4 ms·

Agreed but there is a time component here as well. There may in fact be a doctor's shortage because getting a supply of new doctors takes X number of years but

by AdamN 3y ago

Agreed but there is a time component here as well. There may in fact be a doctor's shortage because getting a supply of new doctors takes X number of years but the demand is now. In the UK with NHS shortages it's all about wages though. The time component just means that whenever they finally get the wages figured out it will still take years to improve.

varispeed 3y ago
We have a peculiar situation where NHS can't raise wages, but they certainly can hire staff from agencies at much higher rates (and agency mark up). Imagine if NHS could hire staff directly at those rates...
- josephg 3y ago
  I’m not familiar with UK politics. Why can’t they raise wages?
  - varispeed 3y ago
    Bureaucracy, corruption...
    - highwaylights 3y ago
      NHS management is notoriously corrupt and a bureaucratic nightmare, which is why the national health service failed in the UK. If you live elsewhere and are surprised to have never heard about this, it’s because it hasn’t been acknowledged yet by the government to save face, but anyone with relatives stuck on a NHS waiting list or who have sadly passed away waiting for an ambulance that doesn’t come already knows this.
  - Tangurena2 3y ago
    The Conservative party wishes to destroy (by privatization) the National Health System. It will be replaced with a "health" system substantially identical to the American system.
    - deleted 3y ago
      [deleted]
  - walthamstow 3y ago
    Leaving aside the political aims of the governing party, the NHS employs a lot of people, it's the biggest employer in Europe and one of the biggest in the world, so even a 1% raise costs a large sum of money. Large nominal sums of money are really easy to turn into a negative headline, rather than the cost of using staffing agencies which requires a bit of analysis. See Brexit for an example. "We're spending £350m per week on this, isn't that mad?!" versus "various analyses and projections show that raising trade barriers and reducing staff mobility will likely have a negative effect on domestic businesses"
    - mrguyorama 3y ago
      >"We're spending £350m per week on this, isn't that mad?!" Aren't you sorta forgetting the more salient point of this headline? That it was an outright fabrication with no justification or basis in reality?
      - walthamstow 3y ago
        I know, but it doesn't necessarily matter in this context, my point is that big simple numbers make good headlines, and complicated analyses do not.
johngladtj 3y ago
That's always an excuse to not pay market rates. If you really need doctors NOW, bump up the rates as high as they will go. At some point you will either run out of money, or you'll find a doctor somewhere in the world willing to take the 12 hour plane to move to the UK for the 1 million pound an hour wage you're offering them.
- bell-cot 3y ago
  Or you don't literally run out of money...but it still doesn't work out so well - https://en.wikipedia.org/wiki/Hyperinflation_in_the_Weimar_Republic https://en.wikipedia.org/wiki/Hyperinflation_in_the_Weimar_R... Also worth keeping in mind - there's a big difference in "market rate" between "well-treated doctor in a well-functioning health system" and "relentlessly over-worked doctor in a wretchedly crumbling health system". And even if paid well above "market rate", the latter position will attract far fewer applicants who really care about patient welfare and outcomes. And suffer considerably higher turn-over.
  - highwaylights 3y ago
    I do see your point, but the fall of the Weimar Republic isn’t a great comparison. Ultimately, it still boils down to “I think you should be limited to making X for doing job Y, because I don’t believe it should be worth as much as job Z, which is clearly prestigious enough to be worth 2X.” Market forces are a surprisingly efficient means of separating perceived and actual value for pretty much anything, even with some fairly sizeable warts.
    - bell-cot 3y ago
      > of the Weimar Republic isn't a great... Yes and no. A nation like the UK can afford to pay any one doctor millions of pounds. But that solution scales poorly to a national level. And worse if you try to scale it to all the other sorts of essential workers. And when an extremely large, complex system is wretchedly mismanaged - paying the guys in the trenches 10X does not fix that. For example, many of the UK's public buildings were built with "RAAC", and are at risk of collapse: https://www.theguardian.com/uk-news/2023/sep/04/raac-crisis-who-knew-what-when-crumbling-concrete-england https://www.theguardian.com/uk-news/2023/sep/04/raac-crisis-... Meanwhile - a rather large number of HNer's seem to disagree with you about the virtues of those "efficient market forces" when it comes to health care. Perhaps discuss it with them here? - https://news.ycombinator.com/item?id=37398504 https://news.ycombinator.com/item?id=37398504

by AdamN 3y ago

varispeed 3y ago

We have a peculiar situation where NHS can't raise wages, but they certainly can hire staff from agencies at much higher rates (and agency mark up). Imagine if NHS could hire staff directly at those rates...

