6 ms·

The Business of Health Care Depends on Exploiting Doctors and Nurses

49 points by yhoneycomb 7y ago

qrbLPHiKpiux 7y ago
I’m a provider. Yes, it does. And they have a perfect opportunity. With the amount of student debt they have, they have to work. It is a perfect exploit. Plus, the license is on the individual, not the health care entity. They can just get another provider.
- naveen99 7y ago
  The entities have their own licenses also. For example a famous heart transplant program was shut down recently. The providers just found other jobs. Edit: I am a provider also
- chapium 7y ago
  The scariest thing about quitting a job you are deeply unhappy with is what to do about health insurance. I totally agree.
RandomInteger4 7y ago
Does it though? Given how much they charge, does it really depend on exploiting those folks? Are they really being exploited given how high their salaries are? Like, just for patient safety, I agree, these folks should not be working the ridiculous hours they work, but would they really agree to that if it meant a salary decrease?
- muzani 7y ago
  As it is, everyone accepts that if you want lots of money and no quality of life, be a doctor. There should be a middle option like in other careers where they can be moderately well off with only moderate commitment.
  - aianus 7y ago
    > hey can be moderately well off with only moderate commitment Primary care physician is like this, no? I guess your quality of life is still awful during training and residency.
  - ghufran_syed 7y ago
    There is, if you like emergency medicine: you get paid per hour, so you can work as much or as little as you like.
  - RandomInteger4 7y ago
    I completely agree to be honest, but it seems like when you see Doctors and nurses complaining on social media, it's almost like they do it as a badge of honor and not because they actually want fewer hours, given the implications that come with fewer hours (i.e. lower salaries). That's assuming hospitals are actually operating on a tiny profit margin, but if the margin is huge, then there should be more demands. I mean, there's the nurses union at least, but what about the doctors, or the various technicians. Either way though, the system is still broken with respect to how much the patients have to pay.
- mpmpmpmp 7y ago
  It really does. I have 6 family members in healthcare some on provider side and some on admin side. The provider side always talking about lack of resources and longer hours. Staff leaving and not being replaced. But then talk to the admin side and they talk about reimbursement being so bad taking on some patients are a money pit. Seems like the exploitation is the only way the admin side knows how to keep the wheels from falling off.
  - maxxxxx 7y ago
    There is a lot of complaining in health care but there are a lot of people making very good money and the overall system is way too expensive. The whole system is ripe for an overhaul but I bet they will fight any reform tooth and nail because there is much money to be made with the current system.
  - RandomInteger4 7y ago
    That's not exploitation. Exploitation is the admin side doing great and still demanding long hours and minimal staff.
sambull 7y ago
Health care is the US is broken; I recently hurt myself, the diagnosis alone (xray, CT and doctor apt) was over $4,000 out of pocket, with good insurance that my CEO sent a email last year telling me was the reason we won't get raises.. that damn health insurance cost. I had a cousin talking about retirement, the only thing preventing them is... health insurance
- nickthemagicman 7y ago
  My aunt was bitten by a rattlesnake on her finger. It cost 46,000 dollars for a vial of anti-venin and and one night stay for observation. This happens in India all the time with King Cobras and I know they can't afford 46,000. It's a total racket and scam because on a system of supply and demand like American capitalism... what has a greater demand to someone than a their life so the only limit to price is on the supply side.
  - Wowfunhappy 7y ago
    > This happens in India all the time with King Cobras and I know they can't afford 46,000. Your larger point notwithstanding, it's important to remember that overall cost of living in India is lower as well. So hospitals are inherently cheaper to run.
    - oneplane 7y ago
      That's not why it's cheaper: money doesn't universally trump wellbeing in Inda like it does in USA.
      - m52go 7y ago
        No, it's because insurance hasn't hijacked the system in India like it has in the US. Watch pet health costs...with the recent advent of pet health insurance, it's just a matter of time before costs skyrocket for veterinary care.
        7y ago
rayiner 7y ago
Nurses and doctors in the US work a lot, but they also get paid very well compared to say the UK. Nurses in particular. Starting salary for a nurse in the UK NHS is 23,000 pounds: https://fullfact.org/economy/pay-rises-how-much-do-nurses-police-teachers-and-mps-get-paid https://fullfact.org/economy/pay-rises-how-much-do-nurses-po.... That’s about $29,000. (This is a bachelors degree required position.) Starting salary for a US nurse with a bachelors degree is well over double that: https://online.drexel.edu/online-degrees/nursing-degrees/nursing-salary-guide/index.aspx https://online.drexel.edu/online-degrees/nursing-degrees/nur.... EDIT: Adding taxes to the calculation adds an additional dimension. Online calculators show that the total tax on 23,000 pounds with a 9% NHS pension contribution amount to 25%, leaving 17,500 pounds or about $22,300. In Maryland the total tax rate is the same for someone making $65,000, leaving $48,000. That’s after paying for social security, which will pay out about as much as an NHS pension would pay. A US nurse typically will receive health benefits on top of the salary. Even if the employer doesn’t cover 100% of premiums, the out-of-pocket premium payments (which are per-tax) are unlikely to be more than $5,000.
- di4na 7y ago
  Keep in mind that this salary for the US do not count in healthcare and pension that the UK nurse is entitled to. I know it may feel like a nitpick, but it does make a huge difference when you add that cost of living.
  - astockwell 7y ago
    This. The American urge to compare only base salaries (because that's all you have in America) is why Americans don't understand what they're missing. It's not in the salary! Its in the alleviation of $1000/month medical insurance premiums, in addition to $4000 ER visits (inclusive of said insurance), and pensions. And before someone bemoans the taxes, let me clarify that those medical premiums and ER visits are AFTER-TAX dollars, so add an additional 15-30% on top.
    - aianus 7y ago
      The annual base salaries Americans quote are AFTER medical insurance premiums. They are not deducted from your quoted base pay.
oneplane 7y ago
