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Dusn

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  • Avatar Dusn 
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    Status: Physician
    Posts: 198
    Joined: 01/02/2018

    Anne does bring up a good point that sometimes policies are discussed years in advance and maybe we can stop them if we speak up.

    The next change seems to be obvious: independent practice CRNAs replacing anesthesia and independent NPs replacing primary care doctors and others.

    (I’d also add that for many specialists the benefits of the compressed schedule were among the benefits sold to them when they were hired . .. which is partly why so many are pissed.)

    in reply to: VA docs, change to hourly from salary #252070 Reply
    Avatar Dusn 
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    It is unbelievably expensive it is to send a patient out to see a specialist because that specialist was not available at the VA.  At our VA the cost to send patients out to a surgical retina specialist to treat retinal detachments alone (a fairly small number of patients) costs about 2 million a year.  You could hire a lot of doctors for that amount.  I wonder if the plan is to get specialists to leave to speed up the privatization of the VA.

    in reply to: VA docs, change to hourly from salary #251982 Reply
    Avatar Dusn 
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    It’s going to drastically reduced the VA’s ability to hire and retain subspecialists.   As it is the VA pays about a third or less than private practice in many specialties.   In the past, however, sub specialists were often given a compressed tour so that they worked 4 longer days instead of 5 regular days.   This meant that in the past they had to use 4 days of vacation instead of 5 to take a week off.   Now that has changed, essentially cutting down the vacation and sick time.   I honestly can’t see any reason for a sub specialist to be a full-time employee of the VA.   I might consider working for them as a fee-basis contractor where they pay per patient seen.  Just to give you an idea of the discrepancy — as a contractor, paid-per-patient, the VA would pay me as much in one day per week of work  as I would make as a full-time employee.

    in reply to: VA docs, change to hourly from salary #251815 Reply
    Avatar Dusn 
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    It seems as though there is a bias toward highly paid specialists on this forum. Some of the salaries I see here seem astronomical. So that helps the optimism.

    Also there’s a bias here towards keeping a low cost of living, which helps our financial outlook.

    But to be fair, I do think that the increasing percentage of docs becoming employed and being bought out by private equity is a major problem and is not good.

    What we need are blogs and/or medical school/residency education how to to start and run a medical practice so that more docs stay self-employed.

    in reply to: What do you think about the future of medicine? #248593 Reply
    Avatar Dusn 
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    We hire people to become our partners, not to screw them over.

    Click to expand…

    I think, in many medical fields, that sentiment has changed….  But a contract negotiator still won’t help.

    in reply to: Physician Contract Negotation #243055 Reply
    Liked by billy
    Avatar Dusn 
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    I found it sort of ridiculous because it ignores the length of residency/fellowship training.  I know many female physicians who’ve had to undergo IVF or could not have children, likely at least partly due to waiting until training was over.   I think our residents get two weeks off after delivery.

    Better alternatives: CRNA, probably dental, many fields of business, law, engineering…

    Alternatives in terms of making the system more family friendly?  Shorten undergrad-medschool so that training is typically completed several years earlier like it is in other countries.

    in reply to: Times article about female docs and work/life balance #240803 Reply
    Avatar Dusn 
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    What area of the country are you?  What’s the noncompete?  What leverage does she have?  I agree, your wife is getting severely underpaid.   Ophtho is a predatory field with large noncompetes, where younger ophthalmologists are, IMO frequently getting screwed, and somehow both Lizzie and mjohnson are correct in the range of salaries they’ve quoted – despite there being such a large disparity in their numbers.   I think the higher end of salary range really has to do with having ownership, ASC etc.

    I would apply to other jobs so that she can go to the negotiating table with higher offers or leave if they don’t give her what she wants.   Is there a VA nearby?  Because the VA will probably pay her about 100K higher than her current salary with likely better benefits (and will not be restricted by her noncompete).  If they know she can’t leave, unfortunately her negotiating power will be limited.

    Unfortunately it sounds like they’re using her to build up their satellite clinics without adequate compensation.

    I’d read the book “Never Split the Difference” and watch some videos on negotiating on youtube (Deepak Malhotra is good: https://www.youtube.com/watch?v=km2Hd_xgo9Q ).  But I think she also needs some leverage from competing job offers.

