Helsinki hospitals severely overcrowded, emergency rooms full to capacity | Hacker News Reader

Helsinki hospitals severely overcrowded, emergency rooms full to capacity

yle.fi

46 pointsweberer84 comments

“Shortage of nurses”

There is no such thing as a shortage of labor. There are only shortages of wages. They should have paid more.

Not if you have licensing and immigration rules that make it impossible for new people to enter the field in response to a demand surge

So what your saying is that instead of paying more we should import cheap labor at the expense of anyone who might be a nurse locally? Therefore depressing all wages across the board?..

Parent didn't say anything about cheap labor? What if there are just too few nurses locally?

I think the idea is that if you pay more, people will switch careers and become nurses. This isn't a great argument when it takes years to make a nurse, but you could at least get some people out of retirement or to afford childcare and come back to work.

That is not how I read it. I understood if you only have X people licensed as nurses you cannot hire X+Y people to be nurses where Y is greater than zero, even if you increase wages for all nurses.

You seem to think there's a solution that doesn't get implemented at someone's expense.

You may import cheap labor at the expense of local nurses. Or you may import expensive labor at the expense of the foreign patients and local taxpayers. Or you may do nothing at the expense of local patients.

The harsh reality is that there's not enough people being allowed to fill the jobs, and you can't create them without changing something - your policies or your standards.

Don't forget that every healthcare practitioner the West imports - I'm sorry "encourages to immigrate" - they remove a healthcare practitioner from a country that educated them, trained them, invested in their residence/practicum/rotations, and almost certainly needs them more than the West.

After all, why grow your own capacity to train and retain health care practitioners, when you can just take the non-Western world's instead?

> every healthcare practitioner

Just say every productive young person. West has decided to not have babies of its own and instead just import them from poorer parts of the world. As an immigrant myself, I'd say it is a good deal for the West and those immigrants, but will need homogeneous cultures to be open to cultural changes.

This also includes people that went through schools in Finland and would be paid the same money as a native.

There just a massive issue with our immigration service running out of capacity to handle applications in a timely manner and some stupid laws that need changing/updates.

Basically applications for a work permit can take somewhere between 3 to 9 months currently. A lot of people can't live that long in the country without a job so they will just go to some other EU/EEA country. Norway is a very popular option for example and will give you a yes or no decision in a week or two instead of half a year.

Would you rather have enough health care capacity, or be called a racist by the corporate media?

Tough choice if you're an oligarch.

If, as you say, this is a demand surge, classical economics would suggest that the price of the demanded good/service should go up.

The article, however, is very clear that this is a supply issue, and not a "demand surge."

In either case, it seems that equilibrium would set wages higher.

Why would you assume a free market system in healthcare?

Is that a free market system? It seems to me the parent is talking about the concept of price equilibrium, nothing else.

Price equilibrium is a foundational free market concept. It technically can't exist in a non-free market.

Why are you assuming that the labor market = the healthcare market?

I completely agree that "healthcare" is not a very free market. But we are not talking about buying medicine or medical procedures, are we?

There could be, at least in Italy demographic crisis is already here.

If they paid a billion $ a week to be a nurse there would not be a shortage of nurses.

If you have to go through training and licensing, there would be, until such time as enough people have completed it.

Artificial barriers… real training barriers have some lag but can be overcome pretty quickly in a pinch.

Artificial or not (I argue not), my statement is still correct. I am not sure what you are defending here.

There would still be if it took years to get a nursing certification and essentially everyone with one was already employed. I can't just decide that I'm a nurse tomorrow and start on Monday, no matter what they pay.

Lots of people have left nursing in the past few years. If it paid a decent wage many would come back.

If you never fixed the criterial pipeline sure you would have a temporary shortage because that was your bottleneck. But there are plenty of people with equivalent skills, past or military experience that could do the job or be trained quickly to do it. It’s just a lack of desire to actually deal with the problem

You don't need to pay millions. But when you pay the minimum wage and exploit those people to the maximum, you get what you sowed. When they find a minimum wage job with better working conditions, they flee.

Hence why many fled for huge pay raises as travel nurses

In Italy IT salaries are going up, well above nurses ones, still there's not enough IT people. There simply isn't the people. Almost no one really grasp how bad is italian demography.

Not really. If its appropriately staffed for most of the year, then there is a crunch period its realistically better to suffer the crunch than have excess staff for most of the year.