That's because if you run critical services like a generic for-profit business you almost automatically exploit everyone who is in it for more ethical or intrinsically motivated reasons. There is a big disconnect between why you'd do the doctoring and hospital-running vs. the admin side of things. Once a business has a certain size it all becomes the same: bottom line, marginalisation, and bubbles of speculation under the name of financial management. The issue with doing that to healthcare is that you have to recoup your business failures in a way that is incompatible with saving lives; i.e. you have to make things more expensive to get your money but since for the people at the bottom of the chain that means having someone die vs. live they will not really be give a choice; choosing between getting healthy (but paying a butload of money) and getting dead (so you don't have to pay) is basically extortion. A lot of excuses are made that 'you pay for what you get' meaning the quality is super high and thus expensive, or that the cost is very high, and that has to be calculated in to the prices, or that the business side is very hard and complex and can only be done that way; but unless they have unicorns and rainbows we don't know about those excuses are just that: excuses. The cost is high, and the quality doesn't match it - almost all healthcare systems in other developed countries is both higher quality and cheaper at the same time as well as having lower mortality rates. Exploiting people that are intrinsically motivated to help people who put their lives their hands is just another sign of the administrative side of this deal completely doing it wrong. The same people, buildings, services, machines, procedures in a different country with a better end-result and lower mortality rate should be enough proof.
- makotech222 7y ago
  Its not intrinsically the administration, it's capitalism. The administration in these cases just happen to represent the owners, who's goal is to increase profits at all costs. Imagine how hospitals would be if they were owned by the doctors and nurses instead?
- rayiner 7y ago
  I guess the UK NHS is run like a for profit business: https://www.theguardian.com/society/2019/feb/17/nhs-staff-quit-record-numbers-work-life-balance https://www.theguardian.com/society/2019/feb/17/nhs-staff-qu... > Health unions have been warning for years that NHS personnel are cracking under heavy workloads, rising demand for care and widespread understaffing. Many staff report routinely working beyond their normal hours to complete all their tasks.
ineedasername 7y ago
The article cites the fact that there are 10 administrators for every actual doctor or nurse, and these lines should be cut in half to instead be spent on more doctors and nurses. I think this represents a gross oversimplification, overlooking the necessary work of administrative staff. It's not unlike the airforce: there are about 23,000 pilots but 500,000 personnel, a ratio of more than 20:1. It takes a lot to support the enterprise that keeps planes in the air. In the medical profession, someone has to keep the enterprise running. Cataloging medical imagery & seek and retrieve records as needed. Accountants and HR departments, IT departments, working with insurance companies, all of it. Even with the amount of EMR work doctors & nurses may do themselves, it takes a tremendous amount of background "plumbing" work to allow them to focus on the actual treatment. I'm not saying there isn't any administrative bloat anywhere, but I am saying that non-practitioner staff in the industry feel this resource crunch quite a bit themselves too. The technician running the radiology suite feels just as much pressure to help fit in that extra patient and stay beyond scheduled hours to do so. Treating the entire non-doctor/non-nursing staff as bloat is an extreme disservice to the mission critical work they perform. I am literally taking my 1.5 year old son home from the hospital today after an emergency visit that kept us there for days, and during this ordeal I dealt with at least 3 or 4 non practicing staff that went above and beyond their duties to help with something and smooth the process over for the work that doctors and nurses needed to perform. These staff feel the ethical drive to serve every bit as much, it just happens to be less visible.
- danmaz74 7y ago
  How much of the administrative staff you mention is only needed because hospitals have to work as for profit organizations? And don't forget to add the administrative staff from the insurance companies themselves.
  - ineedasername 7y ago
    Insurance companies are a separate issue, though some of their administrative functions would be required in any healthcare system. (Certainly not all though). As for hospitals working for-profit, about the only administrative function I can think of that is unique to that model is marketing. I may be missing something, but even so it would be very, very much less than the 50% the author of the article would do away with.
markroseman 7y ago
Healthcare is under stress everywhere, but those of you in the USA who don't understand how fundamentally broken your system is need to give your heads a shake. It's precisely because of how it's treated like a business first, thinking that competition is the solution to the problem, and applying other business principles is the way to improvement that things are the way they are. Read medical forums like KevinMD and you hear constantly about highly trained physicians ready to abandon the profession because they're treated like automatons, high suicide rates, and the best way to find a side hustle because their jobs suck so badly. Your country is being held back by the ludicrous way healthcare is structured, citizens shackled to employers, with the worst results for money spent anywhere in the civilized world. Citizens are so brainwashed they're unwilling to acknowledge the ideological morass that created and sustains this all. People who remain so frightened when people say the word 'socialism' that they double down on stupidity. Or refuse to look outside your borders because you're self-evidently the greatest country on earth. Pitiful.
0815test 7y ago
That's the nice thing about 996ICU for doctors and nurses: they don't have to walk very far to get to the ICU. Oh and also, they're pulling pretty good money for their "exploitation" at least in the US. Want to address the overwork issue? Increase medical residency opportunities and available medical-school admission seats.
Proven 7y ago
The usual leftist whining... Does anyone actually believe that "exploited" personnel provides better service? That wouldn't make any sense. Do disgruntled programmers make better software? Let's consider for a moment why these unhappy, burned out workers don't go someplace else? Because State regulates like crazy so there is little difference among workplaces. Deregulate and workers will be better off.

