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While I am aware of the extent of the morale and exhaustion problems in health care, and largely sympathetic, I must push back against the overuse of the word "

While I am aware of the extent of the morale and exhaustion problems in health care, and largely sympathetic, I must push back against the overuse of the word "collapse" for everything these days. I must have seen hundreds of headlines since the beginning of the pandemic about how this country's health care system is collapsing or that country's health care system. Here's what an actual collapse of a health care system would look like to me: - 95% of a country's health care personnel disappearing - Hospitals have to close because they no longer have any health personnel. All hospitals, not just rural hospitals. And the closures must be permanent. Since HN's crowd heavily tilts toward the US West Coast and the Bay Area in particular, I googled a list of all hospitals in San Francisco.[1] - California Pacific Medical Center - Davies Medical Center - Kaiser San Francisco Medical Center - Friends of Laguna Honda Hospital - Langley Porter Psychiatric Institute - Letterman Army Hospital - Pacific Dispensary for Women and Children - Public Health Service Hospital (San Francisco) - Saint Francis Memorial Hospital - St. Joseph's Hospital (San Francisco) - St. Luke's Hospital (San Francisco, California) - St. Mary's Medical Center (San Francisco) - San Francisco Chinese Hospital - San Francisco General Hospital - San Francisco VA Medical Center - And the UCSF system A proper collapse of the Bay Area's health care system, to me, would entail the permanent closure of every one of the above. All of them. A "every man for himself" scenario. A scenario where there are no more nurses; no more doctors; no more surgeons. A scenario where health care requiring any kind of advanced equipment is no longer possible, where MRIs become impossible, where cancer treatments become impossible, for rich and poor people alike. A scenario where pregnant women have no choice but to give birth at home. A scenario where no one but the wealthiest billionaires can access any kind of health care that's not a Tylenol or an Advil. That's a collapse. 25% of nurses leaving within a year (and being replaced), or anecdotes of personnel calling out sick, while deeply concerning (as I wrote above, I am very sympathetic), just aren't bad enough to warrant the use of the word "collapse". [1] https://en.wikipedia.org/wiki/Category:Hospitals_in_San_Francisco https://en.wikipedia.org/wiki/Category:Hospitals_in_San_Fran...