I'm sorry but this is a really poorly informed opinion. You actually can have a shortage of labor - see e.g. countries like Japan and Russia, where the demographics are very skewed towards the geriatric, and you literally have more jobs than people to do them. Birth rates in these countries have been too low to keep populations stable, and as people retire you wind up with a labor shortage.

This is starting to happen all over the world as the global baby boomer generation is aging into retirement. It's started to happen in most of western Europe, China, Japan, Russia, even the US. It's absolutely not a wage issue, it's a demographic issue.

They are correct. If the pay would be better more people would learn to do it.

Sure, but what's the lag time on that? Four years? Ten?

It's possible to claim they should have paid more in the past, and that's part of the problem, but unless you're going to help immigrate already-qualified nurses from another country you can't simply increase wages and solve the problem you're having today.

You can kind of. You can raise the pay for nursing assistants and lower the credential bar for actual nursing, and raise pay to entice those that quit to come back. There are probably enough skilled folks out there to make that happen

Depending on the labor market in question, there could still be a labor shortage though. Those new nurses aren't just appearing from the aether. In places with very low unemployment they'd likely be leaving other jobs. You're then only moving the labor shortage to some other area of the economy.

Sure, now you might have enough ER nurses, but maybe now you've got a lack of primary care nurses. Or nurses at nursing facilities. Or maybe instead of just drawing from the pool of nurses you've now got fewer doctors or PA's, since you've now incentivized nursing over being an MD.

So more people learn that trade and another one loses its staff.

Labor shortages aren’t just money. Nauru has tech labor shortages. Singapore has notable farmer shortages. There are teacher shortages in the US even where wages pay well because teachers are sick of regulations or students. Korea has such an inverted population pyramid that its only possible future is half the country devoting their lives to caring for old people at the expense of either industries having no workers, and immigration isn’t a solution because other countries will be hitting similar problems at the same time.

This. It's the same in a country where I live in which has a sociliazed health care.

Nurses and young doctors are paid like shit so they're obviously all quitting and those that remain get so much more workload they they eventually also quit.

And then the ministers/politicians complain that "the doctors and nurses have no right to protest again" lol.

You can either have well paid healthcare personal or socialized health care you can't have both, specially when population is shrinking which is why healthcare across Europe (and Canada) are having the same issues.

Why?

Governments don't have unlimited money and hospitals aren't run to make profit which could translate into wage rising (or not). There is a reason people who want to make bank are in the private sector (In my country doctors can work both, so they make bank in the private side)

For governments ro invest more in nurse/doctor wage with a decreasing population they would need to collect more taxis (or implement copay), none are popular among the voting people.

Another reasons is that healthcare is run by policians and mostly don't know how to run things without it being at a loss.

All of your assumptions are untrue.

(1) Governments don't need unlimited money, just to allocate what they have better

(2) For-profit hospitals don't pay better wages because they are for-profit. They exist for the owners/stock-holders, not the employees, who are viewed as 'human capital', not partners. There is no reason a for-profit hospital would pay its workers any more than any other, and many reasons why it would pay less

(3) People who want to 'make bank' are not nurses -- they just want to be paid fairly for the work they do, and to be able to have decent work conditions. The ones who are in it for the money are not going to be in the intake at the emergency department no matter what country or profit/social system is in effect

(4) Why would they need more taxes to pay more wages? They could take taxes they already spend on something and move it to wages, or they could borrow money, or remove inefficiencies, or print more money, or invest in the economy which will bring in more taxes -- it is not a binary decision

(5) And you think that running healthcare with CEOs and stockholders in charge who require profit growth every quarter and are used to working their staff to the point where it is just barely enough to not have everything break because that is the most profitable way to run a business -- is better?

Of course, even in the US where we pay twice as much for healthcare for the same outcome compared to CA and EU, doctors and nurses are in short supply. Seems like something else may be going on.

Just because healthcare is expensive in the US it doesn't mean nurses get well paid.

No, but while offering more pay might bring back nurses who have left for other careers, it will not bring new nurses on quickly as training takes a lot of time.

"Shortage of homes"

There's no such thing as a housing shortage. There are only shortages of money. You should have paid more for homes.

Well yeah, that's exactly the case. There might be a shortage of affordable homes in big metropolitan cities, but there's certainly no shortage of houses in general.

Housing isn’t a free market, the supply is artificially constrained.

The supply of nurses can grow and shrink arbitrarily in response to demand.

We have a shortage of affordable houses and nurses. Unlucky I guess.

Not quite.

