9 ms·

ERs are hiring fewer doctors to save money

56 points by t23 4y ago

VWWHFSfQ 4y ago
While also giving Nurse Practitioners and Physicians Assistants more responsibilities while paying them far less than an MD. Just the same as attorneys are expensive, so you just give everything that lawyers used to do to paralegals and pay them 1/4 as much.
- magic_man 4y ago
  Ama also keeps supply of doctors down too. That's why all these medschools have such low acceptance rates. If you are an Indian and have a 3.8 gpa you still might not get into medschools which is pretty absurd.
- wyldfire 4y ago
  Note that the term "Medical Assistants" in the US generally refers to the folks who are able to take vitals and minimal-complexity care. They're not given anywhere near the responsibility of an RN let alone an NP.
  - VWWHFSfQ 4y ago
    Yeah I was actually thinking of Physician Assistant
wyldfire 4y ago
> While diagnosing and treating patients was once doctors' domain, they are increasingly being replaced by nurse practitioners and physician assistants, collectively known as "midlevel practitioners," who can perform many of the same duties and generate much of the same revenue for less than half the pay. IMO, PAs and NPs are a good idea for medicine overall. Especially since lots of folks who would consider a career in medicine are turned off by residency. In the ER, though -- I can see the case for experienced MDs making a big difference in outcomes. Disclosure: my wife is a PA.
- shiftpgdn 4y ago
  Counterpoint: You can go read the “Noctor” subreddit or ask any practicing physician why it’s bad for patient outcome. Ultimately we need more doctors and less hospital administrators.
  - themitigating 4y ago
    Doctors say we need more of them and their high pay?
    - oaktrout 4y ago
      I'm sure the high paid software engineers at boeing said something similar when jobs were being outsourced "we need more US engineers". Look at the software problems they had and tell me they were wrong. Just like software engineers are best qualified to evaluate software quality, doctors know medicine better than anyone else. Just because they are incentivized to protect their job doesn't mean they are wrong.
      - themitigating 4y ago
        That's correct but I believe their bias makes them a untrustworthy worthy source
      - 908B64B197 4y ago
        > Just like software engineers are best qualified to evaluate software quality, doctors know medicine better than anyone else. Just because they are incentivized to protect their job doesn't mean they are wrong. It was rather trivial for Boeing engineers to show, without a doubt, that the cheap offshored programmers didn't write software as good as they did. The design simply spoke for itself and didn't perform to spec. Why not simply have doctors do the same? If their fellow medical workers can't deliver the same quality of care at the same speed and cost, then it should be trivial to show.
        oaktrout 4y ago
ganlaw 4y ago
Hospitals shouldn't be a profitable business. The primary goal of a hospital should be serving patients sickness. (Easier said than done) My partner is a physician at a hospital in NYC, and something that they are struggling with now is lack of social services for patients to get them out of hospital beds and into homes/rehabs. As a immigrant in this country, I am constantly flabbergasted by the state of healthcare here and people's willingness to accept hospitals as profit seeking businesses the same as a fortune 500. Obviously if the law allows these hospitals to seek profits, they will. So the question is, how do we change the law? And why don't people want to change it?
- deleted 4y ago
  [deleted]
- abfan1127 4y ago
  Profit is a strong incentive to optimize. non-profit organizations are under different incentives. They both have pitfalls, they both have advantages.
  - conscion 4y ago
    Profit is a strong incentive when there's active competition. When there's not competition, for-profit business turn to extracting rents on captive customers. Health care larger is not a competitive market. Lots of customers only have limited options (i.e. rural hospitals) and the urgency of some purchases don't support competition (i.e. ER visits)
    - abfan1127 4y ago
      I agree its not a competitive market. Rural areas suffer in all areas of limited markets, medical isn't special. Government involvement (including, but not limited to limiting licensing). insurance clouds the market as well (both how we procure insurance and government limitations of insurance).
  - yunwal 4y ago
    > Profit is a strong incentive to optimize. Optimize what? Certainly not costs, since for-profit hospitals have every incentive to push for unneeded expensive operations. Maybe you’re mistaking healthcare for a market where meaningful competition and information symmetry exists?
deleted 4y ago
[deleted]
ourmandave 4y ago
My last ER visit I was seen by a PA, which is fine. They're more than competent. The part I didn't like was how they made me get out a credit card while they we're treating me. Which, according to a story by the NY Times, is a common thing. Send a nurse around with a swipeable tablet to ask how you'd like to pay. https://www.nytimes.com/2023/01/25/podcasts/the-daily/nonprofit-hospitals-investigation.html https://www.nytimes.com/2023/01/25/podcasts/the-daily/nonpro...
- azinman2 4y ago
  Same thing happened to me in Canada.
- quasse 4y ago
  > The part I didn't like was how they made me get out a credit card while they we're treating me. Yes, I recently had to visit urgent care after probably ~8 years of staying out of the hospital. To be allowed in the door of the building I was required to swipe a credit card (literally 5 feet inside the front door, "we need you to authorize a charge on your card for this visit to proceed") and then they had credit card readers inside the patient rooms attached to the EMR computers for "charge as you go" medical care. The whole thing made me sick to my stomach.
- schemescape 4y ago
  Did they tell you how much the charge would be?
- bluesquared 4y ago
