Weekend Open Thread

JBuzz' update on 1Mom from last night:

They are releasing 1Mom (today.) They didn't install the vacuum pump in her wound because she would have to be there for another two days. She ate all of her breakfast even though she is still nauseated. She is much better today after they repaired her wound yesterday. She increased her food intake which is very good. Hubby and Phyllis decided they would just go home and skip the rehab center. She will have in home care as well as in home therapy. They are both happy with that instead if dealing with crap institutions.
Immediately, the family circled the wagons and prepared for her return home. Her sister bought her a hospital bed and hubby rented one until it arrives. Hubby's sister and her husband went to the house and got everything ready for her homecoming. Mom's sister and boyfriend will stay with her tomorrow while hubby runs out for the supplies and meds they need. Thank God for their family.
Mom says her pain is down from an 8 to a 5. She didn't get sick after each meal. That's progress. She's praying for a good night's sleep tonight. These are updates from throughout the day. Hubby is so thankful he can have her at home where he can oversee her care. He hated the idea of the rehab center where he couldn't be with her 24/7.
They want to thank everyone who has been praying for them.

All Pets Day
Open Thread

It's the return of All Pets Day here at RS!

Post a photo of one of your pets, past or present, and let the voting begin. Give the name of the pet and any extra information you want to include. Winner will be announced at 7PM Eastern as determined by the most votes and then enshrined in the "Pets of Fame" tab.

RS Recipes

By popular demand, I am including a recipe tab here at RS. Please share your favorites!


- Post clear ingredient lists and procedures. Try and minimize confusion or having people ask questions.
- Post a picture of the finished product if you have one.
- If your recipe is one on a food website, do not just post a link. Try to give a summary and photo as well.
- Recipes for your favorite coctails are encouraged.
- Please do not post things like: "Open can of beans and dump on toasted bread." Serious recipes only, thanks.

Ultimately, I prefer for you to actually post the recipe yourself as links change or are deleted on websites all the time.

Prayer Circle

This page is open to those who wish to gather in prayer or for anyone asking for prayers for themselves or others.

The War
- by Doc Holliday

I have consolidated several posts by Doc Holliday that discuss the state of his current workplaces. They outline the age-old issues facing every large or aspiring business with regards to competing and controlling factions and the self-destructive nature these groups have on a business when focus is lost on the end product and instead is given way to power and control.

So thanks, Doc. While your nurses were eating fatty foods and making Tik-Tok-Twerking Videos, you were doing something productive!

Note: This is not the Daily Open Thread. *************************************************************************************************************************
Remember I told you I would write a bit about the ongoing battle between my group and the hospital? Well, here we go.

The War - Part 1

An introduction...

To understand this you must understand that a Hospital is a separate business from the various doctors that work in the hospital. Doctors may work for the hospital as employees, or they may be work in the hospital as private doctors if they have "privileges"--which means they have the permission of the medical staff and the hospital to work there. Doctors work together as "the medical Staff" to pass by laws, which regulate how the medical staff operates and how the hospital interacts with them. The second thing to understand is that the Administration of a hospital is interested in the perpetuation, expansion, and maintenance of one thing, and one thing only--their power and it's associated monetary rewards. They will always start every policy with some phrase to the effect of, "Let's all agree we're here to provide the best patient care possible...." This phrase is usually trotted out just before they do something that screws both the patients and the staff, including doctors. Similarly, the administration is also interested in keeping the Board off their backs, which is easy to do with the appropriate massaging of numbers.

Knowing these two things, you can see a power conflict immediately--the Medical Staff has certain needs and goals revolving around patient care and what they do and how, and these often conflict with the goals of the suits in the Administration, who want control, prestige, power, and to keep the Board as comatose as possible. This problem is magnified in our town, where there is only one hospital. Competition blunts it in a town like Birmingham, where there are a multitude of hospitals. My group started off as a hospital employed group, then we got tired of the hospital's crap, and left and became a private group, but still worked in the hospital. That progression of annoyance with the hospital's endlessly critical, ignorant, and controlling behavior marks the beginning of The War.

The War - part 2

Rumblings of war

I said the decision to leave and become a private group was the beginning of the War. That was certainly true for us, but the first battle of the War actually involved, not us, but the nursing staff. Here we have to go back and understand the Administration's desire to have absolute, unquestioned control over every entity in the hospital. So they first attacked the nursing staff.

