20 ms·

While it's anecdote, every single peer in bedside medical care I know without exception has either left the field, or has immediate plans to as soon as student

by phil21 5y ago

While it's anecdote, every single peer in bedside medical care I know without exception has either left the field, or has immediate plans to as soon as student loan debt is repaid. The few older medical professionals in my family are simply sticking out the last few years until they can retire early. This was generally the case prior to pandemic due to how poor the work environment has become, but the pandemic seems to have broken the few remaining folks who still had hopes and dreams. How doctors of all professions lost their professional agency to do-nothing administrators within a generation is quite puzzling and a bit terrifying to me.

salt-thrower 5y ago
> How doctors of all professions lost their professional agency to do-nothing administrators within a generation is quite puzzling The profit model of the U.S. healthcare industry might have something to do with it. The fact that hospitals are run like businesses and have shareholders is insane to me. I know other countries' healthcare systems got hit hard by the pandemic too, but it seems like the uniquely capitalist nature of healthcare in the U.S. sets it up to mistreat workers and cut corners for the benefit of administrators and executives.
- reedjosh 5y ago
  If they can't throw some medication with pharma kickbacks at you, they probably won't do much at all. My 6 month old son was put on topical steroids for a small rash on his back and the doctors solution when this turned into a progressive issue was more and stronger topical steroids. Eventually I learned about topical steroid withdrawal, and after a hellish withdrawal period, my son has no real skin conditions. https://www.youtube.com/watch?v=PpW4VV2bsD8&t=28s https://www.youtube.com/watch?v=PpW4VV2bsD8&t=28s And yes, my son at ~1 year old was red and bleeding like that head to toe. When I brought up steroid withdrawal I was rudely dismissed by multiple doctors including dermatologists. Doctors currently have willful blinders on at a minimum, and some may be a true embodiment of evil. I hope the whole for profit medical system crashes and burns.
  - Enginerrrd 5y ago
    Steroids are so commonplace and old, I really doubt anyone was getting pharma kickbacks in the case of your son. There's just a large range in quality amongst doctors. What you're calling "willful blinders" or "true embodiment of evil" is more likely just a failure to adapt out of a simple paradigm: {Inflammation}->{Treatment = steroids}. And a failure to recognize when that was causing a loop. Maybe they forgot about steroid withdrawal. In fact, as someone with quite an interest in pharmacology and some background as a paramedic, this is the first I've ever heard of it, and I love obscure medication issues.
    - reedjosh 5y ago
      > Maybe they forgot about steroid withdrawal. As I mentioned in my comment I mentioned steroid withdrawal to many doctors when my son was literally only sleeping an hour or so a night from itching and I was dismissed out of hand. If its not kickbacks, then its such a terrible arrogance as to be evil. How can a dermatologist not know of my son's condition? Particularly seeing as steroids have been around for a while as you've mentioned. Even when I brought the idea to the dermatologist, after a bit of head nodding his solution was another two weeks of a yet stronger steroid to `calm it down`, and then to taper. There's a nonprofit trying to get doctors to properly acknowledge the condition. https://www.itsan.org/ https://www.itsan.org/ There's as I linked above about a million videos of people recovering from TSW as well. There's even a study out of Autstralia that followed 10 children with what was called bad eczema, but after a withdrawal period every child at max had pruritis on elbows or knees. https://www.medicaljournals.se/acta/content_files/files/pdf/99/6/5412.pdf https://www.medicaljournals.se/acta/content_files/files/pdf/... If my job were skin, and topical steroids was one of the main things I used as a tool, how could I not know about these issues? You'd have to be such a hack that nobody would consider you a professional, yet the same dermatologist that offered yet another round of steroids had his office on the penthouse suite of a downtown building with a showcase displaying awards. It may seem hyperbolic to you, but you didn't live through this like I did. You didn't see your young child in complete misery due to medical authorities you thought you could trust misguiding you. It's evil of some form.
- toiletfuneral 5y ago
  [dead]
- theklub 5y ago
  It’s not just that, some hospitals are outsourcing everything disenfranchising the people that work there. And I mean everything from the doctors themselves to IT to the cleaning lady to the food workers and selling the buildings to lease them back. It’s the fleecing of America.
- bitsnbytes 5y ago
  profit model is not the issue. How the compensation and rewards are structured is the issue.
  - defterGoose 5y ago
    So...we need to manage that better?
    - bitsnbytes 5y ago
      absolutely.We need to look at ways to make monetary compensation more aligned with the best interest of the patient. Having said that we also need to look at patients taking more accountability for their health and consequences for wasting medical professional times.
orangepurple 5y ago
> How doctors of all professions lost their professional agency to do-nothing administrators within a generation is quite puzzling and a bit terrifying to me. I would bet it's caused by: - stifling bureaucracy - hostile legal climate - massive start up costs The only winning move is not to play. Let the system fall apart and join on the later upswing. The unfortunate part is all the needless suffering people will endure during this process.
