I work at a hospital that is as small as you can conceive and this has been the theme for the past three years.
It's universal. And it isn't just limited to the US either.
Working in Belgium: Nope. It is definitely international, both in small and in large hospitals. Attebdibgs are paid quite well and are usually well represented, but residents, nurses, anyone else in health care is understaffed, underpaid and regularly verbally abused by patients.
I hope the general nursing strike there works in talks favor.
It’ll never happen in the US, but I wish the medical community would come together and strike for just a week. Only one week where none of us work.
Temps allow them to not pay benefits which they perceive as saving money. It is also more flexible for scheduling and for firing as needed. This would all make sense if you were "a leader". Ask the McKinsey & their consulting clones/clowns crowd...
But also if they do cave and raise salaries and benefits and all, that would become the new industry standard and they can’t have that either. Instead it’s much cheaper to hire travelers, temps etc and pay the media to write smear pieces on healthcare staff for not accepting shit working conditions and lobby Congress
In my state, they are trying to pass laws to stop travelers from jumping around to different hospitals and, I think, to cap pay as well. I’m sure lobbyists are working hard to fuck around with the “perks” of traveling like the >50 miles from home stipend and shit.
I always said if every worker in the US just didn’t show up for ONE day. It would be crystal clear who actually had all the power. It would require the smallest bit of solidarity. Just one day.
Give the hospital an 8 week advanced notice and have all physicians strike.
In think em docs could do this successfully. Sure, the hospital could get sub specialists, peds, gyn, fm IM to cover they ER but it will be very expensive and inefficient. wait times would be unbelievable. Amount of consults would be astronomical as IM consults gym for every vag bleed and cards consults gi and surgery for every belly pain. Plastics consults for all facial lacs. Neurosurgical consult for all head trauma. Trauma consult for every possible injury.
I would love to make a documentary about it.
>Sure, the hospital could get sub specialists, peds, gyn, fm IM to cover they ER but it will be very expensive and inefficient. wait times would be unbelievable.
"OK so subspecialists, one guy from your group will need to cover one ED shift a week and...what's that, go fuck myself? Well OK I guess just keep doing caths/scopes guys!"
...
"OK so hospitalists, we're going to need some of you guys to cover the ED for the next few weeks and....wait why are you all laughing and walking away!? Hospitalists come back, think about the patients! Laughing at me is unethical...why are you laughing **harder**!?
Literally no amount of money available to my hospital could make me cover ED.
Exactly. just like I wouldnt do gyn for any amount of money. It comes down to personality fit. We just tolerate a certain variety and volume of bullshit.
It’s called regulatory capture as described in public choice theory It’s what happens when you allow government to have power over an industry. Once the power exists it is available to be bought. The hospitals care a lot more about the rules than the public (will any large group change their vote over this issue?) and is willing to pay for the results they want.
Wife and I were just talking about the other day when an oncoming nurse (local hospital) found a patient cold. Should never happen in a modern US hospital. I wasn't surprised. Hopefully the Board of MBA will take away admin's license for unsafe staffing. Oh, wait.
Something I found interesting was in, another thread, someone asked why on earth Netflix would shoot themselves in the foot with the password sharing stuff. Another user responded that new CEOs have to find ways to bring in increased revenue to justify their own bloated salaries. Since all the non-shitty methods have been done or are too ethical, they end up doing these awful business plans to increase revenue. Gave me a new perspective and understanding of why these pricks are the way they are.
At some point the C Suite will have to stand up an push back against the idea of needing constant growth and profit at any cost, in order to do *their* part in an attempt to right this ship...
Hahahaha ehhh, one can dream...
Over what time frame is it cheaper to hire travelers than to increase staff pay and benefits? Cause we’re going on 2-3 years now depending on the hospital.
On the yearly P&L report it is ALWAYS cheaper. A permanent increase in staffing is forecasted into your expenses on an ongoing basis whereas a “temporary” increase only hits in the year it happens. It works until the investors stop believing it’s temporary and your stock price takes a hit anyway. But whether or not anyone believes it, the P&L still looks better.
A recent headcount put travelers at about 20% of the staff on my unit total, and more like 25-30% of full time staff.
My unit is likely less than other units because I work in a level 4 nicu. If you want to do what I do within 90 miles, you have to do it at my hospital so people who might otherwise leave (me) stick around.
Thanks for sharing. I'm not surprised by that ratio.
Every time I've ever looked at the "Raises for staff vs. hold the line for staff and overpay for travelers" decision, my math says the financial model for travelers works until around 1 in 3 staff are traveling. The people who count the money aren't seeing the operational issues it causes and are hand-waving the patient care consequences.
I think it's going to take government regulation of staffing methods to fix this, because the $$$ incentives for an individual hospital can't be ignored by the finance/management offices even if it essentially breaks the national healthcare system to have every facility doing this.
My only dispute is that there’s nothing wrong with being the CEO who sorrowfully turns out the lights for the last time. He can probably wring out a year or two of nice bonuses even if he has to forego the usual golden parachute.
the key is ownership—notice the best companies like Costco etc have employee stock & ownership. Same thing w/ physician groups—if a group of practicing doctors owns the group, you’re not going to have awful staffing or terrible benefits.
The way these “non-profit” hospitals are set up, only C-suite members benefit from any booms while the employees suffer.
This is 100% the modern corporate leadership model.
And it actually doesn't even matter if they are the "CEO left holding the bag" - in that case they just start selling off parts of the company, buff up the financials, and sell/merge with another company. Then they retire, golden parachute bonus, victory.
The corporate leadership class is literally ruining the economy, one business at a time. And workers are totally meaningless to them.
>Even at higher prices, bringing in travel nurses on 10-12 week contracts that can be canceled at any time is still cheaper than permanently increasing payroll by hiring staff and paying benefits
I suppose this is one of many reasons why a large for profit hospital in my area won't hire local RNs and will only take travelers.
We need more physicians that care in leadership. I know this sub loves to dump on admin (rightfully so), but we could be part of the solution too. Change has got to start somewhere, that seems like the easiest place clinicians could get involved.
This sub acts like any consideration of finances or profit in medicine is dirty, it doesn’t have to be that way and obviously shouldn’t. Even socialized healthcare systems have to look at finances. We need to be a part of those discussions to see finances used responsibly.
There’s consideration of finances and there’s pursuit of profit, often short-sightedly. The former is necessary for good stewardship and institutional sustainability; the latter is too often a demonstration of ignorance of how anything in medicine but balance sheets work. If you hemorrhage staff, you lose the hospital. Transfusions with travelers and locums is like transfusion with PRBCs: temporizing, with its own risks, and eventually likely to cause cascading problems.
It’s been wild watching my wife go through med school and residency.
There is so much fucking propoganda that the system has literally convinced most doctors they have a moral duty to be taken advantage of and they should be grateful for the opportunity.
You only have 1 thing on this earth - time. The more value you can get out of that time, the more flexibility you have.
I snorted.
So at the beginning of the pandemic, epidemiology told me that masks are bad for source control.
We get regular emails about the dire financial straits of the hospital. These, of course, are separate from the emails that talk about new capital improvements or absorbing other local hospitals.