PaulDavisThe1st 4y ago
Speaking for myself, I think that's an overly strong requirement for the use of "collapse". I'm not sure I agree that it's the right phrase for the situation(s) described in TFA, but I don't feel it would be wrong to use it for a scenario where, say, 25% of people with previously treatable conditions in fact die.
- nradov 4y ago
  What are you considering as a treatable condition? We will probably still be able to deliver urgent and emergency care to patients with acute conditions. There won't be a lot of patients bleeding to death in ER waiting rooms because there are no staffed beds available (although you can find isolated incidents where that sort of thing has happened). What we're more likely to see are longer delays and worse service quality for patients with chronic conditions that probably would have eventually killed them anyway. Like a patient with congestive heart failure might expect to live for 5 years with the best possible care, but might only live for 3 years with limited care. That will be a bad situation that harms many people, but it won't be a collapse.
  - nubinetwork 4y ago
    We've had to call a "code gridlock" several times since COVID started... (For those not in the field, that means the ER is full, and any unused beds on wards have to become immediately available for them to use) On top of that, even before COVID, "code zeros" (no available ambulances) were an almost monthly occurance.
AlotOfReading 4y ago
You're free to use weird personal definitions, but I don't think a definition of collapse that excludes places like civil war Syria and Venezuela is useful. Frankly, I'm not sure that anything that would qualify has ever happened.
- mr_toad 4y ago
  If you search for “health system collapse” you can find an article on that topic for every year, stretching back as far back as records exist. So I don’t think the common use of collapse is very useful either.
  - anothernewdude 4y ago
    I can find an article on the topic of "Russia War" every year too. Please stop being ridiculous.
abeppu 4y ago
I think for the argument you're making, the thing to cite isn't a category list of hospitals in a major city, but the definition of "collapse". Consulting a standard source [1], I note that while two definitions do involve the completeness of the change being described ("to fall or shrink together abruptly and completely", "to break down completely"), a definition which seems to reasonably apply to a partial failure is "4. to suddenly lose force, significance, effectiveness, or worth". But I also think a lot of rural communities have had a much more complete failure of the healthcare system, where sometimes there is very little to draw medical professionals who have some pick in where they go. When this results in either primary care doctors or hospitals closing, patients can end up a long way away from care. It's also worth pointing out that while the SF Bay Area does have a lot of health care institutions, your list includes multiple that are permanently closed (e.g. Letterman Army Hospital, St Joseph's) and some that aren't actually hospitals (Friends of Laguna Honda Hospital is a non-profit for volunteers associated with the Laguna Honda long term care facility, which has its own collapse story). [1] https://www.merriam-webster.com/dictionary/collapse https://www.merriam-webster.com/dictionary/collapse [2] https://www.aha.org/news/headline/2022-09-08-aha-report-rural-hospital-closures-threaten-patient-access-care https://www.aha.org/news/headline/2022-09-08-aha-report-rura...
betaby 4y ago
> - Hospitals have to close because they no longer have any health personnel. All hospitals, not just rural hospitals. And the closures must be permanent. In Canada admission to medical schools is not changing with the population growth. Is it the same in California?
- nubinetwork 4y ago
  AFAIK, you can go to medical school, but the problem is what happens afterwards. Each province regulates how many graduates get assigned to hospitals (or allowed to open family doctor practices). If the openings "aren't there", you just wasted your time going to school, or you move somewhere that will accept you.
  - nradov 4y ago
    The issue is similar in the US. Every year we have some students who graduate from accredited medical schools but are unable to practice due to a shortage of residency program slots. Residencies are almost all funded by the federal government through the Medicare program and Congress hasn't significantly increased funding for years. It's an absurd situation given the current shortage.
- neaden 4y ago
  In the US the real cap is on residency programs which are handled physicians. So there has been a slight increase in medical schools but not as much of an increase in residency programs which leaves some unfortunate graduates unmatched.
- bryanlarsen 4y ago
  My sister teaches at a medical school in Canada that she graduated from ~15 years ago. Class sizes have approximately doubled in that period.
- nwmcsween 4y ago
  So, the average wage of a nurse is ~$35/hr, the average price of a house in Canada is ~$680,000. As someone who has family working in hospitals the issue isn't a worker shortage, it's a CoL issue.
anothernewdude 4y ago
> 25% of nurses leaving within a year That's precisely a collapse. You don't just absorb that many people leaving without issue. You put more strain on the people remaining, and see even more leave next year, and fewer people coming in.
deleted 4y ago
[deleted]
CaptainZapp 4y ago
I think the 93 year old woman with a broken hip who waited in agony 25 hours for an ambulance[0] disagrees with your opinion. [0] https://www.theguardian.com/society/2022/dec/20/93-year-old-left-screaming-in-pain-on-floor-during-25-hour-ambulance-wait https://www.theguardian.com/society/2022/dec/20/93-year-old-...

PaulDavisThe1st 4y ago

Speaking for myself, I think that's an overly strong requirement for the use of "collapse". I'm not sure I agree that it's the right phrase for the situation(s) described in TFA, but I don't feel it would be wrong to use it for a scenario where, say, 25% of people with previously treatable conditions in fact die.

nradov 4y ago
What are you considering as a treatable condition? We will probably still be able to deliver urgent and emergency care to patients with acute conditions. There won't be a lot of patients bleeding to death in ER waiting rooms because there are no staffed beds available (although you can find isolated incidents where that sort of thing has happened). What we're more likely to see are longer delays and worse service quality for patients with chronic conditions that probably would have eventually killed them anyway. Like a patient with congestive heart failure might expect to live for 5 years with the best possible care, but might only live for 3 years with limited care. That will be a bad situation that harms many people, but it won't be a collapse.
- nubinetwork 4y ago
  We've had to call a "code gridlock" several times since COVID started... (For those not in the field, that means the ER is full, and any unused beds on wards have to become immediately available for them to use) On top of that, even before COVID, "code zeros" (no available ambulances) were an almost monthly occurance.

