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Comment by orzig | Hacker News Reader

I know much more about healthcare than the Navy, but it’s notable that they both have rigid stratification between roles. I could imagine that hampering operational feedback loops in normal times, and strategic feedback loops given the labor supply/demand situation in these extraordinary times.

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At least in healthcare, I doubt this is a major causative factor (presuming when you say roles you mean physicians and nurses) -- the physicians are extremely supportive of the nurses, and their demands for more pay and better conditions in all the healthcare settings I've worked.

The real problem is the unaccountable bureaucratic management, which are neither physicians nor nurses, and the numbers of which continue to expand (sucking up financial resources) while physicians and nurses workload increases and pay continues to decrease in real terms.

I tend to agree with the parent post about the extreme rigidness though causing issues. My wife is an Occupational Therapist and in some states she can supervise showering and some states only nurses can. Some states she can initiate cases and some states she can't.

There are too many micro-specialties and not enough crossover. Imagine if once you were a frontend dev you would have to go back to school for 2 years full time to be legally allowed to do ui design of a button even though there is a lot of crossover and knowledge sharing between roles.

This definitely causes shortages and issues when the demand naturally rises and falls for various Healthcare disciplines.

I'm not saying formal education isn't important but there could be a much more fluid crossover between various allied health disciplines than their is currently.

Maybe more transition programs or seeing individual billing codes for Medicare attached to education modules

It's driven (or at least exacerbated) by the physician shortage.

If it weren't profitable to have large numbers of staff per doctor, there wouldn't be large numbers of staff per doctor.

Even if we had more licensed physicians we would still have a large number of staff per doctor. A radiologist might be able to administer contrast to a patient, check their vital signs, transport them to the MRI machine, and run the scan but that's not a good use of a radiologist's time. Better to have nurses, orderlies, and technicians do all that so the radiologist can focus on reading the images.

Yes, it's obvious that some level of support staff are a good idea.

Now make an argument that the current arrangement is more optimal than the one we might end up with if there were more doctors.

That part is obvious. Regardless of the number of physicians, they will always be the most expensive resources. Thus any procedure which can safely and legally be performed by less expensive resources, should be.

That is scarcity thinking.

Yes resources will always be scarce and we need to manage accordingly. That is reality.

In the UK at least, there's much less stratification than there once was I think.

For example Advanced Nurse Practitioner status grants nurses almost all prescribing rights you'd get as a doctor. They're allowed scheduled drugs (ie stuff that's commonly abused) because a bunch of those are effective painkillers and a key reason to have Advanced Practitioner is that "This patient is in agony, and I know the only thing a doctor would do is give them these stronger drugs, but I'm not allowed to do that on my own" is a stupid situation to put an experienced nurse in, so let's just authorise them to do it.

I believe there are Advanced Practitioner variants for several other healthcare roles including midwife and pharmacist; in some cases you just get limited prescription rights (so you can only give people some specific prescription drugs from a list) but in other cases like Advanced Nurse Practitioner it's the whole thing, if your knowledge and experience tells you that off-label use of a heart medicine is the right way to solve your patient's acute hiccups you can do that just like a doctor could.

To qualify for advanced practice these professionals are doing much of the same work student Doctors do - but just focused to their specific discipline. Lots of Chemistry, learning how to read research literature, and so on. They get a post-graduate degree of some sort, I don't remember the exact title.

> in these extraordinary times.

What in the world is that supposed to mean? I've been hearing that for years now, and I have not the foggiest idea of what we're even talking about.

Nothing is different. What is extraordinary?

Edit to add: If these times are extraordinary, then that is a valid excuse for rust and a lot of other problems.

That's been used to refer to the changes caused by Covid over the last couple years. It's added mostly up to mild inconvenience for me, but it definitely has had serious impact on the Healthcare sector and is being blamed for the undermanned crews in the Navy.

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