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DippyMagee555 t1_j90b6z0 wrote

Reply to comment by WolfDogJulius in Penn Medicine residents and fellows want a union, citing grueling workloads and 80-hour workweeks by nankles

>Large health systems (literally every one in the area) would not be able to function without their resident/fellow workforce.

This is the issue. The system can't function without those people hours the residents put in. It's not like they're sitting there picking their noses.

If you take that away, the whole system is in shambles. Some departments of hospitals had this happen when covid would spread amongst those residents. Now imagine that happening not just to departments, but to entire hospitals? It can't happen. The issue as far as I can tell is that more residents are needed to spread out those hours.

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tablesawsally t1_j917md2 wrote

Honestly (I work in healthcare finance in a large health system) the issue isn't lack of funds or staffing but ridiculous misappropriation of funds and staff.

A decent example is Hospitals everywhere regularly burn through admin staff (patient schedulers, coordinators, etc) refusing to give them a livable wage, so they leave. In the departments I have worked for it's uncommon to find someone in these roles who has been there for more than 3 years. These people are the backbone of hospitals (just like residents and fellows) They ask for a raise and get told no, so they leave. This seems like a random side note but the MDs in these departments are earning 10-15x the salary, a salary they earn 100% because of the efforts of the admin staff. When the a MDs admin leaves, their productivity dives, they have to work extra hours to meet quota and they become miserable. But... When budget season comes around the MDs gladly take their 5% raise and 10% bonus without a word about the admin folks that hold them up. Do the math, 5% of a 10x salary is half the admin salary... That's just the raise for inflation!

Every provider should be in support of paying everyone else more, we all are on the same team and need each other. Too many MDs and MBAs (nearly all hospital leadership are MD or MBA) say they want to fix things but don't actually put the ink to paper.

I could give 50 more examples of gross waste, from materials to art for the lobbies, but it just deviates from the point- hospitals can afford to pay these residents and fellows, it wouldn't break the system, it would just require the hospital to pay the people who are actually doing the work for their hours.

The argument is that in a few years the residents and fellows will get their big pay checks but at whose expense ... The patients!

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effdubbs t1_j93iqhm wrote

I endorse this. I’m not a doctor (NP), but I work for a surgeon and see 100% of his post-ops. We absolutely could not do our jobs without the admin support staff. Surgical schedulers work miracles! The front desk is the face of the health system. I could go on and on. They need to be paid more and treated better. (Patients also need to be accountable for how they treat them, but that’s another story.)

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lubacious t1_j962wh1 wrote

Remember when the AMA fought against Nurse Practitioners having increased responsibilities in care providing settings?

Look at the trains - we said things would break if we allowed workers to strike to pursue things like better staffing ratios and safer working conditions. The strike was prevented/broken and East Palestine is paying for the greed of the railroads.

It seems like these hospitals *will* break as a matter of when, not if. The number of Alzheimer's, Parkinson's, and other neurodegen. disease patients is going to increase significantly as boomers and millenials age.

The for-profit hospitals' dilemma during the pandemic (a short-term shock of many patients everywhere at the same time) could not be resolved by clever management of travel nurses. Just-in-time deliberately removes as much slack as possible to turn it into profit, patients and care providers be damned.

We can pull the band-aid off sooner or we can deal with infection and sepsis later, but the bill for these profits that most of us don't see will come due.

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