The Business of Health Care Depends on Exploiting Doctors and Nurses

[ismnotwasm]

You are at your daughter’s recital and you get a call that your elderly patient’s son needs to talk to you urgently. A colleague has a family emergency and the hospital needs you to work a double shift. Your patient’s M.R.I. isn’t covered and the only option is for you to call the insurance company and argue it out. You’re only allotted 15 minutes for a visit, but your patient’s medical needs require 45.

These quandaries are standard issue for doctors and nurses. Luckily, the response is usually standard issue as well: An overwhelming majority do the right thing for their patients, even at a high personal cost.

It is true that health care has become corporatized to an almost unrecognizable degree. But it is also true that most clinicians remain committed to the ethics that brought them into the field in the first place. This makes the hospital an inspiring place to work.

Increasingly, though, I’ve come to the uncomfortable realization that this ethic that I hold so dear is being cynically manipulated. By now, corporate medicine has milked just about all the “efficiency” it can out of the system. With mergers and streamlining, it has pushed the productivity numbers about as far as they can go. But one resource that seems endless — and free — is the professional ethic of medical staff members.

https://www.nytimes.com/2019/06/08/opinion/sunday/hospitals-doctors-nurses-burnout.html

[tulipsandroses]

1. I can certainly relate

I have spent hours after my 12 hr shift completing documentation. My 12 hr shift ends up being 13-14 hrs. Many days, no break during those shifts. I was happy to hand in my 2 week notice recently to move on to the next phase of my career. They say never say never but I don't see hospital work in my future. I plan to work in out patient care from now on.

Healthcare is a business no matter where you are. However corporate greed in hospitals has become unbearable for me.

[ismnotwasm]

3. I enjoy hospital work

We have a decent union, but the missed lunches and breaks and unpaid labor with ridiculous charting is rampant as is the issue in many, many hospitals

[tulipsandroses]

8. I enjoy the work itself - I love helping the patients

I just hate the corporate greed. My current organization has completely soured me on hospital work.

One example - We recently had a JCAHO visit - that week every unit was overstaffed. After the visit we went back to bare bones staffing. Its just outrageous- they put profit ahead of patient safety. More patients, more documentation. It seems like every time I go back to work, there is a new memo about new documentation added! I don't have more hours in my shift to get it done though, neither do I have more staff to help.

[ismnotwasm]

9. We just passed the missed break law here in Washington state

The one that that idiot said something about nurses “playing cards” instead of working. It helps, it gives teeth to our union, and management does a fairly decent job of responding. We have tons of charting, but they are streamlining some of it, as it gets completely redundant. We staffed up during JACHO as well. I rolled my eyes so hard I thought they were going to stick that way

[tulipsandroses]

12. No union in GA- But I'm hoping HR 2392 passes

[link:https://www.nationalnursesunited.org/press/rns-applaud-reintroduction-federal-safe-staffing-bills-mandating-nurse-patient-ratios|[link:https://www.nationalnursesunited.org/press/rns-applaud-reintroduction-federal-safe-staffing-bills-mandating-nurse-patient-ratios|

Playing cards instead of working. What a joke! There are days I can't even make it to the restroom!

[Horse with no Name]

2. I work 10-20 hours of uncompensated time per week

Fighting for what patients need.
The problem is that they call the customer service phone number and the insurance tells them that it’s the doctor’s office who isn’t doing what they need them to do—paid customer service agents. We call the other number where those folks are anything but customer service agents and are rewarded when they say no.
It’s exhausting.

[Wounded Bear]

4. The real problem is in the thread title...

The business of health care...

Perhaps health care should not be a business.

Perhaps life and death decisions should not be based on profit motives.

But that's just me.

[ismnotwasm]

5. Perhaps

But even run as a charity, or as single payer, or a public option, people still need to be paid, equipment needs to be bought—small rural hospitals send out patients they can’t work up because of lack of equipment and personnel—medicines need to be developed, tested and given. Healthcare is complex.

