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Comment by bkjelden | Hacker News Reader

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.

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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?

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.

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.

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.

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.

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.

Do nurses have work unions? Would that solve the issue?

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.

Yes, they have massive unions but that doesn't seem to be helping.

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

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