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Why do we need the federal government to fund these slots at all? Hospitals work resident physicians to the bone and bill patients exorbitantly for it. Their

Why do we need the federal government to fund these slots at all? Hospitals work resident physicians to the bone and bill patients exorbitantly for it. Their hours are capped at 80 per week yet they receive no overtime pay[1]. Yes, the residents are "in training" but it's not like it's a burden for a hospital to take them on - they are the workhorses that handle a huge number of cases and drive hospital revenue. [1] - https://en.wikipedia.org/wiki/Medical_resident_work_hours https://en.wikipedia.org/wiki/Medical_resident_work_hours

refurb 7y ago
Residents are closely supervised by another physician. So it's not just paying for the resident, it's paying for the supervisor as well. And early on, the supervisor is going to be combing through the details of each patient to make sure mistakes aren't made. That plus the throughput of residents is going to be much lower than a trained physician. As such, Medicare pays a "training institution" premium for all billing. It's a small bomb (5%?) but pays for the resident.
- triceratops 7y ago
  Why can't the resident sign a contract with the hospital promising to work there a certain number of years after finishing residency? That's what other industries with a training period do.
gamblor956 7y ago
Most hospitals operate at a loss. The ones that don't nickel and dime their patients, or even engage in outright billing fraud. Do you really want to move more hospitals to the latter form of doing business? Because they would be a huge net loss for everyone except the hospital CEOs.
- programmertote 7y ago
  Not doubting you (because I know that the mergers are happening a lot often these days, but could be partly because it's the natural conclusion of capitalism). Could you share any reference to the claim that most hospitals operate at a loss?
  - asdff 7y ago
    these are tough search terms to use with all the blogspam these days, but here is an article from a few years ago. huge losses in 2016 at least. https://hbr.org/2017/10/how-u-s-hospitals-and-health-systems-can-reverse-their-sliding-financial-performance https://hbr.org/2017/10/how-u-s-hospitals-and-health-systems...
- MrBuddyCasino 7y ago
  Given the medical costs in the US, this really begs the question: why?
  - a2tech 7y ago
    To receive federal and state funding as well as accept residents hospitals have to run an ER and accept patients regardless of payment ability. Some facilities will do their best to help a patient that will be unable to pay. Others will simply stabilize the patient until they're not going to die immediately and then kick them out. Since medical care is very expensive a single non-covered ED patient could EASILY cost the hospital 250k+ per visit. For example maybe a homeless person is found and brought in unconscious. They're then discovered to have untreated diabetes, rot in their feet, and psychiatric issues. They'll be in the hospital for at least a week, surgery to clean up any rotten tissue, and then maybe a stay in the psych ER or other facility. Every day wracking up huge charges which the hospital will never be compensated for..except by spreading the loss around to others.
    - wolco 7y ago
      No hospital is going to pay for long tern psychiatric treatment unless it consists of pills during a short ER visit until social services can take over.
    - MrBuddyCasino 7y ago
      This looks like a crude version of socialised healthcare to me. Other socialised healthcare systems around the world should in theory face the same problem, wouldn't they? But AFAIK they do not nearly have the same cost issues as the US, at least I'm not aware of this here in Germany. One theory I've heard that sounds plausible is that a) insurers do not pay anywhere near what hospitals bill to uncovered patients b) hospitals do not even expect patients to pay the whole bill, but more like 20% of it, so it is always good to contest the bill So the problem is that hospitals are cash-strapped for systemic reasons, but can't get it from insurers or the state because those have contracts in place. So hospitals try to squeeze uninsured patients as much as they can with inflated bills, with predictably horrifying consequences. Insurers don't mind because that makes the case for buying insurance even stronger. So one solution might be to pay for poor/homeless care via state/federal budgets. This could cover poor people up to an income level that can afford insurance.
- rhexs 7y ago
  Do they truly operate at a loss, or do they operate at a loss in the same way Hollywood films never make money? That's absolutely fascinating if so.
  - MagnumOpus 7y ago
    It's the latter. Whenever they would make money, they hike pay for senior administrators, of which there are a huge number (and maybe doctors and nurses too).
- TuringNYC 7y ago
  Many tech startups also operate at a loss. Plenty provide valuable services. Few have millions of dollars billables per workers, as doctors do. I wish the government would pay my junior engineers’ salaries.
  - gamblor956 7y ago
    Generally, any random doctor at a hospital provides valuable services. I honestly can't name more than a handful of large or small startups that do anything remotely valuable. And the ones that do provide actual value don't operate at a loss...
    - petra 7y ago
      Startups are experiments. Sometimes, you learn something really valuable in the process. Often, you don't.

