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ERs are hiring fewer doctors to save money

npr.org

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Re: ERs are hiring fewer doctors to save money

#61

Post by yunwal »

abfan1127 wrote: post #13
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.

> Profit is a strong incentive to optimize.

Optimize what? Certainly not costs, since for-profit hospitals have every incentive to push for unneeded expensive operations.

Maybe you’re mistaking healthcare for a market where meaningful competition and information symmetry exists?

Re: ERs are hiring fewer doctors to save money

#62

Post by isleyaardvark »

nicoburns wrote: post #45
ghufran_syed wrote: post #20

Earlier quoted context omitted.

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).

That, plus the CNN article shared above can’t simply be reduced to failure of “the model”:

> Explanations for the current crisis “have to start with a consideration of Covid-19,” Ben Zaranko, an economist at the Institute for Fiscal Studies (IFS) whose work focuses on Britain’s health care system, told CNN. “There’s the simple fact that there are beds in hospitals occupied by Covid patients, which means those beds can’t be used for other things.”

Re: ERs are hiring fewer doctors to save money

#63

Post by mucholove »

VWWHFSfQ wrote: post #42
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.

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.

Private is not the same thing as for profit. A non-profit is a private entity. They are not part of the public sector.

In fact, much healthcare was delivered like so pre-WW2. Still today, Kaiser and Cleveland Clinic are non-profit.

Re: ERs are hiring fewer doctors to save money

#64

Post by jzymbaluk »

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…

> 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

If I had the choice between system A with excellent community health outcomes, but didn't turn a profit, was heavily subsidized, and ran with operational bloat, versus system B which ran lean/efficiently but produced poor health outcomes I would choose A every single time and I imagine most people would

Currently in the US we have neither. We have a bloated/inefficient system that also produces poor community health outcomes. But at least a few private equity firms might turn a profit, so at least there's that??

Re: ERs are hiring fewer doctors to save money

#65

Post by schemescape »

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...

Did they tell you how much the charge would be?

Re: ERs are hiring fewer doctors to save money

#66

Post by VWWHFSfQ »

mucholove wrote: post #63
VWWHFSfQ wrote: post #42

Earlier quoted context omitted.

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.

Private is not the same thing as for profit. A non-profit is a private entity. They are not part of the public sector. In fact, much healthcare was delivered like so pre-WW2. Still today, Kaiser and Cleveland Clinic are non-profit.

I'm happy with my private, for-profit healthcare. But I'm also glad to support public healthcare services with taxes. It's not just one or the other, we can have both of them.

Re: ERs are hiring fewer doctors to save money

#67

Post by nostromo »

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 drugs are often funded by their profits from America.

Re: ERs are hiring fewer doctors to save money

#68

Post by mikeyouse »

ghufran_syed wrote: post #54
seanmcdirmid wrote: post #47

Earlier quoted context omitted.

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.

What risk? Malpractice coverage is provided by the hospital, or more typically, the private equity group that owns the ER physician practice. Last I looked, independent ER docs pay something like $15k more per year than IM docs for solo coverage... there's still quite a ways to go to make up that other quarter million dollars.

I don't think the average person realizes that Blackstone is one of the largest employers of ER docs... it's not "supply and demand" that's increasing ER salaries, it's a private equity cartel that aggressively upcodes routine treatment and then sues hospitals to increase their reimburesment rates.

https://en.wikipedia.org/wiki/TeamHealth

https://tennesseelookout.com/2022/05/09/tennessee-health-bil...

Re: ERs are hiring fewer doctors to save money

#69

Post by klyrs »

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.

I'm not sure about that. Private health care is largely beneficial in countries with strong socialized health care. I'm definitely no expert on financial regulation, but I see the practice of "flipping" businesses as the real problem. Where I live, we've recently introduced a "house flipping tax" (which doesn't go far enough, in my opinion, but that's another conversation). A similar approach could be taken to private sales of businesses: if you buy and sell a company in a relatively short period of time, the gains (from the sale, from income, etc) should be taxed at a steeply elevated rate.

Re: ERs are hiring fewer doctors to save money

#70

Post by mikeyouse »

robertlagrant wrote: post #56
mikeyouse wrote: post #48

Earlier quoted context omitted.

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.

Of course there's a European style in contrast to the American style.. Single payer coverage governed by a government/quasi-government body with no profit taking and rates for drugs and care negotiated by the payer. Some have free point-of-service care, some have copayments, some have private insurance or supplemental insurance but the contours are the same.

There are dozens of huge pharma companies in Europe inventing life-saving drugs with plenty of profits to go around, this conceit that we need to price gouge Americans to pay for Research while the same firms spend more on marketing than R&D is just the dumbest thing.

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