The nursing staff at our hospital at the time was fully staffed with excellent nurses. There are 3 nursing schools in this small city, so we were well supplied with new blood, and the loyalty of the older nurses was rewarded with a special payment system that allowed flexibility in scheduling for less desirable shifts. The nurses were very happy with this system.

Enter a new nurse manager named Elaine. (Not her real name, but close enough) Nurse managers are hired by Administration, and are generally in house talent--someone who has been there for years. Elaine was an outsider, and got the job over a highly respected nurse who had been there 30 years. As you might expect, disaster ensued. Elaine, with the full blessing of Administration, ended the differential pay which had rewarded the loyalty of the long term nurses. Not only did she end that, but the new pay scale made it more profitable to drive 40 minutes down the road to work at one of the UAB Hospitals--and they did. To this day, we are more than 60 nurses short, and cannot hire enough, even with 3 nursing schools in town. Elaine left, but the damage she left behind remains. We are now understaffed dramatically, and many nurses are now travelers, who have no particular loyalty and are of lower quality in general.

The Administration did not care--they had won the first round. The nursing staff's cohesion was broken, and the Administration had thereby removed one power competitor from the field.

The War - Part 3

The Battles between my group and the hospital

So having wrecked the nursing staff, the Administration needed a new target. That would be us, the hospitalist in our private group. To understand why, an explanation is in order. We are one of two hospitalist groups at my hospital--the difference being that we are totally private and do not receive ANY money from the hospital. On the other hand the other group is sponsored by the hospital, and receives a stipend of $3 million per year. This subsidized group has NEVER been able to recruit a sufficient number of doctors to cover the hospital, so the Administration asked us to begin to work at the larger of our two hospitals, which we previously had not worked in. We agreed. We rapidly expanded from 2 docs to 8, and we now see 1 in every 3 patients in the hospital. We also quickly eclipsed their group's size and productivity. And as we did so, their hostility to us increased. They did not like our system for seeing patients and they attacked that system, they attacked some of us individually, and they constantly were trying to exaggerate small issues to imply we weren't doing our jobs properly.

You might be curious as to why they would attack a successful group. In so doing you have answered the question--we were making their group look bad, and they were concerned that the Board would awaken from their coma, and ask "Why are we giving this other group $3 million, when they can't keep up with the private group?" So they spent enormous effort trying to develop criticisms they could relay to the board and use as a cudgel to threaten us with.

Then they proposed we merge with their group. Having left their clutches just a few years before, we politely declined. That conversation was what enlightened me to their true purpose--they were trying, once again, to get control of us, as we are opinionated and often disagree with their plans, particularly my partner who is the head of the group, and who is both a doctor and a lawyer. In essence, they were trying to shut us up.

The War - Part 4

The Administration Wrecks another Service...

So as I noted before, the War isn't just about my group versus the hospital. Let me see if I can state, as plainly as possible, the Adminstration's goal: The Goal is to consolidate control and power by reducing the medical staff to employees of 3rd party entities. The medical staff is the biggest thorn in the side of Administration. The bylaws allow the docs to block many of the more egregiously stupid or destructive ideas of the Administration. Like any group of Totalitarians, the Administration hates this restriction on their authority. So they seek to make everyone an employee of a staffing company, so they can then go to that company and demand the company get rid of troublesome docs. Of course they would do so quietly, to hide their involvement and keep their hands clean. This is not speculation--they have done it to our pulmonary docs.

We have an excellent group of very well respected pulmonary critical care docs who have been there for years. The Administration, having hired yet another outsider, this time for COO, suddenly decided they wanted a new intensivist group and closed ICUs. Our own Pulmonary group was blindsided--but they put in a bid, asking for help with recruiting 2 new docs to provide all the coverage the hospital wanted. The Administration chose an outside group to provide the service, spending AT LEAST $8.4 million dollars a year for something the native group would have done for around $1 million. As you can imagine, this national group has a few good docs, and a lot of average or worse docs. NONE of them live here--the hospital has to fly them in and house them, and it takes 4 of them to cover 24/7. So that $8.4 million above is way short of the full cost. But again, they do not care. They have now reduced the power of one of the most respected groups in the hospital, and they count that as a win. And the Board? They are still sleeping.

