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Medical Forum / General / General / January 2006Why are there so many health care jobs compared to others?
I don't know if anyone else has noticed this, but every time I open the want ads, the amount of job openings in the health care field (nurses, therapists, technicians, paperpushers, etc) is HUGE compared to other fields. Does anyone know the reason(s) for this phenomenon? The salaries mentioned in the ads seem very generous with sign-up bonuses and what not. For example, a freshly minted RN with NO experience can now rake in as much as a long-time engineer or accountant, so I don't think the disproportionate number of job openings is because of RNs retiring or quitting their jobs due to low pay... >I don't know if anyone else has noticed this, but every time I open > the want ads, the amount of job openings in the health care field [quoted text clipped - 6 lines] > openings is because of RNs retiring or quitting their jobs due to low > pay... They US population is aging and thus, on average, needing more care. The nursing schools are full. They can not hire more faculty because typically the school they are embedded in puts a cap on salaries at different levels so it is hard to get someone into teaching - you need experience and advanced degrees. On the other hand, the faculty is aging and retiring. Bill xxx@yy.zz wrote... > >I don't know if anyone else has noticed this, but every time I open > > the want ads, the amount of job openings in the health care field [quoted text clipped - 12 lines] > is hard to get someone into teaching - you need experience and advanced > degrees. On the other hand, the faculty is aging and retiring. Once the libertarians in the GOP kill off the entitlement programs, those newly-minted health care workers will be out of a job.  SignatureHow can the economy be improving when real wages are down $600 million and the number of American people in poverty has increased 14 percent since 2000? http://www.census.gov/prod/2005pubs/p60-229.pdf, pg 53 > xxx@yy.zz wrote... > > [quoted text clipped - 17 lines] > Once the libertarians in the GOP kill off the entitlement programs, > those newly-minted health care workers will be out of a job. Hi, Not likely. With a shortage now and the training of new bottlenecked by salary limits, the wages of health care workers are likey to remain well above average for far into the future. I say the US needs a "crash program" to train new doctors, nurses, and such using newer instruction methods including the internet and apprentice programs with hospitals. Whose real wage is down $600,000,000? I wish I had a wage that could drop that much ;-) The reason US wages aren't rising enough is that not enough Americans are getting education/training in the fields of greatest demand. Like in medical fields. >....and the number of American people in poverty > has increased 14 percent since 2000? > > http://www.census.gov/prod/2005pubs/p60-229.pdf, pg 53 The definition of "poverty" keeps changing to insure that the percent living "in poverty" does not drop. Most living "in poverty" in the US would be not be considered poor if they lived exactly the same way (same car, same food, same house, same TV, etc.) anywhere except in the USA. ,,,,,,, _______________ooo___(_O O_)___ooo_______________ (_) jim blair (jeblair@wisc.edu) Madison Wisconsin USA. This message was brought to you using biodegradable binary bits, and 100% recycled bandwidth. For a good time call: http://www.geocities.com/capitolhill/4834 >Not likely. With a shortage now and the training of new bottlenecked by >salary limits, Salary limits? Umm who's undercutting the market forces? >the wages of health care workers are likey to remain well >above average for far into the future. With the influx of foreign nurses and doctors undercutting the market pressures? With hospitals moving to independent contracting and "temporary staffing "to avoid unions and benefits? Not likely. - - - - Just another albino black sheep > >Not likely. With a shortage now and the training of new bottlenecked by > >salary limits, [quoted text clipped - 10 lines] > - - - - > Just another albino black sheep The influx of professionals don't undercut anything. Wages are paid and earned based on professional status and not origin. I don't know what they mean by "wages are well above average". The strike in NY is about full retirement benefits at age 50. Transit workers for the city make more than fireman and police. I don't know anyone able to retire at age 50 who works in a hospital. I know somebody with the same college degree I have and option for hospital work or private work and he choice private non-healthcare work. He makes more than I do and doesn't have to punch in or out and can come and go as he pleases working for the city. He laughs at my pay. When I got out of college I graduated with a friend who worked as a checkout clerk for a large grocery store and laughed at the pay he was presently getting compared to the pay he would be getting after five years of hospital work. Much more at his present job that put him through school. It would be a cut in pay for him to follow that healthcare path. >> >Not likely. With a shortage now and the training of new bottlenecked by >> >salary limits, [quoted text clipped - 13 lines] >The influx of professionals don't undercut anything. Wages are paid and >earned based on professional status and not origin. Nope . wages are a function of