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One lesson might well be that the relative pay gap between senior nurses and senior doctors is too big - i.e. senior doctors should be paid less / we should emp

One lesson might well be that the relative pay gap between senior nurses and senior doctors is too big - i.e. senior doctors should be paid less / we should employ fewer doctors and more nurses. But that's probably a very very hard thing to actually do politically both in terms of internal hospital/NHS politics and national politics. There are strongly entrenched interests in the NHS which I suspect constrain relative pay between professions and grades much more tightly than they constrain absolute pay numbers.

mjevans 7y ago
Probably a better approach would be less pay for better quality of life jobs* which would still require more doctors and slightly more overall pay. Also a lot more nurses; since with the baby boomer generation in and entering retirement the need isn't going to go down relative to historic levels. * Edit: By better quality of life I mean things like having a 4 x 8 hour shifts with each having about 2 hours of overlap for review of records, passing down, and filling out post shift paperwork. Yes nurses would need similar shifts, the overlap also gives time for the transfer of knowledge, in the process of getting it entered/updated in the health record systems.
- tracker1 7y ago
  A lot of nurses already work 3x13 or 4x10-12 shifts, many also work secondary nurse staffing (temp/onsite) jobs beyond their regular work. The work is definitely under valued, and there is some range in pay, but the top caps out relatively low for the knowledge and experience. Some locations don't allow nurses to unionize or strike. In AZ, for example, there's an inverse-union all the hospitals joined that member providers for staffing have to comply with contracted rates, etc. Which I don't know why it doesn't go afoul of the right to work laws here, I don't know (probably lack of prosecution). In the end, it varies a lot and at some point there will definitely be more collective negotiation going on. Pay will have to go up in a lot of locations.
opportune 7y ago
In the US I typically receive very poor care from people with the title "Nurse Practitioner" who are usually hired for the exact purpose of getting people to do doctor-like work for cheaper. They are ok at dealing with very normal conditions like the flu/cold, acute non-critical injuries, etc. (which you honestly don't even need to get care for anyway) but not good at dealing with issues outside of that
- barry-cotter 7y ago
  There’s no evidence to suggest inferior results or standards of care from nurse practitioners than primary care doctors. COMPARISON OF PRIMARY CARE OUTCOMES OF NURSE PRACTITIONERS AND PHYSICIANS https://research.libraries.wsu.edu/xmlui/bitstream/handle/2376/3781/K_Stidham_010083140.pdf?sequence=1 https://research.libraries.wsu.edu/xmlui/bitstream/handle/23... > Relevant Research Findings There are two landmark studies on the quality of the primary care delivered by nurse practitioners in regards to that of physicians. The first was by Mundinger, et al. (2000) and a follow-up study by Lenz, Mundinger, Kane, Hopkins & Lin (2004). ... > The results indicated tllat there were no significant differences in patient outconles regarding health status, physiologic test results or health status utilization. Patients seen by NPs did have a statistically significant, but not clinically significant lower diastolic blood pressure (82 vs. 85 mm Hg; p==.04). ... > The outcomes compared were health status, utilization of health services, and satisfaction with health care. The investigators found no significant differences in outcomes between the two groups, one seen by MDs and the other seen by NPs. The only difference in the results is the average number of primary care visits during year two for each discipline
  - opportune 7y ago
    You left out a crucial sentence from the paragraph you cited: > The study was a randomized double-blind trial to compare outcomes of patients assigned to either NPs or MDs for follow-up care after initial management at either an emergency department or urgent care clinic for asthma, diabetes, and/or hypertension. This excludes what I originally meant to refer to, which is non-routine care. I am fully confident that NPs can handle routine care, what I was asserting is that they are (anecdotally) bad at handling more complex/infrequent issues

mjevans 7y ago

Probably a better approach would be less pay for better quality of life jobs* which would still require more doctors and slightly more overall pay. Also a lot more nurses; since with the baby boomer generation in and entering retirement the need isn't going to go down relative to historic levels. * Edit: By better quality of life I mean things like having a 4 x 8 hour shifts with each having about 2 hours of overlap for review of records, passing down, and filling out post shift paperwork. Yes nurses would need similar shifts, the overlap also gives time for the transfer of knowledge, in the process of getting it entered/updated in the health record systems.

tracker1 7y ago
A lot of nurses already work 3x13 or 4x10-12 shifts, many also work secondary nurse staffing (temp/onsite) jobs beyond their regular work. The work is definitely under valued, and there is some range in pay, but the top caps out relatively low for the knowledge and experience. Some locations don't allow nurses to unionize or strike. In AZ, for example, there's an inverse-union all the hospitals joined that member providers for staffing have to comply with contracted rates, etc. Which I don't know why it doesn't go afoul of the right to work laws here, I don't know (probably lack of prosecution). In the end, it varies a lot and at some point there will definitely be more collective negotiation going on. Pay will have to go up in a lot of locations.

opportune 7y ago

In the US I typically receive very poor care from people with the title "Nurse Practitioner" who are usually hired for the exact purpose of getting people to do doctor-like work for cheaper. They are ok at dealing with very normal conditions like the flu/cold, acute non-critical injuries, etc. (which you honestly don't even need to get care for anyway) but not good at dealing with issues outside of that

barry-cotter 7y ago
There’s no evidence to suggest inferior results or standards of care from nurse practitioners than primary care doctors. COMPARISON OF PRIMARY CARE OUTCOMES OF NURSE PRACTITIONERS AND PHYSICIANS https://research.libraries.wsu.edu/xmlui/bitstream/handle/2376/3781/K_Stidham_010083140.pdf?sequence=1 https://research.libraries.wsu.edu/xmlui/bitstream/handle/23... > Relevant Research Findings There are two landmark studies on the quality of the primary care delivered by nurse practitioners in regards to that of physicians. The first was by Mundinger, et al. (2000) and a follow-up study by Lenz, Mundinger, Kane, Hopkins & Lin (2004). ... > The results indicated tllat there were no significant differences in patient outconles regarding health status, physiologic test results or health status utilization. Patients seen by NPs did have a statistically significant, but not clinically significant lower diastolic blood pressure (82 vs. 85 mm Hg; p==.04). ... > The outcomes compared were health status, utilization of health services, and satisfaction with health care. The investigators found no significant differences in outcomes between the two groups, one seen by MDs and the other seen by NPs. The only difference in the results is the average number of primary care visits during year two for each discipline
- opportune 7y ago
  You left out a crucial sentence from the paragraph you cited: > The study was a randomized double-blind trial to compare outcomes of patients assigned to either NPs or MDs for follow-up care after initial management at either an emergency department or urgent care clinic for asthma, diabetes, and/or hypertension. This excludes what I originally meant to refer to, which is non-routine care. I am fully confident that NPs can handle routine care, what I was asserting is that they are (anecdotally) bad at handling more complex/infrequent issues