I am a junior neurosurgical attending practicing for three plus years now. I have been hospital employed health system. The pay is good, but the bending over to the health system, and inability to pick my staff is frustrating. It seems to me that generation before us, which sold their practices to the health systems, had the bargaining power and could stand up to hospital administrations to advocate for themselves. In our current systems I feel we are losing that.
This issue is the current private jobs out there seem to be from bigger groups and a pyramid scheme which you can never really become an equal. Going solo has a high barrier for entry and big EMR systems are making this a more difficult option.
What are other people experiencing out there? Is independent practice gone? Are some people happy working in the employed systems and if so, what are some of the things that help. One of my bigger frustrations is being on call for many hospitals that I don’t go to, and getting called for clearly non-surgical stuff by a growing number of NP/PA’s that don’t’ know how to manage non-operative spine. If the radiologist says anything on the report they don’t understand, they call and write down any narrative they want in the chart. Then the CMO’s try to encourage remote management without ever seeing the patient. Private ortho spine attendings refuse to take call ED call, take block time at the health system, and when their post ops hit the ED, they reflexively call the on-call for their post ops and if push comes to shove we have to take their post-op complications.
Who’s having a better time out there? What's our options ?
(12-19-2021, 01:34 PM)Guest Wrote: I am a junior neurosurgical attending practicing for three plus years now. I have been hospital employed health system. The pay is good, but the bending over to the health system, and inability to pick my staff is frustrating. It seems to me that generation before us, which sold their practices to the health systems, had the bargaining power and could stand up to hospital administrations to advocate for themselves. In our current systems I feel we are losing that.
This issue is the current private jobs out there seem to be from bigger groups and a pyramid scheme which you can never really become an equal. Going solo has a high barrier for entry and big EMR systems are making this a more difficult option.
What are other people experiencing out there? Is independent practice gone? Are some people happy working in the employed systems and if so, what are some of the things that help. One of my bigger frustrations is being on call for many hospitals that I don’t go to, and getting called for clearly non-surgical stuff by a growing number of NP/PA’s that don’t’ know how to manage non-operative spine. If the radiologist says anything on the report they don’t understand, they call and write down any narrative they want in the chart. Then the CMO’s try to encourage remote management without ever seeing the patient. Private ortho spine attendings refuse to take call ED call, take block time at the health system, and when their post ops hit the ED, they reflexively call the on-call for their post ops and if push comes to shove we have to take their post-op complications.
Who’s having a better time out there? What's our options ?
i am a chief resident signing with jobs. it seems that the day where private groups held the upper hand to hospitals is slowly dwindling. there just aren't a lot of jobs out there that have the private groups dictate what/how they want their practice to be run. case in point is hiring/firing of staff. you have no control in a hospital employed system who you want to have working for you, whereas in private practice you do have control.
that's pretty insane that private orthopods refuse to take their post-ops in the ED. i would refuse those consults. i just don't know of a good way to refuse them if i were working for a hospital employment system. unfortunately, it seems you don't have control over your own practice in a hospital employed system and have to do what the hospital wants you to do.
This is probably the most important post in this site that I have read in a long-time.
Everyone loves a juicy high income guarantee but the hospitals are absolutely winning in the long-run
I get livid with the events regarding call and structure regarding block time and not pulling weight. It's the most frustrating thing. Money talks and patients talk. It's as simple as that.
I interviewed with pp groups and got some of same vibe. I can't really argue with that though. They created the thing. They will never view you as equal even if it's fiscally equal.
I've been extremely taken back by how awful some of the other people in the community can be in regards to dealing with their call and how surgeons treat other surgeons. So much manipulation and then positioning and then the occasional lying to patients. Don't be that person.
...and I'm in academics
I think pp grass is greener but who knows. hospital employed is not good generally...
Posts: 44
Threads: 0
Joined: Mar 2018
Reputation:
0
Sobering thread to read. I've consistently heard problematic things about hospital-employed jobs. The starting money looks great but you pay for it in other ways. Always hire a contract lawyer before signing.
Of all the graduates from our program, the people having the best time are those who joined regionally powerful groups with decent colleagues. The size of those groups ranges from 3-8+, but the consistent thing was that they are a big player in the area.
As far as people refusing to manage their own post-op complications - why not just dictate in the chart that they were contacted and refused to see the patient? After 4-5 of those, it's an easy report to the medical board or to their hospital's chief of surgery. Some of those we're going to have to deal with, namely CSF leaks.
