[HN Gopher] Report: 90% of nurses considering leaving the profes...
___________________________________________________________________
Report: 90% of nurses considering leaving the profession in the
next year
Author : dr_pardee
Score : 889 points
Date : 2022-04-27 14:54 UTC (8 hours ago)
(HTM) web link (www.healthcareitnews.com)
(TXT) w3m dump (www.healthcareitnews.com)
| phil21 wrote:
| 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 to have
| broken the few remaining folks who still had hopes and dreams.
|
| How doctors of all professions lost their professional agency to
| do-nothing administrators within a generation is quite puzzling
| and a bit terrifying to me.
| api wrote:
| > lost their professional agency to do-nothing administrators
|
| You just summarized the decline of Western civilization in one
| phrase.
|
| This has happened almost everywhere and efforts to push back
| have proven extremely difficult. I personally place a lot of
| the blame on the educational system for overproducing
| administrative skill sets and underproducing practical skill
| sets. There is some role for those things of course but we have
| far too many people for the administrative roles we really need
| and far too few for many other professions. This combined with
| the tendency of people to recruit people like themselves has
| oversaturated the market with administrators looking for
| reasons to exist.
|
| The rot is to the point that we have the spectacle of Elon Musk
| looking like superman. Why does he look like superman? Because
| he actually does things instead of having meetings to discuss
| the meeting schedule. He's just a reasonably competent engineer
| and business founder with huge resources who... does things...
| and this makes him look superhuman by comparison to the hordes
| of administrators that only discuss doing things and commission
| studies about hypothetically doing things.
| hedora wrote:
| See also: California's plan to eliminate algebra 2 and
| calculus from the highschool curriculum. It is being
| spearheaded by someone without a math degree, in the name of
| improving marketability of the kids for data science
| positions, or something.
|
| See also (2): Monty Python's bicycle repairman sketch.
| tick_tock_tick wrote:
| > in the name of improving marketability of the kids for
| data science positions, or something.
|
| They have been very clear and upfront about the goal. They
| want to "solve" racial discrepancies in graduation rates so
| they've taken the classes often failed and are removing
| them.
| api wrote:
| Yeah that proposal is insane.
|
| For a while now it feels like the left and the right are
| attempting to one-down each other on how stupid they can
| get. That proposal seems like an example of the left trying
| to out-stupid Trump and the alt-right. Don't worry I'm sure
| the right is working on things even dumber than this, and
| then those will have to be topped, and so on. In 2024 we
| will have Dr. Oz and Marjorie Taylor Greene running against
| Oprah Winfrey and Kamala Harris.
|
| I'm not sure how this downward spiral ties into the
| administrative position over saturation problem, but I have
| the intuition that it does somehow. Maybe what we have are
| a whole ton of people who don't really know how to do
| things who vote. Voting is ultimately a hiring decision, so
| what we get is a voting process that hires a whole bunch of
| either administrators who themselves don't know how to do
| things or crackpots because people without practical
| knowledge can't spot a crackpot.
| selimthegrim wrote:
| Oprah would actually not be the worst candidate -
| certainly better than Michelle Obama.
| api wrote:
| https://slate.com/health-and-science/2018/01/oprah-
| winfrey-h...
| selimthegrim wrote:
| My counters are
|
| a) Forsyth County, GA in 1987
|
| b) Michelle Obama's senior thesis at Princeton
| hedora wrote:
| I think the root problem is that administators without
| practical skills are running everything.
|
| Since they got by without any practical skills, they
| don't value such things. Now, they want to eliminate them
| entirely from the educational system.
|
| The managers are at war with the individual contributors,
| and they don't understand that someone has to actually do
| work, or the system will collapse.
| base698 wrote:
| https://www.amazon.com/Managerial-Revolution-What-
| Happening-...
|
| > Burnham's claim was that capitalism was dead, but that
| it was being replaced not by socialism, but a new
| economic system he called "managerialism"; rule by
| managers.
|
| In 1941.
| trasz wrote:
| It's not about Western civilisation, it's about economic
| neoliberalism, replacing every existing metric with a single
| one: shareholders' profits. Those do-nothing administrators
| _do_ have a marketable skill: they make money for the
| company. Or at least appear to, according to (obviously
| flawed) criteria that are being used to evaluate ones' work.
| tristor wrote:
| Pretty much. Unfortunately, we've also created a massive
| underclass in the West who have effectively no applicable
| skills. They can neither administrate, or do things, and so
| they are effectively dead weight on society. Ironically,
| considering that administrators are driving us over the
| cliff, the underclass is less problematic than the
| administrators. At some point we'll hit a critical mass and
| there will be so few people left that know how to do things
| that we literally will be unable to maintain the basic
| infrastructure of civilization. The cracks are already
| starting to show.
|
| The sad thing is that this is so very obvious, and yet such
| an intractable problem to solve. The entrenched systems at
| every level of society will fight you at every turn when you
| try to improve things.
| stripline wrote:
| I recently saw a good talk about this point.
|
| Preventing the Collapse of Civilization.
| https://www.youtube.com/watch?v=ZSRHeXYDLko
| RyEgswuCsn wrote:
| That is an interesting observation. I wonder how much of the
| advent of "talking over doing" is related to the development
| of mass/social media.
|
| Influence can propagate so easily through mass media, meaning
| that it is now possible to generate enough business interest
| just through "hyping" (it's difficult to achieve this when
| messages have limited reach) --- combined with the fact that
| it is often cheaper and less risky to "talk" than to actually
| "do", we end up with a culture where hyping is preferred
| whenever possible.
| bpodgursky wrote:
| The shift to EMRs (more-or-less forced by the ACA) has been a
| huge quality-of-life loss for doctors. Tons of time spent on
| Epic or Cerner checking boxes and selecting drop-downs.
|
| Turned a "trusted professional" advisory role into a keyboard
| role.
| notch656a wrote:
| There are medical scribes who will do all that for the
| physician and for dog-shit wages. Usually these are medical
| school-wannabes so they can easily be tricked into working
| for minimum wage, and once they're suitably trained the
| physician just has to briefly scan the EMR for completeness
| and sign off on it.
| bpodgursky wrote:
| I have not seen this happen extensively, in practice.
| ryan93 wrote:
| There are like 4 million nurses. Where are they going to go for
| even remotely similar wages?
| legitster wrote:
| > How doctors of all professions lost their professional agency
| to do-nothing administrators within a generation is quite
| puzzling and a bit terrifying to me
|
| This should terrify everyone. Large segments of our society are
| failing us despite being stuffed to the gills with
| administrative staff that don't contribute much to productivity
| but rob professions of their independence. We're managing
| ourselves to death.
| csa wrote:
| I frequently say that administrators have killed both the
| education (esp. tertiary) and medical fields in the US.
|
| I'm pretty sure both of these will implode under the
| bureaucratic weight at some point -- the financial and social
| costs of the excessive administrators is not justified by their
| (often minimal or negative) value added.
| throwawayboise wrote:
| Yes, it's like someone held up a mirror when you look at what
| has happened in Higher Ed when the professors stopped running
| things, and Health Care when doctors stopped running things.
| Costs skyrocketed, outcomes stagnated or declined,
| satisfaction plummeted.
| salt-thrower wrote:
| > How doctors of all professions lost their professional agency
| to do-nothing administrators within a generation is quite
| puzzling
|
| The profit model of the U.S. healthcare industry might have
| something to do with it. The fact that hospitals are run like
| businesses and have shareholders is insane to me. I know other
| countries' healthcare systems got hit hard by the pandemic too,
| but it seems like the uniquely capitalist nature of healthcare
| in the U.S. sets it up to mistreat workers and cut corners for
| the benefit of administrators and executives.
| toiletfuneral wrote:
| theklub wrote:
| It's not just that, some hospitals are outsourcing everything
| disenfranchising the people that work there. And I mean
| everything from the doctors themselves to IT to the cleaning
| lady to the food workers and selling the buildings to lease
| them back. It's the fleecing of America.
| reedjosh wrote:
| If they can't throw some medication with pharma kickbacks at
| you, they probably won't do much at all.
|
| My 6 month old son was put on topical steroids for a small
| rash on his back and the doctors solution when this turned
| into a progressive issue was more and stronger topical
| steroids.
|
| Eventually I learned about topical steroid withdrawal, and
| after a hellish withdrawal period, my son has no real skin
| conditions.
|
| https://www.youtube.com/watch?v=PpW4VV2bsD8&t=28s
|
| And yes, my son at ~1 year old was red and bleeding like that
| head to toe.
|
| When I brought up steroid withdrawal I was rudely dismissed
| by multiple doctors including dermatologists.
|
| Doctors currently have willful blinders on at a minimum, and
| some may be a true embodiment of evil. I hope the whole for
| profit medical system crashes and burns.
| Enginerrrd wrote:
| Steroids are so commonplace and old, I really doubt anyone
| was getting pharma kickbacks in the case of your son.
|
| There's just a large range in quality amongst doctors. What
| you're calling "willful blinders" or "true embodiment of
| evil" is more likely just a failure to adapt out of a
| simple paradigm: {Inflammation}->{Treatment = steroids}.
| And a failure to recognize when that was causing a loop.
| Maybe they forgot about steroid withdrawal. In fact, as
| someone with quite an interest in pharmacology and some
| background as a paramedic, this is the first I've ever
| heard of it, and I love obscure medication issues.
| reedjosh wrote:
| > Maybe they forgot about steroid withdrawal.
|
| As I mentioned in my comment I mentioned steroid
| withdrawal to many doctors when my son was literally only
| sleeping an hour or so a night from itching and I was
| dismissed out of hand.
|
| If its not kickbacks, then its such a terrible arrogance
| as to be evil.
|
| How can a dermatologist not know of my son's condition?
| Particularly seeing as steroids have been around for a
| while as you've mentioned. Even when I brought the idea
| to the dermatologist, after a bit of head nodding his
| solution was another two weeks of a yet stronger steroid
| to `calm it down`, and then to taper.
|
| There's a nonprofit trying to get doctors to properly
| acknowledge the condition.
|
| https://www.itsan.org/
|
| There's as I linked above about a million videos of
| people recovering from TSW as well.
|
| There's even a study out of Autstralia that followed 10
| children with what was called bad eczema, but after a
| withdrawal period every child at max had pruritis on
| elbows or knees.
|
| https://www.medicaljournals.se/acta/content_files/files/p
| df/...
|
| If my job were skin, and topical steroids was one of the
| main things I used as a tool, how could I not know about
| these issues? You'd have to be such a hack that nobody
| would consider you a professional, yet the same
| dermatologist that offered yet another round of steroids
| had his office on the penthouse suite of a downtown
| building with a showcase displaying awards.
|
| It may seem hyperbolic to you, but you didn't live
| through this like I did. You didn't see your young child
| in complete misery due to medical authorities you thought
| you could trust misguiding you. It's evil of some form.
| hedora wrote:
| I had some digestive issues, and the specialist's
| diagnosis boiled down to: I have the same issue. You're
| getting older.
|
| The correct diagnosis was: That sounds like chronic
| inflammation. Hit the gym and lose 20 lbs, fattie.
| [deleted]
| bitsnbytes wrote:
| profit model is not the issue. How the compensation and
| rewards are structured is the issue.
| defterGoose wrote:
| So...we need to _manage_ that better?
| orangepurple wrote:
| > How doctors of all professions lost their professional agency
| to do-nothing administrators within a generation is quite
| puzzling and a bit terrifying to me.
|
| I would bet it's caused by:
|
| - stifling bureaucracy
|
| - hostile legal climate
|
| - massive start up costs
|
| The only winning move is not to play. Let the system fall apart
| and join on the later upswing. The unfortunate part is all the
| needless suffering people will endure during this process.
| brightball wrote:
| 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.
| slantedview wrote:
| Insurance companies are awful and should not exist, sucking
| up a lot of doctor time, but when it comes to nursing,
| hospitals are particularly awful, cutting staffing levels to
| the bone in order to maximize profit. People die as a result,
| and nurses are burnt out.
| mfer wrote:
| In the book _The innovator 's prescription: a disruptive
| solution for health care_ by Clayton Christenson, there are
| some good analysis of where the complexity and problems come
| from in the current US medical system.
|
| A lot of it has to do with size and the complexity that goes
| along with it. So, as hospitals get bigger, do more, and
| increase in size and complexity these issues become worse.
|
| The economics math even mirrors factories... a factory that
| can build 100 things compared to one that just produces one
| thing.
|
| The book was enlightening, even though many of the time
| frames called out in the book were wrong. Disrupting medicine
| is a lot harder than something like technology.
| mikkergp wrote:
| I think this alludes to it, but it's one thing mentioned in
| one of Atul Gawande's book is that in India they have
| hospitals that focus on one thing:
|
| https://www.businessinsider.com/inside-indias-no-frills-
| hosp...
|
| So like a 2000 bed hospital just for heart surgeries. Like
| you're saying, the more a heart surgeon specializes, the
| better they are at it and the cheaper they can do it.
| Better Outcomes for less money.
| 2143 wrote:
| Yes there are hospitals in India that cater to a specific
| aliment. For instance, eye hospitals, cancer centres,
| hospitals that cater to pregnancy, childbirth and
| neonatology etc.
|
| > Like you're saying, the more a heart surgeon
| specializes, the better they are at it and the cheaper
| they can do it. Better Outcomes for less money.
|
| Not necessarily.
|
| 1. A heart surgeon is going to be doing heart surgery at
| more or less the same frequency regardless of whether the
| hospital they're at handles only heart patients or not.
| Wouldn't they?
|
| 2. I doubt if anybody here considers them cheap. Yes it's
| probably cheaper than in the US, but still it's rather
| expensive. But then again, since life is priceless, ...
| mikkergp wrote:
| At a 2000 bed facility though, you could specialize in
| specific types of heart surgeries. At a general hospital
| you're probably more likely to take on a wider variety of
| heart procedures. It's not just experience, but
| experience in specific procedures that can dictate
| outcomes:
|
| https://www.reuters.com/article/us-healthcare-quality-
| surger...
|
| Maybe cheap is the wrong term, but less expensive? I mean
| $800 may be expensive but certainly it's better than
| more?
| lettergram wrote:
| No one wants to hear the truth.
|
| There's near-infinite demand for healthcare and a constrained
| (mostly artificially) supply.
|
| Insurance, people and government can't solve the problem of
| the supply and demand by throwing money on it.
|
| You either expand supply or remove demand. Given removing
| demand is... not desirable. The only alternative to fix the
| issue is remove regulation and expand supply. That's it.
|
| Insurance makes the issue worse by increasing demand and in a
| way limiting supply through requirements and procedures.
|
| Government limits supply through regulation AND expands
| demand by paying for procedures.
|
| An approach is to deregulate, such as removing government
| licensing, remove Medicare, etc.
|
| Imo Prices would drop >95% within a 2-5 years (to India or
| Mexico levels).
|
| I worked in medical billing for a few years and the issues
| are beyond obvious.
| lefstathiou wrote:
| I think there needs to be some new approach to how medical
| services are being paid for. My 70yo father fell off a
| ladder and drove himself to the hospital in Calhoun Georgia
| (2 hours north of Atlanta, a small town) with a bruised eye
| and a broken wrist. He got in late afternoon, left the next
| day, and the bill to insurance (which of course they won't
| pay) was $69,000... more than per capita income in the US.
| The system is ridiculous.
|
| In my opinion, healthcare has reached the state where the
| people who receive the benefit are too far removed from the
| people who pay for it and given there is no "victim" of
| price gauging, the prices will just keep going up up and
| way.
|
| I defer to those wiser than me for the solution. I don't
| like complaining without being constructive so here is my
| ignorant pass at it. This will require a few key steps: 1)
| Yes, we need more supply (by deregulating the profession)
| 2) I personally think a more effective solution would be to
| gradually eliminate insurance except for catastrophic risk
| (like emergency medical care from a car accident). #2 will
| shift responsibility to the individual and the system will
| be capped at what they can charge based on the average
| person's ability to pay for it (which is how it works in
| many parts of the world).
| ClumsyPilot wrote:
| > Yes, we need more supply (by deregulating the
| profession)
|
| So it looks like software development? Are you
| comfortable for your life to be in the hands of a rando
| who just finished a 6-months bootcamp?
| lefstathiou wrote:
| I don't think it has to be binary. For situations that
| are life threatening, I'll opt for a premium service and
| for situations that are not, I may opt for an
| alternative. I think almost anyone at our company can be
| trained to reliably operate and interpret an x-ray
| machine for the vast majority of use cases.
| ClumsyPilot wrote:
| 'For situations that are life threatening, I'll opt for a
| premium service'
|
| 1 - what does the 'non-premium', i.e. bottomn of the
| barrel service look like, is that incompetent people
| offering rock bottom prices (resulting in death?).
|
| 2 - are you sure you can identify a life threatening
| situation correctly? Because my father did not.
|
| 3 - how do you know the 'premium' provider in question
| results in better outcomes, rather than being the same
| rubbish well presented in fancy packaging?
| lettergram wrote:
| > left the next day, and the bill to insurance (which of
| course they won't pay) was $69,000
|
| I agree with you and the quote above is because of
| insurance. Medicare will pay 10% of that total and your
| father would be charged 2-5%. If he has private insurance
| you'll see something different, maybe 15% and your father
| would be charged 3-6%. If he's going out of network could
| be 100%. Hospitals / practices charge insane bills
| because people pay just a small fraction typically. It
| really impacts those without insurance or private
| insurance the worst. It is insane.
|
| This is why I have suggested deregulation, particularly
| around licensing. It drives down the cost. Insurance may
| cover doctor X, but if nurse Y can do it for 5% the
| price... well use the nurse. All doctors would have to
| reduce prices and insurance would have to raise the
| coverage amount to compete. It's what is done elsewhere
| in the world.
| jodrellblank wrote:
| > " _An approach is to deregulate, such as removing
| government licensing, remove Medicare, etc._ "
|
| This worked so well for Rosemary Kennedy when she could be
| prescribed an ice pick lobotomy. And so well for Eben Byers
| when his doctor prescribed him radioactive water, and he
| drank so much his jaw rotted off. It works brilliantly for
| this woman[1] and her cheap Turkish dentist work leaving
| her in pain. And for, well all of this junk: https://en.wik
| ipedia.org/wiki/List_of_unproven_and_disproven...
|
| Deregulation is what we had when things were terrible.
| Regulation and licensing is what we use to block the most
| obvious junk 'treatments' and the worst con artists.
|
| > " _Given removing demand is... not desirable._ "
|
| Removing demand is enormously desirable. Regulate the shit
| out of CocaCola, Marlboro, and all the other health
| destroying parasites and their advertising, tax them,
| rework town and city planning to remove driving as the
| primary transport in life and all the associated exhaust
| fumes, rework public schooling and rebuild trust in the
| government and medics so people aren't anti-health-advice
| on principle, rework employment so that employees have some
| rights and aren't stressed out all the time with no sick
| breaks. Rework medical access so people can see medical
| professionals, and sickness can be caught and treated
| early, which reduces demand on seeing much sicker people
| later.
|
| > " _Insurance makes the issue worse by increasing demand
| and in a way limiting supply through requirements and
| procedures._ "
|
| Insurance makes the issue worse by driving up costs to
| patients and at the same time driving down pay to medical
| staff, by insurance taking as much as possible. Without
| insurance, supply and demand could remain the same, medical
| staff earn more, patients pay less, and services be more
| efficient with less time wasted fighting insurance
| companies and filling in insurance paperwork.
|
| [1] https://old.reddit.com/r/northernireland/comments/ua9me
| 9/eas...
| mola wrote:
| You should educate yourself about how most of the western
| world manages to have a functioning semi social health care
| system. US is broken because of this blind fantaic faith in
| _free markets_ _deregulation_ simplifications.
|
| The problem is a large swath of the population that believe
| in all earnestly that squeezing profit is some magical tool
| for a functioning economy.
|
| Too bad US is so good at PR, this mind virus is wreaking
| havoc all over the world.
| lettergram wrote:
| > You should educate yourself about how most of the
| western world manages to have a functioning semi social
| health care system. US is broken because of this blind
| fantaic faith in free markets deregulation
| simplifications
|
| Most healthcare in the west is subsidized by the US. The
| US market is far more lucrative, so companies do R&D and
| make capital from the US. The US also subsidizes in terms
| of both military and energy almost every western country.
| Even then, Europe has a higher tax rate and on average is
| far poorer.
|
| I'm well educated on this subject and worked in this area
| in the US and spent time in other countries. You have no
| idea what you're taking about.
| ClumsyPilot wrote:
| "The US also subsidizes in terms of .. energy almost
| every western country"
|
| These claims are outrageous and totally unsubstantiated.
| How does US subsidise energy of France or Japan?
|
| "Most healthcare in the west is subsidized by the US."
| "The US market is far more lucrative, so companies do R&D
| and make capital from the US. "
|
| You are subsidising the companies, not my healthcare. And
| they pay out this money in dividends to shareholders. I
| am sure they are very gratefull, maybe you should ask
| them for a rebate.
|
| Stop subsidising them and overpaying - do you think
| healthcare costs in Europe will rise? If you do, I've got
| a wager.
| spaniard89277 wrote:
| I would say that most western countries do have both
| public and private healthcare. I did have private
| insurance here in Spain and it's nothing like in the US,
| as far as I can tell. Service was excelent and I didn't
| felt everyone was stressed.
|
| In france your public insurance allows you to walk in a
| private clinic or hospital too, as a relative did and
| they cover her post-cancer treatment better than in the
| public hospital (by her account at least).
|
| So yeah, "free market deregulation" may be an
| oversimplification but you have a problem in the US
| that's also far more than just being for-profit. We have
| for-profit over here and it works.
|
| And that includes private & public institution doing
| medical R&D and selling their products to the national
| health services and private clinics, like quite a bunch
| of spanish companies do, for example. I say this becase
| it weirdly pops as an argument when it's totally
| unrelated, and it may be only a tiny fraction of the
| total cost.
| onlyrealcuzzo wrote:
| Have US hospitals ever had transparent pricing?
|
| This seems like the root of the problem, and insurance seems
| like what "fixes" that but causes tons of downstream unwanted
| side-effects.
| teeray wrote:
| It's always astonishing how I can get a fully itemized vet
| bill right after a visit and pay for it. Meanwhile going to
| the hospital is like "well gee, let's submit to insurance,
| see what they'll pay, we'll readjust prices and then come
| back to you in a few months."
| lostcolony wrote:
| More than that, I can get an estimate upfront, that in
| 100% of cases matches the bill unless they find something
| additional they need to do, which they'll inform me of
| and create a new total estimate for.
|
| Of note, my vet insurance doesn't negotiate on my behalf;
| they just pay X% afterwards. The price the provider
| quotes for a given service is the price everyone gets
| (probably; some of the smaller vets might modify it if
| someone is low income and in need).
| MiddleEndian wrote:
| Months after my last real procedure in a hospital, even
| after the insurance was settled, I could not get them to
| tell me how much money I owed them. Even when I went in
| person and told them "I want to pay you all of the money
| right now" they just shrugged their shoulders and told me
| they didn't know how much I owed them.
|
| They just sent me a bunch of small bills in the mail one
| at a time and had a text field online where I could
| blindly pay them without indicating whether or not I had
| completed my payments.
| lostlogin wrote:
| Makes you wonder how this works for them. How do they
| know if they are in the black or the red if they can't
| tell who owes what?
| MiddleEndian wrote:
| Fucking beats me (although this particular hospital seems
| to be very disorganized). I will never understand why
| anyone would make it difficult for me to give them money.
| brightball wrote:
| Yep. Seems ripe for fraud too.
| MiddleEndian wrote:
| I ended up getting sent to collections for $40-50 for
| missing one of the bills. Never in my life have I not
| wanted to pay a bill, but god forbid any large
| organization just take my money and leave me alone.
| lostcolony wrote:
| Yes. Prior to insurance. Insurance is the reason prices
| aren't transparent; insurance companies demanded discounts,
| so providers raised their prices to then say "you're saving
| X from list". But not every company had the same bargaining
| power, and individuals had none, so the actual desirable
| price to offer couldn't be made broadly available. With a
| hidden price (so no shopping around), that is discounted at
| wildly different rates (so no meaningful way for third
| parties to track it), and a necessary service (so no just
| avoiding it), in a private for profit industry, of course
| it skyrockets.
|
| Our options are either to mandate publicly available price
| lists that are adhered to and hope the market pushes things
| downwards, mandate prices, or socialize insurance (so that
| the sole representative of everyone can negotiate the price
| downwards using the leverage of the provider risking losing
| most if not all their clients). Or, you know, keep doing
| what we're doing which is working so well ( _/ sarcasm_).
| caycep wrote:
| Granted, there's a niche for cash pay docs. Example being
| psychiatry - it's extremely hard to find a psychiatrist who
| takes insurance, even Medicare. The good ones are all cash
| pay...
| micromacrofoot wrote:
| I've heard the same thing from mental health counselors and
| therapists. In wealthier areas many will just stop accepting
| insurance entirely and make people pay out of pocket to avoid
| all the insurance paperwork and requirements (some insurers
| require specific diagnosis to continue paying for services).
| If an insurer decides to not pay you? good luck. Now you need
| to throw hours of unpaid labor at them to get money you're
| owed.
|
| Unsurprisingly, this means many normal people can't afford a
| therapist and they're getting harder to find.
| UncleOxidant wrote:
| This. I had a great doc until a few years back. Best doc I've
| ever had by a long ways. He'd spend a good amount of time
| with you, actually listen to your concerns and even bring up
| recent papers he'd seen on topics related to my health
| issues. A few years ago he decided to mostly get out of
| doctoring because he was tired of dealing with insurance
| companies. For a while he went to a retainer model ($2K/year
| up front, $250/visit) and cut the number of patients he was
| seeing down significantly. I can't say as I blame him.
| brightball wrote:
| MDVIP does that model in the US too.
| brimble wrote:
| Consolidation's a big part of it. The last decade has seen
| nearly all the small practices and offices in my city gobbled
| up by a couple of huge companies. With that comes the MBAs
| and the bureaucracy.
| Workaccount2 wrote:
| The healthcare in my area is like watching feudal lords
| rapidly claiming their territory. With central fortresses
| (hospitals) and outposts (smaller treatment centers).
| cwbrandsma wrote:
| The hospitals themselves are also to blame. There are a
| couple court cases where the hospital threw the nurse under
| the bus to cover up for their own issues (short staffing, bad
| safety procedures, covering up for a doctor, etc), and nurses
| are justifiably pissed off right now.
|
| There was a time when hospitals could have helped the nurses
| with the stress and workload, but the admins bungled it at
| every possible turn, and now it seems they missed their
| window.
| polskibus wrote:
| It's like that in many countries, also in EU. Average age of
| a nurse is rising, richer countries rescue themselves by
| importing workforce, because they can't find workers for the
| rates they have budgeted at home.
|
| It's is like that in other professions too if it's only the
| tech that gets compensated well. There is a shortage of
| skilled labour.
| soco wrote:
| Errata: there's a shortage of skilled labour _for these
| working conditions_. Said budgeting is not set in stone,
| and as long nurses and whatever else professions can vote
| with their feet (by leaving the profession) no amount of
| politics-led finger-pointing can replace a real-world
| change in the healthcare policies.
| ajross wrote:
| > 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.
|
| Framed that way, this sounds terrible. But... the truth is
| actual health care outcomes for insured patients in the USA
| are _extremely good_. This holds in comparison to other
| nations, when corrected for GDP and patient income, etc...
|
| "Insurance companies" are, at least in the narrow sense,
| doing what we pay them to do really well.
|
| They may or may not be making things easier for nurses, which
| is a different metric. But nurses aren't their customers, we
| are. And we're getting a fairly good[1] product.
|
| [1] Albeit extremely expensive relative to other nations.
| belval wrote:
| I doubt that it's as simple as that. Nurses are also leaving
| in Canada and we don't have insurance breathing down their
| neck.
| icelancer wrote:
| Insurance / government repayment is mostly the same thing.
| A layer of bureaucracy.
| tubalcain wrote:
| Canada's solution will be to mass-import nurses from the
| third world who will do twice as much work for half as much
| money. Mark my words.
|
| It's already happened with low-wage fast food jobs. Health
| care is next. Nurses and doctors will be replaced by
| poorly-trained third-world counterparts.
| alexashka wrote:
| Are they? Leaving to do what, exactly?
|
| For every story of 'X leaves to do Y', there are a thousand
| people claiming they'll leave, that never do.
| belval wrote:
| Some just leave to stay-at-home, some go back to school
| and a lot will take early retirement.
| klyrs wrote:
| Instead, you're left with the diminished quality of care
| from people who desperately want to leave but they're
| only there because they can't afford to.
| reedjosh wrote:
| But they have zero autonomy there too I assume?
| belval wrote:
| Sample size of 1, but my gf blames forced overtime. Being
| legally obliged to stay for an 8 hours shift after
| finishing one has a way to drive you to depression.
| px43 wrote:
| I would pay more to go to a hospital where I know people
| are actually well rested. My last few hospital stays have
| been saturated with clearly agitated staff (doctors,
| nurses, reception) who were putting in minimal effort,
| and clearly didn't want to be there, and I can't blame
| them given the conditions that they're being forced to
| work under.
|
| This is in the US, and I can't figure out why the
| Department of Labor hasn't cracked down on the medical
| industry yet. It's really horrific, especially because
| these are the people we're supposed to be relying on to
| keep us healthy and safe.
|
| How hard is it to enforce 8 hour days 5 days a week?
| Every other industry has figured it out.
| belval wrote:
| To be fair, most industries don't have evening and night
| shifts and a supply mismatch, most nurses want to work
| the day shift, it's harder to find candidates for evening
| and night.
| rootusrootus wrote:
| At least at my local hospital, it's not just overtime --
| regular shifts are 12 hours even when everything is
| normal. That's nuts.
| syedkarim wrote:
| Why doesn't the American Medical Association start its own
| insurance company?
| bitsnbytes wrote:
| Insurance companies is a symptom of the REAL issue.
|
| Unfortunately the American public hasn't figured out what the
| real issue is yet. They reason why they haven't is mostly
| because the Democrat party , Republican party, entertainment
| industry , the Main Stream Media, tech industry, and the the
| Commission on Presidential Debates (CPD) has them occupied
| with the symptoms of the REAL issue in order to keep them
| chasing their tails.
|
| The REAL ISSUE why healthcare isn't getting fixed is because
| of Conflict of interest.The American public hasn't figured
| out that going to congress who is riddled with conflict of
| interest and who designed the existing system that we have in
| place and is benefiting from it, might not be the best idea
| to fix healthcare.
|
| In fact the best thing to fix healthcare (and the other 99
| problems)is to STFU about it and focus ONLY On reducing
| conflict of interest in congress. Until we reduce conflict of
| interest in congress nothing will be fixed.
|
| The Democrat party ,republican party, CPD and MSM want you
| focused on everything but reducing conflict of interest in
| congress. In order to fix healthcare and any of the other
| issues we must FIRST try to minimize conflict of interest by
| implementing the following as a start:
|
| 1. Term limits
|
| 2. Closing or reducing revolving doors between private and
| public sector.
|
| 3. No private campaigning contributions. Use tech to overcome
| the need of money.
|
| 4. Reform lobbying by doing away with the money aspect of it
| and utilizing technology to get your voice heard.
|
| 5. Pay congress members more and better benefits, but in
| return demand complete transparency from financial
| information to limitations in investments , NCA , and make
| pay and benefits tied to the general overall approval of
| congress by the American tax payers.
|
| 6.etc
|
| Both party and the MSM solution to fix healthcare is the
| equivalent of going to the MOB and asking them to fix crime
| in your neighborhood which the MOB is benefiting from and is
| promoting. It just makes no sense to talk solutions with
| people riddled with conflict of interest.
|
| You want to fix healthcare stop talking about healthcare and
| get the individual republicans and individual democrats to
| put their political ideology on hold and join forces to
| demand that their party ONLY focuses on reducing conflict of
| interest in congress.
| darkerside wrote:
| I don't hear it talked about enough, but I think the biggest
| problem with insurance is that their profits are pinned to
| how much they spend on medical costs.
|
| https://www.verywellhealth.com/health-insurance-companies-
| un....
|
| In theory, this sounds like a great way to make sure
| insurance companies aren't just taking unreasonable profits,
| and that they are spending money on medical care, not
| administration, keeping the business lean.
|
| In _practice_, what it means is that profits are constrained
| by medical costs, so the insurance companies are literally
| incentivized to pay _more_ for medical services. Originally,
| insurance companies were supposed to be an intelligent
| negotiator on behalf of their customers. After all, their
| experts should know much more than a layperson every will.
|
| But with the poisoned incentive to raise costs, customers are
| basically held hostage by a bag faith negotiator. Not bad
| faith as in malicious, but in terms of having an enormous
| conflict of interest.
| legitster wrote:
| I've worked with both, and by far hospitals are much, much
| worse actors.
|
| Hospitals are _legally enforced_ local monopolies (look up
| Certificates of Need). Meanwhile, you might have a dozen
| choices of insurance companies, but they all suck because
| they have to take what the hospital billing departments give
| them and take the blame or risk being dumped by the hospital.
| at_a_remove wrote:
| 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.
| Melatonic wrote:
| Offer to pay in cash and it is amazing how much better the
| customer service and general demeanour is from a medical
| office - it always blows me away. They must REALLY hate
| dealing all of the insurance BS.
|
| I had not done an eye appointment in years and years because
| my vision is generally very good - I went in expecting to
| offer cash, negotiate, and generally play a bit of hardball.
| I was amazed when the front desk person IMMEDIATELY perked
| up, looked super happy, and started offering massive
| discounts before I even threw numbers out. The eye doctors as
| well were very enthusiastic.
| bakuninsbart wrote:
| It is definetely a (big) part of the reason, but if it was
| the only one, things wouldn't be in a similarly terrible
| situation in other countries. Take the UK as an example which
| has a single-payer system, and morale is overall really low,
| too, and nursing isn't an enticing career. (On a side-note,
| the BBC show "This is going to hurt" is quite good and on
| topic)
|
| Apart from administrators and insurers, I think a large
| problem is that the job has become substantially more
| difficult and technology intense, while support and pay
| hasn't kept pace. At the same time, liability is more serious
| these days, which I don't think is a bad thing, but certainly
| sucks for the workers who have to constantly justify
| themselves and can get crucified for mistakes.
| seabrookmx wrote:
| +1 very similar story in Canada.
|
| It blows my mind that super long shifts are the norm for a
| job that's generally more exerting/stressful than your
| average 9-5. But it's a viscious cycle now because of the
| shortages of qualified staff.
|
| Here in BC we have a full on crisis where family doctors
| are retiring at an alarming rate and not being replaced.
| andrei_says_ wrote:
| Prioritizing profit corrupts the commitment to providing
| care.
|
| Healthcare can be either care or industry.
|
| Applying corporate values to a healthcare system leads to
| maximum wealth extraction from both providers and patients.
|
| In this context innovation focuses not on the care part but
| on the extraction. The care is secondary.
|
| How can anyone who cares be a proponent or coexist with a
| healthcare industry?
| DaltonCoffee wrote:
| This inefficiency and it's resulting poor working conditions
| aren't unique to countries with health insurance and private
| healthcare tho, see Canada.
| rootusrootus wrote:
| > You can't do anything unless it's exactly how insurance
| wants and only for what insurance will pay.
|
| This is the part that makes the whole experience so sadly
| ridiculous. Nobody could ever tell patients what something
| might cost and let them make choices, it was (and is) "Sign
| here to acknowledge you'll ultimately be responsible for all
| charges, no matter what they turn out to be." But the
| insurance company doesn't operate like that, they say "Want
| to be part of our network? Guess what, you have to ask us for
| permission or we just won't pay you."
|
| We need to rip off the bandaid, as it were, and reboot the
| damn system. Pick one of any number of good examples from
| other modern industrialized nations that have functioning
| healthcare, and copy it. Yes, everything will be a zoo for a
| while. We'll survive, and maybe even come out the other side
| with a better system. And maybe some bankrupt insurance
| companies, let me find my handkerchief.
| pc86 wrote:
| 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**,
| healthcare in the US is going to absolute shit***.
|
| * I strongly believe that only physicians should be running
| hospitals. Certainly not administrators whose only education
| is an MHA and only experience is working for for-profit
| health companies. Medical decisions need to be made outside
| of cost considerations. The only factors should be medical
| science, quality of life, and patient wishes (in that order).
|
| ** In stark contrast to asking questions and trying to
| understand. But I have family members who are the "look
| everything up and then try to tell my doctor how they're
| going to treat me" ilk and it's crazy.
|
| *** I don't think the above points are unique to US
| healthcare other than cost considerations, but that's all I
| have experience with.*
| giraffe_lady wrote:
| The "only physicians should run hospitals" doesn't make
| that much sense to me. Reminds of the technocratic argument
| you used to see a lot on the internet that instead of
| politicians we should have scientists and engineers in
| legislature.
|
| The issue is if you have someone with a scientific
| background doing politics, what you have at the end is
| still a politician. Same thing here. An MD doing hospital
| administration is an administrator.
|
| Which is _not_ to devalue specialist expertise in these
| roles. I definitely think you want people with these
| backgrounds in those roles as well. Just not necessarily
| exclusively. A career administrator has different skills
| than a physician, you want people with both, and other,
| roles working to run a hospital.
|
| The real problem as I see it is probably the incentives,
| constraints, and pressures they work under, or towards. A
| physician forced to run a for-profit hospital maximizing
| returns is going to make a lot of the same decisions as
| someone with a business background in the same situation.
| The thing is to change the situation, not put different
| people into that role and expect them to do it dramatically
| better.
| caycep wrote:
| The problem with this is that the MBA programs that churn
| out hospital administrators tend not to be very
| good...focus on mergers, cost cutting, not so much on
| optimizing care. The pendulum has swung too much onto the
| MBA for MBA's sake hospital administrators and less so on
| actual medicine.
| slantedview wrote:
| > A physician forced to run a for-profit hospital
| maximizing returns is going to make a lot of the same
| decisions as someone with a business background in the
| same situation.
|
| Indeed! Whereas a doctor might say yes, give that patient
| with cancer the treatment they need, the MBA is going to
| say no, it costs to much, let them die. If the goal is to
| maximize profit, the MBA is doing a better job. If the
| goal is to maximize the health of your patients, the
| doctor is. We must realize that these two goals are
| fundamentally in conflict with one another.
|
| The question isn't whether a doctor or an MBA should be
| running a for profit hospital, it's whether we should
| even have for profit hospitals. If we care about people
| more than profits, then clearly we should not.
| brianwawok wrote:
| At some point, you have to put a value on a human life.
|
| It sucks and no one likes it, but what is the
| alternative?
|
| Each human life is worth infinity? So we should bankrupt
| the entire country, spending 10 trillion dollars on a
| surgery that has a 1% chance to save a 98 year olds life?
|
| Obviously that is an extreme example.. but the point is
| sound. We only have so many resources, how do they get
| divided up? Should be spend millions to give 80 year olds
| 1 more year of life? Do we value life on the reverse of
| age, so a baby we value at 10 million dollars, but a 90
| year old we value at $20,000? What if that 90 year old is
| your Grandpa?
| slantedview wrote:
| > So we should bankrupt the entire country, spending 10
| trillion dollars on a surgery that has a 1% chance to
| save a 98 year olds life?
|
| This is a pretty wild straw man fallacy, but I'd like to
| give a good faith response nonetheless.
|
| You may not know, but the US spends more per capita on
| healthcare than any other country in the world, by a
| longshot. Many other countries provide unimpeded
| treatment for all of their patients. If a doctor in Japan
| wants chemo, the patient gets chemo, and treatment starts
| immediately. So how does it make sense that we spend more
| on our patients but doctors are still told no, the
| patient can't have that treatment? It's because a larger
| share of our biggest-in-the-world healthcare spending
| goes to for profit companies, like insurance companies,
| than anywhere in the world.
|
| So when an insurance company says no to a treatment, it's
| not because we don't collectively spend enough for that
| treatment, we do! It's just that the insurance company
| wants that spending for themselves.
| calvinmorrison wrote:
| Let's not be obtuse though. The majority of healthcare
| costs are incurred at end of life. Perhaps insurers and
| the government should not subsidize any life saving care
| for those over the average mortality.
|
| I know for example, my grandmother who lived in europe
| many years ago, had failing kidneys. While today it's
| likely she could have subsisted for more years on
| dialysis, perhaps that money didn't need to be spent.
|
| Life is finite, and racking up bills at EOL is a waste.
| People need to learn how let others die with grace,
| instead of giving chest compressions to a 85 year old
| 80lb grandmother.
| ClumsyPilot wrote:
| If you want to do that, then you have to legalise
| euthenasia and dace all the thorny questions that comes
| with
| nickff wrote:
| > _" This is a pretty wild straw man fallacy, but I'd
| like to give a good faith response nonetheless."_
|
| Your interlocutor was actually using "reductio ad
| absurdum", which is a valid style of argumentation.
| https://en.wikipedia.org/wiki/Reductio_ad_absurdum
|
| You didn't address the scenario as presented, or
| demonstrate how it violated a principle you had
| described. Instead, you shifted to excoriating the
| insurers for greed and waste.
|
| Should the insurance company bankrupt itself on the first
| client? If not, how should they decide how much to spend
| on each? I should note that non-profit hospitals have
| similar results as for-profit hospitals (in the USA), so
| there's little evidence of shareholder greed playing a
| significant role (though there are many other
| stakeholders including employees).
| JackFr wrote:
| I would recommend the following EconTalk podcast on the
| history of the American healthcare system.
|
| https://www.econtalk.org/christy-ford-chapin-on-the-
| evolutio...
|
| Spoiler alert -- the author being interviewed doesn't
| have a solution, quick, easy or otherwise. But the
| history is fascinating -- in the end there are a lot
| fewer villians than you might imagine. A lot of good
| faith decisions seemingly made in the public interest
| over the past 150 years have led us into a weird local
| minimum that seems inescapable. Where we are was not
| inevitable, and as they say if something is unsustainable
| it has to end eventually, but before suggesting sweeping
| solutions I'd recommend hearing a detailed history.
| status_quo69 wrote:
| We already have decent (not always great but decent
| enough) government provided healthcare for the elderly
| through Medicare. So in fact, we've completely avoided
| your example already and said "yep, all life has value if
| you're eligible for medicare".
|
| Of course resources are finite, nobody ever argues that
| they're infinite. But we treat healthcare as if there's a
| constant scarcity of medicine with how much is charged
| because there's a constant urge to squeeze even more
| profits out of patients who probably have only 2 choices-
| pay for the medicine or die.
| zip1234 wrote:
| The counterpoint is that you have the exact same
| decisions being made in systems like the UK. People get
| refused cancer treatment because they were too old and
| their were younger patients that had a better prognosis.
| The fact is both types of systems don't have unlimited
| resources.
| slantedview wrote:
| Yes, care rationing is a thing. But in the UK care is
| rationed due to capacity constraints whereas in the US
| it's rationed in order to make a profit. These are very,
| very different things. It means that people's welfare,
| and death, is being traded for profit.
| woah wrote:
| Works pretty well for lawyers. It's not perfect, but
| lawyers have to adhere to a code of legal ethics, and
| only lawyers can have equity in law firms. Seems like
| this model could be transferred directly to the medical
| industry. It would not solve every problem ever, but it
| is an interesting thing to look into.
| JackFr wrote:
| There might be a parallel to a medical group or a
| professional corporation, but a law firm is a vastly
| simpler operation than a hospital. Orders of magnitude
| simpler.
