Yet another new medical TV drama

“'The Resident’ follows an idealistic young doctor who begins his first day under the supervision of a tough, brilliant senior resident who pulls the curtain back on all of the good and evil in modern day medicine.” So says the article announcing Fox’s pilot for a new medical TV show.

As opposed to all the other medical dramas, this one features an idealistic young doctor and a tough, brilliant supervisor. How original.

I tweeted the show's premise and got several humorous replies prompting me to write this post.

There is no such thing as an original medical show. Original would be a resident sitting in front of a computer 75 percent of the time and then leaving the hospital in the middle of a great case because of work hour restrictions. While at home he plays video games for five straight hours.

Someone wondered if “The Resident” would find romance—possibly in a convenient storage closet. I wouldn’t know about that because I trained at a Catholic hospital.

Another asked if there would be a tough staff with soft hearts, a hospital administrator who put profit before patients, a second-generation physician who cracks under pressure, and a renegade doctor who breaks all the rules but saves the day.

What about a show with overworked, stressed, but oh-so-average attending physicians and idealistic, but basically inept residents?

I’d like to pitch an idea. It’s called “The Administrator” and follows an idealistic young deputy assistant junior vice president who begins his first day under the supervision of a tough, brilliant hospital CEO who pulls the curtain back on all of the evil and none of the good in modern day medicine.

Think of all the dramatic meetings involving committees, ad hoc committees, lean, six sigma, budgets, root cause analyses, public relations, whether to buy a third robot, and so much more. True to life, the administrators never leave the C-suite*.

*C-suite (def): A widely-used slang term collectively referring to a corporation's most important senior executives. C-Suite gets its name because top senior executives' titles tend to start with the letter C, for chief, as in chief executive officer, chief operating officer and chief information officer. [From Investopedia]

Thanks to the Twitter folks who contributed: @smootholdfart, @DrDes1970, @geekpharm, @JessicaDeMost, @DrMikeSimpson, @jsekharan, @mjaeckel

Why is medical school tuition so high?

A couple of weeks ago, BoingBoing posted a picture of a tuition and fee schedule for San Diego State University in 1959. Tuition was free for California residents but they still had to pay $33 for materials and services and $8 for student activities. Nonresident tuition for a full-time student was an additional $127.50. These charges were apparently all per semester.

Using this handy inflation calculator, the total per semester cost for a California resident of $41 equates to $340.16 in 2016 dollars, an inflation rate of 729.6%. Free tuition ended in 1970. Current tuition and fees at San Diego State for the year are now $7084 or $3542 per semester—compared to $340.16 that’s a 941% increase.

Just for fun I decided to run the numbers for my medical school tuition. In 1967, my first year, the total tuition for the year was $1200 or $8674.06 in 2016 dollars. The current tuition for the private medical school I attended is $52,000, a 499% increase.

Medicine, like air travel, once was fun

A Wall Street Journal blog about a reunion of employees of American Airlines lamented the good old days of air travel. Here's an excerpt:

"They came together to celebrate the days when flight attendants in white gloves hustled to serve you, gate agents doled out upgrades and arranged seating so families could be together, and managers worked flights with the single mission of ensuring excellent customer service."

The employees told tales of the fun they had and the camaraderie they shared. The passengers had fun too.

One retiree said of today's airline employees, "They don't look like they are having any fun at all."

Certainly the same can be said of today's passengers.

I'm usually not a fan of the airline-medicine analogy, but I'm going to make an exception here.

Back in the day, those of us in medicine had fun too. Don't get me wrong. It wasn't at the expense of the patients.

We always approached our patients with a proper attitude of respect. But it was OK to enjoy those encounters and also the fellowship of colleagues. We helped each other out, and we did it with spirit and camaraderie.

Not anymore.

All we read about now is how doctors are burned out, stressed, depressed. We battle with electronic records, hospital administrators, clipboard carriers, third-party payers, the government and just about everyone else.

What happened to the fun? It's all about the money.

David Shaywitz in Forbes: "The view from the front lines suggests that hospitals and care delivery systems are obsessing like never before on doing whatever they possibly can to maximize their revenue. They are consumed, utterly consumed, by this objective."

He added: "Many (I’d say most) providers and provider groups feel that they are locked in a deadly battle with payors (and increasingly, other providers) for their livelihoods; many feel they are having to work harder and harder to bring in the same (or less) money then doctors a generation ago. Many feel that the profession has lost the autonomy and respect it used to enjoy, and that providers are now viewed as mechanized assembly line workers, held to strict quantitative “quality” metrics that rarely capture the complexity, or essence, of the patient experience."

I believe what Shaywitz said is true. Can anything be done or is it hopeless?

Performance goals for hospital CEOs discourage change

A big problem with changing the focus of healthcare in the United States is that hospital chief executive officers are incented to produce profits for their institutions.