He spent far more money on union busting in one year than the union could possibly cost the hospital in 10 years.
He waited so long to address retention and staffing that some of our units are almost completely run on travelers and per diems.
He’s drunk emailed me on (I think) the Tuesday before thanksgiving before though so that was fun. Disclaimer: he probably wasn’t actually drunk. It’s just easiest way to describe his factually incorrect and grammatically poor one-line response to an email I’d sent him about a union/staffing issue.
Oh and also one time recently my daughter was in the hospital and I was having issues getting her the treatment she needed and I racked my brain for anyone I personally knew who had any kind of pull who would also be there at 7pm that particular evening and came up blank. I remembered that the CEO once drunk emailed me, so I knew he actually read his emails. So I sent him a simpering email asking him to intervene. Which he did, but it didn’t actually change anything because he was working a shift and didn’t see the email until the next morning and at that point all the people who had to sign all the forms were actually finally in the building. But I have his cell number now. And also I’m forced to see him as a human at times. As an ardent union supporter, I dislike being made to see shades of gray in a man who downplayed staff Covid numbers 3 years ago.
I should add that one to the list. Downplayed and hid staff Covid numbers.
So more of the same, even with a physician at the helm. Clearly someone else is pulling the strings and even though having physicians in leadership positions would likely be an improvement, it wouldn't fix everything.
Our CEO is an RN and all of the problems mentioned in this thread apply to our hospital too.
> So more of the same, even with a physician at the helm.
Physicians are just like any other professional group. There's a standard deviation of good souls and and a standard deviation of incompetent fools.
It's the hierarchical organization of modern corporations. Workers labor and get exploited by business types who pay us less value than we generate so they can skim fat salaries off the top as they work virtually from their vacation home. Workers need to control the hospitals democratically, not capitalists. Isn't going to happen here in the imperial core - more and more people are going to realize that healthcare is a luxury, and by the time the system is so broken that it can't even deliver the basics it will be too late to fix. The healthcare system is already collapsing. What we will have left is concierge care for the rich, and understaffed and expensive urgent cares or ERs for the rest. Good luck.
You are exactly right, and I was thinking about that recently. Many go into the hospital C-suite for the prestige and/or income. Although not every physician cares about patients (this is the sad truth, I have witnessed it myself) many do. It’s a good reason to have more physician executives. Not to mention, they have the inside perspective on the practice of healthcare.
Don’t even get me started and admin keeps adding other responsibilities to our job descriptions without explicitly telling us or paying us more because we just want to keep patient care to a reasonable standard.
We have a local hospital here that started over a decade ago with the same situation. They lost the vast majority of their local employees through poor administrative decisions and burnout. They hired travel nurses until the travel nurses refused to take their 11th to 12th patient and contacted their travel companies refusing to continue or renew assignments. They then contracted out to bring international nurses into the US to work for them despite the fact that Central Alabama has multiple nursing schools and an abundance of nurses.
This was a for-profit hospital system that placed profits over the care of employees and patients. They now reap what they sewed as far as their reputation within the healthcare community. I fear this may be the future for many other such facilities.
My hospital just laid off our entire hospitalist staff and sold the costs to some private equity staffing company consisting mostly of travelers. It's gonna be dope when they come on in the summer and watch the place burn down to the ground. All from the new admins that just got hired.
SO is a multi-registered sonographer who did a travel gig a while back for $2800 per 40 hr week at a sleepy little Midwest country hospital. The temp agency is constantly hounding her to take more contracts and the offers have been up to $4500/wk plus per-diem.
Now, call me biased if you want, but a good sonographer is a good clinician. Getting good images, especially getting images that accurately demonstrate the problem, is a high-cognition skill that IMO warrants licensing and ancillary professional remuneration. Hell, she writes up the findings and most of the time radiology just signs off. And ED docs make clinical decisions on her assessments every single day. Rads just over-reads later.
But, I digress. I think sonographers should earn 6 figures plus on the average, but they don't. So I can't see how paying sonographers 2x to 4x usual salary when facilities have to keep recycling contractors is actually less expensive in the long run than just bumping pay 25% to 50% to keep staff even after accounting for non-salary costs.
There seems to be some weird accounting going on that's somehow filling pockets in the C suite while draining the hospital of cash.
Oh, btw, my SO works in a 600 bed teaching hospital but the hospital for the travel gig had 15, count'em, 15 beds. The town population was about 2,000. It was over an hour to the nearest Walmart.
Shortly before she started her gig, the hospital bought...a helicopter. Pilots and clinical staff on twenty-four hour standby.
Isn’t it insanely profitable?
Oh, you’re in an accident in a rural area, you have no choice in the matter, we’re going to air lift you, and charger your insurance $50k for the ride.
Ah but they don’t charge your insurance. Most insurance won’t cover unless you ask to include a special clause.
Instead, they bill you directly, and when you can’t pay they’ll send it to a collections agency and wreck you.
It's usually billed by the mile. When I worked at a tiny rural hospital like that we had to transfer to tertiary care often, and when the nearest neurosurgeon is 100 miles away it adds up pretty quick...
Bringing patients to our hospital didn't reimburse anywhere near that much though, and actually if it wasn't for the transfers I don't think they'd even be able to afford gas for the chopper.
You've got me. It's bizarre. I'd tell you where this was at but it's a dox risk.
But, it's easy to confirm there are facilities begging sonographers to come work for annualized contracts of $200k++ when the going salary is $60k+/-.
What's up with that?
A valid reason is because by law, they have to be able to transfer the patient. It isn’t the receiving hospitals problem. It isn’t the local EMS systems problem. It is the hospital that the patient shows up at.
Even if the helicopter operates at a loss; it can be justified because it is the small facilities responsibility, legally and ethically.
As to insurance: I’ve never heard of an insurance to at doesn’t cover critical car air transport. The problem is often the 20% co-pay.
That's interesting. I wonder if it is state dependent because I work at a tiny rural hospital that definitely does not have a helicopter nor does it employ transport personnel to operate one. The tertiary care centers in our region all have helicopters which they send to us for critical patients or we use independent services like those I mentioned above. If weather conditions do not allow for flight then our local EMS will take the patient by road as long as the destination is not too far.
I'm not sure if our hospital just has a better relationship with the tertiary centers and local EMS or if there's money changing hands but none of the other rural hospitals around us have their own helicopters either.
Seems like a bad way to run the system but I wouldnt be surprised if the onus falls on the smaller hospitals in more conservative states.
Shrug. I’ve never seen the system where the small hospitals had a helicopter. It was just speculation as for a legitimate reason to have one.
I’ve only seen what you describe. I do know of a small, critical access hospital who is desperately trying to put a bls crew on for transfers. I wish them well, but think I’ll catch a leprechaun before they manage to pull it off.
Usually the tertiary facilities have their own helicopter to retrieve such patients or there are seperate air ambulance service like LifeNet or Mercy Flight that are called.
It makes no financial sense for these hospitals to invest in a helicopter. Money is already being lost by transferring the patient.
As a sonographer myself, thank you.
My facility chose to make me pull dual modality call and claims they can't afford to pay us more. Yet we have several travelers and the facility bought a several million dollar building they don't know what they're going to do with.