| giraffe_lady wrote:
| Yeah that sounds fine too if you can do it. Anything that
| prevents hospitals from being operated by large profit-
| seeking entities with no other stake in them would
| probably be a strict improvement over the current system.
|
| I think the practical issue is those fields that have
| similar restrictions basically predate a major societal
| shift. We now consider the only valid limits on profit
| and ambition to be market forces. I'm not sure
| restricting hospitals in this way is less radical than
| just nationalizing them, in terms of practical politics.
|
| Anyway, again, sure. I'm not informed enough on this
| subject to know what model would actually work best. I
| think the problem is the raw exclusive profit motive
| rather than who specifically is running them, but there
| are a lot of ways to eliminate that.
| legitster wrote:
| > after service has been rendered can decide to pay less,
| or not pay at all, or stop paying that provider altogether,
| etc
|
| This actually isn't necessarily true when you learn how
| billing codes work. Most insurance companies pay out at a
| fixed rate per billing code based on your plan. That
| doesn't change. What does change is that hospitals can
| retroactively apply new additional billing codes.
|
| This happened to us once for an ER visit where we got 3
| additional surprise bills over 6 months because the
| hospital retroactively applied new billing codes to our
| visit.
| JackFr wrote:
| > * I strongly believe that only physicians should be
| running hospitals. Certainly not administrators whose only
| education is an MHA and only experience is working for for-
| profit health companies.
|
| The skills need to run a hospital are quite different than
| those required to be a doctor. I'm not saying hospitals
| aren't unique - I believe they are and their adminstration
| is highly specialized. Doctors should inform the
| administration at every level but it would be a waste of
| their training and a bad idea for doctors to run
| everything.
|
| > Medical decisions need to be made outside of cost
| considerations. The only factors should be medical science,
| quality of life, and patient wishes (in that order).
|
| Would you be as quick to say "Doctors should work without
| pay." ?
| DocTomoe wrote:
| > The skills need to run a hospital are quite different
| than those required to be a doctor.
|
| And still, in many countries, including highly
| industrialized ones, hospitals are run by doctors. So
| either US administrators are making their hospitals run a
| lot better (which does not seem to be the case), or the
| core incentives each group optimizes for are different.
| cmorgan31 wrote:
| Why would not paying doctors be the natural consequence?
| It's a fairly significant jump to go from don't let cost
| be a primary decision driver to let's force doctors to
| work without pay.
| bumby wrote:
| Because in reality, there are always tradeoffs and
| constraints. In the US, a disproportionate amount of
| healthcare costs come at the very, very end of life.
|
| It's possible to meet the sole criteria of science,
| quality, and patient wishes with exploding costs. I think
| the OP's point was that money has to come from somewhere.
| zeruch wrote:
| "a disproportionate amount of healthcare costs come at
| the very, very end of life."
|
| One might ask why that is; while some is surely due to
| natural decline in later years, one could likely also
| posit that the cost-fears leading up through that period
| (decades), and the general inability to get people to do
| preventative care throughout adulthood contribute to that
| significantly.
| _jal wrote:
| > One might ask why that is
|
| Indeed.
|
| It is one consequence of a highly atomized culture. I
| suspect it happens because individuals are expected to
| take responsibility for their care (basically, this is
| the human side of cost-shifting and corporate planning
| around the care gradient available to someone at a given
| wealth level).
|
| To someone at the end of their life, money is usually
| less interesting to them than a few more days of
| breathing. So the market provides.
| bumby wrote:
| The explanation I've heard is that it's rooted in the
| cultural sanctity of life and how that translates to
| trying to preserve life at any costs (even when quality
| of life is no longer present).
|
| To be clear, I'm talking about the absolute twilight of
| one's life that's reached regardless of levels of
| preventative care. I think there's potentially an
| opposite point that could be made: taking care of one's
| self can prolong this period and make it cost more.
| Someone who drops dead of a heart attack one afternoon
| won't have the same end-of-life costs as someone who
| gradually becomes enfeebled with age.
| ClumsyPilot wrote:
| > The skills need to run a hospital are quite different
| than those required to be a doctor.
|
| Why do you think law firms and accountancies are
| partnerships? Because the best proffesional for managing
| lawyers/accountants/develipers is such a proffeshional
| with loads of experience. Thats why we have progression,
| you gain management skill as you bevome more senior but
| you still know how the industry works and the people you
| manage
| scarface74 wrote:
| That's the definition of the "Peter Principle". Just
| because you are good at your profession doesn't mean that
| you are good at management.
| ClumsyPilot wrote:
| Is it impissible to select those who are good at
| management from the pool of thousands of people who are
| good at that proffeshion?
| scarface74 wrote:
| No, you first find people who want to go into management,
| then you give them management responsibilities without
| promoting them until they prove they can handle it.
| towaway15463 wrote:
| It should still be doctors. Just makes administration a
| career path that a doctor can choose to move into. There
| would be plenty of takers from the ranks of those burnt
| out on patient care. They could even find new meaning in
| being able to help people without going through the
| bedside wringer. If professional administrators have a
| place in the system it's in positions under experienced
| physicians where they can help with implementation of
| policy, not shape it.
| Spooky23 wrote:
| Doctor pay is high because supply is constrained.
|
| We're "fixing" this by flooding the market with less
| trained nurse practitioners and PE. Doctors are being
| gobbled up by regional medical cartels and put where they
| can maximize billing.
| ejb999 wrote:
| >>We're "fixing" this by flooding the market with less
| trained nurse practitioners and PE.
|
| In reality though, the overwhelming majority of cases
| that walk into a doctors office on any given day do not
| require an actual MD - NP and PA's are more than capable
| of handling many, many things that a typical patient
| needs.
|
| Everybody tends to think they need a 'real doctor', they
| usually don't. Its good they are there when they are
| really needed, but do you really need an MD to diagnose a
| sore throat, adjust your BP meds or many other routine
| things that are people are seen for everyday?
| Spooky23 wrote:
| True, but which ones?
| scarface74 wrote:
| Opposite anecdote: For done reason about 10 years ago my
| asthma that had just been a minor nuisance and didn't stop
| me from running, teaching fitness classes part time, etc.
| for a decade, sent me to the hospital and kept me coughing
| for nearly a year.
|
| The doctors and specialists gave me every treatment under
| the son to no avail.
|
| Then I did my own research and read I should try OTC
| psuedophredrine. It worked like a charm. Now every time I
| catch a cold (and when I got Covid), I pop psuedophredrine
| for a few days and I am good.
|
| Yes, psuedophredrine is suggested to treat Covid if you
| have virus induced asthma.
|
| Second anecdote: I have relatively mild cerebral palsy. As
| I've gotten older, my affected foot tightens up especially
| in the winter. My neurologist said it was physical and not
| neurological. I went on vacation and was drinking more
| alcohol than I usual do. I noticed I was walking without
| pain. I did my research when I got home and found a
| prescription muscle relaxant with the fewest side effects
| and ask my doctor about it. He prescribed it to me.
|
| He didn't bother telling me that I should get blood work
| done to check for liver problems. I had to bring it up to
| him.
|
| I can now walk without pain and run when properly
| conditioned.
| umvi wrote:
| > * I strongly believe that only physicians should be
| running hospitals.
|
| Strong disagree. This same attitude pervades the military
| ("only pilots should run the air force") and really all it
| does is that lower representation of the interests of the
| other non-pilot 90% of your organization and put a pilot
| bias on every decision being made.
| advael wrote:
| Those are extremely different situations and you've not
| really justified why they're being compared. A "doctor
| bias" in every decision being made would ideally
| prioritize health outcomes over decisions made for profit
| or convenience. It's possible that doctors will make poor
| decisions too, but on balance our expectation based on
| their training is that decisions made because of
| healthcare outcomes would be more likely in this scenario
| than the current state of affairs, which prioritizes
| economic considerations as administrators in every
| context currently tend to
| bumby wrote:
| I think the point is that "doctor bias" will not take a
| balanced approach to the other systemic factors. I'd
| argue it's the same with the pilots. If you asked pilots,
| they'd likely say the same thing: their priorities are
| going to align with the mission better than anyone
| else's.
|
| Anecdotally, this has been true in my experience on
| complex engineering projects. When the project manager is
| a mechanical engineer, guess which systems get the most
| time, money, and priority? Mechanical. And when it's an
| electrical engineer, the electrical system gets the
| priority. When it's a software engineer, the software
| etc. They all recognize the other systems, but
| availability bias skews their worldview and priorities to
| the neglect of others.
| hinkley wrote:
| > 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
|
| That's not always the case. The reason I stopped writing
| mobile applications long ago was because the mobile
| carriers were doing exactly this, and not even providing
| enough paperwork for you to argue with them about it.
|
| People like to lambast the Apple App Store for being
| greedy, but the fact of the matter is that people netted 3x
| as much off Apple that they did from the carriers. They are
| asking too much money _now_ but their rates were absolutely
| defensible at the time. It 's not a coincidence that we had
| a gold rush that started almost exactly when the App Store
| became a viable target.
|
| One might ask what would happen if we joined the rest of
| the 1st World in providing medical care and marginalized
| private health insurance. Would it be a similar watershed
| moment?
| towaway15463 wrote:
| The only gold rush in medicine where I'm from involves
| moving to the US to get away from a nationalized health
| care system.
| ejb999 wrote:
| curious - where is that?
| slantedview wrote:
| > I strongly believe that only physicians should be running
| hospitals.
|
| More than that - hands on healthcare should not be a for
| profit industry. The need to make profit is fundamentally
| opposed to providing the best care. As the push for profit
| increases, more people get sick and die. This goes for long
| term care as well, which is facing a similar staffing
| crisis for similar reasons.
| legitster wrote:
| Your local hospital is likely a non-profit. Your health
| insurance company might even be a non-profit. But they
| don't do any better. Corporate profit motive doesn't seem
| to be at play here.
| candiddevmike wrote:
| It's executive/board/administrative compensation that's
| more of a problem than profits for most
| hospitals/insurance companies.
| scythe wrote:
| >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
| telling me that my broken hand needs to be judged _outside
| of cost considerations_? Give me a break.
|
| The problem is that there is a lack of "trustworthy"
| parties to evaluate cost expectations in medicine. The
| patient often doesn't understand their condition _or_ its
| treatments, the doctor has a clear perverse incentive to
| inflate costs, and the insurance company may actually be
| _better off_ if the patient _dies_. At least that 's the
| conventional picture. Leftist pundits often complain that
| the American economy is based on "greed", but a more
| precise criticism is that there has recently been a trend
| away from expecting benevolence and for-its-own-sake
| honesty from anyone under any circumstances, or
| equivalently an increasing cynicism about human
| motivations. It remains to be seen whether a medical system
| can function when nobody expects to trust anyone.
| inglor_cz wrote:
| "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.
| [deleted]
| ipaddr wrote:
| * In this day and age not being your own doctor/advocate
| will produce unwanted unnecessary results.
|
| If you look up possible treatments /side effects and your
| personal history you will be in a better position to engage
| and weight options. If you blindly accept everything you
| will end up on the most profitable treatment plan plan
| insurance allowed.
| bumby wrote:
| > _I strongly believe that only physicians should be
| running hospitals._
|
| Can you elaborate on your rationale? I ask because I've
| worked in hospitals run by a cadre of physicians and it was
| not run well. Anecdotal, obviously, so I'm curious on your
| thoughts on what they provide.
|
| My worry is that it can lead to an unbalanced technocracy.
| It's like saying a politician needs to come from [industry
| x] to govern [industry x]. Technical competence is a
| necessary, but insufficient criteria when managing a
| multifaceted problem. The risk is that the front-line
| physician priorities would always become the organization's
| top priority. In reality, a hospital administrator has to
| manage competing priorities across many different domains.
| adolph wrote:
| > Medical decisions need to be made outside of cost
| considerations.
|
| A common attitude which may cause:
|
| _Health care is extremely costly in the United States.
| Although the rate of growth in spending has attenuated in
| recent years, per capita spending on health care is
| estimated to be 50 to 200 percent greater in the United
| States than in other economically developed countries.
| Despite leading the world in costs, however, the United
| States ranks twenty-sixth in the world for life expectancy
| and ranks poorly on other indicators of quality._
|
| https://journalofethics.ama-assn.org/article/complex-
| relatio...
| inglor_cz wrote:
| Looking at the levels of obesity in the U.S., I consider
| the 26th place a true miracle of American medicine. If it
| can prevent people who devastate their bodies with junk
| food for decades from dying at 50 ...
|
| On the other hand, imagine the world where Coca-Cola
| makes billions on healthy drinks, people are slim and fit
| until they die, and half of the money spent on treatment
| of chronic diseases of excess can be used for something
| else.
| rootusrootus wrote:
| > Looking at the levels of obesity in the U.S.,
|
| This is not unique to the US. Can't really say "but we
| only have 25% obesity here" and call that any kind of
| win. Maybe the US leads in this regards (though it varies
| by region, some areas have European-level obesity rates),
| but obesity is a worldwide problem.
| ryanbrunner wrote:
| > * In stark contrast to asking questions and trying to
| understand. But I have family members who are the "look
| everything up and then try to tell my doctor how they're
| going to treat me" ilk and it's crazy.
|
| I think this is exacerbated by doctors a lot of the time.
| I'm in Canada so it's obviously a very different system,
| but visits to a GP often have strict time limits and "one
| issue only" rules. When you can only talk about one
| symptom, and you only have 5 minutes to explain it, it's
| natural to try and do homework first to see what you're
| going to use your limited time on.
| 93po wrote:
| > 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 looking at results at a
| glance - when I had searched myself earlier and dug deeper
| though, it was clear to me the result he was looking at was
| just plain wrong
|
| 3. Doctors that provide very little to no guidance about a
| wide selection of medications available to treat a problem,
| leaving me to essentially guess which option of a dozen or
| more I should go with
|
| 4. Doctors that force me to advocate for myself and my
| condition before they agree to help treat it - so much so
| that I had to visit 4 different doctors to find one that
| would, wasting nearly a thousand dollars of office visits
| with nothing to show for it.
|
| It's no wonder people do their own research and dare to
| advocate for themselves. Most doctors are fucking
| worthless.
| 77pt77 wrote:
| You forgot one.
|
| Doctors that blatantly lie to your face because they want
| to push some procedure.
| hallway_monitor wrote:
| 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.
| aqfamnzc wrote:
| It also probably doesn't help that doctors are jacks-of-
| all-trades medically - there are simply too much
| complexity to thoroughly understand the nuances of every
| obscure condition and interaction.
|
| However, I think acknowledging when one doesn't know
| something is a skill many could benefit from improving...
| momirlan wrote:
| just adding a case when a doctor prescribed double the
| quantity for an infant. i spotted it right away, he
| panicked, asked to have the prescription back and
| promptly destroyed it.
| ClumsyPilot wrote:
| Indeed, there have been mutiple instances where, if I had
| not put my foot down,i would be left untreated and
| undiagnosed.
|
| Doctors are not like other proffeshions, they cannot put
| things right if the opportunity for treatment is missed
| Melatonic wrote:
| I felt the same way until I started being more active in
| choosing quality doctors. Doctors are no different than
| any other profession - there are the ones at the bottom
| of their league that are just going through the motions
| and there are the superstars working for some of the best
| institutions in the world. The key I have found is to
| specifically look for doctors that are either actively
| involved in academic research pertaining to your ailment
| or are working at quality institutions that are engaging
| in research that is at least tangentially related to your
| issue.
|
| Keep in mind they also have to do a stupid amount of
| paperwork these days for every patient and the place they
| work for may be overscheduling the crap out of them -
| generally (unfortunately) I always consider my first
| appointment to be sort of a wash due to this and assume I
| am not going to really get anywhere until the second time
| I see them.
| Djvacto wrote:
| 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 don't want to help" (this applies to both
| patients coming in with a suspicion of what they have, or
| getting a diagnosis from another doctor) - burn-
| out/overworking, where doctors have a hard time managing
| all the different cases coming at them without dropping the
| ball here and there
|
| It's not a simple, single-cause problem at all, but just
| want to provide an alternative point of view about patients
| who look things up or come in asking about a specific
| condition or diagnosis.
|
| When I got my ADHD diagnosis after a quarter-century, I
| went in specifically asking about ADHD because I had seen
| some flags that made me think I might have ADHD. Contrast
| that with the people doctors screen out who are trying to
| get a stimulant prescription despite not needing it, and
| you have a situation where it's hard for doctors to tell
| who does or doesn't need meds, and where patients with
| actual conditions have to fight hard for those to be
| diagnosed.
|
| Even in cases like POTS, which has no medication involved
| in treatment, just lifestyle changes, and yet people close
| to me who have POTS all had an uphill battle getting it
| recognized by anyone, especially doctors who could diagnose
| (disclaimer: sample size = 3).
| argc wrote:
| > When I got my ADHD diagnosis after a quarter-century, I
| went in specifically asking about ADHD because I had seen
| some flags that made me think I might have ADHD. Contrast
| that with the people doctors screen out who are trying to
| get a stimulant prescription despite not needing it, and
| you have a situation where it's hard for doctors to tell
| who does or doesn't need meds, and where patients with
| actual conditions have to fight hard for those to be
| diagnosed.
|
| I told my doctor I had already been diagnosed with ADHD
| because I had a strong suspicion I had it and wanted to
| see for myself if the medication helped (it helped
| massively). I think medicine should be accessible for
| patients who need it but I don't know how to avoid large
| amounts of patients then taking medications for the wrong
| thing, which would probably happen if it was a free-for-
| all. It kinda comes down to the question of having the
| personal freedom to hurt yourself doing something stupid,
| which is a balance (a little of that freedom is good, too
| much probably bad). All-in-all I lean toward the current
| system of using on experts to make the final decision.
| Still, I would be really pissed if a doctor prevented me
| from getting stimulants for something I believe I need,
| so I am not 100% satisfied with the current system
| either.
| suchire wrote:
| Another wrinkle to the problem with that gatekeeping
| structure is that it is so prone to bias against women
| and people of color, who are much more likely to be
| undiagnosed and ignored or dismissed.
| tomrod wrote:
| I'm not sure why this is being downvoted. This is a
| legitimate issue, divorced from politics completely
| (politics usually result in downvotes).
|
| [0] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4638275/
|
| [1] https://www.medicalnewstoday.com/articles/gender-
| bias-in-hea...
| lostlogin wrote:
| Could someone explain what's inaccurate here?
|
| Edit: It originally appears to be getting heavily
| downvoted.
| clankyclanker wrote:
| Nothing is inaccurate. Here's a few primary and secondary
| sources.
|
| https://www.health.harvard.edu/blog/women-and-pain-
| dispariti...
|
| > a 2000 study[0] published in The New England Journal of
| Medicine found that women are seven times more likely
| than men to be misdiagnosed and discharged in the middle
| of having a heart attack.
|
| 0:
| http://www.nejm.org/doi/full/10.1056/NEJM200008243430809
|
| https://www.independent.co.uk/life-style/health-and-
| families...
|
| > women with chronic pain conditions are more likely to
| be wrongly diagnosed with mental health conditions than
| men and prescribed psychotropic drugs, as doctors dismiss
| their symptoms as hysterics [1].
|
| 1: https://psycnet.apa.org/record/1990-98104-000
|
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4843483/
|
| > racial bias in pain perception is associated with
| racial bias in pain treatment recommendations... Black
| Americans are systematically undertreated for pain
| relative to white Americans.
| advael wrote:
| I view drug enforcement policy meant to prevent
| individuals from making decisions for themselves as
| always doing more harm than good. The place for
| regulation in this space is controlling what claims
| profit-motivated entities can make about drugs, enforcing
| quality and safety standards in manufacturing, and
| honestly tying the hands of insurance companies as much
| as possible, if not just gutting them altogether
| Melatonic wrote:
| The counterpoint to your last thing is that there are
| also many ailments that we literally just do not have
| enough info about yet to have proper treatments. And if
| we are studying such things many doctors are not going to
| always be up on the latest research for that specific
| condition.
|
| I have found it helpful to approach it in more of a
| teamwork-like mentality. Don't just read WebMD and try to
| diagnose yourself - journal your symptoms, observe the
| trends, record data. If it seems like it points to a
| specific condition hop on Google Scholar and look for
| some legitimate new research the average doctor may not
| have heard about. Print that out and then when you go in
| show them and ask questions without attempting to
| specifically diagnose yourself.
|
| You could be totally wrong but with some background info
| your doctor is much more likely to accurately diagnose
| and take you seriously.
| drc500free wrote:
| 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).
| 77pt77 wrote:
| > criminally under-diagnosed because they tend to effect
| women
|
| I just can't understand this argument. Women already live
| 5 years longer than men on average. You mean to tell me
| if the system didn't discriminate so strongly against
| their best interest they'd live even longer than men?
| ejb999 wrote:
| nurses are 91% female and doctors are about 37% female -
| are they also 'criminally under-diagnosing'? Seems there
| are quite a few more women in healthcare than men these
| days.
| thewebcount wrote:
| 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.
| wolf550e wrote:
| re: "Medical decisions need to be made outside of cost
| considerations."
|
| In the end, labor hours of professionals are finite. Even
| if you don't need to pay doctors, you only have so many,
| they can only work so many hours, you will need to
| prioritize who to help in what way, which procedures to do.
| Same with all the other personnel, the consumable stuff,
| the devices/scanners/equipment, etc. So someone is going to
| have to prioritize. It can be just "how much quality of
| life can we save using the resources we have", regardless
| of the patient's ability to pay/insurance/citizenship, but
| some prioritization will need to happen. The policy of the
| death panels can be changed, but their existence is
| inevitable.
| slantedview wrote:
| > labor hours of professionals are finite.
|
| This is why it makes no sense to have doctors and nurses
| waste time battling insurance companies over treatments,
| and hospitals over staffing. Their time is indeed too
| valuable.
| wing-_-nuts wrote:
| This is exactly why we should simply just expand medicare
| to be an option for everyone. If it's good enough for
| everyone over 65, it's good enough for everyone under it
| too. I'm ok with paying a reasonable premium to have
| access to the largest insurance network in the nation.
| elhudy wrote:
| Simply? It is not so simple. Medicare reimbursement rates
| are way below commercial rates and hospitals wouldn't
| survive just from medicare reimbursement alone.
|
| Let's stop trying to come up with "simple" solutions to
| the healthcare catastrophe in the US because the reality
| is more complex.
| wing-_-nuts wrote:
| So raise the reimbursement rates to the point where
| hospitals can survive, or cut the fat. See? Simple.
|
| Every time someone makes an argument like this, it's
| always to say that somehow, medical treatment in the USA
| is _special_ compared to other countries. We couldn 't
| _possibly_ have universal healthcare work here. Please.
| bumby wrote:
| Possibly misattributed, but usually given to HL Mencken:
|
| "For every problem, there is a solution that is simple,
| neat, and wrong."
|
| Don't kid yourself into thinking a complex system that
| makes up 20% of GDP is going to have a simple solution.
| Just a couple examples you'd have to contend with:
|
| 1) Insurance companies get a say too, according to the
| Constitution. That means they get to lobby in their own
| interests. That political problem itself is a boondoggle.
|
| 2) The US funds a disproportionate amount of medical R&D.
| Some of that fat is going to be cut from research. You
| need to have a plan on how that will effect long term
| quality of care and innovation.
|
| 3) Physician licensures are limited by the AMA. If you
| expand coverage, you will need to expand supply because
| any time something becomes "free", people will consume
| more of it. That's not a necessarily bad thing in
| healthcare, but needs to be addressed. The AMA also gets
| to defend their political interests.
|
| There's lots and lots of other issues. I'm not claiming
| the US healthcare system is great. But pretending it has
| a simple fix is naive.
| wing-_-nuts wrote:
| Again, I point to the fact that nearly every other
| industrialized nation does it better than us, with a
| fraction of the resources. I find it highly suspect when
| people say the problem is so complex we can't possibly
| fix it. Every other major western (and some asian)
| economy has addressed this. We are not exceptional. We
| can fix this too.
| bumby wrote:
| Yes, but that is, in part, because the US effectively
| subsidizes other countries medical R&D. Similar when
| other countries cap their drug costs while the profits
| are made up within the US. That means we subsidize other
| countries healthcare costs at the expense of our own. A
| country-to-country comparison is incomplete without
| understanding those systemic issues.
|
| It's like when people point out how much the US spends on
| the military compared to other Western industrialized
| nations. Part of that discrepancy is due to the fact that
| the US disproportionately funds organizations like NATO.
| Other countries reap the benefit without footing the
| bill. There was a lot of outrage in Europe when the US
| tried to enforce the NATO GDP spend that other countries
| _already agreed to._
|
| The US can do better, but I would argue we can't unless
| we fully understand the complexities of the system. That
| means not getting enamored by the idea that there are
| simple fixes. The first step IMO is getting the political
| will to do so (and to understand the tradeoffs within a
| complex system), because many of the potentially
| solutions are stymied at Congress.
| bumby wrote:
| But this is exactly why administrative roles are created
| to help alleviate that dilemma, so primary care providers
| can focus more time on patients.
| [deleted]
| samstave wrote:
| > _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.
| dr_ wrote:
| Let me add two more payment scenarios: 1) Pay in the form
| of a credit card number, where the provider ends up paying
| CC processing fees to process the payment. 2) Ask for the
| money back, months later.
| dan_quixote wrote:
| > 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
|
| This is precisely why I think we will never be able to
| effectively treat healthcare as a "free market" with tools
| like HSAs, posted price sheet, etc. The end user can never
| know the true cost of their procedure until it's long over
| (sometimes years later) and often don't get to choose at
| all.
| mminer237 wrote:
| > I strongly believe that only physicians should be running
| hospitals.
|
| This is how it is for other professional industries. As an
| attorney, you can lose your license for sharing any profits
| with someone who isn't a lawyer. I believe states typically
| require accounting and engineering firms to either be
| wholly or two-thirds owned by such professionals as well.
| scarface74 wrote:
| What does that even mean? All lawyers have support staff
| where the lawyers "share" their billable votes with non
| lawyers
| brianwawok wrote:
| > I believe states typically require accounting and
| engineering firms to either be wholly or two-thirds owned
| by such professionals as well.
|
| What states are these, Canadian states?
|
| In the US, many many many SaaS shops are wholly owned by
| businessmen / bean counters. It's like, weird, to be an
| engineer who runs a software company.
| nawgz wrote:
| > engineering firm
|
| > SaaS shop
|
| Now, I get we like to refer to ourselves as Software
| Engineers, but surely you understand he means actual
| certified engineering firms, not groups of code monkeys,
| right? Software is virtually never engineering, you'd
| have to get to a situation like flight control software
| before you're doing anything legit
| brianwawok wrote:
| I am a software engineer and do not consider myself a
| code monkey. Do not speak for all of us.
| nawgz wrote:
| If you have never stepped into a domain where you have to
| formally verify your software, I think you should
| probably not take too much offense to such a comment.
| While I admit it may be slightly negatively connoted, I
| primarily used it to illustrate that the kind of
| engineering going into making a bridge differs greatly
| from making your UI widget pixel-perfect or your SQL
| query from being too polynomial
| scarface74 wrote:
| I'm sure "sales engineers" feel the same way...
| chrisux wrote:
| I feel like the person you are responding to was not
| meaning software engineering. Electrical engineering,
| Chemical engineering, Civil engineering, Mechanical
| engineering, etc are all more likely: especially as what
| you say about software engineering is definitely well
| known.
| [deleted]
| Workaccount2 wrote:
| They are talking about the "applied physics" engineering
| fields.
| kllvql wrote:
| I believe this is in reference to Professional
| Engineering firms, which often requires PEs either as
| owners or in certain roles. As far as I'm aware software
| engineers are not required to be Professional Engineers
| in the US for most tasks, nor are SaaS shops required to
| be licensed as Engineering firms.
|
| [1]
| https://www.harborcompliance.com/information/engineering-
| fir...
| bumby wrote:
| NCEES did toy with the idea of a software engineer
| Professional Engineer license, but it went away due to
| too little interest. I think it was in part that industry
| didn't want it because it would give more leverage to
| SEs. IMO the only way that will become commonplace is if
| it is forced by regulation.
| zip1234 wrote:
| From what I can tell, this is just to keep money in the
| hands of lawyers and keep prices high.
|
| There are plenty of things that could be done better now
| by non-lawyers with the help of lawyers (look at Rocket
| law).
| j-krieger wrote:
| Why _shouldn't_ money from law be kept in the hands of
| lawyers? It's a grueling education with an even more
| grueling exam and even now a lot of law graduates can
| barely afford to keep a roof over their head
| bumby wrote:
| Because the profession is meant to serve the public
| interests and not just be a money grab. According to
| government data, the median lawyer is in the top 10% of
| income earners.
| scarface74 wrote:
| To put numbers on it. To get to the top 10% of income you
| only have to make around $120K.
| bumby wrote:
| Correct. ONet data puts the median lawyer at about $127k.
| From what I could find, 90th percentile of income is
| around $126k.
|
| While I know HN is probably SV and software biased,
| saying "only" $120k comes across as out-of-touch for the
| way most people live. For comparison, the median SF
| lawyer makes $191k according to BLS data. I could not
| quickly find 90 percentile data for the area.
| scarface74 wrote:
| Your average Enterprise CRUD developer in any major city
| in the US can hit that number within 3-5 years and a job
| hop. It's not exclusively a SV thing.
|
| And your number is correct according to Census data.
|
| https://dqydj.com/average-median-top-individual-income-
| perce...
| bumby wrote:
| I agree, but it's still out of touch. (not a knock on
| you, we are all subjectively influenced by what we come
| into contact with the most and interpreting it as
| 'normal'. It's also why something like 90% of people
| consider themselves middle class.) The fact that you have
| to narrow it down to software development and major
| cities should tell you that much. That's also why my
| original comment included both SV and software as biasing
| factors.
|
| The average person does not develop software and does not
| live in a major city. If somebody is making double the
| median wage and 2.5x the average wage and complaining
| about keeping a roof over their head, they can probably
| expect some sideways glances. It's like when people
| complain about the difficulty of making ends meet once
| they make their Lexus payment and pay their kids private
| tuition bill. The subjective struggle may be legitimate
| but it's still out of touch with the experience of most
| people.
| WoahNoun wrote:
| Many states of laws regulating the "corporate practice of
| medicine." But it seems like that leads to a hospital
| just being bunch of loosely held together independent
| businesses/contractors.
| travisjungroth wrote:
| > * In stark contrast to asking questions and trying to
| understand. But I have family members who are the "look
| everything up and then try to tell my doctor how they're
| going to treat me" ilk and it's crazy.
|
| I still think it's better than the other extreme of just
| showing up and trusting the professionals. That should work
| in theory, but my experience for myself and those around me
| is it's incredibly ineffective. If what you're dealing with
| requires the least bit of thought, odds are you're getting
| brushed off to the extent you allow.
|
| The _real_ model of US healthcare is essentially apprentice
| /master, with the patient as apprentice. Apprentice does a
| lot of the work, not all, some needs to be approved by the
| master and the apprentice better know how to learn from the
| master, when to push back, and how to make it seem like it
| was their idea all along. You can imagine how this falls
| apart for mental health.
| AlphaOne1 wrote:
| I also think the complete implosion of family medicine
| has made this worse. In the past, you would keep the same
| family medicine doctor for decades and trust them. They
| in turn would know what your values and priorities are.
| Moreover, they would be able to guide you through
| difficult healthcare decisions that inevitably come up
| (cancer diagnosis, mental health etc.). We have lost the
| human connection aspect of medicine and those few
| physicians that are able to hang on to it are burning out
| due to the massive amounts of paperwork they need to
| accomplish. From the hospital perspective, (which many
| physicians now work for) good paperwork=good patient
| care. Paperwork is measurable. Relationships (other than
| in the abstract) are not.
| kurthr wrote:
| Having worked in Tech for many years at corporations large and
| small, I have seen companies run by Founders, by Sales, by
| Marketing, by Finance, by Engineering, and by Legal. Each had
| their plusses an minuses.
|
| Until I saw hospital nursing, I had never seen a company run by
| HR.
|
| Every decision starts and ends with HR. From hiring, to wages,
| to discipline and promotion, to IT and pay-roll, to
| reorganization and spending priorities, there is a rule for
| that. Maybe that rule originally came from the CEO or the CNO,
| but they say things like "may" and get interpreted as "shall"
| (or the manager faces a bad review and/or termination) or they
| are interpreted beyond any rational meaning. My best
| explanation is that it comes from a fear of litigation and a
| lack of leadership at the top. The final hilarious story is the
| CEO negotiating a big deal with lawyers and VPs shaking
| hands... and then saying without joking, "but I'll have to get
| HR's approval". The meeting wasn't important enough for HR to
| show up, but they had the last say.
| beezlebroxxxxxx wrote:
| If you follow the history of HR departments in a lot of
| modern corporations you often see them operating as private
| in-house legal firms, and aggressively expanding their
| purview to include even actions at the executive level. The
| only thing most HR departments look out for is HR. Everything
| they do resolves around continuing or expanding the power of
| the HR department.
|
| Your comment on lack of leadership is spot on. No one wants
| to be accountable. Instead HR departments put in place
| bureaucracy that works to deny individual fallibility in the
| name of a "system of human resource management". They want to
| treat people like a cog in a machine instead of as people.
| inetknght wrote:
| > _No one wants to be accountable._
|
| That is American corporations in a nutshell. Outsource
| everything, put layers upon layers, and insulate yourself.
| Then when fecal matter hits the rotary you can put the
| blame on others and, at worst, you get fired and there's
| little to no worry about any sort of legal reprecussion
| because... well you weren't accountable for the problems in
| the first place!
|
| It's a massive problem created from little cuts here and
| there with a few big lawsuits mixed in.
| kickout wrote:
| Agree with you, but people on HN and other places tend to
| flame/heckle companies that don't do this too, aka Elon
| Musk. Love him or hate him he does things 'his' way
| without all the seemingly built-in middle layers. I like
| it as opposed to the HR led office space cosplay, but
| people seem to want their cake and eat it too.
| smoe wrote:
| Both my mother and sister were nurses and disenchanted with the
| profession (in Switzerland) long before the pandemic hit, as
| the hospitals got completely mba'd during their careers.
| Whereas in the past they could actually take time interacting
| with patients, now everything needs to be Lean and it's just
| about shoveling people through the system with minimum
| resources while extracting ever more money. I don't see how
| this can end well.
|
| My mother switched to an administrative role internally, 10
| years before she got retired and my sister went from nurse to
| anesthetist and now in the progress of moving to IT as a domain
| expert for medical software so she can work from home.
| Spooky23 wrote:
| Yes. The system is gross. When my dad suffered from a stroke
| (pre-COVID), the level of neglect and poor care he received was
| startling. He died before he should have after making
| substantial recovery due to the side-effects of being in a
| hospital.
|
| My mom was a long-retired medical director of a hospital and
| even she was shocked at poor quality of care, compassion and
| competence. Even in the ER of a recognized trauma center,
| things were pretty meh. Some specialist floors and ICU were
| good, but when an infection caused by poor hospital hygiene
| struck, he was relegated to the "medical" floor, where he was
| not fed, medicated, turned or treated with respect. Ultimately
| we maintained a 24x7 staffing of family volunteers for over 6
| weeks.
|
| Many of the staff frankly sucked. But it was easy to see why -
| the staffing levels were so poor _pre-COVID_ , that any RN
| risks license every day by virtue of being there. The smart
| ones GTFO. You can't care for 15 patients.
| dsugarman wrote:
| 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.
| archhn wrote:
| See "The Managerial Revolution" by James Burnham.
| m_ke wrote:
| My SO is a healthcare worker as well, she just graduated 2
| years ago and has major regrets about her decision. She'd leave
| and try and do something else but she has mid 6 figure debt, to
| make things worse she was rear-ended her last year of school
| and has back issues that make it hard for her to handle the 12
| hours shifts.
|
| She's looking to switch jobs now and her first offer expected
| her to travel to locations deep in queens, manhattan and
| brooklyn, seeing on average 50 patients a day. She currently
| works at one of the largest hospital chains in NY and is now
| negotiating an offer from the other largest chain, initially
| she was told to not worry about salary and that they'd be able
| to match her previous offer, then HR called her and told her
| she had 1 and not 2 years of experience so the best offer they
| can offer her is lower than expected, she said she wouldn't be
| able to do it so the HR people went to check again to see what
| they can do and it turns out they called up the hospital that
| my SO works at now and checked their pay tiers and said they
| can only match the number that they were told. The new position
| was close to where we live so she considered taking it anyways
| but they just called her again and asked her if she'd be
| willing to travel to other locations multiple times a week to
| help fill in gaps (but weren't even able to tell her which
| locations before accepting the offer).
|
| TLDR: don't let your friends and family go into healthcare
| anon23anon wrote:
| I'm sure this is the top comment b/c we as developers have
| basically lost our professional agency to do do nothings roles
| like project manager/project owner/"business people". It's
| frustrating. I've been in the game a long time. It was way more
| fun when the web was still new and for the most part didn't
| care a whole lot about tech.
| zeruch wrote:
| "is quite puzzling"
|
| Is it?
|
| The financialization of every aspect of life, in this case with
| for-profit hospitals through multiple layers of insurance
| middle-men, the exodus you describe would seem one of the
| natural byproducts from miles away.
| PragmaticPulp wrote:
| > How doctors of all professions lost their professional agency
| to do-nothing administrators within a generation is quite
| puzzling and a bit terrifying to me.
|
| I have a lot of friends at various levels of healthcare, from
| nursing up through low and mid-level administrative positions.
|
| The one thing they all seem to agree on is that patient
| satisfaction surveys have been terrible for healthcare.
|
| Once the emphasis shifted to patient satisfaction, everything
| became more of a game of catering to what the patient _thinks_
| they want. With the spread of rampant medical misinformation on
| the internet and the rise of alternative-medicine podcasts
| /blogs/influencers masquerading as informed medical
| professionals they have a constant influx of patients who show
| up believing they have a certain condition or need a certain
| medication. If you disagree too much or refuse to give them the
| medication they want, you risk a negative review. Too many
| negative reviews could negatively impact your compensation or
| even cost you your job.
|
| Even at offices that don't perform patient satisfaction
| surveys, providers are at the mercy of negative online reviews.
| Again, if you don't do exactly what the patient thinks they
| want, you risk scathing online reviews.
|
| This is terrifyingly problematic given the trend of people to
| self-diagnose with anxiety or infections who show up demanding
| Xanax or antibiotics. Puts doctors in a situation where they
| don't really think prescribing those medications is a good
| idea, but they also feel like they can't deny too many patients
| or they risk their reputation/bonus/reviews.
|
| It's also a huge problem with conditions like obesity or
| alcoholism or smoking, where the doctors can see obvious
| patient-induced health issues but the patient really doesn't
| want to hear the truth from their doctor.
| CityOfThrowaway wrote:
| Patient satisfaction surveys are the legible feedback
| mechanism showing that something is deeply broken, but not
| the _source_ of the problem itself.
|
| It's clear from your comment that the _source_ of the problem
| is the increasingly sharp divide between what the
| credentialed medical professionals believe and what lay
| people believe. The satisfaction survey is simply uncovering
| that fact.
|
| It would be vastly worse if patients were being treated and
| had no recourse when they felt their health was mismanaged.
| It may well be the case that the patients are _wrong_ , but
| it is extremely dystopian to imagine a world where
| individuals are not empowered to make decisions about their
| own bodies.
| pc86 wrote:
| Patients have always been entitled to make decisions about
| their bodies. You can decline procedures, and treatment,
| and you can get second, third, fourth, fifth opinions.
| Satisfaction surveys do nothing to increase that autonomy.
| The dystopian world you speak of is a straw man.
|
| The problems stems from people believing they are consumers
| of healthcare, on equal footing with the practitioner they
| are seeing. They're not, objectively. A 45 minute Google
| search doesn't equal 4 years of college (usually in
| something like biochem but not always), 4 years of medical
| school, 3-7 years of residency training and potentially
| another 1-4 years of fellowship training. If you're seeing
| anyone above a family doctor/PCP, they 100% know more about
| your condition than you do, whether you've been living with
| it for a decade or not.
|
| That doesn't mean you don't have autonomy, or that you
| shouldn't question your doctor's decisions and ask for
| explanations, but it does mean you should err on the side
| of thinking the person whose spent at least a decade, but
| probably closer to two, educating themselves to get where
| they are probably knows what they're talking about.
| PaulDavisThe1st wrote:
| > they 100% know more about your condition than you do,
| whether you've been living with it for a decade or not.
|
| I was with you up until this point. Part of the problem
| is that this cannot be true in all cases, unless either
| (a) your condition is commonplace (b) the doctor
| specializes in your condition.
|
| Yes, doctors know more than you in almost every way about
| bodies about medicine, about drugs. However, people with
| relatively uncommon conditions have been enabled (largely
| by the internet) to create communities of fellow
| condition-sufferers, and the collections of anecdata that
| result represent a resource that generalist doctors do
| not have access to. The good specialists, in some cases,
| will take occasional dips in to augment their own
| knowledge and expertise.
|
| Case in point: my daughter has had two major hip
| surgeries. While there is no way anyone in their right
| minds would have chosen someone who had not performed
| these surgeries previously (preferably, many times), and
| while it was completely clear that the surgeons really
| really really knew what they were doing, it was also the
| case that various online communities made up of people
| who have been through this procedure were able to provide
| lots of information that the surgeons could/would not.
| This was particularly true of the recovery process, where
| there were a number of common oddities that most people
| who have the procedure experience, and they're really not
| a problem. They are scary however, and the actual medical
| professionals really had nothing useful to say about
| them.
|
| There's another issue with the blanket "doc knows best"
| rule. If you've had a GP for many years, or a specialist
| helping you with a condition for many years, then it's
| probably a great rule of thumb. On the other hand, if
| you've moved, or for any other reason switched doctors,
| and you're the kind of person who does _pay attention_ to
| their body, there 's a reasonable chance that you're
| going to know things about yourself/your body that the
| new doc(s) will likely not be aware of. They can (and
| will) learn, of course, and there's no reason to be
| aggressive or patronizing about it. But for example, you
| may understand the way you typically recover from
| antibiotic treatments, or the consequences of lack of
| sleep, or your tendency to always pull a lower back
| muscle given certain movements, etc. etc. in ways that
| your (newish) doctor may not yet be wise to.
| Buttons840 wrote:
| > The problems stems from people believing they are
| consumers of healthcare, on equal footing with the
| practitioner they are seeing. They're not, objectively.
|
| Objectively, the patient is the only one who has 500,000
| hours of experience with the unique and very complicated
| system we call a body, and is objectively the only one
| who comprehends what they're feeling. They're also the
| one who experiences the consequences, they're the only
| ones with literal skin in the game. How much is all of
| this worth?
|
| It's a difficult thing. The answer is some mix of giving
| the doctor and patient power.
| pc86 wrote:
| The patient already has absolute power. They don't have
| to accept any treatment they don't want to.
|
| The patient may be comprehending how they _feel_ but that
| absolutely doesn 't mean that they understand the complex
| interactions within their body, which the physician does
| know.
| PragmaticPulp wrote:
| That's the theory - That patient satisfaction surveys will
| uncover the bad providers.
|
| But in the real world, if someone is receiving bad care
| they don't continue making followup appointments with that
| doctor. Nobody continues going back to the same bad doctor
| over and over again and writing negative reviews. It's
| really easy to calculate churn rate for individual
| providers.
|
| The hot topic now is tracking outcomes: The idea is that
| with enough data collection and crunching, we can
| eventually start tracking which providers have better
| outcomes among their patients. This is one of those things
| that sounds great on paper but has a lot of challenges in
| the real world. It's also prone to gaming, as we've seen
| from surgeons who have learned to avoid difficult cases so
| they can avoid the risk of another patient death statistic.
