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While important, this is immaterial to the NBC article. The PE firms CUT the number of employees in ER rooms in this paper, so having more doctors wouldn't actu

While important, this is immaterial to the NBC article. The PE firms CUT the number of employees in ER rooms in this paper, so having more doctors wouldn't actually help out the problem that the NBC article is describing. "The increased deaths in emergency departments at private equity-owned hospitals are most likely the result of reduced staffing levels after the acquisitions, which the study also measured, said Dr. Zirui Song, a co-author and associate professor of health care policy and medicine at Harvard Medical School." The issue with American healthcare is the profit-seeking capitalists.

jwilber 1y ago
Well, it could be both. Having more doctors before cuts means having more after cuts.
- leoc 1y ago
  And the more expensive a doctor is, the more you save by cutting one/the larger the total wage bill for doctors is for a fixed number of doctors, making that bill a higher proportion of total expenses and a higher priority for cuts/the fewer doctors you get for a fixed amount of money.
khimaros 1y ago
theoretically, wouldn't increasing the supply of doctors have a downward pressure on wages and thus make it cheaper to employ more of them?
- banannaise 1y ago
  Sure, it would make it cheaper. Would that result in these companies employing more doctors to perform the same amount of care at higher quality, or would it result in them retaining the standard of care they're currently providing while taking home a larger profit margin?
  - mothballed 1y ago
    There are a lot of hospitals where there is an endless supply people showing up to the ER with non-emergent stuff because it is the only place required to take them, and their number is only limited by wait time due to triage; they'll just leave if it takes too long as their life isn't threatened and they have something else to do. You could hire a whole army of doctors and they'd still be there, word gets around. If the doctors are cheap enough to cover whatever you can get from debt collection agencies to sell off the debt they'll never pay, then you could hire a lot.
    - rileymat2 1y ago
      If this is happening now, why would they cut the number of doctors?
      - mothballed 1y ago
        They can't sell the debt for uninsured non-emergent case for enough money to cover the doctor. Cutting doctors means only the most prioritized triage cases makes it to doctors, which skews towards people that are employed or on medicare and the money can be recouped, and thus improves profitability. It's an end-run against the requirement they take in the hordes of people with no insurance who show up to the ER for low-income cases and no way to pay it. If doctors were so cheap as to be covered by the sales to debt collectors, the whole thing gets flipped, as it would be profitable to just hire armies of them to cover the hordes who come in with non-emergent cases.
        rileymat2 1y ago
        Do we really think an increase in the supply of doctors will cause prices to collapse so hard that selling off unpaid medical debt will be profitable?
        mothballed 1y ago
        That depends, can we use IRS agents with guns to collect money to backstop unpaid medical debt?
- matheusmoreira 1y ago