The War - Part 5

The Biggest Battle So Far

So let's state it again: The Administration's goal is to consolidate control and power by reducing the medical staff to employees of 3rd party entities. Having wrecked the pulmonary service and introduced a lower quality 3rd party Intensivist group at ENORMOUS cost, the Administration with their new COO turned their attention back to us.

Our hospital has 2 facilities. At the smaller facility, my group had held the exclusive hospitalist contract. Administration quickly announced they would not be renewing our contract and they wanted bids for a new group at this smaller hospital. Their excuses were incredibly lame--the new COO blatantly lied to the Board about our performance, then lied to us about the reasons for the failure to renew, even claiming we were "Hard to get in touch with" despite the fact that there are full time nurses who answer our calls and the nursing staff overwhelming praises how easy it is to get us on the phone.

We did not take this lying down. We had heard rumors this was coming, and had been running billboards to develop name recognition, we started an internet campaign for supporters, and we basically forced the hospital to answer to the press about what they were doing. Needless to say, they didn't like that AT ALL. We even had one of our black doctors write an editorial about how administration didn't reflect the racial makeup of town. (Dirty leftist argument? Maybe so, but this is War). In the end, they rewarded the contract to a combination group made up of THEIR OWN HOSPITALIST GROUP plus a small recruiting company. In my opinion, this was their way of further covering for their own decision to fund the other group to the tune of $3 million a year.

So we lost out. But in so doing, they have made a terrible and expensive mistake, which we will explain in the next section.

The War - Part 6

The Administration Steps on a Landmine.

So with the change to the contract at the smaller of the hospital, it would seem the Administration has made an enormous mistake. Allow me explain. My group, over the course of the last few years has acquired the contracts for admitting virtually all the patients from all the private docs in town. Importantly, this means that we have ALL THE PATIENTS WITH INSURANCE. In addition, according to the By-laws, private groups have the right to choose who admits their patients--and that means us, for the vast majority of patients.

So what's the big deal? Well, our current status owning all the contracts means the new group will be left with unattached patients (people with no doctors) with no insurance. Good luck paying your docs, administration!

Not only that, but Administration's aggressive anti local doctor behavior has so rattled the docs in the other group that several of them are leaving--they are simply disgusted with the Administrations behavior. This is a HUGE PROBLEM for the Admnistration-remember, this is the group that has NEVER REACHED FULL CAPACITY which caused us to start working at the larger hospital. Now they need a total of 30 Docs--and they started with 17, and 5 have quit. So they need to recruit 18 doctors to little ol' Tuscaloosa, something they have never accomplished in more than 10 years. If they can't--and they can't--the hospital will have to hire traveling doctors. These are called Locum tenums, and they are ridiculous expensive.

So the hospitals belligerence has left them with a situation of losing docs, having to recruit, pay locums, AND THEIR PATIENTS HAVE NO INSURANCE. A total and utter disaster!--They have certainly earned it!

The War - Part 7

So the War continues after a brief hiatus at my hospital.

The hospital's new selected group has started seeing patients at our smaller campus. They are still having a difficult time recruiting--I know some of the people an hour away in Birmingham who they have been trying to recruit, and they report the offers are being laughed at. But never fear! The morons who run our hospital will persist in their foolishness.

Why? Well, let's remember this has to do with CONTROL and MONEY and NOT patient care. And as I mentioned in the last section, they are being eaten alive already by money issues. The big new conflict now is they are actively stealing patient from us, by forcing the consults to go to their group, even though the consult specifies us. This is in direct violation of the Bylaws which the hospital is supposed to run on, and so you know what has happened--we are suing them. We had an initial hearing and the court did not provide injunctive relief (we thought that would be the case) and so now there will be a trial. I'm not sure when just yet, but it's coming and we hope for a major beat down for the hospital and for the court to order them to resume following the bylaws. But this is a small town, the Hospital is a Big Player, and the Good Ol' Boy network is in effect, so we may be out of luck from a judicial standpoint.

Nevertheless, we have received some unexpected good news--one of the Cardiologist, who is not a big fan of ours (and the feeling is mutual), has some insight due to his committee assignments and states the current Administration of the hospital is quickly getting into hot water because they are posting big losses, which seems to be the only thing that gets our comatose Board's attention. He said he does not expect to see the current Administration last 2 more years and sometime soon, "...they will be swept away." How much have they lost? Apparently, they posted, or are about to post, a $25 MIILLION dollar loss. Ouch. I learned of this from another doc who is from the Pakistan/India area, who said with a laugh, "So you just sit tight and be like the Taliban, and these people will leave." I laughed and said, "Where do I get my black Turban?" This doc is very in the know about all the goings on, so if he believes this, I'm pretty sure it's accurate. We shall see.