Free markets don’t instantly respond to changes in demand, but they do respond to price signaling. The fact that the number of nurses isn’t increasing dramatically suggests the market is reasonably happy with their numbers.

I'm not quite sure what you are trying to say. Wouldn't whatever you are talking about also apply the the number of homes?

NYC’s housing issues can’t get solved by people trying to toss money and manpower at the problem if the city doesn’t let them. Regulate away the free market and you don’t get to blame the free market for the resulting failures.

So is nursing. It takes years to train, requires approved qualifications etc.

No market can respond instantly to changes in demand. Nursing’s lead time is less than many other goods, just look at how long it took Tesla to ramp up production.

What’s illustrate is the supply of new nurses isn’t dramatically increasing suggesting the market is roughly happy with their current numbers.

Two things can be true:

-> Nurses don't get paid enough, and should be paid like tech workers for the work they do

-> Demographics changes means there simply aren't enough bodies to become nurses. This is especially true in the west now. Ontario in Canada is facing the same problem[1].

[1] https://www.ona.org/news-posts/20221117-nurse-staffing-repor...

> Demographics changes means there simply aren't enough bodies to become nurses.

True. This is a direct consequence of people refusing to have kids. What may be a sensible decision at an individual level is going to have disastrous consequences for societies; particularly the advanced homogeneous ones who have the unique combination of falling birthrates, generous welfare programs which need taxpayers and who are averse to immigrants from a very different culture.

Countries like USA should fare relatively better since it is easy to assimilate young people from any other country. My prediction is that small nation states in Western/Northern Europe will be the first ones to break.

Society should pay more to have kids then.

Scandinavia has some of the most generous benefits to have kids. And yet...

Canada is a terrible example. Like 90% of applicants who try to get into nursing school are rejected... Plus wages should be higher. Plus the work kind of sucks. It's a crisis that's *entirely* our governments' doing.

Indeed. This problem was foreseen years ago, and the fix is easy. Increase seats in schools, pay more, provide better hours. It's not rocket science. The resistance comes from just not wanting to do any of things because its expensive.

Demographics can cause aggregate worker shortage, but not enough that industrial poilcy can't fully staffing specific sectors.

This is usually the correct take. Labor shortages are typically propaganda for below-market wages. This should be your default assumption whenever you hear about any labor shortage until there's evidene otherwise.

Here I think it's a little different. First, you can't just mint new nurses. That takes time. Second, a lot of nurses have left the profession (or at least specialties like ER and ICU) because of years of stress dealing with the fallout of the pandemic.

Nurses were at one point and in some locations quite literally choosing who gets to live and die. If you don't think that puts stress on someone, combined with being overworked, I'm not sure what to tell you. So it's not just an issue of money to lure them back, particularly when (later on) so much of this death was entirely self-inflicted (ie people choosing not to be unvaccinated).

You shouldn’t put so much blame on individuals. The excess death are mostly a result of really poorly executed public health policies and messaging. Government officials, lied to everyone and sowed a lot disinformation and that caused mistrust and poor infection control. The resulting public health chaos resulted excess death, and people believing all sorts of wacky stuff.

In the long-run, but this also works both ways. On one hand the recent years have resulted in hospitals rapidly going over capacity, and nurses quitting from overwork. But nurses have negotiated higher pay in general, on top of things like hazard pay. That can lead to shortages if hospitals can't/won't afford to pay for sufficient staff. Moreover, hospitals (particularly places like US) seem to have an economic incentive to keep staff low during tighter periods because good nursing staff does not reflect billable service.

In Finland, they'll expect an average of 13% raise in wages from 2022-2025 - https://www.helsinkitimes.fi/finland/finland-news/domestic/2... . There's no reason to believe that shortages are solely owing to insufficient pay.

False.

With population decline and a shrinking workforce, the labor market takes time to readjust to the new norm of lower wealth (because lack of labor in one area means less output of services/goods).

For wages to increase taxes have to increase which also reduces viability of certain low margin businesses and further decreases societal wealth in that area of the economy. It’s all a trade off under the new reality.

The nonsense words that people have to invent to explain socialism are extraordinary.

False.

You don't need to increase taxes to increase wages - you could actually collect the taxes that are due but being funnelled off into offshore accounts, you could limit the bonuses being paid to CEOs while workers struggle to heat their homes, you could cut military spending, you could not give £35B of public money to a few mates in exchange for them pretending to supply PPE. The list goes on.

You do for public workers assuming all else equal; if you fix the corruption you point out, that will always help regardless of the situation present and it would constitute a new baseline from which taxes would have to be risen.

