ER physician pay cut at Beth Israel Deaconess

[Birdstrike]

Its not the only option. Another way of looking at this problem is you have two options:

1) One ventilator, one patient. The one on the ventilator probably lives because we know how to treat ARDS with lung protective ventilation. The other probably dies.
2) One ventilator, two patients. Now the chances of either patient living are unknown because we don't know how well the vent splitting will work with rapidly changing compliance.

It's not about saving 1 vs saving 2. Its about saving 1 vs risking more and maybe saving 2 and maybe killing 2. That's a harder choice.

It might not be your only option. But if I'm this guy, it's the only option.

---

Members don't see this ad.

 

[TooMuchResearch]

Now that Dyson is making vents instead of $500 vacuums, our problems are solved?

 

[Birdstrike]

Now that Dyson is making vents instead of $500 vacuums, our problems are solved?

Your coronavirus will be cured and we'll have the most dust and dander-free windpipes of all time.

 

[alpinism]

You guys really want to get depressed one of my ER PA friends just got offered a position at one of the NYC Health public hospitals with a well known EM residency for 225/hr moonlighting shifts. The same place is currently paying faculty 215/hr for moonlighting shifts.

 

[Dr Mantis Toboggan]

they really do hate us, don’t they?

you doing OK alp? seen a lot of stuff on social and regular media about how bad it is, but hard to tell what’s real these days.

You guys really want to get depressed one of my ER PA friends just got offered a position at one of the NYC Health public hospitals with a well known EM residency for 225/hr moonlighting shifts. The same place is currently paying faculty 215/hr for moonlighting shifts.

 

[RustedFox]

We need a #physicianrevolution.

 

[thegenius]

What's your conversion rate for PUI's (persons under investigation) locally? Nationally, 83% of those suspected test COVID-19 negative. Some places are as high as 97% negative. On the other hand, New York is 64%. "Probable COVID-19" means "not COVID-19" the majority of the time.

These could (probably will) change, but for your location's current numbers, check here.

I wonder how good these tests are. My friend runs an Urgent Care in the Bay Area, he has I think 3 or 4 locations. He said his positive percentage is around 1-2%.

Then Hayward (a city in the Bay Area) opened up free testing and on their first day had almost a 25% positive rate.

It just doesn't make sense.

 

[TooMuchResearch]

WTF.

You guys really want to get depressed one of my ER PA friends just got offered a position at one of the NYC Health public hospitals with a well known EM residency for 225/hr moonlighting shifts. The same place is currently paying faculty 215/hr for moonlighting shifts.

 

[erdoc00]

You guys really want to get depressed one of my ER PA friends just got offered a position at one of the NYC Health public hospitals with a well known EM residency for 225/hr moonlighting shifts. The same place is currently paying faculty 215/hr for moonlighting shifts.

Must be some real sucker physicians in NYC right now.

 

[Brigade4Radiant]

Here is the joint statement from multiple critical care societies about multiple patients per ventilator. Bottom line - don’t do it.

Joint Statement on Multiple Patients Per Ventilator

The Anesthesia Patient Safety Foundation (ASPF), Society of Critical Care Medicine (SCCM), American Association for Respiratory Care (AARC), American

www.apsf.org

Any evidence of harm? Because ARDS is about proning and supportive care? What other option due you have except denying care which may have a heavy risk of liability

 

[Splenda88]

 

[miacomet]

I'd imagine its in the contract. Most of the time there is going to be an option to quit with some time frame notice, usually 90 days. But I'd imagine any lawyer could get you out of that if the contract terms were violated. If they for instance are contractually obligated to pay you and they can't, you shouldn't be contractually obligated to give 90 days notice. I can't imagine an attorney couldn't help get you immediately out of that contract.

I'm not saying that anyone SHOULD do that and abandon their hospital, but it may be nice to know if this is the case, because it would give ED docs a ton of leverage to say to their hospital if you do this, you will need locums tomorrow. Good luck.

If there's an addendum, you just don't have to sign it. It's a change to the contract you either accept or you don't.

Nurses are now making more than doctors. Everyone hates us.

 

[Splenda88]

 

[RustedFox]

View attachment 300453

Yep. Gotta preserve those administrative bonuses at all costs.

Thieves. Special place in hell for them.

