Doctors Are Disappearing from Emergency Rooms as Hospitals Look to Cut Costs | Hacker News Reader

Doctors Are Disappearing from Emergency Rooms as Hospitals Look to Cut Costs

khn.org

31 pointselectic9 comments

We are watching the collapse of our medical systems in slow motion. Doctors, nurses, and others are not being produced at rates necessary for replacement of retirees, much less to track growth of our population. Another pandemic could well be the last straw, so better hope that the current wave of bird flu does not make the jump to a human population.

Personally, I expect to die of something trivial that could have been diagnosed and treated, but I will not be able to access the necessary expertise and medicine. After repeated experiences been seen by grossly unqualified staff, I no longer trust the system to function, and I have given up with any kind of preventative checkups or exams. I am also likely to refuse emergency care, because I would rather die than bankrupt my family.

> Doctors, nurses, and others are not being produced at rates necessary for replacement of retirees,

But the reason for that is not that no-one wants to practice these occupations though; it’s all solvable by ‘just’ money of which there is plenty in the US. If it pays enough, people will do it.

I want to offer my perspective, as a former physician-in-training. I left US medical school immediately after my Emergency Medicine Clinicals... well over a decade ago (pre-Obamacare):

You simply cannot pay a US-trained physician enough money for the extensive sacrifices required just to prescribe you Scheduled drugs...

If you want to make money &/or "help people" &/or be respected: there are millions of alternative careerpaths with much simpler accreditation.

My wife wanted to become a nurse, but she could not get into any of the programs in the area. Admittance is based on a point system, effectively requiring students to repeat classes until they get straight A’s. There are more students that want to become nurses than opportunities for them, so this is a matter of intentionally restricted supply.

Cheating was rampant in her classes, and at least one of those cheating students got a slot over my wife. That person paid others to take her tests. The schools don’t care.

It is a true race to the bottom here, and it’s going to end very badly for everyone.

But what is the cause? To me it still sounds like money?

Supply is artificially constrained through, primarily, residence programs.

If it pays enough, demand will be induced by people wanting to be paid that much. Supply significantly lags demand for a combination of factors, among them the limited supply of residencies and time needed for a newer school to achieve some beand recognition. In the meantime, med schools can and do raise prices to re-equilibrate the desirability of med school.

PA schools have proliferated to an incredible degree in the last 10 years, because they do 90% of what doctors do for half or less of the cost. Unfortunately, that last 10% can really matter. Also unfortunate, PA isn't prestigious enough to buck its healthcare work tendency to be overwhelmingly female, meaning you get less bang for the education buck by lower workforce participation. Those smart women, to the extent that they're marrying, are wanting to work just a couple days a week (student loans permitting) so they can spend time with their kids.

Things to look forward to, suggested by the forward-looking single payer military system: in the future, you'll schedule your annual 'physical' phone call 2 months in advance, after filling out a 10 page questionnaire. When your 'physical' comes along, a nurse will call, ask if you're going to kill yourself, then sign you off once you finish realizing that her phone tree of, 'Is there anything else I can help you with?' is all dead ends.

When healthcare is 20% of GDP and we still don't have access to doctors.

You think that 20% of GNP is for you and that other guy over there ? Dream on.

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