Budgetary gerrymandering

Hey doctors!

Have you ever been told that you don’t bill enough to cover the salary you receive, or that your entire department or division is a money-loser?

If so, give me 7 minutes and 47 seconds of your time and let’s re-calibrate your B.S. detector.

My latest video.


  • This video had only been posted for a few hours when the “B-b-b-but…!” messages began to trickle into my DMs. One commenter suggested that my argument fails because not even the chairs, deans, or even the top hospital administrators know the full finances. Thus, the “argument that employees should say, ‘pay me, the money is there somewhere’ is moot and unlikely to convince those responsible for the pursestrings. If [a chair/dean/administrator] cannot account for the revenue gained (or lost) by an employee, they cannot responsibly offer any more money.” Sigh. I’ll give you a moment to digest that claim… because it really sums up the whole purpose of budgetary gerrymandering. But I’ve also gotta point out that this assertion that it is unknown and unknowable how much revenue a physician produces for the hospital is not only self-serving – it’s provably false. Hospitals routinely estimate the amount of revenue each physician generates, and in matter of fact, share these figures with each other. The physician recruitment firm Merritt-Hawkins surveys hospitals regarding the value add of different physician types and publishes these data in a semi-annual report. For reference, the 2019 survey estimated that the average internal medicine physician generated $2,675,387 for their hospital – which ought to be more than enough to cover their salary. (For anyone interested, Twitter user @DatadrivenMed produced a nice graphic showing longitudinal trends.)
  • This video was originally inspired by a Tweet from a hospitalist at UCSF. You can find her original Tweet here, and my comments here.
  • Though I’d like to claim I came up with it myself, the term budgetary gerrymandering also comes from Twitter. Here’s the first known use, so far as I’m aware. (And for anyone unaware of the etymology of the term gerrymander, that history is reviewed here.)
  • Historically, I’ve shared most of my thoughts on Twitter… which, of course, is under new management. It’s not clear whether Twitter will continue to be a good place to reach the people that I’m trying to reach (read: people who want to change medicine and medical training for the better). Obviously, this site isn’t going anywhere, and I do have a growing collection of videos on my YouTube channel (and some occasional posts on Instagram as well), so be sure subscribe/follow me in all of these places if you want to keep up even if Twitter crumbles.

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