brightball 5y ago
Insurance companies. Everything is controlled by insurance companies. You can’t do anything unless it’s exactly how insurance wants and only for what insurance will pay. It limits everything, including how every profession can be compensated simply because you can’t easily hire somebody for more than what insurance will pay for their services. You can, but the funds have to come from somewhere.
- belval 5y ago
  I doubt that it's as simple as that. Nurses are also leaving in Canada and we don't have insurance breathing down their neck.
  - reedjosh 5y ago
    But they have zero autonomy there too I assume?
    - belval 5y ago
      Sample size of 1, but my gf blames forced overtime. Being legally obliged to stay for an 8 hours shift after finishing one has a way to drive you to depression.
      - px43 5y ago
        I would pay more to go to a hospital where I know people are actually well rested. My last few hospital stays have been saturated with clearly agitated staff (doctors, nurses, reception) who were putting in minimal effort, and clearly didn't want to be there, and I can't blame them given the conditions that they're being forced to work under. This is in the US, and I can't figure out why the Department of Labor hasn't cracked down on the medical industry yet. It's really horrific, especially because these are the people we're supposed to be relying on to keep us healthy and safe. How hard is it to enforce 8 hour days 5 days a week? Every other industry has figured it out.
        5y ago
PragmaticPulp 5y ago
> How doctors of all professions lost their professional agency to do-nothing administrators within a generation is quite puzzling and a bit terrifying to me. I have a lot of friends at various levels of healthcare, from nursing up through low and mid-level administrative positions. The one thing they all seem to agree on is that patient satisfaction surveys have been terrible for healthcare. Once the emphasis shifted to patient satisfaction, everything became more of a game of catering to what the patient thinks they want. With the spread of rampant medical misinformation on the internet and the rise of alternative-medicine podcasts/blogs/influencers masquerading as informed medical professionals they have a constant influx of patients who show up believing they have a certain condition or need a certain medication. If you disagree too much or refuse to give them the medication they want, you risk a negative review. Too many negative reviews could negatively impact your compensation or even cost you your job. Even at offices that don't perform patient satisfaction surveys, providers are at the mercy of negative online reviews. Again, if you don't do exactly what the patient thinks they want, you risk scathing online reviews. This is terrifyingly problematic given the trend of people to self-diagnose with anxiety or infections who show up demanding Xanax or antibiotics. Puts doctors in a situation where they don't really think prescribing those medications is a good idea, but they also feel like they can't deny too many patients or they risk their reputation/bonus/reviews. It's also a huge problem with conditions like obesity or alcoholism or smoking, where the doctors can see obvious patient-induced health issues but the patient really doesn't want to hear the truth from their doctor.
- hedora 5y ago
  That reminds me. I have one laying around to fill out. 10/10 plan to get sick again.
- CityOfThrowaway 5y ago
  Patient satisfaction surveys are the legible feedback mechanism showing that something is deeply broken, but not the source of the problem itself. It's clear from your comment that the source of the problem is the increasingly sharp divide between what the credentialed medical professionals believe and what lay people believe. The satisfaction survey is simply uncovering that fact. It would be vastly worse if patients were being treated and had no recourse when they felt their health was mismanaged. It may well be the case that the patients are wrong, but it is extremely dystopian to imagine a world where individuals are not empowered to make decisions about their own bodies.
birdmanjeremy 5y ago
I'm friends with quite a few nurses, primarily travel nurses, and not a single one is considering a change in career that I am aware of. Simply an anecdotal counterpoint and nothing more.
- pc86 5y ago
  Travel nurses are compensated quite a bit more in my understanding. And the travel aspect means they can leave the more toxic locations more easily.
  - phkahler 5y ago
    They're paid a shit ton more. And because of that, more nurses are quitting to do the travel thing, which worsens the shortage and increases demand for travel nurses ;-) never seen an industry fuck itself over so bad. That's really the issue - healthcare has become an industry, not a profession.
    - joshgel 5y ago
      It's really amazing to see travel nurses come back to work at a place they just left. They are now doing the same job as before, are getting paid almost twice as much with better schedules and are working next to people that they know and are friends with. It's honestly surprising that more haven't taken the jump and is really shocking that hospitals aren't doing more to retain critical staff.
      - TecoAndJix 5y ago
        The hospitals have been asking Biden to put a stop to it: https://www.npr.org/2022/02/02/1077710203/hospitals-ask-biden-administration-to-help-lower-the-soaring-cost-of-travel-nurs https://www.npr.org/2022/02/02/1077710203/hospitals-ask-bide...
        pc86 5y ago
        It sounds nurses just need to be paid more, or travel nurses need to be paid less. Equilibrium is probably somewhere between the two extremes. Apropos of nothing but why is the knee jerk reaction "we need executive action to fix this staffing problem?"