  I was having a minor anaphylactic reaction to something - not enough to restrict my breathing or make me want to use my epipen yet - but I experienced the same thing. Went to the ER, face red and swelling, lips starting to tingle, the whole 9 yards. They had me enter all my personal info, name, address, insurance card, etc. Then swipe for my $250 ER copay all before seeing anybody competent. The worker at the desk didn't understand what I meant when I said "anaphylactic reaction" I had to gesture at my face and say "allergic reaction" ffs! At least my reaction wasn't as bad the first time. That time was pre-covid and they had somebody with experience and functioning brain cells at the check-in and they brought me right in and started taking vitals and did an IV literally right on the other side of the check-in desk. On that visit they had the payment person come around hours later while I was recovering in a bed on a different unit for monitoring while I was coming down off of the meds they pumped me full of.
oaktrout 4y ago
There is some evidence in the primary care world that going to a NP for primary care costs more than going to a doctor: https://www.ama-assn.org/practice-management/scope-practice/amid-doctor-shortage-nps-and-pas-seemed-fix-data-s-nope https://www.ama-assn.org/practice-management/scope-practice/.... In short, NPs order more tests without improving patient outcomes. I have no doubt that it's the same in the ER. It takes training and knowledge to know what test you don't have to order. Do you really need a CT scan for your diarrhea? That being said, I think there is definitely a role for NPs : low complexity and/or non-acute highly specialized care. The emergency department is not the environment for that.
- tyoma 4y ago
  Is it though? There are quite a few people who lack access to the normal healthcare system and use the ER as primary care of last resort because no one is turned away. PAs and NPs would be perfect for those patients.
- mikeyouse 4y ago
  The AMA probably isn't the best source for that type of data. The little throwaway lines in that review are funny; "Patients deserve care led by physicians—the most highly educated, trained and skilled health care professionals. Through research, advocacy and education, the AMA vigorously defends the practice of medicine against scope-of-practice expansions that threaten patient safety." Weird because the study they're talking about didn't say a word about patient safety. Their metrics are weird too - it's looking at hospital spend "per member per month" which was higher with the non-physician staff but I'd be curious if the $30 difference was more or less than the difference in salaries between the two groups.
  - oaktrout 4y ago
    The AMA obviously has an agenda, but that doesn't that change the fact that non-physicians cost patients and taxpayers more money, hard to argue with the cms data. Who cares if your doctor gets paid more if he is saving you and the taxpayers money. I guess it might make business sense from a hospital perspective, because physicians are more expensive to employee than NPs and hospitals don't have a business reason to save taxpayers or patients money.
klyrs 4y ago
> Private equity companies pool money from wealthy investors to buy their way into various industries, often slashing spending and seeking to flip businesses in three to seven years. The focus of the article is on physicians vs. NPs and PAs, but the real driver of the enshittification is, yet again, private equity firms extracting short-term profits, to hell with long-term outcomes.
- azinman2 4y ago
  We need to outlaw for profit anything with healthcare. The incentives are misaligned with society’s needs.
  - wahnfrieden 4y ago
    Why only healthcare specifically?
    - l33t233372 4y ago
      We’ve seen that having a profit motive is, to a point, generally good in many areas of commercial life. Healthcare is not one of these areas.
      - dariusj18 4y ago
        Let's do the same for housing
      - wahnfrieden 4y ago
        I'm asking why the difference? Why is it good for society sometimes, and sometimes terribly wrong, in your view?
        darkmarmot 4y ago
        Inelastic demand is one oft cited trait.
        4y ago
mikeyouse 4y ago
The reimbursements for ER doctors are incredibly out of wack with the training and responsibilities compared to similar physicians, and especially with advanced practice nurses/PAs. In some places, it's not uncommon to have ER docs making over $500k while the internal medicine docs that they turn their sickest patients over to will make less than half of that. The non-physician staff performing the same will see less still. Compared to the IM docs, they have the same educational requirements, same residency length, they work at the same hospitals, but the ER docs just rake it in.
- seanmcdirmid 4y ago
  Don’t ER docs have to work odd hours and see patients without any prep or background? I get the docs have the same education, but I can see taking half pay for a more predictable schedule and patient load, along with lots of time before hand to figure things out. They are different jobs, supply and demand probably sets one to be higher paid than the other.
  - ghufran_syed 4y ago
    Right - and the risk is much greater seeing “unfiltered” emergency patients, compared to a patient who has had a full assessment in the ED, had surgical issues ruled out, etc and was then admitted to the internal medicine service.
    - mikeyouse 4y ago
      What risk? Malpractice coverage is provided by the hospital, or more typically, the private equity group that owns the ER physician practice. Last I looked, independent ER docs pay something like $15k more per year than IM docs for solo coverage... there's still quite a ways to go to make up that other quarter million dollars. I don't think the average person realizes that Blackstone is one of the largest employers of ER docs... it's not "supply and demand" that's increasing ER salaries, it's a private equity cartel that aggressively upcodes routine treatment and then sues hospitals to increase their reimburesment rates. https://en.wikipedia.org/wiki/TeamHealth https://en.wikipedia.org/wiki/TeamHealth https://tennesseelookout.com/2022/05/09/tennessee-health-billing-firm-accused-in-court-of-cartel-like-behavior/ https://tennesseelookout.com/2022/05/09/tennessee-health-bil...
