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I don’t want overworked medical professionals. I want the hospitals to hire more people to work healthy 8 hour shifts. There is a viable different approach, bu

I don’t want overworked medical professionals. I want the hospitals to hire more people to work healthy 8 hour shifts. There is a viable different approach, but the employers do not like it. Let’s stop pretending.

Proven 5y ago
And you'd also like that healthcare be free, and affordable. Keep going - what else would you like to have?
asdfasgasdgasdg 5y ago
Ultimately, it's payers -- taxpayers and insurance payers -- that aren't down the the "hire more people" solution. Another stakeholder group that's not down with it? Doctors. The AMA, who doctors control corporately, don't certify enough medical schools to train sufficient doctors to make the reality you want possible.
- whatever1 5y ago
  Does the AMA certify the colleges of nurses? No. And yet here we are: https://www.theguardian.com/society/2019/feb/12/nurses-hospitals-understaffed-risks-burnout https://www.theguardian.com/society/2019/feb/12/nurses-hospi...
  - asdfasgasdgasdg 5y ago
    I didn't say doctors were responsible for all understaffed roles in the country. But they are partly responsible for understaffed physician roles. :) The payer aspect I mentioned is relevant for the nurses.
    - whatever1 5y ago
      In America we pay on average ~$3000 per day of stay in the hospital. How much extra do we have to pay to have enough nurses so that we don't work them to death? Why British hospitals have a fraction of that cost (1/10th)? Oh yes, it is because they decided that it is not a moneymaking business. Overworked employees should not blame themselves for not being able to keep up with unreasonable hours. They should blame the real responsible for their misery. Their employer.
      - asdfasgasdgasdg 5y ago
        It feels good to have a villain to blame, but in a complicated problem, there are often complicated reasons. https://www.investopedia.com/articles/personal-finance/080615/6-reasons-healthcare-so-expensive-us.asp https://www.investopedia.com/articles/personal-finance/08061... Hospital profits are part of the costs, but doctors and nurses here are also paid more than elsewhere. Doctors in the US are paid multiple times as much as doctors in the UK, and supply restriction is a big part of why that is possible. There are also administrative costs, drug costs, and insurance overheads to deal with.
        nicoffeine 5y ago
        It's not that complicated. When we setup competition for infrastructure, we needlessly duplicate management, marketing, accounting, and everything else that does not directly result in the service being provided. The US is doubly idiotic by creating huge financial barriers for anyone who wants to enter healthcare. We make the problem even worse with a system that encourages people to delay treatment for problems that get more expensive to treat over time. The less money you have the more you delay, so the entire system eventually ends up overpaying for a worse outcome. This doesn't factor in all the time spent dealing with inscrutable billing practices for fully insured people having routine medical procedures, or the tens of thousands who are bankrupted every year by the same practices. We recently took our daughter to the ER, which is supposed to be a $400 copay. We now have three separate bills from that visit totaling $1100, and I have no idea how many hours it will take to sort out. The same billing department sent us a $380 invoice six months after her birth because (in their description) they forgot she was there.
        bumby 5y ago
        >It's not that complicated Just out of curiosity, what’s your proposed solution? There's been decades of very smart people working on this problem and its still a problem largely because of its complexity. If there was a simple solution, I have a feeling it would have been implemented already. The irony of your post that starts with "its not that complicated" ends with an anecdote about just how complicated the system is.
AQuantized 5y ago
Are 8 hour shifts healthy for patients? More handovers is strongly correlated with poorer patient outcomes. We need to strike a balance between the falloff in ability that comes with consecutive hours awake past a certain point, and minimizing handover.
- snowwrestler 5y ago
  You’re not wrong, but when doctors work longer shifts, they work fewer days of the week. The total weekly hours are the same, they are just distributed differently.
- whatever1 5y ago
  Refineries have blown up because of messed handovers, is the solution to have the console operators on 24h/7 days-a-week shifts? Like the sibling comment said, if you are overworking then the process is broken. The thing that I added, is that maybe the process remains broken because the employer finds it profitable.
  - AQuantized 5y ago
    NHS doctors will typically have a significant part of their rota made up of 'long days'. The 'solution' is never 24/7, or less hyperbolic but still overly long hours, because there is a median decrease in cognitive function that renders additional benefit from fewer handovers moot. But as regards 'overworking', while that is certainly true for many US residents in particular, I think the majority of people would be overworked on a surgeon's schedule. Yet reducing it significantly would probably be much worse for patients and decried by surgeons. My viewpoint is mostly informed by the British neurosurgeon Henry Marsh's opinion on working hours.
bumby 5y ago
Hiring may be a part of it, but not the whole answer. It actually needs a more process-oriented solution. Adding people to a broken process makes things worse. When people complain of being over burdened, more often than not it means the process they worked within had a lot of waste. Invariably, the proposed solution was always “we need more people”. You can sometimes hide process waste problems with inventory. The number of times hiring people made for a long term solution is exactly zero in my experience, and this includes process improvement work within healthcare. “Just hire more people” tends to be a myopic view that underscores a misunderstanding of the systemic effects at work.