 

[miacomet]

You guys really want to get depressed one of my ER PA friends just got offered a position at one of the NYC Health public hospitals with a well known EM residency for 225/hr moonlighting shifts. The same place is currently paying faculty 215/hr for moonlighting shifts.

I asked for $300 at HHC. They laughed. Apparently, we are worth much less than PAs. Northwell is only paying $200. I always said nursing was a better career.

 

[erdoc00]

I asked for $300 at HHC. They laughed. Apparently, we are worth much less than PAs. Northwell is only paying $200. I always said nursing was a better career.

I think it's great that nurses are making $5k to 7k per week dealing with the hardest hit hospitals. Nurses work their asses off and provide essential care and they are putting their lives on the line during this.

ER and critical care docs should see a similar "hazard" bonus. Instead physicians are making excuses in support of having their hours and pay cut.

 

[qwerty89]

I think it's great that nurses are making $5k to 7k per week dealing with the hardest hit hospitals. Nurses work their asses off and provide essential care and they are putting their lives on the line during this.

ER and critical care docs should see a similar "hazard" bonus. Instead physicians are making excuses in support of having their hours and pay cut.

Meanwhile...



"a friend of mine was recently hired for a similar position for $140,000"

 

[ShockIndex]

Any evidence of harm?

There is no prospective data nor will there ever be for this practice. This is an expert consensus statement. Do with it what you will.

 

[deleted836128]

If the hospital breaks the contract, is that not illegal? It's a contract. Wouldn't that give the physicians their the right to just quit without any 90 day out or whatever is stated in the contract? IDK, I'm not a lawyer, but it would seem that if a hospital just decided they were going to violate the terms of your contract, you'd have every right to quit on the spot.

Or you can be like my hospital and just send out new contracts to be signed when circumstances change...you either sign it, or you don’t have a job.

 

[deleted941485]

Must be some real sucker physicians in NYC right now.

Trust me they were suckers preCOVID. The idiots continue to work for the greater good while their admin put PPE under lock and key and cut pay.

Honestly when are these idiots gonna start calling in sick en masse? A lot of them are probably infected already.

 

[inspirationmd]

There is no prospective data nor will there ever be for this practice. This is an expert consensus statement. Do with it what you will.

One Ventilator, Two Patients: New York Hospitals Shift to Crisis Mode

At least one New York hospital has begun putting two patients on a single ventilator machine, an experimental crisis-mode protocol some doctors worry is too risky but others deemed necessary as the coronavirus outbreak strains medical resources.

www.medscape.com

Evidently it’s now being done. Should be interesting to read the publications on the outcomes data when this is over. Hopefully, the strategy doesn’t have to be duplicated nationwide.

 

[gro2001]

It might not be your only option. But if I'm this guy, it's the only option.

My point is that even if we are short on ventilators, saving one might be preferable to jeopardizing both. Which is why the Society for Critical Care Medicine, American Society of Anesthesiology, and the American College of Chest Physicians all came out with a statement against it:

SCCM | Consensus Statement on Multiple Patients Per Ventilator

The Society of Critical Care Medicine (SCCM), American Association for Respiratory Care (AARC), American Society of Anesthesiologists (ASA), Anesthesia Patient Safety Foundation (ASPF), American Association of Critical-Care Nurses (AACN), and American College of Chest Physicians (CHEST) issue...

www.sccm.org

I am not saying they are definitely right and the vent splitters are definitely wrong. I am saying however that its not obvious which way is right. I'd rather definitely save one than probably kill both.

 

[Birdstrike]

Add Alteon to the list of EM staffing companies cutting ER physician pay during the coronavirus outbreak

A Major Medical Staffing Company Just Slashed Benefits for Doctors and Nurses Fighting Coronavirus

Alteon Health, backed by private-equity firms Frazier Healthcare Partners and New Mountain Capital, will cut salaries, time off and retirement benefits for providers, citing lost revenue. Several hospital operators announced similar cuts.

www.propublica.org

 

[miacomet]

The VA just gave clinical staff a 20% bonus. Health and Hospitals in NYC is offering $300 an hour for EM docs. Weird how some places are paying more, others are cutting.