armchairhacker 4y ago
Check out https://www.reddit.com/r/nursing/ https://www.reddit.com/r/nursing/ to get a glimpse of the modern US healthcare system (Canada and EU are similar). I don't really know what else to call it than "shitshow". In an effort to cut costs hospitals severely overwork their doctors and nurses. It's endemic, anyone who knows anything about healthcare understands that people work >12hour shifts where they are always busy and you can see the constant chaos in any ER. Moreover, despite being overworked and literally caring for people's lives nurses are severely underappreciated. Because people are rude and needy especially when they are sick or their loved one is sick, and a lot of people just don't realize what nurses have to deal with. Though some nurses really are terrible at their jobs: nurses who are externally apathetic or downright sadistic or dangerously incompetent. But that too leads back to healthcare being mismanaged and underfunded, because proper management and funding is required to find and fire these nurses and or prevent them from being hired. Also, environments in many healthcare orgs are toxic. Probably because of all the stress that working >12 hour shifts and seeing people severely sick. The drama and absurd rules go beyond anything I've ever heard about in any tech company, things are normalized that in a software job nobody would tolerate. To say it's "a complex/hard problem" is an understatement. Healthcare is one of the biggest expenses of any country. It really does require tons of resources to diagnose and treat a sick patient: there are only so many surgeons and drug manufacturers and MRI machines, and the same symptoms can be from 1000 different diseases and the same disease can present different symptoms in 1000 patients. In first-world countries we expect to provide quality care to anyone rich or poor, because to deny care is very wrong, but in practice that means we have over 400 million people that need specialized visits and treatment. But at the least people need to understand, and governments need to stop funding other various things when what we really need is more hospitals and salaries for more healthcare workers. It seems every day I hear about Canada cutting or ignoring healthcare costs or US fighting over funding and whether insurance should be private. As a tech worker I think doctors and nurses should be payed more than tech workers, because what I do is very important, but what they do is moreso because they are literally saving people's health.
- ghufran_syed 4y ago
  Everyone in healthcare is overworked - but at least in the US people have the choice to move to a better-paying employer. I work in Northern california with a nurse who lives in Florida and flies out for a bunch of shifts, then takes a few weeks off. In the UK where I originally trained, the pay is shockingly low compared to the US, due to lack of competition IMO: https://www.salary.com/research/salary/alternate/registered-nurse-rn-level-1-salary/ca https://www.salary.com/research/salary/alternate/registered-... https://www.payscale.com/research/UK/Job=Registered_Nurse_(RN)/Salary/9c6a680a/Entry-Level https://www.payscale.com/research/UK/Job=Registered_Nurse_(R...
ghufran_syed 4y ago
The example of the woman who went three times before seeing a doctor and having a diagnosis made is a little silly - regardless of who sees the patient, it often takes repeat 1-2 repeat blood tests every 48 hours to figure out if the patient’s HCG level is rising enough or falling which is needed to help figure out whats going on [1]. The patient is often told to return to the ED for those return visits because its almost impossible to get seen by an Ob-Gyn in that timescale, and the main concern is to not miss a life-threatening ectopic pregnancy. [1] https://wikem.org/wiki/Ectopic_pregnancy https://wikem.org/wiki/Ectopic_pregnancy
nobodyandproud 4y ago
I think a dual system is necessary, due to the US’ reluctance on relying heavily on government (on paper). https://en.m.wikipedia.org/wiki/Healthcare_in_South_Korea https://en.m.wikipedia.org/wiki/Healthcare_in_South_Korea https://en.m.wikipedia.org/wiki/Healthcare_in_Taiwan https://en.m.wikipedia.org/wiki/Healthcare_in_Taiwan Both countries are market based societies, each have taken a somewhat different approach to the problem, yet both systems are quite efficient.
mattpallissard 4y ago
I can tell you from personal experience that hospital funding priorities are wild. It's an ongoing turf war between hospitals. * Buying up private practices * Remodels so the hospital has a more pleasant ambiance * Having an excessive amount of cash on hand to signal various things to various parties * Working out the cost schedules with insurance companies * Audits for a certifications outside of regulatory requirements that are useless on the nursing floor (lean/six sigma/etc) * Adding new types of facilities outside the core competencies of the organization such as gyms or specialized satellite facilities. Really, healthcare is a cutthroat industry that's all about signaling.
cptcobalt 4y ago
> While diagnosing and treating patients was once doctors' domain, they are increasingly being replaced by nurse practitioners and physician assistants, collectively known as "midlevel practitioners," who can perform many of the same duties and generate much of the same revenue for less than half the pay. [...] In a statement to KHN, American Physician Partners said this strategy is a way to ensure all ERs remain fully staffed, calling it a "blended model" that allows doctors, nurse practitioners and physician assistants "to provide care to their fullest potential." This seems like you're expecting your ER docs to handle the worst of the worst for days on end, rather than a good blend of patients. Seeing a "routine" ER patient may offer a mental break between a more critical patient. It truly seems like an actively shitty work environment to always walk into have the worst of the worst cases—because going to the ER is already a worst case. This is not the right way to keep humans running well, for both the sick and the docs.