api 5y ago
> lost their professional agency to do-nothing administrators You just summarized the decline of Western civilization in one phrase. This has happened almost everywhere and efforts to push back have proven extremely difficult. I personally place a lot of the blame on the educational system for overproducing administrative skill sets and underproducing practical skill sets. There is some role for those things of course but we have far too many people for the administrative roles we really need and far too few for many other professions. This combined with the tendency of people to recruit people like themselves has oversaturated the market with administrators looking for reasons to exist. The rot is to the point that we have the spectacle of Elon Musk looking like superman. Why does he look like superman? Because he actually does things instead of having meetings to discuss the meeting schedule. He's just a reasonably competent engineer and business founder with huge resources who... does things... and this makes him look superhuman by comparison to the hordes of administrators that only discuss doing things and commission studies about hypothetically doing things.
- hedora 5y ago
  See also: California’s plan to eliminate algebra 2 and calculus from the highschool curriculum. It is being spearheaded by someone without a math degree, in the name of improving marketability of the kids for data science positions, or something. See also (2): Monty Python’s bicycle repairman sketch.
  - api 5y ago
    Yeah that proposal is insane. For a while now it feels like the left and the right are attempting to one-down each other on how stupid they can get. That proposal seems like an example of the left trying to out-stupid Trump and the alt-right. Don't worry I'm sure the right is working on things even dumber than this, and then those will have to be topped, and so on. In 2024 we will have Dr. Oz and Marjorie Taylor Greene running against Oprah Winfrey and Kamala Harris. I'm not sure how this downward spiral ties into the administrative position over saturation problem, but I have the intuition that it does somehow. Maybe what we have are a whole ton of people who don't really know how to do things who vote. Voting is ultimately a hiring decision, so what we get is a voting process that hires a whole bunch of either administrators who themselves don't know how to do things or crackpots because people without practical knowledge can't spot a crackpot.
bpodgursky 5y ago
The shift to EMRs (more-or-less forced by the ACA) has been a huge quality-of-life loss for doctors. Tons of time spent on Epic or Cerner checking boxes and selecting drop-downs. Turned a "trusted professional" advisory role into a keyboard role.
- notch656a 5y ago
  There are medical scribes who will do all that for the physician and for dog-shit wages. Usually these are medical school-wannabes so they can easily be tricked into working for minimum wage, and once they're suitably trained the physician just has to briefly scan the EMR for completeness and sign off on it.
  - bpodgursky 5y ago
    I have not seen this happen extensively, in practice.
hedora 5y ago
Also anecdotal, but we’re looking for home healthcare for a parent. There are zero in a 50+ mile radius. One of their neighbors used to work for a home healthcare company in the area.
kurthr 5y ago
Having worked in Tech for many years at corporations large and small, I have seen companies run by Founders, by Sales, by Marketing, by Finance, by Engineering, and by Legal. Each had their plusses an minuses. Until I saw hospital nursing, I had never seen a company run by HR. Every decision starts and ends with HR. From hiring, to wages, to discipline and promotion, to IT and pay-roll, to reorganization and spending priorities, there is a rule for that. Maybe that rule originally came from the CEO or the CNO, but they say things like "may" and get interpreted as "shall" (or the manager faces a bad review and/or termination) or they are interpreted beyond any rational meaning. My best explanation is that it comes from a fear of litigation and a lack of leadership at the top. The final hilarious story is the CEO negotiating a big deal with lawyers and VPs shaking hands... and then saying without joking, "but I'll have to get HR's approval". The meeting wasn't important enough for HR to show up, but they had the last say.
- beezlebroxxxxxx 5y ago
  If you follow the history of HR departments in a lot of modern corporations you often see them operating as private in-house legal firms, and aggressively expanding their purview to include even actions at the executive level. The only thing most HR departments look out for is HR. Everything they do resolves around continuing or expanding the power of the HR department. Your comment on lack of leadership is spot on. No one wants to be accountable. Instead HR departments put in place bureaucracy that works to deny individual fallibility in the name of a "system of human resource management". They want to treat people like a cog in a machine instead of as people.
  - inetknght 5y ago
    > No one wants to be accountable. That is American corporations in a nutshell. Outsource everything, put layers upon layers, and insulate yourself. Then when fecal matter hits the rotary you can put the blame on others and, at worst, you get fired and there's little to no worry about any sort of legal reprecussion because... well you weren't accountable for the problems in the first place! It's a massive problem created from little cuts here and there with a few big lawsuits mixed in.
csa 5y ago
I frequently say that administrators have killed both the education (esp. tertiary) and medical fields in the US. I’m pretty sure both of these will implode under the bureaucratic weight at some point — the financial and social costs of the excessive administrators is not justified by their (often minimal or negative) value added.