| hedora wrote:
| That reminds me. I have one laying around to fill out.
|
| 10/10 plan to get sick again.
| bitsnbytes wrote:
| "The one thing they all seem to agree on is that patient
| satisfaction surveys have been terrible for healthcare."
|
| My Wife is an ER nurse manager and while you have many self
| entitled idiotic patients that think they are staying in a
| resort versus visiting an ER, the patient satisfaction
| surveys is not very high in regards to the issue and why
| nurses are leaving.
|
| My wife actually had a person complain that the ER did not
| have cow bells to call for a nurse (She claimed to be a
| retired nurse and they always had that for back up, lol) and
| they constantly complain how come they came in first for a
| stubbed toe, but another patient with a gunshot wound or
| heart attack is being seen first.
|
| The bigger issue as why nurses are leaving the field from
| what she has seen and experienced is:
|
| 1. wages: The wages are beyond inadequate in certain nursing
| specialties and many have left to become traveling nurses or
| contracted nurses that get paid double the standard nurse
| pay.
|
| 2. Burn out: Besides covid, Hospitals Patient to nurse ratio
| is often exceeded and no accountability for the hospital to
| break those ratios. Nor any consideration for a high demand
| patient versus a low demand patient. Then when something goes
| wrong the hospital looks to pin it on the nurses. This was an
| issue before covid . but covid just added fuel to the fire.
|
| 3. BS. nurses get bs from ALL sides. They get bs from the
| patients and even more bs from upper management who set
| unrealistic process in place that is more concerned by hiding
| accountability and making things look good on paper than
| actual patient care. Then you had that whole BS covid
| movement crap calling nurses hero but besides lip service
| they did absolutely nothing for them. In fact they did the
| opposite. I know my wife had to fight the executives because
| they wanted to make nurses use their vacation time for sick
| time if they got covid. Their explanation for this that if
| the nurses got covid it was not likely from the hospital as
| the hospital takes extreme precautions to prevent it. The
| funny thing was that the same hospital spewing that BS also
| wanted nurses to not wear mask due to possible shortages at
| the beginning of covid. Insert the BS is to DAMN High meme
| here.
|
| 4. RaDonda Vaught's conviction. This is certainly not helping
| the case to get more nurses.
| PragmaticPulp wrote:
| > My Wife is an ER nurse manager and while you have many
| self entitled idiotic patients that think they are staying
| in a resort versus visiting an ER, the patient satisfaction
| surveys is not very high in regards to the issue and why
| nurses are leaving.
|
| ER is definitely a different ballgame. Thanks for the
| additional perspective.
|
| The patient satisfaction surveys apply more to domains
| where repeat visits are the norm: Family doctor, nurse
| practitioners, and so on. (Ideally, none of us becomes a
| frequent customer of the ER nurses!)
| ev0lv wrote:
| >>4. RaDonda Vaught's conviction. This is certainly not
| helping the case to get more nurses.
|
| The precedent RaDonda's conviction set is far from
| favorable to a profession which is already very difficult
| and taxing. This is a BIG reason.
| [deleted]
| mikkergp wrote:
| I get what you're saying, but the promise of the medical
| system and the implementation of the medical system aren't
| really aligned. Sure 50% of problems are naive patients, but
| the other 50% are doctors or a system that doesn't know how
| to talk to you or treat you, or there's just an ocean of
| uncertainty in how to operate. You show the negative side
| from the doctor perspective, but on the other hand. Doctor's
| aren't really trained in 'health' they're trained in
| pathology. If you're really sick they can provide help, but
| if you want to optimize or you're kind of sick, or your
| numbers are borderline. Medicine is just sort of not a hard
| science, there's way too much uncertainty. You mention people
| demanding antibiotics, but the doctor's are just as bad --
| last time I tried to have a nuanced discussion about it with
| a practitioner, the answer was a simple "x days is the
| standard of care". Not to mention that the doctors would have
| to be up to date on the latest versions of research in a ton
| of different areas to have some of those answers anyway. I'm
| not going to leave terrible reviews about it, but I rarely
| leave a medical office feeling satisfied that there are firm
| answers on anything.
| 77pt77 wrote:
| > How doctors of all professions lost their professional agency
| to do-nothing administrators within a generation is quite
| puzzling and a bit terrifying to me.
|
| Same thing with professors.
| birdmanjeremy wrote:
| I'm friends with quite a few nurses, primarily travel nurses,
| and not a single one is considering a change in career that I
| am aware of. Simply an anecdotal counterpoint and nothing more.
| pc86 wrote:
| Travel nurses are compensated quite a bit more in my
| understanding. And the travel aspect means they can leave the
| more toxic locations more easily.
| phkahler wrote:
| They're paid a shit ton more. And because of that, more
| nurses are quitting to do the travel thing, which worsens
| the shortage and increases demand for travel nurses ;-)
| never seen an industry fuck itself over so bad. That's
| really the issue - healthcare has become an industry, not a
| profession.
| lotsofpulp wrote:
| As you noted at the beginning of your comment, the issue
| is the pay to quality of life at work ratio being too
| low.
| s1artibartfast wrote:
| AT some point you hit diminishing returns on the pay/QAL
| ratio.
|
| IF the tradeoff is bad at 200k/yr, it wont be better at
| 225k/yr or 250k/yr
| lotsofpulp wrote:
| Then increase the pay even more or increase the quality
| of life at work.
|
| Instead of $250k, halve the work load somehow and make it
| two $125k.
|
| If there is no number, then society cannot afford it.
|
| But this is nursing, not trying to find ways around the
| 2nd law of thermodynamics. If nurses received $300k/year
| income, then there probably would not be a shortage since
| the barrier to entry is not that high.
|
| If we really want to get down to the nitty gritty of it,
| most people cannot afford quality nurse care (or doctors
| or hospitals). So the question really comes down to how
| much wealth is society willing to redistribute to those
| who need it in the form of healthcare?
| s1artibartfast wrote:
| Totally agree. With lowering wages and cranking out more
| nurses. I think this is a more sustainable solution.
| [deleted]
| t-3 wrote:
| Sure, but nurses are more like 30-40k/yr. Plenty of room
| for improvement.
| ejb999 wrote:
| >>Sure, but nurses are more like 30-40k/yr.
|
| Not even close if you are talking about the USA (and
| actual nurses, not CNA's or MAs) - starting pay for 2
| year RN degrees near me are about 55-65K, and you easily
| go over 100K in a few years.
| s1artibartfast wrote:
| The point is that I know nurses that make 200k a year and
| still complain about the workload. More nurses and better
| hours is the solution. Meanwhile the trend is to make it
| more and more difficult to become a nurse and higher and
| higher for hospitals to have nurses
| dragonwriter wrote:
| > Sure, but nurses are more like 30-40k/yr. Plenty of
| room for improvement.
|
| "Nurses" can be used to mean many things (CNAs,
| LVNs/LPNs, RNs) but this is specifically RNs, who, make
| much more than that, generally (median $77.6k/yr)
| https://www.bls.gov/ooh/healthcare/mobile/registered-
| nurses....
| JumpCrisscross wrote:
| > _median $77.6k /yr_
|
| Given the amount of school a nurse must have, that's low.
| ejb999 wrote:
| 2 years of school to be an RN, 4 for BSN - it's not a lot
| of school, it's an average amount of school at most.
| BobbyJo wrote:
| The market... finds a way.
| joshgel wrote:
| It's really amazing to see travel nurses come back to
| work at a place they just left. They are now doing the
| same job as before, are getting paid almost twice as much
| with better schedules and are working next to people that
| they know and are friends with.
|
| It's honestly surprising that more haven't taken the jump
| and is really shocking that hospitals aren't doing more
| to retain critical staff.
| TecoAndJix wrote:
| The hospitals have been asking Biden to put a stop to it:
| https://www.npr.org/2022/02/02/1077710203/hospitals-ask-
| bide...
| pc86 wrote:
| It sounds nurses just need to be paid more, or travel
| nurses need to be paid less. Equilibrium is probably
| somewhere between the two extremes.
|
| Apropos of nothing but why is the knee jerk reaction "we
| need executive action to fix this _staffing problem_? "
| lotsofpulp wrote:
| Why would travel nurses need to be paid less?
| pc86 wrote:
| If wages equalized, it's unlikely they would all equalize
| to the top of the range. It's more likely to be somewhere
| in the top quartile or quintile.
| lotsofpulp wrote:
| Why would they equalize? I assume there is a premium
| required for not going back to one's own home everyday.
| Sohcahtoa82 wrote:
| I can only react with this face: https://i.kym-
| cdn.com/photos/images/original/000/112/480/Opo...
|
| Help me understand this. Make it make sense...
|
| 1. Hospitals pay their nurses $X, which is way too low
|
| 2. Nurses quit because they're underpaid and overworked
|
| 3. Hospitals have a nurse staffing crisis and so pay
| travel nurses 2 * $X (or more!)
|
| 4. Hospitals are in a panic over the cost of travel
| nurses, yet instead of paying their nurses more to keep
| them around and eliminate the need for travel nurses,
| they ask the government to cap the cost of travel nurses
|
| My mind is exploding over the ridiculousness of it.
| zaptheimpaler wrote:
| Its hilarious that nursing shares this problem with the
| tech industry and probably with most other industries.
| Every company is extremely allergic to giving raises and
| is happy to let their workforce churn constantly. You
| would think they believe that experience has no value.
|
| But on the hiring side, experience is one of the most
| widely accepted signals of value.
| ProAm wrote:
| A travel nurse means you just have to work across town you
| dont have to travel out of state, out of country, or to
| middle of nowhere. And these people are bringing in 5k a
| week currently. None of them are leaving.
| Eric_WVGG wrote:
| Funny you should mention that... reading all of this, I was
| thinking of a podcast interview with a nurse who was retiring
| from hospital work. His primary reason for leaving was being
| tired of fighting with hospital ownership and administration,
| and was planning on switching to travel nursing which appears
| to be more of a "gig" space.
|
| He did consider that a career change, I think in the same
| sort of way that a computer programmer like (presumably) most
| of us would consider quitting Google to work on an indie app
| or videogame development would be a career change.
|
| The larger point is, medical professionals are bailing from
| the hospital system, which looks pretty busted.
| tubalcain wrote:
| Travel nurses make six figures and get to sample choice cuts
| from the local Tinder menu every time they take on a new job.
| muh_gradle wrote:
| I can add another data point. One of my mother's friends
| works as a travel nurse. I don't envy her lifestyle, but she
| seems to find that the compensation makes it worth her time.
| drnonsense42 wrote:
| The other responder said the same thing, but to add, a
| traveling nurse I'm friends with , in Texas, gets paid 5k a
| week if he chooses to work and chooses where he wants to
| work. So again, this is like making a judgment about software
| development working conditions by using people rest and
| vesting at FAANG as an example.
| rdtwo wrote:
| A lot of nurses are becoming travel nurses because they will
| get paid market rate
| mfer wrote:
| The travel nurse market is growing due to supply and demand
| problems.
|
| The demand for nurses is increasing as people are leaving and
| there are more from the boomer generation hitting an age
| where they need more care.
|
| The supply has stayed the same. Schools local to me have not
| increased output for various reasons (lack of instructors,
| lack of space in local hospitals where nurses train, etc).
| The supply is too low.
|
| So, we have a supply and demand problem. Travel nurses get
| paid a lot more because of this.
|
| The solution is to produce more nurses. Something few are
| talking about.
|
| One of the local schools, to me, turned away half of
| applicants because the program isn't increasing capacity.
| jwagenet wrote:
| No, the solution is to pay nurses better. There are already
| tons of high quality nurses who don't want to do it anymore
| because of poor pay in the face of demanding hospitals and
| patients.
| mfer wrote:
| Pay is a problem. I don't disagree with that.
|
| But, before COVID there was already a supply problem. The
| supply problem has been slowly getting worse for years
| and then COVID accelerated it. If every nurse came back
| to working as a nurse who wanted to work there would
| still be a supply problem.
|
| Supply has not been growing to meet the demand growth for
| years.
| rightbyte wrote:
| Poor pay? Judging by the nurses I have talked too in big
| proper hospitals stress and scheduling are their main
| concerns, not pay.
|
| Obviously higher pay would increase their abuse
| tolerance, but I think it is only part of the problem and
| a short term solution since no amount of pay will offset
| stress problems.
|
| County level nurses seem to have much better work
| conditions than hospital nurses.
| sixothree wrote:
| Nurses in outpatient offices haven't seen many of the pay
| perks related to covid that hospital staff get, even
| though they are still facing risk.
| s1artibartfast wrote:
| Strong disagree.
|
| Nurses are generally payed very well. This is a supply
| problem driven by increasing restrictions on nursing
| degrees and insurance.
|
| Not enough nurses and high cost leaves hospitals
| understaffed and nurses overworked, leading to a feedback
| cycle.
| vkou wrote:
| Travel nurses are paid well. Full-time nurses are not,
| considering the amount of education they need, and the
| difficulty of their work.
| llbeansandrice wrote:
| pay, benefits, and hours
|
| I suppose you could just pay people more money to make it
| worth it but the long hours take a toll in other ways as
| well and contribute to burnout no matter how much you get
| paid.
| hedora wrote:
| Also anecdotal, but we're looking for home healthcare for a
| parent. There are zero in a 50+ mile radius.
|
| One of their neighbors used to work for a home healthcare
| company in the area.
| agumonkey wrote:
| I'm surprised how long and deep the medical bleeding has been
| going. You'd think a vital organ bleeding would cause faster
| reaction..
| vonnik wrote:
| I work at a startup* trying to tackle nurse burnout, and two of
| my family members are nurses. Here are a few things I've learned:
|
| - Nurses were getting burned out before the pandemic, and the US
| has a nursing shortage that's been going on for about 90 years
| (it started with an infrastructure buildout in the 1930s).* So
| it's a secular problem, with chronic as well as acute causal
| factors.
|
| - There is a ladder of nursing credentials, and the shortage
| effects them differently. Hiring for roles like CNA and LPN/LVN
| has exploded because of the shortage of RNs and above. CNAs get
| trained in 4-12 weeks to do the heavy lifting of care; RNs get ~3
| year degrees to perform much more complicated tasks.
|
| - Burnout, and the nursing shortage, are in a positive feedback
| loop/downward spiral. That is, the more nurses burn out, the more
| they cause other nurses to burn out. Short-staffed facilities
| have a very hard time pulling back to normal staffing, because
| nobody wants to join a skeleton crew. (I know of long-term care
| facilities where the scheduling nurses (the bosses) are working
| the graveyard shift because they can't fill it.)
|
| - Many nurses work rigid schedules on 12-14 shifts, and a lot of
| medical errors happen at the end of those shifts. **
|
| - The hot US job market (Great resignation, great reshuffle) is
| hitting nursing especially hard; it is very sensitive to external
| shocks. There are paths to easier work and higher pay.
|
| - Many healthcare facilities and systems don't give nurses
| flexibility or the possibility of advancement. (One family member
| will need to quit her current job and come back in a year or two
| to her current employer if she wants to move up a pay grade --
| which is like some tech companies -- but slower moving and lower
| paying.)
|
| - Many facilities are run entirely on foreign staff (the H2-B
| visa allows that). And many nurses are imported from the
| Philippines.
|
| * https://clipboardhealth.com
|
| * https://www.nursing.upenn.edu/nhhc/workforce-issues/where-di...
|
| **
| https://www.nytimes.com/video/opinion/100000008158650/covid-...
|
| (plug: if you're interested in this problem, we're hiring:
| https://culture.clipboardhealth.com)
| xkbarkar wrote:
| Find it a bit amazing that so many here act as if the past two
| years are the sole reason.
|
| Few people have been as relentlessly toxic and unforgiving on
| social media as nurses.
|
| As a child of a nurse, that job has sucked for at least the past
| 40 years. The pay is average. Workplace is a cesspool of gossip
| and toxic work culture. Management is generally terrible. Also,
| the pandemic has exposed how many in the profession really are
| just narcissists.
|
| The amount of facebook posts from indignant nurses spreading the
| most horrible comments , just to receive likes and be perceived
| as heroes, these past two years have made my stomach turn.
|
| Its about time we cleaned up in healthcare. Not just aduquate
| pay, making sure we properly manage healthcare professionals and
| evolve healthcare management to grow where its needed.
|
| I am 100% positive a flexible healthcare system that expands and
| shrinks after societal need is possible.
|
| Not this crazy old fashioned fixed set of beds for x or y, that
| gets cut in some wave when they are needed less. Only to cause
| havoc in years when they are needed more.
|
| Make sure the good nurses dont burn out and quit leaving the
| narcissist and ego maniacs behind.
|
| There are amazing nurses out there, but we need to face that many
| of them are absolute shit at their jobs. And should seek other
| venues. This exodus may be a good thing in the end.
| asdfasgasdgasdg wrote:
| > This exodus may be a good thing in the end.
|
| Hrmmm. Pretty sure if 90% of nurses actually left the
| profession it would be a serious problem.
|
| That being said, I would be surprised if this actually
| happened. If even 5% left the profession would probably become
| more lucrative, since pay would have to rise to retain those
| who remain. Meanwhile, although nursing is not super highly
| compensated, the alternatives for someone who has only a
| nursing education and skillset will likely be worse. That may
| lead to a gap in ideation about leaving vs actually leaving,
| because the fact of the matter is that we all still have to put
| food on the table.
| everhard_ wrote:
| This seems like a world-wide pattern, and it was already an issue
| even before covid.[1] I'm curious about what alternatives they
| have, may be joining newer tech-enabled companies with nursing
| services, or going fully independent and work solely by their own
| terms with some patreon-like app... ?? Or is it the case that
| they are really sick of nursing and might prefer changing
| professions or even unemployment?
|
| [1]
| https://www.icn.ch/system/files/2021-07/ICN%20Policy%20Brief...
| andrewclunn wrote:
| Meaningful Use, ICD-10, more and more top down "big data"
| standards and approaches, that focus on qualitative data entry AS
| care. I mean this literally: thanks Obama.
| oversocialized wrote:
| thenerdhead wrote:
| My sister is a RN training to be a NP. Caring for others has
| always been in her blood. But I can tell she's not happy over the
| last few years (even prior to covid).
|
| This survey has such a low number of responses to make any
| meaningful conclusion from. 200 people surveyed. Non surprising
| stats like 71% of respondents having 15+ years of experience
| wanting to quit.
|
| What really should be the lesson here is that capitalism does
| what capitalism does best:
|
| It cuts costs.
|
| - More patients to nurse ratio (Simply unsafe given most medical
| professionals already lack sleep)
|
| - Little to no compensation relief on the way. (Huge boom of
| travel nursing during pandemic)
|
| - Excess job responsibilities (More paperwork/aid duties, less
| actual nursing)
|
| - New talent / old talent challenges (Larger incentive to switch
| jobs, hard to properly train)
|
| We better figure out something soon. The medical field feels like
| it's holding on by a thread. Insurance companies run rampant with
| no end in sight. Health care continues to increase in costs and
| fail patients to the point of walking out or even dying to get
| care.
|
| While I think generally speaking, nurses like my sister just want
| to feel appreciated like other jobs people are burning out in.
| You can do that in many different ways:
|
| - Don't overwork them.
|
| - Don't underpay them.
|
| - Don't give them unwanted responsibilities.
|
| - Most importantly, listen to them.
|
| I think you may find that people actually do love the profession
| as it's one of the most noble professions out there, just that
| they are being forced out of doing something they love because of
| greed. Greed is not good.
| adventured wrote:
| Report: 90% of people want to stop working.
| uf00lme wrote:
| Poor pay, shift work, bad working conditions and multiple chances
| of catching all kinds of diseases. Most nurses I know have above
| average intelligence with an excellent work ethic. Just one
| bootcamp away from a much better life.
|
| So much sacrifice for the greater good, we the public are not
| worth it.
|
| Another profession I always think of are math teachers, they are
| good people.
| SomeCallMeTim wrote:
| A bootcamp doesn't guarantee anything; without the right
| aptitude and temperament the tech industry is just as
| miserable, with a side of failure if you can't keep your jobs.
|
| And no, "excellent work ethic" isn't enough.
| germinalphrase wrote:
| What non-technical bootcamps provide actual on-ramps into the
| industry?
| lexwraith wrote:
| My wife was/is both an RN and a DNP in NYC during the entirety of
| the pandemic. I'm an Iraq infantry veteran. Our experiences are
| remarkably similar and there are major trends as to why there is
| unsustainable turnover.
|
| 1. Everyone pays lip service. People stand at airports and say
| thank you for your service the same way they open their windows
| at 7PM and start clapping and cheering during shift turnover.
| Sometimes they'll say they know people who are veterans or
| 'frontline healthcare workers' as a sign of solidarity
|
| 2. Nobody actually wants to hear what you went through. Hearing
| people die or knowing people are about to die in sometimes
| painful, unfortunate ways is too raw for people to try to seek
| out and understand, despite the fact that for a significant
| portion of the population that's how we're going to go out, in a
| hospital with all sorts of drugs pumped into our system
|
| 3. There's a constant barrage of emotional/mental harm. Believe
| it or not, you don't magically 'harden up' immediately.
| Absorbing/witnessing drastic outcomes gets easier, but the burden
| doesn't get lighter. This isn't to mention physical harm. People
| do all sorts of things out of desperation and frustration.
|
| 4. The systems that manage you are byzantine if not kafkaesque.
| You're never sure how the decisions are made, yet you're the one
| that will be paying the most for it. You know deep down that
| you're just a number on a spreadsheet, and the only reason that
| keeps you going is internal motivation to do what you think is
| right, so you push on
|
| 5. The people who can help rarely think about you. Very few
| politicians will mention your name or your union that is doing
| its best to get some kind of safe nurse:patient ratios or even
| get the hospital to pay for your scrubs that they mandate. Very
| few billionaires have mentioned healthcare workers or veterans at
| all. As a whole, until someone has an emergency that threatens
| their physical or financial status, healthcare and security is
| treated as a black box with unreal expectations and extra
| sensitivity to deviations from said expectations, despite a
| complete lack of introspection and information on how those
| expectations came to be
|
| I don't know what the solution is. In healthcare, every system is
| so deeply connected to the rest that destroying one or even
| refactoring takes down everything else, and we need it to stay
| online. The same applies to the continuation of geopolitics by
| other means. You can give every IC the best EMR system, the best
| rifle and radio, the best monitor/laptop/keyboard, but it's all
| for nothing if the system as a whole is a dumpster fire. Her
| frustration is palpable every time she finishes a rough shift
| (probably 2 out of 3), and the best I can do is lend my ear and
| pour a glass of wine.
|
| That being said, I am grateful that she is continuing on the
| path. Our shared experiences have brought us closer than ever.
| springsprint wrote:
| My wife works as a floater pharmacist in retail, can confirm, the
| situation is quite similar and very dire. She cannot even get a
| couple of days of UNPAID time-off when needed. The scheduler and
| the management are quite abusive with the way how they treat
| their staff. There is no such thing as a work-life balance.
| civilized wrote:
| This is a PR firm plant http://www.paulgraham.com/submarine.html
|
| In fact the entire website is probably a PR plant.
| pbuzbee wrote:
| Is this a shock?
|
| - Demanding work: 12 hour shifts, irregular schedules, night
| shifts, physically exhausting, limited breaks (including
| bathroom/water!)
|
| - High responsibility with unsafe conditions. You're literally
| responsible for people's lives. Poor staffing ratios stretch you
| thin and make you more likely to make mistakes. And if you make a
| mistake, you're at huge risk for litigation... and now criminal
| consequences too. Responsibilities, resources, and staffing
| stretched even thinner due to the pandemic.
|
| - Administration that treats you as something to be optimized and
| does the absolute bare minimum to support you. Instead they tack
| on additional tasks, expectations, and requirements ("no water at
| a nurse's station!"). They encourage a culture where nurses
| provide a concierge service to 'guests' instead of critical care
| to patients.
|
| - Hostile/entitled patients. I'd guess many/most patients are not
| an issue, but it only takes a couple of difficult/combative
| patients to really ruin your conditions.
|
| - Low pay given the responsibility and working conditions for
| non-travel nurses. https://nurseslabs.com/nurse-
| salary/#nurse_salaries_by_state Like many others pointed out
| here, in tech I make way more than a nurse for a job that's less
| demanding, has far lower stakes, and is of far less value to
| society.
|
| To me the blame lies mainly in middle/upper management, whose
| role is to build and empower an effective workforce. If 90% of
| your workers are considering leaving, you blew it.
| tsol wrote:
| The pay was good enough last year, what changed? In my opinon
| nursing has always been a difficult job, yet they've always had
| people lining up to become nurses. So it must be more than just
| 'the job is too demanding'.
| anonporridge wrote:
| Pure speculation, but if I had to hazard a guess, it's
| because the job is becoming increasingly inhumane.
|
| More and more, nurses have to act like robots to remain in
| compliance, and that's not what any of them signed up for,
| and the increasing lack of intangible reward that comes from
| caring for people and creating a human connection, means they
| demand more explicit monetary reward for temporarily
| suppressing their humanity to do the job.
| goodpoint wrote:
| Can we stop posting posting US-related stuff without a clear tag
| in the title?
| [deleted]
| fumeux_fume wrote:
| Of course the answer to this problem is more optimization and AI.
| Lol, wtf website is this?
| johndhi wrote:
| I've worked in healthcare law for a few years and I think the
| problem boils down to how it's regulated.
|
| It's super, duper complex with lots of paperwork. The complexity
| is too great to run a small practice, the Medicare/Medicaid fees
| are too small to make up for it, and it increases the importance
| of administrators in the hospital system.
|
| If I had a bunch of time I'd love to go through and write up a
| proposed alternative approach, and congressional bill -- but I
| have to imagine even if I did that, no one would listen to it.
| artur_makly wrote:
| I'm sure Elon has a solution for this in 2023.
| nameless912 wrote:
| Anecdotally, many of my partner's coworkers have been on the
| school setting therapist -> hospital setting therapist -> burnt
| out craft store employee pipeline over the last couple of years,
| and my partner is desperate to join them once we have enough
| savings to allow her to quit her job. This is within the
| Speech/Language, Physical, and Occupational Therapist realm, so
| not nurses exactly, but it's similarly bad for a lot of medical-
| adjacent jobs right now.
| nfriedly wrote:
| My mom was a RN (Registered Nurse) for 30+ years. She quit doing
| what most people think of as "being a nurse" about 10-15 years
| ago and switched to related work (home checkups, teaching,
| medical billing, etc.) because of how stressful and demanding
| working the floor in a hospital was.
|
| Last year she retired from the profession entirely, a few years
| ahead of "normal retirement age", and now she works part-time at
| a local farm/fruit stand. The main things that drove her to
| retire early was management insisting on 12 hour shifts and not
| hiring enough staff.
| tssva wrote:
| 12 hour shifts have long been the standard for nurses in a
| hospital setting. A full-time hospital nurse usually works 3 12
| hour shifts in a week.
| nfriedly wrote:
| Yes, you're right, and there are some reasonable arguments
| for it. But I'm not convinced that it's the optimal solution
| for all situations.
|
| I my mom's case, she was mostly doing paperwork, so many of
| the arguments weren't as applicable. She had done 8 or 10
| hour shifts for a while and found that she really preferred
| it (and was staying on top of her work), but then a different
| manager was brought in that forced everyone back onto the
| "standard" 12 hour shifts.
| geocrasher wrote:
| Nurses have an extremely hard job. Before my wife died, she spent
| days to weeks at at time in hospitals over and over again. She
| went out of her way to show them kindness despite her suffering,
| and they always thanked her for it. Most patients treat them like
| _slaves_ and are even abusive toward them- at the very least,
| thankless. COVID only made this worse. It 's no wonder they are
| leaving in droves.
| jmyeet wrote:
| The number of people in the US who continue to defend the
| abhorrent health insurance system is absolutely mind-boggling.
| The level of brainwashing that pervades discourse about single-
| payer health insurance being some sort of communist plot is
| testament to some of th emost successful propaganda of all time.
|
| What's worse is it belies an ugly aspect of human nature
| (particularly pervasive in the US IME) that people absolutely do
| not give a fuck about anyone else when it comes down to it. As
| long as someone is fortunate enough to have decent health
| insurance through their job, people who don't are lazy.
|
| The big picture here is that the wealthy want people dependent on
| jobs and to be in debt (eg student debt) because it makes them
| compliant.
|
| So I'm not surprised nurses are leaving. Insurance companies make
| providing healthcare an absolutely miserable business and
| deliberately killing people ("prior authorizations", "pre-
| existing conditions", etc) should not be the basis for commercial
| enterprise. Denying someone life-saving or life-changing care
| should not be a profit motive.
|
| What's worse is that a lot of the burnout is effectively caused
| by people who are profoundly selfish and are voluntarily choosing
| to get sick and die of what is now a highly preventible disease.
|
| It's a hard situation because people depend on nurses so
| collectively they're torn. Teachers OTOH aren't life-critical
| (but still obviously important) so I'd actually like to see them
| make a mass exodus over all the right-wing censorship they're
| facing in most states.
| fundad wrote:
| Yeah it's wild how well the grift works. My coworkers want
| private insurance (because we get it) and oppose universal
| healthcare. I think generally people in the states are ok with
| a grift if it hurts poor people worse. Because of that
| literally everyone expects they are getting grifted at all
| times and trusts no one.
| Ericson2314 wrote:
| There should be strikes until we get medicare for all. Simple as
| that.
| lucidone wrote:
| I have family members who work in health care here in Canada. The
| fact that their wages are subject to regulation (e.g., they are
| effectively getting a paycut this year with inflation), they
| realistically cannot strike to improve their working conditions
| (people will die), and that their work is very demanding
| (physical labour, emotional labour, shift work, constantly
| understaffed) makes this an unsurprising statistic from my
| anecdotal experience.
| Footkerchief wrote:
| Is that 90% figure new, or has it been the case in past years?
| gagan2020 wrote:
| Why no one talking about survey size of 200 nurses of particular
| area only
| AviationAtom wrote:
| How are more people not sounding alarms about the future of our
| society with more bleak headlines like this? I fear we have
| become far too reactive to many problems that should have been
| anticipated, and planned for.
| Zeetah wrote:
| Wonder if this is a US phenomenon or a global phenomenon?
| thg wrote:
| It's about the same here in Germany.
|
| Source: Got nurses in the family.
| bezospen15 wrote:
| How do we reduce the cost of health care while simultaneously
| paying nurses more?
| jmugan wrote:
| A lot of us are saying we need to increase the pay of nurses, but
| we also believe that medical care is too expensive. So, where is
| all that money going? There are a lot of flippant answers but
| they never seem to lead anywhere actionable.
| eksx wrote:
| One example is drug waste. Insulin for example is charged per
| vial to the patient but usually only a minimal fraction is
| actually used and the remainder is disposed of.
| jeffrallen wrote:
| And then the patient is charged a disposal fee.
| jrochkind1 wrote:
| I am not sure, and I'm not saying this is the WHOLE problem (in
| fact I am confident it is not), but... in 2017 (first hit I got
| googling) 7.9% of all healthcare expenditure in the USA ($275
| billion) went to insurance overhead, vs 2.8% in Canada.
|
| But yeah, in general, this is a problem (healthcare in general,
| healthcare expenses, nurse job experience) where almost all
| other countries with similar wealth are doing so much better
| than us, it shouldn't be _that_ mysterious to solve it, right?
| It 's not like, who knows if it's even possible to do better!
| Like, we know it is... figuring out what the difference between
| them and us isn't trivial, but it should be easier than
| something there isn't a model for.
|
| The most obvious difference would seem to be how insurance (and
| universal coverage thereof) is handled.
| orwin wrote:
| In France, 18% to 22% of the money given to our public
| insurance is used for administrative stuff, which i thought
| was a lot. Then I learned that 31% of what my company pays
| for my private insurance is used for administrative purpose.
| So either private companies are way less efficient than
| public service, or i should immediately buy shares from
| Swisslife and others.
|
| Guess what my first major investment was?
| ciphol wrote:
| It goes to treating crises (expensive) rather than preventing
| them (cheap)
| shantnutiwari wrote:
| The article seems to focus too much on : How can IT fix this
| problem?
|
| Ugggh, maybe it can't? As the main problems seem to be political,
| not tech related?
|
| You might as well ask how IT can be used to fix homelessness or
| police brutality?
| bell-cot wrote:
| My last experience in a hospital was Dec'21. ICU, at an old
| friend's bedside, in a large (500+ beds, "teaching") hospital
| that is part of a big (50+ hospitals) chain.
|
| The nurses seemed excellent...but the amount of time and
| emotional energy they had to put into dealing with multiple
| computerized systems - just within my friend's room, to replace
| an empty IV bag - was staggering. The "smart" IV pump was the
| worst - a crappy little display, a minimized number of flaky
| buttons as the only interface, and the nurse had to drill down
| into multiple sub-sub-sub menu's to do even basic stuff.
|
| My first thought was that you could triple nurse productivity
| (as in "care given to sick humans") if you had two IT tech's
| following each nurse around, tasked with doing all the "re-
| redundant data entry & dealing with computerized shit" that had
| obviously become the nurse's primary job.
|
| My second thought was that interfaces which the nurse had to
| deal with should be restricted to 1950's-industrial-control-
| panel style - nothing but well-labeled, single-purpose physical
| buttons, switches, & dials. And the data entry that they had to
| do was restricted to wax pencils on well-laminated paper -
| which could be fed to a scanner, to update the patient records
| database. ( _Displays_ , say of vital signs & such, could be
| fancy. But the "50's control panel" rule could put an end to
| "oh, that information is hidden down in a sub-sub-sub-menu
| here..." shit.)
| ed_balls wrote:
| The average ago of nurses went from 46 to 55 in my country. The
| current retirement age is 60.
| detcader wrote:
| because the headline can never be "90% of nurses' employers fail
| their employees this year"
| TOMDM wrote:
| Well yeah, because it's reporting on a survery of nurses which
| included a question about whether they're considering leaving
| the profession.
|
| I think your would be headline is a fair inference to come to,
| though not the sole cause.
|
| With how over sensationalised our media is, can we avoid
| complaining when headlines actually directly match the thing
| they're reporting on for once?
| fitba72 wrote:
| In my experience, most nurses come in, socialise and cheer you
| up, take your blood pressure and temperature with automated
| devices, that one can buy for home use, and give you medicines
| that a doctor has prescribed (someone can also can do at home if
| they are feeling up to it). This is a wonderful profession and
| they should be highly paid but do they really need a bachelor's
| degree or master's degree to do this job? Some specialised nurses
| can even draw blood but, again in my experience, many of those
| were unable to "find a vein" and had to call on someone more
| experienced or a doctor. Pretty sure some experienced heroin
| users could do a better job at this. Just my experience.
| [deleted]
| shadowofneptune wrote:
| Where a less credentialed person can do the job it has already
| been done. Here's how it breaks down:
|
| Registered Nurse (RN): The 'specialized nurses' you talk of,
| and what this article is mainly about. Requires at least an
| associate's degree to be licensed, but increasingly an
| bachelor's is expected. Only they can administer any medication
| a doctor prescribes, and only they can assess your condition.
|
| Licensed Practical Nurse (LPN): If they are certified they can
| also do blood draws. Requires graduation from an LPN program
| (usually about one year) to be licensed. They perform easily
| predicted tasks like a dressing change that do not require
| assessment. They can also administer some drugs based on the
| situation.
|
| Unlicensed Assistive Personnel (UAP): In a big hospital, these
| are who are checking your temperature most of the time. They
| can only do basic tasks that do not require any medical
| training, even if their experience is larger than the RNs and
| LPNs they're under.
|
| There are also many different technicians. In a big hospital,
| an RN acts as a middle manager delegating their work to these
| many different tiers. In an ICU, or in a small hospital, it
| will be done much more by themselves.
| theguyovrthere wrote:
| Nurses leaving the field is only part of the larger problem.
|
| Nursing educators aren't exactly a dime a dozen. The average age
| of a masters prepared nursing educator in the us ranges between
| 56-62. Doctorally prepared is higher. The country is facing a
| nursing shortage, and a nursing educator shortage.
|
| Now my doctor has an interesting theory that some of the pain
| points for nurses is being created by the hospital systems and
| industry themselves as an excuse to say we dont have enough
| nurses and bring in nurses from other countries like the
| Philippines, as they'll be glad to come to the US and work for
| less, and will be so grateful for the opportunity that they'll go
| along with whatever the hospital says they need to do. (This was
| in the context of vaccines.)
|
| The other thing that has nurses worked up is recently is this
| case: https://www.cbsnews.com/news/radonda-vaught-nurse-guilty-
| dea...
| jrochkind1 wrote:
| There's even more in here beyond the headline about nurse
| satisfaction.
|
| USA healthcare pretty broken, and sliding into catastrophe. Nurse
| dissatisfaction is just the tip of the iceberg, or the canary in
| the coalmine.
|
| > Eighty-four percent of emergency room nurses and 96% of
| intensive care or critical care nurses have a 4:1 ratio, which is
| double the optimal target of 2:1.
|
| > Thirty-six percent of nurses said they've seen patients with
| acute health conditions walk out of the ER because of the wait
| times for an inpatient bed. And 37% said that surgeries had to be
| rescheduled because of bed shortages.
| sujitjadhav wrote:
| Time to bring Robots faster.
| [deleted]
| djohnston wrote:
| I would expect robots to replace physicians before nurses for
| the same reason I'd expect them to replace architects before
| plumbers.
| manuelabeledo wrote:
| So my Roomba still gets stuck under the sofa, and robots still
| cannot make a full lunch, but they will replace nurses? Yeah,
| good luck with that.
| fallingfrog wrote:
| Never seen an industry that needed unions more.
| susrev wrote:
| They surveyed "more than 200 hospital registered nurses based in
| the U.S.". Does this small of a sample size truly reflect the
| feelings of the ~2.4 million (2019) registered RN's in the US?
|
| That is 0.00008 % of all RN's in the US.
| stakkur wrote:
| I work for a major healthcare provider (thousands of nurses) and
| while there's a lot of unhappiness, nowhere near '90%' are
| considering leaving.
|
| And really, this is a red herring; the real problem started long
| before COVID. This video essay nails it (or so care practitioners
| at my workplace say, anyway):
| https://www.nytimes.com/video/opinion/100000008158650/covid-...
| [deleted]
| sllewe wrote:
| Using an anecdotal source - My Wife (ICU RN) this is sounds
| right.
|
| Outside of the existing issues with Bedside nursing (long days,
| physically demanding) - the primary issue is staffing. Pre-
| pandemic the ratios were already bad but now many are leaving for
| travel contracts which carry significantly better wages. It
| quickly becomes a loop where employees leave for Travel
| Contracts, and then can only be backfilled with Travel Contracts.
| The remaining FT staff nurses are left making much less money,
| and have to assist "training" with the outside Travel nurses. And
| while this is nothing against them - The travel RNs also often
| have a different "vibe" as they are much less focused on long
| term improvement or problem solving within the Unit.
|
| Also ICU/PCU/ER nursing throughout the pandemic was a terribly
| depressing place to be. Leaving many of my Wifes colleagues
| (including herself) with what is essentially PTSD with little or
| no support from the Hospital System.
| durrden wrote:
| My wife (ER/Trauma RN) feels the same way. They will need to
| double the pay of non-travel nurses to get through this.
| alostpuppy wrote:
| The existence of travel nurses should really be indicative of
| a problem.
| pmulard wrote:
| Travel nurses serve a need, like if another nurse gets
| injured or has a child, and they will need to be
| temporarily replaced.
| solenoidalslide wrote:
| Shouldn't travel positions exist for every other
| profession?
|
| The reason why it's expected for nursing in particular is
| the indicator that something here is very wrong.
| InitialLastName wrote:
| Should it? The market for medical care has a base rate (and
| appears to be clearly under-staffed for that rate), but
| (especially in a pandemic) it's rather peaky and the basic
| skills appear to be VERY transferable from location to
| location. If there are people with the skills that are
| willing to travel, it seems that a system that maintained
| maximum capacity in all locations would be a very wasteful
| one.
| alimov wrote:
| Yes, it should be indicative of a problem. The fact that
| nurses are overworked, and underpaid is a big issue.
|
| > If there are people with the skills that are willing to
| travel, it seems that a system that maintained maximum
| capacity in all locations would be a very wasteful one.
|
| The general idea here is that more and more nurses are
| willing to do this because they are underpaid and
| overworked in their regular (non-Travel Nurse) positions.
| I didn't see anyone arguing for "maximum capacity"
| either... just better wages and working conditions.
|
| > basic skills appear to be VERY transferable from
| location to location
|
| If you read the parent comment by sllewe you will see
| that there are other costs and concerns around this which
| do more to stress existing nurses at whatever hospital is
| being filled with travel nurses. Imagine training a new
| someone every week (or however often new travel nurses
| pop up) while also having to do your own job...
| especially when you are already being overworked and when
| a miscalculation on your part could result in loss of
| life. All the while knowing that the travel nurse is
| making significantly more money than you, negotiated
| their hours of availability and doesn't have to care
| about the unit beyond whatever contract length they
| signed up for..
| mansilladev wrote:
| As the son of a retired nurse, I can tell you that this has been
| true since the dawn of the nursing profession.
| sonicggg wrote:
| Nurses complain about their work conditions, but I don't
| understand them. They had this massive leverage during the
| pandemic to discuss improvements. Some people may say "Oh but it
| is illegal for nurses to strike in country X", but what will
| governments and companies realistically do if all nurses decide
| to stop, arrest everyone and let the health system collapse? Not
| a reasonable option.
|
| There's just something masochist about their profession.
| d4mi3n wrote:
| Legalities aside, how would you feel about refusing to work for
| poor pay/conditions if you knew for a fact that said decision
| would result in many deaths?
|
| Not a chance, not a speculation, but absolute awareness of the
| number of patients that will not receive care and likewise will
| die as a result.
|
| I don't think it's fair to blame nurses for poor treatment when
| they have a multitude of terrible options to pursue in order to
| improve their working conditions.
| belval wrote:
| It's unfortunate to see this downvoted because I've heard this
| sentiment echo'ed a lot and I think it's worth explaining.
|
| It's not about the illegality, it's really just about people
| dying. Yes you can go on a strike but your patient that's in
| critical condition won't survive on principle. You could say
| "just don't care about the patient and strike anyway", but
| that's extremely hard to do.
|
| Striking when it hurts some millionaire owner is one thing, you
| wouldn't feel bad about yourself. Striking when it hurts
| someone post-op who did nothing wrong aside from being sick
| isn't noble, you get to live with the fact that as an
| individual you could have saved them, yet you didn't because
| you wanted money.
| sonzohan wrote:
| It seems like your comment would be better directed towards
| weak or absent nurse unions, instead of individuals. I had
| countless nurse and physician friends go to their hospital
| directors/HR/managers during the pandemic "I need a raise
| because I have absorbed the load of 3 other workers and am
| working harder than ever." Not only were they refused, many
| instead received 10-33% pay cuts, with hospitals citing
| increased Opex costs despite decreased staffing, significant
| government assistance, and increased volunteer (0-cost) help.
|
| It'd also be enlightening for people in this thread to have
| hospital executives explain how they have some of the highest
| patient numbers in history yet they're hemorrhaging so much
| money their physicians had to take pay cuts.
|
| Nurses, due to their profession having relatively low barriers
| to entry yet requiring years of operational knowledge to truly
| be effective, need collective bargaining. Nurses do strike, and
| nurse strikes are actively occurring on the U.S. West Coast.
| However, the unions they represent are small and have little
| power overall. For a strike to be successful you need
| solidarity from a majority of workers in the area you want to
| impact. You also need buy-in from the hospital/region that
| union nurses will provide superior care to non-union nurses.
