That makes no sense, if the capital is expensive then you should hire more labor.
It is also hard to get patients to agree to having tests done at 5am or 9pm, so it's a case of diminishing returns. The staff penal rates go up too, so the squeeze comes from all sorts of directions.
In the US? With health care prices as they are? There are people that travel to entirely other countries for access to health. I'm plenty sure lots wouldn't mind at all to have an exam at 9pm if it meant it was way cheaper.
Reading what an MRI costs in the US, I do wonder if a trip to NZ for the scan would actually be cheaper.
Medicare/insurance reimbursement rates for MRI (the professional fee component) are less than Canada (a system I know).
We scan outpatients near 24/7 on some of our magnets in Canada, the ones we don’t are because we don’t have MRI technologists to staff the shifts (the more expensive part as they have unions with labour laws, radiologists can be worked like dogs with no benefits/protections as contractors).
I’m surely misunderstanding you - you aren’t saying techs cost more than radiologists in Canada are you?
Doing those hours with outpatients is very impressive, though I hope to never be involved in such things. Weekends are bad enough!
> I’m surely misunderstanding you - you aren’t saying techs cost more than radiologists in Canada are you?
Individually not at all but in aggregate yes. Disbursements to nursing/techs/allied health (who are also the majority of employees to be fair) are somewhere around 60% of hospital expenditures in Ontario (noting physicians are not included in this budget).
It will vary from institution to institution (and union) but probably similar in most places, for MRI my last institution required 3 technologists per magnet (or 5 for 2 magnets) considering break rules, techs also got an after-hours premium so it worked out to something like $90/tech/hour. You'd also have to hire more as techs are employees so they get work-hour limits and time-off requirements (i.e. can't just offer "extra evening shifts" for those who want it, have to grow the pool) so add whatever employee overhead is (30%?).
The radiologist fee depends on the study type and duration but to keep it simple I'd expect to bill $150-300 for an hour worth of MRI scans on average. These get reported the next business day so there's no extra cost from the radiologist perspective and we can tolerate the added volumes so no need to hire (an average radiologist working hard can cover 2-3 magnets worth of cases in realtime).
For other modalities like ultrasound it's an even bigger gap, I'd expect to bill $30-60/technologist-hour worth of work.
My day job is staffing magnets, and the staffing levels you mention exactly match what I do.
The radiologists struggle to keep up with our output when we do MSK work or horrendous post treatment livers - I think we need you over here.
MSK joint studies are definitely higher throughput but those are fun too. We would try and schedule "overnight MSK blitzes" q10min to minimize contrast reaction disruptions for the residents on call which would substantially change the financials I quoted. Ontario still has an add-on code for "3D sequence" if you can believe that so knees/shoulders pay a lot for how little effort they take to read.
> The radiologists struggle to keep up with our output
I noticed during fellowship that US radiologists seem to have lower volumes on average. Canadian radiologists are very overworked in my opinion (90+ CTs in an 8 hour shift, daytime MR seat of 40-50 cases is pretty common) which is largely why I left (also weather).
> I think we need you over here.
If you're in a metro with > 1 million people that's above freezing temperature > 6 months of the year and hiring I'm currently in the job market!
Housing is way overpriced and the cost of living is high, but with the negatives out the way, the rest is pretty good.
All equipment is brand new, mostly Siemens.
If you are interested, we are hiring and my contact details are in my profile.
I work as a nurse on nights and everything said above has been quite accurate. A textbook understanding of... well anything really, does not serve someone well now.
EDIT: Also these companies now often run pharmacies, investment systems, healthcare programs... patient care is by no means the biggest earner.
Are you referring to companies like Optum in the US?
They own entire medical systems(Everett Clinic in Washington), an insurance company(United Healthcare), and a pharmacy(Optum Rx) as subsidiaries so if there’s a problem everyone can point fingers and nothing gets done. This seems to be the new model for healthcare in the US.
We used to have bursaries to cover the cost of training for nurses, but, austerity and all.
Of course you now need to pay people more to be working in the weekends, but that’s a different question.
Perhaps this is a problem with the UK system.
It’s a problem everywhere isn’t it? There aren’t enough surgeons and the price is too high.
It’s nursing costs and bed counts.
Look at Canada for an example, we have unemployed surgeons and interventional radiologists/cardiologists with surgical backlogs > 1 year.
We have the rooms, the hospital I trained at had 90 operating rooms but only 4 are funded for after-hours and on weekends, the rest run 8am-4am but no nursing money for the OR, recovery room, or patient wards.
[0]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5866140/ [1]: https://www.cbc.ca/news/politics/canada-turning-away-home-gr...
That you are not running these rooms as much as possible indicates some failure in pricing/profit seeking, but I have no idea how the Canadian medical system works.
> 11-18% of newly certified specialists cannot find work at the time of their certification.
> 75% of those who are continuing training do so because they think this will make them more employable.
[0] https://www.royalcollege.ca/ca/en/health-policy/building-med...
From your first reference:
> Traditional unemployment is rare; underemployment is not.
> Eleven per cent of the cohort described themselves as primarily locum surgeons. When asked why they did locums, the most common responses were “waiting for a job to open up at locum site” (46%) followed by “could not get the staff job that I wanted” (23%).
It's not unemployment in the traditional sense, in the medical community it looks like a liver surgeon (2 years of extra training) doing appendectomies in a small town or a neurosurgeon forced into only doing spine work (both need monitored beds +/- ICU). Or doing multiple fellowships until you find something.
Sure you can work as a locum (temp) or go to [very undesirable location doing general work] if you're in a specialty like general surgery that allows for that kind of practice environment. Tough luck if you're a cardiac surgeon/interventional cardiologist or oncologic subspecialist of any kind that needs high nursing support, inpatient beds and expensive instruments.
Note that these training positions are mostly all funded by the government in Canada and allocated based on their needs assessment (so it's not people choosing some unemployable niche by choice per se).
> AFAICT, Canada has a shortage of physicians.
We have a shortage of primary care physicians (because no one wants to do it), we have enough specialists by body count but no jobs/rooms for them (see underemployment points and how many go to the US).
> I have no idea how the Canadian medical system works.
Hospitals are run by the provincial governments. Physician compensation also comes from the same ministry but not out of the hospital's budget with "fixed professional fees" set by the single payer.
> That you are not running these rooms as much as possible indicates some failure in pricing/profit seeking
This has truth to it, the hospital's incentive is to prioritize their budget and they have little incentive to maximize throughput.
Due to funding nuances they're essentially incentivized to prioritize acute/emergent care (which gets some extra $) and have less throughput for things with consumables (like procedures) that come out of the hospital's budget.
It's pretty common for Canadian surgeons to admit someone to facilitate a surgery so we can use an "emergency OR room" even though they don't need the bed. Entirely wasteful but from the hospital's perspective the bed is paid for (we're constantly at capacity, there's no reality where a bed is unused) and a broken bone admitted unnecessarily doesn't cost anything extra as they don't particularly need nursing or have nearly as many consumable costs like a person hospitalized for acute illness.