49 points by yhoneycomb 7y ago

I’m a provider. Yes, it does. And they have a perfect opportunity. With the amount of student debt they have, they have to work. It is a perfect exploit. Plus, the license is on the individual, not the health care entity. They can just get another provider.

naveen99 7y ago
The entities have their own licenses also. For example a famous heart transplant program was shut down recently. The providers just found other jobs. Edit: I am a provider also
chapium 7y ago
The scariest thing about quitting a job you are deeply unhappy with is what to do about health insurance. I totally agree.

RandomInteger4 7y ago

Does it though? Given how much they charge, does it really depend on exploiting those folks? Are they really being exploited given how high their salaries are? Like, just for patient safety, I agree, these folks should not be working the ridiculous hours they work, but would they really agree to that if it meant a salary decrease?

muzani 7y ago
As it is, everyone accepts that if you want lots of money and no quality of life, be a doctor. There should be a middle option like in other careers where they can be moderately well off with only moderate commitment.
- aianus 7y ago
  > hey can be moderately well off with only moderate commitment Primary care physician is like this, no? I guess your quality of life is still awful during training and residency.
- ghufran_syed 7y ago
  There is, if you like emergency medicine: you get paid per hour, so you can work as much or as little as you like.
- RandomInteger4 7y ago
  I completely agree to be honest, but it seems like when you see Doctors and nurses complaining on social media, it's almost like they do it as a badge of honor and not because they actually want fewer hours, given the implications that come with fewer hours (i.e. lower salaries). That's assuming hospitals are actually operating on a tiny profit margin, but if the margin is huge, then there should be more demands. I mean, there's the nurses union at least, but what about the doctors, or the various technicians. Either way though, the system is still broken with respect to how much the patients have to pay.
mpmpmpmp 7y ago
It really does. I have 6 family members in healthcare some on provider side and some on admin side. The provider side always talking about lack of resources and longer hours. Staff leaving and not being replaced. But then talk to the admin side and they talk about reimbursement being so bad taking on some patients are a money pit. Seems like the exploitation is the only way the admin side knows how to keep the wheels from falling off.
- maxxxxx 7y ago
  There is a lot of complaining in health care but there are a lot of people making very good money and the overall system is way too expensive. The whole system is ripe for an overhaul but I bet they will fight any reform tooth and nail because there is much money to be made with the current system.
- RandomInteger4 7y ago
  That's not exploitation. Exploitation is the admin side doing great and still demanding long hours and minimal staff.