supply and demand. Foreign workers come and accept lower pay because its more than they can make at home. They undercut market forces here that would lead to rising wages, which would lead to more enrollees to get those wages, >I don't know what they mean by "wages are well above average". >The strike in NY is about full retirement benefits at age 50. Transit [quoted text clipped - 9 lines] >work. Much more at his present job that put him through school. It would be >a cut in pay for him to follow that healthcare path. - - - - Just another albino black sheep <retrogrouch@comcast.net> wrote in message > >The influx of professionals don't undercut anything. Wages are paid and > >earned based on professional status and not origin. > > Nope . wages are a function of supply and demand. Correct. They are a function of supple and demand and everybody is treated the same without regard to origin. These are licensed profressionals. The opening is for the job which requires a license. These wages are posted and everyone is subject to that pay scale.Where that person comes from has no bering on what the wage is. Foreign workers come > and accept lower pay because its more than they can make at home. That doesn't earn them a license. They don't have to accept lower pay. They have the same pay as it is competitive and hospitals compete for by giving higher wages in those hospitals that have problems or are not competitive in the job market. There is a bounty of thousands of dollars to a person who refers a nurse and that nurse stays for one year. They > undercut market forces here that would lead to rising wages, which > would lead to more enrollees to get those wages, That is correct if "they" means licensed personnel, but that happens anyway if you only have a few nurses here and don't allow entry of foreign nurses then the pay scale would go up anyways with the few nurses here through competition so I agree with you. There are other issues such as patient nurse ratios that are mandated so the number of nurses is the determining factor and whether domestic production of nurses or foreign entry is not really the question. It is the number of nurses in the national pool that is the determinant of wages. These are not illegal residents so the foreign or not really doesn't apply as they are legal. It's just not true that foreign graduate professionals are making less than domestically trained personnel as they would just go hospital shopping. The hospitals are at a disadvantage as there is a shortage. This is a sellers market and not a buyers market. I would bet that the shortage is caused by the unattractive nature compared to other jobs that creates the shortage of healthcare workers here. I voice that by saying that there was a transfer of RN's away from hospitals and into more allied related jobs or home health. Some RN's simply left the field. I personally wouldn't mind earning less if I could have some help vs earning little higher wages without help. That only causes more problems. It's not simply wages but working conditions that apply also. >> Nope . wages are a function of supply and demand. >Correct. They are a function of supple and demand and everybody is treated >the same without regard to origin. In your dreams. A Filipino nurse escaping the Philippines will be happy to work for far less than a US native Union member nurse. Which is of course why health care providers work to get them work permits. - - - - Just another albino black sheep > >> Nope . wages are a function of supply and demand. > >Correct. They are a function of supple and demand and everybody is treated > >the same without regard to origin. > > In your dreams. A Filipino nurse escaping the Philippines will be > happy to work for far less than a US native Union member nurse. Not in my dreams but in reality. A filipino nurse is happy to work for less but the reality is they don't have to. Your premise is wrong. When I started in this field in the mid-70's there were no filipino nurses here and there was a large surplus of healthcare workers and so the pay was low. It was very hard to find a job because of competition. With DRG's and healthcare spending decreasing and hospital closings in the 90's job were still very competitive in order just to keep your job. Pay was bad. Most people left healthcare work. Today we have a shortage of workers and because of this the pay is better. We still have a shortage and foreign workers are filling the holes. Most healthcare workers are not union workers. Most hospitals have survey's of other hospital workers in order to keep pace with wages of it's workers in the area. I don't have to look for a higher paying job because the hospital will make adjustments to my pay in order to keep me at the hospital. This keeps people from leaving and going to another hospital. There is a shortage of workers and there is no need for filipinos or anyone else to work for less. It doesn't happen that way. Give me a list of those nurses working for less and I will tell them they can get more money working the same pay as other nurses and I will get a $2000 BONUS for each one of them that is hired. > Which is of course why health care providers work to get them work > permits. They have to have a license and they are not slaves. They can leave anytime they want. I have yet to see a nurse on a permit. Most are legal residents and or citizens. The ones who seek out the permit ones are the hositals who can not recruit nurses because they