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Right - and the risk is much greater seeing “unfiltered” emergency patients, compared to a patient who has had a full assessment in the ED, had surgical issues

Right - and the risk is much greater seeing “unfiltered” emergency patients, compared to a patient who has had a full assessment in the ED, had surgical issues ruled out, etc and was then admitted to the internal medicine service.

mikeyouse 4y ago
What risk? Malpractice coverage is provided by the hospital, or more typically, the private equity group that owns the ER physician practice. Last I looked, independent ER docs pay something like $15k more per year than IM docs for solo coverage... there's still quite a ways to go to make up that other quarter million dollars. I don't think the average person realizes that Blackstone is one of the largest employers of ER docs... it's not "supply and demand" that's increasing ER salaries, it's a private equity cartel that aggressively upcodes routine treatment and then sues hospitals to increase their reimburesment rates. https://en.wikipedia.org/wiki/TeamHealth https://en.wikipedia.org/wiki/TeamHealth https://tennesseelookout.com/2022/05/09/tennessee-health-billing-firm-accused-in-court-of-cartel-like-behavior/ https://tennesseelookout.com/2022/05/09/tennessee-health-bil...
- ghufran_syed 4y ago
  because besides money, maybe some human doctors find it emotionally difficult to tell someone their family member died because we made the wrong diagnosis, or took too long to make the correct diagnosis? By analogy, if you have home insurance, you don’t mind if your house burns down? Seems unlikely…
- seanmcdirmid 4y ago
  > What risk? Malpractice coverage is provided by the hospital, or more typically, the private equity group that owns the ER physician practice. Stress isn't alleviated just by insurance. Sometimes people care about doing their job right and "winning". ER docs are just put on the spot constantly. > I don't think the average person realizes that Blackstone is one of the largest employers of ER docs... It doesn't really matter, unless you want to claim that they employ more ER docs than the other systems put together, which I doubt they are even close to that. If Blackstone had a lock up on ER services, you would think they would not pay their ER docs as much to stick around since they would have fewer places else to go.
  - mikeyouse 4y ago
    The popular conception of an ER doc is completely divorced from the day-to-day reality.. This isn't House, they're not "put on the spot" constantly like they're on some island. They are part of a care team and they call for IM/ID/Cardio/Radiology consults when they have any question about a diagnosis. They certainly have stressful jobs but no moreso than the floor physicians or other providers who work the same shifts and who take the critically ill patients when they need care beyond the capabilities of the ER.
    - seanmcdirmid 4y ago
      If being an ER doctor is such a cushy deal for more money, doctors who would otherwise choose internal medicine would just choose that. There is plenty of variation in medical specialties, but, at least for people who are going to medical school today, I'm sure they are well informed what is in demand and what isn't. At least in this case, I don't see non-market forces at work (whereas medicine has plenty of those in other places).

mikeyouse 4y ago

What risk? Malpractice coverage is provided by the hospital, or more typically, the private equity group that owns the ER physician practice. Last I looked, independent ER docs pay something like $15k more per year than IM docs for solo coverage... there's still quite a ways to go to make up that other quarter million dollars. I don't think the average person realizes that Blackstone is one of the largest employers of ER docs... it's not "supply and demand" that's increasing ER salaries, it's a private equity cartel that aggressively upcodes routine treatment and then sues hospitals to increase their reimburesment rates. https://en.wikipedia.org/wiki/TeamHealth https://en.wikipedia.org/wiki/TeamHealth https://tennesseelookout.com/2022/05/09/tennessee-health-billing-firm-accused-in-court-of-cartel-like-behavior/ https://tennesseelookout.com/2022/05/09/tennessee-health-bil...

ghufran_syed 4y ago
because besides money, maybe some human doctors find it emotionally difficult to tell someone their family member died because we made the wrong diagnosis, or took too long to make the correct diagnosis? By analogy, if you have home insurance, you don’t mind if your house burns down? Seems unlikely…
seanmcdirmid 4y ago
> What risk? Malpractice coverage is provided by the hospital, or more typically, the private equity group that owns the ER physician practice. Stress isn't alleviated just by insurance. Sometimes people care about doing their job right and "winning". ER docs are just put on the spot constantly. > I don't think the average person realizes that Blackstone is one of the largest employers of ER docs... It doesn't really matter, unless you want to claim that they employ more ER docs than the other systems put together, which I doubt they are even close to that. If Blackstone had a lock up on ER services, you would think they would not pay their ER docs as much to stick around since they would have fewer places else to go.
- mikeyouse 4y ago
  The popular conception of an ER doc is completely divorced from the day-to-day reality.. This isn't House, they're not "put on the spot" constantly like they're on some island. They are part of a care team and they call for IM/ID/Cardio/Radiology consults when they have any question about a diagnosis. They certainly have stressful jobs but no moreso than the floor physicians or other providers who work the same shifts and who take the critically ill patients when they need care beyond the capabilities of the ER.
  - seanmcdirmid 4y ago
    If being an ER doctor is such a cushy deal for more money, doctors who would otherwise choose internal medicine would just choose that. There is plenty of variation in medical specialties, but, at least for people who are going to medical school today, I'm sure they are well informed what is in demand and what isn't. At least in this case, I don't see non-market forces at work (whereas medicine has plenty of those in other places).