sambull 7y ago

Health care is the US is broken; I recently hurt myself, the diagnosis alone (xray, CT and doctor apt) was over $4,000 out of pocket, with good insurance that my CEO sent a email last year telling me was the reason we won't get raises.. that damn health insurance cost. I had a cousin talking about retirement, the only thing preventing them is... health insurance

nickthemagicman 7y ago
My aunt was bitten by a rattlesnake on her finger. It cost 46,000 dollars for a vial of anti-venin and and one night stay for observation. This happens in India all the time with King Cobras and I know they can't afford 46,000. It's a total racket and scam because on a system of supply and demand like American capitalism... what has a greater demand to someone than a their life so the only limit to price is on the supply side.
- Wowfunhappy 7y ago
  > This happens in India all the time with King Cobras and I know they can't afford 46,000. Your larger point notwithstanding, it's important to remember that overall cost of living in India is lower as well. So hospitals are inherently cheaper to run.
  - oneplane 7y ago
    That's not why it's cheaper: money doesn't universally trump wellbeing in Inda like it does in USA.
    - m52go 7y ago
      No, it's because insurance hasn't hijacked the system in India like it has in the US. Watch pet health costs...with the recent advent of pet health insurance, it's just a matter of time before costs skyrocket for veterinary care.
      - 7y ago

rayiner 7y ago

Nurses and doctors in the US work a lot, but they also get paid very well compared to say the UK. Nurses in particular. Starting salary for a nurse in the UK NHS is 23,000 pounds: https://fullfact.org/economy/pay-rises-how-much-do-nurses-police-teachers-and-mps-get-paid https://fullfact.org/economy/pay-rises-how-much-do-nurses-po.... That’s about $29,000. (This is a bachelors degree required position.) Starting salary for a US nurse with a bachelors degree is well over double that: https://online.drexel.edu/online-degrees/nursing-degrees/nursing-salary-guide/index.aspx https://online.drexel.edu/online-degrees/nursing-degrees/nur.... EDIT: Adding taxes to the calculation adds an additional dimension. Online calculators show that the total tax on 23,000 pounds with a 9% NHS pension contribution amount to 25%, leaving 17,500 pounds or about $22,300. In Maryland the total tax rate is the same for someone making $65,000, leaving $48,000. That’s after paying for social security, which will pay out about as much as an NHS pension would pay. A US nurse typically will receive health benefits on top of the salary. Even if the employer doesn’t cover 100% of premiums, the out-of-pocket premium payments (which are per-tax) are unlikely to be more than $5,000.

di4na 7y ago
Keep in mind that this salary for the US do not count in healthcare and pension that the UK nurse is entitled to. I know it may feel like a nitpick, but it does make a huge difference when you add that cost of living.
- astockwell 7y ago
  This. The American urge to compare only base salaries (because that's all you have in America) is why Americans don't understand what they're missing. It's not in the salary! Its in the alleviation of $1000/month medical insurance premiums, in addition to $4000 ER visits (inclusive of said insurance), and pensions. And before someone bemoans the taxes, let me clarify that those medical premiums and ER visits are AFTER-TAX dollars, so add an additional 15-30% on top.
  - aianus 7y ago
    The annual base salaries Americans quote are AFTER medical insurance premiums. They are not deducted from your quoted base pay.

oneplane 7y ago

That's because if you run critical services like a generic for-profit business you almost automatically exploit everyone who is in it for more ethical or intrinsically motivated reasons. There is a big disconnect between why you'd do the doctoring and hospital-running vs. the admin side of things. Once a business has a certain size it all becomes the same: bottom line, marginalisation, and bubbles of speculation under the name of financial management. The issue with doing that to healthcare is that you have to recoup your business failures in a way that is incompatible with saving lives; i.e. you have to make things more expensive to get your money but since for the people at the bottom of the chain that means having someone die vs. live they will not really be give a choice; choosing between getting healthy (but paying a butload of money) and getting dead (so you don't have to pay) is basically extortion. A lot of excuses are made that 'you pay for what you get' meaning the quality is super high and thus expensive, or that the cost is very high, and that has to be calculated in to the prices, or that the business side is very hard and complex and can only be done that way; but unless they have unicorns and rainbows we don't know about those excuses are just that: excuses. The cost is high, and the quality doesn't match it - almost all healthcare systems in other developed countries is both higher quality and cheaper at the same time as well as having lower mortality rates. Exploiting people that are intrinsically motivated to help people who put their lives their hands is just another sign of the administrative side of this deal completely doing it wrong. The same people, buildings, services, machines, procedures in a different country with a better end-result and lower mortality rate should be enough proof.