Proven 5y ago

And you'd also like that healthcare be free, and affordable. Keep going - what else would you like to have?

asdfasgasdgasdg 5y ago

Ultimately, it's payers -- taxpayers and insurance payers -- that aren't down the the "hire more people" solution. Another stakeholder group that's not down with it? Doctors. The AMA, who doctors control corporately, don't certify enough medical schools to train sufficient doctors to make the reality you want possible.

whatever1 5y ago
Does the AMA certify the colleges of nurses? No. And yet here we are: https://www.theguardian.com/society/2019/feb/12/nurses-hospitals-understaffed-risks-burnout https://www.theguardian.com/society/2019/feb/12/nurses-hospi...
- asdfasgasdgasdg 5y ago
  I didn't say doctors were responsible for all understaffed roles in the country. But they are partly responsible for understaffed physician roles. :) The payer aspect I mentioned is relevant for the nurses.
  - whatever1 5y ago
    In America we pay on average ~$3000 per day of stay in the hospital. How much extra do we have to pay to have enough nurses so that we don't work them to death? Why British hospitals have a fraction of that cost (1/10th)? Oh yes, it is because they decided that it is not a moneymaking business. Overworked employees should not blame themselves for not being able to keep up with unreasonable hours. They should blame the real responsible for their misery. Their employer.
    - asdfasgasdgasdg 5y ago
      It feels good to have a villain to blame, but in a complicated problem, there are often complicated reasons. https://www.investopedia.com/articles/personal-finance/080615/6-reasons-healthcare-so-expensive-us.asp https://www.investopedia.com/articles/personal-finance/08061... Hospital profits are part of the costs, but doctors and nurses here are also paid more than elsewhere. Doctors in the US are paid multiple times as much as doctors in the UK, and supply restriction is a big part of why that is possible. There are also administrative costs, drug costs, and insurance overheads to deal with.
      - nicoffeine 5y ago
        It's not that complicated. When we setup competition for infrastructure, we needlessly duplicate management, marketing, accounting, and everything else that does not directly result in the service being provided. The US is doubly idiotic by creating huge financial barriers for anyone who wants to enter healthcare. We make the problem even worse with a system that encourages people to delay treatment for problems that get more expensive to treat over time. The less money you have the more you delay, so the entire system eventually ends up overpaying for a worse outcome. This doesn't factor in all the time spent dealing with inscrutable billing practices for fully insured people having routine medical procedures, or the tens of thousands who are bankrupted every year by the same practices. We recently took our daughter to the ER, which is supposed to be a $400 copay. We now have three separate bills from that visit totaling $1100, and I have no idea how many hours it will take to sort out. The same billing department sent us a $380 invoice six months after her birth because (in their description) they forgot she was there.
        bumby 5y ago
        >It's not that complicated Just out of curiosity, what’s your proposed solution? There's been decades of very smart people working on this problem and its still a problem largely because of its complexity. If there was a simple solution, I have a feeling it would have been implemented already. The irony of your post that starts with "its not that complicated" ends with an anecdote about just how complicated the system is.

AQuantized 5y ago

Are 8 hour shifts healthy for patients? More handovers is strongly correlated with poorer patient outcomes. We need to strike a balance between the falloff in ability that comes with consecutive hours awake past a certain point, and minimizing handover.

snowwrestler 5y ago
You’re not wrong, but when doctors work longer shifts, they work fewer days of the week. The total weekly hours are the same, they are just distributed differently.
whatever1 5y ago
Refineries have blown up because of messed handovers, is the solution to have the console operators on 24h/7 days-a-week shifts? Like the sibling comment said, if you are overworking then the process is broken. The thing that I added, is that maybe the process remains broken because the employer finds it profitable.
- AQuantized 5y ago
  NHS doctors will typically have a significant part of their rota made up of 'long days'. The 'solution' is never 24/7, or less hyperbolic but still overly long hours, because there is a median decrease in cognitive function that renders additional benefit from fewer handovers moot. But as regards 'overworking', while that is certainly true for many US residents in particular, I think the majority of people would be overworked on a surgeon's schedule. Yet reducing it significantly would probably be much worse for patients and decried by surgeons. My viewpoint is mostly informed by the British neurosurgeon Henry Marsh's opinion on working hours.

bumby 5y ago

Hiring may be a part of it, but not the whole answer. It actually needs a more process-oriented solution. Adding people to a broken process makes things worse. When people complain of being over burdened, more often than not it means the process they worked within had a lot of waste. Invariably, the proposed solution was always “we need more people”. You can sometimes hide process waste problems with inventory. The number of times hiring people made for a long term solution is exactly zero in my experience, and this includes process improvement work within healthcare. “Just hire more people” tends to be a myopic view that underscores a misunderstanding of the systemic effects at work.