes (despite sharing part of the same education), why on Earth should a school teacher or a plumber not get mad about how much any doctor makes?

People still blame us that their bills are so high. Most doctors when they order a test or prescribe a treatment have no idea how much something costs. That's not always our fault, but the patients blame us for not prescribing a cheaper med or getting the diagnosis without the expensive test. My personal experience has been that if you know how much patients will pay for stuff and are up front about it, then they stop blaming us - but very few doctors are willing/able to do that.

Nurses actually do strike. Seems to be about every 3 years or so. The hospitals bring in travel nurses which are more expensive and usually provide inferior care (they don't know the system well, not a slight on travel nurses) so patients get mad, hospital loses money, and everyone knows that nurses CARE.

We don't need a union to get more time with patients, just change the game. That's why being a doctor is awesome, we have much more freedom than most. If you don't like working for corporate masters, you can hang your own shingle. I did. Google Direct Primary Care. My shortest appointment time is 30 minutes for return patients, 60 for new patients. Its awesome.
 
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At least you guys will get displaced by actual living beings. We're going to get replaced by Watson-powered vending machines and Amazon drones.


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NaOH said:
At least you guys will get displaced by actual living beings. We're going to get replaced by Watson-powered vending machines and Amazon drones.


Sent from my iPhone using SDN mobile
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You should change your name to apothecary and convince the public that it's a new age way of getting medications. Should give you another decade before folks catch on.
 
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