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Sabien Donating Member (430 posts) Send PM | Profile | Ignore Tue Sep-22-09 07:56 PM
Original message
my Doctor sacked because he "wasn't generating enough revenue"
These were his words exactly. Big family and he is not allowed to practice within 20 miles of the clinic.

I was surprised and saddened by the news.

I should have known better - but I didn't even realize that there was this kind of pressure on MDs.

Something's gotta change.
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Odin2005 Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Sep-22-09 07:57 PM
Response to Original message
1. WTF? That's just wrong!
:grr:
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virgogal Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Sep-22-09 07:58 PM
Response to Original message
2. Are you sure there isn't more to this?
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silverweb Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Sep-22-09 07:59 PM
Response to Original message
3. My mom's doctor, too, a few years ago.
It's apparently not all that uncommon in group practices that have their eye primarily on the bottom line.

My mom's doctor told her that he was told to "not spend so much time talking to patients. Do what you need to do and get them out the door." He balked and they cut him loose.

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dmr Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Sep-23-09 06:20 PM
Response to Reply #3
37. Same with one of my docs. They asked him to leave
He found other docs to share office space & expenses & staff; they just worked independently of one anther in their specialties.

This was a few years ago in another state. I always felt at ease visiting with him, he allayed my fears, gave me options, and treated me as an individual. He was also a liberal who lost his wife in one of the twin towers.



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kestrel91316 Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Sep-22-09 08:02 PM
Response to Original message
4. This exact thing happened to me at a vet clinic I worked at 20 years ago.
The owner would present me every week with figures on my per client transaction charges and say how it needed to go up. In most cases the only way to do that would have been to lie to the client about what was necessary.
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Gman2 Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Sep-22-09 08:19 PM
Response to Reply #4
7. How you deal with that is you act patronising to any question asked.
Soon, you will tell them whats what, then they leave, with their questions.
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kestrel91316 Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Sep-23-09 11:33 AM
Response to Reply #7
35. Not at all clear how your post relates to my post........
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imdjh Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Sep-22-09 08:57 PM
Response to Reply #4
16. Dentists are doing this and getting their staff to do it as well. So is the car dealer.
Edited on Tue Sep-22-09 08:57 PM by imdjh
I took my mom's car in for her interval maintenance, and they are pushing the "severe conditions" maintenance schedule. They made a big deal out of the fact that we wouldn't pay $400 for a couple of minor proceedures, tried to lead me to believe it needs a "tune up (his exact words)", and sell me a $70 air filter.

And of course the service advisor sits next to the open door of the service manager, within earshot so it's obvious what's going on. It's new since the econ downturn. So they just lost a regular customer. I quit my dentist last month over this.
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tblue37 Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Sep-22-09 09:49 PM
Response to Reply #16
23. I never take my Toyota to the Toyota dealer here in town for any
Edited on Tue Sep-22-09 09:50 PM by tblue37
repairs--or even an oil change. Every single time I went in to that place, the very next day something serious would go wrong with my car. Sometimes even on the way home the same day. The last time, a $320 repair led to more problems the next day, which cost me an additional $900!

I now go to an honest mechanic, who fixes whatever needs fixing, without fiddling to make things go wrong with my car to cost me huge extra expenses.

Sure, the Toyota dealership made a few extra bucks by f***ing with my car every time they touched it, but they have lost me forever as a customer, and I now warn every other person I know to avoid them like the plague, so in the long run they have lost more than they gained by screwing me over. Meanwhile, the honest mechanic and the honest garage he works for have more work than they can handle, because we all keep referring people to them.

I am astonished that businesspeople can't see that they are shooting themselves in the foot when they screw their customers so obviously. They don't even have the sense to be a little bit subtle about it!
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imdjh Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Sep-22-09 10:06 PM
Response to Reply #23
25. Someone pointed something out about the difference between dealers and local shops.
The car dealer wants you to buy a new car in three or five years. The local shop wants you to keep that car forever. Which one will take better care of it?
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tblue37 Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Sep-22-09 10:59 PM
Response to Reply #25
28. Good point. nt
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sicksicksick_N_tired Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Sep-22-09 08:08 PM
Response to Original message
5. "Sacked" because he wasn't ALLOWED to practice within 20 miles of what clinic?
Edited on Tue Sep-22-09 08:09 PM by sicksicksick_N_tired
:shrug:

Who sacked him?

Is this another insurance shove (always shoving doctors out of practice or patients out of health care)?
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AngryAmish Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Sep-22-09 08:52 PM
Response to Reply #5
13. Non-compete agreement
If he got fired then the er breached the contract and the non-compete does not apply.