This chart from Kaiser Health News shows that the goals for most of the CEOs of major hospitals and health systems are profits. Growth and more specifically, admissions growth, are also mentioned.

It also lists CEO compensation figures, which are quite impressive. In addition to their hefty salaries, most CEOs also command large performance bonuses based on meeting financial goals.

According to Becker's Hospital Review, CEO pay has risen over 4% per year since 2009 with an increase of 4.8% this year.

All this in the era of the $546 charge for 6 liters of saltwater and the $73,002 charge for an emergency department visit for a urinary tract infection.

If you were a hospital CEO, why would you want to emphasize preventive care and outpatient services when your bonus is tied to profits, admissions and growth?

Everyone is entitled to make a living. And for sure most doctors do very well. But doctors are being squeezed on many fronts—declining reimbursements, need to purchase expensive and time-sucking electronic medical records software, more ICD codes, rising overhead to name a few. They are being forced to sell their practices to hospitals. Once the majority of physicians become hospital employees, their incomes will no doubt be squeezed further.

The public is demanding more accountability and transparency from hospitals and more emphasis on keeping people well rather than treating the sick.

Yet those who run hospitals have no reason to stress wellness and every rea$on not to. Don't look for anything to change soon.

In my next life, I want to be a management consultant

I once blogged that in my next life, I wanted to be reincarnated as a weatherman. You get to make predictions and have no accountability when they are wrong (except for one Washington, DC weatherman who was given a "time out" after an erroneous forecast).

I know it can be stressful when you have to stand on the beach in front of a TV camera and try to keep your cap on during a hurricane.

But even so, it seems a bit easier than being a surgeon, a job which is very stressful and carries strong penalties for errors—especially for the patients.

Another occupation that is similar in circumstances and results to meteorology is that of management consultant. They advise, and they leave. They don't see the aftermath of their actions nor do they suffer the consequences. They also make a lot of money.

Wide disparity found in hospital charges for appendicitis. Why?

If you wonder why hospitals are under fire for outrageous and often baffling accounting practices, look no further than a brief paper published last month in Archives of Internal Medicine.

 

Hospital charges for straightforward appendectomies done for acute appendicitis in California in 2009 were examined with the following inclusion criteria:

• Patients between the ages of 18 and 59
• Hospital stays fewer than 4 days
• Discharged home

For the more than 19,000 records reviewed, the median hospital charge was $33,611 with a low of $1,529 and a high of $182,955. Not included in the article but mentioned in news stories about the paper were more details about the care of the two patients at the extremes of charges.

From the Huffington Post: “The costliest bill, totaling $182,955, involved a woman who also had cancer. She was treated at a hospital in California's Silicon Valley. Her bill didn't show any cancer-related treatment. The smallest bill, $1,529, involved a patient who had her appendix removed in rural Northern California. Otherwise, the cases were similar: Both patients were hospitalized for one day, had minimally invasive surgery, and had similar numbers of procedures and tests on their bills.”

A California Healthline story about this clarifies the issue. It said,“Dave Glyer, CFO for Community Memorial Health System, said that the study ‘assumed that hospital charges matter when they don't,’ making it ‘completely off base.’ He said that insured patients pay rates negotiated by health insurers and that certain uninsured patients are aided by assistance programs.”

It’s all clear to me now. Hospital charges don’t matter.

What if you have no insurance and are not one of the “certain uninsured patients” who are aided by assistance programs? You are on the hook for the entire bill unless you can negotiate too.

What’s not clear is how the median hospital charge for a simple procedure such as an appendectomy can be $36,611 with such a large variation. 

May we see an itemized bill for the $182,955 please?

I Missed My Calling: Hospital Execs’ Pay Astronomical

This is probably not news to many but according to data recently published by the Connecticut Health I-Team, hospital executives are being paid handsomely .

Figures from 2009-10 reveal that 18 executives in Connecticut, a state with only 30 hospitals, made over $1 million per year.

Some of these figures include retirement packages. The top earner was the outgoing president of Hartford Hospital, who made nearly $7 million, with “all but $1.1 million of it nontaxable and retirement benefits.”

Below is a table from the Connecticut Health I-Team showing the top 15 highest paid executives.

Some of the hospitals, Yale-New Haven, St. Raphael's and Hartford, are large. Most are between 300-400 beds, but #13 New Milford is only 85 beds.

I realize that hospital executives have a lot of responsibility, but usually when they make a mistake, no one dies. I doubt they are sued very often either.

When I am reincarnated, I thought I wanted to be a weatherman [See my blog about this here] or maybe a consultant (both jobs with good pay and no accountability), but perhaps hospital executive is the best choice.

Oh, and how’s your retirement package looking these days?

[This blog appeared on Sermo yesterday and 95% of doctors who voted felt that hospital execs were paid too much (surprise) and only 13% of doctors felt that their retirement situation was "all set."]