Great post, thank you! As one of the hopefully non feline younger docs, a couple thoughts:
1. I was flabbergasted by this attitude during my residency. Maybe because I had read old books/seen old movies about what medical training was like, but it’s supposed to be hard! And it’s fun and worthwhile doing hard things. But there was such a big push for easier hours, less high standards from the teachers, etc, etc. And yes, the older docs couldn’t believe how coddled we were, and how much less independence we had. If you’ve never read pickwick papers dickens has some funny scenes about starting up your own surgical practice back in the day…
2. The greatest professional decision I ever made was saying no to the big salary, big bonuses, and big resources of big corporate medicine when I was looking for a job. I didn’t start my own practice, but went to work for a retiring doc who did. Small Christian practice, in many ways lacking the resources of the big corporations, but blessedly lacking a single bureaucrat! I 100% would have been fired during Covid had I taken the big money job, I am so grateful I was able to work somewhere small that cares for its employees and protects their consciences.
You sound very smart and very blessed. I finished my residency - general surgery with 1500 cases. Surgical residents today struggle to get 300-400 is what I hear.
Dr. Bob, I have a question. When you say, "private practitioner: he must come if called and take all comers regardless of insurance status", does that mean that doctors in the US are obligated to see all patients who ask? Are private doctors not allowed to choose their patients?
If you care to comment in another article, I'd be curious to hear more about the financial feasibility of working independently, especially with regards to liability insurance. I've heard that quite a few doctors retire early because the insurance is eating up so much of their income.
If you are on the staff of a hospital, you have to follow the rules to maintain your privileges to practice there. The specialist members of the Medical Executive Committee use the rules to defend their turf.. except for taking call where the younger doctors seem to get the call responsibility. Needless to say call usually involves taking care of emergencies and those tend to have much less if any insurance coverage.. Thus it is unlikely the doctor will be able to bill for his part of the bill. The hospital on the other hand frequently gets funding from the state. In Texas --DWI charges have risen so high to fund the cost of car wrecks due to alcohol related accidents. So, the recent hospital I worked at.. got plenty of Texas funding for trauma care.. and some specialty on call physicians got only what they could collect (usually nothing). Only when presenting the public documents -documenting how much that hospital had gotten.. was pressure able to be placed to ask the hospital to pay the on call surgeons in my specialty 650 dollars per night. Wow. Only by digging out the hospital rip off of the doctors and threatening to call the newspapers did they suddenly cave in.
Great post, thank you! As one of the hopefully non feline younger docs, a couple thoughts:
1. I was flabbergasted by this attitude during my residency. Maybe because I had read old books/seen old movies about what medical training was like, but it’s supposed to be hard! And it’s fun and worthwhile doing hard things. But there was such a big push for easier hours, less high standards from the teachers, etc, etc. And yes, the older docs couldn’t believe how coddled we were, and how much less independence we had. If you’ve never read pickwick papers dickens has some funny scenes about starting up your own surgical practice back in the day…
2. The greatest professional decision I ever made was saying no to the big salary, big bonuses, and big resources of big corporate medicine when I was looking for a job. I didn’t start my own practice, but went to work for a retiring doc who did. Small Christian practice, in many ways lacking the resources of the big corporations, but blessedly lacking a single bureaucrat! I 100% would have been fired during Covid had I taken the big money job, I am so grateful I was able to work somewhere small that cares for its employees and protects their consciences.
You sound very smart and very blessed. I finished my residency - general surgery with 1500 cases. Surgical residents today struggle to get 300-400 is what I hear.
Dr. Bob, I have a question. When you say, "private practitioner: he must come if called and take all comers regardless of insurance status", does that mean that doctors in the US are obligated to see all patients who ask? Are private doctors not allowed to choose their patients?
If you care to comment in another article, I'd be curious to hear more about the financial feasibility of working independently, especially with regards to liability insurance. I've heard that quite a few doctors retire early because the insurance is eating up so much of their income.
If you are on the staff of a hospital, you have to follow the rules to maintain your privileges to practice there. The specialist members of the Medical Executive Committee use the rules to defend their turf.. except for taking call where the younger doctors seem to get the call responsibility. Needless to say call usually involves taking care of emergencies and those tend to have much less if any insurance coverage.. Thus it is unlikely the doctor will be able to bill for his part of the bill. The hospital on the other hand frequently gets funding from the state. In Texas --DWI charges have risen so high to fund the cost of car wrecks due to alcohol related accidents. So, the recent hospital I worked at.. got plenty of Texas funding for trauma care.. and some specialty on call physicians got only what they could collect (usually nothing). Only when presenting the public documents -documenting how much that hospital had gotten.. was pressure able to be placed to ask the hospital to pay the on call surgeons in my specialty 650 dollars per night. Wow. Only by digging out the hospital rip off of the doctors and threatening to call the newspapers did they suddenly cave in.
Incredible.