Report: 90% of nurses considering leaving the profession in the next year • Hacker News Board

Re: Report: 90% of nurses considering leaving the profession in the next year

#341

Post by drc500free » Wed, Apr 27, 2022, 5:10 PM UTC

Djvacto wrote: post #194

pc86 wrote: post #85

Earlier quoted context omitted.

Insurance is the only industry where they agree to pay for something (in this case, "medical care"), but then after service has been rendered can decide to pay less, or not pay at all, or stop paying that provider altogether, etc. This combined with hospitals being run by non-physicians*, and people thinking being able to Google and read WebMD qualifies them to argue with their doctor about treatment plans**, healthc…

As a quick counter-point to *, there is another sub-problem with healthcare/doctors in the US, where often patients with chronic illnesses or not-easily-testable conditions have to fight hard for doctors to take them seriously. The why of this varies a lot from what I've seen, but includes: - an attitude of "most patients are just trying to wring medications out of you" - an ego-hit of "if I didn't make the diagnosis…

I'm more and more convinced that POTS/EDS/MCAS aren't rare diseases, they're just criminally under-diagnosed because they tend to affect women. FWIW, POTS is much more manageable with medication (e.g. Midodrine and Florinef).

Re: Report: 90% of nurses considering leaving the profession in the next year

#342

Post by thewebcount » Wed, Apr 27, 2022, 5:10 PM UTC

Djvacto wrote: post #194

pc86 wrote: post #85

Earlier quoted context omitted.

Insurance is the only industry where they agree to pay for something (in this case, "medical care"), but then after service has been rendered can decide to pay less, or not pay at all, or stop paying that provider altogether, etc. This combined with hospitals being run by non-physicians*, and people thinking being able to Google and read WebMD qualifies them to argue with their doctor about treatment plans**, healthc…

As a quick counter-point to *, there is another sub-problem with healthcare/doctors in the US, where often patients with chronic illnesses or not-easily-testable conditions have to fight hard for doctors to take them seriously. The why of this varies a lot from what I've seen, but includes: - an attitude of "most patients are just trying to wring medications out of you" - an ego-hit of "if I didn't make the diagnosis…

Yeah, I've witnessed this first hand with my spouse. She's been told she just needs to exercise more (she was a professional dancer when it hit her), that it's all in her head (actual psychiatrist said otherwise), that it will resolve in 6-18 months (it didn't), etc., etc. It's pretty appalling.

Thanks for mentioning POTS, btw. Despite how many people have it, it's still fairly poorly known about even within the medical community.

Re: Report: 90% of nurses considering leaving the profession in the next year

#343

Post by ren_engineer » Wed, Apr 27, 2022, 5:10 PM UTC

dontbeevil1992 wrote: post #166

germinalphrase wrote: post #55

I have a close relation that works for one of the oldest pediatric hospitals in the country. It was recently revealed that they will be shuttering almost all pediatric services in the next year because they can 10x their profits by only serving elderly clients. The entire purpose of this organization was to provide pediatric healthcare, and it wasn’t losing money… Sometimes, it feels like we’re min-maxing ourselves t…

[flagged]

capitalism is the reason for hospitals choosing to serve patients covered by Medicare which will give them a blank check with tax payer money?

Re: Report: 90% of nurses considering leaving the profession in the next year

#344

Post by samstave » Wed, Apr 27, 2022, 5:10 PM UTC

pc86 wrote: post #85

brightball wrote: post #39

Earlier quoted context omitted.

Insurance companies. Everything is controlled by insurance companies. You can’t do anything unless it’s exactly how insurance wants and only for what insurance will pay. It limits everything, including how every profession can be compensated simply because you can’t easily hire somebody for more than what insurance will pay for their services. You can, but the funds have to come from somewhere.

Insurance is the only industry where they agree to pay for something (in this case, "medical care"), but then after service has been rendered can decide to pay less, or not pay at all, or stop paying that provider altogether, etc. This combined with hospitals being run by non-physicians*, and people thinking being able to Google and read WebMD qualifies them to argue with their doctor about treatment plans**, healthc…

>I strongly believe that only physicians should be running hospitals.