 

[GeneralVeers]

Add Alteon to the list of EM staffing companies cutting ER physician pay during the coronavirus outbreak

A Major Medical Staffing Company Just Slashed Benefits for Doctors and Nurses Fighting Coronavirus

Alteon Health, backed by private-equity firms Frazier Healthcare Partners and New Mountain Capital, will cut salaries, time off and retirement benefits for providers, citing lost revenue. Several hospital operators announced similar cuts.

www.propublica.org

I love how all the physicians in the article say "I can't believe they did that to us!" in regards to pay and hourly cuts. Where have these guys been the last 20 years? Why would anyone "trust" a hospital or CMG? I fully expect all the big companies to pass the cuts onto physicians if they can. That's business.

 

[Birdstrike]

I love how all the physicians in the article say "I can't believe they did that to us!" in regards to pay and hourly cuts. Where have these guys been the last 20 years? Why would anyone "trust" a hospital or CMG? I fully expect all the big companies to pass the cuts onto physicians if they can. That's business.

Yeah. I know. I was just talking to a guy I used to work with in the ED and we both agreed its shocking how not shocking it is.

 

[Birdstrike]

(edit: wrong thread)

 

[deleted109597]

I love how all the physicians in the article say "I can't believe they did that to us!" in regards to pay and hourly cuts. Where have these guys been the last 20 years? Why would anyone "trust" a hospital or CMG? I fully expect all the big companies to pass the cuts onto physicians if they can. That's business.

I expect many of them to cut hours to the bare minimum, and then when this is over, not increase them back quickly, which will nearly murder the docs still working

 

[GeneralVeers]

I expect many of them to cut hours to the bare minimum, and then when this is over, not increase them back quickly, which will nearly murder the docs still working

Vituity in my area has been just itching to cut physician salary (they are not on RVU) and this has given them an excuse. They are going to cut salary due to "unprecedented drop in volume", but my guess is that it won't go back up once things return to normal.

 

[alpinism]

they really do hate us, don’t they?

you doing OK alp? seen a lot of stuff on social and regular media about how bad it is, but hard to tell what’s real these days.

Thanks for asking and yeah I've been doing good. There's actually a major upside to the pandemic here namely way less chronic pain and drug seekers. Not surprisingly the COVID patients have scared almost all of them away and the few that are left don't put up much of a fight when they're discharged. It's actually pretty refreshing not having your patients screaming and threatening you during shifts.

 

[ShockIndex]

One Ventilator, Two Patients: New York Hospitals Shift to Crisis Mode

At least one New York hospital has begun putting two patients on a single ventilator machine, an experimental crisis-mode protocol some doctors worry is too risky but others deemed necessary as the coronavirus outbreak strains medical resources.

www.medscape.com

Evidently it’s now being done. Should be interesting to read the publications on the outcomes data when this is over. Hopefully, the strategy doesn’t have to be duplicated nationwide.

I just did a search of all COVID-related studies on clinicaltrials.gov and found nothing. Either they have not registered it yet, it’s not being being registered (good luck getting it published), or their IRB is putting on the brakes in light of the new consensus statement. I’m pretty sure that our IRB would not allow such a trial given the lack of equipoise if even an ambu bag was available.

 

[Dr Mantis Toboggan]

I texted a former resident who is at Elmhurst.

He says their current joke is that covid 19 cured vaginal bleeding in NYC...

Thanks for asking and yeah I've been doing good. There's actually a major upside to the pandemic here namely way less chronic pain and drug seekers. Not surprisingly the COVID patients have scared almost all of them away and the few that are left don't put up much of a fight when they're discharged. It's actually pretty refreshing not having your patients screaming and threatening you during shifts.

 

[RustedFox]

APP just announced a 10% paycut to us all for the indefinite future.
Just got the email a hot second ago.

 

[bravotwozero]

APP is holding a meeting for us to discuss 'changes in compensation', per the email i just got. Based on what RF says, I think I know what direction the 'changes' will go in.

 

[RustedFox]

APP is holding a meeting for us to discuss 'changes in compensation', per the email i just got. Based on what RF says, I think I know what direction the 'changes' will go in.

Yep. We were invited to a conference call tomorrow to "discuss".

I don't have much to say that hasn't already been said.

#physicianrevolution

 

[Cinclus]

Hours cut at our facility.

 

[WilcoWorld]

APP just announced a 10% paycut to us all for the indefinite future.
Just got the email a hot second ago.

FFS! Sorry to hear that man.

 

[TooMuchResearch]

If you want to open a national telehealth urgent care, I'm in.