I agree completely. Also, it would also help if we didn't treat nurses like garbage. If we offered stuff like paid time off, sick leave, and appropriate levels of staffing. If we didn't lay off half of them and expected the other half to do twice the work.

If you paid more, you still need to wait for new nursing candidates to be trained. They don’t just walk in off the street.

That doesn't really apply when your labor pool requires years of training for a job. In such case you very much can have labor shortages disconnected from wage.

That's pretty much exactly what happened. Nurses demanded higher pay. Government said no. Nurses threatened to strike. Government said they can't do that. Nurses threatened to resign in mass. Government passed a new law forbidding that. Now the government is trying to replace them with 20,000 nurses from third-world countries. And do note that this is all under the left-wing coalition currently in power.

https://yle.fi/a/3-12630457

https://yle.fi/a/3-12681978

This is a long time systemic issue that has been like watching a trainwreck in slowmotion. We're reaping what we've consicously sown over the years. Severe underallocation of resources has lead to very low salaries and heavy overworking conditions as more and more people leave the industry.

The title is partly wrong (badly translated).

Actual emergency services still function and have capacity. What is full/out of capacity is walking into the clinic with smaller issues. Basically if you don't have some immediately life threatening condition it is very likely that you will be sent to another hospital (or told to come back later). Obviously doing this can also have some very bad patient outcomes.

This is partly also due to the fact that the emergency services know what hospital has space and route the ambulance to one that has space. A normal person walking in does not know that.

Here is roughly the same article in Finnish https://yle.fi/a/74-20008425

Not sure if I got the same interpretation (both languages on YLE and HS one seem quite ambiguous).

My interpretation I got is Jorvi cannot even admit in patients from ambulances for urgent care, wheras Töölö, Peijas and Hyvinkää have all beds full.

Some emergency rooms are full because there is no place to send patients for further care. The emergency room is not supposed to be a place to spend a lot of time, they just treat your immediate life-threatening problem and then send you either home or to a hospital bed. But when hospital beds and elderly care units are full, the patients stay in the emergency rooms.

I suspect (but do not know for certain) that part of the reason is the big social and healthcare reform that is to take place in 2023. The responsibility for arranging healthcare lies on municipalities and is going to be transferred to new, euphemistically named "wellbeing services counties". This means that each municipality loses some funds from their budget, and the amount depends on their social-services and healthcare budgets for 2022. This means that keeping the budget artificially low this year means they have more money available for other purposes next year (schools, roads, libraries, what have you).

Here's an article (in Finnish) from 2021 discussing this risk: https://www.iltalehti.fi/politiikka/a/21899c53-d959-4383-a75...

Here is another ongoing discussion about healthcare in US vs Canada and Europe. Overall, I think the situation will get worse with demographic changes (more retired people that need more access to doctors and less medical staff) and higher taxes (pre-existing national debt, less workers than retired people collecting benefits).

https://news.ycombinator.com/item?id=33977716

And the usual closed borders that prevent people that could eventually refill those positions.

The border is just the first step. Afterwards you have to get medical licenses certified which can take years and may require extra coursework.

For example, Spain makes it easier for citizens of ex-Spanish colonies to access citizenship. If they have medical degrees from their home countries, the process to certify them may take years. Afterwards, the public system likely doesn't have a budget to hire them and they end up working for the private system.

Actually it is a bit more preverse than that, they don't have the budget to hire them as employees, but they have the budget for having them as contractors, with much higher rates per hour.

I suppose the same problem as in Canada: population is growing (being that due to immigration/refuges/natural births) while number of seats in medical universities doesn't grow with the rate of population.

I see anecdotally on Twitter and a lot of countries subreddits that there is a huge surge of illness right now. Pretty much everyone I know also has some cough/cold/flu thing going on too.

This all feels more acute than Covid ever did but isn’t getting any airtime.

I think you may not be paying attention to the news - at least here in Canada there has been a discussion since the fall started and the rate of illness skyrocketed.

It’s interesting because people predicting that the rate of increase of common illnesses would skyrocket due to lockdowns were labeled fake news two years ago.

Nobody knows the mechanism. Is it “immune debt” or is it secondary immune weakness due to covid? Or just bad luck? Lots theories little evidence

It's getting airtime here, but there's a lot of tiptoeing around the topic of the last three years of radical interventionism.

I've seen a lot of airtime. Google tripledemic. NYC recommends wearing masks again.

Reply on news.ycombinator.com