    And if she ever decides to go out into solo practice, this blog might be a good resource:

     https://solobuildingblogs.com/2017/07/30/my-story-why-i-opened-my-solo-practice/

     

    in reply to: Advice on academic ophthalmology contract/salary??? #240725 Reply
    Avatar Dusn 
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    I think they’re ultra paranoid about any file sharing — sending files out or putting any files on their computers.   You can’t even stick a USB drive into a VA computer.  To be fair, I’m sure the VA is a huge target for ransomware and they’d make national news if there’s a large data breach.   So as long as the forum can’t do that I doubt they’d care.

    in reply to: I can access the forum from my VA computer??? #240521 Reply
    Avatar Dusn 
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    WashingtonPost, “Democrats back off once-fervent embrace of Medicare-for-all:”

    https://www.washingtonpost.com/politics/democrats-back-off-once-fervent-embrace-of-medicare-for-all/2019/08/19/13c76ffe-c28b-11e9-b5e4-54aa56d5b7ce_story.html

    And we haven’t even gotten to the general election season yet… let alone getting the bill through congress, and then the political pressure from lobbying groups, and then the general public freak out about losing their insurance plan…

    Honestly, if I were a politician I wouldn’t want to have any responsibility for the healthcare system.

    Avatar Dusn 
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    Well, it turned into a political thread (guess I shouldn’t have been surprised!). I understand this is an important sociopolitical issue, but I don’t want to jump into a flamewar as a new poster, so…

    Guess the advice is: keep costs low, save money, and treat it like a possible illness, job loss, or divorce? I’m wondering about stuff like: I’m probably going to have more money coming in now than I will in the future, does that mean I should be more conservative than I otherwise would (more bonds relative to stocks)? Or should I put more in stocks to build capital while I’m able? Does the fact that I’d be paying lower tax rates later make tax-loss harvesting less useful? Stuff like that.

    Click to expand…

    I think the advice is not to worry about it.  “Socialized medicine” is irrelevant. Don’t change your financial plan.

    Avatar Dusn 
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    1) Many specialists in Canada make far more than specialists in the US.   Ophthalmologists in Canada frequently make >1mil, so do interventional radiologists.  They also have far less malpractice and insurance headaches.  So socialized medicine, by itself, does not necessarily mean physicians are going to be paid less.

    2)  Unfortunately in the US the physician lobby is very weak compared to pharma, insurance, etc.  So in the US, physicians will probably be paid less.   But we’re going to get paid less with or without socialized medicine; physicians get cuts to reimbursement every year regardless but I have yet to see pharma get cuts.  The problem is our weak lobbying groups and the fact that political lobbies have such a huge influence on how our tax money is spent.  I don’t see private insurance acting much better than the gov’t in this regard.

    3)  At least in my speciality, the biggest issue for new grads is Private Equity buying out all the practices before they make partner.  Now PE is learning how to buy out all the smaller referral practices to force large groups to sell out at a lower price.  That’s a threat that is here and now and shows no signs of stopping.  Socialized medicine won’t matter much once physicians have become like the pharmacists working for Walmart.

    4) Socialized medicine might solve the biggest issue with FIRE (how to pay for healthcare).  If socialized medicine succeeds (doubtful), there will likely be mass retirements.  Save up and at least you can enjoy early retirement with the rest of us.

    Avatar Dusn 
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    Also I think COBRA coverage (which I’m glad for) was supposed to be the main purpose of HIPAA originally.   That P stands for “portability” not privacy.   I’m not sure how all the excessive privacy regulations got wrapped into it or if they are really even part of it or are made up by “inspectors” who don’t actually know the law.

    in reply to: HIPAA Nonsense #239605 Reply
    Liked by Zaphod, billy
    Avatar Dusn 
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    Agreed.   Meanwhile the only people that I really don’t want to have my health information (insurance companies) already have it and apparently can easily share that health information amongst themselves and with future insurance companies that I may want to buy a policy from.

    in reply to: HIPAA Nonsense #239599 Reply
    Avatar Dusn 
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    Heading towards a recession with astronomical levels of national debt is not my idea of fun.

    in reply to: HUGE sell off today! #239003 Reply
    Avatar Dusn 
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    I’m sure anything that could help her (or both of you) get more rest and sleep in those first few months would be greatly appreciated.

    Congrats!

    in reply to: Ladies – Help! #236813 Reply
    Liked by AZPT
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