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Originally Posted by Justputt
What people haven't talked about is the overall shortage in pretty much all medical fields. Sometimes we see NP and PAs because staffing levels don't support everyone seeing an MD. Most of us remember when it wasn't hard to get into see our MD on the same day as a walk-in. Those days are gone and unlikely to return. Government run healthcare is largely to blame because the payment system (amount, complexity, and requirements) is driving people away.
For example, our 4-hospital system was just driven to convert our individual EMRs to a single EMR called EPIC for around $150M. The process was a nightmare; the company acted like we were their first client, which we were far from being, and the EPIC processes were little more than generic, e.g. Epic had their way to do things (patient flow, schedules, limited interfaces, support) and pushed us to do things their way (not what staff wanted to hear). What does the government reimburse for the required EMR? ZERO dollars! Overall, it will improve the exchange of information between hospitals when we share a patient, but for $150M and I don't know what EPIC charges for the annual licenses and support contracts. But remember, having an EMR is a government requirement that we don't get paid anything for having.
Manpower had been a problem since before COVID, but COVID drove a lot of people out of the field or into retirement. As of 1.5 years ago when I retired, my hospital was grossing more than it ever had (and we were always lean and in the black), but post-COVID, losing $2M/month largely due to the cost of travelers/LOCUMs. It took years to find my replacement, even offering top pay and living in a really nice area. Don't look for things to get any better with the government driving the payment system.
The government requires hospitals to do more and more while bundling more and more charges with the aggregate payment continually being substantially reduced. In my primary field of radiation oncology bundling charges has been very painful, but at least we're still profitable. However, our ability to cover the cost of hospital services that are routinely losses is much more limited. There are only a handful of hospital services that make the money to pay for the others. Then there are the no-pay patients we care for, which can be 35-50% or more of the patients in some areas. We do all the same work, use all the same assets, have all the same malpractice liabilities and zero income. No, the ACA doesn't cover those people as promised.... big surprise.... not! The government is driving this bus, not the hospitals or even the insurance companies.
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Heh. Remember the nine scariest words in the English language?
"I'm from the government, and I'm here to help".
If there is one thing we should have learned by now (but obviously haven't) it is that if Government is doing it, private enterprise can do it better. And faster. And cheaper. Case in point: when we first moved here, I was perplexed by the office of "tax collector". Seemed sort of odd as well as sort of provincial. We were there to get our driver's licenses changed from Minnesota to Florida. Once inside the building we were directed to the end of the hall and told to wait until our names were called (maybe 10 minutes), went to a window, filled out a couple of forms, had our vision checked, etc. At the end of the process I asked the lady how long we'd have to wait for our licenses. She looked at me sort of oddly and said "you'll have them in your hand when you leave here". And we did. In Minnesota that would have been a six-week wait AFTER we got in to see the agent, and no guarantee of even that.
And then of course there is Elon and his reusable rockets.
Driver's licenses and reusable rockets are not health care, but leaving things to the bean-counters and government career turf-builders is at best a guarantee of mediocrity, if even that. Yeah, I realize that a lot of health care is government-funded so there has to be accountability, but the system we have now is way overly complicated and (if what we read is true) incredibly poorly done; and true accountability almost impossible. Dump the bureaucracy and bureaucrats and contract it out to people who KNOW how to get things done