56 points by t23 4y ago

While also giving Nurse Practitioners and Physicians Assistants more responsibilities while paying them far less than an MD. Just the same as attorneys are expensive, so you just give everything that lawyers used to do to paralegals and pay them 1/4 as much.

magic_man 4y ago
Ama also keeps supply of doctors down too. That's why all these medschools have such low acceptance rates. If you are an Indian and have a 3.8 gpa you still might not get into medschools which is pretty absurd.
wyldfire 4y ago
Note that the term "Medical Assistants" in the US generally refers to the folks who are able to take vitals and minimal-complexity care. They're not given anywhere near the responsibility of an RN let alone an NP.
- VWWHFSfQ 4y ago
  Yeah I was actually thinking of Physician Assistant

wyldfire 4y ago

shiftpgdn 4y ago
Counterpoint: You can go read the “Noctor” subreddit or ask any practicing physician why it’s bad for patient outcome. Ultimately we need more doctors and less hospital administrators.
- themitigating 4y ago
  Doctors say we need more of them and their high pay?
  - oaktrout 4y ago
    I'm sure the high paid software engineers at boeing said something similar when jobs were being outsourced "we need more US engineers". Look at the software problems they had and tell me they were wrong. Just like software engineers are best qualified to evaluate software quality, doctors know medicine better than anyone else. Just because they are incentivized to protect their job doesn't mean they are wrong.
    - themitigating 4y ago
      That's correct but I believe their bias makes them a untrustworthy worthy source
    - 908B64B197 4y ago
      > Just like software engineers are best qualified to evaluate software quality, doctors know medicine better than anyone else. Just because they are incentivized to protect their job doesn't mean they are wrong. It was rather trivial for Boeing engineers to show, without a doubt, that the cheap offshored programmers didn't write software as good as they did. The design simply spoke for itself and didn't perform to spec. Why not simply have doctors do the same? If their fellow medical workers can't deliver the same quality of care at the same speed and cost, then it should be trivial to show.
      - oaktrout 4y ago