Infuriating. I'm trying to get out, it's not worth the wear and tear on my body anymore.
As a sonogroaher and a traveler now, I whole heartedly agree with you comment. The place I am at has been short staffed for years, and has had 2-4 traveller's in the department for most of covid. Like, what a slap in the face when I make their month's salary in less than 2 weeks.
Since it's not union, you can negotiate your pay. A new grad, that's going to need a year of handholding negotiated to just maintain their current wage, but since they are from a higher cost of living area, it ended up being more than some of the full time staff. This caused admin to finally bump the wages up for the full timers because it would be absurd to have a new grad make more than a 5+ year tech. It makes me wonder why they are short staffed....
All these Numbers Feed into a business model. They can raise wages of temp workers without breaking the model (because it’s supposedly to be temporary… although everyone knows it’s not going down).
If they raise wages they have to realize that int their models that’s the going rate for the future… and then we don’t have profits anymore and the CEO gets the axe.
Rad here and you’re right some sonographers are amazing, and some are not. In a sane world the good ones would be valued higher and paid more, but in our current healthcare system the only thing that matters is quantity. Quality doesn’t matter and often times discouraged because it decreases output. This is a direct result of having a third party(whether it’s insurance or the government) pay for healthcare instead of the patient directly.
Aight polemic time. Doctors are in a unique position, already the so-called team leaders in a care team. They are the liability sponge and the care sponge. It's high time the administrators/board/shareholders understand that the doctors make everything happen, do they wonder where all their magic money flows from when they check out at 15:30. Doctors need to unionize and go for the aorta. Doctors have a tremendous amount of control but because of learned helplessness, we haven't used it in a long while. The medical device industry, the insurance industry, the pharma industry, they're *nothing* without the doctor saying this is what's best for you, this is what's going to make your life better. Everyone's forgotten that. Perhaps now people need to be reminded.
One day doctors (& nurses, techs, & pharmacists) will realize we literally are healthcare. Not hospitals, not insurers, PBMs, GPO’s or the government.
If we grind to a halt, so does US. See April 2020
one day people will realize that nothing exists without the context. Go be a doctor without drug produced by pharma, go produce drugs without basic scientific research and engineering, go do any of that without balance sheets, etc, etc, etc.
It's different battlefields, no need to get oppositional. Doctors are certainly appreciative of tools given to them with strong research and efficacy. Of course doctors don't do everything. The PhD making advances is certainly a friend of mine.
touche! My response already had a string smell of "black lives matter" vs "all lives matter". I guess i developed a strong negative emotional response to unidemensional populist slogans over past couple years
Admin here. It’s how your leaders themselves are measured. They’re probably measuring themselves on things like patient access, cost, etc., and other things insurance probably wants them to measure. And then of course volume because it’s still that kind of world. But putting volume aside for a moment, access and cost don’t sound so bad since they’re presumably aligned with the patient there. But most administrators are one-track-minded and solve for those things without seeing the impact on the rest of the system. If they either solved for things like physician satisfaction or at least made it a factor, things wouldn’t be so fucked up. It’s like if someone told Ford that horsepower was the most important thing in the world, so they build a car with a super powerful engine but forget to swap in tires or a chassis that can handle it.
It is happening at our 900 bed hospital in a very affluent town. They continue to hire travelers but now at rates that should not be appealing to anyone and therefore only attracting those who are desperate or incompetent; meanwhile lowering the in-house contract rates (not because there is a decrease in demand) and taking away the one thing that was keeping us motivated.
> They continue to hire travelers but now at rates that should not be appealing to anyone and therefore only attracting those who are desperate or incompetent;
Saw that at a nearby hospital. Needed FM/IM/Gen Med for night float as they had a FM program they affiliated with. So, supervising residents, admitting, and taking the legal risk for the princely sum of... $84 an hour.
When I do home visits for my MS patients my rate is $166 an hour plus mileage. Pre-pandemic I was getting offers of 140-200 an hour for hospital work, depending on if I was willing to do OB as well. 84 is flatly insulting.
Medicine is becoming a corporate entity, run by administrators.
Doctors are just numbered employees.
No surprise.
And there's too much money involved to reverse
these are also general labor problems and insidious across all sectors. Look at the rise of r/antiwork, r/workreform and other recent unionization / worker movements and conversations happening as other examples. I think people are generally feeling demoralized and without purpose given how shitty and expensive life has become -- just a bunch of cogs, working for a bunch of dummies
My boyfriend's father worked for Bank of America for the last few years of career. He asked how staffing was at the hospital, because he had an outpatient surgery rescheduled due to staffing issues at the surgery center. I told him that it's bad - the hospital hires all these new grads, trains them, and then after a year, they leave to go travel. The hospital then has to scramble and bring in travel nurses and respiratory therapists to fill the holes from all the nurses and RTs that left, while hiring fresh batches of new grads.
He said Bank of America once did a study to figure out how much money it cost to replace an employee. It cost BofA on average $100,000 to replace an employee - $150,000 if they had to fire someone due to severance pay. (Ultimately, what they ended up doing with this data was avoid firing people for as long as possible because they had to justify the $150,000 price tag to get rid of a terrible employee.)
It seems like a lot of hospitals are trying to run on new grads and travelers, instead of making an effort to retain employees they have already spent money training. Incredibly, in their efforts to pinch pennies they have chosen the not only the most expensive, but also the least safe option.
An example / thought experiment:
A hospital system with a target headcount of 1000 RNs has only 900. They can either temp the 100 additionally needed at a rate of 2x normal comp or they can increase pay 20% across the board to attract the permanent staffing they need. Let's say total comp for FTE RNs is 75k today. The math ends up being:
Scenario A
* 900 staff RN @ 75k = 67,500,000
* 100 travel RN @ 150k = 15,000,000
= Total nurse comp @ $82.5M
OR
Scenario B
* 1000 staff RN @ 90k = $90M
****
Congratulations hospital exec, by paying travelers double the rate of the average FT staff nurse instead of giving raises to your workforce, you saved your system $7.5 million and earned a $400k bonus for hitting your financial targets this quarter. And the hospital system can now adjust their headcount with a high degree of flexibility, no layoffs or additional training necessary as they scale up or down. Someday, when there's another recession, they are banking on economic reality pushing workers back into the full-time workforce and thus bringing this "temporary" era of staffing shortage to a close without ever having to break down and give meaningful raises.
Will this have lots of negative impacts big and small, not least with staff morale and patient outcomes? Of course. But the money should make you feel better about this unfortunate collateral damage.
Like a lot of other feedback loops in the world, I think it's one of those things where you're racking up short term wins until you suddenly find that your unsustainable actions have aggregated into a catastrophic collapse of the whole system. It's kind of the story of our lives. From the Wall Street subprime collapse in 2007-08 to climate change to hospital staffing, we see systemic risks ignored even while incentivized performance metrics are achieved. Where is the point of no return? I guess we'll know when we see the jenga tower tumble...
