[lostlogin]

> It sure sounds to me like that (and thus any knock-on problems) could be solved by more practitioners, spreading the work around.

Sort of. The equipment is so expensive that the actual solution is usually to work the rooms and equipment harder. Night shifts, early starts and evening work are actually shit.

[whimsicalism]

That makes no sense, if the capital is expensive then you should hire more labor.

[lostlogin]

That is literally what I'm saying. Staff are worked harder as shifts are introduced. It is not a nice way to work. Sure, it helps reduce the number of patients, but it destroys work/life balance and that is what the OP was raising as an issue.

It is also hard to get patients to agree to having tests done at 5am or 9pm, so it's a case of diminishing returns. The staff penal rates go up too, so the squeeze comes from all sorts of directions.

[greiskul]

> It is also hard to get patients to agree to having tests done at 5am or 9pm, so it's a case of diminishing returns.

In the US? With health care prices as they are? There are people that travel to entirely other countries for access to health. I'm plenty sure lots wouldn't mind at all to have an exam at 9pm if it meant it was way cheaper.

[lostlogin]

New Zealand. The issue is that the reimbursement is the same whenever the scan is done, but staffing costs more at night (so scans kind of need to cost more at night).

Reading what an MRI costs in the US, I do wonder if a trip to NZ for the scan would actually be cheaper.

[haldujai]

I only know 1-2 NZ radiologists but I understand the system there is egregiously underpaid.

Medicare/insurance reimbursement rates for MRI (the professional fee component) are less than Canada (a system I know).

We scan outpatients near 24/7 on some of our magnets in Canada, the ones we don’t are because we don’t have MRI technologists to staff the shifts (the more expensive part as they have unions with labour laws, radiologists can be worked like dogs with no benefits/protections as contractors).

[lostlogin]

I haven’t heard radiologists complain about their pay here, they seem pretty well paid. The techs are paid nicely too, though that will depend on the employer.

I’m surely misunderstanding you - you aren’t saying techs cost more than radiologists in Canada are you?

Doing those hours with outpatients is very impressive, though I hope to never be involved in such things. Weekends are bad enough!

[shadowofneptune]

The question is what you are angling for. If your goal is, sincerely, to provide better service, then you won't get it. Keep in mind that with so many patients nowadays being eligible for Medicare, the money will come in anyway. Nursing homes got the brunt of the attention for their quality of care, but with hospitals facing the same population the same management techniques come too.

I work as a nurse on nights and everything said above has been quite accurate. A textbook understanding of... well anything really, does not serve someone well now.

EDIT: Also these companies now often run pharmacies, investment systems, healthcare programs... patient care is by no means the biggest earner.

[throwaway173738]

> EDIT: Also these companies now often run pharmacies, investment systems, healthcare programs... patient care is by no means the biggest earner.

Are you referring to companies like Optum in the US?

They own entire medical systems(Everett Clinic in Washington), an insurance company(United Healthcare), and a pharmacy(Optum Rx) as subsidiaries so if there’s a problem everyone can point fingers and nothing gets done. This seems to be the new model for healthcare in the US.

[shadowofneptune]

Optum is an extreme example, but it's all of them. The non-profits run the same as the for-profits, and have converged more and more since 2000 or so.

[2b3a51]

UK: there was a proposal to introduce weekend surgery to make better use of operating theatres. The problem is staffing the facilities. Lead times on training people are long. And in UK the training process is not cheap and has significant up-front costs for the people being trained. Nurses as well as surgeons.

We used to have bursaries to cover the cost of training for nurses, but, austerity and all.

[Retric]

That seems backwards, unless you also need to be preforming more surgeries and thus need more people. Instead reduce the number of operating theaters while keeping a similar number of people. Net result same amount of operations, but lower capital expenditure.

Of course you now need to pay people more to be working in the weekends, but that’s a different question.

[2b3a51]

Yes, the UK needs more surgery capacity.

[Retric]

In that case it needs more workers independent of doing weekend surgery.