are not competitive in terms of region, working conditions, or salary. That is the exception and not the rule. Hospitals have closed and the ones that have remained are the competitive ones. > - - - - > Just another albino black sheep >They have to have a license and they are not slaves. They can leave anytime >they want. I have yet to see a nurse on a permit. Most are legal residents [quoted text clipped - 3 lines] >Hospitals have closed and the ones that have remained are the competitive >ones. I'll take your word on it. I'm merely a consumer, not a worker in the field. But I think we agree the system is incredibly screwed up from both our perspectives. - - - - Just another albino black sheep >> >> Nope . wages are a function of supply and demand. >> >Correct. They are a function of supple and demand and everybody is [quoted text clipped - 6 lines] > Not in my dreams but in reality. A filipino nurse is happy to work for less > but the reality is they don't have to. Your premise is wrong. His premise is correct and the reality is that becasue the H1B visa worker will work for less then the American worker is forced to work for less. > When I started in this field in the mid-70's there were no filipino nurses > here and there was a large surplus of healthcare workers and so the pay was > low. It was very hard to find a job because of competition. Then why did you invest in being a health care worker???? >With DRG's and > healthcare spending decreasing and hospital closings in the 90's job were > still very competitive in order just to keep your job. Pay was bad. Most > people left healthcare work. I don't recall any decrease in health care costs during the 90's and the "competition" for you was from large increases in the H1B system from the Republican congress. > Today we have a shortage of workers and because of this the pay is better. > We still have a shortage and foreign workers are filling the holes. If there is a shortage it is because the H1B system decreased the reward to investing in the education needed to be a health care worker. Republicanism is a self fulfilling prophecy. > Most healthcare workers are not union workers. Most hospitals have survey's > of other hospital workers in order to keep pace with wages of it's workers [quoted text clipped - 3 lines] > There is a shortage of workers and there is no need for filipinos or anyone > else to work for less. It doesn't happen that way. Your "employer" tells you how much the other employers are paying? Did your employer also tell you that Saddam blew up the twin towers? > Give me a list of those nurses working for less and I will tell them they > can get more money working the same pay as other nurses and I will get a > $2000 BONUS for each one of them that is hired. The H1B slave is tied to the current employer. If the slave gives the employer any crap then the slave is on the next boat back to whatever. >> Which is of course why health care providers work to get them work >> permits. The employers will screem there is a shortage of qualified labor until the people providing that labor are begging in the streets. > They have to have a license and they are not slaves. They can leave anytime > they want. And go right back to 3rd world poverty. > I have yet to see a nurse on a permit. Most are legal residents > and or citizens. The ones who seek out the permit ones are the hositals who > can not recruit nurses because they are not competitive in terms of region, > working conditions, or salary. That is the exception and not the rule. Those "competitive hospitals are the hospitals that are making big bucks for the "owners" and they are not the exception. And if your hospital pays good ages they will soon be history. > Hospitals have closed and the ones that have remained are the competitive > ones. Yep..... the ones that use the H1B's will survive and the ones that pay decent wages will go out of business. Signature"I know no safe depository of the ultimate powers of society but the people themselves; and if we think them not enlightened enough to exercise their control with a wholesome discretion, the remedy is not to take it from them, but to inform their discretion by education." - Thomas Jefferson http://GreaterVoice.org >That is correct if "they" means licensed personnel, but that happens anyway >if you only have a few nurses here and don't allow entry of foreign nurses [quoted text clipped - 3 lines] >factor and whether domestic production of nurses or foreign entry is not >really the question. But of course its the question. If nurses were experiencing rising wages more people would want to be nurses for the income. But the massive influx of work permit foreigners willing to work for less is keeping that market action from happening. >It is the number of nurses in the national pool that is >the determinant of wages. These are not illegal residents so the foreign or >not really doesn't apply as they are legal. On work permits bought and paid for and lobbied for by health care corporations. - - - - Just another albino black sheep > >That is correct if "they" means licensed personnel, but that happens anyway > >if you only have a few nurses here and don't allow entry of foreign nurses [quoted text clipped - 5 lines] > > But of course its the question. The question is the size of the available applicant pool. Nurses and other health profressionals require a license. A legal immigrant that has a license is as qualified as any other applicant. These are