  It absolutely would. Source: live in a country which "democratized" access to medical schools and flooded the market with doctors. Consequences? Let's just say that the term "secondary effects" doesn't quite cover it. This thread is talking about ERs so let's focus on that. Pay for a 12 hour shift has fallen by over 50% and that's without accounting for inflation. As a result, only heavily indebted and inexperienced doctors are manning the ERs now. These are critical life saving jobs that ought to attract the most experienced doctors but they turned into reassigned-to-Antartica tier jobs that only new or failed doctors put up with. Now factor in the substandard education provided by the hundreds of newly created medical schools which don't even have a hospital for students to practice in. The result is of course stupid and incompetent doctors manning ERs. I remember one guy who sent home a patient with textbook myocardial infarction symptoms without even ordering a routine EKG, obviously leading to the patient's death. Imagine being that dude's lawyer. Depressing the wages of healthcare workers has fatal consequences. There's no reason at all to spend the best decade of one's life busting ass in medical school and residency if one is not gonna get rich off of it. You want your doctor to be the smartest, most studious, most hard working, most debt-free person you'll ever meet. You don't want to put your life and well-being in the hands of a stupid indebted doctor who graduated from a diploma mill.
myrmidon 1y ago
> The issue with American healthcare is the profit-seeking capitalists. Profit seeking capitalists would be fine if healthcare was a competitive market, like grocery sale. But it isn't, and I honestly don't see how to make it one. Full price transparency would help, but I don't believe classical free market selfregulation can work out for the healthcare sector, by design. You need good ability of healthcare customers to judge quality of treatment/medication, to know prices beforehand and to have sufficient choice for market dynamics to work, and every single one of those points is somewhere between really difficult and impossible.
- rtkwe 1y ago
  An embedded requirement for a rational market is that the customer has to be able to make a rational evaluation of the costs of the good vs the quality, which just doesn't exist in medical fields. Patients don't know enough to make that choice and evaluate the efficacy of many potential choices of providers. Not being able to do that fundamentally kneecaps the implicit assumptions in the already faulty model that underpins the 'competitive market' analysis. We should just accept that and stop trying to treat it as one and provide it as a public good.
  - TheOtherHobbes 1y ago
    That's a cart-before-the-horse analysis. Labelling markets "rational" is pure rhetoric. There's nothing even remotely rational about a market system, because the moral basis of calling markets "rational" is... greed. Just greed. Nothing else. All of the failed outcomes, deaths, pollution, lost opportunities, distortions of democracy, and other damages are a direct consequence of this moral system which claims that greed is rational - when in fact unfettered greed is clearly and objectively sociopathic, with predictable sociopathic outcomes.
    - 20after4 1y ago
      I agree with you but this website is sociopath central so I'm not surprised this got down votes. A lot of Ayn Rand fans here. But you know that already, judging by your karma score.
naasking 1y ago
> so having more doctors wouldn't actually help out the problem that the NBC article is describing. It could because a larger supply of doctors means salaries would be lower, and thus the incentive to cut staff is lower.
GoatInGrey 1y ago
Restricted supply of physicians means that there aren't enough of them to open a competing hospital. Your complaint against for-profit hospitals would apply just as quickly to a nonprofit hospital in a socialist regime. The fundamental problem is monopoly. Because most people don't behave nicely unless they are forced to by market pressures. Whether those markets are economic or social in nature. Even if you ignore present-day socialist economies, you can look to NIMBYism in the developed world as a flagrant example of what happens when "normal people" gain collective control over a resource without any competitors. They immediately weaponize it to the harm of greater society. If not for financial purposes, then ideological ones.

