A Medical Career-Choice After 2012: Intern/ Resident/Fellow/Attending. The Semmelweis Society.

Hospital Salaries / Costs
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Remember, most hospitals accept our tax money (Medicare, etc.) and claim to be non-profits qualifying for a tax-deduction:  De facto, they are public utilities averaging ~5% profit according to the Wall Street Journal, but they are allowed to pay no taxes.   The question naturally arises why our hospitals spend 31.4% on administration, while hospitals in Canada spend 14%. 
 
This is not to say we should adopt Canadian medicine, only that we want to know how accountable to the public American hospital administrators are.  Which hospitals near you are  clean, friendly, kind, responsive?  How much do you want to pay the doctor, technician, nurse, janitor, administrator?  Which of them works at night?  Which of them sits in a large mahogany office?  Which of them comes to the bedside?  When you push the button to call for help, what happens?

Administrative costs in hospitals. Click here.

Salaries and other information on Hospital 1.
Salaries and other information on Hospital 2.
Salaries and other information on Hospital 3.

My shift away from hospital staff membership began in late '90's with dropping hand surgery privileges due to an abuse of my being called for only uninsured patients and no assistance from hospital for post op hand rehab. By early 2000, nearly all my cosmetic work was done in surgery centers or my own surgery suite. I dropped all third party payers and hospital work in 2003; have not had an inpatient since then. I knew my choice was corrct with the EMTALA enslavement. As a surgeon, I do retain privileges at a single small local hospital that offers only basic ER services. The ER has not called in over 7 years. I do not miss the mandatory committee assignments, the increasingly expensive staff fees or petty politics. I resigned from the trauma team, one of my truly gratifying forms of surgery, when my self coded submissions for reimbursement were altered by a certified coding clerk and then submitted to third party for payment. The clerk unbundled, upcoded, altered codes and many other questionably legal actions, all using my name. Protesting to the CEO, hospital staff and Executive Committee the absurdity of altering my coding and creating unnecessary liability, fell upon deaf ears. The succint response was, "she is a CERTIFIED coder and you, doctor, are not." Message heard loud and clear. Being the surgeon in the OR, performing the procedures, creating the peri-operative care documentation disqualified me to code the event unless I took a two week course on "coding excellence." For twenty years I had coded all my activities and procedures, the certified coders didn't know medial from maleolar, medial from lateral, or right/left from bilateral. Add in rotation, advancement, pedicled, myofascial and innumerable other flaps for coverage, and the coder is throwing darts at CPT at best. It was scary what doors of fraud the "certified coder" opened, all with the blessing of the trauma team, as the coding was done under my name. Hospitals are no longer collegial centers of knowledge, expertise and learning, they are profit centers and physicians are an expensive element which must be reduced. So today, it is cash only, exit strategy from medicine on a moments notice.