Meanwhile our outpatient clinic is steadily becoming busier, and we are thinking about adding a franchise urgent care, all to make sure we have a base outside the control of the hospital.

The War - part 8

In which Doc's group engages in Flanking maneuvers...

So a lot is going on in the War. The hospital continues to steal our patients, our court case against them is still pending, but we have maintained a healthy inpatient number as we now have our own patients to admit and some of the private guys and specialists are helping us by having their patients demand to be admitted to us. Since several of our docs are now doing other things, the smaller numbers have not hurt us much financially.

That being said, those of us remaining are well aware the hospital is attempting to undermine us at every opportunity, so we have, as I have previously mentioned, started a new outpatient office. This is actually something I had promised myself I would never, ever do again, but circumstances demand it--and it's working! We are seeing patients 3 days a week, and all 3 of us are now seeing more than 20 people a day.

The BIG news is that one of our former partners and his physician wife have decided to quit their practice, and have asked us to take over their patients--this is an enormous deal--they have a total of 6000 patients, and while that sounds like a lot to non physicians, 3000 patient charts per physician is about normal--obviously not all of these people are still living, or still available. Combine it with our practice and we will instantly be at a profitable level of patients. This has several salutary effects--the office will begin to make enough money to pay us (the physicians) some amount, and the large number of patients will lead to more admissions from our clinic, which the hospital cannot touch (or they haven't tried, as of yet). These new admits will keep us at a nice level of people in the hospital, which is additional very low overhead income for us.

Of course, change is challenging. We will have to move to a new location--we have our eyes on two spots now, and will probably pull the trigger on one in the next 30 days. Some remodeling will be in order, so the actual move in time is up in the air. We are also discussing partnering with some of the local urgent cares to provide higher level lab services and further increase our patient base. We would really like to have an urgent care side and a longitudinal care side for the office. We shall see... In any case, developments thus far are very positive for the office, and interesting things are happening inside the hospital as well. Last update I mentioned that the current administration is getting in hot water with poor financial performance--and recently I got some confirmation of that, when it was announced that one member of the administration is retiring and will not be replaced "due to challenging financial times for the hospital." This is a very interesting, and for us positive revelation--the Doc who is leaving is our arch enemy in the hospital (and he is truly retiring--both from the administration and medical practice, and good riddance), and this is the first time we have heard Administration admit the money is tight. As I've mentioned before, rumors of an administrative shake out are getting louder, and couldn't happen to a more deserving bunch.

So we will continue our positioning to reduce dependency on the hospital, and watch that sucker burn while we point and laugh....

The War - Part 9

"The World is run by people who can do math"--a friend of mine.

We will take a detour in the story of the hospital versus my group for a minute to discuss how we as a group make business decisions regarding the what do. We will leave aside the intricacies of billing and focus on some simple averages which tell the tale. It will not surprise the astute readers here that it all boils down to this: The more people you see, the more money you make.

Let's start in the hospital. The average collection for a doctors visit in the hospital is $75.00. So, let's see what happens with that number over time.

If you have 25 patients a day in the hospital (the doctor slang is "in house" or "on service") year round the numbers look like this:

25 patients x $75/day x 365 days= $684,375 per year Now let's take away expenses of say, $250,000 for your nurse practitioner, fees, licenses, etc. That leaves $434,375 That would be divided amongst the 3 of us, for a total of $144,791 each for the year. Now watch what happens if your patient load expands by 10 patients to 35 patients a day 35 patients x $75/day x 365 days= $958,125 per year Minus those same $250000 in expenses Leaves you with $708,125 Divide that amongst the 3 of us and its $236,041 each. Not a bad raise! Now watch what happens if you have 50 patients in house 50 patients x $75 x 365 days = $1,368,750 Expenses are still $250000 Leaving you with $1,118,750 Divided amongst the 3 of us is $372,916!