Not to hijack the thread - but is widespread hospital employment just an alternative route to consolidation and de facto nationally managed care?
(12-20-2021, 02:57 PM)drstrange Wrote: Not to hijack the thread - but is widespread hospital employment just an alternative route to consolidation and de facto nationally managed care?
This is already underway, but it is being "nationally managed" by profit driven mega-corporations.
(12-19-2021, 01:34 PM)Guest Wrote: I am a junior neurosurgical attending practicing for three plus years now. I have been hospital employed health system. The pay is good, but the bending over to the health system, and inability to pick my staff is frustrating. It seems to me that generation before us, which sold their practices to the health systems, had the bargaining power and could stand up to hospital administrations to advocate for themselves. In our current systems I feel we are losing that.
This issue is the current private jobs out there seem to be from bigger groups and a pyramid scheme which you can never really become an equal. Going solo has a high barrier for entry and big EMR systems are making this a more difficult option.
What are other people experiencing out there? Is independent practice gone? Are some people happy working in the employed systems and if so, what are some of the things that help. One of my bigger frustrations is being on call for many hospitals that I don’t go to, and getting called for clearly non-surgical stuff by a growing number of NP/PA’s that don’t’ know how to manage non-operative spine. If the radiologist says anything on the report they don’t understand, they call and write down any narrative they want in the chart. Then the CMO’s try to encourage remote management without ever seeing the patient. Private ortho spine attendings refuse to take call ED call, take block time at the health system, and when their post ops hit the ED, they reflexively call the on-call for their post ops and if push comes to shove we have to take their post-op complications.
Who’s having a better time out there? What's our options ?
Mandatory EMR was the official time of death for the good old days of solo or small practice.
That said, there are fewer than 4,000 neurosurgeons in the U.S., which means you're probably underestimating how much leverage you have with hospitals.
(12-20-2021, 04:33 PM)Guest Wrote: (12-20-2021, 02:57 PM)drstrange Wrote: Not to hijack the thread - but is widespread hospital employment just an alternative route to consolidation and de facto nationally managed care?
This is already underway, but it is being "nationally managed" by profit driven mega-corporations.
(12-19-2021, 01:34 PM)Guest Wrote: I am a junior neurosurgical attending practicing for three plus years now. I have been hospital employed health system. The pay is good, but the bending over to the health system, and inability to pick my staff is frustrating. It seems to me that generation before us, which sold their practices to the health systems, had the bargaining power and could stand up to hospital administrations to advocate for themselves. In our current systems I feel we are losing that.
This issue is the current private jobs out there seem to be from bigger groups and a pyramid scheme which you can never really become an equal. Going solo has a high barrier for entry and big EMR systems are making this a more difficult option.
What are other people experiencing out there? Is independent practice gone? Are some people happy working in the employed systems and if so, what are some of the things that help. One of my bigger frustrations is being on call for many hospitals that I don’t go to, and getting called for clearly non-surgical stuff by a growing number of NP/PA’s that don’t’ know how to manage non-operative spine. If the radiologist says anything on the report they don’t understand, they call and write down any narrative they want in the chart. Then the CMO’s try to encourage remote management without ever seeing the patient. Private ortho spine attendings refuse to take call ED call, take block time at the health system, and when their post ops hit the ED, they reflexively call the on-call for their post ops and if push comes to shove we have to take their post-op complications.
Who’s having a better time out there? What's our options ?
Mandatory EMR was the official time of death for the good old days of solo or small practice.
That said, there are fewer than 4,000 neurosurgeons in the U.S., which means you're probably underestimating how much leverage you have with hospitals.
i am looking at a hospital employed job right now. how is it that private ortho spine gets block time when they're not employed by the hospital? money is definitely better than private practice but is that the cost of losing the autonomy of the practice? really don't know
Posts: 86
Threads: 13
Joined: Dec 2016
Reputation:
7
I am in solo private practice. Can try to answer questions anyone might have. There are obviously trade offs.
(03-10-2022, 05:00 PM)socrates Wrote: I am in solo private practice. Can try to answer questions anyone might have. There are obviously trade offs.
What is a day in the life like ? How many surgeries would you say you perform annually ? What are theses "trade offs" you mention ? What region of the country is this ? How much do you make ? Are you planning on buying a second yatch ?
and most importantly, what made you choose an independent-style PP over joining a group or academics ?