(Disclaimer: I have been on the design team for several hospitals, including El Camino and San Francisco General, in the bay area - and I have a family of doctors and nurses in my family - my brother was head of the Veteran Administration for the state of Alaska, and is currently CMO for a large health provider (he is a doctor)

---

That said, the "running" of a hospital isa hell of a lot more than medicine (when we are specifically talking to the running of -- but this comment was made in relation to costs/efficiencies as far as outcomes, patient treatment, insurance etc...)

Hospitals are really complex ecosystems and should be thought of more like an aircraft carrier than an other form of business.

The costs within the realm of a hospital are ridiculous - as are the methods and manner in which hospitals raise money.

Insurance is cancer to be sure, but there are so many other factors that go into the operational costs of a hospital - and I don't just mean ngoing care and operations - systems and technology and medicine evolve. People are people and regardless have the same hierachy of needs in any environment.

You have every single actor as an enemy of the hospital bottom line:

New tech, $$

Older nursing pop $$

Current nursing/doctor market salaries $$

Maintenance for existing systems $$

Insurance billing code lock-in $$

Competing hospitals for doctors and nursing staff $$

California $$

Corruption $$

Utilities and related redundant infra to ensure life systems

The ridiculous cost to upgrade

The list goes on and on...

(The cheapest hospital project I worked on was hundreds of millions of dollars)

etc...

Hospitals are really expensive to run, and it requires a hell of a lot more skills than simply being a "doctor" to run one.

Re: Report: 90% of nurses considering leaving the profession in the next year

#345

Post by frgtpsswrdlame » Wed, Apr 27, 2022, 5:11 PM UTC

whatshisface wrote: post #309

jerry1979 wrote: post #225

Earlier quoted context omitted.

[flagged]

I don't even think Marx would agree with that. He thought capitalism produced a stage of history that wasn't exactly capitalist, which then would inevitably produce communism through socialism.

I doubt Marx could have thought of something more capitalist than $THC or $HCA.

Re: Report: 90% of nurses considering leaving the profession in the next year

#346

Post by inglor_cz » Wed, Apr 27, 2022, 5:12 PM UTC

scythe wrote: post #226

pc86 wrote: post #85

Earlier quoted context omitted.

Insurance is the only industry where they agree to pay for something (in this case, "medical care"), but then after service has been rendered can decide to pay less, or not pay at all, or stop paying that provider altogether, etc. This combined with hospitals being run by non-physicians*, and people thinking being able to Google and read WebMD qualifies them to argue with their doctor about treatment plans**, healthc…

>Medical decisions need to be made outside of cost considerations. It's really jarring to read an otherwise reasonable comment that drops a whopper like this. Nothing exists outside of cost considerations. The NSA has cost considerations. The Space Shuttle had cost considerations (obviously, not great ones!). The design of nuclear submarines involves cost considerations, however unsettling that may seem. You're telli…

"The Space Shuttle had cost considerations (obviously, not great ones!)."

It absolutely did, and great ones too. The program was too costly and never lived up to the original expectations of fast and easy access to orbit.

Falcon 9 + Dragon is the first American human-rated launcher and ship that can be labeled as somewhat cost effective.

Re: Report: 90% of nurses considering leaving the profession in the next year

#347

Post by hallway_monitor » Wed, Apr 27, 2022, 5:12 PM UTC

93po wrote: post #339

pc86 wrote: post #85

Earlier quoted context omitted.

Insurance is the only industry where they agree to pay for something (in this case, "medical care"), but then after service has been rendered can decide to pay less, or not pay at all, or stop paying that provider altogether, etc. This combined with hospitals being run by non-physicians*, and people thinking being able to Google and read WebMD qualifies them to argue with their doctor about treatment plans**, healthc…

> people thinking being able to Google and read WebMD qualifies them to argue with their doctor about treatment plans In my experience, I have had: 1. Doctors that know nothing about a really basic ailment and not have any meaningful guidance or treatment to suggest 2. Doctors that Google something literally in front of me, things that I have already Googled myself, and draw the wrong conclusion because they're looki…

I cannot agree enough. I think anyone who has dealt with a puzzling condition quickly learns how limited the "expertise" of these supposed authorities is. Sure, insurance companies are terrible, but so are most doctors. Great, quit, you probably sucked anyway.

