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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

#81

Post by mattpallissard »

I can tell you from personal experience that hospital funding priorities are wild. It's an ongoing turf war between hospitals.

  * Buying up private practices
  * Remodels so the hospital has a more pleasant ambiance
  * Having an excessive amount of cash on hand to signal various things to various parties 
  * Working out the cost schedules with insurance companies
  * Audits for a certifications outside of regulatory requirements that are useless on the nursing floor (lean/six sigma/etc)
  * Adding new types of facilities outside the core competencies of the organization such as gyms or specialized satellite facilities.
Really, healthcare is a cutthroat industry that's all about signaling.

Re: ERs are hiring fewer doctors to save money

#82

Post by mikeyouse »

seanmcdirmid wrote: post #78
mikeyouse wrote: post #68

Earlier quoted context omitted.

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 o…

> What risk? Malpractice coverage is provided by the hospital, or more typically, the private equity group that owns the ER physician practice. Stress isn't alleviated just by insurance. Sometimes people care about doing their job right and "winning". ER docs are just put on the spot constantly. > I don't think the average person realizes that Blackstone is one of the largest employers of ER docs... It doesn't really…

The popular conception of an ER doc is completely divorced from the day-to-day reality.. This isn't House, they're not "put on the spot" constantly like they're on some island. They are part of a care team and they call for IM/ID/Cardio/Radiology consults when they have any question about a diagnosis. They certainly have stressful jobs but no moreso than the floor physicians or other providers who work the same shifts and who take the critically ill patients when they need care beyond the capabilities of the ER.

Re: ERs are hiring fewer doctors to save money

#83

Post by darkmarmot »

wahnfrieden wrote: post #73
l33t233372 wrote: post #34

Earlier quoted context omitted.

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.

I'm asking why the difference? Why is it good for society sometimes, and sometimes terribly wrong, in your view?

Inelastic demand is one oft cited trait.

Re: ERs are hiring fewer doctors to save money

#84

Post by klooney »

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…

Non profit, publicly owned hospitals can be just as bad- https://www.vox.com/policy-and-politics/2019/1/7/18137967/er...

Re: ERs are hiring fewer doctors to save money

#85

Post by oaktrout »

mikeyouse wrote: post #57
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'…

The AMA obviously has an agenda, but that doesn't that change the fact that non-physicians cost patients and taxpayers more money, hard to argue with the cms data.

Who cares if your doctor gets paid more if he is saving you and the taxpayers money. I guess it might make business sense from a hospital perspective, because physicians are more expensive to employee than NPs and hospitals don't have a business reason to save taxpayers or patients money.

Re: ERs are hiring fewer doctors to save money

#86

Post by cptcobalt »

> 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. [...] In a statement to KHN, American Physician Partners said this strategy is a way to ensure all ERs remain fully staffed, calling it a "blended model" that allows doctors, nurse practitioners and physician assistants "to provide care to their fullest potential."

This seems like you're expecting your ER docs to handle the worst of the worst for days on end, rather than a good blend of patients. Seeing a "routine" ER patient may offer a mental break between a more critical patient. It truly seems like an actively shitty work environment to always walk into have the worst of the worst cases—because going to the ER is already a worst case.

This is not the right way to keep humans running well, for both the sick and the docs.

Re: ERs are hiring fewer doctors to save money

#87

Post by cptcobalt »

klyrs wrote: post #69
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.

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 privat…

Yeah, private healthcare can always be a valid addition, but access to "strong socialized healthcare" should be a relatively good minimum floor — something many countries do not have.

All humans need health maintenance, it doesn't need to be a "can I afford it" value proposition. I know friends currently living without it because they can't, even with subsidized social options... this is endemic to the problem of "socializing" a private healthcare system, where $ comes first.

Re: ERs are hiring fewer doctors to save money

#88

Post by antisthenes »

wahnfrieden wrote: post #73
l33t233372 wrote: post #34

Earlier quoted context omitted.

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.

I'm asking why the difference? Why is it good for society sometimes, and sometimes terribly wrong, in your view?

Externalities of the absence of something can be small, large, positive or negative.

What do you think are the externalities of _not_ having healthcare available to majority of your population ?

Re: ERs are hiring fewer doctors to save money

#89

Post by robertlagrant »

mikeyouse wrote: post #71
nostromo wrote: post #67

Earlier quoted context omitted.

European drugs are often funded by their profits from America.

Just a completely evidence-free claim that's repeated ad nauseam. The big European pharmas (along with the big US ones) are repurchasing shares on the order of tens of billions of dollars per year. If they're so reliant on excess profits to fund R&D, maybe they should have held onto those funds?

It's not evidence free. One of the things single payer does is negotiate discounts based on their whole country's population. That's going to fund ops and a bit of profit, not R&D.

> If they're so reliant on excess profits to fund R&D

R&D money comes from profits. It's not specific to the pharma industry. They just have particularly enormous R&D costs.

Re: ERs are hiring fewer doctors to save money

#90

Post by antisthenes »

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.

This comes up in every thread about healthcare and it's just plain wrong/backwards.

The reason they appear to be losing money or close to losing money is by design, because of the incentive to be inefficient. It's a way to balloon the "costs" in their accounting and demonstrate to the outside observers that they are "oh so poor" and need help, whereas in reality, they charge exorbitant amounts for procedures and then mark it off as "losses" when consumers can't pay.

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