Now you probably understand why we get very upset when the hospital steals even a few patients--it makes a HUGE difference in our income. The clinic works much the same way, just substitute a collection of about $100 instead of $75 in the calculations. But that's not the whole story in the clinic--because here, we can supervise nurse practitioners, and see many, many, many more patients. For example, one of the local urgent cares has NPs seeing patients. They see 100 patients a day, and we know for a fact their average collection is $108 per visit.

So let's do the math for this busy group: 100 patients/day x $108/patient x 365 days= $3,942,000 before expenses. And so remove the expenses, which are about 50%, leaves $1,971,000 to be divided That would be $657,000 each for the three of us! That's in addition to the hospital income. So the total potential (if you have 50 inpatients) for this combination is just over $1 million dollars a year! Now do I think we'll hit 100 patients a day in the office? Well, no, probably not anytime soon. Will we hit $108 dollars a visit? No probably not, this is an urgent care which can do many labs and X-rays, and we are a longitudinal office (that's why we're trying to partner with them). But we are aiming high because we want to not be dependent on the hospital. And if we're 50% off? Well $500,000 a year is way more than I make now, so that's still good!

Anyway the point is that under all the complexity, it still comes down to "How many patients do you see and what do you do for them?"--that determines how much you make.

The War, part 10

The Enemy is falling apart.... And the good guys are Rising.... So out of the blue, I received a text from my partner yesterday that made me laugh out loud. Here it is, quoted (almost) verbatim:

😂 [The Big Hospital] had 11 anesthesiologists at the beginning of 2021. By March it will be down to 2. Three left a few months ago and 6 turned in their resignation letters yesterday including *name redacted*.

This is stunning. We have a LARGE surgery department--and 2 anesthesiologist are in no way able to cover all the cases we do, so the hospital will probably be forced to hire locums tenens again for this service in order to provide adequate coverage. This is in addition to the millions in subsidies they are paying out for the Intensivists and the Hopsitalists that I have mentioned before.

Here's the rest of the conversation between my partner and I:

Doc Holliday: Holy shit. What is going on?!?! The *name redacted* curse Strikes again!

My partner: A new bestseller: How to run a health system into the ground by *name redacted*. Foreword by *name #2 redacted*.

Doc Holiday 😂😂😂😂 shorter title: The Demolition Men They were handed a well functioning hospital, all they had to do was build on what they had– – And they couldn't do it. When is the board going to wake up and get rid of these clowns?

My Partner: Idk. And they have a MONOPOLY!

Doc Holliday: 🤡🤡🤡🤡🤡🤡 Yep, they can't blame anyone else. "The competition" is not available for blame

You know something is screwy When you got three full-time nursing schools, and you can't hire sufficient nursing staff. The two names redacted above are two of the big Admin people who have been instrumental in causing these monumental problems for us and our hospital--It's enough to actually make me worry that they are going to bankrupt the hospital. Will the board wake up in time? I don't know but they better do something soon... In good news that I have mentioned before, this Monday our Arch Enemy in the hospital is retiring in full from both medical practice and administrative work. As he is not only our enemy, but undoubtedly part of the foolishness above, I could not be more glad to see him go, not just for us, but for the hospital as a whole. It must really be a drag to know you are retiring as one of the most detested people in the hospital, but that would require self awareness that I doubt this snake possesses. In yet more good news, our new clinic practice is booming, and we are getting ready to remodel and move into a LARGE space in the mall that will allow us to have at least 14-16 exam rooms. The potential is enormous, and it looks like all systems are go thus far.

Then, as icing on the cake, out of the blue another hospital in the general area called my partner about having us do hospitalist work for them--they've already agreed on terms and are now working on a start date--this is also huge, as we will be making money even before our clinic begins to be able to pay us substantially, and will allow us to keep the 4th doctor we have been hoping to have, who doesn't want to do office work, but who would love to do hospitalist work. So things are moving fast, and in the right direction so far!

The War, part 11

In which the Enemy continues to reap the returns of their foolishness, and we continue to get good news

So I got a text out of the blue last night from my partner, the head of our group.