| Something that's hard to do when your average executive thinks
| that the most complicated thing a nurse does is sticking a
| patient.
| Ensorceled wrote:
| It's more a lack of psychopathy in the profession. If nurses in
| Ontario had gone on strike two months ago, a lot of extra
| people would have died.
| sonicggg wrote:
| I know Ontario all too well. The same people that depend on
| nurses won't do more than needlessly beat pots and pans for
| their "heros". They do not even support them with their
| votes, which put in power the nefarious Conservative party.
| Who exactly are the nurses standing for? People that won't
| have their back.
| TOMDM wrote:
| I think there's some middle ground between "Hey, we need
| some more support, our conditions suck" and "Fuck it, we'll
| let the sick die I guess"
| bsedlm wrote:
| at some point, somehow, medical care stopped revolving about
| 'healing' and medicine became all about 'treating'.
|
| the health of the patient became subordinate to the economic
| incentives of the hospitals and the other involved institutions
| (insurance providers, pharmaceutical corporations, etc...)
|
| and so I have the hypothesis that this happened because people
| (young adults) going into medicine because of a vocation to help
| and heal others become disheartened when they find out it's all
| about institutional profit; only them who get into this becuase
| "doctors make good money" really make it to the end (which is not
| terrible, as they usually do learn the methods and techniques of
| medicine, but that in the long run prioritize money over health).
|
| health care should have never been allowed to become a capitalist
| marketplace.
| screye wrote:
| Not to be mean, but 'leave nursing' and then what ?
|
| Nursing is a well paying middle-class job without a lot of
| transferable skills to other professions. Don't say programming.
| It isn't the solution to everything. Other low-entry-barrier jobs
| pay much less and have exploitation problems of their own. For a
| lot of middle class families, dual income is essential to
| maintain their lifestyle. So SAHM is not an option. Nursing has
| clearly gone through a rough 2 years, but I suspect that things
| are going back to normal now. Why leave now ?
|
| > High patient-to-nurse staffing ratios
|
| This bit is confusing me. If supply-demand is in the Nurse's
| favor, then don't they get more leverage on what QOL and wages
| they can demand ? It is not like they can fire a senior nurse on
| low pay, when new nurses are harder to find and demand higher
| wages. I know that the nurses refusing work and resulting deaths
| has bad optics, but it doesn't look like hospitals have a lot of
| leverage right now.
|
| > Administrative burden and manual tasks
|
| Sounds like an opportunity for a startup to disrupt the space.
| But, the jaded side of me thinks that the startup will fail due
| to insufficient political leverage with hospitals/insurance/law-
| makers.
|
| > health IT
|
| Keep calling it health IT and the problems will never be solved.
| Solving hard problems needs reframing of the resources dedicated
| to it. When tech workers are seen as assets and not cost-centers,
| these problems will solve themselves.
| kerbs wrote:
| > 'leave nursing' and then what
|
| When we got married, my wife (Physicians Assistant) made
| handily more than I did. $140k to my $82k midwest, software
| development job.
|
| 10 years later, she makes $130k (after cutting hours back) and
| I make $4-500k as a software engineer in the midwest. The two
| markets crossed _drastically_
|
| Where are they going?
|
| For us, home.
| screye wrote:
| > I make $4-500k as a software engineer in the midwest
|
| This is a massive outlier though. In your case, the exception
| proves the rule.
|
| The rule: "The 1% of Nurses that found a partner in the US
| top 1 percentile will be able to quit their job."
| jewayne wrote:
| $500K as a software engineer? That's the very tip of the
| unicorn's horn. My friend works as a CEO of a (smallish)
| software company and makes half that.
| peanuty1 wrote:
| This forum almost certainly skews heavily towards people in
| Silicon Valley or working at Bay Area companies. AKA the
| very highest earning people in tech.
| titanomachy wrote:
| "If supply-demand is in the Nurse's favor, then don't they get
| more leverage on what QOL and wages they can demand?"
|
| I have a family member who works in public health and is trying
| to staff nursing positions. She has something like a $400k
| budget to hire 4 nurses at $100k each (let's say). She is
| unable to fill the positions because cost of living in her area
| has gone up so much. She'd rather have 2 nurses at $200k each
| instead of zero nurses, but she's simply not allowed to do
| that. She's trying to change policy but it's a massive uphill
| battle.
|
| Power's concentrated very high up in health care, and it's
| exercised through the use of rigid policies. It certainly seems
| like nurses should command higher wages, but the bureaucracy
| has become very effective at preventing basically anything from
| changing quickly.
| warner25 wrote:
| I was thinking the same as your first point. I'm a career
| military officer and know a lot of military families[1]. My
| observation is that the spouses who are doctors and nurses are
| the only ones who can reliably find middle-class employment.
| Becoming a nurse is much easier than becoming a doctor, and
| pays much better than other common things like retail, food
| service, house cleaning, and photography (probably more of a
| hobby).
|
| [1] The labor participation and employment rates for military
| spouses (especially when adjusted for age and education) are so
| low that they're almost off the charts. The causes are frequent
| cross-country moves to economically struggling locations, and
| an extreme need for flexible schedules (e.g. for when service
| members get deployed and spouses become de facto single
| parents). Medicine seems to be unique in that it's everywhere,
| always hiring, and often allows for part-time employment.
| raydev wrote:
| > Nursing is a well paying
|
| Only in a vaccuum. It pays far worse than other jobs at the
| same rate given the effort and stress the job entails.
|
| > don't they get more leverage on what QOL and wages they can
| demand ?
|
| Sure, but it needs to get far worse. The hospitals are only
| going to budge once walkouts are organized. But that can't
| happen without strong unions, most nurses just need to pay the
| bills which is why they continue to put up with it.
|
| I'm not sure you understand who has the leverage. The hospitals
| can let healthcare deteriorate far beyond current expectations.
| They still get paid in the end. The environment for patients
| and nurses will only get worse.
| BeetleB wrote:
| > It pays far worse than other jobs at the same rate given
| the effort and stress the job entails.
|
| Depends on location. Most professions I know with that much
| effort and stress get paid a lot less than $100K, which is
| the median nurse pay in my area. Amazon pays a lot less.
| kerbs wrote:
| > don't they get more leverage on what QOL and wages they can
| demand ?
|
| Following up on this apart from my reply above, my
| observation is instead of raising pay they simply let roles
| languish. It's bizarre.
|
| But then again it feels like that's what happens when
| nursing/AP care is treated as a cost center. It seems like
| they aren't concerned with addressing a market as much as
| keeping cost/income the same as it has always been.
| eftychis wrote:
| What I read here instead is that the American people is fine
| with deteriorating healthcare, and will not regulate the
| industry, nor burst into a walkout of their own.
|
| I find it cheaper to fly back to Europe and pay out of pocket
| (uninsured) for anything non-trivial along with my flight
| ticket than pay for California services. Only two things I
| miss: a) nicely decorated clinics and nurses taking my vitals
| and information instead of the doctor b) heart attack or
| stroke chance while reading the bill.
|
| (Of course, I have the advantage of having people to stay
| with. Perhaps, Airbnb will start offering health services
| that way soon.)
|
| /s
|
| Seriously, we need to start looking as health care for its
| value as health care and not a money grab; we pay enough
| taxes to have a hospital running without the fear of
| profitability I believe -- in California at least.
| jewayne wrote:
| Honestly, unless they're not in the midst of fighting a
| serious illness, most Americans just want to be sure that
| they have access to better healthcare than the people below
| them in the socioeconomic ladder. They're fine with
| healthcare deteriorating, as long as it deteriorates at
| least as much for the guy below them.
|
| Now, if a serious illness comes along, some people do wake
| up and realize it's not a f*cking game. But certainly not
| all.
| sebow wrote:
| No surprise at all. A lot of unnecessary stress (yes, more than
| enough, even for a pandemic) and the top-down approach of the
| institutions really broke the trust of the public in many
| healthcare systems worldwide. I think the sentiment would be the
| same even if wages would be raised (and in many cases they have
| been).
|
| Considering it was bothersome for both healthcare workers and the
| public, in my opinion the friction is more between the healthcare
| workers and management/government entities (& their policies)
| rather than "some patient bothered me" cases.
| TYPE_FASTER wrote:
| I'm a software engineer. My wife is a RN. It's been interesting
| over the past 20+ years to see the parallels in two different
| markets. Temporary staffing is used to fill vacant reqs. Gradual
| erosion of employer provided benefits.
| giantg2 wrote:
| "... poor processes, along with inefficient operational workflows
| and administrative burden are key drivers of frustration and
| burnout among ..." [insert job here]
|
| This is pretty much universal in my experience. As a dev, it
| always seems to boil down to these. It's amazing how the business
| doesn't know their processes, can't document them accurately, or
| simply don't care to analyze and document them. Garbage
| requirements become a garbage system.
| Blackstone4 wrote:
| Might be similar for teachers...I know many have cut back hours
| to part time where they can or are considering leaving. They are
| having to fill in for staff absenses and are stressed.
| mattmaroon wrote:
| It's a lot easier to say you will leave your profession than to
| actually do it, so I don't expect anywhere near 90% to be true.
| But it won't take that many to leave before it becomes a severe
| problem. The industry will be forced to reckon with this. We
| can't not have nurses and healthcare is basically an infinitely
| large industry (people will spend all of their money to stay
| alive) so I'm sure it will be improved.
| t_mann wrote:
| If there ever was a contrarian move then it'd be for an 18-year-
| old to start nurse training now. Probably one of the last
| professions at all to be hit by automation, practically
| guaranteed demand for skilled labour and a hefty shortage thereof
| in the making.
| retr0nerd wrote:
| Get ready for another dark age. The destruction of education and
| medicine in this country means plague doctors will be making a
| return. Better check with your HMO to make sure your policy
| covers them.
| ubermonkey wrote:
| A good friend of mine was a nurse practitioner in cancer care
| here for 17 years, and quit last year to do contract work in
| interesting places. She's unmarried, no kids, etc., so I think
| it's a little bit of a "shake things up" thing but also a little
| bit "make hay while the sun shines."
|
| Her most recent gig was in Antarctica. I mean, cool, right?
| post-it wrote:
| I would love to spend a winter at the south pole station. The
| biggest downside of being able to do my job remotely means I'll
| never get sent to cool places. :(
| pmulard wrote:
| It's even better. You can send yourself to cool places :)
| jimmar wrote:
| A family member just quit her nursing job because she refused to
| learn yet another system. She was great with patients but could
| not stand the computer systems she had to use.
| brimble wrote:
| I feel like quitting _receiving healthcare_ when a provider
| switches their records systems or adds a new one and I have to
| input all the same shit _yet again_ (what the _fuck_ is even
| the point of digital medical records? They can 't keep even the
| most basic info straight anyway!), so I can only imagine what
| that's like for the people who have to work with it daily.
| throw8383833jj wrote:
| Here's my naive understanding of the situation:
|
| It sounds like they're just being overworked. So, just have the
| nurses take a 20 minute break every 2 hours, to go out and take a
| walk. The hospital can require it if it comes to that but why
| wouldn't they just want to do it? and if the hospital doesn't
| want to do it, then the nurses should insist on it and walk off
| the job if not given their breaks. I would imagine the hospital
| would rather agree to 20 min breaks every 2 hours rather than
| loosing 90% of their workforce forever: they don't have a choice,
| they have to agree.
| defterGoose wrote:
| Well, at least you're aware that it's a naive understanding...
| throw8383833jj wrote:
| why doesn't collective bargaining work in this scenario? if
| the demand for nurse labor is so incredibly high, they should
| have a lot more bargaining power, no?
| airstrike wrote:
| Compared to what % historically? If you don't give me historical
| trends, I don't know what to make of this one data point.
| mberning wrote:
| My wife worked bedside at a nationally ranked childrens hospital
| for 5+ years. She left recently for private practice and loves
| it. More money, less stress, better management. The list goes on.
| Bedside nurses are often not paid very well, are treated poorly
| by patients, and even more poorly by administrators. The
| hospital's motto should be "anything for the patient, nothing for
| our employees".
| saos wrote:
| Not surprised. Cost of living is at an all time high whilst wages
| have stagnated. Atleast thats the problem in the UK.
| mfer wrote:
| I've spent a fair amount of time talking with nurses about the
| problems. I'm related to a bunch of people who are nurses across
| disciplines (ER, ICU, med/surg, etc). It's been enlightening
| hearing them talk about the problems...
|
| 1. Many new nurses make the same or more and long time nurses.
| It's frustrating when the nurse in charge with the most
| experience is making less than new nurses. Some hospitals are
| even trying to stop nurses from talking about pay.
|
| 2. Patients in COVID have become downright mean. Add this to the
| problems nurses have management and doctors (who are often rude
| and arrogant) and it's a poor culture. The quality of the
| environment, from a mental health standpoint, is on the decline.
|
| 3. IT systems that they have to use were designed by people who
| have not talked with the workers who use them. They may have been
| designed with laws and compliance in mind. Nurses aren't the
| people who choose or pay for these systems. But, they use them a
| lot (maybe the most) and it's obvious they weren't taken into
| account when designing the UX. It's maddening for them.
|
| This one is big for product designers. Often we listen to the
| people who pay for it and miss out on the people who actually
| have to use it.
|
| 4. Nurses are the catch all for jobs. Not enough aides? Nurses do
| the work. Food service workers don't want to take food into a
| patients room... nurses will do it. Not only do they have higher
| ratios of patients but they fill in the work when other areas
| have shortages, too. So, the work per patient goes up. Pay
| doesn't go up, though.
| abeppu wrote:
| > Many new nurses make the same or more and long time nurses.
|
| Is it mainly lack of information (and exhaustion) that prevents
| these more experienced nurses from negotiating for what they're
| worth?
| causality0 wrote:
| _3. IT systems that they have to use were designed by people
| who have not talked with the workers who use them._
|
| You couldn't be more right about that. Last week a nurse had to
| use a computer in my wife's hospital room to log that she'd
| given her a painkiller. The IT staff had failed to configure
| the hospital computers to disable windows updates or restrict
| them to off-hours and the nurse was forced to stand there for
| ten solid minutes while Update churned, the pc restarted, and
| Update churned some more.
| zdragnar wrote:
| Back in the days before cell phones, my mom would wind up being
| on call for overnight labor & delivery. The final straw
| (certainly not the first) was that they got a call in the
| middle of the night that a woman came in in labor, and she had
| to drive in to work (a half hour drive). This woke up my dad,
| who also happened to be a light sleeper and worked a day shift.
|
| 20 minutes later (while my mom was well on her way into work)
| the phone rang again- it was a false alarm, she didn't need to
| come in anymore. Naturally, it was my (not so happy) dad who
| answered.
|
| By the time she got in, they didn't have anything for her, so
| sent her back home.
|
| At the time, there wasn't quite such a crunch in nursing, so
| the pay part wasn't accurate yet, but everything else you
| listed (substitute COVID for %50+ of patients) was already true
| 30 years ago.
| odysseus wrote:
| I would think some hospitals have rooms dedicated for the on-
| call nurse(s) to sleep in. Especially with something as
| common and false alarm prone as overnight labor & delivery.
| Pretty sure the midwifery I went to had this.
| thepasswordis wrote:
| >Patients in COVID have become downright mean.
|
| Maybe, but nurses have also used "because covid" as an excuse
| to engage in some pretty awful behavior. Fathers have only very
| recently been allowed in the room during ultrasounds, for
| instance. NICUs only recently started allowing both parents to
| visit at the same time.
| majewsky wrote:
| Is this because of the whims of individual nurses, or because
| of policies put forth by the hospital administration?
| [deleted]
| tristor wrote:
| > This one is big for product designers.
|
| You're right that there are definitely opportunities for
| improvement here. As a Product person that has worked in
| EMR/Healthcare IT systems, I can tell you the biggest challenge
| is most of the decisions are driven by legally-required
| compliance. In many cases, you literally cannot make it better
| because the brokenness is /by design/ to comply with the law.
|
| Nearly across the board, especially in the US, our legal and
| regulatory climate has not kept up with technology and often
| actively works to the detriment of technical innovation and
| improving our systems.
| primedteam wrote:
| HITRUST certification is the most demoralizing thing I've
| done in my life. You need a policy, a procedure and evidence
| of things like this:
|
| _Shared system resources (e.g., registers, main memory,
| secondary storage) are released back to the system, protected
| from disclosure to other systems /applications/users, and
| users cannot intentionally or unintentionally access
| information remnants._
| bawolff wrote:
| I mean, if it was really a very high security system,
| ensuring that confidential info in memory cannot be written
| unencrypted to a swap file, does seem like a reasonable
| requirement.
| seanp2k2 wrote:
| Yep, try doing that in an electron context and you quickly
| learn why a lot of this software still runs on mainframes
| with UX from the 80s, hard T1 lines (if they're lucky
| enough to be off ISDNs), faxing things all around since
| that's considered "secure", etc etc. A lot of startups
| can't touch this stuff due to regulatory hurdles. When the
| first step is "go change the law", it's a non-starter.
| tristor wrote:
| I understand exactly what you mean, but having done HITRUST
| CSF certification for a system, I will say that it is not
| as bad as some others, because at least HITRUST is /very/
| clear in its requirements, so there's not as much vagaries
| and back and forth with auditors after the fact, or rushed
| changes. It's truly a nightmare to meet, but once done you
| can be assured you will pass the audit fairly.
| artful-hacker wrote:
| I'm in this business too, and it's not just the direct
| features supporting the law, its the law driving out time and
| talent trying to make things better. We don't have time to
| improve systems because we are all too concerned with meeting
| the latest regulatory pipe dream of interoperable systems.
|
| Systems that nobody has ever asked us to use. Entire APIs
| with full access to key data, that nobody uses.
| tristor wrote:
| Yes, this is probably the bigger impact, to be honest.
| Teams have limited resources and more and more of it is
| cannibalized by regulatory compliance work.
| giantg2 wrote:
| We've created so much regulation that no one person can
| know it all - not the legislators, not the
| agents/bureaucrats, not the judges, and certainly not the
| workers or patients who would be most affected by them.
| jimmydddd wrote:
| Steve jobs mentioned this as a reason he never wanted to do
| enterprise sales. The user and the purchaser are two
| different people.
| m463 wrote:
| I wonder how this is handled inside apple? Are apple
| internal tools good or terrible?
| JaimeThompson wrote:
| Doctors and hospitals control some of the more powerful
| lobbying groups in the United States making it a bit strange
| they haven't worked on those issues.
| namelessoracle wrote:
| "Doctors and hospitals" are not nurses and do not seem
| themselves as akin to nurses.
|
| It's like asking why most software devs don't go to bat for
| technical support people.
| dragonwriter wrote:
| > Doctors and hospitals control some of the more powerful
| lobbying groups in the United States making it a bit
| strange they haven't worked on those issues.
|
| Doctors and hospitals are not necessarily aligned groups
| (either with each other or with nurses) on the issues, and
| private insurers, state governments (as market participants
| themselves, via operating public insurers such as Medicaid
| agencies), and other players are also very powerful
| lobbies.
| asdff wrote:
| It seems the byzantine regulatory compliance software lobby
| is even more powerful then
| lazide wrote:
| Why when they get paid/further protected by it?
| asdff wrote:
| There is a reason why these things are like this. Someone
| with influence is making money hand over fist with the
| current state of affairs, so it says. Regulation are always
| penned by those in industry they are set to regulate with
| government connections. Politicians don't do anything unless
| there is a push for it by lobbyists or donors because that's
| where the incentives are.
| tristor wrote:
| For healthcare the regulations mostly entrench the big
| players in insurance. It's regulatory capture 101.
| asdff wrote:
| And what sucks about this entire situation is even if you
| today fixed healthcare, because you havent fixed
| regulatory capture it will end up screwed up in some
| other direction as soon as the grifters finish planning
| out their graft and ringing personal phone numbers in
| washington DC and state capitols. Fixing regulatory
| capture is therefore required to solve the big problems
| we have, like climate change, housing, and healthcare,
| otherwise no fix will ever be long term and meaningful.
| The incentive structures with regulatory capture favor
| personal profit over public good every time.
| Terry_Roll wrote:
| >3. IT systems that they have to use were designed by people
| who have not talked with the workers who use them. They may
| have been designed with laws and compliance in mind. Nurses
| aren't the people who choose or pay for these systems. But,
| they use them a lot (maybe the most) and it's obvious they
| weren't taken into account when designing the UX. It's
| maddening for them.
|
| >This one is big for product designers. Often we listen to the
| people who pay for it and miss out on the people who actually
| have to use it.
|
| Thats an interesting comment because I know the main developer
| for one of the most popular hospital systems used throughout
| Europe and its popular because its good.
|
| Saying that, I also know there are medical consultants at a
| world famous hospital who dont really know how to program but
| because of their position have got their software in use when
| it perhaps shouldnt be.
|
| I know alot of US programmers doing various medical systems for
| local hospitals and health care regions with various standards
| of programming skills.
|
| Like you I also know of people in various roles, from world
| famous multi millionaire consultants to nurses on the front
| line. Every team & dept is different. Sometimes its a
| managerial problem at the top of the health trust, other times
| its just the team and low level management.
|
| Saying that there is a culture of taking a sicky probably
| because they see consultants putting private work before NHS
| work and they see the wages some of these consultants get paid
| and Google Scholar, PubMed, DrugBank etc keeps highlighting the
| inadequacies of the teaching, ie they dont keep up to date,
| some areas appear to be decades behind the science other areas
| are within a few years of the latest research.
|
| Too much reliance on drug companies when superior non
| patentable solutions already exist.
| meatsauce wrote:
| How, in your opinion, did the Affordable Care Act affect
| nursing? Were you in a position to observe then?
| peoplefromibiza wrote:
| preface: my parents are retired nurses and a big chunk of my
| family works in healthcare.
|
| It sounds like the issues nurses face are global and do not
| significantly change across different systems (the system in my
| country is completely different from USA)
|
| It probably comes down to the fact that this is a human problem
| and to solve it we must radically change the expectations
| around care and primarily being taken care of.
|
| There's no technological deus ex machina or amount of training
| that can change the situation without shifting the POV.
|
| IMO people working in HC are subject to a lot of stress and
| must be protected at the cost of making it a bit unpleasant for
| the patients to be cured.
|
| It's such a fundamental foundation of our lives that the system
| should be calibrated to create the best possible working
| environment for those who are working instead of moving it
| toward a customer reviewd activity that focuses on their
| satisfaction.
|
| I know it can sound unpopular, but receiving the best medical
| care possible is not a right, it's a goal that more often than
| not it's almost impossible to achieve, so let's improve the
| working conditions so that the workers can give their best
| without questioning too much all the sacrifices that the job
| requires.
| lazide wrote:
| Well, first you'd need to get over the idea it's oriented
| around customer satisfaction or outcomes, which it doesn't
| seem to be here in the US.
| peoplefromibiza wrote:
| I don't know the US system so well to argue, I can only
| expand on what I meant: the job of healthcare is not to
| make people comfortable or make their wishes come true, HC,
| unfortunately, it's not a democracy.
|
| What I've seen in the past 30 years is a gradual shift
| towards becoming some sort of wellness centers for disease:
| patients that complain about other patients, patients that
| complain about their accomodations, patients that complain
| about therapies, most of all patients relatives that want
| to have a say on everything that's going on up to the point
| that doctors simply do what asked to not waste too much
| time with them.
|
| And to add insult to injury, all the legalities that made
| taking a decision virtually impossible without risking too
| much.
|
| Of course there are situations were malpractice causes more
| damages than the illness itself and those must be
| reprimanded, we can't afford to disrupt trust in medicine
| in any way, but the results should be taken into higher
| consideration than the opinions.
|
| ER, intensive care and other kinds of "hardcore" department
| should also be judged differently, just like it happens to
| military personnel who are not subject to regular justice
| while on duty.
| safdahfslh23s wrote:
| My partner is a physician in an ICU and a lot of her colleagues
| have talked about leaving the field as well. Their complaints
| are #2 & #3 along with:
|
| 5. Pay cuts - Most of the critical doctor specialties (ER, ICU,
| primary) that were the backbone of the pandemic got "raises"
| that were less than inflation (hers was 1.5%) while profitable
| elective specialties got big raises. The root cause is the
| billing system where elective surgeries bill pay out more than
| critical roles. Still, it's extremely demoralizing to be called
| a "pandemic hero" and have your pay get cut.
|
| 6. Criminal and Financial Liablity - Healthcare is delivered by
| a team yet the financial and criminal penalties for mistakes
| are assessed at the individual level. Recently a nurse was
| given a criminal sentence for a drug mistake which many believe
| was systematic failure (bad UI / IT systems, bad hospital
| practices, AND negligence on the nurse). Imagine getting sued
| or jail time as an engineer for dropping a production database.
| The few malpractice cases my partner has been involved in, it
| was very clear that the issues were systematic and perpetuated
| by hospital practices. However, if they had gone to trial, an
| arbitrary worked would d have been sued and the hospital
| wouldn't change its crappy practices. Institutions have
| effectively dodged liability in many cases.
|
| 7. Chronic understaffing and burnout - most ICUs have been
| understaffed throughout the pandemic. From an economics POV it
| seems crazy that their is a labor shortage but salaries are
| effectively dropping.
| vonnik wrote:
| I work at a startup* trying to tackle nurse burnout, and two of
| my family members are nurses. Here are a few things I've
| learned: - Nurses were getting burned out before the pandemic,
| and the US has a nursing shortage that's been going on for
| about 90 years (it started with an infrastructure buildout in
| the 1930s).* So it's a secular problem, with chronic as well as
| acute causal factors.
|
| - There is a ladder of nursing credentials, and the shortage
| effects them differently. Hiring for roles like CNA and LPN/LVN
| has exploded because of the shortage of RNs and above. CNAs get
| trained in 4-12 weeks to do the heavy lifting of care; RNs get
| ~3 year degrees to perform much more complicated tasks.
|
| - Burnout, and the nursing shortage, are in a positive feedback
| loop/downward spiral. That is, the more nurses burn out, the
| more they cause other nurses to burn out. Short-staffed
| facilities have a very hard time pulling back to normal
| staffing, because nobody wants to join a skeleton crew. (I know
| of long-term care facilities where the scheduling nurses (the
| bosses) are working the graveyard shift because they can't fill
| it.)
|
| - Many nurses work rigid schedules on 12-14 shifts, and a lot
| of medical errors happen at the end of those shifts. *
|
| - The hot US job market (Great resignation, great reshuffle) is
| hitting nursing especially hard; it is very sensitive to
| external shocks. There are paths to easier work and higher pay.
|
| - Many healthcare facilities and systems don't give nurses
| flexibility or the possibility of advancement. (One family
| member will need to quit her current job and come back in a
| year or two to her current employer if she wants to move up a
| pay grade -- which is like some tech companies -- but slower
| moving and lower paying.)
|
| - Many facilities are run entirely on foreign staff (the H2-B
| visa allows that). And many nurses are imported from the
| Philippines.
|
| * https://clipboardhealth.com
|
| * https://www.nursing.upenn.edu/nhhc/workforce-issues/where-
| di...
|
| *
| https://www.nytimes.com/video/opinion/100000008158650/covid-...
|
| (plug: if you're interested in this problem, we're hiring:
| https://culture.clipboardhealth.com)
| clumsysmurf wrote:
| > Many facilities are run entirely on foreign staff (the H2-B
| visa allows that). And many nurses are imported from the
| Philippines.
|
| I'm curious what the consequences of this are, how does this
| impact the profession in the US?
| pvarangot wrote:
| I have training similar to a WFR that I got in Argentina. I
| wanted to certify as an EMT in California because why not? It's
| 160 hours of classes plus 24 hours or practical or something
| like that for the national exam and then it's the state
| requirements. Private training is around 2000 dollars. Ok I'm
| cool with that.
|
| There's no way to get a certification with online learning or
| with any kind of in person time schedule compatible with my
| job... ok... maybe I can get time off? I have to re-get all
| sorts of immunizations I already have and re-do medical checks
| that I already had to get for my green card, like a year ago...
| ok... that's a lot more time off. Oh, they drug check me!
| well... I guess even I would work on healthcare more for
| vocational reasons I'm not doing it while I'm in California.
| It's just too much of a hassle and with the staff shortages I
| feel I'm just being taken advantage off.
|
| In Nevada it's only take the course, pass the exam and you can
| already go on an ambulance, so are most other states.
| strangattractor wrote:
| I always want to quit my job and I'm not a nurse. I think it is
| a growing trend. I spend more time typing in Slack than typing
| in code:)
| ihodes wrote:
| I think this is a great summary of some of the main challenges
| nurses are facing.
|
| I'd add to #1 that travel (temp) nurses are making 4x+ more
| than staff nurses, I've heard as high as $13-17k per week in
| high-demand areas. This exacerbates the problem, as staff
| nurses hear this, and if they can, they leave. Travel nurses
| can be great, but they won't know the facility and workflows
| and people as well as staff nurses: staff nurses now pick up
| more slack, all while getting paid 1/10th what their new
| colleagues are. This is more than most doctors.
|
| For #3, this problem is made worse by additional compliance
| burden. Nurses need to document more and more, click more and
| more, read more and more... with less and less time. And on
| systems that are unpleasant to use. Among other issues, this
| leads to problems like these[0], which drive more and more
| nurses away.
|
| I'm working with a badass team on solving some parts of these
| problems, particularly relating to technology and workflows. If
| you're interested (across basically any role, but product
| designers, engineers, product managers are top of mind right
| now), let me know (email in bio)!
|
| [0]: https://www.cbsnews.com/news/radonda-vaught-nurse-guilty-
| dea...
| luckydata wrote:
| about #3 that ain't a design issue, it's a policy issue. Until
| healthcare in the US is about maximizing profit extraction by
| every party involved things will not change.
|
| For profit healthcare is an abomination and a blight on the
| very soul of this country. If I believed in religion I would
| say God will judge us very harshly for allowing this system to
| stay in place for so long.
| elhudy wrote:
| Don't forget that nurses can now legally be thrown under the
| bus with criminal charges for malpractice while hospitals walk
| away scotch-free [1]. This is huge in the nursing community
| right now.
|
| [1]https://www.npr.org/sections/health-
| shots/2022/03/24/1088397...
| Wistar wrote:
| And, alas, found guilty:
|
| https://www.npr.org/sections/health-
| shots/2022/03/25/1088902...
| gruez wrote:
| Discussed on HN with counter-argument:
| https://news.ycombinator.com/item?id=30778376
| aiisjustanif wrote:
| Jfc that is terrible.
| rectang wrote:
| But the electorate continues to reward "tough on crime"
| prosecutors. Their incentives are all towards maxing out
| the savagery towards defendants, systemic repercussions
| be damned.
|
| From the article:
|
| > _Janie Harvey Garner, the founder of Show Me Your
| Stethoscope, a nursing group on Facebook with more than
| 600,000 members, worries the conviction will have a
| chilling effect on nurses disclosing their own errors or
| near errors, which could have a detrimental effect on the
| quality of patient care._
|
| > _" Health care just changed forever," she said after
| the verdict. "You can no longer trust people to tell the
| truth because they will be incriminating themselves."_
|
| That's the exact opposite of how the NTSB operates. It
| satisfies the infantile urge to blame and shame a
| supposed evildoer, to the great detriment of everybody in
| the long run.
| PaulDavisThe1st wrote:
| > That's the exact opposite of how the NTSB operates.
|
| Bingo! I have a friend in the UK who organizes "post-
| mortem" (no pun intended) workshops and process training
| for hospital staff, precisely to do the NTSB-like thing
| after medical procedure errors occur. Rather than trying
| to point fingers and identify scapegoats, the central
| question is: "what went wrong here, and how do we reduce
| the chances of that happening again?"
|
| Of course, occasionally the answer might be "We hired the
| wrong person, and we should fire them", but that seems to
| be only _very_ rarely true.
| ethbr0 wrote:
| An an organizational ethos, it's hard to argue with a
| default of " _We_ fail, _you_ succeed. "
|
| When failures happen, it's usually the organization
| rather than the individual that's key to changing.
| evil-olive wrote:
| this is fairly common in the medical field, the usual
| name for it is "morbidity and mortality" [0]
|
| > The objectives of a well-run M&M conference are to
| identify adverse outcomes associated with medical error,
| to modify behavior and judgment based on previous
| experiences, and to prevent repetition of errors leading
| to complications. Conferences are non-punitive and focus
| on the goal of improved patient care.
|
| 0: https://en.wikipedia.org/wiki/Morbidity_and_mortality_
| confer...
| dolni wrote:
| > But the electorate continues to reward "tough on crime"
| prosecutors.
|
| Do you believe that people who vote for "tough on crime"
| prosecutors are seeking harsh punishment of mistakes?
|
| Or do they want criminals acting in malice to have the
| book thrown at them so other people aren't needless
| victims?
| rectang wrote:
| I don't think "tough on crime" voters strongly
| differentiate, based on the behaviors of the prosecutors
| themselves. The biggest resume priority seems to be
| maintaining a ludicrously high conviction percentage,
| which is awful for different reasons (innocent defendants
| forced into plea bargains).
|
| Only a small subset of prosecutors elected in the most
| liberal districts are rewarded by their constituencies
| for exercising prosecutorial discretion. I say that
| without making any judgment as to whether they're using
| that discretion well -- I'm just observing that very few
| prosecutors work that way.
| dolni wrote:
| > I don't think "tough on crime" voters strongly
| differentiate, based on the behaviors of the prosecutors
| themselves. The biggest resume priority seems to be
| maintaining a ludicrously high conviction percentage,
| which is awful for different reasons (innocent defendants
| forced into plea bargains).
|
| Well, I think your position is probably one of ignorance.
| Plenty of people I talk to are for tough prosecution on
| things like violent crime and against tough prosecution
| for simple drug possession.
|
| > Only a small subset of prosecutors elected in the most
| liberal districts are rewarded by their constituencies
| for exercising prosecutorial discretion. I say that
| without making any judgment as to whether they're using
| that discretion well -- I'm just observing that very few
| prosecutors work that way.
|
| Yes, that does seem to be a trend. Prosecutorial
| discretion is actually important, but it doesn't mean you
| let crime run rampant, either.
| gruez wrote:
| > The biggest resume priority seems to be maintaining a
| ludicrously high conviction percentage, which is awful
| for different reasons (innocent defendants forced into
| plea bargains).
|
| I don't live in a jurisdiction that elect prosecutors,
| but is this actually a thing? Do candidates/incumbents
| run campaign ads on their conviction rate? Are voters
| researching/talking about the conviction rate of the
| candidates like it's a pissing contest?
| rectang wrote:
| Yes. It was true for our current US Vice President,
| Kamala Harris for example -- but she's not an outlier,
| this happens all the time.
|
| https://theintercept.com/2019/02/07/kamala-harris-san-
| franci...
|
| > _If the conviction rate had been measured by actual
| cases pursued, rather than all cases referred by police,
| Hallinan said, his office would have had a conviction
| rate that was relatively similar to Los Angeles and other
| major cities._
|
| > _And Hallinan was getting results. Overall, crime rates
| were plummeting. Violent crime had gone down close to 60
| percent in San Francisco since Hallinan took office._
|
| > _Still, the low conviction rate resulted in headline
| after headline about San Francisco's permissive attitude
| toward crime, a media environment harnessed by the Harris
| campaign._
| [deleted]
| anonporridge wrote:
| Worse, the family of the victim had apparently forgiven
| the nurse for her mistake and didn't want criminal
| prosecution.
|
| This was driven purely by the state prosecutor.
| HarryHirsch wrote:
| Consider this: someone drives without paying proper
| attention and kills someone. It's time for victim impact
| statements, and relative after relative asks the court
| for lenience on the driver because the victim was a drunk
| and a wifebeater, the world is better off without him.
|
| Not sure that that is a good idea, justice is about more
| than just those immediately affected by a crime
| wonderwonder wrote:
| Do we really want to live in a society where people are
| not prosecuted because the family of the victim forgave
| them? So if two people commit the same offence, Person A
| is not prosecuted because the victim's family forgave him
| but Person B is because the victims family did not? Was
| offender B just unlucky on victim selection? The rule and
| application of law should not be based on the feelings of
| the victims family. Did the dead person forgive them?
| ethbr0 wrote:
| We certainly don't want to ignore them, given they have
| the most immediate understanding of the situation and
| entitlement to guilt.
|
| We don't allow plaintiffs to sue without standing. Why do
| we allow DAs to prosecute without a victim?
|
| The state has a justification to pursue crime, but it
| seems like that should be limited when there's (no
| victim) or (victim who disagrees with prosecution).
| wonderwonder wrote:
| Is the dead person not a victim? If someone is murdered
| and their family is like good I hated them anyway does
| that nullify the existence of a crime? Are we basing
| prosecution now on the character of the victim? That's a
| pretty quick path to deciding that certain victims have
| no value in society.
| graywh wrote:
| it was the county DA and he's up for reelection this year
| wonderwonder wrote:
| Is it though? Should a cop be prosecuted for accidentally
| killing an innocent civilian in the course of duty during
| a non violent traffic stop? I would argue that they
| should be. How many chances should a nurse get to
| accidentally kill someone? Do they only get prosecuted
| the second time? Third?
|
| If you are responsible for the death of another person
| due to your own negligence then you should be prosecuted
| for a crime and be removed from any scenario where you
| are able to repeat that mistake.
| Jiro wrote:
| A cop killing an innocent civilian at a nonviolent
| traffic stop can pretty much happen only because of
| malice or negligence. We use the word "accident", but
| it's never really an accident. If a nurse accidentally
| kills someone, it may really be an accident.
|
| Furthermore, the nurse is in a profession where people
| die all the time due to reasons beyond the nurse's
| control, and surviving relatives are not always rational
| in who they blame. So nurses will be falsely accused much
| more often than police.
| ethbr0 wrote:
| > _A cop killing an innocent civilian at a nonviolent
| traffic stop can pretty much happen only because of
| malice or negligence._
|
| I'm not sure this is true, specifically because the
| difference between a nonviolent traffic stop and a lethal
| (to the officer) traffic stop can be a split second.
|
| If my keyboard had a 0.01% chance of lethally shocking
| me... I'm pretty sure that would alter my typing
| behavior.
| wonderwonder wrote:
| "can pretty much happen only because of malice or
| negligence"
|
| Negligence means "failure to take proper care in doing
| something", which is often just called an accident.
|
| That is exactly what the nurse did, she failed to take
| proper care and someone died. The nice thing about the
| law is that what the relatives feel should not matter at
| all, that's why we are supposed to have impartial
| prosecutors that review the facts and determine if
| charges are warranted.
|
| Bottom line, no matter the profession if you fail to take
| proper care and someone dies as a result, you should be
| prosecuted and prevented from getting the opportunity to
| do it again.
| Jiro wrote:
| >Negligence means "failure to take proper care in doing
| something", which is often just called an accident.
|
| This is not true, because you're equivocating on the word
| "proper". An accident is failure to take proper care,
| where proper care means "care that follows the rules".
| Negligence is failure to take proper care, where "proper"
| means "can reasonably be expected". They are not the same
| thing.
| wonderwonder wrote:
| Not really sure where you are getting those definitions
| from. Proper means proper. The nurse did not follow the
| rules. The nurse did not provide any of the care that
| could have been reasonably expected. Fail to see a
| difference, she failed both of your definitions.
| Jiro wrote:
| It is possible for there to be rules that someone cannot
| be reasonably expected to follow.
| HarryHirsch wrote:
| The solution isn't that Radonda Vought, who killed a
| patient through a string of crassly negligent actions
| should walk free - one would like to see the whole chain of
| command be given serious prison time. It's clear that
| patient safety at Vanderbilt isn't a priority - training
| and safety culture reflects that.
|
| Strange to see that HN, which is generally suspicious of
| copaganda, falls for very transparent nursepaganda.
| Sakos wrote:
| Imagine if aviation functioned like health care in the
| US. We'd have a magnitude more crashes and deaths.
| hawaiianbrah wrote:
| Just one magnitude... ?
| ethbr0 wrote:
| > _one would like to see the whole chain of command be
| given serious prison time_
|
| Absolutely. To each according to their authority.
|
| RaDonda Vaught made a mistake, and admitted it,
| repeatedly, in multiple interviews.
|
| But that mistake was only partly because of her free
| will. Vanderbilt University Medical Center incentivized
| her to make that choice, for their own profit, and with
| control over her employment.
|
| RaDonda Vaught goes to prison.
|
| VUMC pays a fine and nobody goes to prison.
|
| I think HN takes a dim view of a company holding
| someone's contract in their hands, saying "Do something
| illegal or I tear this up," and then blaming the employee
| when everything explodes.
|
| They're playing chicken with patients' lives, and passing
| off the charges to their employees when they lose.
| ikiris wrote:
| Its the strong libertarian vibe. They think consequences
| shouldn't exist, and the dead guy can take his money
| elsewhere.
| LanceH wrote:
| The strong libertarian vibe of npr saying she's being
| scapegoated?
|
| When you have millions of drugs being issued, there will
| be some legitimate mistakes happening -- some will even
| cause death. If you want people to actual work in
| healthcare, they shouldn't be fearing for their lives for
| being less than perfect.
| ikiris wrote:
| please cite where an npr report gives the impression
| she's been scapegoated in such a way that she doesn't
| deserve the consequences she's been given. I'd love to
| read it honestly.
|
| From what I've seen there's been a lot of reporting on
| her case, and how Vandy rightfully deserves a lot of
| pain, and a lot on how a subset of nurses feel she's been
| railroaded, but I've not seen what you claim and would
| like to know where I missed it.
|
| I'll also re note that pharmacists have carried this
| burden for over a hundred years, and their removal from
| the process is part of how this chain of mistakes
| happened to begin with.
| dragonwriter wrote:
| > Don't forget that nurses can now legally be thrown under
| the bus with criminal charges for malpractice while hospitals
| walk away scotch-free
|
| The nurse in that case was prosecuted for criminal reckless
| homicide (not malpractice, which is civil negligence.) The
| characterization of the hospitals direct responsibility is
| negligence not arising to criminal (gross) negligence (as the
| principal of _respondeat superior_ doesn 't apply in criminal
| law, the employees recklessness would not be imputed to the
| employer the way it would in a civil case.)
|
| As for civil liability if the hospital, that was settled out
| of court with the victims family, the hospital did not get
| off scot free.
|
| This... isn't a new thing that deserves the "now" label like
| it is a change. Criminal wrongdoing by employees (including
| in healthcare) very often does not rise to a level of
| criminality for the employer, and that's been true for a long
| time.
| anonporridge wrote:
| This kind of thing is going to further disassociate nurses
| from interacting like a human with their patients. If you
| risk criminal prosecution and prison time from making a
| mistake, everyone starts walking on eggshells and become
| afraid of doing anything beyond box ticking. They'll start
| turning a blind eye to things they know are wrong, because
| the system doesn't see them. All work will align towards pure
| compliance with the law and the hospital system at the
| expense of intimate connection with patients.
|
| And of course, a lot of nurses are in the job for the human
| connection, and will consequently be burned out at an
| increasing rate.
|
| To some degree this might actually be good long term, because
| it will be that much harder for hospitals to manipulate
| nurses into working around the limitations of the system to
| provide real care, which allows the administration to turn a
| blind eye to their own flaws. There's going to be a surge of
| malicious compliance that ends up shining a bright spotlight
| on just how abusive and dysfunctional hospital systems really
| are.
|
| And patients will ultimately be the ones who suffer.
| [deleted]
| [deleted]
| Soulsbane wrote:
| Food service workers don't want to take food into a patients
| room?
