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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

#41

Post by quasse »

ourmandave wrote: post #14

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...

> 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.

Re: ERs are hiring fewer doctors to save money

#42

Post by VWWHFSfQ »

azinman2 wrote: post #23
klyrs wrote: post #17

> 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.

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

A lot of people are perfectly happy with private healthcare. I happen to be one of them. But I'm also not opposed to my tax money funding the county hospital either. We can have both.

Re: ERs are hiring fewer doctors to save money

#43

Post by robertlagrant »

azinman2 wrote: post #23
klyrs wrote: post #17

> 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.

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

Sadly this probably means no covid vaccine and few advancements. It's easy to spread out what we have; it's hard to run an engine of care and innovation at the same time. Choose hard.

Re: ERs are hiring fewer doctors to save money

#44

Post by dsfyu404ed »

azinman2 wrote: post #23
klyrs wrote: post #17

> 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.

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

The overwhelming majority of hospitals are nonprofit.

The overwhelming majority of prisons are run by the state.

The overwhelming majority of higher education is nonprofit.

The Catcholic church circa 1500 was nominally nonprofit.

PE probably does turn everything to shit but acting like not having shareholders or owners who are looking to wring every cent out so they can get the fattest check will solve the problem seems naive at best.

Re: ERs are hiring fewer doctors to save money

#45

Post by nicoburns »

ghufran_syed wrote: post #20
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...

> That model doesn’t seem to be working either

The model works just fine. The reason the NHS isn't working is because the Conservative government has intentionally underfunded it (UK per capita spending on healthcare is significantly lower than other European countries).

Re: ERs are hiring fewer doctors to save money

#46

Post by ganoushoreilly »

idopmstuff wrote: post #29
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…

I think only allowing nonprofit hospitals would be worse than the current state of affairs. You'd still be asking private organizations to be responsible for ensuring we have adequate medical treatment available, but you'd very literally be relying on the charity of strangers to ensure that. For-profit medicine at least provides excellent incentives for corporations to spend the enormous sums of money needed to set u…

It would take a rethinking of how the government would run the medical systems though. For example, the Veterans Administration hospital system is now a mix of Govt. and Referrals to for profit because the Govt. run hospitals have failed to meet standards / needs consistently. The health care has always been deemed pretty subpar / inadequate as well.

I'm not opposed to a government system, but it needs to be a redesign and re-haul of everything we've done so far and the reality is that it's just not likely to happen.

There are some exceptions to quality at the VA, notably when the VA is co-located with a school such as Stanford in Palo Alto. There they often have great medical providers and support.

Re: ERs are hiring fewer doctors to save money

#47

Post by seanmcdirmid »

mikeyouse wrote: post #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…

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.

Re: ERs are hiring fewer doctors to save money

#48

Post by mikeyouse »

robertlagrant wrote: post #43
azinman2 wrote: post #23

Earlier quoted context omitted.

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

Sadly this probably means no covid vaccine and few advancements. It's easy to spread out what we have; it's hard to run an engine of care and innovation at the same time. Choose hard.

I appreciate that R&D funding requires investment, but that doesn't have much to do with hospital reimbursement rates -- especially when the alternative of a more European-style healthcare system comes along with a German company inventing one of the two Covid vaccines (https://en.wikipedia.org/wiki/BioNTech)..

Re: ERs are hiring fewer doctors to save money

#49

Post by dariusj18 »

l33t233372 wrote: post #34
wahnfrieden wrote: post #25

Earlier quoted context omitted.

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.

Let's do the same for housing

Re: ERs are hiring fewer doctors to save money

#50

Post by nobodyandproud »

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_Taiwan

Both countries are market based societies, each have taken a somewhat different approach to the problem, yet both systems are quite efficient.

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