MD Whistleblower

I recently booked a hotel in New York City where I hope to spend several delightful days this coming June.  During the booking process, the hotel’s representative read off a dizzyingly list of taxes and fees that I would be paying.  I don’t think I’ve ever been saddled with so many surcharges on any transaction in my entire life, except for the last time I booked a NYC hotel. I felt that I needed to call my accountant for guidance. Many hotels have become green with envy  (or should I say greed with envy?) over state and local taxing authorities who fleece hotel guests.  Why should hotels, who are highly trained fleecers, be left out? Fortunately for me, I won’t have a car.   Anyone familiar with NYC knows the insanity of bringing a car there.   Beyond the expense involved, and the seemingly impossibility of finding a parking space, there’s the sheer joy of taking a drive through midterm crawling through gridlock with horns bleating while receiving lovely...

It may seem odd that a gastroenterologist patronizes fast food establishments several times each week.  I’m in one right now as I write this.  I eschew the food items –though French fries will forever tempt me – and opt for a large sized beverage.  In truth, I am not primarily there for a thirst quenching experience, but more to ‘rent a table’ so I can bury myself in some reading.  Indeed, many thousands of New York Times issues have been devoured at these tables.  I saw a sign posted on the wall here that I had not seen before. Sorry, No Refunds Refunds?  How often can this happen in a place like this?  We all know that food items in these institutions are remarkably consistent, which is one of benefits that customers enjoy.  Your Big Mac or Whopper will taste the same in Pittsburgh as it does in Peoria.  I questioned the server on this new development and she explained that increasingly customers were demanding refunds for contri...

In our society, there are absurdities that simply defy reason.   In the past week or so, I have read about an individual who was denied the ‘right’ to bring a peacock on board a plane for comfort.   Just this morning, I read of a women who was cruelly denied to fly with her comfort animal – a hamster.   Readers are invited, if they dare, to use their preferred search engine to discover the tragic denouement regarding this hapless hamster. 'Let me comfort you.' * If a person needs a peacock, a snake, a pig, a kangaroo or a pterodactyl for airborne support and comfort, then perhaps flying is not for you.   The rest of us have some rights also.   Rent a car. The medical world has its own exhibits in the Theater of the Absurd.   Here’s our latest performance. Our medical practice received notice last week from The Centers for Medicare & Medicaid (CMS) that we owed the federal government money.   Apparently, according to federal brai...

To accomplish certain tasks, we need a little help from our friends.  No one can do it all, although many of us are more resourceful than others.  Some folks are adventurous and dive into a new arena with excitement.  They may be tinkerers who aren’t afraid to play with new gadgets.  Sure, they might break some china, but they are apt to widen their skill set and enrich their lives.  Others, eschew this dive bomb approach and prefer to wade cautiously into new experiences.  Their comfort zones are narrower.  They never break the china, but their personal growth is likely more stultified.  For some activities, we should simply call upon the professionals straight away.  Here are some examples of jobs that we should pay others to do for us. Cut down a huge dead tree on our front yard.          Replace damaged roof shingles. Investigate why smoke is seeping out of the hood of our car. Prepare our last will an...

Whistleblower readers know that I have spewed some vitriol toward the airline industry, where customer service goes to die.  Indeed, in a prior post I contrasted their routine harassment of frequent fliers with the individualized stroking that Apple customers routinely receive.   For sarcastic scriveners like me, the airlines are the gift that keeps on giving.  The target is so large that one can hit it from miles away with a blindfold on at night. Fun, fun, fun... Some, but now all, sources of customer angst include: The convenience and rationality of the TSA process (“Out with those dentures, Granny!”) The sumptuous meals served aboard. (“Exact change for the pretzels is appreciated.”) The plush and spacious seats which easily accommodate those with BMIs < 18 On-time performance (Do we really know what time is?) Truthfulness with regard to the occasional flight delay  (Pinocchio would nasally impale customers if he worked as a gate agent...