But tell that to a doc.
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Gman2 Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Sep-22-09 08:17 PM
Response to Original message
6. Keep going faster, til you fuck up, there is the sweet spot.
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doc03 Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Sep-22-09 08:20 PM
Response to Original message
8. Yes a friend's Doctor was sacked by
a local hospital a couple years ago. He told my friend the same thing "the hospital told me I wasn't generating enough revenue for them so they cut me from their staff."
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vadawg Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Sep-22-09 08:33 PM
Response to Reply #8
10. seems like every other profession out there, if your not good enough to produce the clients
then your gone, better this than a practice having to keep a bad doctor on the books.
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truedelphi Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Sep-22-09 08:54 PM
Response to Reply #10
14. But this IS KEEPING the bad doctors on the books
Edited on Tue Sep-22-09 09:00 PM by truedelphi
This is keeping the ob/gyn asswipes I was forced by Kaiser Permanente to see - the ones who thought that douching my tumors in warm water would help me (I am not making this up!)

If any of the docotors I saw had voluntarily pointed me toward the much more expensive but actually effective treatment, they would have been asked to leave.

When through internet searches I found out about a real treatment, they duly noted that I mentioned it, as they were afraid of being sacked should they "be guilty" of mentioning it.
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The Gunslinger Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Sep-22-09 09:00 PM
Response to Reply #10
18. yea I'd much rather have a doctor thats only worried about the dollar
rush me in and out the door, than one that's willing to take his time and actually "care' about the patient. It's amazing how so many are willing to blindly follow the corporate money gods.
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vadawg Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Sep-22-09 09:01 PM
Response to Reply #18
19. or mayby he was just a bad doctor that nobody wanted to be his patient
hence his low numbers, this can be read either way...
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nadinbrzezinski Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Sep-22-09 11:17 PM
Response to Reply #19
30. Not in the modern world of corporate medicine
this does not happen in a few places... sadly I can count them with the fingers of my hands.

University hospitals... and not all

Places like the Mayo Clinic, or the Rochester Clinic where doctors are on salary

Tertiary clinics like the Cleveland Clinic

This culture of money first is worst in places like Houston, but it is pervasive.

You should do some readying on this
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Crunchy Frog Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Sep-22-09 09:49 PM
Response to Reply #10
24. Sure, if you equate "revenue generating" with practicing good medicine.
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Mayberry Machiavelli Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Sep-22-09 08:32 PM
Response to Original message
9. Private medical practices are small businesses. They have revenues, and overhead.
Overhead would include the cost to rent or own the office space, hiring nurses, receptionists, physician's assistants or techs, cost of office and medical equipment, malpractice insurance premiums etc.

Revenues would generally consist of fees collected for services rendered via billing insurance and patient copays. There are other possible sources of physician revenue but this is the main one.

If a doctor's practice consumes more in overhead than he or she generates in fees, then that doctor may be considered a financial liability to a group practice and they could be let go. When a doctor is starting in a practice, it is understood that they have to build their practice and patient base and their revenue will "ramp up" and most practices will understand that this process takes time and they may tolerate a low or even negative balance for a time, but there will be some expectation that their practice will grow.

Low revenues will happen if the doctor either doesn't get enough patients to see, works low hours, and/or has too high a proportion of poorly insured/uninsured patients who don't pay their bills.

Generally a doctor will sign an employment contract when joining a group. This will outline things like "noncompete" clauses that define a geographic area where they may not practice for a certain number of years if they leave the group.
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exboyfil Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Sep-23-09 03:13 AM
Response to Reply #9
32. Malpractice Insurance
A quote from the the following:

http://www.insurancejournal.com/news/east/2009/08/12/10...

Physicians in specialties like neurosurgery and obstetrics can pay $200,000 a year for malpractice coverage in New York, though consumer advocates note that others pay less than a quarter of that and many are insured by the hospitals where they work.

A recent report from the New York Public Interest Research Group on federal data showed 2,000 to 2,400 malpractice payments in New York each of the past 15 years, with payouts of $743 million in 2008.

The report said less than 7 percent of some 62,270 New York doctors accounted for half the total payouts.

Let me get this straight - malpractice premiums are $6.2B (assuming $100K/yr) but payouts are $743M. This is almost a ten to one ratio - where is the other money going? Even assuming the lower $50,000 figure, premiums would be $3.1B or 4.4X the actual annual payout. Another way to look at it is each doctor, on average, is paying $12K/yr. Why don't the doctors insure themselves in a pool??? It appears they are being raped by the insurance company. Of course I don't know what it costs to defend these suits and settlements that were not part of judgements.

