My take: Heath Ledger, contracts, disease prevention

February 6, 2008

1) Heath Ledger died as the result of acute intoxication by the combined effects of oxycodone, hydrocodone, diazepam, temazepam, alprazolam, and doxylamine.

My take: Two narcotics, three benzodiazepines, and one sedating antihistamine. If a single physician was responsible for these prescriptions, that’s a serious error in judgment. It is more likely that Mr. Ledger received multiple prescriptions from different physicians around the world, perhaps not knowing the danger these medications have when taken together.

2) Residency generally gives little training in negotiating physician employment contracts.

My take: Another way newly graduated doctors are ill-prepared to face the real world. Remember, physicians are negotiating from a position of strength, as there are shortages in pretty much every area of medicine. Don’t lose this advantage.

There are no circumstances where you should be without a health care attorney and a copy of the latest MGMA Compensation Survey. When talking salary, negotiate in terms of MGMA percentile, rather than absolute numbers.

Remember, everything is negotiable. Without exception.

3) Hillary Clinton’s health care plan is partially paid for by disease prevention that her plan will emphasize.

My take: I wonder what she thinks of the recent study that debunks the myth that preventing obesity and smoking saves money. The bottom line is that healthier people live longer, costing more in the long run.

Universal coverage will cost more money. Period. Hillary/Obama will make this a central, contrasting theme against McCain, essentially rendering the federal election a referendum about whether the American people is willing to pay for universal health care or not.

From where I stand, I see it a 50/50 proposition either way.



Related posts:

  1. So much for prevention saving money
  2. Heath Ledger, accidental overdose
  3. The physician employment contract
  4. My take: Overcrowding, prevention, digital mammograms
  5. How the government is banking on prevention to save money
  6. Prevention of Heart Disease
  7. Universal health care: Slim chance?


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{ 12 comments }

1 Anonymous February 6, 2008 at 4:06 pm

do you really think everything is negotiable? for some organizations, there are many things that are not negotiable without involving more resources than it would be worth for the organization. if you are joining a two person practice, yes everything is negotiable. if you are joining a large multispeciality group, especially as a freshly graduated resident or fellow, very little will be negotiable.

2 Kevin February 6, 2008 at 4:14 pm

Re: “Everything is negotiable”

It doesn’t mean you’ll get everything you want, but every issue can at least be approached and talked about.

Doesn’t hurt to ask, worst that can happen is that they say “no”.

Kevin

3 Anonymous February 6, 2008 at 4:20 pm

I disagree 4:06, it depends on how bad they want you.
Kevin is right, you have the power by taking your little black bag and walking out the door.

4 Anonymous February 6, 2008 at 5:06 pm

And don’t sign restrictive covenants! These are recent additions by older doctors simply to keep younger doctors “in place”. Lawyers don’t use them when hiring a new associate as they think it undermines client-attorney relationships. However, older doctors are very quick to throw the doctor-patient relationship out the window. If we all refused to sign restrictive covenants, they will simply go away.

Underpaid in New York

5 DR. MARY JOHNSON February 6, 2008 at 6:06 pm

“Everything is negotiable”

Another reason my blog should be on your roll (not to mention standard reading for residents in training/public service).

Because my naive friend, (1) you put too much faith in the general integrity of attorneys (including/especially those representing physicians) and (2) everything is most certainly NOT negotiable.

Of course, since my take is not your take, I expect you’ll “moderate” this comment out.

6 Anonymous February 6, 2008 at 6:30 pm

what is the definition of negotiable? certainly everything can be discussed. i don’t think ‘it doesn’t hurt to ask, worst they can say is no’ qualifies as negotiable. i agree it doesn’t hurt to ask, but that in no way implies that there is some way you can get a different response.

anon4:20
how old are you, 12? :)
of course you can walk out the door. technically, you can always walk out the door. you can sign a contract and not show up too. you can violate your contract, so what does it matter? you have the power to leave, they have the power to not offer you a job. but if you are meeting, theoretically you are trying to find out if you can mutually benefit.

experience definitely helps in these matters. you can certainly probe concerning issues but, in the end, most practices have a personality that may or may not fit you. the practice personality may be of more importance to you than the individual personalities of the partners, many of whom may be terrific individuals.
ymmv

7 GingerB February 6, 2008 at 7:53 pm

I do not look for the Democrats to highlight that universal coverage will cost more money. It may be “mentioned” but they will certainly devote 10 times as many words to the coverage aspect than to the financial.

Everybody knows it will cost a fortune and nobody wants to pay.

I think this fellow hits it on the head. Don’t pick someone based on health care. The whole thing has to go through the Congressional wringer.

http://healthpolicyandmarket.blogspot.com/2007/11/when-it-comes-to-health-care-policy-it.html

8 Rositta February 6, 2008 at 8:55 pm

What the heck happened to personal responsibility? I too take pain pills and sometimes get pills from different doctors. It’s up to me to find out what interacts with what and consequence. I know it’s easy to take too much so if I get a migraine I write down the time I took a pill and make certain 4 hours have passed before I take the next one. Doctors need to talk to their patients and explain the danger…ciao

9 paul G, MS2 February 6, 2008 at 8:56 pm

“My take: I wonder what she thinks of the recent study that debunks the myth that preventing obesity and smoking saves money. The bottom line is that healthier people live longer, costing more in the long run.”

-people who live longer, healthier lives, will earn more money over the course of that life and contribute to the health costs. I don’t think you can really say that it’s cheaper for society to have productive members dying off prematurely, especially given the huge investment put into their education/upbringing/job training and experience.

10 Anonymous February 6, 2008 at 9:05 pm

My first post was attempt to be brief, but great job just throwing out an attack there.
My long point is this, know the ins and outs of your contract intimately and last time I checked there was a nationwide shortage. You are the commodity. I don’t see alot of docs out there begging for jobs or hoping to pay a physician for the privilege of taking over his practice when he retires. Those days are long gone. And I do agree both sides want something that is mutually beneficial and as always it depends on how bad each side wants it. It’s better to come to an agreement rather than to become the competition. The days of older partners getting rich off of the labor of younger partners has died off. It still exists in some parts of the country, but for the most part it has gone the way of the Dodo.

11 Kristie McNealy February 6, 2008 at 10:35 pm

Wow, wouldn’t expect so many people to get riled up by someone suggesting people negotiate their contracts. There’s a good chance the answer will be no, but if they want you bad enough, there might be some way office A can step up and offer something to prevent themselves from losing you to office B.

12 Michael Rack, MD February 7, 2008 at 10:23 am

“people who live longer, healthier lives, will earn more money over the course of that life and contribute to the health costs”

Not if these healthy long-living people retire early and start taking social security at age 62.

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