Yep. We were invited to a conference call tomorrow to "discuss".

I don't have much to say that hasn't already been said.

#physicianrevolution

 

[deleted109597]

Yep. We were invited to a conference call tomorrow to "discuss".

I don't have much to say that hasn't already been said.

#physicianrevolution

Yep.
"Well, I don't agree with the new changes. I'll be happy to go work somewhere that pays me my worth. K thx bye"

 

[RustedFox]

Yep.
"Well, I don't agree with the new changes. I'll be happy to go work somewhere that pays me my worth. K thx bye"

What's bothersome to our admins is that they don't have a fiscally solvent company staffing their ER. Dun Dun DUNNN!

 

[RustedFox]

Yep.
"Well, I don't agree with the new changes. I'll be happy to go work somewhere that pays me my worth. K thx bye"

No joke:

I. just. might. do. that.
I do have options.

Note to all medical students and residents:

RUSTEDFOX'S RULES:

1. Have 3-4 months worth of liquid cash money honey in your bank account at all times. Once "perfect" jobs go sour in a hot minute all the time.
2. Keep your options open. Never put all your eggs in one basket.

 

[Backpack234]

I agree with #physicianrevolution

How do we do it though? Does that need a separate thread?

Is PPP enough? That's Physicians for Patient Protection btw, not the Paycheck Protection Program that will undoubtedly exclude most EM providers.

Is AAEM enough?

Or does something else need to happen? It's great that the problem has been identified. But what's the solution?

 

[bravotwozero]

Can you get physicians to band together to defend their profession? So far the answer to that question has been a big fat NO. This is all you need. A unified national front, with the threat of a mass walkout if demands are not met. Can this be made to happen? Every other healthcare profession seems to be able to do this except us...

 

[miacomet]

And...U Mass fired their docs: Wachusett Emergency Physicians P.C.. 100% pay cut.

 

[deleted109597]

Corporate Medicine to doctors and nurses: "We saw you were on fire, so we brought this gasoline..."

Now, from the “Just When You Think They Can’t POSSIBLY Get Any Worse” department… Earlier today, I had a mandatory conference call with our corporate management, for all the medical directors in our corporation. The first part of the call was thanking...

www.dailykos.com

 

[EctopicFetus]

Anyone willing to post the APP email.. 10% cut?

 

[bravotwozero]

Anyone willing to post the APP email.. 10% cut?

On behalf of Dr. ----,



Good afternoon providers.



Let me begin by concurring that today’s town hall call with APP was not at all informative. I think the best solution is to hold a call ourselves amongst the group. We can set that up for tomorrow. I know many may be on shift and unable to attend. You can get caught up by colleagues, or contact one of us locally to further address any outstanding questions. Your site medical director is your best place to start. I will lay out the basics here. Many, if not most, did not have an opportunity to ask questions on that call today. Personally, I have never seen or experienced a conference call where you had to dial in, wait for an operator to admit you to the meeting, and then get permission to ask a question on the call. So I don’t really know what to say about that set up. Except that it was ineffective.

Summary of cost reduction plan:

1. Removal of scribes
2. Matching shift times with volumes
3. 10% reduction in pay, as a “deferral”

Items 1 and 2 are a normal reaction to markedly reduced patient volumes, we would be doing this no matter what the scenario was that got us into this situation. It is being fiscally responsible, given the nearly 50% reduction in patient volumes. We must be good stewards of the balance sheet.



Item 3 is proposed as a “deferral” because if and when volume returns, and hence collections return back towards normal, they will pay it back over time. So it is more like making a loan to the company, as opposed to simply cutting pay rates. A more palatable solution. I can make no certain promises that every dollar is eventually returned, as no one can predict if and when volume returns. They propose returning the money over the same time period as it was withheld. So if they withheld over 4 months, it would be returned over a similar trajectory. Not a lump sum.



I will also add that executive pay (in the home office), RMD and medical director stipends have all also been cut by 10% across the board. So your clinical leaders who manage, and also work clinically, in effect are taking a 20% cut to their comp.



This is a very “rough draft” of what is proposed. Your site medical directors are already enacting the staffing cuts, and updating the schedules. Please check Tangier, and speak with your scheduler to confirm your shift start times. The Scribe America contract has been globally terminated and coverage will end April 30th. There is talk of potentially bringing back some scribe coverage in a “pay to play” type model, whereby providers desiring a scribe can fund it from their payroll. More discussion and clarification is needed on this item.