- throwawayboise 5y ago
  Yes, it's like someone held up a mirror when you look at what has happened in Higher Ed when the professors stopped running things, and Health Care when doctors stopped running things. Costs skyrocketed, outcomes stagnated or declined, satisfaction plummeted.
smoe 5y ago
Both my mother and sister were nurses and disenchanted with the profession (in Switzerland) long before the pandemic hit, as the hospitals got completely mba'd during their careers. Whereas in the past they could actually take time interacting with patients, now everything needs to be Lean and it's just about shoveling people through the system with minimum resources while extracting ever more money. I don't see how this can end well. My mother switched to an administrative role internally, 10 years before she got retired and my sister went from nurse to anesthetist and now in the progress of moving to IT as a domain expert for medical software so she can work from home.
legitster 5y ago
> How doctors of all professions lost their professional agency to do-nothing administrators within a generation is quite puzzling and a bit terrifying to me This should terrify everyone. Large segments of our society are failing us despite being stuffed to the gills with administrative staff that don't contribute much to productivity but rob professions of their independence. We're managing ourselves to death.
Spooky23 5y ago
Yes. The system is gross. When my dad suffered from a stroke (pre-COVID), the level of neglect and poor care he received was startling. He died before he should have after making substantial recovery due to the side-effects of being in a hospital. My mom was a long-retired medical director of a hospital and even she was shocked at poor quality of care, compassion and competence. Even in the ER of a recognized trauma center, things were pretty meh. Some specialist floors and ICU were good, but when an infection caused by poor hospital hygiene struck, he was relegated to the “medical” floor, where he was not fed, medicated, turned or treated with respect. Ultimately we maintained a 24x7 staffing of family volunteers for over 6 weeks. Many of the staff frankly sucked. But it was easy to see why - the staffing levels were so poor pre-COVID, that any RN risks license every day by virtue of being there. The smart ones GTFO. You can’t care for 15 patients.
zeruch 5y ago
"is quite puzzling" Is it? The financialization of every aspect of life, in this case with for-profit hospitals through multiple layers of insurance middle-men, the exodus you describe would seem one of the natural byproducts from miles away.
dsugarman 5y ago
My frame of reference on this topic is that my family is mainly medical doctors and I started and run a yc backed Series A stage startup. In my experience, the administrators are often doctors at hospitals and people all the way to the top have to have strong medical backgrounds. That's not to say there aren't do-nothing administrators, but those do-nothing administrators are often doctors. They tend to adhere to the way things are and always were as an orthodoxy, like 1st year residency is the worst and at these points quality of life improve, but it's almost like a fraternity hazing justifying the insane hours, complete loss of work life balance just because this is how it is. Candidly, there does seem to be a guilty pleasure there. There is little to no real discussion on how to improve not only the work conditions but also the user experience of medical care. In my view, it starts at the top; organizationally, they are lacking an entire skillset to make any improvements what-so-ever.
77pt77 5y ago
> How doctors of all professions lost their professional agency to do-nothing administrators within a generation is quite puzzling and a bit terrifying to me. Same thing with professors.
ryan93 5y ago
There are like 4 million nurses. Where are they going to go for even remotely similar wages?
anon23anon 5y ago
I'm sure this is the top comment b/c we as developers have basically lost our professional agency to do do nothings roles like project manager/project owner/"business people". It's frustrating. I've been in the game a long time. It was way more fun when the web was still new and for the most part didn't care a whole lot about tech.
archhn 5y ago
See "The Managerial Revolution" by James Burnham.
m_ke 5y ago
My SO is a healthcare worker as well, she just graduated 2 years ago and has major regrets about her decision. She'd leave and try and do something else but she has mid 6 figure debt, to make things worse she was rear-ended her last year of school and has back issues that make it hard for her to handle the 12 hours shifts. She's looking to switch jobs now and her first offer expected her to travel to locations deep in queens, manhattan and brooklyn, seeing on average 50 patients a day. She currently works at one of the largest hospital chains in NY and is now negotiating an offer from the other largest chain, initially she was told to not worry about salary and that they'd be able to match her previous offer, then HR called her and told her she had 1 and not 2 years of experience so the best offer they can offer her is lower than expected, she said she wouldn't be able to do it so the HR people went to check again to see what they can do and it turns out they called up the hospital that my SO works at now and checked their pay tiers and said they can only match the number that they were told. The new position was close to where we live so she considered taking it anyways but they just called her again and asked her if she'd be willing to travel to other locations multiple times a week to help fill in gaps (but weren't even able to tell her which locations before accepting the offer). TLDR: don't let your friends and family go into healthcare