makotech222 7y ago
Its not intrinsically the administration, it's capitalism. The administration in these cases just happen to represent the owners, who's goal is to increase profits at all costs. Imagine how hospitals would be if they were owned by the doctors and nurses instead?
rayiner 7y ago
I guess the UK NHS is run like a for profit business: https://www.theguardian.com/society/2019/feb/17/nhs-staff-quit-record-numbers-work-life-balance https://www.theguardian.com/society/2019/feb/17/nhs-staff-qu... > Health unions have been warning for years that NHS personnel are cracking under heavy workloads, rising demand for care and widespread understaffing. Many staff report routinely working beyond their normal hours to complete all their tasks.

ineedasername 7y ago

The article cites the fact that there are 10 administrators for every actual doctor or nurse, and these lines should be cut in half to instead be spent on more doctors and nurses. I think this represents a gross oversimplification, overlooking the necessary work of administrative staff. It's not unlike the airforce: there are about 23,000 pilots but 500,000 personnel, a ratio of more than 20:1. It takes a lot to support the enterprise that keeps planes in the air. In the medical profession, someone has to keep the enterprise running. Cataloging medical imagery & seek and retrieve records as needed. Accountants and HR departments, IT departments, working with insurance companies, all of it. Even with the amount of EMR work doctors & nurses may do themselves, it takes a tremendous amount of background "plumbing" work to allow them to focus on the actual treatment. I'm not saying there isn't any administrative bloat anywhere, but I am saying that non-practitioner staff in the industry feel this resource crunch quite a bit themselves too. The technician running the radiology suite feels just as much pressure to help fit in that extra patient and stay beyond scheduled hours to do so. Treating the entire non-doctor/non-nursing staff as bloat is an extreme disservice to the mission critical work they perform. I am literally taking my 1.5 year old son home from the hospital today after an emergency visit that kept us there for days, and during this ordeal I dealt with at least 3 or 4 non practicing staff that went above and beyond their duties to help with something and smooth the process over for the work that doctors and nurses needed to perform. These staff feel the ethical drive to serve every bit as much, it just happens to be less visible.

danmaz74 7y ago
How much of the administrative staff you mention is only needed because hospitals have to work as for profit organizations? And don't forget to add the administrative staff from the insurance companies themselves.
- ineedasername 7y ago
  Insurance companies are a separate issue, though some of their administrative functions would be required in any healthcare system. (Certainly not all though). As for hospitals working for-profit, about the only administrative function I can think of that is unique to that model is marketing. I may be missing something, but even so it would be very, very much less than the 50% the author of the article would do away with.

markroseman 7y ago

Healthcare is under stress everywhere, but those of you in the USA who don't understand how fundamentally broken your system is need to give your heads a shake. It's precisely because of how it's treated like a business first, thinking that competition is the solution to the problem, and applying other business principles is the way to improvement that things are the way they are. Read medical forums like KevinMD and you hear constantly about highly trained physicians ready to abandon the profession because they're treated like automatons, high suicide rates, and the best way to find a side hustle because their jobs suck so badly. Your country is being held back by the ludicrous way healthcare is structured, citizens shackled to employers, with the worst results for money spent anywhere in the civilized world. Citizens are so brainwashed they're unwilling to acknowledge the ideological morass that created and sustains this all. People who remain so frightened when people say the word 'socialism' that they double down on stupidity. Or refuse to look outside your borders because you're self-evidently the greatest country on earth. Pitiful.

0815test 7y ago

That's the nice thing about 996ICU for doctors and nurses: they don't have to walk very far to get to the ICU. Oh and also, they're pulling pretty good money for their "exploitation" at least in the US. Want to address the overwork issue? Increase medical residency opportunities and available medical-school admission seats.

Proven 7y ago

The usual leftist whining... Does anyone actually believe that "exploited" personnel provides better service? That wouldn't make any sense. Do disgruntled programmers make better software? Let's consider for a moment why these unhappy, burned out workers don't go someplace else? Because State regulates like crazy so there is little difference among workplaces. Deregulate and workers will be better off.