On the other hand, We are currently behind on antibiotic development became there isn’t enough profit for drug companies. So yeah. A lot of work needs to be done

[Cousin Dupree]

6. I once had a job as an RN where one other nurse and I managed a very sick group of patients

with one specific fairly rare diagnosis. We had a huge caseload because we worked at a very large medical center that got referrals from all over the country. On the days we didn’t have clinic, we would come in in the morning and spend all morning responding to voice mails from patients. Sometimes, when we went to lunch we would have 0-3 voice mails left in our inbox. One half hour later, we’d return and we’d often have 50-60 new voice mails. We never caught up. Then the department head told us we had to head a research project on top of all of this. The more you did, the more you were given. It was brutal. And clinic days were even worse because there was no time to deal with anything but the most urgent patient messages. We cared so much for those patients, but management was relentless with demands on us.

[ismnotwasm]

7. Holy crap that's brutal

[FakeNoose]

10. The short supply of doctors used to be at the prerogative of the AMA

I don't know if this is true any more, but the American Medical Association used to make sure that American medical schools graduated few enough doctors and medical professionals in order to maintain a shortage. MDs would always remain at the top of the food chain as long as the shortage continued, so of course it worked to their advantage. Sure there's physician burnout, there's also normal attrition, retirement, career changes, etc. Our population is growing, why are there so few seats available in the medical schools?

[ismnotwasm]

11. An excellent question

Because it’s very true. Also, less people are willing to work so hard in school their entire young adult life for payoff that isn’t worth it, given the relatively low pay for a PCP and the high cost of medical school.
Nursing leaders are working to fix this hole with advanced practice RNs, including a PHD program. PA programs are also an attractive option.

It’s definitely part of the mosaic that is the healthcare picture

[Aristus]

13. The trick on the clinical level is getting all the patients taken care of by C.O.B.

My staff is all unionized, which I support 100%. So when closing time comes, they have to go home. Whether I see sixteen patients in a day, or twenty-five, it's the same.

So I try to free up as much time as possible by managing the expectations of the patients. There's usually only ever time to address one medical complaint. If you bring a laundry list of complaints in with you, you'll have to take it right back out with you after having selected the one thing you don't want to leave without having it addressed.

That may see hard and unfeeling. But I can't count how many times a patient has complained to me about the length of the wait when I finally get in to the exam room. And when I'm done fixing whatever they came in for, they say: "Oh, one more thing!..."

I then explain that they waited so long because every patient ahead of them had "...just one more thing!" And having to address every single little symptom they have is going to send the game into extra innings.

I respect the fact that not every patient can secure the time off from work, or get a babysitter, or whatever they need to do to get in to the clinic to address the complaints the provider said would require additional visits. Time is precious, and nobody who works for a living has enough of it. It's a little dance we're going to have to do until the powers that be finally realize that increased productivity usually leads to poorer clinical outcomes.

Patients: be patient with us. We want to fix your problems. There just aren't enough hours in the day...

[ismnotwasm]

14. I think unions make a huge difference

Strong unions even more. My hospital at least tries, despite having more than our share of the underserved, and the near hopelessly sick. I’ve heard horror stories from nurses from other parts of the country with weak or non-existent Hosptunions.

All that being said, simply ENOUGH clinics, with enough willing providers to do primary care are definitely part of the big picture of how to heal our healthcare system. Thank you for all you do

[Aristus]

15. As a Physician Assistant, I actually have it relatively easy.

The poor MD's I work with have insane productivity requirements. They generally see twenty-five to thirty patients a day.

That is, until they burn out three years into their tenure with our organization, and look for work somewhere else.

I haven't had a vacation in five years. I've had a week off here and there, usually to pay duty calls on family members in other states. But a full-up, out-of-town, pack some luggage, get away with the wife vacation? Five. Fucking. Years.

We're planning a real vacation for this fall. Can't wait...