AlotOfReading 4y ago

You're free to use weird personal definitions, but I don't think a definition of collapse that excludes places like civil war Syria and Venezuela is useful. Frankly, I'm not sure that anything that would qualify has ever happened.

mr_toad 4y ago
If you search for “health system collapse” you can find an article on that topic for every year, stretching back as far back as records exist. So I don’t think the common use of collapse is very useful either.
- anothernewdude 4y ago
  I can find an article on the topic of "Russia War" every year too. Please stop being ridiculous.

abeppu 4y ago

I think for the argument you're making, the thing to cite isn't a category list of hospitals in a major city, but the definition of "collapse". Consulting a standard source [1], I note that while two definitions do involve the completeness of the change being described ("to fall or shrink together abruptly and completely", "to break down completely"), a definition which seems to reasonably apply to a partial failure is "4. to suddenly lose force, significance, effectiveness, or worth". But I also think a lot of rural communities have had a much more complete failure of the healthcare system, where sometimes there is very little to draw medical professionals who have some pick in where they go. When this results in either primary care doctors or hospitals closing, patients can end up a long way away from care. It's also worth pointing out that while the SF Bay Area does have a lot of health care institutions, your list includes multiple that are permanently closed (e.g. Letterman Army Hospital, St Joseph's) and some that aren't actually hospitals (Friends of Laguna Honda Hospital is a non-profit for volunteers associated with the Laguna Honda long term care facility, which has its own collapse story). [1] https://www.merriam-webster.com/dictionary/collapse https://www.merriam-webster.com/dictionary/collapse [2] https://www.aha.org/news/headline/2022-09-08-aha-report-rural-hospital-closures-threaten-patient-access-care https://www.aha.org/news/headline/2022-09-08-aha-report-rura...

betaby 4y ago

> - Hospitals have to close because they no longer have any health personnel. All hospitals, not just rural hospitals. And the closures must be permanent. In Canada admission to medical schools is not changing with the population growth. Is it the same in California?

nubinetwork 4y ago
AFAIK, you can go to medical school, but the problem is what happens afterwards. Each province regulates how many graduates get assigned to hospitals (or allowed to open family doctor practices). If the openings "aren't there", you just wasted your time going to school, or you move somewhere that will accept you.
- nradov 4y ago
  The issue is similar in the US. Every year we have some students who graduate from accredited medical schools but are unable to practice due to a shortage of residency program slots. Residencies are almost all funded by the federal government through the Medicare program and Congress hasn't significantly increased funding for years. It's an absurd situation given the current shortage.
neaden 4y ago
In the US the real cap is on residency programs which are handled physicians. So there has been a slight increase in medical schools but not as much of an increase in residency programs which leaves some unfortunate graduates unmatched.
bryanlarsen 4y ago
My sister teaches at a medical school in Canada that she graduated from ~15 years ago. Class sizes have approximately doubled in that period.
nwmcsween 4y ago
So, the average wage of a nurse is ~$35/hr, the average price of a house in Canada is ~$680,000. As someone who has family working in hospitals the issue isn't a worker shortage, it's a CoL issue.

anothernewdude 4y ago

> 25% of nurses leaving within a year That's precisely a collapse. You don't just absorb that many people leaving without issue. You put more strain on the people remaining, and see even more leave next year, and fewer people coming in.

deleted 4y ago

[deleted]

CaptainZapp 4y ago

I think the 93 year old woman with a broken hip who waited in agony 25 hours for an ambulance[0] disagrees with your opinion. [0] https://www.theguardian.com/society/2022/dec/20/93-year-old-left-screaming-in-pain-on-floor-during-25-hour-ambulance-wait https://www.theguardian.com/society/2022/dec/20/93-year-old-...