legal immigrants and have a right to be here. They are in the pool and whether you like it or not is not the issue. The issue is that they are here. Wages were lower before they were here because of the increased number of health workers. We reduced workers wages have increased. If nursing programs were to expand 10X then there would be a surplus of domestic nurses and the wages would go down again and the foreign nurses would not have a job. It is the number of workers in the pool that determines pay. If nurses were experiencing rising > wages more people would want to be nurses for the income. But the > massive influx of work permit foreigners willing to work for less is > keeping that market action from happening. "Massive" no. If there were a massive influx there would be no shortage and wages would be down again and there would be no opening like we have now. You totally ignore supply and demand and put a foreign spin on it. > >It is the number of nurses in the national pool that is > >the determinant of wages. These are not illegal residents so the foreign or > >not really doesn't apply as they are legal. > > On work permits bought and paid for and lobbied for by health care > corporations. I don't know what you mean by health care corporations. Most hospitals are non-profit and the for profit corporations are not the most positively viewed organizations. They are the minority. > - - - - > Just another albino black sheep >It's just not true that foreign graduate professionals are making less than >domestically trained personnel as they would just go hospital shopping. The >hospitals are at a disadvantage as there is a shortage. This is a sellers >market and not a buyers market. But a Calcutta degree does not have the same market value as a Univ. of Washington degree. You pretend these things are fungible. But they are not. You pretend the market is free and open and it is not. - - - - Just another albino black sheep > >It's just not true that foreign graduate professionals are making less than > >domestically trained personnel as they would just go hospital shopping. The [quoted text clipped - 4 lines] > of Washington degree. You pretend these things are fungible. But they > are not. You pretend the market is free and open and it is not. We are talking about hospital workers that need a state license to be able to work. The degree means nothing. The license is everything. The market is not free as you need a license. It is the license that qualifies you to be hired at those wages and whether you are a domestic worker, foreign or from mars means very little. You have a license and you shop around. I know of some foreign doctors who work as cab drivers. They don't have the license. > - - - - > Just another albino black sheep > >It's just not true that foreign graduate professionals are making less than > >domestically trained personnel as they would just go hospital shopping. The [quoted text clipped - 3 lines] > But a Calcutta degree does not have the same market value as a Univ. > of Washington degree. Hi, ??? Medical training today in many foreign countries is comparable to that in the USA. As it is in many technical fields. I'm afraid they days when the USA was the only place to learn are over. >...You pretend these things are fungible. But they > are not. You pretend the market is free and open and it is not. Doesn't a "free and open" market mean workers are free to seek jobs anywhere? And isn't it clear that by recruiting English speaking nurses from South Africa, India or the Philippines, US hospitals provide better care for their patients and at a lower cost? Do hospitals exist to provide jobs for doctors and nurses? Or to provide treatments and care for patients? ,,,,,,, _______________ooo___(_O O_)___ooo_______________ (_) jim blair (jeblair@wisc.edu) Madison Wisconsin USA. This message was brought to you using biodegradable binary bits, and 100% recycled bandwidth. For a good time call: http://www.geocities.com/capitolhill/4834 > > >It's just not true that foreign graduate professionals are making less > than [quoted text clipped - 17 lines] > Doesn't a "free and open" market mean workers are free to seek jobs > anywhere? It's not a free market for licensed professionals. One must obtain a license first and your education and qualifications must be evaluated by the state in allowing such qualifications to be accepted and on the next step which is testing for the exam. Once you pass the exam and have your license then you are in the same pool for those with the license and only experience is the variable. > And isn't it clear that by recruiting English speaking nurses from South > Africa, India or the Philippines, US hospitals provide better care for their > patients and at a lower cost? NO. The reason why recruiting is undertaken by some desparate organizations is not because foreign trained people "provide better care" or can be hired at a lower cost. The reason they do it is because nobody wants to work for them even after offering very high pay. Again there would be no need to go to the PI for help if there were a surplus of domestic workers. Hospitals want to hold on to their workers because they are scarse. The last thing they would do is hire cheap workers only to see them leave and go to another hospital. These recent foreign grads must be trained and it takes time. Patients would not put up with an entire hospital full of recent arrivals trying to get their US experience. Hospitals are very