Let me end by saying that we are making every attempt to preserve jobs in this difficult situation. You cannot open a web browser or read a news feed without seeing how many companies are laying off millions of workers in every industry. Medicine is not immune. Other groups are enacting the same measures as we are to right-size the coverage, and prepare for the return to normalcy as quickly as possible. Many of the contract mgmt. groups are going much farther, and have furloughed APC’s, eliminated scribes, cut all bonuses and RVU pay, and so forth. Many small to medium sized ER practices will fold due to financial insolvency. Ditto likely for the private FSED space. It is simply too long to muster along with no cash flow when you have rents to pay, staff to employ, benefits to fund, and so on.



Keep an eye out for a scheduled system call. I will work to set that up. Your site medical directors are also well prepared to address your questions and concerns over the situation, so please confer with them as well to ensure you understand the changes.

 

[EctopicFetus]

On behalf of Dr. ----,



Good afternoon providers.



Let me begin by concurring that today’s town hall call with APP was not at all informative. I think the best solution is to hold a call ourselves amongst the group. We can set that up for tomorrow. I know many may be on shift and unable to attend. You can get caught up by colleagues, or contact one of us locally to further address any outstanding questions. Your site medical director is your best place to start. I will lay out the basics here. Many, if not most, did not have an opportunity to ask questions on that call today. Personally, I have never seen or experienced a conference call where you had to dial in, wait for an operator to admit you to the meeting, and then get permission to ask a question on the call. So I don’t really know what to say about that set up. Except that it was ineffective.

Summary of cost reduction plan:

1. Removal of scribes
2. Matching shift times with volumes
3. 10% reduction in pay, as a “deferral”

Items 1 and 2 are a normal reaction to markedly reduced patient volumes, we would be doing this no matter what the scenario was that got us into this situation. It is being fiscally responsible, given the nearly 50% reduction in patient volumes. We must be good stewards of the balance sheet.



Item 3 is proposed as a “deferral” because if and when volume returns, and hence collections return back towards normal, they will pay it back over time. So it is more like making a loan to the company, as opposed to simply cutting pay rates. A more palatable solution. I can make no certain promises that every dollar is eventually returned, as no one can predict if and when volume returns. They propose returning the money over the same time period as it was withheld. So if they withheld over 4 months, it would be returned over a similar trajectory. Not a lump sum.



I will also add that executive pay (in the home office), RMD and medical director stipends have all also been cut by 10% across the board. So your clinical leaders who manage, and also work clinically, in effect are taking a 20% cut to their comp.



This is a very “rough draft” of what is proposed. Your site medical directors are already enacting the staffing cuts, and updating the schedules. Please check Tangier, and speak with your scheduler to confirm your shift start times. The Scribe America contract has been globally terminated and coverage will end April 30th. There is talk of potentially bringing back some scribe coverage in a “pay to play” type model, whereby providers desiring a scribe can fund it from their payroll. More discussion and clarification is needed on this item.



Let me end by saying that we are making every attempt to preserve jobs in this difficult situation. You cannot open a web browser or read a news feed without seeing how many companies are laying off millions of workers in every industry. Medicine is not immune. Other groups are enacting the same measures as we are to right-size the coverage, and prepare for the return to normalcy as quickly as possible. Many of the contract mgmt. groups are going much farther, and have furloughed APC’s, eliminated scribes, cut all bonuses and RVU pay, and so forth. Many small to medium sized ER practices will fold due to financial insolvency. Ditto likely for the private FSED space. It is simply too long to muster along with no cash flow when you have rents to pay, staff to employ, benefits to fund, and so on.



Keep an eye out for a scheduled system call. I will work to set that up. Your site medical directors are also well prepared to address your questions and concerns over the situation, so please confer with them as well to ensure you understand the changes.

WOW... just wow..

 

[deleted109597]

"Dear APP,
**** off. Sincerely,
Dr. ---------

 

[miacomet]

National draft of health workers? To go and work in NYC with no PPE for no money? De Blasio has always been a dweeb, but this is beyond the pale. How about making all those lazy people getting unemployment work in hospitals?

Coronavirus Updates: De Blasio Wants A "National Service" For Healthcare Workers