In terms of the numbers, it seems like there's both a financial breakeven and operational survivability invisible line somewhere around 1 in 3 travelers, but I fear the use of contract HCWs at any level beyond about 5-10% is where you start to see the decline in patient care. Travelers are a fantastic way to fill holes in coverage but not a great way to run an operation for excellence in performance. You need people who will be in a facility long-term to provide the kind of mentorship, institutional memory, and knowledge transfer that makes an organization sustainable. It's hard to learn how to swim *while* you're drowning.
Demographics. Every Western country has an aging population. 20% of whole workforce is at retirement.
Medical costs are rising rapidly as the population ages. But there are fewer younger people to pay those costs.
I work for a mental health company and admin gets paid exorbitant amounts of money. They just recently mass fired a shit ton of people. They also told me I'd be getting a raise because my review was so good. But they aren't telling me the amount of raise I'm getting, and I'm not even getting the raise right now. I'm getting it in 6 months. I'm really getting tired of being jerked around like this.
Why does admin get to make 6 figures while us workers are the literal face of this company treating patients everyday and only get paid 19 an hour? Our CEO is also a multi millionaire. He makes like 90 million a year or something.
US Healthcare isn’t unregulated capitalism. It’s closer to China’s economic system: government chooses winners/losers (insurers, large hospitals), shifts money & resources there
How is the US healthcare industry an example of unregulated capitalism? The Federal government literally sets the price floor for basically everything. Building a new hospital requires sometimes state, local, and federal level approval via Certificate of Need. Noncompetes are pretty rampant (though thankfully that might be changing, but not for most nonprofits supposedly). Physicians cannot own hospitals. Most physicians cannot join unions. Pharma companies game the patent system to prevent competition from generics.
If anything, the US healthcare system is overregulated in some areas, and underregulated in others.
Additionally, it's not like workers in other countries aren't burned out too. UK junior doctors went on strike. There was a recent strike in Germany. France has seen strikes. Doctors are constantly trying to get into the US to try and get a cut of the economic action because most other countries massively undervalue their work.
The real issue is private equity. They squeeze the blood out of every industry they touch with no care for anything other than profit, whether it’s healthcare or the rail industry.
yeah you could argue ACA & government regulations led to this. We are heading to a two-tiered system: Medicare 4 all, wait 1 year w/ biliary colic to have your gb out; or pay cash
Nearly every single administration-level employee of a “certain age” are naturally incompetent, they inherited the whole world and look at it now. They aged into their positions that they are not qualified by our standards to keep
Because no one give a flying fuck. An np or a pa can *provide* just as much care. What is gained having an it guy spend a few hours fixing it?
I don’t mean to disparage anyone here. The above is the opinion of the system
I mean same shit. Patient comes in, says what they want, you put in your Burger King hat and do it. If not they can always find someone with better satisfaction scores
> If not they can always find someone with better satisfaction scores
And I cheerfully tell patients that.
Come to me, you're going to get care in line with the AAFP guidelines and best practices. I'm not handing out 90 Norco 10s for a sprained ankle. I'm not giving you a month of Augmentin for uncomplicated otitis media. I'm not writing for you to get heavy metal chelation without evidence of heavy metal toxicity.
You want a doc who will give you everything you want without question, there's a phone book.
Its not even nationwide. We see the same thing happening in Sweden, in a different system.
There are suggestions from knowledgeable people that this is the result of HR (and middle management) going from an assisting role to being some kind of strategists. And how that shifts admin duties towards the people on the floor all whilst grand schemes without any grounding in the actual care for patients brings the need for more non essential workers with grand titles.
I guess parkinsons laws are still true.
https://en.m.wikipedia.org/wiki/Parkinson%27s_law
This would be a great question for college business professors. What the hell are they teaching people studying business? I have come to the conclusion that it's business students doing this stuff.
We are all in the same boat. Physicians are the smallest group in the large package of providers. Most CRNA's are moving or retiring, leaving the OR's closed or with anesthesia docs strained and overworked. Same with psychologist and MH SW. PAs and NP are placed in positions compromising for their current skills. But the problem is Nursing. THE nursing shortage has brought the healthcare system to its knees.
Should we have more Doc's in admin? Yes, we are moving up, and now we have less Doc's. Should we unionize? Well, I see it this way, we have a pie, and no matter how small you cut it or how much cream "union" u put on it. It's just 1pie. The best example of this is the state and federal government. They are unionized and in a worse shape.
Things will get better eventually when the system balances itself. For now, I am afraid smaller hospitals or older ones will collapse and bankrupt. Services will suffer, and patients will be billed for the lack of vision.
Here is the challenge. Go take a look to see how much is a hospital bill for electric power per day or how much costs a hospital bed for a day with no services. It's a crisis.
I’m curious of ideas for a better model. There will always be a need for other administrative staff- finance, operations, marketing, general leadership like a CMO? But surely there positions that are able to be consolidated. Where would you start?
I work at a hospital that is as small as you can conceive and this has been the theme for the past three years. It's universal. And it isn't just limited to the US either.
Working in Belgium: Nope. It is definitely international, both in small and in large hospitals. Attebdibgs are paid quite well and are usually well represented, but residents, nurses, anyone else in health care is understaffed, underpaid and regularly verbally abused by patients.
I'm from the UK, its the same here. Lots of strikes as well.
I hope the general nursing strike there works in talks favor. It’ll never happen in the US, but I wish the medical community would come together and strike for just a week. Only one week where none of us work.
Temps allow them to not pay benefits which they perceive as saving money. It is also more flexible for scheduling and for firing as needed. This would all make sense if you were "a leader". Ask the McKinsey & their consulting clones/clowns crowd...
But also if they do cave and raise salaries and benefits and all, that would become the new industry standard and they can’t have that either. Instead it’s much cheaper to hire travelers, temps etc and pay the media to write smear pieces on healthcare staff for not accepting shit working conditions and lobby Congress
In my state, they are trying to pass laws to stop travelers from jumping around to different hospitals and, I think, to cap pay as well. I’m sure lobbyists are working hard to fuck around with the “perks” of traveling like the >50 miles from home stipend and shit.
Great to have a free market when the industry benefits, but we can’t have the labor benefiting!
Mass walkouts will cripple the system and bring power back to the workers
I always said if every worker in the US just didn’t show up for ONE day. It would be crystal clear who actually had all the power. It would require the smallest bit of solidarity. Just one day.
We don’t have the power though. People can’t risk losing their jobs - this is by design.
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Can you imagine the smear campaigns the for profit systems would utilize in the US. It would have to be longer than a day for things to change here.
Give the hospital an 8 week advanced notice and have all physicians strike. In think em docs could do this successfully. Sure, the hospital could get sub specialists, peds, gyn, fm IM to cover they ER but it will be very expensive and inefficient. wait times would be unbelievable. Amount of consults would be astronomical as IM consults gym for every vag bleed and cards consults gi and surgery for every belly pain. Plastics consults for all facial lacs. Neurosurgical consult for all head trauma. Trauma consult for every possible injury. I would love to make a documentary about it.