competitive on who attracts patients based on patient experiences. On the job teaching is a negative for the hospital until they get trained. It's a negative in production, and mistakes on patient care for the patient no matter whether it's foreign or domestic. Anybody that gets a new job knows this. Patient surveys are carried out all the time and asked about their experiences good and bad. We reduced training load from 6 to 3 new trainees because of patient complaints. Hospitals are service oriented like a hotel unless you are government run. > > > >It's just not true that foreign graduate professionals are making less > > than [quoted text clipped - 3 lines] > sellers > > > >market and not a buyers market. Robert: > > > But a Calcutta degree does not have the same market value as a Univ. > > > of Washington degree. jeb: > > Hi, > > > > ??? Medical training today in many foreign countries is comparable to that > > in the USA. As it is in many technical fields. > > I'm afraid the days when the USA was the only place to learn are over. > > >...You pretend these things are fungible. But they > > > are not. You pretend the market is free and open and it is not. ... > It's not a free market for licensed professionals. One must obtain a license > first and your education and qualifications must be evaluated by the state > in allowing such qualifications to be accepted and on the next step which is > testing for the exam. > Once you pass the exam and have your license then you are in the same pool > for those with the license and only experience is the variable. Hi, Some confusion here about who says what. I agree that there is not a free market in licensed professionals. But supply and demand still determines or at least influences wages. Wages for medical professionals (esp. nurses and pharmicists) are high (by any reasonable standard) because the supply is low relative to demand. So this is a good field for students to enter, and projections are that it will remain good for a generation at least. The shortages do result in two factors that blunt the upward pressure on the wages of US health care workers: importing foreign HC workers (esp. nurses) and outsourcing patients for foreign medical treatments. Sure immigrant nurses are paid the same as the other similar level nurses at a given US hospital, but the net effect of importing them is to "lower" (reduce the increase) in the wages of US born nurses. And when Americans go abroad for hospital care it lowers the demand for similar treatment in US hospitals. > > And isn't it clear that by recruiting English speaking nurses from South > > Africa, India or the Philippines, US hospitals provide better care for [quoted text clipped - 3 lines] > NO. The reason why recruiting is undertaken by some desparate organizations > is not because foreign trained people "provide better care" Er, it is not that the foreign nurses provide better care than US nurses. It is that the hospital provides better care than it would if those nurses were not present. Because if they were not available, they would not be replaced by US born nurses, because there are not enough of them. >.....or can be hired > at a lower cost. Again, it is not that the imports are paid less, but that the effect of importing them reduces the cost of medical care. >....The reason they do it is because nobody wants to work for > them even after offering very high pay. It is because there are not enough US born/trained to staff all US hospitals at the level thought necessary. > Again there would be no need to go to the PI for help if there were a > surplus of domestic workers. I agree. The shortage is the basis of the situation. And "domestic workers" here means licensed nurses. >.....Hospitals want to hold on to their workers > because they are scarse. Yes. >....The last thing they would do is hire cheap workers > only to see them leave and go to another hospital. I agree. One reason why they let nurses work flexable schedules and provide other perks. But ever rising demand means nurses get offers of more pay/better conditions somewhere else, no matter where they are now. > These recent foreign grads must be trained and it takes time. ??? Most already have the training, and getting them up to speed in a particular hospital is much faster than training a US nurse from high school. >.....Patients would > not put up with an entire hospital full of recent arrivals trying to get > their US experience. I think a sick patient just wants skilled treatment, and if they speak English, does not care that much if they are from Sweden or India or Minnesota or Indiana. Even my mother who was not very favorable towards foreigners, liked her doctor from India because she thought him to be very good. >....Hospitals are very competitive on who attracts patients > based on patient experiences. On the job teaching is a negative for the > hospital until they get trained. It's a negative in production, and mistakes > on patient care for the patient no matter whether it's foreign or domestic. I does not bother me when a student trainee is observing the doctor while I am being examined. I know that this is a good way to make the next generation of doctors better. > Anybody that gets a new job knows this. Patient surveys are carried out all > the time and asked about their experiences good and bad. We reduced training > load from 6 to 3 new trainees because of patient complaints. In Madison, my experience has been just 1 or 2 trainees. Maybe 6 