*Friendly doc name redacted* overheard a Zoom call between In Compass and the Hospital. Subject matter was the terrible length of stay numbers 😂"

"In Compass" is the new recruiting/staffing agency they chose to try to replace us. A bit of explanation is in order as to why this made him (and the rest of us) laugh. Length of Stay, or LOS, is THE metric which Administrators concern themselves with--Hospitals get rewarded or penalized financially depending on whether they can get patients out in accordance to their "expected Length of stay", which is usually termed GMLOS--for Geometric Length of Stay. This is the number generated by averaging patient across the country with similar conditions--it sounds very scientific and mathematical, until one realizes that it is ENTIRELY based on the DESCRIPTIONS given the patients problems--in other words, the more histrionic your note, the longer GMLOS you get. This was the metric that Administration LIED to the board about us meeting--we actually did meet it, which they lied and said we didn't, and they somehow "forgot" to mention they paid us a 6 figure bonus for meeting it.

So why the laugh? Because now their new group, which is already being subsidized to the tune of $7 million, while still floundering about trying to get permanent docs, is losing them even MORE MONEY, because they cannot get anywhere close to the GMLOS--which we were very good at hitting. Serves them right!

This is hilarious to us--the new group is having a difficult time getting people out of the hospital on time. But what do you expect from a group made up mostly of temporary docs with no specific knowledge or motivation into how this hospital works?

So we all got a big kick out of that--A giant "We told ya so!" to the liars.

But the good news (for us) doesn't end there. As of the start of this month, our Arch Enemy on the Medical staff/Admnistration is gone. We could not be more pleased. This particular individual has spent several years maligning us at every opportunity and doing his damnedest to throw us under the bus at every chance he got. He is one of the top 4 people we would like to see leave--and the longest serving, so we are quite pleased that his stench is fading fast. As another doc, who is not in our group said, "That guy is a Snake, and I'm glad he's gone."

The good news continues on the office front as well-we are each seeing over 30 patients a day in office, (we rotate, one doc in the office at a time). This is huge news as we will very soon be able to pay ourselves a bit from the office finally--and we need it, we are all feeling the pain of much reduced income currently. And that dovetails nicely into yet another bit of excellent news--the mall located in central Tuscaloosa has agreed to our plan where they will foot the bill for remodeling in exchange for a higher rent. This is spectacular--it means we don't have to borrow money to get the facility looking like a doctor's office. Now we can focus on equipment--and we expect to be up and running in this new, much larger office probably in mid April. We'll have enough space then for more than one doc, or even all of us, to be seeing patients at the same time. That means YUGE gains in cash flow, which is a big positive from a business perspective. The plan from there will be to get some of our NPs back on board to see patients as well, which will allow us to move even faster.

So overall, good news. Fingers crossed it continues--we know there will be struggles, but we have already crossed several large barriers. There's other news brewing as well. More on that in the next chapter.

The War, part 12

Where Doc and Co. receive some Very Good News.

The office continues to grow--we are seeing over 30 patients per day on average, and I just finished a week of office work--flow is much better now as we have some new assistants, and therefor things go much more quickly and smoothly. The crazy weather this week knocked my numbers down a bit as people did not find that the pleasure of visiting with me outweighed the risk of braving tornadoes. Oh well, that's life in 'Bama.

I wasn't too disturbed by that--because we received some Very Good News. I had mentioned a few updates ago that another hospital, not far outside of town, had called us out of the blue to be their hospitalists, as they were not pleased with the group they had and felt it was time to change. We looked at it--and jumped at the chance. They were offering to pay us the same as we were making at the Enemy Hospital prior to the War, and yet we will only be seeing a fraction of the people we were seeing before. In addition, we detailed to the new hospital HOW we see patients, and they were all for it, contrary to our old hospital, which was constantly hostile to our method. This is Yuge for us--we will return to the income levels we previously had AND be free of any financial dependence on the Enemy hospital--so any work we do there will be pure bonus money. In addition we have the monies coming in from the office, so we are really and truly developing freedom from the disastrously run old hospital, and not a moment too soon, as they continue to flounder about, losing money by the boatload. I found out from a long time nurse that they are even talking about laying off some nurses--when they are already short on staff. Unbelievable, and yet sadly predictable. Will the board wake up in time? I don't know.

Nevertheless, things are going well for us--we kept this new deal utterly secret until the papers were signed--my partner, who was handling it, wouldn't even tell me and the others WHICH hospital it was, for fear that word would leak to the Enemy Hospital and they would try to interfere with out new position--and yes, they are that vindictive. But today, the papers were signed, and we will take over there at the beginning of May.