Anybody a doctor or in the insurance industry that can explain it to me.
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Mayberry Machiavelli Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Sep-23-09 06:04 AM
Response to Reply #32
34. Some doctors DO in fact insure themselves in a pool. Some very large group practices do this.
If the group is large enough, it's generally a MUCH cheaper way than through an insurance company. As you can see, the insurance company keeps a WHOLE lot extra both as overhead and in profits. The doctors themselves have no incentive to collect much larger fees from themselves than they need to settle claims and judgments, so the cost of insuring themselves is much less. Also, if the liability is considered "shared" in the group, then every member has a selfish financial interest in seeing that every other member is delivering safe and quality care.
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Berry Cool Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Sep-22-09 08:39 PM
Response to Original message
11. This is similar to what big law firms are doing.
You either produce the expected number of billable hours or you're out the door. Sometimes even if you're a partner. To hell with whether you do good work or your clients are happy with you.
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santamargarita Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Sep-22-09 08:48 PM
Response to Original message
12. I know a doctor that can't get health insurance...
His wife works so he's covered under her policy. He has to wait two years in order to qualify where he works.
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Mojorabbit Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Sep-22-09 08:55 PM
Original message
I am married to a family physician
who has not been able to get health insurance at any price for the past decade after United dropped him due to a heart attack he had when he was in his early fourties and we have applied everywhere.
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santamargarita Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Sep-23-09 05:48 PM
Response to Original message
36. I'm truly sorry to hear that - it's a crime that care givers can't get care themselves
:(
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Kansas Wyatt Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Sep-22-09 08:55 PM
Response to Original message
15. Now what was this about 'socialist medical care' telling docs where to practice?
:shrug:
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ayeshahaqqiqa Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Sep-22-09 08:58 PM
Response to Original message
17. That's one reason MDs don't like HMOs
Edited on Tue Sep-22-09 08:58 PM by ayeshahaqqiqa
A colleague of my Doc was told by her clinic if she spent more than SIX MINUTES with a patient, she was taking too long. There is no way a doctor can establish a trusting relationship with a patient by spending six minutes with them. I posted a proposal by MDs on using integrative health care as the solution for our health care crisis, and the first item deals with good patient relationships. Naturally, it dropped like a stone, but if you're interested, here's the link:

http://www.democraticunderground.com/discuss/duboard.ph...
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Boxerfan Donating Member (710 posts) Send PM | Profile | Ignore Tue Sep-22-09 09:07 PM
Response to Original message
20. A bad practice common in auto repair etc..."Flat rate " shops-I hate 'em
Frankly then entire incentive is to inflate the repair bill.I didn't last long in shops like that. Honesty almost always bit me in the ass income/job security wise. Thankfully I have a small hobby related machine shop.

Take the same mindset & transfer it to people & you got yourself a broken medical system.

I always try to determine if my Doctor is a Dem or Republican. The Republicans never get into healthcare to heal people. They see us as cash cows to be herded along for slow slaughter.

I dumped my last Republican Dr.His office was always overcrowded & waits beyond your scheduled time.

My last straw was when he asked me why I was there. This is after he made a big deal of me coming back-wich I could hardley afford. And this incompetent SOB can't read his notes or remember details for one week. It wasn't urgent at all. He was jacking the bill.

Getting my records from him was like pulling teeth.

Glad to have an ex hippie as my Dr. now!
We relate much better.
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lindisfarne Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Sep-22-09 09:08 PM
Response to Original message
21. At a major public university medical center, my sister is being pressured to list herself as a
specialist in a type of cancer she's not a specialist in (in addition to accurately billing herself as a specialist in the areas she is board certified in).
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The empressof all Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Sep-22-09 09:12 PM
Response to Original message
22. Common Practice in clinics
This is a constant strong arm with therapists working in non profit Community Mental Health. Every contact needs to be documented and you need a minimum of billable contacts per week. It's generally written into the job description and is generally monitored very closely by management. When you work with such a small margin every penny counts and most clinics just can't afford to carry those staff that can't bring in their salary and a little more.
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slipslidingaway Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Sep-22-09 10:17 PM
Response to Original message
26. Health, Money and Fear: Chapter 6 (The Pressure for Profits)
http://www.youtube.com/watch?v=1MNlsdJ1U14

3:47 minutes

The pressure for profits is talked about in this segment, the entire documentary was made by Dr. Paul Hochfeld, one of the Mad As Hell Doctors heading for D.C.



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TreasonousBastard Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Sep-22-09 10:54 PM
Response to Original message
27. A fundamental problem in all professional practices, and one...
that won't be solved by insurance reform.

Or single payer.

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Lydia Leftcoast Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Sep-22-09 11:08 PM
Response to Original message
29. That happened to my brother
He believes in 1) Spending enough time with each patient to figure out what's really wrong with them, and 2) Using non-surgical, non-drug methods of treatment whenever possible.

Two different group practices kicked him out for not generating enough revenue. He's now in private practice and enjoying excellent word-of-mouth from former patients.
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hunter Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Sep-22-09 11:53 PM
Response to Original message
31. How do you measure the productivity of a doctor?
By the health of their patients or by the $$$ they bring in???

Don't be silly, this is the United States! By the $$$ of course!

Forget outcomes, forget anything else. It's all about seeing the most well insured patients possible with the least number of lawsuits. You hardly need to be a doctor, you just have to have a neat white coat, an honest face, and a good bedside manner. You can sell 'em anything.
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uppityperson Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Sep-23-09 03:40 AM
Response to Original message
33. I worked for a dr once that paid 75% of going rate to employees, it was GREAT!
He told me when I applied that he did this because he spent more time with each person and made less money. Also that people paid in barter. I loved working there, doing true health care and getting paid in dungeness crabs.
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