would be too many. >....Hospitals are > service oriented like a hotel unless you are government run. But like any service, they don't have to try as hard to please when they are over capacity and have a waiting list. ,,,,,,, _______________ooo___(_O O_)___ooo_______________ (_) jim blair (jeblair@wisc.edu) Madison Wisconsin USA. This message was brought to you using biodegradable binary bits, and 100% recycled bandwidth. For a good time call: http://www.geocities.com/capitolhill/4834 "Jim Blair" <jeb@wisc.edu> wrote in message > The shortages do result in two factors that blunt the upward pressure on the > wages of US health care workers: importing foreign HC workers (esp. nurses) Not a real factor as many are not working with a working visa. Most are legal residents already and most are married to citizens. In regards to filipinos, if you ever go to a party and meet their husbands they are all filipino and most were sailors. The Navy had a huge impact on their coming here. After WWII it was a US property much like Puerto Rica is today. After independence PI citizens were allowed to join the Navy. Most filipinos live and work in US Navy port cities. Very few came here on a working visa with signed contracts. > and outsourcing patients for foreign medical treatments. Sure immigrant > nurses are paid the same as the other similar level nurses at a given US > hospital, but the net effect of importing them is to "lower" (reduce the > increase) in the wages of US born nurses. Importing, meaning a working visa is obtained when the US domestic supply is not there. There must be a shortage first in order to justify importation of foreign workers. Ask President Bush and on guest worker programs. It is the chicken and the egg argument. There is a shortage of nurses now and not before. The wages were low with many domestic workers and many left the field because it was so crowded and over supplied. It is because of the shortage that benefits went and wages went up. I know of one hospital that was so desperate it was getting visa worker nurses and it was located in the desert. It was not only nurses but every profession would not go there. Who wants to work in the desert? I don't know of any worker in my hospital that is working on a visa. And when Americans go abroad for > hospital care it lowers the demand for similar treatment in US hospitals. They go abroad for out of pocket surgeries and if half the country were to do this then yes it would have an impact. That that many so it doesn't have an impact. > > > And isn't it clear that by recruiting English speaking nurses from South > > > Africa, India or the Philippines, US hospitals provide better care for [quoted text clipped - 9 lines] > were not present. Because if they were not available, they would not be > replaced by US born nurses, because there are not enough of them. The hospital that was in the desert closed because they couldn't get enough of visa workers and the care suffered. You ignore the fact that these workers must be trained. They don't provide the same level of care. You are well aware of discrimination issues involving foreign workers. Some have strong accents and people have trouble understanding orders on the phone. In reality the preference is to hire domestic workers even now and hire foreign workers second. >Importing, meaning a working visa is obtained when the US domestic supply is >not there. There must be a shortage first in order to justify importation of >foreign workers. Ask President Bush and on guest worker programs. Computer programming is now a glutted field but yet computer programmers are being imported in mass under the H-1b and L-1 visas. Indeed, the special privilege that employers have in importing computer programmers -- on the theory of a labor shortage -- is what glutted this field. > >Importing, meaning a working visa is obtained when the US domestic supply is > >not there. There must be a shortage first in order to justify importation of [quoted text clipped - 4 lines] > special privilege that employers have in importing computer programmers > -- on the theory of a labor shortage -- is what glutted this field. Hi, I don't think the situations are analogous. With a few exceptions, health care providers must be physically present where the patient is. OK, so X-rays, MRI scans and some diagonistic data can be collected in Arkansas and interpreted in India, but most medical care requires physical contact. Unlike programming and other computer related "outsourcing" where the work can be done anywhere. I know a guy who designs and operates web pages for companies all over the country (now, worldwide). He lives in a ski area of Colorado because he is also a ski bum, but he could live anywhere he wants. Question: assuming there IS a "shortage of IT/programmers" what is the justification for bringing foreign ones HERE? Why not send the problems to them? ,,,,,,, _______________ooo___(_O O_)___ooo_______________ (_) jim blair (jeblair@wisc.edu) Madison Wisconsin USA. This message was brought to you using biodegradable binary bits, and 100% recycled bandwidth. For a good time call: http://www.geocities.com/capitolhill/4834 >>>Importing, meaning a working visa is obtained when the US domestic supply > [quoted text clipped - 18 lines] > where the patient is. OK, so X-rays, MRI scans and some diagonistic data > can be collected in Arkansas and interpreted in India, Can they be, really? Radiographic data must be interpreted in context with