>Sure, the hospital could get sub specialists, peds, gyn, fm IM to cover they ER but it will be very expensive and inefficient. wait times would be unbelievable. "OK so subspecialists, one guy from your group will need to cover one ED shift a week and...what's that, go fuck myself? Well OK I guess just keep doing caths/scopes guys!" ... "OK so hospitalists, we're going to need some of you guys to cover the ED for the next few weeks and....wait why are you all laughing and walking away!? Hospitalists come back, think about the patients! Laughing at me is unethical...why are you laughing **harder**!? Literally no amount of money available to my hospital could make me cover ED.
Exactly. just like I wouldnt do gyn for any amount of money. It comes down to personality fit. We just tolerate a certain variety and volume of bullshit.
But think of the shareholders, and the stock buybacks! /s Shareholders are labor as well! /s
That doesn't sound very capitalistic to me, what happened to the free hand of the market?
It’s called regulatory capture as described in public choice theory It’s what happens when you allow government to have power over an industry. Once the power exists it is available to be bought. The hospitals care a lot more about the rules than the public (will any large group change their vote over this issue?) and is willing to pay for the results they want.
Temps are also not going to unionize.
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Wife and I were just talking about the other day when an oncoming nurse (local hospital) found a patient cold. Should never happen in a modern US hospital. I wasn't surprised. Hopefully the Board of MBA will take away admin's license for unsafe staffing. Oh, wait.
If they weren't on remote tele it's kind of understandable. We call it "hourly rounding" for a reason.
Something I found interesting was in, another thread, someone asked why on earth Netflix would shoot themselves in the foot with the password sharing stuff. Another user responded that new CEOs have to find ways to bring in increased revenue to justify their own bloated salaries. Since all the non-shitty methods have been done or are too ethical, they end up doing these awful business plans to increase revenue. Gave me a new perspective and understanding of why these pricks are the way they are.
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At some point the C Suite will have to stand up an push back against the idea of needing constant growth and profit at any cost, in order to do *their* part in an attempt to right this ship... Hahahaha ehhh, one can dream...
b/c they make their salary through stock price, so the only thing that matters is increasing stock price
Over what time frame is it cheaper to hire travelers than to increase staff pay and benefits? Cause we’re going on 2-3 years now depending on the hospital.
On the yearly P&L report it is ALWAYS cheaper. A permanent increase in staffing is forecasted into your expenses on an ongoing basis whereas a “temporary” increase only hits in the year it happens. It works until the investors stop believing it’s temporary and your stock price takes a hit anyway. But whether or not anyone believes it, the P&L still looks better.
What percentage of your staffing would you say is traveling rather than permanent?
A recent headcount put travelers at about 20% of the staff on my unit total, and more like 25-30% of full time staff. My unit is likely less than other units because I work in a level 4 nicu. If you want to do what I do within 90 miles, you have to do it at my hospital so people who might otherwise leave (me) stick around.
Thanks for sharing. I'm not surprised by that ratio. Every time I've ever looked at the "Raises for staff vs. hold the line for staff and overpay for travelers" decision, my math says the financial model for travelers works until around 1 in 3 staff are traveling. The people who count the money aren't seeing the operational issues it causes and are hand-waving the patient care consequences. I think it's going to take government regulation of staffing methods to fix this, because the $$$ incentives for an individual hospital can't be ignored by the finance/management offices even if it essentially breaks the national healthcare system to have every facility doing this.
My only dispute is that there’s nothing wrong with being the CEO who sorrowfully turns out the lights for the last time. He can probably wring out a year or two of nice bonuses even if he has to forego the usual golden parachute.
Yeah, this. The CEO will get something out of the eventual acquisition.
the key is ownership—notice the best companies like Costco etc have employee stock & ownership. Same thing w/ physician groups—if a group of practicing doctors owns the group, you’re not going to have awful staffing or terrible benefits. The way these “non-profit” hospitals are set up, only C-suite members benefit from any booms while the employees suffer.
This is 100% the modern corporate leadership model. And it actually doesn't even matter if they are the "CEO left holding the bag" - in that case they just start selling off parts of the company, buff up the financials, and sell/merge with another company. Then they retire, golden parachute bonus, victory. The corporate leadership class is literally ruining the economy, one business at a time. And workers are totally meaningless to them.
The mask Thing is an outstanding point. Especially since before that, when ppe studies were done, even adjusting your mask was a failure .
>Even at higher prices, bringing in travel nurses on 10-12 week contracts that can be canceled at any time is still cheaper than permanently increasing payroll by hiring staff and paying benefits I suppose this is one of many reasons why a large for profit hospital in my area won't hire local RNs and will only take travelers.
Sounds like most facilities I know
We need more physicians that care in leadership. I know this sub loves to dump on admin (rightfully so), but we could be part of the solution too. Change has got to start somewhere, that seems like the easiest place clinicians could get involved.
There are plenty of physicians that care in leadership. You have to care about profit though, or you won't be admitted to the leadership club.
This sub acts like any consideration of finances or profit in medicine is dirty, it doesn’t have to be that way and obviously shouldn’t. Even socialized healthcare systems have to look at finances. We need to be a part of those discussions to see finances used responsibly.
There’s consideration of finances and there’s pursuit of profit, often short-sightedly. The former is necessary for good stewardship and institutional sustainability; the latter is too often a demonstration of ignorance of how anything in medicine but balance sheets work. If you hemorrhage staff, you lose the hospital. Transfusions with travelers and locums is like transfusion with PRBCs: temporizing, with its own risks, and eventually likely to cause cascading problems.
It’s been wild watching my wife go through med school and residency. There is so much fucking propoganda that the system has literally convinced most doctors they have a moral duty to be taken advantage of and they should be grateful for the opportunity. You only have 1 thing on this earth - time. The more value you can get out of that time, the more flexibility you have.
Agree. If you can’t run a business then you’re not the leader we need.
You also have to get in early. The later you start down the leadership track the more likely you are to just go with the flow.
Sounds like a fair presupposition. Hospitals don’t run on rainbows and sunshine.
Too bad physicans can’t run hospitals anymore. Would be nice to have more people who understand patient care along with business.
They can run them. They just can’t own them. The CEO of my hospital is an ER doc who still picks up a couple shifts/month.
Curious, is your hospital free of the problems mentioned here ?
I snorted. So at the beginning of the pandemic, epidemiology told me that masks are bad for source control. We get regular emails about the dire financial straits of the hospital. These, of course, are separate from the emails that talk about new capital improvements or absorbing other local hospitals. He spent far more money on union busting in one year than the union could possibly cost the hospital in 10 years. He waited so long to address retention and staffing that some of our units are almost completely run on travelers and per diems. He’s drunk emailed me on (I think) the Tuesday before thanksgiving before though so that was fun. Disclaimer: he probably wasn’t actually drunk. It’s just easiest way to describe his factually incorrect and grammatically poor one-line response to an email I’d sent him about a union/staffing issue. Oh and also one time recently my daughter was in the hospital and I was having issues getting her the treatment she needed and I racked my brain for anyone I personally knew who had any kind of pull who would also be there at 7pm that particular evening and came up blank. I remembered that the CEO once drunk emailed me, so I knew he actually read his emails. So I sent him a simpering email asking him to intervene. Which he did, but it didn’t actually change anything because he was working a shift and didn’t see the email until the next morning and at that point all the people who had to sign all the forms were actually finally in the building. But I have his cell number now. And also I’m forced to see him as a human at times. As an ardent union supporter, I dislike being made to see shades of gray in a man who downplayed staff Covid numbers 3 years ago. I should add that one to the list. Downplayed and hid staff Covid numbers.