|
| My mom worked in food service for several years at a hospital
| and took the food into the rooms. Is this not the norm?
| mikewarot wrote:
| >3. IT systems that they have to use were designed by people
| who have not talked with the workers who use them.
|
| Every time the computers went down at a friends ER, the waiting
| room emptied out as the staff were able to use paper forms and
| just get their jobs done, instead of being forced through
| thousands of menu clicks and choices that made no sense.
|
| EVERY SINGLE TIME -- Epic or as I call it... the Epic Failure.
| I always give my condolences to staff forced to use it.
| sli wrote:
| > IT systems that they have to use were designed by people who
| have not talked with the workers who use them.
|
| This was exactly my experience when I worked for a medical
| software startup. Our (very unfinished) software got deployed
| in a hospital with no training, no orientation, no nothing, and
| it was such a disaster that it was a patient safety issue. Mind
| you, the engineering team had no say in any of this, not that
| we were even given the chance, and we weren't even aware that
| the deployment was for real. We were under the impression that
| the deployment was for testing purposes, because we were aware
| that the software was unfinished.
|
| It was a breathtakingly poor decision purely on the part of
| managers (and, frankly, sales) on both sides of that deal and
| it was doctors and patients who suffered because of it. An
| absolute nightmare all around and I'm glad to no longer be
| there.
| mikemac wrote:
| Agree with all of this, and just to add one thing: liability.
|
| Look at the RaDonda Vaught case or the Michelle Heughins case;
| terrifying to be looking at jail time for a med error.
|
| Many nurses are watching these cases more closely and deciding
| that since staffing isn't getting any better and they won't be
| protected, it's not worth the risk.
| sfteus wrote:
| Married to an RN and absolutely sympathetic to the
| staffing/pay plight they're currently facing. I'm
| unfortunately not very familiar with the case of Michelle
| Heughins, but I've heard a lot of the RaDonda Vaught case.
| The high points of the case as I understand them:
|
| * Vaught stated her department was not understaffed, nor was
| she tired. The incident also occurred in 2017, so pre-
| pandemic
|
| * Vaught went to dispense Versed (generic name midazolam) by
| the brand name, instead of the generic name as they're
| trained to do. This led to her selecting vercuronium bromide
| instead
|
| * Vaught stated she had dispensed midazolam several times
| before, which would have had to have been by the generic name
|
| * Vaught ignored several warnings from the dispensing machine
| stating the patient was not prescribed vercuronium bromide
|
| * Vaught ignored the red cap on the vial dispensed that
| stated it was a paralytic agent
|
| * Vaught ignored that vercuronium bromide needed to be
| reconstituted with sterile water (unlike midazolam, which
| comes as a liquid). She stated she thought it was odd that
| she didn't have to reconstitute it before when dispensing the
| correct medicine
|
| * Vaught did not scan in the medication before or after
| giving it to the patient, which would have likely prompted
| another warning about it not being prescribed
|
| * Vaught could not recall exactly how much she gave to the
| patient
|
| * Vaught immediately left the room after injection, and did
| not wait to observe the patient for any side-effects
|
| All of this information is available in the DA discovery
| documents
| (https://www.documentcloud.org/documents/6785652-RaDonda-
| Vaug...) and the CMS report
| (https://www.documentcloud.org/documents/5346023-CMS-
| Report.h...).
|
| The opinions on the case I've observed have been nurses who
| aren't aware of this and saying she should not have been
| convicted, and the nurses who are aware who think the
| conviction is fair ...ish. The latter is at least unanimous
| she should have her license revoked.
|
| Most agree that Vanderbilt should be held responsible for
| negligence as well. My wife's hospital for instance does not
| stock _any_ paralytics within machines, to prevent it being
| accidentally dispensed without involving the pharmacy.
| There's also evidence that Vanderbilt tried to cover the
| incident up.
|
| I've made a point of stressing to any RN I've talked about it
| with the importance of having a lawyer with you when talking
| with investigators. Vaught straight up incriminated herself
| multiple times during her initial interview.
| hermitdev wrote:
| I'm not familiar with the case, but assuming what you've
| outlined above is accurate, I have no doubt a jury would
| convict. Negligence actually sounds like too nice of a word
| for that train wreck of events.
| michael1999 wrote:
| There's a big difference from revoking her license, and
| locking her in a cage for 3 years.
| ikiris wrote:
| Yeah usually that difference is causing someone to die by
| being criminally negligent. Which she was.
| giantg2 wrote:
| I believe you can even be personally liable for HIPPA
| security violations as a user or dev of a healthcare system.
| That seems a bit scary. I agree that regulation persuades
| people not to do things out of fear of breaking the law. We
| see this in it's intentional form with regulation of other
| things such as abortion, guns, etc. Put so many laws in place
| that risk of accidentally breaking one and receiving an
| extensive punishment isn't worth it.
| Sohcahtoa82 wrote:
| > HIPPA
|
| *HIPAA
| throwawayboise wrote:
| > I believe you can even be personally liable for HIPPA
| security violations as a user or dev of a healthcare
| system.
|
| Welcome to being an engineer, if that's what you want to
| call yourself. The engineer who approves a bridge design
| can be held liable if it collapses due to a design fault.
| labcomputer wrote:
| One difference is that HIPAA has a bunch of statutory
| penalties for "technical violations" that might or might
| not harm anyone. For example, if a call center staff
| discloses patient information to, say, the child or
| parent of a patient, that comes with an automatic fine
| and (potentially) jail time.
|
| Another aspect is that certain HIPAA allowances for data
| usage require a lawyer's expertise, not an engineer's.
| For example, can a health insurer use patient data to
| train a model w/o first obtaining patient consent? If the
| model will be used for "healthcare operations" (i.e.,
| adjudicating claims), you might argue that the answer is
| yes. If the same model will be used for suggesting
| treatment options to doctors, you might argue that the
| answer is no. If you answer wrongly, you are hit with a
| statutory fine.
|
| It's like having a fine for painting the bridge the wrong
| color because there is a law that bridges must be green,
| but you used lime. Not because you're worried about the
| bridge collapsing, but because the law says so.
|
| Generally, civil engineers don't need to worry about
| fines or jail as long as things stay up.
| initplus wrote:
| Lot's of better paid gigs with better working conditions
| where you aren't personally legally liable if you write a
| bug. I don't especially care about what job title some
| board thinks I'm allowed to use.
| giantg2 wrote:
| Generally the firm's insurance will cover an engineer
| since they are a "professional". Software "engineers"
| generally have not been individually liable for bugs.
| Usually the software user agreements don't allow for this
| sort of thing.
|
| Basically, contracts can control the liability in most
| cases, but HIPPA prevents that by explicitly defining
| liability under the statute.
|
| Here's some info on the engineer portion.
|
| https://www.nspe.org/resources/professional-
| liability/liabil...
| Shuang1 wrote:
| That case goes far beyond med error and I don't understand
| why people keep bringing it up as an example.
|
| She pulled the wrong med, and then injected it and walked out
| of the room rather than observing for effects. Also the med
| she pulled had warnings on all sides of the bottle and on the
| top saying very clearly that it's fatal to administer without
| ventilation. This went beyond a mistake to negligence.
| rvba wrote:
| > She pulled the wrong med, and then injected it and walked
| out of the room rather than observing for effects
|
| With staff shortages nurses dont have the time for that.
|
| Hire 2x more nurses - so there is 2x more time for each
| patient.
| cyberlurker wrote:
| Right, when I first read the summary it didn't adequately
| cover how careless the nurse was. It wasn't just a small
| mistake.
|
| Edit: I should say that doesn't mean I think it makes any
| sense the hospital isn't liable and jail time for the nurse
| seems odd
| sithlord wrote:
| Literally every medication has warnings slapped all over
| it. My partner worked at Vanderbilt (on a different floor)
| around this time, and one constant complaint I heard (prior
| to the incident) was how there was hardly any controls
| around anything there.
| ikiris wrote:
| Yeah, there's no doubt that this is a shitshow from how
| Vandy is described (and nursing in general especially
| with these automated pharm boxes), but that should be
| additional consequences, not this nurse avoiding hers.
| js2 wrote:
| Janie Harvey Garner, a St. Louis registered nurse:
|
| "In response to a story like this one, there are two kinds
| of nurses," Garner said. "You have the nurses who assume
| they would never make a mistake like that, and usually it's
| because they don't realize they could. And the second kind
| are the ones who know this could happen, any day, no matter
| how careful they are. This could be me. I could be
| RaDonda."
|
| https://khn.org/news/article/radonda-vaught-nurse-error-
| medi...
|
| HN readers can look at this case filing:
|
| https://www.documentcloud.org/documents/6785652-RaDonda-
| Vaug...
|
| > Also the med she pulled had warnings on all sides of the
| bottle and on the top saying very clearly that it's fatal
| to administer without ventilation.
|
| The linked PDF includes images of medicine in question.
| There's a single warning on top that reads "WARNING:
| PARALYZING AGENT" and a red cap. I don't see any warnings
| on the side. The vial appears to be tiny, smaller than my
| thumb.
|
| But yes, she made a series of mistakes, listed on the last
| two pages of the PDF.
|
| I am not a nurse, but I can easily imagine how someone
| could make the errors she did in an overworked and high-
| stress environment. It's a cascading series of errors that
| starts with overriding the medicine cabinet when she can't
| find the medicine she's looking for. But according to her
| defense, overriding the cabinet had become almost standard
| operating procedure at Vanderbilt at that timeframe. Once
| she starts down this path, she's operating on automatic and
| almost blind to what she's doing.
|
| I agree she was negligent. I don't think she should go to
| prison for it. In the bigger picture, this is causing more
| nurses to quit, likely leading to more medical errors and
| deaths, not fewer.
| ikiris wrote:
| If nurses quit over criminal liability for killing
| someone by being that careless, everyone is better off by
| them not being in the field. Pharmacy has had the same
| rules for over a hundred years. A great example is even
| in the movie a wonderful life.
|
| edit: minor grammar fix
| kenjackson wrote:
| If you don't go to jail for this, do you do so for any
| sort of negligence? What about an Uber driver that runs a
| red light and kills a pedistrian walking? Or is drunk and
| kills someone? That worries me a lot more than this
| story.
| gruez wrote:
| >I agree she was negligent. I don't think she should go
| to prison for it.
|
| but we literally have a law for "negligent homicide"?
| js2 wrote:
| Yes we do, but we also give DAs discretion over when to
| enforce it. Given the extenuating circumstances, I don't
| think it should have been enforced here.
|
| Her employer, by not creating a culture of safety, set
| her up for failure.
|
| I just don't see how in the long term this prosecution
| reduces medical errors and generally disagree with
| criminalizing mistakes; even ones such as this.
| ikiris wrote:
| Enforcing criminal liability for homicidal negligence is
| how you force respect of even basic safety requirements
| that already existed.
|
| I'm not arguing that hospitals aren't currently a
| shitshow, I'm aware I've worked in them. That doesn't
| excuse this nurse's complete lack of respect for the
| risks she took.
| Sakos wrote:
| As I've said before, if aviation insisted on criminal
| punishment for pilots, we'd be _far_ worse off. Many
| accidents are caused by fear of punishment. Culture of
| safety can only be implemented and enforced top-down. Why
| punish the nurses when they 're not the ones responsible
| for what kind of culture exists at their institution?
| js2 wrote:
| "The beatings will continue until moral improves."
|
| We cannot prosecute our way out of medical errors, and
| what you claim is at odds with the opinions of medical
| professionals.
|
| https://www.nytimes.com/2022/04/15/opinion/radonda-
| vaught-me...
|
| https://pubmed.ncbi.nlm.nih.gov/25077248/
| chrischen wrote:
| That enforcement causes nurses to not want to work, as
| the nurses aren't the decision makers in making a culture
| of safety. The administrators bear that responsibility so
| maybe we should enforce it on them.
| [deleted]
| ikiris wrote:
| This nurse was the decision maker in whether she bothered
| to check the label on the vial for what she was injecting
| to the patient, and / or bothering to scan it _as
| required_ before leaving them to die in terror.
|
| I'm not sure what world you live in, but I'd like to live
| in the one where criminal negligence resulting in
| avoidable death is prosecuted.
| xyzzyz wrote:
| > 2. Patients in COVID have become downright mean. Add this to
| the problems nurses have management and doctors (who are often
| rude and arrogant) and it's a poor culture. The quality of the
| environment, from a mental health standpoint, is on the
| decline.
|
| Mean customers, and rude coworkers? I sympathize, but this is a
| reality in a lot of industries. I have no reason to believe
| that healthcare here is worse than average.
| woodruffw wrote:
| Most industries are neither tasked with restoring health nor
| with being the bearer of hard truths about a person's health.
| I think it stands to reason that healthcare can be a
| particularly toxic environment for those reasons.
| mfer wrote:
| Half of the toxic problem is from the people being treated.
| The other half (and sometimes more than half) is from
| management and co-workers (i.e. doctors). Not all doctors
| are bad but enough of them are to make an impact.
|
| There's a culture problem there.
| woodruffw wrote:
| Absolutely. In case it wasn't clear: I was saying that
| just _dealing_ with peoples ' health makes for a
| fundamentally stressful and potentially toxic
| environment, even if each individual in question is
| perfectly kind and reasonable.
|
| Mistreatment by doctors and management isn't excused by
| that, but I think it can be seen (partially) through that
| lens.
| titzer wrote:
| fundad wrote:
| Health care seems to be part of the institutions that are
| of no use to certain cults. It's part of the effort to
| dismantle the administrative state and reserve health care
| for the 1%.
| LordDragonfang wrote:
| All customer-facing positions have to deal with rude
| customers. Very few of those positions specifically _select
| for_ customers with a high correlation to selfish and /or
| antisocial conspiratorial behavior. Almost all COVID
| hospitalizations are unvaccinated, and there's a very large
| (if not majority) portion among that population that chose
| not to vaccinate for entirely selfish reasons, and another
| large portion who have been actively consuming media telling
| them the members of the medical profession are the enemy.
| You'd be hard pressed to select for a more adversarial
| customer base.
| nostrebored wrote:
| This isn't particularly reasonable analysis. A large chunk
| of the unvaccinated population is elderly and
| contraindicated for vaccination or in hospice care. From
| talking with nurses, the elderly population has its own set
| of problems and frustrations. Imagine trying to administer
| care to someone who has no idea why they're in a hospital
| setting. Similarly, vaccination status in American COVID-
| hospitalization research classifies people of unknown
| vaccination status as unvaccinated. These people are often
| homeless, isolated and elderly, or mentally unwell and
| unable to provide reliable information to caregivers.
| Again, likely unpleasant to work with.
|
| Grouping these people as conspiratorial is unfair and seems
| politically motivated. While you definitely have some
| overlap with conspiratorial people, people have a right to
| be skeptical of medical care, which is often incorrect and
| potentially life threatening. Being able to explain things
| concisely and with evidence is a core skill for a nurse,
| much like being able to explain to someone why their
| technical decisions are setting them up for failure is a
| core skill for a software architect.
|
| But from talking to nurses, this isn't the drive for
| negative workplace satisfaction. Patients who are
| hospitalized are less likely to be mentally stable: many
| pathways to hospitalization come from extremely poor
| decision making, and many of these people are repeatedly
| hospitalized. Combine this with the fact that it's a very
| physical job, primarily handled by women, and you have a
| multi-faceted problem that's not as easy to solve as just
| giving people right-think.
|
| Personally I think the pathway to fixing this is
| appropriately valuing nursing care, what is often a highly-
| skilled profession with large physical, legal, and
| downstream risk, and compensating people appropriately.
| While nursing is a disproportionately paid job relative to
| educational requirements, current compensation really
| doesn't accurately account for just how demanding a job it
| is.
|
| The amount of nurses you see who become addicted to
| painkillers, benzos, etc., is truly sad. Much like
| teaching, it's an area where I feel that society is
| inaccurately evaluating what the overall impact could be if
| the role functioned well.
| throttledagain2 wrote:
| mfer wrote:
| I've spoken with nurses who've had a variety of other jobs at
| other types of places. They are consistent in telling me that
| working as a nurse is a worse environment in the way they are
| treated.
|
| The example stories they have shared are the type of thing I
| can't relate to and I've worked in software, general
| engineering, food service, construction, and tech support (I
| answered calls for 3 years).
| omegaham wrote:
| This is also my experience being married to a nurse. Any
| story I have about a boss, coworker, or client being a
| jerk, she has about five stories about someone being bad
| enough that I'd already be shooting resumes toward anyone
| who will take me.
|
| She's been punched in the face by a patient, she's had
| coworkers who sabotage each other due to personal
| vendettas, she's had bosses go on racist tirades in
| meetings, and on and on and on. As I remind my wife
| whenever she has a particularly awful day, there's a reason
| why the classic NP-hard CS problem is literally named the
| Nurse Scheduling Problem[1]. And yes, she's considering a
| career change.
|
| [1] https://en.wikipedia.org/wiki/Nurse_scheduling_problem
| bagels wrote:
| Yes, my wife has also been punched working in the
| hospital. She now does nursing by phone where people are
| still really awful to her, but at least they can't
| assault her.
| literallyWTF wrote:
| Yeah I don't know about that bud. Try telling the spouse of a
| dying person that their half baked ideas they read on
| Facebook aren't valid and tell me their meltdowns are
| comparable to working retail.
|
| All jobs suck donkey dick, but jobs directly dealing with
| sick and dying people are on a different level.
| germinalphrase wrote:
| People who are sick, in pain, or possibly dying might be
| slightly less emotionally regulated than your typical
| customer.
| brimble wrote:
| It doesn't help that hospital systems tend to be garbage at
| customer service, so the person's been told to wait an
| indefinite (but always very long) period without any
| indication of how long it'll be, and asked to tediously
| fill out the same information five different times on five
| different pieces of paper and iPads, all while feeling
| terrible, before they finally snap at a poor nurse who
| isn't to blame for their hospital being an uncaring money-
| making machine with little regard for humanity.
| alostpuppy wrote:
| You didn't even mention the anxiety patients are enduring
| over the billing the entire time.
| MomoXenosaga wrote:
| And now they will be billed even more because nobody
| wants to do the job anymore!
|
| Healthcare workers are not slaves they can quit after
| all.
| robertlagrant wrote:
| We make really usable software for nurses, and they absolutely
| love it. I think the effort we go to is totally unnecessary to
| achieve that, as - just as you say - most medical software is
| so bad from a user perspective.
|
| Anyway, it's nice to make software like that :-)
| tmp_anon_22 wrote:
| > This one is big for product designers.
|
| I think this is looking at the problem wrong. The problem is
| that implementing positive change in these systems is
| impossible for reasons far outside the control of any product
| designer or developer currently on the team.
|
| This software is old, has byzantine requirements, probably cut
| costs all over the place, and conceived in a board room without
| the benefit of an adequate development lifecycle or
| stakeholders advocating for the users.
|
| It probably takes 3 months to move a button around, and instead
| of moving that button executives are having them push a feature
| that earns a few more million, or a feature that the customers
| want more then a UX improvement.
| citizenpaul wrote:
| >executives are having them push a feature that earns a few
| more million
|
| I've worked here before... Half our customers are complaining
| about feature X that doesn't work right/ is inconvenient.
| Exec: we don't care they are already paying us on a 3 year
| contract. Hack this new feature into the program that a
| potential new customer wants.
|
| Horrible places to work they are. Thats why I avoid using any
| long term contracts like the plague. The second I see call
| for pricing I close the window.
| mfer wrote:
| > I think this is looking at the problem wrong. The problem
| is that implementing positive change in these systems is
| impossible for reasons far outside the control of any product
| designer or developer currently on the team.
|
| A developer working on something is different from a product
| designer. For product designer I don't mean a UI/UX
| developer. I mean someone empowered to design the thing. This
| is often a leader or product manager.
|
| Product design isn't something taught well in most schools.
| It's often out of sight and mind. An engineer who was good at
| building hardware or writing code didn't learn the skills
| needed for product design through that. Product design
| requires looking at the whole system differently.
|
| > It probably takes 3 months to move a button around, and
| instead of moving that button executives are having them push
| a feature that earns a few more million, or a feature that
| the customers want more then a UX improvement.
|
| A better UX would reduce the amount of time nurses spend
| using these systems. That productivity could be used to do
| more other work (like taking on more patients). I don't like
| this argument but it's easy to make in terms of cost
| effectiveness.
|
| I don't think the cost effective conversations are happening.
| I expect there isn't that level of depth to these. It's hard
| to do when a purchasing organization (like a hospital) only
| have a few options and they are all bad.
|
| This is an opportunity. To build software that is both
| compliant and has a good UX. There's an opportunity to
| disrupt all the crap software here.
| tmp_anon_22 wrote:
| I think what you're describing as the Product Designer who
| can get shit done would need to be at the VP or C level to
| actually accomplish this within an enterprise organization.
|
| > I don't think the cost effective conversations are
| happening.
|
| I think it would take years to overhaul these products and
| the conversations on that and how the price would roll down
| hill to the healthcare organizations have happened, and
| been summarily shut down.
|
| I also think startups have tried to sell software via this
| value prop but have not managed anything close to feature
| parity or sales-org-maturity as the dominant enterprise
| players.
|
| > This is an opportunity.
|
| I think various startups and other organizations are
| _trying_ but there is a reason enterprise-style
| organizations exist and dominant their various verticals.
|
| Its not only about a good product, its about navigating
| painfully expensive sales cycles of multi-year or even
| near-decade, political wheeling and dealing at the
| municipal, state, and federal levels, dealing with
| compliance and legal liabilities etc.
|
| > This is an opportunity.
|
| Is it though? Hospitals still run. Yeah its expensive as
| hell, nurses are quitting, but I don't see the horsemen of
| the apocalypse quite yet. Healthcare outcomes are ok-ish.
| Young people are still entering the medical field as a
| viable profession.
| ajmurmann wrote:
| I think this might be more of a symptom of administration
| being detached from the work on the ground. Even if one app
| had UX that was significantly better (within the realm
| what's possible within regulation. Others here make the
| point that the laws and regulations make the UX
| unregenerate bad), the sale might highly likely go to the
| solution that has more checkboxes filled in the feature
| table.
| histriosum wrote:
| > This is an opportunity. To build software that is both
| compliant and has a good UX. There's an opportunity to
| disrupt all the crap software here.
|
| The thing that everyone is overlooking here is that EMR
| software is not designed with patient outcomes as the top
| priority. Every single EMR software I've seen in the field
| has been designed with BILLING as the top priority --
| everything is organized around making sure that you can
| bill for the maximum number of services.
|
| I don't think this can possibly change without regulation.
| The incentives are all wrong at every other layer.
| rectang wrote:
| It is true that billing is a priority and there are
| profit incentives at work. _That 's exactly why it's
| worth it for hospitals to improve the data entry user
| experience!_
|
| Better documentation means more revenue. If your doctors
| and nurses are not filling in the forms because the
| interface isn't user friendly, you're losing money.
| histriosum wrote:
| > Better documentation means more revenue.
|
| This is not actually the way the system works, as
| currently designed, and so correspondingly this is not
| how EMR systems are designed. The documentation that
| matters is capturing the procedure codes and inventory
| codes for billing -- and EMR systems and the associated
| hospital workflows and security mechanisms are designed
| around making sure that those billing codes must be
| entered in order to do anything else.
| rectang wrote:
| I asked one of my Smarter Dx colleagues who's an expert
| on this subject to clarify, and he had this to say:
|
| > _There are 2 types of billing, even for hospitalized
| patients. FFS and DRG based payments. Fee For Service
| does depend on capturing those billing codes correctly.
| But DRG based payments depend solely on documentation and
| the billing codes are irrelevant. FFS is 2 /3s of US
| health care spend currently ($2.6T) while DRG is $1.3T._
| wtetzner wrote:
| > A better UX would reduce the amount of time nurses spend
| using these systems. That productivity could be used to do
| more other work (like taking on more patients). I don't
| like this argument but it's easy to make in terms of cost
| effectiveness.
|
| I don't think the companies developing the software care,
| because they're getting paid either way.
| redwall_hp wrote:
| > Patients in COVID have become downright mean. Add this to the
| problems nurses have management and doctors (who are often rude
| and arrogant) and it's a poor culture.
|
| So...this is also the biggest reason (besides lack of pay or
| basic human dignity) that restaurants and retailers are having
| a lot more trouble finding employees. Rude (and sometimes
| violent) customers were already an issue, but they've become
| absolute animals lately. It's increasingly bad for your own
| health, mentally and physically, to have any public-facing job.
| In the last few years, we've let go any pretense of expecting
| people to be civil and reasonable, and adult children are
| rewarded for their behavior instead of being trespassed.
|
| Teachers are also quitting in droves (and in the middle of the
| school year, in some cases) for the same reason. Children are
| awful and the parents are worse. You risk sickness and
| violence, and are constantly harassed by parents. Then there's
| the whole attack on the curricula and book banning...
|
| The FAA reported 1099 incidents with unruly passengers last
| year, up from a normal 100-300 in prior years. Because some
| sorts of people simply won't do what they're told...and
| disobeying flight crew instructions is generally a federal
| crime.
|
| Everyone's increasingly overworked and underpaid, and they have
| to deal with degenerates like that daily. Of course they want
| out.
|
| We're having a societal implosion.
| kenjackson wrote:
| Everyone thinks that their belligerence makes them Sam Adams
| or Gandhi rather than just the jerk they likely are. I see
| this every weekend at youth sporting events. I'm just like,
| "it doesn't matter why -- if the ump says you need to leave,
| just leave -- this isn't Game 7 of the World Series".
| balozi wrote:
| _> 4. Nurses are the catch all for jobs. Not enough aides?
| Nurses do the work.... _
|
| The nurses aides would argue that they do the majority of the
| frontline work while getting paid a fraction of what the nurses
| make, and get even less credit.
| mfer wrote:
| Most of the nurses I talk with speak about a lack of nurse
| aides. When there isn't a nurse aide the nurses have to do
| that work. When I speak of a lack of them I know nurses who
| can go multiple consecutive shifts without an aide working
| the floor. When they do work there is 1 aide to a floor and
| can't cover everyone so the nurses do that work.
| MomoXenosaga wrote:
| Dont forget the sexual harassment. Twenty two year old nurse
| and boomer men don't mix.
| maestroia wrote:
| Someone I dated last year has worked on the administrative
| side of hospitals for years. Her statement was "everyone is
| hooking up in them, and it's typically ignored. Unless they
| use a patient bed, then all hell breaks loose."
| ikiris wrote:
| No one cares about ux in hospital purchasing _at all_ unless
| it's an admin app.
| e40 wrote:
| On (3), Kaiser seems to be the exception to this. Their
| systems, on the nurse/Dr side seem very easy to use and the
| connections between different departments work seamlessly. At
| least, from what I've noticed as a 10+ yr Kaiser patient in the
| Bay Area.
| rectang wrote:
| > _3. IT systems that they have to use were designed by people
| who have not talked with the workers who use them. They may
| have been designed with laws and compliance in mind. Nurses
| aren 't the people who choose or pay for these systems. But,
| they use them a lot (maybe the most) and it's obvious they
| weren't taken into account when designing the UX. It's
| maddening for them._
|
| > _This one is big for product designers. Often we listen to
| the people who pay for it and miss out on the people who
| actually have to use it._
|
| This resonates with me strongly for two reasons. First my
| mother is a retired RN, and the electronic record keeping was
| her biggest frustration. It is hilarious to me how much my
| mother hates computers, while I make a living in software.
|
| Second, I'm now working for a startup, Smarter Dx (we're
| hiring: https://angel.co/company/smarterdx/jobs ) that works
| with these records and tries to make better use of them. To the
| extent that we're successful, incentives are created for the
| hospital to improve them, conceivably including improving the
| UX that nurses see. I don't mean to underestimate the
| difficulty of the problem, but I think it's possible to at
| least push in the right direction.
| woodruffw wrote:
| This is a good summary, and it corresponds to what I've heard
| from friends and acquaintances that are currently nurses (or
| left recently).
|
| (2) is a really perverse statistical phenomenon, and it's
| unfortunate that nurses are bearing the brunt of our civic and
| public information failures. It must be particularly soul-
| draining to heal someone who resents the single thing that
| would have protected them the most from needing hospitalization
| in the first place.
| cogman10 wrote:
| The one I think you are missing is that nurses are and have
| been overworked for a WHILE now. (that's what I get from
| /r/nursing)
|
| Hospitals have made sure they hire JUST ENOUGH nurses to cover
| shifts and no more. With covid hitting, this blew out the
| number of nurses needed resulting in a lot of "I know you've
| already worked 60 hours, but can you do another 20? we are
| short!".
|
| Rather than hiring permanent people or upping salary, Hospitals
| have instead elected to just use travel nurses and an extreme
| premium so as to avoid any salary increases.
|
| The fix is one that Hospital admins don't want. Pay your nurses
| more and hire more than the minimum to cover shifts so a nurse
| being out sick doesn't result in another working a 80 hour
| week.
|
| So, instead it's been day old pizza with superhero stickers.
| jonlucc wrote:
| I would add that travel nurses are treated better in a lot of
| ways. Staff nurses must attend certain meetings and training
| aimed at standardizing care and improving outcomes. The
| travelers don't have to attend. Travelers can take off pretty
| much any time they want as long as they know before they sign
| the contract. Sure, they're considered "outsiders" by some
| staff and sometimes get the less enticing patient
| assignments, but for those drawbacks, they get paid 4x (I've
| seen 3-8x staff rates, but 4x seems common) plus a housing
| stipend as long as their location is more than some distance
| (I think 40 miles iirc) from their "home" location. Why would
| anyone be a staff nurse?
|
| Anecdotally, I know a travel nurse who works in pediatric
| ICUs (PICUs). One shift a couple months ago, the overnight
| staff on her unit was >80% travelers. And this is in peds
| units that aren't as affected by COVID, because ~1/2 of the
| patients are cardiac babies with congenital heart issues. The
| _only_ case I can see for not paying staff more to increase
| retention is that they can respond to a dip in cases over the
| summer, but that can 't possibly be an 80% decrease in
| patients. Maybe they're waiting until travel rates come down
| to offer an increase in pay so their 1.2x salary offer is
| more enticing in comparison to the travel rates, but the
| current system is ridiculous financially. I did mention that
| we've seen first-hand that hospitals can afford to pay nurses
| $4k/week, though, and I'm sure I'm not the only one who
| noticed.
| bumby wrote:
| > _The fix is one that Hospital admins don 't want. Pay your
| nurses more and hire more_
|
| As someone who worked in hospitals to help redesign their
| processes, this one piqued my interest.
|
| For every project I worked on (and I mean literally every
| one), the team lead wanted to jump to the solution that they
| just need the ability to hire more people. In the rare
| instances where they were able to convince hospital admins to
| do so, it never fixed the problem. Not once.
|
| Why? Because it never addressed the root causes. They needed
| to take a process-oriented approach. There's a saying that
| adding more people to a broken process makes things worse.
| You can hide a lot of quality issues with inventory; if you
| have a requirements for 100 widgets a day and you have a crap
| process that only makes 10 quality widgets, you can meet your
| goal by increasing throughput 10x, but nobody thinks that
| would be a good approach. It's the same with injecting more
| staff onto a broken system. If the system causes nurses to
| spend disproportionate amounts of time on admin work and not
| on direct patient care, it may be better to look at your
| admin processes rather than just hire more nurses.
|
| It's natural when people to feel overwhelmed to think the
| solution is to just hire more people, but it's almost always
| better to hold off on hiring until the system/process is
| fixed.
|
| Edit: I'm curious about the downvoting. I think it would help
| illuminate the conversation if you could explain where your
| disagreement lies. I'm basing my statements on actually
| tracking when hiring was increased to the levels desired and
| metrics did not improve.
| ben0x539 wrote:
| i think that argument works a lot better in a field where
| they arent bullying people into working overtime near
| constantly
| bumby wrote:
| Perhaps. But again, why is the overtime needed?
|
| If it's because it provides more patient care beyond what
| a nurse can provide in a good system, it might be a valid
| point. But if it's because the system is fundamentally
| broken, I'm skeptical that hiring more people will
| actually fix anything. From personal experience, it will
| only create a lag that will require the same need for
| more hires down the road.
| ben0x539 wrote:
| if the overtime isnt needed let people go home after 6
| hours each day
| bumby wrote:
| I think you're missing the point. Yes, if overtime isn't
| needed people should be sent home. Hospitals agree on
| this; they don't want to pay overtime if it's not needed.
|
| The issue I'm pointing to is that sometimes it's "needed"
| because of a bad process, like when there is redundant
| work. Sometimes it's needed because the system needs
| slack to compensate for disruptions in system dynamics.
| Sometimes it's "needed" because "that's how we've always
| done things." Point being, if it's needed, it should be
| because it contributes directly to better patient
| outcomes.
| kedean wrote:
| You're describing Brook's Law from The Mythical Man-Month.
| It was an observation of collaboration in software
| engineering specifically, and it cannot be applied
| universally to every industry. Really, anything that is
| highly parallel (medicine, teaching, stocking shelves,
| waitstaff, deliveries) can benefit from hiring more people
| until you reach saturation, and medicine isn't there or we
| wouldn't be having the conversation.
|
| The problems are caused by a "just in time" approach to
| staffing, where you have exactly enough people to cover the
| shifts at bare minimum. What solution would you suggest
| _other_ than more people? They are not saying to throw more
| nurses at patients simultaneously, they are saying to hire
| more nurses so existing ones aren 't bound to spent the
| entire week stretching themselves across the hospital.
|
| Also, I think you are being downvoted because you are
| applying software engineering rules to medicine.
| bumby wrote:
| It's interesting because they aren't software engineering
| rules. If anything, they are industrial engineering rules
| that pre-date software and certainly older than the
| mentioned book from 1975. The approach I was using was
| developed specifically for healthcare and with great
| effect in some organizations. I know this is HN, but I
| think it's an error to assume everyone is coming at a
| problem from a software perspective.
|
| > _What solution would you suggest other than more
| people?_
|
| It obviously depends on the situation but most of the
| time it comes down to reducing process waste. That may be
| automation through software where a nurse was hired
| specifically to only generate reports 40 hours a week, to
| re-designing a layout that minimizes travel time for
| nurses when they are delivering to patients. My
| experience with the staffing situation is that managers
| did not know how to staff to meet the needs of their
| patient loads and just revert to simple heuristics that
| left them understaffed at some times while being
| overstaffed at others.
| phil21 wrote:
| > re-designing a layout that minimizes travel time for
| nurses when they are delivering to patients.
|
| I think talking about micro-optimizations like this
| misses the forest through the trees.
|
| It's neat and cool. Fun to wring out those last bits of
| efficiency. But the fact you even need to discuss it
| shows how hiring adequate amount of bedside staff is the
| absolute last thing any medical system will do.
|
| > revert to simple heuristics that left them understaffed
| at some times while being overstaffed at others
|
| Showing that they were better than modern day automated
| shift planning.
|
| I will submit that if your hospital floor staff is not
| 50% idle on your average given fully-staffed boring day,
| you are understaffed. Only extremely exceptional events
| should cause your staff to be booked 100%. When it
| happens it should be root cause analyzed and be immediate
| cause for executive concern.
|
| The trope of card playing nurses _should_ be true,
| because of all industries there are - you want surge
| capacity in healthcare. Both physically speaking in terms
| of warm bodies available, as well as mentally speaking in
| brains not being stressed to their max the entire shift.
| stdgy wrote:
| The rules nurses have to deal with around things as asinine
| as taking PTO are AMAZING. They're required to put in PTO
| requests months in advance and the hospital can and will say
| "Sorry, denied. We don't have enough people..." As they are
| intentionally creating skeleton crews of nurses to wring
| every ounce of profit out of the business.
|
| My mom was a nurse, my aunt was a nurse, my sister is a nurse
| and my best friend's mom is a nurse. I really can't believe
| anyone continues to be a nurse given the insane working
| conditions these folks have to put up with. Twelve hour
| shifts, overflowing with patients, watching newcomers earn
| more than seasoned veterans... When I compare it to my laid
| back software engineering job it's like I'm living in an
| entirely different universe. The hospital industry is a
| hugely demoralizing place.
| a2tech wrote:
| The hospital I work at requires physicians to file their
| schedules 8 months in advance. The only deviation from that
| is for emergencies. Unofficially there's a lot of flex for
| them, but that's the official administration line.
| cogman10 wrote:
| Yeah, my mom was a small town nurse it was the same even
| there. I gave them a bit more slack because it was a
| hospital serving like 2000 people (so not really a high
| profit place) but even there, there was a lot of last
| minute "Oh no! People didn't show up for their christmas
| shifts, could you come in please!"
| ayngg wrote:
| I actually think that this is just one example of many across
| a ton of disciplines where people like Nurses basically are
| forced to deal with costs and responsibilities offloaded onto
| them from above the responsibility chain. Resources are eaten
| up at the top of the chain to their benefit and costs are
| offloaded down the chain until it reaches people like Nurses
| at the end of the line who have to deal with it because there
| is nobody else to offload it to. There is no shortage of
| people wanting to be nurses (in some places it is extremely
| competitive), and there is a huge demand for nurses based on
| shortages everywhere, but somehow we are in a situation where
| nurses are overworked because they are short staffed.
|
| I look at academia which is rife with money sloshing around,
| and see undergraduate classes are taught by grad students who
| make ~30k a year who are basically the Nurses of the academic
| world and treated like garbage. The justice system is
| dysfunctional, courts systems are overwhelmed and
| understaffed so criminals just enter and exit like a
| revolving door, and police is basically useless because the
| best they can do is taxi criminals into the system that
| automatically spits them out again, while they take the brunt
| of public criticism for how they are forced to deal with a
| problem that is mostly beyond their scope.
|
| In all of these cases it seems like the bottom if falling out
| of these institutions, and the responsibilities have fallen
| on their respective janitors to deal with it when the
| solutions need to come from places that have been
| incentivized to create the mess in the first place.
| WalterBright wrote:
| And yet the government budgets rise dramatically year after
| year.
| munk-a wrote:
| The government is one of the few places where you can get
| a job in your twenties and retire comfortably in your 60s
| having made a decent, but certainly not outstanding,
| amount of money with consistent raises and cost of living
| adjustments.
|
| What some people will call government waste - other
| people will call ethical employee treatment... sure there
| are a lot of other sources of inefficiency outside of
| your comment - but complaining about overpaid government
| bureaucrats is essentially advocating for the same race-
| to-the-bottom that has stagnated wages in large parts of
| the labour pool.
| fallingknife wrote:
| It's not that they're paid too much. It's that they do
| too little useful work.
| munk-a wrote:
| A relative of mine works for a state level LEO targeting
| financial crimes - they've spoken often about how
| "smaller government" advocating politicians have
| repeatedly hamstrung the organization when it tries to go
| after large corporations. They've still managed to do
| good work going after smaller scale offenders that fleece
| investors - but I wouldn't put the blame on those
| employees for doing work you don't find useful... it's
| mostly up to politics.
| andybak wrote:
| I've worked public and private sector and know plenty of
| people in both and I've not noticed a huge difference in
| the number of people just coasting vs those who really
| try to make a difference.
|
| What makes you think government is that much worse than
| the private sector in this regard?
| johnnyanmac wrote:
| > There is no shortage of people wanting to be nurses (in
| some places it is extremely competitive), and there is a
| huge demand for nurses based on shortages everywhere, but
| somehow we are in a situation where nurses are overworked
| because they are short staffed.
|
| why is this such a common story across pretty much every
| single industry? There's more people in the country than
| 10, 20, 30 years ago. More customers, more money. Why do
| they think they can handle more work with less workers
| whose salary is less when adjusting for inflation?
| heavyset_go wrote:
| Owners and operators have learned that they can keep the
| lights on by running their businesses with skeleton crews
| and, at the same time, reap the rewards of lower costs as
| profits.
| chiefofgxbxl wrote:
| They don't think they can handle more work with fewer
| workers. It's just a profit squeeze, and someone else
| pays the price.
| TomSwirly wrote:
| > courts systems are overwhelmed and understaffed so
| criminals just enter and exit like a revolving door,
|
| You're delusional. America has more people in jail, serving
| longer sentences, than _any country in history_.
| triska wrote:
| I think this is due to Pournelle's _Iron Law of
| Bureaucracy_ :
|
| https://www.jerrypournelle.com/reports/jerryp/iron.html
|
| "In any bureaucratic organization there will be two kinds
| of people:
|
| First, there will be those who are devoted to the goals of
| the organization. Examples are dedicated classroom teachers
| in an educational bureaucracy, many of the engineers and
| launch technicians and scientists at NASA, even some
| agricultural scientists and advisors in the former Soviet
| Union collective farming administration.
|
| Secondly, there will be those dedicated to the organization
| itself. Examples are many of the administrators in the
| education system, many professors of education, many
| teachers union officials, much of the NASA headquarters
| staff, etc.
|
| The Iron Law states that in every case the second group
| will gain and keep control of the organization. It will
| write the rules, and control promotions within the
| organization."
| TomSwirly wrote:
| I had no idea that Pournelle was claiming credit for
| that!
|
| He nicked it from Robert Michels, who wrote about the
| Iron Law of Oligarchies in 1911:
| https://en.wikipedia.org/wiki/Iron_law_of_oligarchy
|
| I was reading some old Analog magazines the other day,
| and man, Pournelle was one deranged man in his "non-
| fiction".
| tomrod wrote:
| You just explained something I saw on many establishing
| subreddits!
| TomSwirly wrote:
| Here's the original author:
| https://en.wikipedia.org/wiki/Iron_law_of_oligarchy
| [deleted]
| ayngg wrote:
| Thanks for the link, I'll check it out.
| bumby wrote:
| As somebody with experience at NASA, this made me
| chortle. I would NOT characterize the average civil
| servant that I worked with as "devoted to the goals of
| the organization." That includes the lowest level field
| organizations. Unfortunately, for the average employee,
| it eventually gets treated like any other job.
|
| It's possible this dichotomy works in theory only. Being
| generous, it's possible they just disagree about the
| goals of the organization.
| avianlyric wrote:
| That's the point. The second group, those who only care
| about the existence of the organisation, and the
| power/money it provides to them, have taken over at NASA.
|
| As a result only those who act to increase the
| power/wealth at the expense of all else, such as the
| original goals of the organisation, get promoted and hang
| around. The end result, an organisation that achieves
| very little, and consumes huge amounts of resources, full
| of people who really don't care about the fundamental
| goals of the organisation.
| bumby wrote:
| Ok, I see your point and think you're right. The quote
| distinguished between scientists/technicians and
| management. I met many in the former group who cared
| little about the goals of the organization, but to your
| point, they had been within the organization a long time.
| armchairhacker wrote:
| Nurses, teachers, charity workers, IEPs, game devs.
|
| These are all jobs where people sign up _for the job_.
| Whether it's altruism or genuine passion. They're willing
| to compromise and put up with less pay and harder working
| conditions.
|
| But because they're willing to compromise, these people
| are _pushed to their limit_. With not only low pay and
| shit conditions, but higher-ups which actively exploit
| their altruism and passion. "If you don't work, patients
| / children are going to suffer!" coming from the same
| beaurocracy which created the situation where a) they
| suffer or b) you work extra hours.
|
| They're being pushed past the limit in fact, which is why
| there's now a nursing and teaching shortage despite these
| actually being popular fields. A lot of people want to
| work these professions, they just don't want the jobs.
| HWR_14 wrote:
| This is the same reason why startups often phrase what
| they are trying to do as "change the world" and not
| "become filthy rich" to their employees.
| n0on3 wrote:
| This. So much this. In so many fields, it's actually hard
| to find one where this is not the case.