by phil21 5y ago

salt-thrower 5y ago

> How doctors of all professions lost their professional agency to do-nothing administrators within a generation is quite puzzling The profit model of the U.S. healthcare industry might have something to do with it. The fact that hospitals are run like businesses and have shareholders is insane to me. I know other countries' healthcare systems got hit hard by the pandemic too, but it seems like the uniquely capitalist nature of healthcare in the U.S. sets it up to mistreat workers and cut corners for the benefit of administrators and executives.

reedjosh 5y ago
If they can't throw some medication with pharma kickbacks at you, they probably won't do much at all. My 6 month old son was put on topical steroids for a small rash on his back and the doctors solution when this turned into a progressive issue was more and stronger topical steroids. Eventually I learned about topical steroid withdrawal, and after a hellish withdrawal period, my son has no real skin conditions. https://www.youtube.com/watch?v=PpW4VV2bsD8&t=28s https://www.youtube.com/watch?v=PpW4VV2bsD8&t=28s And yes, my son at ~1 year old was red and bleeding like that head to toe. When I brought up steroid withdrawal I was rudely dismissed by multiple doctors including dermatologists. Doctors currently have willful blinders on at a minimum, and some may be a true embodiment of evil. I hope the whole for profit medical system crashes and burns.
- Enginerrrd 5y ago
  Steroids are so commonplace and old, I really doubt anyone was getting pharma kickbacks in the case of your son. There's just a large range in quality amongst doctors. What you're calling "willful blinders" or "true embodiment of evil" is more likely just a failure to adapt out of a simple paradigm: {Inflammation}->{Treatment = steroids}. And a failure to recognize when that was causing a loop. Maybe they forgot about steroid withdrawal. In fact, as someone with quite an interest in pharmacology and some background as a paramedic, this is the first I've ever heard of it, and I love obscure medication issues.
  - reedjosh 5y ago
    > Maybe they forgot about steroid withdrawal. As I mentioned in my comment I mentioned steroid withdrawal to many doctors when my son was literally only sleeping an hour or so a night from itching and I was dismissed out of hand. If its not kickbacks, then its such a terrible arrogance as to be evil. How can a dermatologist not know of my son's condition? Particularly seeing as steroids have been around for a while as you've mentioned. Even when I brought the idea to the dermatologist, after a bit of head nodding his solution was another two weeks of a yet stronger steroid to `calm it down`, and then to taper. There's a nonprofit trying to get doctors to properly acknowledge the condition. https://www.itsan.org/ https://www.itsan.org/ There's as I linked above about a million videos of people recovering from TSW as well. There's even a study out of Autstralia that followed 10 children with what was called bad eczema, but after a withdrawal period every child at max had pruritis on elbows or knees. https://www.medicaljournals.se/acta/content_files/files/pdf/99/6/5412.pdf https://www.medicaljournals.se/acta/content_files/files/pdf/... If my job were skin, and topical steroids was one of the main things I used as a tool, how could I not know about these issues? You'd have to be such a hack that nobody would consider you a professional, yet the same dermatologist that offered yet another round of steroids had his office on the penthouse suite of a downtown building with a showcase displaying awards. It may seem hyperbolic to you, but you didn't live through this like I did. You didn't see your young child in complete misery due to medical authorities you thought you could trust misguiding you. It's evil of some form.
toiletfuneral 5y ago
[dead]
theklub 5y ago
It’s not just that, some hospitals are outsourcing everything disenfranchising the people that work there. And I mean everything from the doctors themselves to IT to the cleaning lady to the food workers and selling the buildings to lease them back. It’s the fleecing of America.
bitsnbytes 5y ago
profit model is not the issue. How the compensation and rewards are structured is the issue.
- defterGoose 5y ago
  So...we need to manage that better?
  - bitsnbytes 5y ago
    absolutely.We need to look at ways to make monetary compensation more aligned with the best interest of the patient. Having said that we also need to look at patients taking more accountability for their health and consequences for wasting medical professional times.

orangepurple 5y ago

> How doctors of all professions lost their professional agency to do-nothing administrators within a generation is quite puzzling and a bit terrifying to me. I would bet it's caused by: - stifling bureaucracy - hostile legal climate - massive start up costs The only winning move is not to play. Let the system fall apart and join on the later upswing. The unfortunate part is all the needless suffering people will endure during this process.

