I was visiting family this week, and my brother in law is a cardiologist finally getting into private practice down in FL after years of expensive schooling and fellowships. He mentioned that he was dismayed by the behavior of his 5 partners in his practice--all older docs--he's the new hire with the fancy tech skills on the newest machines. Some of the practices he mentioned that clearly border on criminal, or at least downright unethical: - Most of his partners openly ignore their hospitalized patients in favor of spending more time at the office. Office visits are more profitable, especially if they can work in stress tests which are apparently a goldmine for cardiologists. So when my bro-in-law does his daily rounds at the hospital after spending the morning in the office, he also checks on his partners' patients, and gets berated by angry family members: "What's going on? Dr. Smith hasn't been by in 4 days!" - All of his partners abuse stress tests. One in particular has a blanket policy of ALWAYS giving a stress on every new patient. Regardless of symptoms. And it's worse. He also a blanket policy of ALWAYS ordering a cath as a followup to the mandatory stress test. Both are cash cows, but the cath is also more invasive and can lead to complications. Apparently stress test results are by definition fairly vague, so there's always wiggle room to allow for a rec of a cath. However, the partners considered buying a new test machine that would replace the stress test, and that doc said "No way. It's too black and white, if you know what I mean." Basically, he wouldn't be able to order caths on people without reason anymore. - Another doc who isn't certified to read some type of particular scan (forget which) does it anyway. He lets the X-ray tech (an associates degree) go ahead and write up the report, and then the doc signs it as his own. My understanding is that he can then charge a hefty fee for analyzing the scan. - There's also just a general tug-of-war in the cardiologist community, apparently, over who gets to give the highly profitable stress tests. A lot of FL residents are snow-birds, they live in Pittsburgh or Cleveland in the summer, where they have one cardiologist, and then winter in FL where they have another one. The two docs try to make sure the patient has their "annual" stress test (I guess insurance companies pay for 1 per year) at their practice. So I'm wondering how widespread folks think this is. Out of the ordinary? Part of the natural order of for-profit medicine? Not a big deal? A huge deal?