other data. When we look at staff at a wholly owned doctors office business, the majority appear to be clerical. Just how much margin can be carved off by outsourcing medical labor? Probably not much. The hive of a "retail" doctors office is designed to maximize utilizaiton of the most expensive resource. If people are serious about cutting medical costs, then the answer isn't longer lines of communications, but restructuring work flows in medical business. This includes standardizing and automating information flows, and rethinking scheduling. > but most medical care > requires physical contact. Unlike programming and other computer related > "outsourcing" where the work can be done anywhere. Some can, some cannot. Much IT work is remarkably site-specific. The remainder involves establishment of an artifical "site" for testing. > I know a guy who > designs and operates web pages for companies all over the country (now, > worldwide). He lives in a ski area of Colorado because he is also a ski > bum, but he could live anywhere he wants. Telecommuting isn't limited to IT work. > Question: assuming there IS a "shortage of IT/programmers" what is the > justification for bringing foreign ones HERE? Why not send the problems to > them? The question is: can you package the problem in such a way that it'll survive the journey? If so, the cost of implemementation probably isn't going to be the long pole in the tent anymore. It's pretty clear that the trend towards developing Bangalore as a center of technology is more about developing a tech culture base, and thereby a center of technology *consumption*, than developing a base for production. If the rationale of simply taking advantage of a wealth of PhD's is valid, why wasn't it done before? It was tried, and it failed. Around 1990-1995, many major corporations tried offshoring, and just failed. This may have been selection bias - the "important" work might have been left "onshore", while the doomed project were selected to be exported. Somewhere about 1996ish, the tendency was for tech worker impact on the organization to rise dramatically, from roughly 5-10% to much more. It's pretty clear that this move was pernicious. At (well) above 10%, you have to have a direct, bottom-line result from the investment. There are two ways to reflect this: investment in intellectual property ( which is very high risk). The other is rebilling labor to other customers. You can become a lawfirm, or a temp agency. Neither develops long term shareholder value. Neither reflects the tried-and-true R&D formula, in which R&D is used to develop products which sustain the company. But it reflected the models expected by the finance people of what you were to be doing. > ,,,,,,, > _______________ooo___(_O O_)___ooo_______________ [quoted text clipped - 3 lines] > binary bits, and 100% recycled bandwidth. For a good > time call: http://www.geocities.com/capitolhill/4834 -- Les Cargill >> With a few exceptions, health care providers must be physically present >> where the patient is. OK, so X-rays, MRI scans and some diagonistic data >> can be collected in Arkansas and interpreted in India, > > Can they be, really? Radiographic data must be interpreted in context with > other data. X-ray interpretation, especially in this era where most radiographs are digital, is routinely done off-shore. One of the most profitable is NightHawk, in Australia. The radiographs go there digitally and they are immediately interpreted. Australia was chosen because it's daytime there when it's night here, so their radiologists can work 9 to 5 and cover some of the greatest need - the multitude of US hospitals that have no night-time radiologist. > When we look at staff at a wholly owned doctors office business, > the majority appear to be clerical. Just how much margin can be carved off > by outsourcing medical labor? Probably not much. The > hive of a "retail" doctors office is designed to maximize > utilizaiton of the most expensive resource. There is no usefulness in outsourcing medical labor in the average-sized medical clinic in the US. > If people are serious about cutting medical costs, then the answer > isn't longer lines of communications, but restructuring work > flows in medical business. This includes standardizing and > automating information flows, and rethinking scheduling. Cutting medical costs in the US has little or nothing to do with decreasing labor costs or "lines of communication". It has everything to do with an increasing demand for expensive, high tech medical care, and providing that medical care for the patient TOMORROW. The solution isn't in labor cost, it's in rationing health care and making high tech diagnostic and therapeutic modalities less conveniently and readily available to US medical consumers. HMc "Howard McCollister" <nospam@nospam.net> wrote in message > Cutting medical costs in the US has little or nothing to do with decreasing > labor costs or "lines of communication". It has everything to do with an [quoted text clipped - 5 lines] > > HMc Agree with you there. I think most people on the outside looking in think that the cost comes from all the labor ie doctors, nurses etc. In reality it is the cost of high tech and pharmaceuticals. >>>With a few exceptions, health care providers must be physically present >>>where the patient is. OK, so X-rays, MRI scans and some diagonistic data [quoted text clipped - 10 lines] > of the greatest need - the multitude of US hospitals that have no