brightball 5y ago

Insurance companies. Everything is controlled by insurance companies. You can’t do anything unless it’s exactly how insurance wants and only for what insurance will pay. It limits everything, including how every profession can be compensated simply because you can’t easily hire somebody for more than what insurance will pay for their services. You can, but the funds have to come from somewhere.

belval 5y ago
I doubt that it's as simple as that. Nurses are also leaving in Canada and we don't have insurance breathing down their neck.
- reedjosh 5y ago
  But they have zero autonomy there too I assume?
  - belval 5y ago
    Sample size of 1, but my gf blames forced overtime. Being legally obliged to stay for an 8 hours shift after finishing one has a way to drive you to depression.
    - px43 5y ago
      I would pay more to go to a hospital where I know people are actually well rested. My last few hospital stays have been saturated with clearly agitated staff (doctors, nurses, reception) who were putting in minimal effort, and clearly didn't want to be there, and I can't blame them given the conditions that they're being forced to work under. This is in the US, and I can't figure out why the Department of Labor hasn't cracked down on the medical industry yet. It's really horrific, especially because these are the people we're supposed to be relying on to keep us healthy and safe. How hard is it to enforce 8 hour days 5 days a week? Every other industry has figured it out.
      - 5y ago

PragmaticPulp 5y ago

> How doctors of all professions lost their professional agency to do-nothing administrators within a generation is quite puzzling and a bit terrifying to me. I have a lot of friends at various levels of healthcare, from nursing up through low and mid-level administrative positions. The one thing they all seem to agree on is that patient satisfaction surveys have been terrible for healthcare. Once the emphasis shifted to patient satisfaction, everything became more of a game of catering to what the patient thinks they want. With the spread of rampant medical misinformation on the internet and the rise of alternative-medicine podcasts/blogs/influencers masquerading as informed medical professionals they have a constant influx of patients who show up believing they have a certain condition or need a certain medication. If you disagree too much or refuse to give them the medication they want, you risk a negative review. Too many negative reviews could negatively impact your compensation or even cost you your job. Even at offices that don't perform patient satisfaction surveys, providers are at the mercy of negative online reviews. Again, if you don't do exactly what the patient thinks they want, you risk scathing online reviews. This is terrifyingly problematic given the trend of people to self-diagnose with anxiety or infections who show up demanding Xanax or antibiotics. Puts doctors in a situation where they don't really think prescribing those medications is a good idea, but they also feel like they can't deny too many patients or they risk their reputation/bonus/reviews. It's also a huge problem with conditions like obesity or alcoholism or smoking, where the doctors can see obvious patient-induced health issues but the patient really doesn't want to hear the truth from their doctor.

hedora 5y ago
That reminds me. I have one laying around to fill out. 10/10 plan to get sick again.
CityOfThrowaway 5y ago
Patient satisfaction surveys are the legible feedback mechanism showing that something is deeply broken, but not the source of the problem itself. It's clear from your comment that the source of the problem is the increasingly sharp divide between what the credentialed medical professionals believe and what lay people believe. The satisfaction survey is simply uncovering that fact. It would be vastly worse if patients were being treated and had no recourse when they felt their health was mismanaged. It may well be the case that the patients are wrong, but it is extremely dystopian to imagine a world where individuals are not empowered to make decisions about their own bodies.

birdmanjeremy 5y ago

I'm friends with quite a few nurses, primarily travel nurses, and not a single one is considering a change in career that I am aware of. Simply an anecdotal counterpoint and nothing more.

pc86 5y ago
Travel nurses are compensated quite a bit more in my understanding. And the travel aspect means they can leave the more toxic locations more easily.
- phkahler 5y ago
  They're paid a shit ton more. And because of that, more nurses are quitting to do the travel thing, which worsens the shortage and increases demand for travel nurses ;-) never seen an industry fuck itself over so bad. That's really the issue - healthcare has become an industry, not a profession.
  - joshgel 5y ago
    It's really amazing to see travel nurses come back to work at a place they just left. They are now doing the same job as before, are getting paid almost twice as much with better schedules and are working next to people that they know and are friends with. It's honestly surprising that more haven't taken the jump and is really shocking that hospitals aren't doing more to retain critical staff.
    - TecoAndJix 5y ago
      The hospitals have been asking Biden to put a stop to it: https://www.npr.org/2022/02/02/1077710203/hospitals-ask-biden-administration-to-help-lower-the-soaring-cost-of-travel-nurs https://www.npr.org/2022/02/02/1077710203/hospitals-ask-bide...
      - pc86 5y ago
        It sounds nurses just need to be paid more, or travel nurses need to be paid less. Equilibrium is probably somewhere between the two extremes. Apropos of nothing but why is the knee jerk reaction "we need executive action to fix this staffing problem?"