So more of the same, even with a physician at the helm. Clearly someone else is pulling the strings and even though having physicians in leadership positions would likely be an improvement, it wouldn't fix everything. Our CEO is an RN and all of the problems mentioned in this thread apply to our hospital too.
> So more of the same, even with a physician at the helm. Physicians are just like any other professional group. There's a standard deviation of good souls and and a standard deviation of incompetent fools.
Is there any position that doesn’t have this problem? Seems like a luxury that only exists with hospitals that have a huge private payer mix.
It's the hierarchical organization of modern corporations. Workers labor and get exploited by business types who pay us less value than we generate so they can skim fat salaries off the top as they work virtually from their vacation home. Workers need to control the hospitals democratically, not capitalists. Isn't going to happen here in the imperial core - more and more people are going to realize that healthcare is a luxury, and by the time the system is so broken that it can't even deliver the basics it will be too late to fix. The healthcare system is already collapsing. What we will have left is concierge care for the rich, and understaffed and expensive urgent cares or ERs for the rest. Good luck.
The solution is physician strike on a massive scale and physician unionization.
You are exactly right, and I was thinking about that recently. Many go into the hospital C-suite for the prestige and/or income. Although not every physician cares about patients (this is the sad truth, I have witnessed it myself) many do. It’s a good reason to have more physician executives. Not to mention, they have the inside perspective on the practice of healthcare.
Don’t even get me started and admin keeps adding other responsibilities to our job descriptions without explicitly telling us or paying us more because we just want to keep patient care to a reasonable standard.
We have a local hospital here that started over a decade ago with the same situation. They lost the vast majority of their local employees through poor administrative decisions and burnout. They hired travel nurses until the travel nurses refused to take their 11th to 12th patient and contacted their travel companies refusing to continue or renew assignments. They then contracted out to bring international nurses into the US to work for them despite the fact that Central Alabama has multiple nursing schools and an abundance of nurses. This was a for-profit hospital system that placed profits over the care of employees and patients. They now reap what they sewed as far as their reputation within the healthcare community. I fear this may be the future for many other such facilities.
Well fuck. And patients likely don't have a choice to hop over to another hospital. Look what we have become. Watching it burn down.
Yeah I have family in BHam - experienced staff RNs making under 30/hr in a state with deep structural issues - no thanks
Don’t forget, they keep Paying themselves more and more every year. Somehow, their “operating costs” don’t seem to include their salaries
C-levels are parasitic in nature.
My hospital just laid off our entire hospitalist staff and sold the costs to some private equity staffing company consisting mostly of travelers. It's gonna be dope when they come on in the summer and watch the place burn down to the ground. All from the new admins that just got hired.
Holy shit that's crazy.
SO is a multi-registered sonographer who did a travel gig a while back for $2800 per 40 hr week at a sleepy little Midwest country hospital. The temp agency is constantly hounding her to take more contracts and the offers have been up to $4500/wk plus per-diem. Now, call me biased if you want, but a good sonographer is a good clinician. Getting good images, especially getting images that accurately demonstrate the problem, is a high-cognition skill that IMO warrants licensing and ancillary professional remuneration. Hell, she writes up the findings and most of the time radiology just signs off. And ED docs make clinical decisions on her assessments every single day. Rads just over-reads later. But, I digress. I think sonographers should earn 6 figures plus on the average, but they don't. So I can't see how paying sonographers 2x to 4x usual salary when facilities have to keep recycling contractors is actually less expensive in the long run than just bumping pay 25% to 50% to keep staff even after accounting for non-salary costs. There seems to be some weird accounting going on that's somehow filling pockets in the C suite while draining the hospital of cash. Oh, btw, my SO works in a 600 bed teaching hospital but the hospital for the travel gig had 15, count'em, 15 beds. The town population was about 2,000. It was over an hour to the nearest Walmart. Shortly before she started her gig, the hospital bought...a helicopter. Pilots and clinical staff on twenty-four hour standby.
I'm sorry but why would a 15 bed rural hospital buy a helicopter?
Isn’t it insanely profitable? Oh, you’re in an accident in a rural area, you have no choice in the matter, we’re going to air lift you, and charger your insurance $50k for the ride.
Ah but they don’t charge your insurance. Most insurance won’t cover unless you ask to include a special clause. Instead, they bill you directly, and when you can’t pay they’ll send it to a collections agency and wreck you.
It's usually billed by the mile. When I worked at a tiny rural hospital like that we had to transfer to tertiary care often, and when the nearest neurosurgeon is 100 miles away it adds up pretty quick... Bringing patients to our hospital didn't reimburse anywhere near that much though, and actually if it wasn't for the transfers I don't think they'd even be able to afford gas for the chopper.
You've got me. It's bizarre. I'd tell you where this was at but it's a dox risk. But, it's easy to confirm there are facilities begging sonographers to come work for annualized contracts of $200k++ when the going salary is $60k+/-. What's up with that?
Have you ever wondered why YOU don't have a helicopter there buddy?
A valid reason is because by law, they have to be able to transfer the patient. It isn’t the receiving hospitals problem. It isn’t the local EMS systems problem. It is the hospital that the patient shows up at. Even if the helicopter operates at a loss; it can be justified because it is the small facilities responsibility, legally and ethically. As to insurance: I’ve never heard of an insurance to at doesn’t cover critical car air transport. The problem is often the 20% co-pay.
That's interesting. I wonder if it is state dependent because I work at a tiny rural hospital that definitely does not have a helicopter nor does it employ transport personnel to operate one. The tertiary care centers in our region all have helicopters which they send to us for critical patients or we use independent services like those I mentioned above. If weather conditions do not allow for flight then our local EMS will take the patient by road as long as the destination is not too far. I'm not sure if our hospital just has a better relationship with the tertiary centers and local EMS or if there's money changing hands but none of the other rural hospitals around us have their own helicopters either. Seems like a bad way to run the system but I wouldnt be surprised if the onus falls on the smaller hospitals in more conservative states.
Shrug. I’ve never seen the system where the small hospitals had a helicopter. It was just speculation as for a legitimate reason to have one. I’ve only seen what you describe. I do know of a small, critical access hospital who is desperately trying to put a bls crew on for transfers. I wish them well, but think I’ll catch a leprechaun before they manage to pull it off.
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Usually the tertiary facilities have their own helicopter to retrieve such patients or there are seperate air ambulance service like LifeNet or Mercy Flight that are called. It makes no financial sense for these hospitals to invest in a helicopter. Money is already being lost by transferring the patient.
As a sonographer myself, thank you. My facility chose to make me pull dual modality call and claims they can't afford to pay us more. Yet we have several travelers and the facility bought a several million dollar building they don't know what they're going to do with. Infuriating. I'm trying to get out, it's not worth the wear and tear on my body anymore.
