[safdahfslh23s]

My partner is a physician in an ICU and a lot of her colleagues have talked about leaving the field as well. Their complaints are #2 & #3 along with:

5. Pay cuts - Most of the critical doctor specialties (ER, ICU, primary) that were the backbone of the pandemic got "raises" that were less than inflation (hers was 1.5%) while profitable elective specialties got big raises. The root cause is the billing system where elective surgeries bill pay out more than critical roles. Still, it's extremely demoralizing to be called a "pandemic hero" and have your pay get cut.

6. Criminal and Financial Liablity - Healthcare is delivered by a team yet the financial and criminal penalties for mistakes are assessed at the individual level. Recently a nurse was given a criminal sentence for a drug mistake which many believe was systematic failure (bad UI / IT systems, bad hospital practices, AND negligence on the nurse). Imagine getting sued or jail time as an engineer for dropping a production database. The few malpractice cases my partner has been involved in, it was very clear that the issues were systematic and perpetuated by hospital practices. However, if they had gone to trial, an arbitrary worked would d have been sued and the hospital wouldn't change its crappy practices. Institutions have effectively dodged liability in many cases.

7. Chronic understaffing and burnout - most ICUs have been understaffed throughout the pandemic. From an economics POV it seems crazy that their is a labor shortage but salaries are effectively dropping.

[killjoywashere]

Thank the hero of Medicare, Lyndon Johnson. When CMS actually needed to start pricing things, he directed them to his old buddy, the famous heart surgeon, Michael DeBakey. DeBakey sent a couple fellows of his to DC to write up the price list for CMS. Shockingly, surgical procedures got a lot of money and office visits got approximately nothing. This has propogated for 60 years now with increasing precision as the rate of inflation gets applied over and over. A WAG of "10,000 for bypass" is now "57,348.32 +/- 343.43" but the error represents the uncertainty in inflation over time, not any better resolution on the cost of the procedure.

[freddie_mercury]

Why are you so quick to assign blame to the first actors? This expectation that the first people to do something need to make it perfect in every way is completely toxic and one reason for the total paralysis of America.

The majority of the blame here lies with the thousands of politicians, bureaucrats, and administrators who haven't reformed the system in *sixty years*. Not the people who were doing their best with much less information than their successors have had.

[brewdad]

I can only hope you feel the same way about a 2nd Amendment written when a single fire musket that took 10-30 seconds to reload was the peak of "arms". 5th Amendment "Papers" could use a bit of rethinking too.

There are a lot of first actions that need to be reexamined in the 21st century.

[bshep]

In relation to #5 we had to drop pay by ~6-7% due to medicare cuts in 2021. Me and my MDs salaries are paid directly from medicare ( and other insurance companies who peg their compensation to the medicare rates ) so we have no choice but to drop salaries or close up shop.

With the inflation numbers this year I have no idea what we are going to do, since we are already 6-7% in the hole from the 2021 cuts and now inflation is 8-9% ( assuming the economic numbers are correct... )

[hansel_der]

> we have no choice but to drop salaries or close up shop

there's bound to be at least a third option and the fact that you ignored it is part of the problem.

[bshep]

There are no other source of income other than insurance plans, so if they decrease rates we have no choice but to decrease pay.

Im not sure where you are getting the ‘you ignored it’ comment, when the new rates were announced we adjusted pay according to the decrease in rates.

[anonuser123456]

Concierge care/Direct primary care or start your own surgical center that takes cash. My company contracts directly with fixed price surgical centers for elective care and bypasses insurance completely.

Insurance is a scam on patients and providers.

[hansel_der]

you seem to imply that pay will go up the same moment rising rates are announced.