There is a steady push to change the way that physicians are paid.  No compensation model is ideal.  The fee-for-service (FFS) model has become Public Enemy #1 as it is felt to be responsible for overtreatment generating excessive costs and utilization.   Salaried physicians may be freed from the FFS conflict of interest, but it has other drawbacks including a diminished incentive to provide exemplary service to patients and to referring physicians.  Since physicians did not initiate compensation and health care reform decades ago when we should have, we are now being squeezed hard by external forces that will overcorrect on the system’s deficiencies.  It’s always better to fix your own house.  There should be a lesson here for other professions who are in need of some reform and repair.  Teachers, in my view, were dragged into the education reform arena, and will suffer because of it.  Attorneys have been smug and cavalier about the legal ...

I attended a medical staff meeting recently.  These are required meetings and attendance is taken, as was done when we were in kindergarten.   While some folks are interested in these meetings’ content, many are not and simply sign the attendance sheet and then slither out in a stealth fashion.   Sly doctors grab their pagers and then leave hurriedly pretending that they were summoned to an urgent medical situation, when they are actually heading for Starbucks.   One of the community hospitals I attend initiated a dastardly procedure when administrators would not post the attendance sign-in sheet until the conclusion of the medical staff meeting.   Under the threat of picketing, a massive walk out, letters to the local paper and other unspecified measures, the evil decree was rescinded. Who says that physicians have no power today? Sadly, most of these meetings have nothing to do with making us better doctors.  The agendas...

As detailed in Part I , FFS or Salaried Medicine, I was a salaried gastroenterologist for 10 years. I resigned, but not in search of the fee-for-service (FFS) cornucopia. The multispecialty group (MSG) that employed me had been purchased by one of Cleveland's medical behemoths a few years before I signed on. After happily practicing gastroenterology (GI) for several years, the corporate owner emerged from the background and forcefully exercised its ownership rights. The business edicts they issued conflicted with our professional mission to advocate and care for live human patients. For example, the community hospital that we had served for half a century was now verboten. This meant that our elderly patients who lived near this hospital, and had been treated there for their whole lives, now had to be hospitalized downtown, if they wanted us to be their physicians. You get the idea. While I acknowledge that these decisions promoted the corporation’s health, they jeopardized our p...

I am qualified to opine on physician compensation formulas, because I’ve spent hard time on both sides of the payment seesaw. For the first 10 years of my career, I was on salary. We were told, however, that we could earn productivity ‘bonuses’, but these rewards were trivial. An ‘employee of the month’ parking spot near the entrance would have been worth more, especially during the frigid Cleveland winters. After 10 years, I moved over to the dark side , where I was paid for each service I provided. In Part I this week, I present pros and cons of salaried medicine. I suspect that I've overlooked some of the advantages and drawbacks of paycheck medicine, so  I hope that readers will correct my errors and omissions. Good Stuff About Paying Gastroenterologists a Salary Lowers health care costs by underpaying specialty physicians Eliminates financial conflicts of interests. The colonoscope is not a capitalist tool. Reduces unnecessary medical procedures as gastro docs would rathe...

Last week, I bravely expressed vigorous support for medical rationing . No one has yet sent the ‘death panels’ after me and I still have a pulse. This week, emboldened by my continued survival, I tread again into dangerous terrain. I will offer support for another policy that is accused of being the cause of ongoing hemorrhage of the health care system. Who would risk public opprobrium by expressing support for a practice that is so corrupt and evil? The Whistleblower knows no fear. Caution! Any minors reading this post are strongly admonished to close this window immediately so that your impressionable minds won’t be irrevocably contaminated. I shall write the nefarious term in the smallest print allowable, hoping it will escape the attention of web censors and the D.C. Health Care Thought Police. Fee-For-Service-Medicine The hardest part of treating an addiction is to admit the problem publically. I stand before you with humility and hope. "My name is Whistleblower a...