ganlaw 4y ago

Hospitals shouldn't be a profitable business. The primary goal of a hospital should be serving patients sickness. (Easier said than done) My partner is a physician at a hospital in NYC, and something that they are struggling with now is lack of social services for patients to get them out of hospital beds and into homes/rehabs. As a immigrant in this country, I am constantly flabbergasted by the state of healthcare here and people's willingness to accept hospitals as profit seeking businesses the same as a fortune 500. Obviously if the law allows these hospitals to seek profits, they will. So the question is, how do we change the law? And why don't people want to change it?

deleted 4y ago
[deleted]
abfan1127 4y ago
Profit is a strong incentive to optimize. non-profit organizations are under different incentives. They both have pitfalls, they both have advantages.
- conscion 4y ago
  Profit is a strong incentive when there's active competition. When there's not competition, for-profit business turn to extracting rents on captive customers. Health care larger is not a competitive market. Lots of customers only have limited options (i.e. rural hospitals) and the urgency of some purchases don't support competition (i.e. ER visits)
  - abfan1127 4y ago
    I agree its not a competitive market. Rural areas suffer in all areas of limited markets, medical isn't special. Government involvement (including, but not limited to limiting licensing). insurance clouds the market as well (both how we procure insurance and government limitations of insurance).
- yunwal 4y ago
  > Profit is a strong incentive to optimize. Optimize what? Certainly not costs, since for-profit hospitals have every incentive to push for unneeded expensive operations. Maybe you’re mistaking healthcare for a market where meaningful competition and information symmetry exists?

deleted 4y ago

[deleted]

ourmandave 4y ago

My last ER visit I was seen by a PA, which is fine. They're more than competent. The part I didn't like was how they made me get out a credit card while they we're treating me. Which, according to a story by the NY Times, is a common thing. Send a nurse around with a swipeable tablet to ask how you'd like to pay. https://www.nytimes.com/2023/01/25/podcasts/the-daily/nonprofit-hospitals-investigation.html https://www.nytimes.com/2023/01/25/podcasts/the-daily/nonpro...

azinman2 4y ago
Same thing happened to me in Canada.
quasse 4y ago
> The part I didn't like was how they made me get out a credit card while they we're treating me. Yes, I recently had to visit urgent care after probably ~8 years of staying out of the hospital. To be allowed in the door of the building I was required to swipe a credit card (literally 5 feet inside the front door, "we need you to authorize a charge on your card for this visit to proceed") and then they had credit card readers inside the patient rooms attached to the EMR computers for "charge as you go" medical care. The whole thing made me sick to my stomach.
schemescape 4y ago
Did they tell you how much the charge would be?
bluesquared 4y ago
I was having a minor anaphylactic reaction to something - not enough to restrict my breathing or make me want to use my epipen yet - but I experienced the same thing. Went to the ER, face red and swelling, lips starting to tingle, the whole 9 yards. They had me enter all my personal info, name, address, insurance card, etc. Then swipe for my $250 ER copay all before seeing anybody competent. The worker at the desk didn't understand what I meant when I said "anaphylactic reaction" I had to gesture at my face and say "allergic reaction" ffs! At least my reaction wasn't as bad the first time. That time was pre-covid and they had somebody with experience and functioning brain cells at the check-in and they brought me right in and started taking vitals and did an IV literally right on the other side of the check-in desk. On that visit they had the payment person come around hours later while I was recovering in a bed on a different unit for monitoring while I was coming down off of the meds they pumped me full of.

oaktrout 4y ago

There is some evidence in the primary care world that going to a NP for primary care costs more than going to a doctor: https://www.ama-assn.org/practice-management/scope-practice/amid-doctor-shortage-nps-and-pas-seemed-fix-data-s-nope https://www.ama-assn.org/practice-management/scope-practice/.... In short, NPs order more tests without improving patient outcomes. I have no doubt that it's the same in the ER. It takes training and knowledge to know what test you don't have to order. Do you really need a CT scan for your diarrhea? That being said, I think there is definitely a role for NPs : low complexity and/or non-acute highly specialized care. The emergency department is not the environment for that.