[whimsicalism]

If you are unable to supply enough surgeons for the surgeries people actually need, something has gone terribly wrong with your price signaling mechanism.

Perhaps this is a problem with the UK system.

[lostlogin]

> Perhaps this is a problem with the UK system.

It’s a problem everywhere isn’t it? There aren’t enough surgeons and the price is too high.

[haldujai]

The expensive labor isn’t physicians and infrastructure/capital expenditures aren’t the barrier either.

It’s nursing costs and bed counts.

Look at Canada for an example, we have unemployed surgeons and interventional radiologists/cardiologists with surgical backlogs > 1 year.

We have the rooms, the hospital I trained at had 90 operating rooms but only 4 are funded for after-hours and on weekends, the rest run 8am-4am but no nursing money for the OR, recovery room, or patient wards.

[whimsicalism]

Research indicates the "unemployed surgeon" problem in Canada is more folklore than reality. [0] AFAICT, Canada has a shortage of physicians. [1] That unemployed people exist at all is not evidence that there is no labor crunch.

[0]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5866140/ [1]: https://www.cbc.ca/news/politics/canada-turning-away-home-gr...

That you are not running these rooms as much as possible indicates some failure in pricing/profit seeking, but I have no idea how the Canadian medical system works.

[haldujai]

From the Royal College (our specialty accreditation society)[0]:

> 11-18% of newly certified specialists cannot find work at the time of their certification.

> 75% of those who are continuing training do so because they think this will make them more employable.

[0] https://www.royalcollege.ca/ca/en/health-policy/building-med...

From your first reference:

> Traditional unemployment is rare; underemployment is not.

> Eleven per cent of the cohort described themselves as primarily locum surgeons. When asked why they did locums, the most common responses were “waiting for a job to open up at locum site” (46%) followed by “could not get the staff job that I wanted” (23%).

It's not unemployment in the traditional sense, in the medical community it looks like a liver surgeon (2 years of extra training) doing appendectomies in a small town or a neurosurgeon forced into only doing spine work (both need monitored beds +/- ICU). Or doing multiple fellowships until you find something.

Sure you can work as a locum (temp) or go to [very undesirable location doing general work] if you're in a specialty like general surgery that allows for that kind of practice environment. Tough luck if you're a cardiac surgeon/interventional cardiologist or oncologic subspecialist of any kind that needs high nursing support, inpatient beds and expensive instruments.

Note that these training positions are mostly all funded by the government in Canada and allocated based on their needs assessment (so it's not people choosing some unemployable niche by choice per se).

> AFAICT, Canada has a shortage of physicians.

We have a shortage of primary care physicians (because no one wants to do it), we have enough specialists by body count but no jobs/rooms for them (see underemployment points and how many go to the US).

> I have no idea how the Canadian medical system works.

Hospitals are run by the provincial governments. Physician compensation also comes from the same ministry but not out of the hospital's budget with "fixed professional fees" set by the single payer.

> That you are not running these rooms as much as possible indicates some failure in pricing/profit seeking

This has truth to it, the hospital's incentive is to prioritize their budget and they have little incentive to maximize throughput.

Due to funding nuances they're essentially incentivized to prioritize acute/emergent care (which gets some extra $) and have less throughput for things with consumables (like procedures) that come out of the hospital's budget.

It's pretty common for Canadian surgeons to admit someone to facilitate a surgery so we can use an "emergency OR room" even though they don't need the bed. Entirely wasteful but from the hospital's perspective the bed is paid for (we're constantly at capacity, there's no reality where a bed is unused) and a broken bone admitted unnecessarily doesn't cost anything extra as they don't particularly need nursing or have nearly as many consumable costs like a person hospitalized for acute illness.

[FrustratedMonky]

Think that is the point. If their is expense equipment, high capital. Then companies will try to maximize the current labor first, grind them down, before taking the leap to hire more labor. Like running 2, 10 hour shifts, with few hours downtime, will be better than running 3, 8 hour shifts, at 24 hour uptime. The incentive is to stretch labor head count out, before adding more.