Comment by BiteCode_dev | Hacker News Reader

Comment by BiteCode_dev | Hacker News Reader

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Indeed, and the surprise is that... it's a surprise to many.

I think inertia allowed things to go sideways for a long time in a lot of professions, without paying the price for it soon enough. It stayed unseen for long because those jobs are often not affecting directly the structure main goals, like sales, manufacturing or field agents. They are support jobs, and help the structure maintain its integrity on the long run.

So it takes time for the problem to be detected, and for the top to even become motivated to fix it. It's quite possible they didn't even know it was a problem, or didn't think it was important. Hell, the person currently in charge have likely arrive at the post way after the decisions to destroy those jobs has been taken, years after years. Each year, one small increment at a time.

We are seeing an extreme version phenomenon in the health system in France. Extreme because it touches more than support jobs. Hospitals are full of exhausted staff that are asked to make yet another effort, "just this once". Getting appointments for specialists now take months, even for repeated sessions. Doctors are making much less money than I do in IT, for much more work, responsibility and administrative pressure. This frog has been boiling for quite some time.

It was an easy to predict consequences of the shift of paradigm in the last thirty to forty years.

With the removal of companies middle layers, paths from operational positions to top management have basically disappeared. That means that at most companies, top managers have made their whole career there often starting in corporate finance jobs or at management consulting firms and have no experience whatsoever of what working for them as an employee is like.

Usually the army fares better here because it still promote from inside its own ranks but apparently it was not enough to avoid this.

Indeed, for the hospital it's probably part of the story: directors are now not required to have been doctors before.

Maybe having pairs (one doctor, one non doctor) for those jobs would be a solution.

But it's probably not the only problem.

France has a budget problem, it's been borrowing more and more, and producing less and less. We can't maintain our way of life without cutting some spending, and you do it where people complain less, or where consequences will be seen way down the road.

Sorry my answer was strictly about the issue with labour in the USA.

The French hospital issues are entirely different. I could a write an entire essay about it - I’m French myself. Most of it is due to brain dead management by the Health Ministry in the 90s. It was thought that by training less doctors, there would be less acts done and it would cost less to the sécurité sociale. The order agreed because it protected their revenue. Add to that that far too many acts which could be done by support staff have to be done by a doctor to be reimbursed and widely underpaid nurses and you get the current shit show.

The US has done much the same thing. Almost all graduate medical education (residencies) is funded by the federal government through the Medicare program. But despite increasing demand, Congress has held that funding roughly flat in order to keep Medicare costs under control. So we have a ridiculous situation where students are graduating from medical school but can't actually practice because they can't get matched to a residency slot. This is leading to delays in care and overwork for existing physicians.

Someone has given you a bill of goods. Any US MD/DO graduate will get a residency position, but there are a few every year that only apply for Orthopedics or Ophthalmology and don't select a backup IM/FM program and thus wind up unmatched. There are IM/FM/PEDS/Internship positions open, but they choose to pass and reapply next year. The only reason they couldn't get any residency is bad advising or an issue which is expected to prevent them from getting a medical license.

The medical schools carefully coordinate admissions with residency counts so that everyone is guaranteed a spot.

The Boomers climbed the ladder then cut all the opportunities out from below them and pocketed and spent the money and didn’t save for retirement.

As a whole, they are clearly going senile and mentally declining a lot faster than their parents. Also they’re selfish whiners. Most of em deserve cattle call retirement line up take your meds in run down projects they never bothered to upgrade.

Prison not pensions for a bunch of them.

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