[toomuchtodo]

We need more doctors and nurses [1], full stop. Anything that prevents an aggressive increase in supply of these workers is something that needs to be actioned against.

Healthcare is a utility masquerading as a profit based industry. Squeeze the profit and inefficiency out, any comp should be going directly to systems and people providing care. Insurance companies? Gone [2]. Pharmacy benefit managers? Gone [3]. Lock private equity out of owning anything healthcare related [4] [5] [6]. I don’t want to knee jerk “union” for individual contributors, but you need some sort of governance mechanism so the CEO of a non profit hospital isn’t taking home $1M/year [7] [8] [9] while doctors and nursing are fighting for proper compensation and work life balance (including patient ratios, which are used to increase labor load without increasing labor costs or hiring more practitioners [10]).

[1] https://thehill.com/changing-america/well-being/prevention-c...

[2] https://penncapital-star.com/uncategorized/americans-suffer-...

[3] https://www.ftc.gov/news-events/news/press-releases/2024/07/...

[4] https://www.amjmed.com/article/S0002-9343(23)00589-2/fulltex...

[5] https://www.washingtonpost.com/business/2024/10/17/private-e...

[6] https://www.theguardian.com/business/2024/oct/10/slash-and-b...

[7] https://www.npr.org/sections/shots-health-news/2024/08/19/nx...

[8] https://www.audacy.com/wwjnewsradio/news/national/revealed-c...

[9] https://arstechnica.com/health/2023/10/nonprofit-hospitals-s...

[10] https://healthjournalism.org/blog/2023/09/a-primer-for-cover...

[moduspol]

> We need more doctors and nurses, full stop. Anything that prevents that is what needs to be actioned against.

I agree we have a shortage, but to offer a counter-argument:

We shouldn't need a 100% full-blown doctor for everything doctors do today. We could also help address the shortage by splitting out some responsibilities that are restricted to just doctors among professionals that only have 80% (or 60%, or 50%) of the training / certifications of an MD.

We've already presumably been doing this in the US with physician assistants and nurse practitioners. It hasn't solved it, but the problem would undoubtedly be many times worse without them.

[toomuchtodo]

Great call out, I agree. NPs [1] are the NCOs (non commissioned officers) of the medical field. Where applicable, level up folks with the desire and aptitude from RN->NP. This specific pain point is a talent pipeline health and structure challenge. MD feelings around this are going to be something to consider, to note when preparing for the opposition [2].

[1] https://en.wikipedia.org/wiki/Nurse_practitioner

[2] https://www.ama-assn.org/practice-management/scope-practice/...

[dematz]

If you said "Where applicable, level up folks with the desire and aptitude from IT support->senior engineer. This specific pain point is a talent pipeline health and structure challenge. SWE feelings around this are going to be something to consider, to note when preparing for the opposition" people would go wait, maybe the occasional fresh bootcamp grad or ITsupport technician has the potential to do strong work or manage a team, but in general their education has not prepared them. Of course if you ask a doctor "could the RN or NP run this floor" there's a conflict of interest when they tell you "no", but they're also correct.

Having a nurse is probably better than no medical care at all, so a tiered system where poor people get nurses without realizing they're worse than doctors would have that advantage, but the right overhaul imo would be reducing the years of schooling required to become a real doctor (undergrad, med school, residency, maybe fellowship, finally attending). If doctors skipped undergrad and cut out some med school or fellowship requirements, they'd start working earlier and could afford to choose specialties that pay less. As well as expanding residency slots and moving insurance compensation to family medicine and pediatrics.

edit - here's a good example, https://old.reddit.com/r/medicine/comments/1f6m5i9/its_scary... the good news is they'd agree with you that midlevels do have a role, the problem with scope creep is defining what that role is, and the assumption that the training is 80% or even 50% there

[dctoedt]

> the CEO of a non profit hospital isn’t taking home $1M/year while doctors and nursing are fighting for proper compensation and work life balance (including patient ratios).

In Houston, the renowned Texas Children's Hospital did layoffs — after paying millions to their CEO and other executives. FTA: "Over a seven-year period from 2016 – the earliest year of data published by the Internal Revenue Service – to 2022, the average pay for Texas Children’s 10 highest-paid leaders ballooned from $963,971 to nearly $2.2 million, an increase of 125%. (The latest tax filings do not reflect how much leaders at Texas Children’s earned this year, after the hospital reported major financial losses.)" [0]

The usual response defending such high compensation is something like, "We have to pay our execs so much because we're competing for talent with the for-profit hospitals." OK, one possible solution might be returning marginal income tax rates — across the board — to what they were in the 1950s. That would help neutralize the constant craving for more money as one of the main ways that execs judge their personal career success. "The top income tax rate reached above 90% from 1944 through 1963 ...." [1]

[0] https://www.houstonchronicle.com/projects/2024/texas-childre...

[1] https://www.wolterskluwer.com/en/expert-insights/whole-ball-...