I work in a large teaching hospital affiliated with a big fat public research university with a solid medical school. I love my job & I love what I do, I love the school & the hospital & the folks I work with, & I get to see at least some of the inner workings of how all this shit goes down.

Frankly, the dept. that deals with insurance companies is full of steel-boned saints. I don't know how they put up with the bullshit.

The hospitals in the uni system here are all NPOs, so there's no profit in the sense of having shareholders & stock & that sort of thing. There's just revenue, & then that gets folded back into the hospital in a bunch of ways.

FYI, we get about half of our revenue from Medicaid patients.

That's not uncommon at all, throughout the US healthcare industry.

@MidnightRider Right?? & on the flip side, a lot of people have gotten used to having lots of diagnostics & will flat-out demand it. Overuse of medical resources is just one complicated part of the whole puzzle.

@Impious_Jade Preach! I did a full skull series and cervical on an 8 year old. What happened Billy? I tripped on my sister's Barbie and landed on the carpet. Mkay, in my day you would have received a washcloth with ice cubes, if you wanted to go back to playing withing five minutes it was considered cured. Also, self referral to imaging centers for kickbacks is RAMPANT, I saw the Christmas checks flying at the xmas parties.

@MidnightRider UGH kickbacks are a fucking scam. We don't even let vendors on campus at all without either an actual need, or if a particular provider is interested in a specific product & wants to make the case to bring it in. Oh, & prescription salespeople? HELL NO, they aren't allowed on campus AT ALL.

@Impious_Jade I like a more specific fishing net. My work on campus with Companion Animal Hospital was in support of imaging technology they already bought. I loved working there and being part of cutting edge animal medicine.

@MidnightRider Oh sweet. Yeah that's one of the awesome things about working for a teaching hospital, so many of the providers I work with are doing amazing research as well as their clinical work. It's one of the reasons I love working there too.

@Impious_Jade I did that too, both during college and after. I even taught at U of M occasionally, certainly the most expensive college I taught at for sure.

@Impious_Jade Beg any physician to pay a larger bill, you won't get any pushback. The Neurosurgeons were expected have at least 70% of office visit patients result in a surgery, what a crock that is !

@MidnightRider Knowing how much surgeons want to be in the OR I have to wonder if the neurosurgeons weren't at least partly OK with it!

Source: work w/surgeons, some of them neurosurgeons

@Impious_Jade No cutting no Benz, so yeah they were all aboard. I will say the internists and Othopaedic doctors I worked with were not like that one bit, all above board, it was a great pleasure to work with them.

@MidnightRider It's really interesting to work with surgeons, because they are SO confident, & so willing to push for what they want. Which is often great! & then fortunately there are administrative folks that will push back if needed. Man, it's a balance tho', staying on the cutting edge w/o burning needlessly thru revenue.

@MidnightRider Are you familiar w/Dr. Glaucomflecken at all?

@Impious_Jade Nope, I'm old, so old what I taught isn't even known in the museum of my company I recently visited.

@MidnightRider Take a gander when you have a sec. He's an ophthalmologist who does vids about life in the medical field. https://www.youtube.com/@DGlaucomflecken

@Impious_Jade Haha I watched Radiology, I know who Sir Godfrey Hounsfield is and I'll tell you this a CT scan beats exploratory surgery and I lived through the transition.

@MidnightRider LOL

@Impious_Jade I wasn't joking, my first year doing OR rotations included extra surgery time allotted to essentially "look & fix". I used to tell patients about it who were afraid of CT, "hey you could be golfing after lunch with your morning CT, try that after exploratory surgery the old school way.

@MidnightRider Oh, no, I totally believe you & didn't think you were joking at all!

@Impious_Jade I've seen some "stuff" including several feet of my uncle's bowel out on the table.

@MidnightRider That had to be a trip. Yikes.

@Impious_Jade Not as much as what he was babbling in pre-op! 😂 He wasn't my patient I just happened to be scrubbed in for another case and watched from the window. Later that week I moved him from his bed to the bathroom after he pled with me, certainly glad he didn't get hurt on the trip, I understood his angst about the "pan depth" and did some on the spot changes to the surgeon's orders.

@Impious_Jade Radiologists used to have a lot of power within the Hospital as well, now not so much. I'm fine with some bravado, confidence is important but the person who's playing that card has to have the talent and knowledge to back that bravado or they lose my enthusiasm.

@Impious_Jade I have really good health insurance from the marketplace cuz of the weirdness I have. My insurance app keeps track of how much I've spent all year including on meds and its a healthy $7000 right now and I still got surgery to go in just over a month. That price includes the visits for counseling and psych care thanks to trauma from family cuz insurance doesn't like to pay for mental health care

@insomniacviolin Ugh I hear you about mental health care. I've pretty much given up on finding a therapist despite needing one. I can't afford it even with the policy I have, which is way better than most.

@Impious_Jade it's terrible trying to get one unless you have a medicaid policy then boom...covered.