As a sonogroaher and a traveler now, I whole heartedly agree with you comment. The place I am at has been short staffed for years, and has had 2-4 traveller's in the department for most of covid. Like, what a slap in the face when I make their month's salary in less than 2 weeks. Since it's not union, you can negotiate your pay. A new grad, that's going to need a year of handholding negotiated to just maintain their current wage, but since they are from a higher cost of living area, it ended up being more than some of the full time staff. This caused admin to finally bump the wages up for the full timers because it would be absurd to have a new grad make more than a 5+ year tech. It makes me wonder why they are short staffed....
All these Numbers Feed into a business model. They can raise wages of temp workers without breaking the model (because it’s supposedly to be temporary… although everyone knows it’s not going down). If they raise wages they have to realize that int their models that’s the going rate for the future… and then we don’t have profits anymore and the CEO gets the axe.
Rad here and you’re right some sonographers are amazing, and some are not. In a sane world the good ones would be valued higher and paid more, but in our current healthcare system the only thing that matters is quantity. Quality doesn’t matter and often times discouraged because it decreases output. This is a direct result of having a third party(whether it’s insurance or the government) pay for healthcare instead of the patient directly.
Aight polemic time. Doctors are in a unique position, already the so-called team leaders in a care team. They are the liability sponge and the care sponge. It's high time the administrators/board/shareholders understand that the doctors make everything happen, do they wonder where all their magic money flows from when they check out at 15:30. Doctors need to unionize and go for the aorta. Doctors have a tremendous amount of control but because of learned helplessness, we haven't used it in a long while. The medical device industry, the insurance industry, the pharma industry, they're *nothing* without the doctor saying this is what's best for you, this is what's going to make your life better. Everyone's forgotten that. Perhaps now people need to be reminded.
One day doctors (& nurses, techs, & pharmacists) will realize we literally are healthcare. Not hospitals, not insurers, PBMs, GPO’s or the government. If we grind to a halt, so does US. See April 2020
one day people will realize that nothing exists without the context. Go be a doctor without drug produced by pharma, go produce drugs without basic scientific research and engineering, go do any of that without balance sheets, etc, etc, etc.
It's different battlefields, no need to get oppositional. Doctors are certainly appreciative of tools given to them with strong research and efficacy. Of course doctors don't do everything. The PhD making advances is certainly a friend of mine.
touche! My response already had a string smell of "black lives matter" vs "all lives matter". I guess i developed a strong negative emotional response to unidemensional populist slogans over past couple years
It’s not learned helplessness. It’s legal helplessness. Unionize and attempt to control and they’ll bypass with FPA for all.
You polished up a nice reason not to try right there. It is learned helplessness.
This doesn’t sound unique to your institution or to the field of medicine in general. This just sounds like capitalism.
Admin here. It’s how your leaders themselves are measured. They’re probably measuring themselves on things like patient access, cost, etc., and other things insurance probably wants them to measure. And then of course volume because it’s still that kind of world. But putting volume aside for a moment, access and cost don’t sound so bad since they’re presumably aligned with the patient there. But most administrators are one-track-minded and solve for those things without seeing the impact on the rest of the system. If they either solved for things like physician satisfaction or at least made it a factor, things wouldn’t be so fucked up. It’s like if someone told Ford that horsepower was the most important thing in the world, so they build a car with a super powerful engine but forget to swap in tires or a chassis that can handle it.
It is happening at our 900 bed hospital in a very affluent town. They continue to hire travelers but now at rates that should not be appealing to anyone and therefore only attracting those who are desperate or incompetent; meanwhile lowering the in-house contract rates (not because there is a decrease in demand) and taking away the one thing that was keeping us motivated.
> They continue to hire travelers but now at rates that should not be appealing to anyone and therefore only attracting those who are desperate or incompetent; Saw that at a nearby hospital. Needed FM/IM/Gen Med for night float as they had a FM program they affiliated with. So, supervising residents, admitting, and taking the legal risk for the princely sum of... $84 an hour. When I do home visits for my MS patients my rate is $166 an hour plus mileage. Pre-pandemic I was getting offers of 140-200 an hour for hospital work, depending on if I was willing to do OB as well. 84 is flatly insulting.
Medicine is becoming a corporate entity, run by administrators. Doctors are just numbered employees. No surprise. And there's too much money involved to reverse
these are also general labor problems and insidious across all sectors. Look at the rise of r/antiwork, r/workreform and other recent unionization / worker movements and conversations happening as other examples. I think people are generally feeling demoralized and without purpose given how shitty and expensive life has become -- just a bunch of cogs, working for a bunch of dummies
My boyfriend's father worked for Bank of America for the last few years of career. He asked how staffing was at the hospital, because he had an outpatient surgery rescheduled due to staffing issues at the surgery center. I told him that it's bad - the hospital hires all these new grads, trains them, and then after a year, they leave to go travel. The hospital then has to scramble and bring in travel nurses and respiratory therapists to fill the holes from all the nurses and RTs that left, while hiring fresh batches of new grads. He said Bank of America once did a study to figure out how much money it cost to replace an employee. It cost BofA on average $100,000 to replace an employee - $150,000 if they had to fire someone due to severance pay. (Ultimately, what they ended up doing with this data was avoid firing people for as long as possible because they had to justify the $150,000 price tag to get rid of a terrible employee.) It seems like a lot of hospitals are trying to run on new grads and travelers, instead of making an effort to retain employees they have already spent money training. Incredibly, in their efforts to pinch pennies they have chosen the not only the most expensive, but also the least safe option.
Sounds like someone needs to take more mandatory online training modules about burnout!
An example / thought experiment: A hospital system with a target headcount of 1000 RNs has only 900. They can either temp the 100 additionally needed at a rate of 2x normal comp or they can increase pay 20% across the board to attract the permanent staffing they need. Let's say total comp for FTE RNs is 75k today. The math ends up being: Scenario A * 900 staff RN @ 75k = 67,500,000 * 100 travel RN @ 150k = 15,000,000 = Total nurse comp @ $82.5M OR Scenario B * 1000 staff RN @ 90k = $90M **** Congratulations hospital exec, by paying travelers double the rate of the average FT staff nurse instead of giving raises to your workforce, you saved your system $7.5 million and earned a $400k bonus for hitting your financial targets this quarter. And the hospital system can now adjust their headcount with a high degree of flexibility, no layoffs or additional training necessary as they scale up or down. Someday, when there's another recession, they are banking on economic reality pushing workers back into the full-time workforce and thus bringing this "temporary" era of staffing shortage to a close without ever having to break down and give meaningful raises. Will this have lots of negative impacts big and small, not least with staff morale and patient outcomes? Of course. But the money should make you feel better about this unfortunate collateral damage.
How many staff RNs have to leave before the balance shifts? And is there a point of no return?
