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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

#31
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...

Same as Canadian. It took me 7 months to get an endocrinologist appointment. Luckily I was in traveling in Mexico and saw one there. If I had waited for my Canadian appointment, i would have lost all my hair and over 30kgs by that time. (It was a harmone related problem).

Re: ERs are hiring fewer doctors to save money

#32
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.

Re: ERs are hiring fewer doctors to save money

#33
Check out 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.

Re: ERs are hiring fewer doctors to save money

#34

Earlier quoted context omitted.

We need to outlaw for profit anything with healthcare. The incentives are misaligned with society’s needs.

Why only healthcare specifically?

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.

Re: ERs are hiring fewer doctors to save money

#35

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…

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.

Re: ERs are hiring fewer doctors to save money

#36
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…

Hospitals shouldn't be a profitable business.

Then elide "profitable" since that is the goal of every business.

Re: ERs are hiring fewer doctors to save money

#37
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…

Aren’t most hospitals in the states non-profit? But all those doctors and administrators want money, so it hardly matters.

Re: ERs are hiring fewer doctors to save money

#38
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.

> Ultimately we need more doctors and less hospital administrators.

I guess I tend to agree but you can't just conjure them up. You can set policies to encourage physicians to emigrate to the US and make it easier for students to pay for med school, but in the end only so many people are going to want to become doctors.

Re: ERs are hiring fewer doctors to save money

#39
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

Re: ERs are hiring fewer doctors to save money

#40
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.

I know plenty of "practicing physicians" that speak highly of midlevels. Comparing tenured doctors to the student-filled shit factory that is "noctor" is either extremely disingenuous or extremely ignorant.
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