| notch656a wrote:
| I don't disagree nurses DESERVE to be paid more (I'm not
| sure if the economics bear out but they're certainly as
| WORTHY as many other professions), but wouldn't the fact
| that these nurses continue to work in nursing despite
| considering leaving bolster the argument even further that
| they are receiving adequate compensation?
|
| Staying when you want to leave indicates there's enough
| compensation to 'make it worth it' at least versus whatever
| shitty alternatives you have. Leaving when you want to
| stay, to me, would be a much bigger indicator that nurses
| who want to stay in the profession can't because of
| wage/benefits/conditions issues.
| alexashka wrote:
| That's not how the real world works.
|
| People don't 'switch careers' when they've spent years
| getting good at it. What they do instead is sit around
| posting on HackerNews and fucking the dog in all sorts of
| other ways.
|
| Do you realize the irony of it all? This place gets like
| 1/10th the traffic on weekends. That's not a coincidence.
| tetraca wrote:
| > Staying when you want to leave indicates there's enough
| compensation to 'make it worth it' at least versus
| whatever shitty alternatives you have. Leaving when you
| want to stay, to me, would be a much bigger indicator
| that nurses who want to stay in the profession can't
| because of wage/benefits/conditions issues.
|
| I think the conclusion of this sort of economic thinking
| is basically: Give your employees just enough money that
| they can keep they keep their head above the water but
| not enough to flourish, and just enough
| pressure/responsibility that they don't have energy to do
| anything else, but not too much that they have a complete
| mental breakdown that leaves them with the conclusion
| that they should leave your industry at any cost.
|
| When you spent a lot of time and money into a specialized
| and demanding career, I imagine it practically very
| difficult to actually change your career, even if it's
| killing you. It's probably even worse if you have
| familial obligations. You likely do not have time or
| energy to better your situation after hours, and if you
| quit, you potentially resign yourself (perhaps) to many
| years of destitution while you accumulate the necessary
| knowledge to do something else. I would not be surprised
| if many people just bear bad conditions because the cost
| to do anything else worth one's time is simply too high.
| nradov wrote:
| Employers are going to pay the minimum wages they can in
| order to retain sufficient workers. They obviously aren't
| going to voluntarily pay extra just so that employees can
| flourish.
|
| There are a lot of jobs openings available to someone
| with an RN certificate and some experience. Unemployment
| in that group is close to zero. They don't all work in
| direct patient care roles.
| landemva wrote:
| Many can't afford to not work due to debt/rent/child
| support payments. If you don't pay rent you lose the
| apartment and the weekend parenting time. Miss the child
| support payments which were being taken from paycheck and
| child support enforcement takes driver license and starts
| process to take the car that is in your name.
|
| Many people don't have even a little optionality.
| notch656a wrote:
| That's actually my point. IF they are able to meet their
| obligations in nursing and their job is literally such a
| superior option to all the alternatives that they don't
| have 'optionality' then it's a weird flex to be angry at
| your one best(least bad) option that actually pays your
| rent and child support. Be angry that the alternatives
| aren't as good as the nursing gig you have.
|
| I definitely feel for those paying child support, because
| 'imputed income' means you must pay at whatever rate the
| judge thinks you can make the best money at. You can
| never take a more relaxing lower paying job, because it
| will result in your imprisonment. Those people really
| have no future in the US -- their only option to throttle
| back their income is suicide, leave the country, or wait
| to go to jail. I blame society for the existence of these
| debtor's prisons, not nursing employers.
| landemva wrote:
| Seems you understand the more income -> more support
| trap. Mandatory overtime is considered in support
| calculations. That sets high water mark so going back to
| 40/hours week does not lower payments. I learned the hard
| way, and last employer I regularly sent email to boss
| thanking them for opportunity to work voluntary overtime.
| I would subpoena the boss's response of 'yes' for
| evidence in child support hearing to only use 40/hours
| week. The courts and county child support enforcement are
| wicked and liars.
| notch656a wrote:
| Yes that never made the slightest sense to me. As someone
| married with a kid, when I get a raise or bonus it goes
| to my retirement -- not as a change in quality of life
| for a child who already has food/shelter/education. The
| kid still gets the same amount now as when I made
| significantly less. The idea that a kid needs more money
| because you worked overtime is quite possibly one of the
| dumbest ideas I've ever heard.
| Sakos wrote:
| Are you familiar with the US? I don't see how you can in
| good faith argue that if people don't like what they have
| to do and/or what they get paid for it, they can just go
| do something else.
| ayngg wrote:
| I am not really specifically making an argument on their
| salaries, I guess I am saying that Nurses are in the
| position where they have the least leverage in the system
| so they end up bearing a lot of the responsibilities that
| should be held elsewhere while having a disproportionate
| amount of resources allocated to them.
|
| In healthcare I get the feeling that a lot of workers
| feel stuck in that there are many patients and people
| depending on them, and to leave would sort of be like
| abandoning them while increasing the burden on ex-
| cowoerkers.
| pojzon wrote:
| Most of those ppl cannot leave due to various
| obligations.
|
| If you want to see an indocator of terrible compensation
| - check why pretty much noone (at least here) wants to be
| a nurse.
|
| Profession is rapidly aging because new ppl are not
| joining. And they are not joining because work is hard
| and pay is terrible.
|
| The whole Healthcare system if we dont get robots in
| place fast is going to crumble soon like a house of
| cards.
| maxerickson wrote:
| The US has lots of people interested in nursing and not
| enough infrastructure to turn them into nurses:
|
| https://www.npr.org/sections/health-
| shots/2021/10/25/1047290...
|
| The work is hard, but the pay is well above many other
| jobs and there are jobs everywhere.
| KarlKemp wrote:
| This reads too much like a generalization of the standard
| complaints about management and their stupid meetings, the
| basic thesis of that web comic that was neither funny nor
| true, Dilbert.
|
| The criminal justice system may be overwhelmed, but its
| reaction certainly isn't to just let criminals "exit like a
| revolving door". The US is still incarcerating people at
| 10x the rate of other wealthy countries.
|
| Nurses being overworked is simply due to there not being
| enough nurses. It matters little if there's too much
| bureaucracy somewhere, or if too much money is spent on
| pharmaceuticals (about twice as expensive as anywhere else)
| or if doctors make too much money or if the US has a
| uniquely unhealthy population.
| johnnyanmac wrote:
| >Nurses being overworked is simply due to there not being
| enough nurses.
|
| yes but this begs the obvious question of "why?", which
| either leads to the immediate thoughts of
|
| 1. not enough people want to be nurses 2. companies don't
| want to hire more nurses
|
| I'm assuming #1 is false, so #2 is the go-to conclusion,
| at least on the high level. I'm sure I'm missing some
| more nuanced #3/4/5 explanations, but it does seem to
| ultimately come down to money that isn't being spent (be
| it maliciously or simply due to not having the budget).
| pessimizer wrote:
| Dilbert wasn't a webcomic, it was in the paper.
| linsomniac wrote:
| In cases I'm familiar with, they aren't hiring JUST ENOUGH
| nurses, they are hiring AS FEW NURSES as they can get away
| with. More like half as many as they should. IIRC, nurse-to-
| patient ratio should be around 1:5, but it can often be more
| like 1:10 or worse.
|
| On top of that, they also hire as few orderlies and nursing
| assistants as possible, so the nurse doesn't even have anyone
| to offload things to, and ends up having to do more work on
| more patients.
|
| This has been a problem well before the pandemic.
|
| It's a trope among nurses that they are so busy they don't
| have time to use the bathroom, let alone eat lunch.
|
| Source: My wife is a nurse, most of her friends are nurses,
| and she left the profession ~a year before the pandemic
| because of exactly these issues.
| eigen wrote:
| and now nurses are apparently solely responsible for medical
| errors and will not be supported by their employer. the cause
| of which appears to be related to #3 in GP above where
| overrides are a regular occurrence and quickly loose meaning
| if you have to do it multiple times per day.
|
| https://khn.org/news/article/radonda-vaught-fatal-drug-
| error...
| tom-thistime wrote:
| Yeah, anecdotally, experienced nurses were fed up in the
| mid-1980s.
| HWR_14 wrote:
| Do you have anything I can see about that, or did you just
| know people who were fed up and retired then.
| conductr wrote:
| Yes and No.
|
| On an individual basis, nurses are overworked because they
| choose to be and their employers allow for it. The standard
| work week is 3 12 hour shifts, which is much less than most
| professionals work. Like a retail or warehouse worker, they
| are expected to clock out as soon as possible and leave when
| the shift ends. Those of us with salary jobs knows how
| difficult that can be in our arrangements and how much "free"
| work we end up performing. They get paid premiums for
| everything; night, weekend, etc. And since they're hourly,
| they typically LIKE the overtime and signup for it as much as
| possible. They also might work FT at one hospital and pull
| extra shifts at another hospital on a PRN basis. These things
| are very common. Just like in a retail environment, people
| typically LIKE to work holidays so long as it's voluntary
| because it's 1.5x pay (or more?).
|
| > Rather than hiring permanent people or upping salary,
| Hospitals have instead elected to just use travel nurses and
| an extreme premium so as to avoid any salary increases.
|
| This makes no sense. Capacity is the problem, paying more for
| the same capacity does not solve the problem. Hospitals try
| very hard to avoid overtime and the travel nurses due to the
| cost. It's also a very elastic model to balance and a lot of
| flex (non Full Time) folks are needed to fill the gaps and
| manage cost somewhat.
|
| > The fix is one that Hospital admins don't want. Pay your
| nurses more and hire more than the minimum to cover shifts so
| a nurse being out sick doesn't result in another working a 80
| hour week.
|
| That is the current system. The problem is usually time. If
| someone calls in sick, they do it an hour before their shift
| starts. They usually can solve for this. Either they call
| from their roster or a supervisor level person with an active
| RN license steps into the clinical side that day. Staffing at
| 2x just in case everyone calls in makes no sense. Staffing at
| 5x just in case a pandemic hits makes no sense.
|
| Hospitals barely make money as it is, I don't see how this is
| a sustainable solution. Paying more does not create capacity
| in this industry.
|
| It's also important to note that "nurse" is a very generic
| term. For example, ICU nurses is a very distinct type of
| nurse that has been dealing with COVID first hand (caring for
| vent patients). They are the ones you hear about making
| $150-200/hour in COVID times. It is difficult to become an
| ICU nurse. It hasn't been possible for a surgical nurse to
| pivot to ICU nurse in these times so the labor pool has been
| rather fixed, or shrinking due to natural churn and inability
| to onboard new folks. It would be akin to suggesting why does
| some [insert super specific domain expertise] developer make
| $1M/year at FAANG when they could hire a PHP coder for
| $15/hour on a freelance website. There is no immediate/cheap
| substitute for the experience and knowledge that the
| expensive developer has, so they cost more. This is happening
| in nursing where some are thriving while many actually got
| furloughed early on in the pandemic.
|
| My personal opinion on the matter, is one only has to look at
| the demographics of an average nurse. It's become quite "old"
| and like other industries, the boomer's retiring is causing a
| labor issue. The handful of nurses that made 5-10 years of
| salary since Q1.2020 are now ready to retire early as well. I
| don't blame them.
| robonerd wrote:
| > _Capacity is the problem_
|
| Capacity is generally limited by staffing, not space or
| actual beds. When hospitals report how many "beds" they
| have available, they're generally not talking about the
| furniture.
| conductr wrote:
| They are absolutely talking about actual physical beds.
| The bed is licensed by the state and inspected by a
| regulator and is an indication of how many patients can
| stay in the hospital. As as been shown these years, they
| can and will pay what is needed, finding qualified people
| is the hardest part.
| robonerd wrote:
| If a hospital has 200 beds but only enough nurses to
| staff 100 of them, they have "100 beds".
| conductr wrote:
| Maybe to you, but officially you have 200 beds at 50%
| occupancy. If needed, nurses can be added by other means.
| For example, the army, FEMA, etc. will ship in nurses and
| just need to know if the bed is physically there and
| certified for use.
| robonerd wrote:
| > For example, the army, FEMA, etc. will ship in nurses
|
| _Might_ ship in more nurses, and until they do, the beds
| that can 't be staffed don't count towards capacity.
|
| > _50% occupancy_
|
| Having the capacity to staff those beds is not the same
| as the beds being occupied. Beds are occupied by
| patients, not nurses.
| thebradbain wrote:
| "Hospitals barely make money as it is, I don't see how this
| is a sustainable solution. Paying more does not create
| capacity in this industry."
|
| The problem is - and this may be very bizarre in a society
| as capitalistic as the US - healthcare should not be
| beholden to making a profit.
|
| Rehabilitating people is clearly "valuable" to the economy
| in that without people to participate in the economic
| system, a debt-based economy collapses; I'd argue that
| healthcare is much more valuable to capitalism than is
| reflected on a balance sheet of paper
| costs/revenues/profits, and yet a system such as ours has
| absolutely no way in its current form to price that in
| (sure, in an academic defense you could wave hands that
| "positive externalities" such as these should be priced in
| to the model, but it's clear with the racket the medical
| industry has found itself in that will never happen
| practically).
|
| The main issue profit-seeking conflicts with is that whole
| rehabilitating/healing/saving people is an intrinsically
| good thing to do, and that letting people who have full
| lives to live die or suffer is an intrinsically bad thing
| to do.
|
| What's not sustainable is that healthcare has to survive
| within the confines of a system that is many times in
| complete opposition to it. Other otherwise-capitalist
| countries have at least _tried_ to insulate their
| healthcare industry from market forces, meanwhile the US
| has just wrapped it in another layer of capitalism with its
| insurance market.
| landemva wrote:
| It makes sense to the $250k/year hospital chief bureaucrat
| (not a medical person) and the Pres. and board accept that
| the extra contractor pay is just short term.
| conductr wrote:
| So are pandemics if you look at it that way
| landemva wrote:
| It was great for revenue. Hospitals got paid for using
| Remdesivir, which has no approved medical use anywhere
| worldwide and had a test on Ebola virus patients halted
| because it was killing faster than the Ebola virus.
| https://www.cms.gov/medicare/covid-19/new-
| covid-19-treatment...
|
| ' October 22, 2020, the FDA approved remdesivir (Veklury)
| for the treatment of COVID-19 for adults and certain
| pediatric patients requiring hospitalization '
|
| That stuff is lethal.
| https://www.fiercebiotech.com/biotech/gilead-mulls-
| repositio...
| nradov wrote:
| Hospitals receive very little revenue for administering
| remdesivir. It's not a material item on their financial
| statements.
| BeetleB wrote:
| > Rather than hiring permanent people or upping salary,
| Hospitals have instead elected to just use travel nurses and
| an extreme premium so as to avoid any salary increases.
|
| In case people want an idea of what travel nurses made during
| COVID...
|
| https://khn.org/news/highly-paid-traveling-nurses-fill-
| staff...
|
| > In April, she packed her bags for a two-month contract in
| then-COVID hot spot New Jersey, as part of what she called a
| "mass exodus" of nurses leaving the suburban Denver hospital
| to become traveling nurses. Her new pay? About $5,200 a week,
| and with a contract that required adequate protective gear.
|
| > Months later, the offerings -- and the stakes -- are even
| higher for nurses willing to move. In Sioux Falls, South
| Dakota, nurses can make more than $6,200 a week. A recent
| posting for a job in Fargo, North Dakota, offered more than
| $8,000 a week. Some can get as much as $10,000.
| jonlucc wrote:
| These contracts are likely emergency contracts, which pay
| outrageously but often require a full week of 12-hour
| shifts or something similar with the expectation the nurse
| will only do one week then recover. I've seen this for
| COVID peaks and when a hospital's entire nursing staff is
| planning to strike. The $5200/wk rate is more likely 3 or 4
| 12-hour shifts.
| BeetleB wrote:
| I'm not sure I follow:
|
| > The $5200/wk rate is more likely 3 or 4 12-hour shifts
|
| 3 or 4 12 hour shifts a week is normal for salaried
| nurses. $5200/wk isn't. It's over double.
|
| > which pay outrageously but often require a full week of
| 12-hour shifts or something similar with the expectation
| the nurse will only do one week then recover.
|
| I'm not sure what you're trying to say. Yes, it may be a
| full week of 12 hour shifts, but it's still a much higher
| pay. And if you get the next week off, it's a _fantastic_
| deal.
|
| For context, pre-pandemic, I knew a nurse who often would
| do this schedule for her salaried job - she requested it
| as she liked having a full week off.
|
| What I mentioned elsewhere: Travel nurses have a lot more
| control over the contracts they take. They can work fewer
| hours per year and still make significantly more. They
| may have stretches of long hours in a given contract, but
| annually they work less.
| jonlucc wrote:
| > 3 or 4 12 hour shifts a week is normal for salaried
| nurses. $5200/wk isn't. It's over double.
|
| It's a normal shift schedule, and they pay travel nurses
| much more than staff nurses to work the same shift
| schedule. These are typically 3 month contracts, but not
| always.
|
| > I'm not sure what you're trying to say. Yes, it may be
| a full week of 12 hour shifts, but it's still a much
| higher pay. And if you get the next week off, it's a
| fantastic deal.
|
| I don't disagree, but a lot of people do not want to work
| (or feel like they can't provide good care for) 12 hours
| every day for a week.
| BeetleB wrote:
| Ah I see - we're in agreement!
| ben0x539 wrote:
| How many working hours are in those weeks?
| jonlucc wrote:
| I replied to the parent, but the highest quotes are
| probably emergency contracts for 5 or 7 shifts of 12
| hours but only for a week. Longer contracts are often 3
| months at 3 or 4 shifts per week.
| BeetleB wrote:
| I haven't found concrete figures, but from what I've
| read, they do often work more hours during the contract.
| However, travel nurses in general have far more control
| over their schedule than regular salaried nurses. A
| salaried nurse cannot refuse to work, but travel nurses
| routinely say "No" to contracts if they don't like the
| pay or the hours.
|
| What happens is they'll accept a few weeks (or 2 months)
| of long hours, and then take a month off and relax. As
| you can imagine, if they're getting paid $6000/week, they
| can easily take a lot of time off and still get paid more
| annually than their salaried counterparts (while overall
| working fewer hours per year).
| pbuzbee wrote:
| Travel nursing is definitely a great way to turn the tables
| if you can do it. The money you can make is clearly quite
| high! I fully support those nurses using travel nursing to
| get greater pay.
|
| But it also isn't an option for everyone. Many don't have
| the flexibility to switch to travel nursing. For example,
| you may not be able to get a nearby contract and may not be
| able to travel (e.g. because you have children). Plus,
| traveling isn't an option for new nurses without
| experience, who now have to work in hospitals that are
| hemorrhaging experienced nurses to traveling AND have worse
| staffing ratios than ever.
| ARandomerDude wrote:
| > Hospitals have made sure they hire JUST ENOUGH nurses to
| cover shifts and no more.
|
| This is a two-edged sword. If you hire more than you need,
| the nurses' hours will be cut during normal situations and
| they won't make enough money. If hospitals don't cut extra
| hours and instead keep the staff on the clock, a public
| scandal will erupt surrounding well-paid medical
| professionals sitting around doing nothing.
| runnerup wrote:
| You can pay people fixed monthly salary + overtime hours.
| You don't need to cut their hours and their pay, though
| that's often the choice that employers make.
| munk-a wrote:
| Exactly, choosing to cut hours or pay due to a lull in
| business is a choice made by the employer. It's not like
| these hospitals are sputtering along right at the fringe
| of solvency and one bad choice will bankrupt them -
| private health providers tend to make pretty comfortable
| profit margins and the fact that they can pay such
| outrageous surge prices for travel nurses is a pretty
| clear proof of how much they have to spare.
| nradov wrote:
| Many hospitals literally are sputtering along right at
| the fringe of solvency. This is particularly a problem
| with non-profit hospitals in poor and rural areas. Summer
| have shut down in recent years, and the pandemic is
| accelerating that trend.
|
| https://www.beckershospitalreview.com/finance/12-latest-
| hosp...
| munk-a wrote:
| _Some_ hospitals are sputtering right along, and a list
| of 12 isn 't a great piece of evidence that those
| hospitals (many of which are run by regional
| organizations which are essentially consolidating patient
| pools into a central location) are being run effectively
| - especially if these hospitals are paying 10k/week for
| travel nurses.
|
| If there's a location that isn't profitable to operate a
| hospital in then the hospital will probably fail. America
| is the country still clinging to market-driven healthcare
| services and the market can be a cruel mistress.
|
| And all that doesn't at all erode the fact that nurses
| are paid pauper's wages at extremely profitable hospitals
| - some tech companies are going out of business, some
| probably closed their doors today... that doesn't mean
| that all engineers are expected to work for 60hrs/week at
| $15/hr.
| nradov wrote:
| That article was just a recent example. If you search
| around you can find many other hospitals which have
| closed down or gone through bankruptcy in recent years.
|
| https://www.gpb.org/news/2022/04/08/wellstar-closing-er-
| hosp...
|
| https://www.post-
| gazette.com/opinion/editorials/2022/04/04/c...
|
| In 2020 the US median salary for an RN was $75K. That was
| well above the median household income. Hardly pauper's
| wages.
|
| Most hospitals are not extremely profitable. In fact the
| majority are run by governments or non-profit
| organizations.
|
| https://www.kff.org/other/state-indicator/hospitals-by-
| owner...
|
| Tech companies will pay engineers as little as they can
| get away with. Expectations have nothing to do with it.
| Wages are set by the market.
| tinco wrote:
| > a public scandal will erupt surrounding well-paid medical
| professionals sitting around doing nothing
|
| I don't think that's true. Increasing the amount of nurses
| means simply increasing the amount of care. If you have
| twice as many nurses, you'll have twice as much care for
| your patients. No way nurses would be sitting around doing
| nothing.
| coryrc wrote:
| That's not how healthcare works. That it is does not
| function that way is why free-at-point-of-use public
| healthcare systems are capable of working.
| bumby wrote:
| Not sure why you're being downvoted, but the idea that
| doubling nurses doubles the amount of patient care shows
| an ignorance of the healthcare system. "Patient care" is
| a nebulous term and needs to be further defined in that
| statement. Do you now get two catheters instead of one?
| Or get your vitals taken twice as often? Both double
| patient care but only one is relevant.
| Firmwarrior wrote:
| I could definitely imagine nurses having twice as much
| time to carefully read my charts, or twice as much time
| to sleep at night and be well rested so they don't fuck
| things up, or being able to come by and help with
| something twice as quickly
| bumby wrote:
| That would provide better patient outcomes, I agree.
| Whether hiring more nurses translates to actually
| doubling that, is another question. To be clear, I'm not
| saying that increased staff is not part of the solution;
| it's just been my experience that it's rarely the sole
| part (or often even the majority part) of the solution.
| ikiris wrote:
| It's because it would actually double the amount of care
| on most floors, because they're usually at 60% of the
| staffing they need as a start because they've been able
| to get away with that for years.
| bumby wrote:
| That doesn't really answer the question. "it would
| actually double the amount of care". It would double the
| amount of staff hours. How those staff hours are used is
| a measure of patient care and not all hours are equally
| relevant to the patient.
|
| As an example, if we assume you are a software engineer
| and you double your work hours, will you double your code
| output? Probably not, just like it's not a 1:1
| translation of nurse hours to patient care.
| [deleted]
| ikiris wrote:
| Comments like this are showing just how much you don't
| understand maintaining a service level based care, and
| are stuck in thinking in terms of producing a product.
|
| Combined with willfully ignoring that basically all
| floors are intentionally understaffed and have been for
| _years_.
| bumby wrote:
| I can tell you from my years in healthcare that many of
| the people who think they know how the system works only
| have a very myopic understanding and they usually are the
| one's who have the most confidence that their simple
| solution will fix the problem. Unfortunately, there's a
| lot of nuance in complex systems like healthcare.
|
| We probably agree about the staffing levels to an extent,
| but I would be curious to hear the staffing estimation
| methodologies used in your experience.
| ikiris wrote:
| Yeah, I agree. You sound like many healthcare admins I've
| worked with and for.
|
| I'm not sure its the flex in this argument you think it
| is.
| bumby wrote:
| I wasn't healthcare admin and most of my department was
| staffed with nurses. But we were very data oriented and
| it helped buffer us from emotional responses to problems.
| tomc1985 wrote:
| At the rate that healthcare charges in the US, hospitals
| can more than afford to keep X+1 or +2 needed nurses around
| in three 8-hour shifts. They just don't.
| conductr wrote:
| Not even close. Most hospitals have trouble staying
| afloat as is. And there are disciplines within nursing,
| so you'd have to overstaff by quite a bit more such that
| closer to 2x is a backup but leads back to the GP's
| point.
|
| They employ on-call, PRN, contract nurses, etc to fill in
| the gaps which mostly works in non-pandemic situations.
| a2tech wrote:
| Reading threads like this really hammers home most of HN
| have never worked in health care. Hospitals BARELY make
| their budget. 1% over cost of doing business is
| considered a really good year for my institution.
|
| Also if I never have to hear people complain about
| bloated admin budgets in education and healthcare ever
| again it'll be too soon. Those admins aren't sitting
| around on their thumbs--they're dealing with the
| ridiculous legal and administrative system the insurance
| companies and government have created. Those people are
| absolutely critical for the institution to exist.
| jonlucc wrote:
| Hospitals have been paying 4x staff rates for travel
| nurses for multiple years now, though.
| bri3d wrote:
| This seems to be highly bifurcated, like so much in the
| US, between the haves and the have-nots. But overall I
| don't think it's fair to say "Hospitals BARELY make their
| budget." As usual, the whole system is broken. There are
| some hospitals with a wealthy customer base with full-
| ride insurance who can bill obscene amounts and profit
| massively, and then there are some hospital systems with
| uninsured and underinsured customer bases who are just
| scraping by.
|
| I looked up my local hospital network, UCHealth
| (Colorado, there are many UCHealths it would seem), and
| their EBITDA in 2021 was 16.6%. Mayo Clinic posted 1.2
| billion dollars in _operating profit_ in 2021, and also
| have a gigantic investing arm with several billion
| dollars under management.
|
| Then we look at networks like Spectrum in Michigan, who
| posted only a 3.6% margin, or Henry Ford, with a negative
| operating margin offset by investment income, and it
| becomes clear that _some_ hospitals barely make their
| budget while _others_ rake in dollars.
| tomc1985 wrote:
| How badly is the entire industry mismanaged if hospitals
| have to charge thousands-to-millions of dolllars for
| treatments? There is no possible way that is just barely
| supporting facilities+medical staff+reasonable
| administration+liabilities if other countries can do it
| at tiny fractions of our price.
|
| Instead, the story as I've heard it seems to be similar
| to education: massive administrative overhead permitted
| by fundamentally broken insurance billing.
|
| Sure I may not know healthcare but they really need to
| fix their shit.
| mgr86 wrote:
| My Daughter was born on the winter solstice this year. We had
| a broken sink in our hospital room and someone came by to fix
| it. He had a trainee with him. Who was mentioning that he was
| scheduled to work New Years Eve and then again the next day
| on New years day. A 3rd shift followed by an immediate 1st
| shift. He was casually talking to the guy training him and
| mentioned that had to be a mistake. The guy in charge said
| something like "what did I tell you. _They_ don 't care about
| you". I sure felt angry for both of them at that moment.
| nradov wrote:
| Hospitals operate 24x7. Someone has to work those shifts.
| Usually it ends up being the employee with the least
| seniority. What's the alternative?
| krisoft wrote:
| The problem is not that they had to work on those days.
|
| The problem is that they had two consecutive shifts.
|
| The alternative is that the hospital hires enough people
| so they can schedule them such that everybody has time to
| go home relax and sleep after they are done with a shift.
| dham wrote:
| My first year at the movie theater I had to work
| Christmas Eve, Day, New years eve and day, all for
| minimum wage. People are just more entitled now a days.
| krisoft wrote:
| Did you go home and sleep between working on on new years
| eve and new years day? If yes then what you had is not
| what the complaint is about.
| ikiris wrote:
| for those that aren't aware, a while here reads as at least
| 40 years, and it gets worse every year, especially the last
| 10 or so.
|
| With additional nuance that this kind of thing used to be
| protected a bit by the additional guard of a pharmacist. The
| automated dispensary changed those criminally liable people
| into a checkbox bypass that this nurse (and from the sounds
| of it, the rest of them by effect of policy) regularly
| bypassed.
| Sohcahtoa82 wrote:
| This ended up being the last straw for one of my friends who
| was a nurse.
|
| He kept getting vacation requests denied due to lack of
| staffing, yet if he asked if they were looking to hire, the
| answer was always No.
|
| He was super lucky and had some early cryptocurrency
| investments pay off big, so he decided he was done with it
| retired. He said that he loved helping people as a nurse, but
| not at the cost of his own physical and mental health, having
| to work 60-80 hours/week. If he ever gets back into it, he
| would establish at the interview phase that he works 50
| hours/week tops, and that vacation "requests" are not
| requests, but notices.
| landemva wrote:
| That describes me, though in tech. Trying to step back in
| to tech and recently had interview. After I explained
| parenting time schedule, HR guy said everbody works 60 hour
| weeks every week so there is not a role for me.
| notch656a wrote:
| That sounds perfectly fair actually. You explained you
| can't work 60 hours a week and he explained it's not the
| role for you. Complete honesty and the choice was made
| not to do the deal. You shouldn't get special hours or
| treatment for being a parent.
| landemva wrote:
| I agree with you, and I wanted them to know my needs so
| we all succeed. Hilariously the guy never asked my pay
| needs (low) and talked to me about the top of the pay
| range. I didn't care to correct him since the expectation
| was overtime all the time for everybody. Looks like a
| management culture I don't want to struggle against, so I
| can look elsewhere.
| ikiris wrote:
| Yeah the incredulous looks I get when I turn down gigs at
| "unlimited" PTO positions are just wild.
|
| Like what did you expect to happen? We're not stupid.
| Sohcahtoa82 wrote:
| "Unlimited" gets a bad rap.
|
| At the place I'm at right now, we have an unlimited
| policy and I've got 25 days of PTO planned over the
| course of the year that's all been approved.
|
| But yeah...I do know not every place is that good about
| it.
| ikiris wrote:
| Its just corpspeak for "we don't want to commit to you
| getting time off or a possible slight payout"
| taurath wrote:
| A good friend of mine couldn't get a single 3 day weekend
| approved (so one day of PTO) several months in advance.
|
| Then I open my recruiter inbox and I see like 20 new B2C
| healthcare startups.
|
| It really feels like the entire economy is designed to
| prevent problems being solved. Some people in healthcare are
| making massive amounts of money and the quality of life of
| everyone that performs the actual work has taken a nosedive
| when it was already a really crappy situation.
| 14 wrote:
| From a Canadian stand point you American nurses are already
| highly paid. My brother works in the US and was recently
| thinking of coming back to work closer to where he grew up.
| The best deal he could get here was $20usd less then what he
| makes there. So on top of making $20 more then a nurse here
| he is also making it in USD. He is making huge amounts of
| cash as a nurse down there. How much more do nurses need?
| gruez wrote:
| >you American nurses are already highly paid. [...] How
| much more do nurses need?
|
| This seems perfectly consistent with econ101. Prices for
| something is high, so we need more supply.
| callmeal wrote:
| >How much more do nurses need?
|
| Something something freemarket no longer applies when it
| comes to paying peons?
| sophacles wrote:
| > Something something freemarket no longer applies when
| it comes to paying peons?
|
| It never did.
| conductr wrote:
| The nursing labor market is so fluid, so much turnover,
| it operates much more like a commodity exchange where
| prices are concerned. This doesn't apply to people to
| refuse to change employers so incentivizes short term
| rate chasing
| Melatonic wrote:
| Apparently quite a bit if 90% hate their jobs
| freeflight wrote:
| Nursing, just like many other social oriented
| professions, attract a lot of people for the right
| reasons, like wanting to help other people, yet too often
| that well-meaning motivation is then exploited to the
| maximum by overworking and underpaying these people.
|
| They will bear a lot of that, because these people care
| for their patients and leaving a job because of bad
| circumstances also means leaving their patients behind
| _with_ those bad circumstances.
|
| Which is not something that comes easy to everybody who
| makes "helping others" such a big part of their work
| motivation.
| ethbr0 wrote:
| It's the game developer of health care.
|
| People get into it because they love it, and then have
| their love exploited for profit by businesses
| masquerading as social charities.
|
| Some hospitals and clinics do great philanthropic work.
| There are also a lot that don't, but have the same cross
| over their door.
| soared wrote:
| Without starting values and locations (COL) you can't
| compare values in this way.
| tenpies wrote:
| Canada is generally more expensive and taxes more
| (especially when you factor in sales taxes and such).
|
| To be honest, I am amazed that Canada has a healthcare
| system left.
|
| Decades of mismanagement and underinvestment aside,
| almost any Canadian healthcare worker can cross the
| border and instantly see a substantial pay bump and
| increase in QoL.
|
| I do imagine within the next 20 years, Canadian
| healthcare is going to look vastly different. Like
| something from an emerging market, where sure there is
| universal healthcare, but you generally avoid it if you
| have the means.
| GoodJokes wrote:
| psychlops wrote:
| They use the extra money here to pay for healthcare.
| cogman10 wrote:
| > How much more do nurses need?
|
| What you need to realize is that nursing salaries in the US
| are NOT uniform. From what I've seen in past discussions
| about it is they range anywhere from $20/hr -> $100k/year.
| The $100k/year are usually achieved only in cities and
| generally only by travel nurses.
|
| The majority of nurses, that I've seen, are clocking in at
| 50->60k yearly salary.
|
| Sort of like saying "Oh, that google dev makes $300k a
| year. How much more do devs in the US need?"
| ethbr0 wrote:
| "Nurse" is a pretty broad title when popularly thrown
| about, given that it spans from LPN to DNP and med-
| surg/clinic to ICU.
|
| "Sysadmin" seems the most readily comparable title in IT,
| going from "I push software to Windows PCs" to "I manage
| supercomputer clusters."
| [deleted]
| BeetleB wrote:
| > The $100k/year are usually achieved only in cities and
| generally only by travel nurses.
|
| While $100K/year is not the norm throughout the country,
| it is normal in my city (non-SV). Travel nurses made a
| _lot_ more during COVID.
|
| From my conversations, pay is not the reason they are
| considering leaving. Working conditions are.
| 14 wrote:
| He was an icu nurse not a travelling nurse and not in a
| big city. Washington state I forget the city but it
| wasn't a big city like Seattle.
| redwall_hp wrote:
| > Sort of like saying "Oh, that google dev makes $300k a
| year. How much more do devs in the US need?"
|
| And the answer to that is "how much is Google worth?" If
| your business relies on the efforts of software engineers
| to design and build your primary products, they should
| have the primary equity in the company. So no, even
| Google developers aren't paid nearly enough...and they're
| certainly overworked, regardless of how much they make.
| davidgay wrote:
| https://www.sfgate.com/news/article/Highest-paying-jobs-
| in-S... reports Registered Nurses as getting $150k/year
| in San Francisco, and $83k nationally.
| bratwurst3000 wrote:
| here in germany nurses make 15EUR And in switzerland nearly
| the double. I can understand their frustration and those
| who can leave or get new jobs.
| MomoXenosaga wrote:
| They are looking into getting nurses from the Philippines
| and Africa. Works for the UK maybe but there's a huge
| language barrier for the rest of Europe.
|
| Besides they need their health workers too.
| cogman10 wrote:
| Something that should always be considered is US
| healthcare is an expensive nightmare. Public healthcare
| is a HUGE benefit that I think a lot of outside of US
| people underestimate. (And no, nurses don't get free
| healthcare from their hospitals. They have the same
| terrible insurance everyone else gets).
|
| For example, I have to pay $9000 a year BEFORE my
| insurance starts covering healthcare costs. (at $5000 my
| insurance starts paying out and I owe 10% of the bill).
| My insurance does not cover medicine costs at all.
| [deleted]
| munk-a wrote:
| In Germany's defense, at least, Switzerland has some of
| the most insane wages in the world, and the cost of
| living there is equally high.
| noTooMooch wrote:
| boringg wrote:
| Executive hospital pay is ridiculous AND the executives are
| often times just some MBA type without any real value add.
| How about you chop up their comp between the nurses - would
| be a start. Nurses are the lifeblood of the hospitals for
| anyone who has had the unfortunate circumstances of having to
| spend any time there.
| AussieWog93 wrote:
| >1. Many new nurses make the same or more and long time nurses.
| It's frustrating when the nurse in charge with the most
| experience is making less than new nurses. Some hospitals are
| even trying to stop nurses from talking about pay.
|
| I think non-performance-based pay is something endemic to many
| female-dominated professions. My wife used to work in
| childcare, and it did her head in that she was paid less than
| complete idiots who'd been working there longer than she had.
| hadlock wrote:
| Not only are nurses talking about leaving the industry, in the
| "newbie programmer" groups I help mentor in, there is an alarming
| number of people who were _considering_ going in to health care
| /nursing, who are now seriously reconsidering their options, or
| changing majors in college mid-way through to move into
| technology/programming.
|
| I guess my point is, not only is the current healthcare labor
| market at stake, but hiring/pay/working conditions now are having
| upstream impacts on the labor pipeline of people coming into the
| market, or evaluating entering healthcare. Having recently gone
| to the ER with my toddler, I can tell you this is not an area you
| want the market going for lowest bidder when you do have to use
| healthcare services.
| dukeofdoom wrote:
| I have a nurse friend that was fired because she did not want to
| take the vaccine. She had covid before, and strongly believes in
| bodily autonomy. She did not want to be forced to put something
| in her body against her will. She's started a business cleaning
| houses now, and says is making same money. Except now she isn't
| pressured to be rushing from patient to patient like crazy. She's
| choosing her hours, works during the day at her pace and doesn't
| bring home the emotional stress of dying people. She worked as a
| nurse for 7 years and in that time she had thousands of patients.
| She said in all that time she only discharged 3 patients after
| chemo therapy. She's kind of convinced both are billion dollar
| scams by medical industry.
| LatteLazy wrote:
| You see these numbers come out of nursing and teaching regularly.
| But they both have very high retention rates. Because in both
| cases, people stay because they would feel bad if they left.
| They're not there for the money. This is why they're so badly
| paid. This is why I didn't go into teaching: you cannot compete
| with people who will work for emotional rewards instead of cash.
| pkaye wrote:
| A couple changes I've heard from nurses would be helpful:
|
| 1. Safe mandated staffing ratios. California is one that does
| this and many nurses seem happy with the ratios.
|
| 2. Safe harbor laws. If the nurse feels they are pushed into a
| risky situation, they should have a right to notify management
| which will take on liability if they do not resolve it. A few
| states have this but hospitals bully nurses not to invoking it.
|
| 3. Better pay for the liability they take. Unlike management,
| they could go to prison for mistakes they make. There was a
| recent case nurses were outraged about.
|
| 4. Unions are beneficial. In California the nurses union is
| pretty strong to negotiate better terms and conditions.
| xyzzy123 wrote:
| Canberra flagged, Tasmania exempted, Sydney and Melbourne
| upvoted.
| honkycat wrote:
| Greed is destabilizing society everywhere you look.
|
| 1. Hire more nurses to spread the load around
|
| 2. Pay existing nurses more
|
| 3. Incentivize people to get the technical training required to
| become a nurse.
|
| "But what about my boss's 4th home?" I know. I am worried about
| that too. i pay 1500/mo to live there, and the costs will
| probably trickle down to me. we will have to figure something
| out.
|
| "But we don't have the money! Who is going to pay for it?" Well.
| Then I guess the goose is cooked. We no longer have the resources
| to run a functioning society. I want you to think about that, and
| maybe think if we could get the funding from somewhere.
|
| We are out of trained workers. The money diet our overlords put
| us on has officially starved us. Welcome to the 3rd world. Hope
| you saved up enough money for a ticket to Elysium.
|
| Nobody wants to take out student loan debt anymore. If you are
| over 30, let me fill you in: cost of college has gotten even more
| insane than when we were in school.
|
| we are seeing the same thing in our courts. Everyone is mad at
| the PDX DA for turning people loose all the time, but the secret
| is: there are not enough public defenders, and we can't hold
| people indefinitely without cause. There are literally not enough
| lawyers graduating from law school/graduated in the past to fill
| these spots.
|
| Our society is falling apart and all anyone can talk about is how
| lazy the homeless are and obsess over what genitals people are
| born with.
| fallingfrog wrote:
| "Well. Then I guess the goose is cooked. We no longer have the
| resources to run a functioning society. I want you to think
| about that, and maybe think if we could get the funding from
| somewhere."
|
| Absolutely! Thanks, this made me laugh out loud. It's almost as
| if the people in charge of society don't have the same
| interests as the rest of us..
| dcchambers wrote:
| The burnout in healthcare is unreal and is a problem we should
| all be worried about.
| tedmcory77 wrote:
| My partner works in the healthcare industry; the Radonda Vaught
| ruling and outcomes are going to echo through that industry in a
| very significant way.
| qclibre22 wrote:
| These "nursing crisis" articles are a semi-annual feature, likely
| a PR stunt by the hospitals for more subsidies and guest nurses.
|
| The nursing crisis is 57 years old now:
| https://pubmed.ncbi.nlm.nih.gov/14252064/ (1965)
|
| Similar articles WHY THE NURSING SHORTAGE
| PERSISTS. HALE T. N Engl J Med. 1964 May 21;270:1092-7.
| doi: 10.1056/NEJM196405212702105. PMID: 14121489 No abstract
| available. STUDENTS' DISAPPOINTMENTS IN PUBLIC
| HEALTH NURSING. HANSEN AC, THOMAS DB. Nurs Outlook. 1965
| May;13:68-72. PMID: 14291737 No abstract available.
| chillingeffect wrote:
| A good path to explore, but requires more data points than two
| from 60 years ago... Let's try this approach: [0] steady with
| huge uptick since the pandemic [1] steady decline with uptick
| in July 2021 [2] sparse, but slow incline since July 2021 [3]
| shallow dip ~2013, slow include since
|
| [0]
| https://trends.google.com/trends/explore?date=all&geo=US&q=n...
| [1]
| https://trends.google.com/trends/explore?date=all&geo=US&q=n...
| [2]
| https://trends.google.com/trends/explore?date=all&geo=US&q=n...
| [3]
| https://trends.google.com/trends/explore?date=all&geo=US&q=n...
| gjsman-1000 wrote:
| A family friend was talking to a doctor who was considering
| quitting.
|
| The reason why, at least for that doctor, wasn't really the
| stress from patients. It was all the damned paperwork and the
| stress that created.
| pavon wrote:
| Agreed. This article is so off the mark, trying to talk all the
| ways technology can help this problem without a single sentence
| retrospecting about any of the problems that shitty EMRs have
| caused or at least facilitated. The massive increase in
| charting, and the fact that nurses spend more time on CYA than
| providing care these days is the number one reason I've heard
| from nurses who are trying to get out. High patient-to-staff
| ratios is the second, which wouldn't be quite as bad if it
| weren't for all the charting.
| christophilus wrote:
| I've known a few nurses, doctors, and PTs who expressed exactly
| this sentiment. It's such a stupid problem, too. There's no
| reason they should have such an onerous burden, and yet they
| all do.
|
| One of the PTs I know spent at least as much time filling out
| paperwork as he did with patients. This was partly due to the
| volume of paperwork required by govt / insurance / lawyers /
| whatever, and partly due to absolutely awful software.
| treeman79 wrote:
| I got badly injured. Everyone refused to do paperwork. Every
| doctor said it was every others job. I had great disability
| coverage. (In theory)
|
| Result. Spent 2 years trying to work when I couldn't get out
| of bed and was mostly blind.
