The hero tax: Why 'selfless' workers are professionally exploited
bbc.com
bbc.com
When you’re on a severely understaffed ward, you have to get the work done whatever it takes. If the next shift fails to turn up, you can’t just go home. People’s lives are at risk. You’re responsible until you can hand the care over to someone else.
Like this, things can be stretched to unhealthy or even dangerous levels for a long time before there’s any accountability for the management. The front line staff have to get the work done, often at great personal expense.
Honestly, I don’t know how people do it.
If you're on your feet and working for 14 hours straight with no rest, you will make more mistakes. It's just being human. Pretending that isn't the case and punishing those mistakes won't reduce them.
Agree with your point that the people creating these situations should be held accountable in some form, although I'm unsure if the will exists for accountability. America runs on "maximum extraction minimum liability" as a philosophy.
https://www.axios.com/2023/08/27/labor-shortages-air-traffic...
https://www.axios.com/2023/10/26/health-care-doctor-shortage...
https://www.axios.com/2024/03/08/aging-health-care-labor-sho...
https://www.axios.com/2023/05/08/us-labor-shortage-older-wor...
It's somewhat similar to how having a handful of remote individuals in a mostly in-person company can lead to significant communication issues, but a fully/mostly remote company builds and leverages tools and processes to reduce these issues significantly.
There might a world where if we lower the bar of medical school, it turns out at the end it results in fewer mistakes because of the increased supply.
That said, you can accomplish a lot by leaving MD education alone and allowing the "technician" type health care workers like PAs and NPs to do more.
You're being exploited by someone who should face legal repercussions for the situation that they have negligently created. But they won't be.
That's the problem. That's all it is. There's no corrective mechanism from the legal system in play so the problem festers.
Direct Supervisor of 10 staff. Ward supervisor of 50 staff. Hospital manager of, say, 500 staff.
An extra 1-2 hours, +5% pay/hr, manager -1%/10, ward -1%/50, hosp man -1%/500
2nd extra 1-2 hours, +10% pay/hr, manager -2%/10, ward -3%/50, hosp man -5%/500
3rd extra 1-2 hours, +20% pay/hr, manager -5%/10, ward -10%/50, hosp man -20%/500
4th extra 1-2 hours, +35% pay/hr, manager -10%/10, ward -20%/50, hosp man -40%/500
...
People go to the most effective people with their problems and high-stakes projects. The reward for good work is more work.
Then one of the other people on the team, one of the lowest performers, got promoted over me and I lost it. Apparently the CIO wasn't looking at the metrics.
He made sure I got a raise and got slotted in for the next available promotion, which was only a few months away.
Then the company that was contracting us early termed their contract, and they only asked me to stay to build a new team, based on the CIO's recommendation. Metrics are a pain but they can also be a life saver.
A good manager knows the difference.
It's also possible to enjoy working for a while at an unsustainable pace, but a good manager should often tamp back on this b/c:
(a) an IC that burns themselves out and has a long recovery period of lower engagement may be less effective than an IC with sustained productivity and
(b) the swing between high and low productivity can cause issues for the team overall, esp if peers at first try to compete on pace and then have to shift to share the weight after someone burns out
There's a few usually bad options like drafting the email yourself, teaching the PM english, etc. Whatever is done, the best engineers I've seen know their job and their role, and can tell others. They balance their sense of responsibility with the reality of what they control. They price work outside of their job role, to be paid in political capital, e.g. a promotion.
If the professional does not define their role, other people will do it for them. If the professional avoids pricing, they're saying their time is free. That person get marked as a patsy or a cog. Someone who messes can be dumped on and who, thanks to corporate Pavlovian conditioning, gets work done without upsetting the status quo. The more messy the work is, the less control you have, the more time you personally need to sacrifice. It's a recipe for burn out, role confusion, and other people's ideals becoming your performance standards.
Over a few years I worked on several projects, which all became the company's product suite. They all gained adoption, became very valuable and were sold to several customers, but they were not reliable. Even less so after they moved me off. But they were solving real problems, and customers were still happy, and so the company still kept them alive with bigger teams.