The War, part 13

Wherein Doc illustrates the level of sleaze of the Enemy Hospital Administration.

So I know I just posted part 12 about 48 hours ago, but I have found some new bits of information that are very helpful in illustrating the nature of the sleazy people we are dealing with in Administration of the Enemy Hospital.

First off, one of my other partners, who we will call partner #2, is part of something called the PAC committee. What's that? It the Physician Activity Committee, and it's the equivalent of the Star Chamber or any other secret court--it's designed to accuse and intimidate physicians of wrong doing and force them to change or leave. Of course, it's not supposed to be used for political gamesmanship but believe me, it is. I've commented recently on the horrendously unpopular physician administrator who recently retired--this was his specialty--he was the consigliere for the Administration, who "spun narratives" to try and force physicians into doing what the administration wanted. And he was a total asshole, a liar, and our arch enemy.

So about a year and half ago, the Administration continued their attacks against us, this time trying a new attack against us, questioning the way we did notes and the way we used our Nurse practitioners. But then they made a huge mistake--they demanded our two chief NPs testify before the PAC. The whole administration was in attendance, and they hoped to make it look like our NPs were not adequate for the job, or in some way underperforming. What a mistake!

The two NPs they interviewed are two of the most intelligent and righteously ferocious ladies I have ever meet. And being long time nurses, they have a clear understanding of and lack of tolerance for Administrative bullshit. So the Administration brought them in, hoping to humiliate them--instead, according to partner #2, the two ladies SHREDDED the Administration TO THEIR FACES, and made the PAC jerks look like fools, and the reasonable people on the committee were on our side. This was a huge win for us, but it was one of the reasons the Administration was so hell bent on getting rid of us--they couldn't bear getting humiliated by our nurses.

The next bit of sleaziness we discovered involved a large contract we were pursuing--it was held at the time by the other hospital associated group--but the head of the company we were looking to cover for was VERY interested in us taking over their patients, as we were willing to do it for slightly less than the hospital group. We even went, as a full group, to meet with him--and things seemed to be going well, then suddenly he began to act equivocal, and then it was announced they would stick with the Hospital's group. Strangely, and I'm sure quite coincidentally, that gentleman was then elected to the Hospital Board, immediately thereafter. I'm sure there was no deal struck to keep the patients with the hospital's group in exchange for a Board seat, of course. And if you believe that, I've got a nice bridge to sell you in Brooklyn... Anyway, this was another thing that fueled Administration's hatred of my group--it would have killed their group had we received the contract.

Finally, tonight I got a text from my partner #1, the head of our group. Seems that the Enemy hospital is truly scraping the bottom of the barrel for help--their most recent hire has an arrest record:

*Mid Eastern name redacted*
3 Arrests in FL
1. Battery causing bodily harm
2. False imprisonment
3. Tampering with a witness

This guy is approved, and already working at one of our hospitals. This is the quality of people they are bringing in. Needless to say, we are not impressed and this kind of thing REEKS of Desperation.

We'll see what happens...

The War, part 14

In which the stuff hits the rotating device in a big way, Karma strikes the Enemy Hospital Administration, and Doc and Co. come out smiling.

Well. I must admit I didn’t expect this to happen with this sort of suddenness. But happen it has, and it is glorious! Let me temper my enthusiasm, back up a bit and I’ll explain. There are (or were) four individuals who made up what my group considered the four horsemen of the hospital apocolypse. You’ve already read about the recently retired urologist whose removal drastically improved the smell of the place. He was the Consigliere for the Administration, and a total jerk. He is gone, and so we were left with 3 of the Horsemen, including the 2 of those directly responsible for the horrendous decisions extending all the way back to the beginning of this sordid tale, and their lap dog spokesperson.

Frustration within the medical community has continued to grow until now certain private clinics are considering admitting patients 1 hour away in Birmingham, rather than have their patients suffer the indignities and ridiculous wait times at DCH. But until now, the public knew little of this, and only knew of their own and family members’ experiences, which are getting more and more frustrating. That changed in the last 48 hours–the problems exploded into the open–let me link you an article that explains the issues better than I can:


Yes, you read that correctly–the hospital is posting a $60 Million dollar LOSS. And finally–FINALLY!--the Board and the local powers that be have awoken to the problems. Note that the article mentions very little about administration, but is an absolute indictment of how the hospital has been run. And less than 24 hours after that, we get this sublime headline:


Wow, just wow. This is the guy who started the whole ball of foolishness, and he is finally being held accountable! And he is leaving! So now we are down to 2 of the Horsemen left–the lapdog spokesperson, and the guy who was the catalyst and driver of all this failure. The COO–this is the guy who lied to our faces and to the board about our performance, and has been the source of every bad idea that has injured the hospital. Since he was hand picked by the CEO as his replacement, we guessed today that he would be leaving soon as well.