(03-10-2022, 03:36 AM)Guest Wrote: (12-20-2021, 04:33 PM)Guest Wrote: (12-20-2021, 02:57 PM)drstrange Wrote: Not to hijack the thread - but is widespread hospital employment just an alternative route to consolidation and de facto nationally managed care?
This is already underway, but it is being "nationally managed" by profit driven mega-corporations.
(12-19-2021, 01:34 PM)Guest Wrote: I am a junior neurosurgical attending practicing for three plus years now. I have been hospital employed health system. The pay is good, but the bending over to the health system, and inability to pick my staff is frustrating. It seems to me that generation before us, which sold their practices to the health systems, had the bargaining power and could stand up to hospital administrations to advocate for themselves. In our current systems I feel we are losing that.
This issue is the current private jobs out there seem to be from bigger groups and a pyramid scheme which you can never really become an equal. Going solo has a high barrier for entry and big EMR systems are making this a more difficult option.
What are other people experiencing out there? Is independent practice gone? Are some people happy working in the employed systems and if so, what are some of the things that help. One of my bigger frustrations is being on call for many hospitals that I don’t go to, and getting called for clearly non-surgical stuff by a growing number of NP/PA’s that don’t’ know how to manage non-operative spine. If the radiologist says anything on the report they don’t understand, they call and write down any narrative they want in the chart. Then the CMO’s try to encourage remote management without ever seeing the patient. Private ortho spine attendings refuse to take call ED call, take block time at the health system, and when their post ops hit the ED, they reflexively call the on-call for their post ops and if push comes to shove we have to take their post-op complications.
Who’s having a better time out there? What's our options ?
Mandatory EMR was the official time of death for the good old days of solo or small practice.
That said, there are fewer than 4,000 neurosurgeons in the U.S., which means you're probably underestimating how much leverage you have with hospitals.
i am looking at a hospital employed job right now. how is it that private ortho spine gets block time when they're not employed by the hospital? money is definitely better than private practice but is that the cost of losing the autonomy of the practice? really don't know
They can take their cases elsewhere. You can’t.
(03-10-2022, 09:21 PM)Guest Wrote: (03-10-2022, 03:36 AM)Guest Wrote: (12-20-2021, 04:33 PM)Guest Wrote: (12-20-2021, 02:57 PM)drstrange Wrote: Not to hijack the thread - but is widespread hospital employment just an alternative route to consolidation and de facto nationally managed care?
This is already underway, but it is being "nationally managed" by profit driven mega-corporations.
(12-19-2021, 01:34 PM)Guest Wrote: I am a junior neurosurgical attending practicing for three plus years now. I have been hospital employed health system. The pay is good, but the bending over to the health system, and inability to pick my staff is frustrating. It seems to me that generation before us, which sold their practices to the health systems, had the bargaining power and could stand up to hospital administrations to advocate for themselves. In our current systems I feel we are losing that.
This issue is the current private jobs out there seem to be from bigger groups and a pyramid scheme which you can never really become an equal. Going solo has a high barrier for entry and big EMR systems are making this a more difficult option.
What are other people experiencing out there? Is independent practice gone? Are some people happy working in the employed systems and if so, what are some of the things that help. One of my bigger frustrations is being on call for many hospitals that I don’t go to, and getting called for clearly non-surgical stuff by a growing number of NP/PA’s that don’t’ know how to manage non-operative spine. If the radiologist says anything on the report they don’t understand, they call and write down any narrative they want in the chart. Then the CMO’s try to encourage remote management without ever seeing the patient. Private ortho spine attendings refuse to take call ED call, take block time at the health system, and when their post ops hit the ED, they reflexively call the on-call for their post ops and if push comes to shove we have to take their post-op complications.
Who’s having a better time out there? What's our options ?
Mandatory EMR was the official time of death for the good old days of solo or small practice.
That said, there are fewer than 4,000 neurosurgeons in the U.S., which means you're probably underestimating how much leverage you have with hospitals.
i am looking at a hospital employed job right now. how is it that private ortho spine gets block time when they're not employed by the hospital? money is definitely better than private practice but is that the cost of losing the autonomy of the practice? really don't know
They can take their cases elsewhere. You can’t.
so you're essentially trapped?
|