The company attained unicorn status, but I never really got ownership of any 1 project or product. I'd get increasing requests for help across the growing product suite, was able to help effectively, and simultaneously took on new feature development work.
In the latter part of my time there, I found out I may have been in the bottom quartile of pay for the team I was in, while being perceived as the top performer by coworkers.
I was in a slow 'burn out' but never fully checked out. Maybe because I think I rarely put in over 50 hours a week. Never touched comms during weekends.
If you value their work, you should pay them adequately rather than act like they are in it for the good feels.
Also, covid was a huge missed opportunity for creating standards for distributing health info and instructions via internet in a sensible fashion to prevent the ERs and hospitals from being so overwhelmed and thereby actively spreading the infection.
Also a missed opportunity for developing a healthier set of social expectations and best practices for how to have reasonable and productive discussions of health topics in the face of uncertainty and possible death. We really seem to have screwed that pooch globally, or at least in English-speaking spaces.
Sure, but even if you pay me a lot you're still expected to be nice to me.
>Also, covid was a huge missed opportunity for creating standards for distributing health info and instructions via internet in a sensible fashion to prevent the ERs and hospitals from being so overwhelmed and thereby actively spreading the infection.
Was it? Tele-health boomed during the pandemic to the point where I've sometimes had trouble getting in-person appointments when I felt it was necessary.
>Also a missed opportunity for developing a healthier set of social expectations and best practices for how to have reasonable and productive discussions of health topics in the face of uncertainty and possible death. We really seem to have screwed that pooch globally, or at least in English-speaking spaces.
Also, did it really? I feel like we've made a lot of progress against the "go to work even if you're sick" idea being a virtue and enabled a lot of people to work from home while a little sick and made people considerably more willing to just stay home when they were sick.
The CDC and related government entities really fucked up when they sent out messaging that cared more about results of the message than the truth of the message. They started out by discouraging masks and then changed tack. They exaggerated advice and never clearly represented uncertainty. The headline message was never about the best that was known at the time and the confidence in that message to try to empower people to make their own decisions. Instead they pretended to certainty that was impossible and encouraged pro/anti message moralization so that your health choices were supposed to be collective instead of individual and aligned with your political affiliation instead of your own situation and appetite for risk.
I'm someone who hasn't lived "conventionally" in a lot of years and I seem to generally be out of step with popular opinion.
I think it was or I wouldn't have said it. Granted, personal opinions and individual experiences will vary.
We do a poor job generally of accounting for that online. If your experiences fall outside the Overton Window, you may be accused of being a liar rather than a statistical outlier.
If I pay you 'a lot', get back to work and stop fucking moaning.
The absurd strawman argument would be to make their work day worse to increase compensation by decreasing supply of doctors and nurses.
I doubt you should assume that with the growth of venture capital owned medical facilities.
I was in the mindset to follow Sheryl Sandberg's advice “If you're offered a seat on a rocket ship, don't ask what seat.” But what ended up happening was the people who knew how to ask for better seats actually got them.
People need to organize.
One link early in the article points to another article about a shortage of volunteer firefighters. How can the richest country on the planet rely on volunteer firefighters?
Volunteer firefighters: some areas are full of people who don't want their taxes to go up to pay for a career department. Many areas are so sparsely populated they can't afford one even if willing. The amount of training and education required keeps going up, and not everyone has a job they can just walk off from to respond to calls on no notice. It's harder to effectively volunteer as a FF than it was even a few decades ago. Sometimes it's addressed by having formerly all volunteer or smaller combination career/volley departments be absorbed into a neighboring career department that can spread the cost out to a larger area. Sometimes egos win out and the ability to do the job suffers.
And just to illustrate the difference, I think a "passion" profession that's not considered heroic is video game developer. My vague impression is the pay and working conditions for them are much worse than for other kinds of software development work, because there a lot of people who are so passionate about video games they'll sacrifice a lot to work on them (until they burn out, at least).
lots of all of this in the world of fine arts, performance and literate arts
And that assumption is true to some extent. People don't just slip and fall into a set of scrubs and become a nurse or medic. They choose that path based on an analysis (yes, the average person is capable of making reasoned decisions, although that's shocking to many). People have other options besides becoming "heroes" and yet, they choose it. Why?