Re: Report: 90% of nurses considering leaving the profession in the next year

#348

Post by tubalcain » Wed, Apr 27, 2022, 5:12 PM UTC

klyrs wrote: post #158

duxup wrote: post #41

Earlier quoted context omitted.

I was under the impression that nurses were paid pretty well (generally speaking).

They're paid alright (generally speaking), but most devs wouldn't even consider a job at that rate. And the bar for entry is way higher: years of competitive and expensive schooling. And that's ignoring the other factors that GP mentioned. I don't get assaulted on a daily/weekly basis. I'm not getting coughed on by COVID-infected patients who want to kill me because they don't believe that COVID is real. I don't endu…

It makes zero sense for a person to consider straight-up nursing as a career in this age. The school is too competitive to get into, the pay isn't worth it, the job at the end is laborious, the culture is vile. If one does go into nursing, becoming an NP, CNA, or travel nurse are the only logical options from a time invested to income and burnout standpoint.

If a student wants a health care professional job, medicine and dentistry are better options and require just as much academic competition. Failing that, the student is better off going into tech or law.

If they're not smart enough for either of those? I dunno? Onlyfans? Permanent serfdom? I fear that our new society will have many who are left behind and struggling.

Re: Report: 90% of nurses considering leaving the profession in the next year

#349

Post by dsugarman » Wed, Apr 27, 2022, 5:12 PM UTC

phil21 wrote: post #17

While it's anecdote, every single peer in bedside medical care I know without exception has either left the field, or has immediate plans to as soon as student loan debt is repaid. The few older medical professionals in my family are simply sticking out the last few years until they can retire early. This was generally the case prior to pandemic due to how poor the work environment has become, but the pandemic seems…

My frame of reference on this topic is that my family is mainly medical doctors and I started and run a yc backed Series A stage startup.

In my experience, the administrators are often doctors at hospitals and people all the way to the top have to have strong medical backgrounds. That's not to say there aren't do-nothing administrators, but those do-nothing administrators are often doctors. They tend to adhere to the way things are and always were as an orthodoxy, like 1st year residency is the worst and at these points quality of life improve, but it's almost like a fraternity hazing justifying the insane hours, complete loss of work life balance just because this is how it is. Candidly, there does seem to be a guilty pleasure there.

There is little to no real discussion on how to improve not only the work conditions but also the user experience of medical care. In my view, it starts at the top; organizationally, they are lacking an entire skillset to make any improvements what-so-ever.

Re: Report: 90% of nurses considering leaving the profession in the next year

#350

Post by at_a_remove » Wed, Apr 27, 2022, 5:13 PM UTC

brightball wrote: post #39

phil21 wrote: post #17

While it's anecdote, every single peer in bedside medical care I know without exception has either left the field, or has immediate plans to as soon as student loan debt is repaid. The few older medical professionals in my family are simply sticking out the last few years until they can retire early. This was generally the case prior to pandemic due to how poor the work environment has become, but the pandemic seems…

Insurance companies. Everything is controlled by insurance companies. You can’t do anything unless it’s exactly how insurance wants and only for what insurance will pay. It limits everything, including how every profession can be compensated simply because you can’t easily hire somebody for more than what insurance will pay for their services. You can, but the funds have to come from somewhere.

Previously, that wasn't entirely true.

In the very early nineties, insurance companies lured doctors in with promises of referral if they would just accept certain terms. Originally, this was to the benefit of the doctor -- more referrals. But only originally: once lock-in occurred, the insurance companies began to set their own terms. They couldn't have accomplished this without some greed on the part of many doctors early on.