And the news gets better, because later in the day, we received initial confirmation from 2 sources. First, a retired physician who is big in the political scene and active with the Hospital Foundation told my partner that the COO should “pack his bags–he’s out of here soon”. Then, independently, one of the pulmonary guys actually ran into the COO, and asked if the CEO had really wanted to retire, to which he replied, “He(the CEO) had been thinking about it.” Which translates as “No, he was asked to leave.” The pulmonary guy then asked, “Well, what are YOU going to do? Will you be staying or going?” To which the COO had no answer for a few moments of deer in the headlights blinking, followed by, “Well, these things tend to happen in waves.” You bet they do, you lying clown. Now pack your bags.

As for the lapdog spokesperson, all fully expect him to slink out the door with his master as the situation unfolds. He’s old enough he could retire most likely. Whatever he does is fine, as long as he leaves.

So today was a glorious day.

Meanwhile our practice is booming, we have a new contract at a new hospital, and now the enemy crumbles before us from his own foolishness. Good riddance. Much work will be needed, but now there is hope the hospital will get back on track.

More to come.

The War, part 15

In which Doc and Co. celebrate the fall of the final Horsemen of the Apocalypse

Well, well, well. This week we got the wonderful news…I’ll post the body of the email here:

I am writing today to announce the resignation of NAME REDACTED as DCH’s chief operating officer effective July 29, 2022. After much consideration, NAME REDACTED has made this decision in order to pursue other career opportunities.

NAME REDACTED came to DCH in February of 2018, and in his time here he has been a driving force for change. He was instrumental in guiding us through a ransomware attack, an electronic medical record update and responding to COVID-19. Additionally, he provided the direction and leadership for implementing an intensivist program and a new hospitalist program.

NAME REDACTED will be greatly missed. Please join me in offering NAME REDACTED thanks for his years of service to DCH and the community.

End of email.

So there it is!

The worst decision ever made by the Administration is now walking out the door, no doubt to fail upwards and wreck some other hospital somewhere else. I don’t care where he goes as long as he goes. This guy is the Captain of the 4 horseman, the source of every stupid and destructive idea that has taken our hospital from a stable position to one of financial instability and poor morale, and a bold face sociapathic liar. By any metric, one can simply go to 2018 and find the downturn of that metric corresponds DIRECTLY to the date this guy was hired. Every one of those items listed in the email turned out utterly disastrously and cost–and continue to cost– the hospital millions of dollars.

Now I know some of you sharp eyed types are saying, “Doc, you said there were 4 Horsemen, but this only makes 3 that have left!” Aye, but the fourth guy is a miserable yes man, a creature whom I fully expect to slink away from the hospital in the dead of night on some obscure Friday afternoon when everyone else isn’t looking. He too, will not be missed. His departure will probably warrant even less of an email than the one above. He is the Grima Wormtongue of Administration for you LOTR fans, and will meet a similar (if less violent) disgraceful end.

And speaking of that email, it is hilarious to me that it was announced this way. When the CEO announced his resignation, it was front page news, literally, in the local paper. This guy, the COO? This fountain of foolishness and destruction? An intranet email within the hospital. And that tells you all you need to know about his place in the mind of those in the hospital–the last line of the email is a statement of profound irony–he will NOT be missed, at all, by anyone. Everyone will be relieved. It must truly suck to know you are leaving as an utterly despised failure, but that does require self awareness, which is sorely lacking in this creature. As for me and my group, things continue to move right along. We have started the new job at the rural hospital, which is both technologically sophisticated beyond what you would expect, and lucrative for us as well. We are moving into a beautiful new office at the end of this month, and we continue to see gargantuan numbers of people. It’s exhausting, but yet more changes are coming, and they will make our lives easier.

For now though, raise a toast to the end of the 4 Horsemen, and say a prayer that the new team can resuscitate our hospital. Cheers!