api 5y ago

> lost their professional agency to do-nothing administrators You just summarized the decline of Western civilization in one phrase. This has happened almost everywhere and efforts to push back have proven extremely difficult. I personally place a lot of the blame on the educational system for overproducing administrative skill sets and underproducing practical skill sets. There is some role for those things of course but we have far too many people for the administrative roles we really need and far too few for many other professions. This combined with the tendency of people to recruit people like themselves has oversaturated the market with administrators looking for reasons to exist. The rot is to the point that we have the spectacle of Elon Musk looking like superman. Why does he look like superman? Because he actually does things instead of having meetings to discuss the meeting schedule. He's just a reasonably competent engineer and business founder with huge resources who... does things... and this makes him look superhuman by comparison to the hordes of administrators that only discuss doing things and commission studies about hypothetically doing things.

hedora 5y ago
See also: California’s plan to eliminate algebra 2 and calculus from the highschool curriculum. It is being spearheaded by someone without a math degree, in the name of improving marketability of the kids for data science positions, or something. See also (2): Monty Python’s bicycle repairman sketch.
- api 5y ago
  Yeah that proposal is insane. For a while now it feels like the left and the right are attempting to one-down each other on how stupid they can get. That proposal seems like an example of the left trying to out-stupid Trump and the alt-right. Don't worry I'm sure the right is working on things even dumber than this, and then those will have to be topped, and so on. In 2024 we will have Dr. Oz and Marjorie Taylor Greene running against Oprah Winfrey and Kamala Harris. I'm not sure how this downward spiral ties into the administrative position over saturation problem, but I have the intuition that it does somehow. Maybe what we have are a whole ton of people who don't really know how to do things who vote. Voting is ultimately a hiring decision, so what we get is a voting process that hires a whole bunch of either administrators who themselves don't know how to do things or crackpots because people without practical knowledge can't spot a crackpot.

bpodgursky 5y ago

The shift to EMRs (more-or-less forced by the ACA) has been a huge quality-of-life loss for doctors. Tons of time spent on Epic or Cerner checking boxes and selecting drop-downs. Turned a "trusted professional" advisory role into a keyboard role.

notch656a 5y ago
There are medical scribes who will do all that for the physician and for dog-shit wages. Usually these are medical school-wannabes so they can easily be tricked into working for minimum wage, and once they're suitably trained the physician just has to briefly scan the EMR for completeness and sign off on it.
- bpodgursky 5y ago
  I have not seen this happen extensively, in practice.

hedora 5y ago

Also anecdotal, but we’re looking for home healthcare for a parent. There are zero in a 50+ mile radius. One of their neighbors used to work for a home healthcare company in the area.

kurthr 5y ago

Having worked in Tech for many years at corporations large and small, I have seen companies run by Founders, by Sales, by Marketing, by Finance, by Engineering, and by Legal. Each had their plusses an minuses. Until I saw hospital nursing, I had never seen a company run by HR. Every decision starts and ends with HR. From hiring, to wages, to discipline and promotion, to IT and pay-roll, to reorganization and spending priorities, there is a rule for that. Maybe that rule originally came from the CEO or the CNO, but they say things like "may" and get interpreted as "shall" (or the manager faces a bad review and/or termination) or they are interpreted beyond any rational meaning. My best explanation is that it comes from a fear of litigation and a lack of leadership at the top. The final hilarious story is the CEO negotiating a big deal with lawyers and VPs shaking hands... and then saying without joking, "but I'll have to get HR's approval". The meeting wasn't important enough for HR to show up, but they had the last say.

beezlebroxxxxxx 5y ago
If you follow the history of HR departments in a lot of modern corporations you often see them operating as private in-house legal firms, and aggressively expanding their purview to include even actions at the executive level. The only thing most HR departments look out for is HR. Everything they do resolves around continuing or expanding the power of the HR department. Your comment on lack of leadership is spot on. No one wants to be accountable. Instead HR departments put in place bureaucracy that works to deny individual fallibility in the name of a "system of human resource management". They want to treat people like a cog in a machine instead of as people.
- inetknght 5y ago
  > No one wants to be accountable. That is American corporations in a nutshell. Outsource everything, put layers upon layers, and insulate yourself. Then when fecal matter hits the rotary you can put the blame on others and, at worst, you get fired and there's little to no worry about any sort of legal reprecussion because... well you weren't accountable for the problems in the first place! It's a massive problem created from little cuts here and there with a few big lawsuits mixed in.

csa 5y ago

I frequently say that administrators have killed both the education (esp. tertiary) and medical fields in the US. I’m pretty sure both of these will implode under the bureaucratic weight at some point — the financial and social costs of the excessive administrators is not justified by their (often minimal or negative) value added.