jwilber 1y ago

Well, it could be both. Having more doctors before cuts means having more after cuts.

leoc 1y ago
And the more expensive a doctor is, the more you save by cutting one/the larger the total wage bill for doctors is for a fixed number of doctors, making that bill a higher proportion of total expenses and a higher priority for cuts/the fewer doctors you get for a fixed amount of money.

khimaros 1y ago

theoretically, wouldn't increasing the supply of doctors have a downward pressure on wages and thus make it cheaper to employ more of them?

banannaise 1y ago
Sure, it would make it cheaper. Would that result in these companies employing more doctors to perform the same amount of care at higher quality, or would it result in them retaining the standard of care they're currently providing while taking home a larger profit margin?
- mothballed 1y ago
  There are a lot of hospitals where there is an endless supply people showing up to the ER with non-emergent stuff because it is the only place required to take them, and their number is only limited by wait time due to triage; they'll just leave if it takes too long as their life isn't threatened and they have something else to do. You could hire a whole army of doctors and they'd still be there, word gets around. If the doctors are cheap enough to cover whatever you can get from debt collection agencies to sell off the debt they'll never pay, then you could hire a lot.
  - rileymat2 1y ago
    If this is happening now, why would they cut the number of doctors?
    - mothballed 1y ago
      They can't sell the debt for uninsured non-emergent case for enough money to cover the doctor. Cutting doctors means only the most prioritized triage cases makes it to doctors, which skews towards people that are employed or on medicare and the money can be recouped, and thus improves profitability. It's an end-run against the requirement they take in the hordes of people with no insurance who show up to the ER for low-income cases and no way to pay it. If doctors were so cheap as to be covered by the sales to debt collectors, the whole thing gets flipped, as it would be profitable to just hire armies of them to cover the hordes who come in with non-emergent cases.
      - rileymat2 1y ago
        Do we really think an increase in the supply of doctors will cause prices to collapse so hard that selling off unpaid medical debt will be profitable?
        mothballed 1y ago
        That depends, can we use IRS agents with guns to collect money to backstop unpaid medical debt?
matheusmoreira 1y ago
It absolutely would. Source: live in a country which "democratized" access to medical schools and flooded the market with doctors. Consequences? Let's just say that the term "secondary effects" doesn't quite cover it. This thread is talking about ERs so let's focus on that. Pay for a 12 hour shift has fallen by over 50% and that's without accounting for inflation. As a result, only heavily indebted and inexperienced doctors are manning the ERs now. These are critical life saving jobs that ought to attract the most experienced doctors but they turned into reassigned-to-Antartica tier jobs that only new or failed doctors put up with. Now factor in the substandard education provided by the hundreds of newly created medical schools which don't even have a hospital for students to practice in. The result is of course stupid and incompetent doctors manning ERs. I remember one guy who sent home a patient with textbook myocardial infarction symptoms without even ordering a routine EKG, obviously leading to the patient's death. Imagine being that dude's lawyer. Depressing the wages of healthcare workers has fatal consequences. There's no reason at all to spend the best decade of one's life busting ass in medical school and residency if one is not gonna get rich off of it. You want your doctor to be the smartest, most studious, most hard working, most debt-free person you'll ever meet. You don't want to put your life and well-being in the hands of a stupid indebted doctor who graduated from a diploma mill.

myrmidon 1y ago

> The issue with American healthcare is the profit-seeking capitalists. Profit seeking capitalists would be fine if healthcare was a competitive market, like grocery sale. But it isn't, and I honestly don't see how to make it one. Full price transparency would help, but I don't believe classical free market selfregulation can work out for the healthcare sector, by design. You need good ability of healthcare customers to judge quality of treatment/medication, to know prices beforehand and to have sufficient choice for market dynamics to work, and every single one of those points is somewhere between really difficult and impossible.

rtkwe 1y ago
An embedded requirement for a rational market is that the customer has to be able to make a rational evaluation of the costs of the good vs the quality, which just doesn't exist in medical fields. Patients don't know enough to make that choice and evaluate the efficacy of many potential choices of providers. Not being able to do that fundamentally kneecaps the implicit assumptions in the already faulty model that underpins the 'competitive market' analysis. We should just accept that and stop trying to treat it as one and provide it as a public good.
- TheOtherHobbes 1y ago
  That's a cart-before-the-horse analysis. Labelling markets "rational" is pure rhetoric. There's nothing even remotely rational about a market system, because the moral basis of calling markets "rational" is... greed. Just greed. Nothing else. All of the failed outcomes, deaths, pollution, lost opportunities, distortions of democracy, and other damages are a direct consequence of this moral system which claims that greed is rational - when in fact unfettered greed is clearly and objectively sociopathic, with predictable sociopathic outcomes.
  - 20after4 1y ago
    I agree with you but this website is sociopath central so I'm not surprised this got down votes. A lot of Ayn Rand fans here. But you know that already, judging by your karma score.

naasking 1y ago

> so having more doctors wouldn't actually help out the problem that the NBC article is describing. It could because a larger supply of doctors means salaries would be lower, and thus the incentive to cut staff is lower.

GoatInGrey 1y ago

Restricted supply of physicians means that there aren't enough of them to open a competing hospital. Your complaint against for-profit hospitals would apply just as quickly to a nonprofit hospital in a socialist regime. The fundamental problem is monopoly. Because most people don't behave nicely unless they are forced to by market pressures. Whether those markets are economic or social in nature. Even if you ignore present-day socialist economies, you can look to NIMBYism in the developed world as a flagrant example of what happens when "normal people" gain collective control over a resource without any competitors. They immediately weaponize it to the harm of greater society. If not for financial purposes, then ideological ones.