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ERs are hiring fewer doctors to save money

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Re: ERs are hiring fewer doctors to save money

#11

Post by Spooky23 »

wyldfire wrote: post #3

> 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…

I strong disagree. From the hospital perspective, NPs and PAs are cannon fodder thrown on the line.

My sister in law is a NP who quit the ER. She worked as an RN in an ER for a decade and knew that she lacked the training and skills to be doing some of the stuff she was forced to do.

Patient lives and her license were at risk every day.

Re: ERs are hiring fewer doctors to save money

#12

Post by [deleted] »

ganlaw wrote: post #7

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 h…

[deleted]

Re: ERs are hiring fewer doctors to save money

#13

Post by abfan1127 »

ganlaw wrote: post #7

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 h…

Profit is a strong incentive to optimize. non-profit organizations are under different incentives. They both have pitfalls, they both have advantages.

Re: ERs are hiring fewer doctors to save money

#14

Post by ourmandave »

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/nonpro...

Re: ERs are hiring fewer doctors to save money

#15

Post by oaktrout »

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/.... 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.

Re: ERs are hiring fewer doctors to save money

#16

Post by adam_arthur »

ganlaw wrote: post #7

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 h…

Most hospitals are already losing money or close to losing money. Taking away profit motive from them e.g. by subsidizing operation would only increase cost of care, because the incentive to run lean/efficiently goes away.

The insurance system and perverse incentives embedded in it is the primary reason healthcare is expensive here. Also many countries have price controls on drugs, and US does not (thus subsidizing RoW in regards to new drug research).

https://www.chiefhealthcareexecutive.com/view/hospitals-losi...

Re: ERs are hiring fewer doctors to save money

#17

Post by klyrs »

> 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.

Re: ERs are hiring fewer doctors to save money

#18

Post by [deleted] »

ganlaw wrote: post #7

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 h…

[deleted]

Re: ERs are hiring fewer doctors to save money

#19

Post by ketzo »

shiftpgdn wrote: post #5
wyldfire wrote: post #3

> 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…

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.

Man, that subreddit reads like the most massive case of sour grapes imaginable.

It's just people (presumably a lot of physicians / med students?) griping about how NPs and PAs are acting too good for their titles. All the actual stories are, like, one-off anecdotes about how some NP made some medical mistake. As if MDs don't make a massive amount of mistakes, I guess?

Edit: lol, reading more, and I have seen multiple posters and commenters directly reference how much less "intelligent" NPs and PAs are. This whooooole sub is just a massive superiority complex

Edit2: There's a moderator bot that automatically responds with a list of rebuttals, which includes this beauty:

> You're just sexist. Ad hominem noted.

Re: ERs are hiring fewer doctors to save money

#20

Post by ghufran_syed »

ganlaw wrote: post #7

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 h…

The uk National Health Service is free at the point of use, and is a completely government run, non-profit service. That model doesn’t seem to be working either:

https://www.cnn.com/2023/01/23/uk/uk-nhs-crisis-falling-apar...

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