|
| All because doctors didn't want to spend 20 minutes filling
| out forms. Plus Disability companies lie constantly until
| various deadlines pass.
| gbear605 wrote:
| Obviously the doctors should have done the paperwork and
| you shouldn't have had to deal with that. But it seems like
| the root cause isn't that doctors don't want to do
| paperwork, it's that the insurance is introducing too much
| paperwork.
| bkjelden wrote:
| My partner is an NP, not only is there an astounding amount of
| paperwork, usually it's done outside of working hours because
| management took the chunks of the work day that were previously
| blocked off for doing paperwork and turned them into more
| patient visits so they could make more money.
| henchore wrote:
| During my last physical, the doctor was trying to listen to my
| symptoms while getting frantically pinged from the hospital or
| something. I don't blame him at all, but this trend of always-
| on + interruptions at work is disastrous, I imagine especially
| so for people like doctors doing extremely high level
| intellectual work.
| nittanymount wrote:
| this is more correct, the medical fields have to do a lot of
| paperwork to follow rules and avoid issues (legal?) almost half
| of their time are on charting instead of taking care of
| patients, paperwork is needed, but in most facilities, it takes
| too much time, and the workflows are not optimized enough as
| well...
| hateful wrote:
| I've always wondered why they don't hire an assistant that
| JUST does the paperwork/coding for the doctor. They could
| follow them into room and just take notes (and leave at times
| when it is appropriate).
|
| How much could it cost to pay someone else to do this? Surely
| less than a doctor makes doing it... It can become its own
| profession. It's a separate skill - separate from what a
| doctor should be focusing on.
|
| On a side note, it seems that a lot of professions would
| benefit from having an assistant - a thing that seems to have
| disappeared - if what I've seen in old movies in shows is to
| be believed. Another side-case of this is the fact that
| technical people tend to be promoted into management roles
| and have to deal with attendance and time-sheets - why not
| have someone else do it? The work only suffers.
| pomian wrote:
| Brilliant suggestion. Some of us still remember the days
| when we were paid to be creative engineers, solid creative
| engineers, designing elegant solutions. Didn't know or need
| to know how to type, design layout of reports, kerning and
| fonts, didn't keep track of bills and accounts: Just
| engineering. (Of course report presentation, review and
| editing were still necessary, not not the actual technical
| aspects.)
| opwieurposiu wrote:
| My kid's pediatrician has a guy that does this. The job
| title was "Scribe." A little bit crowded in the exam room
| but you get used to it.
|
| The Scribe had a laptop and could look up whatever info was
| needed while the doc was doing his thing. If a scrip is
| needed the scribe types it in to the system and then the
| doc had to read it and approve.
|
| Just keeping the docs hands clean from not having to touch
| a dirty laptop/iPad all the time has a health benefit I
| bet.
| hateful wrote:
| My wife is a PA - here are a few things we've (anecdotally)
| noticed:
|
| 1. A few doctors left practices after they got taken over by a
| bigger entity and the hoops they had to jump trough weren't
| worth it, so they retired.
|
| 2. The insurance companies - they control EVERYTHING. One thing
| that happens a lot is that they don't allow her to order an MRI
| unless she orders an X-Ray first - even if what they're testing
| for wouldn't show up on an X-Ray. And this slows down the
| process of diagnosis by days. There are more examples of things
| like this - things that should be up to the provider, but end
| up being up to the insurance company (what drug to prescribe or
| what treatment to pursue first) - it makes no sense (at least
| from what I hear from her).
| gadflyinyoureye wrote:
| The software in this space is terrible. The system is designed
| for admins not practitioners. For example blood pressure entry
| is odd with two boxes. Note capture is slow due to needing it
| be typed rather than written. Sharing out of the core system is
| onerous.
|
| FHIR would be a good idea, but in practice its hard to
| correlate a patient across the systems. Few hospitals and
| doctors setup a push notification for when they change a
| patient's record.
|
| Essentially all of the software needs to be redone with a focus
| on a centralized record tracking system. The rewrite needs
| practitioners (all of them, not just Docs, but the lowly CNA
| too) to drive the requirements. Admins should be included, but
| not the target of day to day UI.
| [deleted]
| BouffantJoe wrote:
| I've heard a lot of the same from teachers.
| ghaff wrote:
| My primary care doctor dropped me a few years back. He said his
| solo practice couldn't handle the paperwork of having so many
| patients so he went to just seeing patients for his specialty.
|
| He was admittedly older and had never particularly embraced
| computers and so forth.
|
| (And then my new PCP retired during the pandemic.)
| dt3ft wrote:
| Isn't there any software for solo practices out there?
| JshWright wrote:
| Obvious bias, since I work there, but Elation Health is
| very focused on building EHR software that makes it
| possible for independent primary care providers to be
| successful and not have to spend hours per day doing
| paperwork.
|
| https://www.elationhealth.com/
|
| Speaking from personal experience, moonlighting as a
| paramedic, paperwork is a universal challenge in healthcare
| (I often spend more time documenting a call than the call
| itself took from patient contact to transfer of care to the
| ER). It is shockingly rare for EHRs (regardless of the
| speciality they focus on) to actively try to make life
| better for the clinician. That's a large part of why I'm at
| Elation for my day job; the founders (and therefore the
| whole company) have a ton of empathy for the doctors (and
| staff) we serve.
| ghaff wrote:
| He was part of a hospital system so he used their software.
| I know nothing about medical software but my impression is
| that there is a huge amount of paperwork regardless
| involving insurance, prescriptions, testing, etc. Stuff is
| more integrated and electronic than it used to be but
| there's still a lot of manual interactions, phone calls,
| faxes, etc.
| pavon wrote:
| In the 20 years since I've graduated college, the longest
| I've had the same PCP is 3 years, about half of the remainder
| I had for 2 years, and the rest I only saw once before they
| left and I had to change again. Even if they do stay, they
| have to see so many patients (~1000 per PCP is what I've
| heard) that they won't remember anything about me, and will
| be no better at treating me than a doctor pulled at random.
|
| For people with chronic conditions a PCP makes sense, for the
| rest of us it is just another pointless loop you have to jump
| through.
| mistrial9 wrote:
| almost every single general/primary care Medical Doctor's
| office in this area of California closed doors after the year
| 2000 or so.. Paperwork related to insurance billing, and
| inability to compete with Big Managed Care (Kaiser Health)
| for work conditions and benefits, is what I heard as
| reasons.. the offices were empty commercial space, it was
| noticeable how many there were...
| crawfordcomeaux wrote:
| I'm so excited about the idea of creating an anarchic healing
| network of former medical industry workers looking to create a
| new system oriented toward meeting all the needs, not just some &
| also not for profit.
| next_xibalba wrote:
| Sometimes the only way to recognize and solve problems is to go
| through a crisis. I hope all of these nurses quit and the rest of
| us wise up to how important they are.
|
| (I have a nurse in my family)
| dijonman2 wrote:
| Maybe we shouldn't have fired a bunch of them.
| kxyvr wrote:
| My wife is an ICU physician, so I've been watching this from the
| sidelines. I can't emphasize enough on how badly COVID broke the
| system. There's always been problem with staffing and burnout.
| However, COVID really brought out the worst in people. The
| patient population became far more abusive than it had in the
| past and this was during a period where all healthcare providers
| were working extremely hard, not seeing their families, and
| sacrificing their personal health to help people. Then, a large
| part of society decided that COVID wasn't an issue, refused to
| mask, and refused to vaccinate. At some point, a large portion of
| providers decided enough was enough and quit:
|
| https://www.beckershospitalreview.com/workforce/if-1-in-5-he...
|
| Now, the problem is that when people started quitting, there were
| fewer nurses to take care of the patients and their ratios went
| up. During normal times, a floor nurse might be 6-8 patients to
| one nurse, a step down unit might be 4-1, and an ICU might be 1-1
| or 1-2. It depends on the level of care required. Now, they're
| doing more than double this on a regular basis. And, frankly,
| they can't do it, at least safely. There's a number that a nurse
| can call if they believe they have an unsafe number of patients
| in order to get some kind of legal protection, but they still
| have to see that number of patients. And, frankly, it's
| incredibly stressful because they really, truly can't take care
| of that many patients, so they quit. A friend of my wife is a
| nurse trainer at a large hospital. They're having 80% of new
| nurses quit during their onboarding process because the ratios
| are absurd. A good portion of my wife's time is spent figuring
| out who's the least sick patient to discharge from the ICU
| because they don't have the staff.
|
| Unfortunately, I don't think we're even close for this to being
| over either. The constant refrain is that COVID is the new normal
| and we need to adjust. I would contend that a new normal would
| imply a stable operating point and I do not believe this to be
| the case. It's going to take a really long time to restaff
| appropriately where the patient ratios and stress level
| manageable. Long time means years because, really, hospitals want
| and need BSNs and not just associates level training. In the mean
| time, every time we have a COVID surge, the hospital gets
| flooded, everyone gets overworked and abused, and more people
| quit.
| tomohawk wrote:
| What I've seen: health insurance companies and large medical
| companies were able to get everything they wanted. The result was
| Obamacare. It's been down hill from there.
|
| I have family members in medicine, and they see the same thing.
| There was a really good opportunity at that time to address some
| glaring issues with healthcare, and we ended up with this thing
| that did not address those issues and created a lot more issues.
| Kharvok wrote:
| Hospital consolidation into major for-profit networks is largely
| to blame
| mikewarot wrote:
| This is the direct and extremely unalterable consequence of one
| decision, to base our medical system on profit, instead of
| results, or capabilities. We've left a matter of national
| security in the hands of accountants.
|
| The tragic insertion of a middle layer, the insurance industry
| (AKA Death Panels), makes it even more tragic and inefficient.
|
| You can not seek profits in a competitive environment without
| reducing every cost to the bare minimum. Until recently, it
| happened slowly, but the public health emergency is a forcing
| function that will not be ignored.
|
| This wave of resignations will be replicated in teaching, by the
| way.
| sumanmd wrote:
| Being a physician, Since IT came, it has alleviated some problems
| but has unleashed a monster which tend to cause lot more data
| driven to documentation to burnout. Every physician in United
| States currently experiences some kind of burn out. Nurses on the
| other hand experience much worse, 12-14 hrs shifts of constant
| stress. Overall health system in US is broken just as the
| insurance system. People will leave jobs when there is no
| satisfaction and just burn out.
|
| In my opinion nurse should have shorter 8 hrs shifts and 4 per
| week . In this capitalistic driven health care system, where
| being a patient and health care provider comes with a cost.
| indymike wrote:
| As a patient I dread interacting with healthcare... but I can
| only imagine how horrible it would be to be on the clinical staff
| where you are wedged between people needing care and 52 bosses
| trying to minimize risk, maximize billing, and reduce expenses.
| monkpit wrote:
| The survey sample was 200 RNs in the USA.
| PheonixPharts wrote:
| Standard error in this case, assuming the 200 are randomly
| sampled is:
|
| sqrt((p*(1-p)/n)
|
| sqrt((0.9*0.1)/200) = 0.021
|
| So 95% confidence interval for this ~ 0.86 - 0.94
|
| Does that radically change the message of this article?
| tqi wrote:
| That also assumes there is no response bias. The linked
| article doesn't seem to go too deep on methods but the source
| is a content marketing piece for Hospital IQ, so I'd take it
| with a grain of salt.
| jonshariat wrote:
| Also my first thought when I saw n was 200, lots of surveys
| make mistakes in sample selection or question writing but
| it seems with the responses here and my own observations
| being close to nursing, the main point checks out. Lots of
| burn out and leaving the profession.
| tqi wrote:
| Agree, I'm definitely not making any statements as to
| whether or not the burnout is real. I just think that a
| lot times the assumptions we make when we apply
| statistical concepts (like standard error) to real world
| data don't hold up.
| monkpit wrote:
| It's good information to have in the comments, I was not
| making any judgement.
| seaman1921 wrote:
| lol.. what kind of calculation is this? n is 1 in this case,
| the survey was not repeated 200 times from which you derived
| 90% as the mean number of nurses quitting.
| PheonixPharts wrote:
| It's a normal approximation of the expected variance (in
| terms of standard deviation) in the estimate of the mean of
| the sum of 200 Bernoulli random variables. Each nurses'
| response is considered an observation of a Bernoulli
| distributed random variable, and we trying to determine the
| rate of that variable.
|
| You are incorrect that "n is 1" since, by that logic one
| survey talking to 100,000 nurses would be the same as one
| talking to 3.
|
| If you would like an alternate, more Bayesian formulation
| we can use the Beta distribution which is parameterized by
| alpha (numbers of 'yes') and beta (number of 'no').
|
| This approach is a bit more intuitive than the Frequentist
| method since it answers the question "what do we believe to
| be the expected rate of nurses answering 'yes'"
|
| In this case alpha=180 and beta=20, we'll include uniform
| prior of alpha_prior = 1, and beta_prior = 1
|
| For Betas the posterior is defined quite nicely as:
|
| Beta(alpha_posterior, beta_posterior) =
| Beta(alpha_likelihood + alpha_prior, beta_likelihood +
| beta_prior)
|
| In general for Beta distributions we can compute the
| expectation as:
|
| E[Beta(alpha,beta)] = alpha/(alpha + beta)
|
| In this case: 181/202 = ~0.9
|
| And the variance of a Beta distributed random variable is:
|
| Var[Beta(alpha, beta)] = (alpha*beta)/((alpha+beta)^2 *
| (alpha + beta + 1))
|
| Which for our case is:
|
| 0.00046
|
| and the standard deviation of this is just it's square
| root:
|
| 0.021
|
| Which gives us the same answer as we get with the normal
| approximation.
| seaman1921 wrote:
| Thank you for taking the time to explain your modelling.
| Unfortunately I will need to read more on this topic,
| because I do not understand the intuition behind the
| priors "uniform prior of alpha_prior = 1, and beta_prior
| = 1".
|
| The way I would generally approach such a problem is by
| running monte carlo simulations. Assuming the true rate
| of nurses quitting is X, what is the chance that a random
| sample of 200 nurses has the expectation of quitting >=
| 90%. To get the lower bound of the confidence interval, I
| will run this simulation for several values of X,
| starting at say X=60%, increasing until I get >95% chance
| that a random sample of 200 nurses has E(quitting) > 90%.
| Do you think this approach makes sense ?
| [deleted]
| PheonixPharts wrote:
| Simulations are fantastic, and often necessary for tricky
| statistics problems, however what you are describing is
| reinventing so much of the wheel using simulation that
| you are going to be spending multiple orders of magnitude
| extra computation to get an approximately correct
| solution. You also do have some conceptual errors in your
| plan.
|
| For example
|
| > Assuming the true rate of nurses quitting is X, what is
| the chance that a random sample of 200 nurses has the
| expectation of quitting >= 90%.
|
| You have just described the Binomial distribution [0],
| which is probably the most elementary distribution you
| learn about when studying probability and statistics
| (even the Bernoulli is just a special case of it).
| There's no need to run simulations to answer this
| particular question.
|
| There are also some fundamental misunderstandings with
| your approach:
|
| > increasing until I get >95% chance that a random sample
| of 200 nurses has E(quitting) > 90%.
|
| The probability of getting > 90% 'yes/quitting' (i.e.
| more than 180) if the true probability 'yes' is in fact
| 0.9 is only 0.46. You won't cross your threshold of 95%
| here until you reach X=0.933
|
| If you wanted to construct the 95% CI from pure
| simulation, a better approach would be to sample 200
| observations from a 0.9 Bernoulli random variable (just
| sample from a uniform, and check if it's less than 0.9),
| compute the mean of the samples, and repeat this 10,000
| or so times. Then look at the empirical CDF [1] (fairly
| easy to implement in code) and look at the lower 2.5% and
| upper 2.5% values and you have your bounds (which will be
| the same as the ones I posted within some epsilon).
|
| I do recommend, if you're seriously interested in
| understanding this, picking up a basic probability/stats
| book and work your way through it.
|
| 0. https://en.wikipedia.org/wiki/Binomial_distribution 1.
| https://en.wikipedia.org/wiki/Empirical_distribution_func
| tio...
| [deleted]
| spywaregorilla wrote:
| That's plenty so long as the sample is random
| [deleted]
| vmception wrote:
| And for just one year with no information on what they would
| have said in other years.
|
| "I plan on quitting my job if I had money" wow stop the
| presses.
| degenerate wrote:
| I wish there was some law requiring surveying companies to
| fully disclose their method of contact and compensation. I can
| absolutely see an employee looking to leave their job being
| more receptive to taking a survey. Those happy with their jobs
| are not as likely to respond to third-party entities like "
| _Hospital IQ_ " contacting them. Maybe the survey company
| masked this survey as a "pre-screen" to finding new jobs! We
| will never know. The process of recruiting survey participants
| has GREAT implications on the results.
| mikkergp wrote:
| Nursing is a underappricated underpaid job, but we can't get
| 90% of people in this world to agree that the sky is blue.
| bitcurious wrote:
| A lot of the work nurses and doctors have had to do over the past
| few years has been truly soul crushing. Imagine getting a patient
| you know is likely to die and telling them that no, they can't
| die at home. No, they can't see their family. No, they can't opt
| out of the then. For certain groups of patients, the work of
| nurses has turned into death row prison wardens, because there is
| a 10% chance they might be saved, and for a while there was no
| way to opt out of that.
|
| Second hand impression from a doctor friend.
| badtoro wrote:
| I am sure that the policy that forced nurses with natural
| immunity to be vaccinated or lose their job has nothing to do
| with.
| eksx wrote:
| I work in tech with no college degree and about 9 years of
| programming experience. I make mid 100,000's per year. My S/O has
| 6 years of Emergency Department experience and a bachelors degree
| and she made about 65k at our local hospital. I think pay is an
| enormous factor in this. Her local hospital has nurses with less
| than 1 year of experience being preceptors to new grads.
| giarc wrote:
| She should apply for tele medicine. I knew a few nurses that
| took this on during the pandemic and were making about
| $50-60/hr from home. I suspect there are fewer opportunities
| like this now, but it's worth a shot.
| notch656a wrote:
| How long did it take you to break 100k? Be sure to include
| those pre-employed years when you didn't even know what 'if'
| statement meant. A nurse can hit that in 6 years easy through
| BSN+NP, and that's starting at literally NOTHING.
| (Alternatively there's a like path for PAs to practice in a
| mid-level practitioner role that is comparable to NP in those
| same 6 years)
| eksx wrote:
| I spent a bit of time making basic webpages throughout
| middle/high school using front page. I didn't start taking
| programming seriously until about early 2013. It took me
| until about 2019 to hit 100k salary. My girlfriend has 4
| years of schooling and 6 years of experience as a nurse. So i
| guess she has even more total experience than I do.
| DontMindit wrote:
| Anyone can become a nurse. It doesint take exceptional talent
| or brains. Programming does though. A nurse can't beat a
| programmer for salary, they're in different leagues
| narcindin wrote:
| When you say "mid 100,000's" do you mean ~150k or ~500K?
| jjcon wrote:
| I would interpret that as 130k-170k
| eksx wrote:
| Correct! Thanks for clarifying!
| eksx wrote:
| Sorry, meant ~150k!
| germinalphrase wrote:
| 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 to death over
| here.
| dontbeevil1992 wrote:
| capitalism
| ren_engineer wrote:
| capitalism is the reason for hospitals choosing to serve
| patients covered by Medicare which will give them a blank
| check with tax payer money?
| Sohcahtoa82 wrote:
| > Medicare which will give them a blank check with tax
| payer money?
|
| Whoever implanted this idea into your head was lying to you
| and you should probably question the other claims that
| person or organization has said.
| gen220 wrote:
| Medicare is not a blank check. It's a standard check (see
| sibling comment on fee schedules), and each check tends to
| actually be quite low of an amount.
|
| The magnitude of "standard" and "low" are both demonstrated
| by the fact that when private insurers negotiate pricing
| contracts (basically, a one-off fee schedule) with hospital
| groups, they express prices in terms of "medicare
| multiples".
|
| For example, the insurer will pay up to 13x of what
| Medicare pays for an fMRI administered under non-emergent
| circumstances with medically-justifiable cause. Pretty much
| every multiple is >1x, many are far more than 10x.
|
| And medicare is arguably more expensive to provide, since
| the probability of confounding issues from disability or
| age is higher than in the general insured population.
|
| Medicare is very consistent with paying, especially in
| comparison to private insurance, but the a la carte fees
| are quite "low" by relatively-freer-market definitions (I
| say relatively, because the reality is that private
| insurers negotiating with hospital groups is the antithesis
| of a free market, in most conceivable dimensions).
|
| ---
|
| The main reason medical groups lobby against "medicare for
| all" is that they will lose lucrative "20xM" payouts from
| private insurers, and it's difficult to see how their
| ballooning administrative costs can survive on such a lean
| diet.
|
| Of course, this line of thinking is deliberately ignorant
| of the thought that medicare fee schedules can be
| renegotiated to reflect the population of patients
| "medicare for all" would incorporate. But nobody's
| interested in thinking two turns ahead, let alone advancing
| the game state, when their pockets are nicely-lined on turn
| zero.
| thedataslinger wrote:
| It's not because Medicare offers a "blank check"; after all
| --the amount of revenue that the hospital can generate will
| always be hard-capped by the number of
| beds+/physicians+/resources available.
|
| They go with Medicare because the pay-out rate (i.e.
| "collect-ability") for billable services is much higher--
| and much more predictable--than if they attempted to
| collect/negotiate with non-governmental providers. A LOT of
| money is lost by hospital systems due to unpaid patient
| responsibility (e.g. insurance deductibles), which they can
| minimize by offering only services already guaranteed to be
| covered by Medicare.
| Clubber wrote:
| >Medicare ... will give them a blank check with tax payer
| money?
|
| Whoever gave you that idea, you should stop listening to
| them.
|
| Medicare payments are subject to a medicare fee schedule,
| which is typically much lower than a traditional private
| enterprise's fee schedule. What that means is medicare gets
| billed a lot less than a regular patient with insurance.
|
| https://www.kff.org/medicare/issue-brief/how-much-more-
| than-... "Private insurers paid nearly
| double Medicare rates for all hospital services (199% of
| Medicare rates, on average), ranging from 141% to 259% of
| Medicare rates across the reviewed studies."
| "The difference between private and Medicare rates was
| greater for outpatient than inpatient hospital services,
| which averaged 264% and 189% of Medicare rates overall,
| respectively." "For physician services, private
| insurance paid 143% of Medicare rates, on average, ranging
| from 118% to 179% of Medicare rates across studies."
| LewisVerstappen wrote:
| The healthcare system in the US clearly has nothing to do
| with free markets considering how unbelievably opaque and
| regulated everything is.
| cowpig wrote:
| There's no such thing as a "free market" for healthcare.
| The ability for consumers to exit a market is one of the
| prerequisites for the invisible hand effect. You can't exit
| the healthcare market.
| nickff wrote:
| You also can't exit the food market, or the shelter
| market, or the clothing market, yet those seem to work
| much better.
| landryraccoon wrote:
| Food, shelter and clothing generally have discoverable
| pricing.
|
| I challenge you to find the price of a cancer treatment
| regime protocol in the United States. I will bet you any
| amount of money you care to wager that no US provider
| exists anywhere that will give you a price quote for lung
| cancer treatment in writing anytime before that treatment
| is provided.
|
| And even IF you could, that only covers the cases where
| you are still have enough health and mind to rationally
| evaluate the prices. If you've been in a car accident and
| are dragged unconscious and bleeding into the ER, you
| can't shop around, even if they DID give you a price,
| which they certainly won't until you're already treated.
| nickff wrote:
| I agree with your points, but I think there are narrower
| solutions. With respect to pricing, the problem seems to
| be the negotiations between hospitals and insurers, as
| well as hospitals' failures to institute cost-accounting.
| Forcing them to do better accounting, and have a clear
| price-list would probably help, but getting rid of the
| employer healthcare tax subsidy (or expanding it) would
| likely be a better solution.
|
| With respect to ER care, it does seem impossible to 'shop
| around', but these cases make up a minority of healthcare
| expenditures. Perhaps government should cover these cases
| (though this could have horrible incentive problems), or
| this type of insurance should be separated from the rest,
| and somehow priced clearly and in advance (according to
| level of care) by a cartel arrangement or state regulated
| rates.
| jewayne wrote:
| > Forcing them to do better accounting, and have a clear
| price-list would probably help, but getting rid of the
| employer healthcare tax subsidy (or expanding it) would
| likely be a better solution.
|
| Believe it or not, it would be way easier politically to
| implement Medicare For All than to do piecemeal reforms.
| nickff wrote:
| 'Medicare for all' will cause a number of foreseeable and
| unforeseeable problems (and benefits). It would be
| interesting to see one or more states do it, and observe
| the results.
| jewayne wrote:
| I think the experience in Vermont suggests that it's
| unlikely to ever happen at the state level. It's far more
| likely to be a big bang at the national level.
| dragonwriter wrote:
| How can a state do universal single payer of its own
| design when there are multiple direct federal health care
| systems covering a substantial portion of the population,
| plus a huge tranch of the money states rely on for health
| care tied to a federal/state cooperative program with
| federal programmatic and eligibility constraints?
| marcusverus wrote:
| You can't exit the food market, either, and yet there is
| clearly a thriving free market for food. How does your
| theory account for this?
| Sohcahtoa82 wrote:
| This is a bad faith question asked without any basic
| thought.
|
| Within 5 miles, I have at least 10 different grocery
| stores to shop at. Each will carry hundreds of products
| at less than $10 each. Not only do I have tons of
| choices, but the pricing is completely transparent. And
| that's just grocery stores. Add restaurants (Both sit-
| down restaurants and fast food), and that number quickly
| reaches over 100 within a 5-mile radius.
|
| If I'm in a medical emergency and someone dials 911, I'm
| likely just being brought to the nearest hospital. I have
| zero choice in the matter, and will come out with
| whatever bill they want to charge me.
|
| Even in non-emergencies, good luck shopping on price.
| Doctor offices don't like giving that out.
|
| There's competition in the food market, but not
| healthcare.
| jewayne wrote:
| 45 million Americans are on the SNAP (food stamp)
| program. Does your definition of "thriving free market"
| account for this?
| wcfields wrote:
| I think you're being purposefully obtuse, but here's why:
|
| - SNAP / EBT / Foodstamps for people making so little
| money. Add onto that, Food banks.
|
| - Farm subsidies for many cheap foodstuffs (Corn) causing
| massive cheap, albeit junk food that can sustain.
|
| - I can literally grow food in the ground for "free", put
| it in mason jars and save my food for a year. I can't
| open a fresh can of broken-arm at the fixed cost.
|
| - Food is fungible, if I'm hungry, I can wait 2, 3, 8+
| hours to eat, or have a quick snack until meal time. It's
| not like I need a Big Mac infusion in the next 10 seconds
| or else I'll die from lack of special sauce.
|
| - You have many options of food. You can eat Soylent,
| rice&beans, or steak for every meal at various price
| points. You don't really get an ala carte when it comes
| to Chemotherapy.
|
| - You can always eat monkey pellets [1]
|
| [1] https://www.reddit.com/r/moreplatesmoredates/comments
| /qbfkfl...
| asimilator wrote:
| > I can literally grow food in the ground for "free", put
| it in mason jars and save my food for a year.
|
| This is true only in an extremely pedantic, unrealistic
| kinda way. If it was easy/free everyone would be growing
| all their own food.
| germinalphrase wrote:
| At least here in the Midwest, people grow food all the
| time. Can't grow strawberries in December, of course -
| but we eat up canned goods from friends/family throughout
| the winter.
| throwawayboise wrote:
| Sure you can. You can decide that you are not going to
| enrich an industry that basically does nothing for you in
| the long run. Everyone ends up dead, and I for one do not
| plan to spend my final years under constant care from a
| industry that is designed to drain every last dollar I
| have before I pass on.
| jewayne wrote:
| I think the majority of people say something to that
| effect at some point in their life. But the only real
| alternative is suicide of some kind, and how many people
| actually follow through with suicide?
| jerry1979 wrote:
| That's probably why the commenter (blithely) said
| "capitalism" which is the name of the economic system which
| produced the health care system in the United States.
| marcusverus wrote:
| By that line of reasoning, capitalism produced Social
| Security and communism is produced Alibaba.
| marcusverus wrote:
| By that line of reasoning, capitalism produced Social
| Security and communism produced Alibaba.
| whimsicalism wrote:
| I don't think the US can be summed up with a single word.
|
| Can I hire my friend who is a medical student to perform
| surgery on me legally? No?
| wcfields wrote:
| > I don't think the US can be summed up with a single
| word.
|
| I think it can, I've been thinking about this and it's
| "scam".
|
| Like, think how often everything in our country is a
| straight up scam. Healthcare, parking tickets, basically
| anything you buy. It's almost all snake-oil flim-flam
| every which way and as a 'consumer' you have to wade
| through the mire every single day to get scammed as
| little as possible.
| yoyohello13 wrote:
| So true! Everywhere I turn it's just people trying to
| extract the maximum amount of money from me for the
| minimum amount of value in return. It can't be good for
| our psyche.
| LewisVerstappen wrote:
| Sure, but that's like blaming "humanity" for all the woes
| of the health care system. It's humans who produced the
| health care system in the US after all.
|
| You have to be more precise as there are clearly aspects
| of capitalism that have resulted in tremendous
| improvements in quality of life (look at North Korea vs.
| South Korea).
|
| Regulatory capture is one of the issues & revolving door
| politics. Especially a big problem in the healthcare &
| finance industries (the current head of the SEC spent his
| career at Goldman Sachs for ex.)
| whatshisface wrote:
| 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.
| frgtpsswrdlame wrote:
| I doubt Marx could have thought of something more
| capitalist than $THC or $HCA.
| orwin wrote:
| It is what he called late stage capitalism. He might have
| been wrong on the solutions, but he nailed the problem
| quite well.
| whatshisface wrote:
| He could have and did: factories and craftspeople from
| Adam Smith's world are the epitypes of capitalist
| activity. Giant corporations that half-merge with the
| government are Marx's final, dying and barely capitalist
| stage of capitalism, that hardly involves markets at all.
| He thought capitalism (factories and craftspeople) would
| reach the end of its lifespan and give birth to $THC or
| $HCA.
| callmeal wrote:
| >The healthcare system in the US clearly has nothing to do
| with free markets
|
| Ahem. Regulatory capture would like a word.
| dnissley wrote:
| How has regulatory capture helped create the US
| healthcare system?
| yhoneycomb wrote:
| Actually, that's exactly how unfettered "free market"
| capitalism operates. The end game is big companies end up
| controlling everything, including the regulations in order
| to tip the scales in their favor.
| LewisVerstappen wrote:
| Regulatory capture is the issue that needs to be solved.
| _Not_ free markets.
|
| Free markets are the most efficient way for information
| to be transferred throughout the system.
|
| Stricter campaign finance laws, ending revolving-door
| politics, etc.
|
| But putting the blame on free markets seems like a
| mistake.
| frgtpsswrdlame wrote:
| Feels a lot like 'Real free markets have never been
| tried!' which we all know from its standard form on the
| left. If, at this point in history, real free markets
| have been unable to sustain themselves in the areas of
| the economy that people depend on the most (healthcare as
| a major example) then perhaps we ought to consider
| whether they're able to sustain themselves at all. I
| believe free markets and meritocracy are two systems
| commonly pointed to today that may be 'ideal' in one
| sense or another but which in practice cannot help but
| sow the seeds of their own destruction.
|
| Markets exist by virtue of laws created by governments -
| property law being the primary example - expecting actors
| in a free market who aggregate enough wealth to affect
| those governments not to just strikes me as unrealistic.
| It reminds me a bit of gaming. Everyone agrees that in a
| competitive game the most fun part is early on before a
| 'meta' can be established. But of course that meta will
| always end up established and it's basically dumb to be
| mad at people for metagaming or to otherwise expect them
| not to.
| tverbeure wrote:
| Instead of advocating for and gambling on a "free market"
| health care system that has never been tried successfully
| anywhere, and hoping that it will work out (because
| dogma?), why not advocate for systems that have been
| tried all over the world that have been proven to work?
|
| I'd sign up for a significant increase in my taxes if the
| US system were replaced by the system that I experienced
| in Belgium for the first 30 years of my life.
|
| And by successfully, I mean: everybody, irrespective of
| income or status, can expect to get the care they need.
| throwaway0a5e wrote:
| It takes an exceptional breed of ignorance to say "just
| implement whatever <country> has" as if that is a silver
| bullet and that the same forces that caused the current
| debacle wouldn't also do their magic on anything we
| attempt to transition to.
|
| If it was as easy as paying out way out of the problem
| we'd have done it already.
| tverbeure wrote:
| It also takes an exceptional amount of knee jerk assery
| to interpret my comment as "change the US system to the
| Belgian one". The Belgian system is one that works more
| or less from my experience. Most inhabitants of Germany,
| France, the Netherlands, and others will claim the same
| for theirs.
|
| Nobody is claiming that the US should copy the system of
| some specific country verbatim. But it's equally dumb to
| dismiss the common traits of these other systems, and say
| "nah, let's do just the opposite."
| throwaway0a5e wrote:
| >It also takes an exceptional amount of knee jerk assery
| to interpret my comment as "change the US system to the
| Belgian one"
|
| Well you literally said "I'd sign up for a significant
| increase in my taxes if the US system were replaced by
| the system that I experienced in Belgium for the first 30
| years of my life" so why don't you tell me how that was
| supposed to be interpreted?
|
| America shares a very long border with a nation with a
| functional healthcare system and we generally prefer to
| compare to them.
| tverbeure wrote:
| I wrote "why not advocate for systems". Notice the plural
| form. Did you assume that by writing "all over the
| world", I actually meant the superpower of Belgium?
|
| What all those systems have in common is that they are a
| mix of free market and strong regulation. The opposite of
| "let's do even more free market than what we have now."
|
| I don't know how the US can get there. It's probably
| impossible, just like school shootings and the "No Way To
| Prevent This,' Says Only Nation Where This Regularly
| Happens" argument.
| pitaj wrote:
| The free market healthcare system in the USA worked great
| up until regulations pushing out mutual aid societies
| completely changed it. Costs were affordable for
| everyone.
|
| http://freenation.org/a/f12l3.html
| JaimeThompson wrote:
| >Free markets are the most efficient way for information
| to be transferred throughout the system.
|
| Would such a market allow NDAs?
| thomasahle wrote:
| Monopolization and regulatory capture are standard
| features of free markets, if you leaving them running
| long enough.
| AlexandrB wrote:
| > Free markets are the most efficient way for information
| to be transferred throughout the system.
|
| What do you think of VC-funded "growth" companies that
| lose money for years while providing products/services at
| below cost? Is this a case of the free market working or
| of it being subverted?
| thedataslinger wrote:
| Wait, wait, wait--you're saying that we need to solve
| issues like regulatory capture through legislation... so
| that we can have a market without governmental
| interference (aka a "free market")? Huh?
|
| You can't on the one hand tout the "free market", while
| on the other complain that we don't have the "right" kind
| of governmental interference.
|
| Even if you could square that circle, it still sounds
| disingenuous to argue that we could have the most
| efficient system if only we were to eliminate _thing that
| said system actively encourages_. The failure is baked
| into the game, my friend.
| Cederfjard wrote:
| I don't think that reasoning is necessarily unsound. For
| there to be regulatory capture, there needs to be
| regulation. The legislation proposed could be to remove
| or minimize that regulation, and thus limit the "hooks"
| whereby to capture it with. Replacing "governmental
| interference" with "less governmental interference", not
| "different governmental interference".
|
| I don't take such a libertarian view myself, by the way.
| Just pointing out that I don't think you can pick apart
| the argument of the person you replied to in that way.
| elhudy wrote:
| The healthcare industry disaster wasn't born out of
| regulatory control - though money does now follow the
| regulations. The disaster was born out of regulatory
| mistakes(in particular, look back to the 1940's when the
| govt made it tax free to offer health insurance as a
| benefit). [1]
|
| The industry is an onion and in order to understand why
| it is the way it is today you need to peel back all of
| the layers that have been added by the govt over time and
| the unintended consequences of those.
|
| [1] https://www.npr.org/2020/10/07/921287295/history-of-
| employer...
| lghh wrote:
| There is no such thing as free market capitalism. This is
| why the parent comment said "capitalism" and not "free
| markets". I assume that's what you meant by putting "free
| market" in quotes, I'm just making an explicit
| clarification.
| Clubber wrote:
| I would say the drug cartels are about as close to free
| market capitalism as we have today. They are largely
| unregulated because they can either buy off the
| regulators / government, or fight them with armies.
| slothtrop wrote:
| The U.S. economy isn't unfettered free market, including
| in this sector. The policy is just bad.
| Aperocky wrote:
| > they can 10x their profits by only serving elderly clients.
|
| I knew of certain defunct malls that decided to get rid of
| things that doesn't make money and only keep the high profit
| inventories.
|
| Soon people stopped coming and they went under..
| mumblemumble wrote:
| The Invisible Hand works generally fine-ish for non-essential
| and commodity goods. People might be sad their favorite store
| went away, but, for the most part, life goes on. It seems to
| even be the least bad way to handle these sorts of things.
|
| It's a bit harder for me to see this as an acceptable
| approach to health care. Not every segment of the economy
| needs to be a constant drunkard's walk in search of maximum
| profitability in the aggregate. Sometimes what the public
| actually desires is stability and reliability.
| throwawaygh wrote:
| _> > they can 10x their profits by only serving elderly
| clients._
|
| _> Soon people stopped coming_
|
| Ah, yes. Why didn't we think of this before? By increasing
| the cost of (geriatric) healthcare, we can destroy demand.
| That's how supply/demand curves work right? In this way the
| invisible hand delivers unto us a fountain of youth ;)
| Aperocky wrote:
| They may 10x their profit by serving elderly clients but
| that is assuming x more elderly clients would want to
| suddenly come.
|
| But why? Are elderly clients underserved in that area? Are
| they going to ditch their original care provider and all
| come here?
| throwawaygh wrote:
| _> But why?_
|
| Old people in the USA are EXTREMELY wealthy in terms of
| healthcare purchasing power. All retired people have
| medicare. Many retired people have additional healthcare
| coverage from their former employers (doesn't exist
| anymore -- disappeared along with pensions -- but this
| benefit used to be common). Many retired people have
| significant savings in addition to medicare and private
| health insurance.
|
| Most new parents have little to no government assistance,
| do not have significant expendable income, and have
| little to no accumulated wealth. Children, of course, are
| even poorer than their deadbeat parents.
| titanomachy wrote:
| If we stop providing health care to young people, then
| everyone will just die and there won't be any old people left
| to profit off of.
| cryptonector wrote:
| No, more likely you'd see a ton of alternative medicine and
| self-diagnostic/treatment options for young people. I'm not
| entirely sure that I wouldn't want this.
| ugh123 wrote:
| Capitalism and health care just don't mix
| whimsicalism wrote:
| > The entire purpose of this organization was to provide
| pediatric healthcare, and it wasn't losing money...
|
| If it's entire purpose was to provide pediatric healthcare it
| should probably have registered itself as a not-for-profit.
| germinalphrase wrote:
| Why register as a not-for-profit when you're profitable?
| dragonwriter wrote:
| > Why register as a not-for-profit when you're profitable?
|
| If your purpose isn't to return a profit to stakeholders,
| but to serve some social purpose eligible for charity
| nonprofit status plus like "pediatric healthcare",
| registering as a nonprofit gives you more surplus revenue
| because of tax exemption _and_ the ability to accept
| donations that are tax deductible for the donors.
|
| It's also often good PR.
| anonporridge wrote:
| Cronus devouring his children.
| black_puppydog wrote:
| Yeah if they're only after profits, why not become a hedge
| fund?
| 93po wrote:
| Many are owned by hedge funds:
|
| https://www.nbcnews.com/health/health-care/private-equity-
| fi...
| Kranar wrote:
| The majority of hedge funds fail within 3 years, having never
| reached profitability.
| whimsicalism wrote:
| Becoming a hedge fund is actually a bad idea if you are only
| after profits because it is unclear that over long-time
| horizon this is actually a very profitable activity. We only
| remember the winners.
| Bilal_io wrote:
| So, a hospital can close a service with no repercussions, and
| if workers at a "critical" secure decide to strike they'd be
| ordered by a judge to get back to work...
|
| I hate every part of it.
| divbzero wrote:
| There seems to be two sides to this.
|
| The first, mentioned already in this thread, is that maximizing
| profits should not be the ultimate yardstick in all cases.
|
| The second is that we are not setting incentives correctly in
| healthcare: preventative care still plays second fiddle to
| curative care. If the healthcare industry were purely free
| market, this could be attributed to individuals not
| understanding the long-term benefits of preventative care, or
| overly discounting the distant future. But the healthcare
| system is _not_ purely free market. The largest payers, public
| and private, could do a lot to correct the incentives by
| setting their reimbursements accordingly.
| hedora wrote:
| We're facing some massive generational crises at this point,
| and it feels like the only solution is to wait for the current
| leadership to die off, and hope the gen x'ers fix it.
|
| The WWII generation fixed the ozone hole, but their kids didn't
| lift a finger for global warming.
|
| Subsequent generations are scrambling to pick up the pieces for
| our kids, while crap like this, and our rapidly collapsing
| democracy keep sabotaging our efforts. Heck, in California,
| we're actively causing psychological harm to an entire
| generation of kids (with masks) because of a tiny minority of
| anti-vaxxer school teachers.
|
| Of course, progressive boomers exist, as do idiotic younger
| people. However, the current generation of leadership in the US
| has completely failed us.
|
| Anyway, it's not surprising to me that that crowd decided to
| shunt healthcare resources away from their (great) grandkids
| and into elder care.
| ISL wrote:
| The WWII generation may have worked to fix the ozone hole,
| but they also unknowingly created it:
|
| https://en.wikipedia.org/wiki/Chlorofluorocarbon#History
| karmelapple wrote:
| And all of the generations helped create climate change,
| yet we're not doing all that much to comprehensively combat
| it at a government level.
| whimsicalism wrote:
| > The WWII generation fixed the ozone hole, but their kids
| didn't lift a finger for global warming.
|
| Let's not pretend these are comparable challenges.
|
| > our rapidly collapsing democracy keep sabotaging our
| efforts.
|
| When people say stuff like this, are they being hyperbolic or
| do they actually mean it? How long is the democratic
| tradition in the US that is collapsing?
| germinalphrase wrote:
| If they're not being hyperbolic, they might be reacting to
| stories like this:
|
| https://talkingpointsmemo.com/news/j-michael-luttig-op-ed-
| ja...
| rurp wrote:
| We just had a candidate openly try to steal the last
| presidential election and face no real consequences as a
| result. In fact, it likely strengthened his position. 10
| years ago I would have thought the end of American
| democracy was extremely unlikely, now though we're only a
| few small steps away and that bridge could be crossed at
| any point.
|
| This isn't some outlier event either, democracy has been
| receding around the world for years. I really, really hope
| the trend reverses itself, but am scared at how real the
| threat is.
| whimsicalism wrote:
| I don't think we were even _remotely_ close to somehow
| Trump remaining on as president.
|
| > democracy has been receding around the world for years
|
| I am skeptical. Majoritarian democracy in the US has only
| really existed for 40-50 years and I perceive it as
| continuing to expand both here and abroad.
| cogman10 wrote:
| While I think SOME longevity in congress/the senate is a good
| thing (You get more done). I really wish we had something
| like an age cap.
|
| It's really crazy that the only way it seems like we can get
| these senators/congresspeople out of office is death from old
| age.
|
| The fact is, your mind DOES deteriorate when you get older.
| That's why so many phone scams are special built to target
| older people.