tyoma 4y ago
Is it though? There are quite a few people who lack access to the normal healthcare system and use the ER as primary care of last resort because no one is turned away. PAs and NPs would be perfect for those patients.
mikeyouse 4y ago
The AMA probably isn't the best source for that type of data. The little throwaway lines in that review are funny; "Patients deserve care led by physicians—the most highly educated, trained and skilled health care professionals. Through research, advocacy and education, the AMA vigorously defends the practice of medicine against scope-of-practice expansions that threaten patient safety." Weird because the study they're talking about didn't say a word about patient safety. Their metrics are weird too - it's looking at hospital spend "per member per month" which was higher with the non-physician staff but I'd be curious if the $30 difference was more or less than the difference in salaries between the two groups.
- oaktrout 4y ago
  The AMA obviously has an agenda, but that doesn't that change the fact that non-physicians cost patients and taxpayers more money, hard to argue with the cms data. Who cares if your doctor gets paid more if he is saving you and the taxpayers money. I guess it might make business sense from a hospital perspective, because physicians are more expensive to employee than NPs and hospitals don't have a business reason to save taxpayers or patients money.

klyrs 4y ago

> Private equity companies pool money from wealthy investors to buy their way into various industries, often slashing spending and seeking to flip businesses in three to seven years. The focus of the article is on physicians vs. NPs and PAs, but the real driver of the enshittification is, yet again, private equity firms extracting short-term profits, to hell with long-term outcomes.

azinman2 4y ago
We need to outlaw for profit anything with healthcare. The incentives are misaligned with society’s needs.
- wahnfrieden 4y ago
  Why only healthcare specifically?
  - l33t233372 4y ago
    We’ve seen that having a profit motive is, to a point, generally good in many areas of commercial life. Healthcare is not one of these areas.
    - dariusj18 4y ago
      Let's do the same for housing
    - wahnfrieden 4y ago
      I'm asking why the difference? Why is it good for society sometimes, and sometimes terribly wrong, in your view?
      - darkmarmot 4y ago
        Inelastic demand is one oft cited trait.
      - 4y ago

mikeyouse 4y ago

The reimbursements for ER doctors are incredibly out of wack with the training and responsibilities compared to similar physicians, and especially with advanced practice nurses/PAs. In some places, it's not uncommon to have ER docs making over $500k while the internal medicine docs that they turn their sickest patients over to will make less than half of that. The non-physician staff performing the same will see less still. Compared to the IM docs, they have the same educational requirements, same residency length, they work at the same hospitals, but the ER docs just rake it in.

seanmcdirmid 4y ago
Don’t ER docs have to work odd hours and see patients without any prep or background? I get the docs have the same education, but I can see taking half pay for a more predictable schedule and patient load, along with lots of time before hand to figure things out. They are different jobs, supply and demand probably sets one to be higher paid than the other.
- ghufran_syed 4y ago
  Right - and the risk is much greater seeing “unfiltered” emergency patients, compared to a patient who has had a full assessment in the ED, had surgical issues ruled out, etc and was then admitted to the internal medicine service.
  - mikeyouse 4y ago
    What risk? Malpractice coverage is provided by the hospital, or more typically, the private equity group that owns the ER physician practice. Last I looked, independent ER docs pay something like $15k more per year than IM docs for solo coverage... there's still quite a ways to go to make up that other quarter million dollars. I don't think the average person realizes that Blackstone is one of the largest employers of ER docs... it's not "supply and demand" that's increasing ER salaries, it's a private equity cartel that aggressively upcodes routine treatment and then sues hospitals to increase their reimburesment rates. https://en.wikipedia.org/wiki/TeamHealth https://en.wikipedia.org/wiki/TeamHealth https://tennesseelookout.com/2022/05/09/tennessee-health-billing-firm-accused-in-court-of-cartel-like-behavior/ https://tennesseelookout.com/2022/05/09/tennessee-health-bil...