> "This is a clear fallacy in inferential reasoning and logic"
This is that thing people do when they want to sound smart. Actually two things: (1) Don't address the claim, just call it wrong (2) overcomplicate your sentence with obscure words
https://www.bbc.co.uk/worklife/article/20240409-heroic-jobs-...
Couple of weeks ago, my boss gave me a "promotion". Went on about how he had to clear it with the board, etc. It's a title change and 0.5% equity on a brand new 45 month vesting schedule with a new 12 month cliff. No cash money, I'm still making junior dev salary.
CEO tried to talk to me about it, it was the verbal equivalent of a pizza party. I just didn't engage at all, and the planned announcement to the whole team silently never happened.
Coincidentally, this happened a couple of days after I had updated my indeed resume with the same title they later "promoted" me to.
Job was fun at first, but the CEO is extremely confidently driving the company straight into the ground. Fake monopoly money isn't going to keep me on this sinking ship, my guy.
> Stanley's findings chime with the opinions of Nicki Credland, a reader in critical care nursing at the University of Hull, UK. She argues that the hero narrative can undermine the skill and education of her colleagues. "[It suggests] we do our jobs because we have a calling and an innate desire to help people – but that's no more true of nursing than it is of many other professions," she says. "And it has a negative impact when we want to be appropriately remunerated for the skills and expertise that we have."
A related effect is the US' tendency to pay lip service to "support our troops!" while our VA is in shambles.
The largest cohort are people who are unaware of what the sacrifices of service members are, even in peaceful times, more out of ignorance than anything else.
https://en.wikipedia.org/wiki/Parable_of_the_Workers_in_the_...
What we are talking about here is why people who do things that make a particularly important contribution to society get paid less than people doing otherwise similar (e.g. in terms of skill required etc.) jobs.
Very few things like this are new, but I think it has probably become worse in recent times.
Take nurses, doctors or firefighters, what are they going to do if they don’t get better working conditions ? Refuse to work ? A strike ? That’s impossible because they know the consequences (or depending the country because they aren’t even allowed to).
Even in France with our culture of strikes, people working in healthcare have poor working conditions because they basically can’t stop working even if they’re unionized.
Same for teachers : for them it’s pretty different, they do strikes frequently to ask for better conditions but it’s basically never effective because governments know they’ll eventually get back to work. And ultimately the only ones to suffer from those strikes are the teachers themselves and the children they strive for.
Job market just isn’t working for people who want their work to be meaningful or important to the society.
I really do not understand why people think it is fair that teachers in the UK get paid about half of what train drivers do. The fact that they do is because train drivers strikes have more immediate impact than those of teachers, but the fact that the public do to realise the problems this causes (e.g. a shortage of teachers, overworked teachers meaning they do their jobs less well, etc) might be explained by the perception that they are adequately rewarded by knowing their work matters.
A teacher? It takes 20-30 years to know if they’ve done anything.
In the parable workers work all day and are paid the same as workers that work for a very short time. As a parable it does not work very well without the content of the disciples questions but it is still a very old story about not valuing those that work more.
In the US, our nurses buy half million dollar homes. The physicians have their own little city in the suburbs composed of multimillion dollar homes.
(Artificially) high wages are bad for the customer, and we sure see the effects.
Is that supposed to be outrageous? Given how much rise we've seen in house prices in the past few years I'm not really sure whether that's supposed to mean they're underpaid or overpaid. Why not just say their mean annual pay is $94,480 compared to $65,470 for all occupations[1]?
MDs may be overpaid and there are a lot of problems with how residency works in the US (both in terms of too-few residents and abusive treatment of the few who get in) but nurses are absolutely not overpaid for the work they do.
And yes, I'm considering bumping someone out of med-school and residency. I am a 1%er, I'll get in.
I sure hope they do!
Do you even know what a half-million dollar home looks like in any major city? Hell, my house is only 3 bedroom and 1800 sq feet, and it's worth $550K. If this house was in the SF Bay area, it'd probably be $1.0-1.5M.
Dude, half a million for a home ain't what it used to be, it's just below average home. Why would a nurse not afford a home?