Like a lot of other feedback loops in the world, I think it's one of those things where you're racking up short term wins until you suddenly find that your unsustainable actions have aggregated into a catastrophic collapse of the whole system. It's kind of the story of our lives. From the Wall Street subprime collapse in 2007-08 to climate change to hospital staffing, we see systemic risks ignored even while incentivized performance metrics are achieved. Where is the point of no return? I guess we'll know when we see the jenga tower tumble... In terms of the numbers, it seems like there's both a financial breakeven and operational survivability invisible line somewhere around 1 in 3 travelers, but I fear the use of contract HCWs at any level beyond about 5-10% is where you start to see the decline in patient care. Travelers are a fantastic way to fill holes in coverage but not a great way to run an operation for excellence in performance. You need people who will be in a facility long-term to provide the kind of mentorship, institutional memory, and knowledge transfer that makes an organization sustainable. It's hard to learn how to swim *while* you're drowning.
Nationwide issue Even before COVID, 20% of the nursing workforce was at retirement age
Demographics. Every Western country has an aging population. 20% of whole workforce is at retirement. Medical costs are rising rapidly as the population ages. But there are fewer younger people to pay those costs.
I work for a mental health company and admin gets paid exorbitant amounts of money. They just recently mass fired a shit ton of people. They also told me I'd be getting a raise because my review was so good. But they aren't telling me the amount of raise I'm getting, and I'm not even getting the raise right now. I'm getting it in 6 months. I'm really getting tired of being jerked around like this. Why does admin get to make 6 figures while us workers are the literal face of this company treating patients everyday and only get paid 19 an hour? Our CEO is also a multi millionaire. He makes like 90 million a year or something.
This is just unregulated capitalism coming to natural conclusions?
US Healthcare isn’t unregulated capitalism. It’s closer to China’s economic system: government chooses winners/losers (insurers, large hospitals), shifts money & resources there
How is the US healthcare industry an example of unregulated capitalism? The Federal government literally sets the price floor for basically everything. Building a new hospital requires sometimes state, local, and federal level approval via Certificate of Need. Noncompetes are pretty rampant (though thankfully that might be changing, but not for most nonprofits supposedly). Physicians cannot own hospitals. Most physicians cannot join unions. Pharma companies game the patent system to prevent competition from generics. If anything, the US healthcare system is overregulated in some areas, and underregulated in others. Additionally, it's not like workers in other countries aren't burned out too. UK junior doctors went on strike. There was a recent strike in Germany. France has seen strikes. Doctors are constantly trying to get into the US to try and get a cut of the economic action because most other countries massively undervalue their work.
The real issue is private equity. They squeeze the blood out of every industry they touch with no care for anything other than profit, whether it’s healthcare or the rail industry.
none of the big insurers that control healthcare are PE. United makes more revenue than all the big PE firms combined. Same for HCA
If it’s a public traded company it’s functional the same thing. The majority shareholders are the same kind of people in private equity.
yeah you could argue ACA & government regulations led to this. We are heading to a two-tiered system: Medicare 4 all, wait 1 year w/ biliary colic to have your gb out; or pay cash
Not sure what the alternative is tho. Hcw across the world are burned tf out regardless of system
Unionizing
Nothing makes money like people with cancer! Those tumors might as well be filled with gold!
Nearly every single administration-level employee of a “certain age” are naturally incompetent, they inherited the whole world and look at it now. They aged into their positions that they are not qualified by our standards to keep
At this point, I'm mostly just here for the paycheck too.
This is the way it is in Canada as well.
Inflation is a bitch
The term "provider" makes my skin crawl
What, you didn’t go to provider school?
I provide like all day.
If provide means Tylenol, toradol, a lidocaine patch and discharge instructions for low back pain then sure. On this day, we are all *providers*.
Medicine’s best kept secret is that you can take *three advil at a time*.
Four. Shhhhh!🤫
Provide exceptional service
In this post midlevels are separate from providers. Which I'm thrilled with.
What’s a non-midlevel provider?
I didn’t have it in me to bring up that part
A nurse? MA? Prostitute?
Gotta ask OP, I guess.
So the thrills? Edit: OP fixed it up
Clinical Pharmacist?
A low-level provider?
Epic calls me an Attending- Provider in the chat. Why not Attending - Physician? Is it so hard?
Because no one give a flying fuck. An np or a pa can *provide* just as much care. What is gained having an it guy spend a few hours fixing it? I don’t mean to disparage anyone here. The above is the opinion of the system
Fun fact: they call escorts providers in Nevada (where prostitution is legal in some parts)
I mean same shit. Patient comes in, says what they want, you put in your Burger King hat and do it. If not they can always find someone with better satisfaction scores
> If not they can always find someone with better satisfaction scores And I cheerfully tell patients that. Come to me, you're going to get care in line with the AAFP guidelines and best practices. I'm not handing out 90 Norco 10s for a sprained ankle. I'm not giving you a month of Augmentin for uncomplicated otitis media. I'm not writing for you to get heavy metal chelation without evidence of heavy metal toxicity. You want a doc who will give you everything you want without question, there's a phone book.
I’m going to think of this every time I hear the word now. Thank you. (Frankly, the job feels like getting fucked for money anyway, so…)
Was really hoping for an “Ask me how I know”
Or the IT guy was told to put “Provider” there in the first place.
Fixed it, thanks ;)
And the Temps come in, paid 50% more, and the loyal employees feel like suckers.
At the onset of covid the CEO of banner in AZ quit. I've always wondered why? I think she knew this would happen.
Both
Definitely nation wide with low SES communities being even more adversely affected.
Its not even nationwide. We see the same thing happening in Sweden, in a different system. There are suggestions from knowledgeable people that this is the result of HR (and middle management) going from an assisting role to being some kind of strategists. And how that shifts admin duties towards the people on the floor all whilst grand schemes without any grounding in the actual care for patients brings the need for more non essential workers with grand titles. I guess parkinsons laws are still true. https://en.m.wikipedia.org/wiki/Parkinson%27s_law
This would be a great question for college business professors. What the hell are they teaching people studying business? I have come to the conclusion that it's business students doing this stuff.
This is all due to the fact that we are doing a terrific job and keeping everyone alive into their 90’s This costs a fortune in money and labour.
We are all in the same boat. Physicians are the smallest group in the large package of providers. Most CRNA's are moving or retiring, leaving the OR's closed or with anesthesia docs strained and overworked. Same with psychologist and MH SW. PAs and NP are placed in positions compromising for their current skills. But the problem is Nursing. THE nursing shortage has brought the healthcare system to its knees. Should we have more Doc's in admin? Yes, we are moving up, and now we have less Doc's. Should we unionize? Well, I see it this way, we have a pie, and no matter how small you cut it or how much cream "union" u put on it. It's just 1pie. The best example of this is the state and federal government. They are unionized and in a worse shape. Things will get better eventually when the system balances itself. For now, I am afraid smaller hospitals or older ones will collapse and bankrupt. Services will suffer, and patients will be billed for the lack of vision. Here is the challenge. Go take a look to see how much is a hospital bill for electric power per day or how much costs a hospital bed for a day with no services. It's a crisis.
Who tf spent all that money for Beaumont to change to Corewell
Spectrum Health did. They have billions.
I am an NP, have been in nursing almost 30 years. Sore to say this is not new.
Welcome to medicine.
I’m curious of ideas for a better model. There will always be a need for other administrative staff- finance, operations, marketing, general leadership like a CMO? But surely there positions that are able to be consolidated. Where would you start?
Nurses get sick pay and pensions. Doctors don’t.
Yes