josephg 3y ago
I’m not familiar with UK politics. Why can’t they raise wages?
- varispeed 3y ago
  Bureaucracy, corruption...
  - highwaylights 3y ago
    NHS management is notoriously corrupt and a bureaucratic nightmare, which is why the national health service failed in the UK. If you live elsewhere and are surprised to have never heard about this, it’s because it hasn’t been acknowledged yet by the government to save face, but anyone with relatives stuck on a NHS waiting list or who have sadly passed away waiting for an ambulance that doesn’t come already knows this.
- Tangurena2 3y ago
  The Conservative party wishes to destroy (by privatization) the National Health System. It will be replaced with a "health" system substantially identical to the American system.
  - deleted 3y ago
    [deleted]
- walthamstow 3y ago
  Leaving aside the political aims of the governing party, the NHS employs a lot of people, it's the biggest employer in Europe and one of the biggest in the world, so even a 1% raise costs a large sum of money. Large nominal sums of money are really easy to turn into a negative headline, rather than the cost of using staffing agencies which requires a bit of analysis. See Brexit for an example. "We're spending £350m per week on this, isn't that mad?!" versus "various analyses and projections show that raising trade barriers and reducing staff mobility will likely have a negative effect on domestic businesses"
  - mrguyorama 3y ago
    >"We're spending £350m per week on this, isn't that mad?!" Aren't you sorta forgetting the more salient point of this headline? That it was an outright fabrication with no justification or basis in reality?
    - walthamstow 3y ago
      I know, but it doesn't necessarily matter in this context, my point is that big simple numbers make good headlines, and complicated analyses do not.

johngladtj 3y ago

That's always an excuse to not pay market rates. If you really need doctors NOW, bump up the rates as high as they will go. At some point you will either run out of money, or you'll find a doctor somewhere in the world willing to take the 12 hour plane to move to the UK for the 1 million pound an hour wage you're offering them.

bell-cot 3y ago
Or you don't literally run out of money...but it still doesn't work out so well - https://en.wikipedia.org/wiki/Hyperinflation_in_the_Weimar_Republic https://en.wikipedia.org/wiki/Hyperinflation_in_the_Weimar_R... Also worth keeping in mind - there's a big difference in "market rate" between "well-treated doctor in a well-functioning health system" and "relentlessly over-worked doctor in a wretchedly crumbling health system". And even if paid well above "market rate", the latter position will attract far fewer applicants who really care about patient welfare and outcomes. And suffer considerably higher turn-over.
- highwaylights 3y ago
  I do see your point, but the fall of the Weimar Republic isn’t a great comparison. Ultimately, it still boils down to “I think you should be limited to making X for doing job Y, because I don’t believe it should be worth as much as job Z, which is clearly prestigious enough to be worth 2X.” Market forces are a surprisingly efficient means of separating perceived and actual value for pretty much anything, even with some fairly sizeable warts.
  - bell-cot 3y ago
    > of the Weimar Republic isn't a great... Yes and no. A nation like the UK can afford to pay any one doctor millions of pounds. But that solution scales poorly to a national level. And worse if you try to scale it to all the other sorts of essential workers. And when an extremely large, complex system is wretchedly mismanaged - paying the guys in the trenches 10X does not fix that. For example, many of the UK's public buildings were built with "RAAC", and are at risk of collapse: https://www.theguardian.com/uk-news/2023/sep/04/raac-crisis-who-knew-what-when-crumbling-concrete-england https://www.theguardian.com/uk-news/2023/sep/04/raac-crisis-... Meanwhile - a rather large number of HNer's seem to disagree with you about the virtues of those "efficient market forces" when it comes to health care. Perhaps discuss it with them here? - https://news.ycombinator.com/item?id=37398504 https://news.ycombinator.com/item?id=37398504