armchairhacker 4y ago

Check out https://www.reddit.com/r/nursing/ https://www.reddit.com/r/nursing/ to get a glimpse of the modern US healthcare system (Canada and EU are similar). I don't really know what else to call it than "shitshow". In an effort to cut costs hospitals severely overwork their doctors and nurses. It's endemic, anyone who knows anything about healthcare understands that people work >12hour shifts where they are always busy and you can see the constant chaos in any ER. Moreover, despite being overworked and literally caring for people's lives nurses are severely underappreciated. Because people are rude and needy especially when they are sick or their loved one is sick, and a lot of people just don't realize what nurses have to deal with. Though some nurses really are terrible at their jobs: nurses who are externally apathetic or downright sadistic or dangerously incompetent. But that too leads back to healthcare being mismanaged and underfunded, because proper management and funding is required to find and fire these nurses and or prevent them from being hired. Also, environments in many healthcare orgs are toxic. Probably because of all the stress that working >12 hour shifts and seeing people severely sick. The drama and absurd rules go beyond anything I've ever heard about in any tech company, things are normalized that in a software job nobody would tolerate. To say it's "a complex/hard problem" is an understatement. Healthcare is one of the biggest expenses of any country. It really does require tons of resources to diagnose and treat a sick patient: there are only so many surgeons and drug manufacturers and MRI machines, and the same symptoms can be from 1000 different diseases and the same disease can present different symptoms in 1000 patients. In first-world countries we expect to provide quality care to anyone rich or poor, because to deny care is very wrong, but in practice that means we have over 400 million people that need specialized visits and treatment. But at the least people need to understand, and governments need to stop funding other various things when what we really need is more hospitals and salaries for more healthcare workers. It seems every day I hear about Canada cutting or ignoring healthcare costs or US fighting over funding and whether insurance should be private. As a tech worker I think doctors and nurses should be payed more than tech workers, because what I do is very important, but what they do is moreso because they are literally saving people's health.

ghufran_syed 4y ago
Everyone in healthcare is overworked - but at least in the US people have the choice to move to a better-paying employer. I work in Northern california with a nurse who lives in Florida and flies out for a bunch of shifts, then takes a few weeks off. In the UK where I originally trained, the pay is shockingly low compared to the US, due to lack of competition IMO: https://www.salary.com/research/salary/alternate/registered-nurse-rn-level-1-salary/ca https://www.salary.com/research/salary/alternate/registered-... https://www.payscale.com/research/UK/Job=Registered_Nurse_(RN)/Salary/9c6a680a/Entry-Level https://www.payscale.com/research/UK/Job=Registered_Nurse_(R...

ghufran_syed 4y ago

The example of the woman who went three times before seeing a doctor and having a diagnosis made is a little silly - regardless of who sees the patient, it often takes repeat 1-2 repeat blood tests every 48 hours to figure out if the patient’s HCG level is rising enough or falling which is needed to help figure out whats going on [1]. The patient is often told to return to the ED for those return visits because its almost impossible to get seen by an Ob-Gyn in that timescale, and the main concern is to not miss a life-threatening ectopic pregnancy. [1] https://wikem.org/wiki/Ectopic_pregnancy https://wikem.org/wiki/Ectopic_pregnancy

nobodyandproud 4y ago

I think a dual system is necessary, due to the US’ reluctance on relying heavily on government (on paper). https://en.m.wikipedia.org/wiki/Healthcare_in_South_Korea https://en.m.wikipedia.org/wiki/Healthcare_in_South_Korea https://en.m.wikipedia.org/wiki/Healthcare_in_Taiwan https://en.m.wikipedia.org/wiki/Healthcare_in_Taiwan Both countries are market based societies, each have taken a somewhat different approach to the problem, yet both systems are quite efficient.

mattpallissard 4y ago

I can tell you from personal experience that hospital funding priorities are wild. It's an ongoing turf war between hospitals. * Buying up private practices * Remodels so the hospital has a more pleasant ambiance * Having an excessive amount of cash on hand to signal various things to various parties * Working out the cost schedules with insurance companies * Audits for a certifications outside of regulatory requirements that are useless on the nursing floor (lean/six sigma/etc) * Adding new types of facilities outside the core competencies of the organization such as gyms or specialized satellite facilities. Really, healthcare is a cutthroat industry that's all about signaling.

cptcobalt 4y ago

> While diagnosing and treating patients was once doctors' domain, they are increasingly being replaced by nurse practitioners and physician assistants, collectively known as "midlevel practitioners," who can perform many of the same duties and generate much of the same revenue for less than half the pay. [...] In a statement to KHN, American Physician Partners said this strategy is a way to ensure all ERs remain fully staffed, calling it a "blended model" that allows doctors, nurse practitioners and physician assistants "to provide care to their fullest potential." This seems like you're expecting your ER docs to handle the worst of the worst for days on end, rather than a good blend of patients. Seeing a "routine" ER patient may offer a mental break between a more critical patient. It truly seems like an actively shitty work environment to always walk into have the worst of the worst cases—because going to the ER is already a worst case. This is not the right way to keep humans running well, for both the sick and the docs.