refurb 7y ago

Residents are closely supervised by another physician. So it's not just paying for the resident, it's paying for the supervisor as well. And early on, the supervisor is going to be combing through the details of each patient to make sure mistakes aren't made. That plus the throughput of residents is going to be much lower than a trained physician. As such, Medicare pays a "training institution" premium for all billing. It's a small bomb (5%?) but pays for the resident.

triceratops 7y ago
Why can't the resident sign a contract with the hospital promising to work there a certain number of years after finishing residency? That's what other industries with a training period do.

gamblor956 7y ago

Most hospitals operate at a loss. The ones that don't nickel and dime their patients, or even engage in outright billing fraud. Do you really want to move more hospitals to the latter form of doing business? Because they would be a huge net loss for everyone except the hospital CEOs.

programmertote 7y ago
Not doubting you (because I know that the mergers are happening a lot often these days, but could be partly because it's the natural conclusion of capitalism). Could you share any reference to the claim that most hospitals operate at a loss?
- asdff 7y ago
  these are tough search terms to use with all the blogspam these days, but here is an article from a few years ago. huge losses in 2016 at least. https://hbr.org/2017/10/how-u-s-hospitals-and-health-systems-can-reverse-their-sliding-financial-performance https://hbr.org/2017/10/how-u-s-hospitals-and-health-systems...
MrBuddyCasino 7y ago
Given the medical costs in the US, this really begs the question: why?
- a2tech 7y ago
  To receive federal and state funding as well as accept residents hospitals have to run an ER and accept patients regardless of payment ability. Some facilities will do their best to help a patient that will be unable to pay. Others will simply stabilize the patient until they're not going to die immediately and then kick them out. Since medical care is very expensive a single non-covered ED patient could EASILY cost the hospital 250k+ per visit. For example maybe a homeless person is found and brought in unconscious. They're then discovered to have untreated diabetes, rot in their feet, and psychiatric issues. They'll be in the hospital for at least a week, surgery to clean up any rotten tissue, and then maybe a stay in the psych ER or other facility. Every day wracking up huge charges which the hospital will never be compensated for..except by spreading the loss around to others.
  - wolco 7y ago
    No hospital is going to pay for long tern psychiatric treatment unless it consists of pills during a short ER visit until social services can take over.
  - MrBuddyCasino 7y ago
    This looks like a crude version of socialised healthcare to me. Other socialised healthcare systems around the world should in theory face the same problem, wouldn't they? But AFAIK they do not nearly have the same cost issues as the US, at least I'm not aware of this here in Germany. One theory I've heard that sounds plausible is that a) insurers do not pay anywhere near what hospitals bill to uncovered patients b) hospitals do not even expect patients to pay the whole bill, but more like 20% of it, so it is always good to contest the bill So the problem is that hospitals are cash-strapped for systemic reasons, but can't get it from insurers or the state because those have contracts in place. So hospitals try to squeeze uninsured patients as much as they can with inflated bills, with predictably horrifying consequences. Insurers don't mind because that makes the case for buying insurance even stronger. So one solution might be to pay for poor/homeless care via state/federal budgets. This could cover poor people up to an income level that can afford insurance.
rhexs 7y ago
Do they truly operate at a loss, or do they operate at a loss in the same way Hollywood films never make money? That's absolutely fascinating if so.
- MagnumOpus 7y ago
  It's the latter. Whenever they would make money, they hike pay for senior administrators, of which there are a huge number (and maybe doctors and nurses too).
TuringNYC 7y ago
Many tech startups also operate at a loss. Plenty provide valuable services. Few have millions of dollars billables per workers, as doctors do. I wish the government would pay my junior engineers’ salaries.
- gamblor956 7y ago
  Generally, any random doctor at a hospital provides valuable services. I honestly can't name more than a handful of large or small startups that do anything remotely valuable. And the ones that do provide actual value don't operate at a loss...
  - petra 7y ago
    Startups are experiments. Sometimes, you learn something really valuable in the process. Often, you don't.