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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

#51

Post by ghufran_syed »

armchairhacker wrote: post #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…

Everyone in healthcare is overworked - but at least in the US people have the choice to move to a better-paying employer. I work in Northern california with a nurse who lives in Florida and flies out for a bunch of shifts, then takes a few weeks off. In the UK where I originally trained, the pay is shockingly low compared to the US, due to lack of competition IMO:

https://www.salary.com/research/salary/alternate/registered-... https://www.payscale.com/research/UK/Job=Registered_Nurse_(R...

Re: ERs are hiring fewer doctors to save money

#52

Post by linuxftw »

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…

> 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.

The reason for this is opiates. Any time any place in the US sets up free or low cost shelter, the dope addicts move in.

Other industrialized nations don't seem to have as many addicts as the US, or maybe they still have real heroine instead of fentanyl.

Re: ERs are hiring fewer doctors to save money

#53

Post by oneepic »

armchairhacker wrote: post #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…

+1. Without citing sources, I will also say I think hospital admins, directors, execs, etc. are constantly looking for ways to cut costs, while the top execs take home millions in pay. Even in nonprofits that haven't been touched by private equity. They don't value the providers, nurses, doctors, or PAs.

Re: ERs are hiring fewer doctors to save money

#54

Post by ghufran_syed »

seanmcdirmid wrote: post #47
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.

Right - and the risk is much greater seeing “unfiltered” emergency patients, compared to a patient who has had a full assessment in the ED, had surgical issues ruled out, etc and was then admitted to the internal medicine service.

Re: ERs are hiring fewer doctors to save money

#55

Post by VWWHFSfQ »

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.

mRNA vaccine research was funded in large part by DARPA grants in the USA.

Re: ERs are hiring fewer doctors to save money

#56

Post by robertlagrant »

mikeyouse wrote: post #48
robertlagrant wrote: post #43

Earlier quoted context omitted.

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 )..

"European-style" isn't so much of a thing. There are all sorts of models. BioNTech is a public listed for-profit company that partnered with Pfizer, a public listed for-profit company, to develop that vaccine.

There needs to be lots of profit in healthcare for anyone to do anything, or even to be in a position to do anything.

Re: ERs are hiring fewer doctors to save money

#57

Post by mikeyouse »

oaktrout wrote: post #15

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…

The AMA probably isn't the best source for that type of data.

The little throwaway lines in that review are funny; "Patients deserve care led by physicians—the most highly educated, trained and skilled health care professionals. Through research, advocacy and education, the AMA vigorously defends the practice of medicine against scope-of-practice expansions that threaten patient safety."

Weird because the study they're talking about didn't say a word about patient safety.

Their metrics are weird too - it's looking at hospital spend "per member per month" which was higher with the non-physician staff but I'd be curious if the $30 difference was more or less than the difference in salaries between the two groups.

Re: ERs are hiring fewer doctors to save money

#58

Post by lowercased »

adam_arthur wrote: post #16
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 R…

> 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.

But... if they're already losing money because they're inefficient, with a 'profit motive' in place... it's obviously not enough of a motive to be efficient. They may be losing money not because of inefficiency anyway, but assuming so... existence of 'profit motive' coupled with inefficiency should be evidence enough that they're not linked.

Re: ERs are hiring fewer doctors to save money

#59

Post by Pet_Ant »

dsfyu404ed wrote: post #44
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.

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 se…

I think the problem here is that "profit motive" is reduced to capitalism. For politicians profit is votes so under funding hospitals and prisons to spend in high profile pork projects (can even be tax cuts) is still profit motive. It's a rational choice if they think they can get more votes, more bang for their buck, by spending it elsewhere. This isn't traditionally seen as "profit motive", but really it is because it was done for the private benefit instead of over arching ethical deliberations or calculations for net good etc.

Re: ERs are hiring fewer doctors to save money

#60

Post by abfan1127 »

conscion wrote: post #28
abfan1127 wrote: post #13

Earlier quoted context omitted.

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

Profit is a strong incentive when there's active competition. When there's not competition, for-profit business turn to extracting rents on captive customers. Health care larger is not a competitive market. Lots of customers only have limited options (i.e. rural hospitals) and the urgency of some purchases don't support competition (i.e. ER visits)

I agree its not a competitive market. Rural areas suffer in all areas of limited markets, medical isn't special. Government involvement (including, but not limited to limiting licensing). insurance clouds the market as well (both how we procure insurance and government limitations of insurance).
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