throwawayboise 5y ago
Yes, it's like someone held up a mirror when you look at what has happened in Higher Ed when the professors stopped running things, and Health Care when doctors stopped running things. Costs skyrocketed, outcomes stagnated or declined, satisfaction plummeted.

smoe 5y ago

Both my mother and sister were nurses and disenchanted with the profession (in Switzerland) long before the pandemic hit, as the hospitals got completely mba'd during their careers. Whereas in the past they could actually take time interacting with patients, now everything needs to be Lean and it's just about shoveling people through the system with minimum resources while extracting ever more money. I don't see how this can end well. My mother switched to an administrative role internally, 10 years before she got retired and my sister went from nurse to anesthetist and now in the progress of moving to IT as a domain expert for medical software so she can work from home.

legitster 5y ago

> How doctors of all professions lost their professional agency to do-nothing administrators within a generation is quite puzzling and a bit terrifying to me This should terrify everyone. Large segments of our society are failing us despite being stuffed to the gills with administrative staff that don't contribute much to productivity but rob professions of their independence. We're managing ourselves to death.

Spooky23 5y ago

Yes. The system is gross. When my dad suffered from a stroke (pre-COVID), the level of neglect and poor care he received was startling. He died before he should have after making substantial recovery due to the side-effects of being in a hospital. My mom was a long-retired medical director of a hospital and even she was shocked at poor quality of care, compassion and competence. Even in the ER of a recognized trauma center, things were pretty meh. Some specialist floors and ICU were good, but when an infection caused by poor hospital hygiene struck, he was relegated to the “medical” floor, where he was not fed, medicated, turned or treated with respect. Ultimately we maintained a 24x7 staffing of family volunteers for over 6 weeks. Many of the staff frankly sucked. But it was easy to see why - the staffing levels were so poor pre-COVID, that any RN risks license every day by virtue of being there. The smart ones GTFO. You can’t care for 15 patients.

zeruch 5y ago

"is quite puzzling" Is it? The financialization of every aspect of life, in this case with for-profit hospitals through multiple layers of insurance middle-men, the exodus you describe would seem one of the natural byproducts from miles away.

dsugarman 5y ago

My frame of reference on this topic is that my family is mainly medical doctors and I started and run a yc backed Series A stage startup. In my experience, the administrators are often doctors at hospitals and people all the way to the top have to have strong medical backgrounds. That's not to say there aren't do-nothing administrators, but those do-nothing administrators are often doctors. They tend to adhere to the way things are and always were as an orthodoxy, like 1st year residency is the worst and at these points quality of life improve, but it's almost like a fraternity hazing justifying the insane hours, complete loss of work life balance just because this is how it is. Candidly, there does seem to be a guilty pleasure there. There is little to no real discussion on how to improve not only the work conditions but also the user experience of medical care. In my view, it starts at the top; organizationally, they are lacking an entire skillset to make any improvements what-so-ever.

77pt77 5y ago

> How doctors of all professions lost their professional agency to do-nothing administrators within a generation is quite puzzling and a bit terrifying to me. Same thing with professors.

ryan93 5y ago

There are like 4 million nurses. Where are they going to go for even remotely similar wages?

anon23anon 5y ago

I'm sure this is the top comment b/c we as developers have basically lost our professional agency to do do nothings roles like project manager/project owner/"business people". It's frustrating. I've been in the game a long time. It was way more fun when the web was still new and for the most part didn't care a whole lot about tech.

archhn 5y ago

See "The Managerial Revolution" by James Burnham.

m_ke 5y ago

My SO is a healthcare worker as well, she just graduated 2 years ago and has major regrets about her decision. She'd leave and try and do something else but she has mid 6 figure debt, to make things worse she was rear-ended her last year of school and has back issues that make it hard for her to handle the 12 hours shifts. She's looking to switch jobs now and her first offer expected her to travel to locations deep in queens, manhattan and brooklyn, seeing on average 50 patients a day. She currently works at one of the largest hospital chains in NY and is now negotiating an offer from the other largest chain, initially she was told to not worry about salary and that they'd be able to match her previous offer, then HR called her and told her she had 1 and not 2 years of experience so the best offer they can offer her is lower than expected, she said she wouldn't be able to do it so the HR people went to check again to see what they can do and it turns out they called up the hospital that my SO works at now and checked their pay tiers and said they can only match the number that they were told. The new position was close to where we live so she considered taking it anyways but they just called her again and asked her if she'd be willing to travel to other locations multiple times a week to help fill in gaps (but weren't even able to tell her which locations before accepting the offer). TLDR: don't let your friends and family go into healthcare