|
| A change I'd make to the constitution is that "nobody over
| the age of 70 can hold a governmental position".
| manmal wrote:
| Please, don't spread ageism. Yes, brains perform worse in
| many kinds of ways when they age. But that's highly
| variable. And there are narcissists and sociopaths in every
| age group.
| throwawayboise wrote:
| Mandatory retirement is a thing in a lot of professions.
| Should be in government as well.
| usrn wrote:
| It's possible we have _too much_ democracy. A lot of stuff
| got changed because we thought the previous configuration
| didn 't make sense but it may have been that way for a
| reason.
| JaimeThompson wrote:
| Which things do you thing should change back and what
| should they change back into?
| I-M-S wrote:
| End to NIMBYism. Current homeowners should not be able to
| block new developments and encase a neighbourhood in
| amber.
| JaimeThompson wrote:
| It would need to apply to everyone. No more of this open
| up single family housing is this middle class area while
| protecting the parks / forest in the wealthy areas.
|
| What about things like AirBnB? Limiting those is a form
| of NIMBYism as is limiting where factories and polluting
| buildings can be placed and/ran.
| whimsicalism wrote:
| We want people to be housed in the places they want to
| live which is why we want to lessen restrictions on
| building.
| usrn wrote:
| whimsicalism wrote:
| No more election of judges.
|
| Campaign finance restrictions.
|
| Referenda that can't be overriden by legislature should
| require 50% of eligible voter population to support, not
| 50% of voters in that particular election.
|
| No special elections.
| bsedlm wrote:
| > We're facing some massive generational crises at this
| point, and it feels like the only solution is to wait for the
| current leadership to die off, and hope the gen x'ers fix it.
|
| oh man, I choose to laugh so I don't start crying hahaha.
|
| I want to turn this into an argument of why age-reversal and
| other longevity research is such a bad idea (personally, I
| think it's kind of evil; but maybe I've seen too many
| villanous cartoon characters throwing everything under the
| bus so the can live forever).
| wardedVibe wrote:
| I mean, making sure Putin doesn't live forever seems like a
| pretty high priority to me.
|
| There's also the fact that science might lock up, since old
| scientists have more reputation at stake in the old
| theories (there's an adage "science advances one funeral at
| a time"). We're not ready as a species for immortality
| BLKNSLVR wrote:
| That quote applies to many (all?) disciplines:
|
| "X advances one funeral at a time".
| archon810 wrote:
| Can you share the hospital name?
| bkjelden wrote:
| Not surprising. My partner is a DNP and has pretty strongly
| considered leaving the entire profession.
|
| From my perspective, the entire healthcare industry is set up to
| treat any frontline worker without an MD after their name as
| completely expendable, nothing more than a row in a spreadsheet
| that can be optimized for middle management to hit next quarter's
| bonus targets.
|
| You can meet all metrics management sets out for you, have
| amazing patient satisfaction scores, etc, and every 6 months some
| spreadsheet wielding online MBA graduate is going to show up to
| turn the screws and tell you you need to work harder for the same
| pay, and to just be happy you aren't getting laid off.
|
| At some point in time, the workers realize the joke is on them
| and find another profession.
| vincnetas wrote:
| Do nurses have work unions? Would that solve the issue?
| tick_tock_tick wrote:
| Yes, they have massive unions but that doesn't seem to be
| helping.
| asmithmd1 wrote:
| Yes. Massachusetts which is NOT a right-to-work state. That
| means the union can negotiate a clause in the contract that
| any nurses working at the hospital must join the union. Here
| is a current contract that includes pay ranges:
|
| https://www.massnurses.org/public/resources/bargaining-
| unit/...
|
| 'Step' is years of experience
| bkjelden wrote:
| In some states, RNs working in hospitals are unionized. And
| that does help with some of the things I mentioned.
|
| Outside of hospitals, and outside of RNs, unionization is
| much less common. E.g. in a clinic setting very few employees
| are unionized.
| UnpossibleJim wrote:
| This is totally anecdotal, so take it for what it's worth, but
| in addition to nurses leaving the profession I've seen quite a
| few doctors in my area leaving the profession as well.
| Relatively young men and women retiring the profession
| completely post pandemic, though I haven't had an opportunity,
| nor would I, to ask them why they left the position. I have no
| idea if it has anything to do with the pandemic or the
| administration or working with insurance =/
|
| here are some "articles" on the subject:
|
| https://www.bmj.com/content/373/bmj.n1594
|
| https://www.beckersasc.com/benchmarking/22-of-physicians-con...
|
| https://www.medpagetoday.com/practicemanagement/practicemana...
|
| And one of these articles (the last) is from 2013, talking
| about a change in healthcare practices (corporate unification),
| the ACA (limits on accepting medicare patients) and the health
| reform law (liability reform). So, I guess medical burnout has
| been coming log before Covid and we have just been ignoring it?
| bkjelden wrote:
| I have no doubt that MDs are leaving as well - but, at least
| from my perspective, in any large healthcare system, there is
| a drastic difference between the way middle management treats
| MDs and the way they treat everyone else. The latter is
| completely expendable, whereas the MDs do have a fair amount
| of negotiating leverage around their working conditions.
| UnpossibleJim wrote:
| Oh, don't get me wrong. The way nurses are treated is
| horrible. I wasn't arguing that and I hope it didn't come
| across that way.
| bkjelden wrote:
| Not at all!
|
| I'm just sharing what I've seen - middle management
| treats MDs drastically different than NPs and PAs, even
| in states where the latter have almost the same scope of
| practice.
|
| This is not to say that MDs don't have their own reasons
| to be mad at the system - insurance, changes in patient
| attitudes, etc.
| thr0wawayf00 wrote:
| Doctors aren't happy about it either.
|
| I was at my family's Easter lunch last week and one of my
| uncles who's an MD was telling me about the mass exodus of
| doctors from the profession since COVID hit. Anyone who was
| thinking about retiring did so once the pandemic took off.
|
| He then tried to convince me that I'm not too old to go to
| medical school. Yeah, no thanks.
| derekdahmer wrote:
| Same story from my partner who is a PA. The private practice
| she worked for for years got acquired by a big name system and
| over the next 2 years they "optimized" a job she loved so far
| that she had to leave.
|
| By the end she was seeing twice as many patients a day as
| before with no time to do admin stuff at work even after
| skipping her lunch break so she also had to do more work when
| she got home. The reward for doing double the work as before? A
| 10% pay increase barely above inflation. Meanwhile a few
| coworkers left and no new ones were hired so the workload just
| kept increasing.
|
| It puts providers in such a bad position because the only way
| to push back is to drop the level of care, which has real human
| consequences.
| xeornet wrote:
| Many people in many professions have the same considerations
| about leaving. But then they realise they have a mortgage to pay,
| responsibilities (debts) they have signed up for, and never
| leave. Such is the system.
| rdtwo wrote:
| Another wage shortages (for the quality of work conditions) that
| will be reported as a worker shortage
| poorbutdebtfree wrote:
| People should stop giving them such a hard time for dancing every
| once in a while.
| oliverafajardo wrote:
| My experience: I'm an icu nurse in the sf bay area. I make a good
| salary. However, you can make this and more with a job with less
| physical and emotional stress/abuse. Even the "best" hospitals
| like kaiser/stanford/ucsf are always short staffed. I considered
| another area of nursing/hc but it's really all the same BS of
| being short staffed, constantly being denied vacations, etc.
|
| I feel like a waitress, custodian, social worker, therapist,
| punching bag and other stuff - It's never ending. This has
| effected my mental health so much that I am slowly doing my
| career switch to SWE. While I know every job has it's own
| difficulties bs/stress/politics, the one's i deal with as a nurse
| now I can no longer deal with. I don't regret this career path
| because it has taught me a lot, and their is something better for
| me out there.
|
| Career: I did consider other areas of nursing, but they didn't
| satisfy me, ICU is relatively the most enjoyable for me. On a
| regular hospital floor/intermediate floor, a nurse will be given
| 4-5 patients and let me tell you its a ZOO! In ICU i only have 2,
| and those keep you busy the whole shift. They're both different
| kinds of crazy.
|
| I will say, being a nurse in California is 5x better than
| anywhere else simply because their are laws that allow us to have
| uninterrupted breaks!
| gsatic wrote:
| Depressing. It's like we are losing control of different
| subsystems of Jurassic Park every single day :(
| gigel82 wrote:
| We've read similar reports about the "great resignation" with
| software engineers. Attrition is actually lower now than it was
| before the pandemic, so...
| rel2thr wrote:
| Wages need to go up. Also I think there will be a big push to
| open up immigration to nurses and doctors over the coming decades
|
| Kind of weird that the usa prioritizes software developers over
| healthcare workers in the immigration system .
| lotsofpulp wrote:
| There has long been an immigration program for foreign doctors
| to gain the right to live and work in the US in exchange for
| first living in a rural/poor part of the US where most doctors
| do not want to live.
| aluva wrote:
| If have a nursing degree it's easy to immigrate to USA, in fact
| you will be coming in with a green card unlike tech worker. So
| to your point, US does prioritize nurses over others. Doctors
| are different and it's incredibly difficult for a doctor with a
| foreign degree to practice in US. I know this for a fact since
| I come a place where almost every other house has a nurse
| working in Europe/US
| lotsofpulp wrote:
| https://www.uscis.gov/green-card/green-card-
| eligibility/gree...
|
| Immigrant doctors have to be willing to live in the least
| popular parts of the US.
|
| > One reason USCIS may grant the national interest waiver is
| because a physician agrees to work for a period of time in a
| designated underserved area.
| maerF0x0 wrote:
| Cynicism and complaint is our zeitgeist. Answer me how many
| actually left in year prior if you want my attention.
|
| Lots of considering leaving a profession, also considering losing
| fat on Jan 1, and saving for retirement.
|
| When people are surveyed there is a big difference between why
| they say and why they actually are doing the action. For example
| "Yeah, covid has been tough... and those insurance companies
| though... And doctors really dont respect my profession... Oh my
| [pregnancy/parental leave/dream of being a DJ]? yeah that has
| nothing to do with it."
|
| These kinds of opinion surveys are just barely "science" .
| hemreldop wrote:
| tmcw wrote:
| Similarly via a quick Google search:
|
| - "Almost HALF Of San Francisco Residents Considering Leaving
| City" (according to survey of 500)
|
| - "One in three New Yorkers Considering Leaving The State"
|
| - "Over Half Of Young Lawyers Considering Quitting by 2027, IBA
| Report."
|
| Look for X people considering Y, and you'll find them.
| Considering is cheap.
|
| The awful experience of nurses, absolutely, true. But this, like
| so many others, is a silly poll that doesn't say anything.
| tsol wrote:
| I don't mean to by cynical, but this is kind of my feeling.
| Throughout the pandemic I saw story and story about nurses
| getting overworked and being underappreciated. There was lots
| of talk of a nurse exodus.. and yet it's never happened. Even
| now it's just talk of a possible exodus. Maybe there are just
| no similar fields to switch into with comparable pay, but it
| seems as though nurses are sticking it out in the grand scheme.
| Are plenty of older nurses retiring? Yes. Are some younger
| nurses also leaving the field after being burned? Yep. But for
| the majority of nurses, the pay is still worth all the
| difficulty they see. Hearing about a co-worker getting attacked
| by an anti-vax patient is alarming, but until it happens to you
| you're not gonna make any major life changes to avoid that
| chimprich wrote:
| My wife is a nurse in the NHS. She actually saves people from
| cancer, or at least prolongs their lives. Her work is difficult,
| with huge responsibility. She gets a pay cut this year in real
| terms.
|
| I make slight improvements to computer systems. In most of the
| jobs I've done, despite my best efforts to work for reasonably
| ethical companies, I've not been convinced I've made anyone's
| lives better. Yet my salary is 2-3 times hers.
|
| I find it hard to believe there can't be a better way to arrange
| this kind of stuff.
| mikkergp wrote:
| It's an interesting problem, because we currently align
| economic 'productivity' and pay rather than social value and
| pay, which is efficient since we don't have to redistribute
| resources between industries or roles, and resource
| redistribution is a dirty word, at least in America. My wife is
| a doctor and I make significantly more than her working as an
| SRE, when her job is significantly more difficult (particularly
| emotionally) and time consuming than mine. She's paid
| relatively well on a societal scale, but I'd still call it a
| labor of love. If you're not in one of the high paid
| specialties, you don't do it for the money.
|
| Even in the (US) medical system, pay/insurance reimbursement is
| based on the number of procedures you do, not how involved the
| treatment is. This is why surgeons get paid so much more.
| dudul wrote:
| We do not align productivity and pay, we simply align pay and
| how difficult it is to find someone to do the job.
| mikkergp wrote:
| Not directly, but indirectly, this is one reason why bigger
| companies can pay more than small companies, more
| efficiencies, automations, and economies of scale means the
| output per employee is higher.
| gruez wrote:
| >It's an interesting problem, because we currently align
| economic 'productivity' and pay rather than social value and
| pay
|
| How do you define and measure "social value"?
| tomatowurst wrote:
| Athletes and celebrities are paid because of economic
| productivity? It definitely seems like social value based on
| restricted supplies.
|
| If there are lot of participants in a labor pool, naturally
| wages will be under constant pressure. The barriers to entry
| also play a role.
|
| For those RN's quitting, they will simply be replaced by
| foreign workers. It's similar to how certain jobs no longer
| have locals in it anymore, instead relying on migrant
| workers. It's the reality in Singapore for instance and
| naturally creates an implicit caste system.
|
| Now the markets have evolved/evolving where incumbent locals
| are no longer granted the same privileges they once enjoyed,
| somebody who does not have the luxury to consider
| alternatives will be the ones who fill the jobs, and get the
| blame when the descendants of local incumbents cannot make
| their way back.
|
| This is sort of the system I am seeing emerging and it
| explains the anxiety of us vs them. In reality, the
| government, markets simply do not care for such
| superficiality. It seeks to accomodate those who are
| productive, not sit around waiting for higher powers to
| "fix". And as such, this dynamic ensures wages in certain
| industries stagnate, and it's especially true in markets with
| the characteristics I mentioned above: low barrier to entry
| and abundant supply of labor.
| r3trohack3r wrote:
| Anecdotally - I have an acquaintance exiting the field of
| pediatric nursing. They worked in the ICU and with chronic
| conditions (cancer, heart disease, etc.).
|
| The deaths were always hard when working with little kids - and
| there were a couple a month. But towards the end of COVID they
| were losing 4 kids PER WEEK (anecdote - I have no data other than
| listening to them vent) that this nurse firmly believed were
| avoidable had they received appropriate care.
|
| What caused them to exit was how the hospital handled COVID: they
| postponed all elective surgeries. For these children, an elective
| surgery was anything where they "wouldn't die tomorrow" if the
| surgery wasn't done (somewhat of an oversimplification - but
| ballpark correct).
|
| During that time hearts got worse, cancer progressed, bodies shut
| down until electives became emergencies... Success rates of
| surgeries dropped. And once restrictions started lifting the
| staff was underwater, they had a huge backlog of "electives"
| piled up on top of the normal ingress - kids were dying from
| waiting.
| pessimizer wrote:
| They'll leave with the teachers. Female-coded professions being
| derided for political capital as often as "inner-city crime"
| might tempt one to wonder which came first, the female-coding or
| the disrespect.
|
| Just kidding. Teachers used to almost all be male until public
| schooling and the resultant budgeting turned them female (to pay
| them less.) It's like reverse computer-programming where the
| profession turned male when they started paying more.
|
| Pay them and they won't leave. Pay them a lot, and dudes will
| start writing essays about how the reason women aren't being
| hired and are leaving the profession is because they naturally
| have less of an interest and aptitude for nursing than males.
| tomatowurst wrote:
| There's no need to politicize this off completely unrelated
| tangent. The whole industry is under stress. It won't change.
| They will just hire foreign workers to deal with shortages.
| nickstewart wrote:
| My wife is a NICU nurse at a major NICU... she has worked there
| four years and is almost at her maximum pay, outside of COL
| increases, so right now she makes around $64k a year before
| tax/etc..
|
| The travel nurses make significantly more and now that she has
| basically hit her cap (after just four years) I've been trying to
| convince her to move to a different unit or get a different job
| Victerius wrote:
| U.S. nursing salaries relative to average U.S. wages are above
| the OECD average: https://www.oecd-
| ilibrary.org/sites/health_glance-2017-58-en...
|
| So pay isn't the problem.
|
| The U.S. is also above the OECD average for the number of nurses
| per 1000 population:
| https://www.researchgate.net/publication/334515420/figure/fi...
|
| So staffing isn't the problem either.
|
| The U.S. is below the OECD average for the number of doctors per
| 1000 population:
| https://www.nurses.co.uk/Images/Blog/media/ddad9fa9-b06d-43d...
|
| If nurses could work a regular 40 hours a week and be paid more,
| as they would like, the additional money and staffing need to
| come from somewhere. In the United States, we've decided that
| private hospitals could have the right to exist. Most nurses are
| thus beholden to a free market. So the question is why other
| hospitals aren't trying to poach nurses with better wages and
| schedules. The reason may be that the supply of nurses remains
| large enough that hospitals don't feel pressured to make these
| concessions. The business model of hospitals is also drastically
| different from that of, e.g., tech companies. Tech companies can
| afford to pay their employees outrageous salaries because it is
| possible for one software engineer to create a product that will
| generate $100M in revenue. A nurse's labor has a cap on how much
| economic value it can generate. Hence why nursing salaries are
| constrained.
| shadowofneptune wrote:
| From such a high level, staffing may not seem like a problem.
| When it comes to the hospital floor level, staffing's been a
| big issue these last two years. Keep in mind that the common 12
| hour shift for a nurse came about because of 70s staff
| shortages.
| chrisseaton wrote:
| > U.S. nursing salaries relative to average U.S. wages are
| above the OECD ... So pay isn't the problem
|
| Do you think when someone evaluates if they're paid enough
| they're thinking 'what is my income relative to what someone
| else's income is in Belgium relative to other people in
| Belgium?'
| MisterBastahrd wrote:
| ?
|
| Most nurses work three 12 hour shifts and are paid for 40. It's
| so prevalent that a lot of them will pick up an extra shift or
| two at an entirely different hospital.
| woodruffw wrote:
| These numbers don't necessarily tell the full story, since
| "nurse" isn't necessarily a fungible title across the OECD:
| nursing requirements and qualifications vary by country, as do
| the job's obligations. This is probably particularly true
| during the last two years, as nurses (everywhere, but
| particularly in areas that have refused vaccination) have
| assumed greater daily responsibilities.
| kemayo wrote:
| It sounds like your last statistic means that U.S. nurses need
| to do more work than their counterparts in other countries (to
| make up for a lack of doctors), which suggests that pay and
| staffing _might well_ be the problem...
| manuelabeledo wrote:
| Comparing the US with OECD isn't proof that pay or staffing
| aren't part of the problem. Nurses can be underpaid, and still
| earn more than their peers in other countries.
|
| Also, it looks like the outrageous costs of healthcare in the
| US don't correlate at all with nurses' wages. If I were a
| nurse, I would feel demoralised if I was doing a lot of the
| hard work, yet administrators and middlemen still get the most
| money.
| Ensorceled wrote:
| Canadian nurses are also leaving the profession in droves for
| many of the same reasons ... so this might be a universal
| problem.
| fnordpiglet wrote:
| They do detail what the nurses themselves say are the problems
| in the article. I'm not sure I see a reason to doubt their
| reasons. They didn't identify a shortage of doctors but rather
| a shortage of low skilled workers whose jobs they're having to
| pick up in addition. Also while the population ratios might be
| in their favor, apparently the patient to nurse ratios aren't.
| Even if they're better than most of the world that doesn't mean
| they're necessarily happy - when you're unhappy telling someone
| that there's someone worse off doesn't improve their situation.
| krisoft wrote:
| > So pay isn't the problem.
|
| Or pay is a problem elsewhere too.
| JaimeThompson wrote:
| >So staffing isn't the problem either.
|
| You don't have enough data to determine that as you are
| assuming that the staffing levels should be the same between
| countries when due to things like a huge push to increase
| profits, more paperwork, and other such things they can be
| drastically different.
| nine_zeros wrote:
| From my friends anecdotal experience, burnout in medical industry
| is partly due to too much administrative work.
|
| It is also partly because the number of patients is increasing
| disproportionately, mostly because people are getting older. An
| individual at the age of 50 needed fewer medical appointments
| than an individual at the age of 70. That's literally from 2002
| to today.
|
| There just aren't enough nurses and doctors to tend to such a
| large old population.
| FactualActuals wrote:
| High stress environment, stagnant wages unless you're a travel
| nurse, underappreciated during the pandemic, and having friends
| turn on you because they associate you with some crazy conspiracy
| theory. These are all reasons I've heard of career nurses
| quitting and going into other industries.
| Ensorceled wrote:
| Conflicts with patients and their families. Politicians
| claiming you are overpaid and your friends and family believing
| them. Increased responsibilities without increased pay,
| something experienced nurses really feel.
|
| I'm trying to think of how any of those can be solved with
| "technology" :-/
| starik36 wrote:
| This I have to hear. What politician is claiming that nurses
| are overpaid?
| [deleted]
| duxup wrote:
| I was under the impression that nurses were paid pretty well
| (generally speaking).
| zdragnar wrote:
| It depends on where you go (and when; things have changed
| somewhat recently) but I know some CNAs who never became RNs
| because the time it would have taken to claw back the money
| spent on the degree wasn't worth the added stress of actually
| being an RN.
| omginternets wrote:
| I went to an undergraduate school with a fairly large nursing
| program, and interacted with a fair number of nursing
| students. One thing I noted was that a large proportion of
| nursing students were first-generation college students from
| lower-middle-class and working class backgrounds. I suspect
| that the meme of nursing being "well paid" stems from the
| fact that it is a step-up in that context.
| gedy wrote:
| This is my antidotal experience as well from extended
| family and friends. Many (mostly young women) weren't
| really sure what to do and picked nursing because "it pays
| well" and had a romanticized/simplistic view of nursing.
| Didn't seem particularly interested or passionate about it,
| so I can see how many would lose interest once the reality
| of the hard work in the midst of a pandemic.
| bryanlarsen wrote:
| Sure, there are lots of nurses making well into the 6
| figures. But they're working 60-80 hours a week, most of them
| night shifts.
|
| A nice 9-5 weekday nursing job makes a couple dollars more
| per hour than the receptionist out front.
| woodruffw wrote:
| Nurses are paid well, relative to the average American
| salary. I don't think they're paid particularly well relative
| to the job's lifestyle requirements and latent stress levels,
| especially during a pandemic.
|
| Looking at my area (NYC), I'd have to take over a 50% pay cut
| from my engineering job to be "paid well" as a nurse. And I
| suspect my job is a lot less stressful.
| duxup wrote:
| That's not that usual of a dynamic.
|
| I think the "hardest" job I ever worked was a PC tech
| support call center or a job at a pizza place. I didn't
| pick my hours ... and the job was a heck of a lot harder
| than my coding job that pays WAY more.
|
| But it wasn't like I could just go and get a coding job at
| the drop of a hat.
| woodruffw wrote:
| Sure. Both programming and nursing are relatively niche
| fields. Nursing is arguably a significantly more
| _professional_ field, given that (1) formal requirements
| are higher, and (2) Nurse Practitioners are effectively
| educated at the MS level (versus a BS or lower for the
| average programmer).
|
| If we're using job difficulty and stress as some of our
| metrics for fair pay, then I would argue that tech
| support and pizza delivery should _also_ be higher
| paying! But even with that, it doesn 't seem unreasonable
| to factor in the professional qualifications (and
| corresponding time and money commitments) required of
| nursing. Relative to all three, it's a remarkably low-
| paying job.
| LegitShady wrote:
| While I don't doubt that nurses have very high stress jobs,
| the reason why you'd take a pay cut to become an nurse is
| because their job is a lot less technically difficult.
|
| I have some friends from university who became nurses, one
| of which I was roommates with for two years during school.
| I helped them study for 'their most difficult math test'
| and it was a relatively straightforward test on changing
| units. They would not have passed a first year calculus
| class. The majority of their academic work was
| memorization, and then lots of hands on work in hospitals.
| The reason they get paid well is because the job is
| important and stressful, not because it requires highly
| technical people of which there is limited supply.
|
| I don't say that as a slight - I know many nurses who are
| very intelligent people, its merely a judgement as to the
| academic rigor involved in getting your nursing
| credentials.
|
| PS I worked at home depot during busy periods in the summer
| when the store was understaffed, I've worked as a waiter
| where I was the only person on shift because the
| owners/manager were idiots, and I've worked cleaning big
| chicken barns out in preparation for new chickens and those
| were all significantly more stressful than my technical
| work. Stress is not correlated with difficulty or limit of
| supply.
| woodruffw wrote:
| Were your friends NPs, CNAs, or something else? There's a
| wide variety in nursing roles, with a corresponding wide
| range in technical difficulty and expected proficiency.
| The average NP is certainly more technically proficient
| than the average undergraduate with a CS degree, albeit
| not in a domain the CS undergraduate might understand.
|
| Tangentially: I'm not sure what the relevancy of "passing
| a first year calculus class" is. Just about every BA/BS
| passes one, and I (a program analysis researcher) have
| never even remotely needed by calculus knowledge in my
| day job. I don't think it's a good proxy for technical
| skill whatsoever, given that "technical skill" is a
| domain-specific qualifier.
| FactualActuals wrote:
| I don't think they are paid as well as they should be
| considering the need for most nurses now to be on-call 24/7
| and dealing with the stress from patients and their families,
| and administrative bloat.
| klyrs wrote:
| 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 endure
| a regular drumbeat of patient deaths and the constant second-
| guessing "what if I did X differently". I don't need to
| handle people's bodily fluids. And then there's the politics,
| internal and external (the conspiracy nuts, the fucked-up
| pecking order in hospitals, unions, insurance- and pharma-
| driven policies, politicization of healthcare, etc). I could
| go on and on, and I only know one nurse personally.
|
| Nurses are not paid anywhere near "pretty well." They're
| treated like shit and the pay isn't anywhere near fair
| compensation for the service that they provide.
| listless wrote:
| ShiftKey now has shifts listed for upwards of 80$+ per
| hour. This is probably the future we're looking at and way
| overdue.
| duxup wrote:
| >but most devs wouldn't even consider a job at that rate
|
| Lots of people ... most people work jobs that fall into
| that category.
|
| I'm not sure that means much. I don't know how many folks
| who go into nursing are likely to just chose to be a
| developer or if it is that simple for them.
| tubalcain wrote:
| 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.
| bluesquared wrote:
| Nurses are paid well compared to the average worker in the US,
| but not compared to the service they provide. My wife, an RN
| BSN, was hit with a pay _cut_ due to hospital system being
| bought out by another larger one. That 's right, a pay _cut_ ,
| during a pandemic. Now on a fixed pay scale, with no raises
| built in. $3/hr shift differential for working night shift in
| no way makes up for the strain it puts on your body, your free
| time, and your relationships. Tons of attrition in her hospital
| and department, no signs of retention bonuses or anything other
| than a "We <3 our healthcare heroes" sign out front.
| ryanmarsh wrote:
| I'm going to offer a counter point, anecdotally of course. My
| daughter is in university right now. She's a in pre-nursing. She
| says most of the people in her major this year switched to
| nursing from other majors during the pandemic because they saw it
| as the most economically viable major compared to their previous
| major. In a nutshell the pandemic scared people into being
| pragmatic about their degree plan.
|
| So hospital administration will have a fresh crop of graduates,
| new to the system, to abuse. The cycle will continue unabated.
| smm11 wrote:
| It's the bare-minimum staffing that's done in nursing, in
| addition to the bizarro pay scale.
| nomoreusernames wrote:
| think about this statement, good nurses are taking care of the
| people you love the most in their most helpless hours. how
| fucking cruel are we as a society for taking this type of love
| for granted? its just wrong to use people like that. nurses
| biggest psychological problem is that they ignore themselves and
| love others and take care of them better. i think its really
| shitty. like veterans of defensive wars.
| Copenjin wrote:
| It's the same in Europe, but I don't know if they are extremely
| underpaid in the same way. Money could fix part of the problem.
| vmception wrote:
| Skimmed the article, what is that number like in other years?
| kingkawn wrote:
| Lots of blame being placed onto the business managerial class
| that has turned hospitals and the practice of medicine into a
| nightmare a la Kafka, but I think that the casual brutality of
| the healthcare educational model deserves a ton of the blame for
| this burnout. The reaction to all emotional trauma is to bury it
| and place all the energy into negotiating for higher pay. Money
| cannot endlessly sit in the place of enduring suffering, and the
| professions (medicine, nursing, PA, etc) will continue to degrade
| in quality as long as this barbaric understanding of emotional
| health is encouraged in the educational institutions.
| yalogin wrote:
| Nurses is a tough profession. They are required to work for
| longer hours and not paid that much. With Covid, dealing with
| anti-science patients must have been very draining mentally. On
| top of changing the working conditions and increasing pay, may be
| we should make the nurses training free to make the field more
| attractive.
| ryanSrich wrote:
| To the surprise of absolutely no one who understands healthcare.
|
| I have many friends and relatives that are nurses, MDs, and
| therapists.
|
| Compensation is about as backwards as you can get. Seniority has
| no impact on your pay. Once you hit the ceiling you'll never make
| more money. This is especially true for Nurses and therapists.
| Even if you switch jobs. The market rate is what you're going to
| get paid (within 10%).
|
| My wife is a PT and made 3x more traveling as a contract
| therapist than she did as a full time employee. Three times.
| That's absolutely absurd.
|
| Benefits are also beyond comical. Healthcare insurance costs for
| healthcare workers are higher and the benefits are worse than if
| you just bought Obamacare directly.
|
| Beyond horrible pay with no upward mobility, you'll also have to
| deal with completely disconnected management that has never done
| any clinical work in their lives. They'll bitch and moan about
| saving money, and often enforce policies that put clinicians at
| risk of malpractice. All to save money.
|
| So yeah. If I were to give any young people advice, it would be
| to stay as far away from healthcare as you can.
| giarc wrote:
| I work in healthcare but not as a nurse. I'm in a somewhat
| obscure field that became pretty important during the pandemic
| (infection control). No one outside the hospital knew we existed
| before the pandemic. Then the pandemic hit, conspiracies' started
| to float around and we had to take our contact list off the
| public website as colleagues were receiving death threats.
|
| I can't even imagine what nurses have gone through being front
| line staff interacting with patients (and their families) all
| day. We need a zero-tolerance policy for families that verbally
| abuse front line staff, but instead they are often let off due to
| "stress of a family member in hospital" or the need for "family
| centered care".
| JaimeThompson wrote:
| Perhaps allowing modern MBAs to cost optimize most every single
| thing we do isn't the best way to assure mid and long term
| security and profitability.
| tyrfing wrote:
| Doesn't that pretty much start with the fact that Medicare pays
| far under cost? "Just stop optimizing costs" is a hard sell
| when a huge chunk of services are sold at a loss. Either
| optimize the business or go bankrupt.
| manuelabeledo wrote:
| Maximising profit by cutting down wages and personnel is not a
| MBA specific problem.
| anarticle wrote:
| Ah, but it is the only thing MBAs are "good" at. /s
| ironmagma wrote:
| It is a problem fostered by that culture though.
| manuelabeledo wrote:
| Is it, though.
|
| If you have the opportunity to take a look at the content
| of your typical business administration book, or even the
| Harvard Business Review magazine, they essentially are
| collections of success stories. Instead of setting the
| narrative, they go and say "this or that worked/didn't
| work, to get this company out of a slump".
|
| The issue, I believe, stems from the fact that "bringing in
| the MBAs" happens when a company doesn't hit inflated
| targets, and for that you have to thank the c-suite, which
| isn't necessarily a bunch of kids with master degrees.
| ironmagma wrote:
| In that content is the sometimes implicit, sometimes not-
| so-implicit understanding that efficiency is something
| positive. The very first thing a finance textbook will
| inform you of is that the market is efficient and that
| this is what allows it to function.
|
| When in reality, efficiency and fragility are two sides
| of the same coin. You might not want to maximize your
| efficiency if you also want to be resilient.
| katbyte wrote:
| Cost optimization usually have huge gaps in things that are
| hard to measure like onboarding cost/time or morale or benefits
| of experience. Who cares about any of that when you can make
| the shareholders another million a the expense of literally
| everyone else?
| FredPret wrote:
| The thing is though this is good for shareholders only in the
| very short term. In the decades-plus term, doing the right
| thing is best for the owners.
|
| And this is why we need savvy shareholders who vote in AGMs.
| rjbwork wrote:
| Efficient systems are brittle systems. You wring all the slack
| out of it and any shock is going to cause failure. In this
| case, the slack is the nurses and other healthcare workers'
| mental health and burnout limits and pay and culture etc. etc.
| The slack is being pulled to lower costs and increase
| insurance/hospital profits.
|
| It's unsurprising that what has happened in the past couple of
| years is putting stress on a system with the slack pulled out
| of it.
| TrispusAttucks wrote:
| You're spot on. This pattern is emerging across many
| structures. Efficiency is inverse correlated with resiliency.
| JIT systems have spread over the globe but they don't handle
| shocks in the pipeline very well.
| etchalon wrote:
| "Efficiency is inverse correlated with resiliency.".
|
| Well, I'm jotting that down in a notebook.
| TrispusAttucks wrote:
| You may enjoy the paper "Examining the balance between
| efficiency and resilience in closed-loop supply chains"
| [1] from August 2021.
|
| EDIT: Also interesting relationship with sustainability
| [2].
|
| [1] https://link.springer.com/article/10.1007/s10100-021-
| 00766-1
|
| [2] https://www.researchgate.net/figure/Sustainability-
| curve-map...
| say_it_as_it_is wrote:
| This isn't a problem that can be solved by an IT solution. Nurses
| have more patients assigned to them than what they can manage.
| They don't need another system of forms and workflows to fill out
| in addition to their overloaded plate. If anything, the solution
| is the opposite of an IT solution in that hospitals must hire
| more nurses and stop following the recommended lean-management
| staffing numbers provided by software.
| acchow wrote:
| As nurses quit, nurse compensation will increase and the number
| considering leaving will start to fall
| tyrrvk wrote:
| We talk about insurance killing the medical field, but I'd also
| argue that EMR companies are doing a number on the profession as
| well. Have you seen the Epic campus? Epic - located in Wisconsin
| (not the gaming company). The amount of overhead a hospital needs
| to support/run that behemoth can't be small. And Epic is
| _swimming_ in cash.
| vlunkr wrote:
| I'd like to know what "considering leaving" means in this study.
| I consider leaving my profession every time a React hook
| misbehaves and locks up my browser, but I'm not actually going to
| leave. 90% seems way too high to be people who are actively
| wanting to leave.
| [deleted]
| cupofpython wrote:
| > 90% seems way too high to be people who are actively wanting
| to leave
|
| We are talking about the people who clean up the nastiest human
| waste that our bodies are capable of producing. I was already
| surprised that this number was ever less than 100% tbh
| lbebber wrote:
| A friend of mine was (is?) completely unfazed by this sort of
| thing--right from the start, it was not some resistance built
| up over time.
|
| She left the profession due to the long hours, low pay, and
| poor treatment.
| vlunkr wrote:
| Well they knew that going in, so I'm not convinced that's a
| factor.
| ejb999 wrote:
| right, and while nurses do have to do some things I would
| consider gross, more often than not, it is the lower paid
| medical assistants and CNA's that get the real awful jobs
| that does not require a nursing degree - i.e. changing
| diapers in nursing home, bathing people etc - won't find
| too many nurses doing that in the nursing homes around me.
| [deleted]
| ejb999 wrote:
| Yes, but that is what they signed up for - i.e. they knew it
| going in, and that has not all of a sudden changed.
|
| I couldn't do it, and god bless them, but that is unlikely a
| cause of people leaving the profession - that would be like a
| computer programmer saying they were leaving the profession
| because they suddenly found out they have to stare at a
| screen most of the day.
|
| I also find that '90%' number suspect as someone that works
| very closely with the healthcare community - there is a lot
| of turnover, and its hard to hire nurses right now - but
| almost always when someone leaves their job it is because
| they went down the street and got a 25% raise, i.e. they
| didn't leave their profession, just their job.
| supertrope wrote:
| Stated and revealed preferences are very different.
| makeitdouble wrote:
| 90% leaving might be too high, but even of a tenth actually
| manages to move on it will have a huge impact.
|
| More importantly, a lot of them will be leaving though burnout
| and depression (a significant number of hospital staff is
| already on this course).
| mulmen wrote:
| I did IT support in a hospital for a year. Nurses do everything.
| Their job is both _hard_ and _thankless_. I do not doubt
| satisfaction is low.
|
| But this sounds like the employee satisfaction corollary to
| Sturgeon's Law [1].
|
| "90% of _employed people_ are considering leaving their
| profession in the next year."
|
| This survey would be more compelling if it compared nurses
| responses with the general employed population over time. I only
| skimmed so maybe it does and I missed it.
|
| [1]: https://en.m.wikipedia.org/wiki/Sturgeon's_law
| timcavel wrote:
| T3RMINATED wrote:
| slantedview wrote:
| It would be interesting to see data on this by state. Nursing,
| unfortunately, is much more difficult in states without unions.
| In California, the strong nurses union has ensured somewhat
| better staffing ratios and much better pay than in other states.
| [deleted]
| weatherlite wrote:
| Hard profession but one of the last things to be automated imo,
| guaranteed income for next 30-40 years. Don't think you can say
| the same about certain types of doctors for instance.
| xhkkffbf wrote:
| A friend who is an anesthesiologist said that he was retiring
| because the new machines were so good that no one wanted to pay
| for an anesthesiologist anymore. They were happy with a nurse.
| So you're right.
| weatherlite wrote:
| It is very algorithmic in nature afaik, so quite easy to
| automate. As is oncology, radiology and many aspects of
| family medicine. It won't be tomorrow, but 10-20 years from
| now I think is very realistic for huge changes. Brave new
| world...
| theguyovrthere wrote:
| CRNA != Nurse in the same sense as a registered nurse in an
| ICU or med-surge department.
|
| CRNA is the Nurse Practitioner version of Anesthesiologists.
|
| They're paying for less anesthesiologists and hiring more
| Certified Registered Nurse Anesthetist because they're
| cheaper, perform a sweeping majority of the same function,
| and multiple can be supervised by an anesthesiologist who is
| on hand to fill the small gap between theirs and the CRNA
| scope of practice.
| biohax2015 wrote:
| There are tons of openings for anesthesiologists paying
| 400k+.
| https://www.gaswork.com/search/Anesthesiologist/Job/All
| weatherlite wrote:
| That's quite pricey, sounds like a good candidate for
| automation :)
| mbg721 wrote:
| Nursing won't be automated soon, but automated systems will be
| used for things that nurses used to do (with predictably worse
| results).
| lghh wrote:
| Nurses do a lot of menial tasks that they are overqualified
| for. Could those not be freed up by automation so that nurses
| can do the high-skill tasks they are uniquely qualified to
| do?
|
| I think you're right in the sense that I expect we won't
| shoot to automate the menial tasks first, and instead will
| let our hubris guide us to automate the high-skill tasks. But
| speaking optimistically, there's a lot of productive
| automation that can happen. Heck, a lot of it has already
| happened via digital record keeping.
| weatherlite wrote:
| But much of those menial tasks are quite difficult to
| automate - changing IVs, bed sheets, patient clothes,
| bandages, diapers etc etc...I don't think AI/robotics is
| anywhere close. However, it is possible that much of the
| menial work will be delegated to lower paid "nurse aides"
| that don't really need much medical knowledge , while the
| real therapeutic work start being automated by machines and
| algorithms. Thus salaries will be squeezed downwards, which
| in the end is what the system wants obviously.
| quxbar wrote:
| The market will surely adjust, by killing off people who can no
| longer afford nursing.
| plaguepilled wrote:
| I'd laugh, but I have this sinking feeling you're right...
| ashitlerferad wrote:
| Salaries about to go through the roof. Time to be a nurse more
| than ever.
| petermcneeley wrote:
| Most people work for money so I would take all this with a grain
| of salt. If you are a RN what are you going to do if not nursing?
| The same applies to all fields including Physicians.
| chrisseaton wrote:
| > If you are a RN what are you going to do if not nursing?
|
| You can do almost any job with almost any degree.
| notch656a wrote:
| Being able to do it doesn't mean someone will hire you.
| Almost anyone may be able to become an engineer but you
| hardly have a prayer of being hired for a well compensated
| and benefited role unless you have years of experience or a
| (science or engineering) degree combined with internship(s).
| shadowofneptune wrote:
| Both physicians and nurses have a lot of options beyond working
| at a hospital. Private practice, small clinics, education,
| consulting, etc. People who will be leaving in these next few
| years won't necessarily be retiring.
| shadowgovt wrote:
| One interesting thing to spot-check in this study would be
| geographic distribution.
|
| Salary for nurses varies widely, and in some places, they're
| wage-competitive with Amazon delivery drivers now. I can easily
| see people deciding that even though they like helping folks,
| getting paid less than the people who drive around and drop
| packages all day doesn't seem like a fair deal.
| ranci wrote:
| Typically nurses are women. Typically women are married to men.
| Men worthy of a relationship or marriage to begin with
| typically have an income significantly higher than min wage,
| potentially capable of sustaining a family on his own. Nurses
| are women usually and women have options, usually.
| mrtranscendence wrote:
| This comment is kooky. Are you implying that one option for
| women nurses is marrying a higher-income man and becoming a
| stay-at-home spouse?
|
| Men making less than the median for their gender (something
| like $55k in the US) are still marriageable; plenty of women
| marry men who can't support families on their salary alone.
| Even at the median salary, supporting two people -- let alone
| a larger family -- could be a struggle, depending on debts
| and other commitments.
|
| And then there are women who are not married to a man who
| makes money, either because they remain unmarried or because
| their husband has lost his job or cannot work for some
| reason.
|
| Further, even if the cards align, it's not great to be in a
| position of dependence on your spouse's salary. Sometimes you
| have to split up and sometimes your spouse dies without
| leaving significant insurance or inheritance.
| bhandziuk wrote:
| I think they're saying that married people might have a
| little more leeway in changing careers because they have
| the stability of a second income in their household
| already.
| n8cpdx wrote:
| There's a huge labor shortage, they could do just about
| anything and get a pretty sizable bonus to sign up. I've heard
| $20k bonus for trucking, local transit agency is offering 7.5k
| to sign up as a bus driver, police nationwide are desperate and
| the requirements for the local agency consist of any 2 year
| degree + being willing to be drug tested, construction industry
| is trying to recruit women now, etc.
| mrtranscendence wrote:
| I'm not a nurse, so grain of salt and all that, but I think
| I'd rather be a nurse than any of those things. And except
| for (some) trucking, RNs generally get paid more than all of
| them, I think.
|
| There's a lot of white collar work that only requires a
| nonspecific college degree, but I'm not aware of such a high
| demand for for HR staff or accounts payable specialists.
| notch656a wrote:
| Probably true in certain areas, but nurses are unique in that
| they occupy one of the few high-wage jobs in rural areas.
| Nurses, on average, are probably more likely to be in places
| where it is difficult to find alternative jobs of equal pay.
|
| If you're a typical white-collar professional in say some
| business/science/engineering field you'll typically, unlike
| nurses, live somewhere with abundant other high wage jobs.
| ModernMech wrote:
| Whether or not any particular nurse follows through with
| thoughts of quitting, all else being equal I think we want
| nurses who enjoy and want to stay being nurses rather than
| nurses who are thinking about quitting. Nurses who are happy
| provide better care than nurses who are so unhappy they want to
| quit.
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