night-time > radiologist. I understand that, but I'm still curious as to what the real economics of this are. I don't see either of doubliing of radiographic capacity nor cost of radiography as a significant bottleneck, and the risk of miscommunications of results seems higher than the benefeit. Of course, we dont' have any real numbers to work from... >>When we look at staff at a wholly owned doctors office business, >>the majority appear to be clerical. Just how much margin can be carved off [quoted text clipped - 4 lines] > There is no usefulness in outsourcing medical labor in the average-sized > medical clinic in the US. I wouldn't think so. There might be utility in normalizing the data flow for billing, for example. I suspect that doens't happen for other reasons. >>If people are serious about cutting medical costs, then the answer >>isn't longer lines of communications, but restructuring work [quoted text clipped - 5 lines] > increasing demand for expensive, high tech medical care, and providing that > medical care for the patient TOMORROW. I presume that this is economically not-justifiable, then? It's pretty clear that surgery is abhorrently expensive, and that any 'high-tech' solutions have to justify themselves in terms of reducing dependence on surgery. I don't see how an MRI scan can possibly be more expensive than an exploratory. The remainder becomes an exercise in financing. > The solution isn't in labor cost, > it's in rationing health care and making high tech diagnostic and > therapeutic modalities less conveniently and readily available to US medical > consumers. So what's the bottleneck there? All other technology vending has adapted to a sort of self-flensing pyre of relentless cost reduction. I suspect the hidden element is simply liability insurance cost for practitioners. That, or just the classic sloppy software engineering horror stories from various disasters. > HMc -- Les Cargill >> X-ray interpretation, especially in this era where most radiographs are >> digital, is routinely done off-shore. One of the most profitable is [quoted text clipped - 9 lines] > bottleneck, and the risk of miscommunications of results seems > higher than the benefeit. 24/7 radiology coverage is expensive - it's cheaper for a hospital to contract with Nighthawk to read xrays after a US radiologists's normal working hours than it is to pay for that local radiologist to be available to read them. In other cases, radiology groups that provide xray coverage for a hospital don't want to be on call, so they don't provide for anyone in their own group to read xrays after hours and force the hospital to find that coverage elsewhere - in Australia, for example. Of course, digital radiographs could be read by any radiologist with a modem and a DICOM monitor, but in most cases Nighthawk is cheaper than US radiologists providing the same coverage. >> Cutting medical costs in the US has little or nothing to do with >> decreasing labor costs or "lines of communication". It has everything to >> do with an increasing demand for expensive, high tech medical care, and >> providing that medical care for the patient TOMORROW. > > I presume that this is economically not-justifiable, then? That's up to the US consumer. As long as they're willing to pay for their MRI scan to be done tomorrow at an MRI scanner 5 blocks from their house instead of 4 weeks from now at a scanner 180 miles away in the next province, then they must deem it economically justifiable. What's NOT justifiable is for them to expect/demand that level of service then bitch about the high cost of health care. > It's pretty clear that surgery is abhorrently expensive, and that > any 'high-tech' solutions have to justify themselves in terms > of reducing dependence on surgery. A very substantial part of that expensive "high tech" solution is IN surgery, however. Otherwise yes, the premise for a CT scan as standard of care for everybody with suspected appendicitis is to avoid sending that oft-quoted 25% of patients who DON'T have it to the operating room. Supposedly, that's economically justifiable as a process. HMc > >>Computer programming is now a glutted field but yet computer programmers > >>are being imported in mass under the H-1b and L-1 visas. Indeed, the [quoted text clipped - 11 lines] > Can they be, really? Radiographic data must be interpreted in > context with other data. Hi, In addition to Nighthawk in Australia, I read about Pap (?) smears being digitized, and sent to experts in India for rapid interpertation. They require a skilled expert to decide if one indicates a positive hit for cancer. Some US women have died because their Pap was mis-read. So some hospitals and doctors outsource the data and get more accurate results faster and cheaper than if they waited for the few overworked US experts did the job. So is this "outsourcing" a GOOD thing? Would it be better to have US workers do the job, even if it means waiting longer? I assume that some day an electronic scanner and data processing program will be able to provide an even faster, more accurate, and cheaper evaluation of a Pap test. If (when?) this happens, it will have the same effect as the outsourcing, only more so. Another example of where oursourcing and new technology have the same effect. > When we look at staff at a wholly owned doctors office business, > the majority appear to be clerical. Just how much margin can be > carved off by outsourcing medical labor? Probably not much. The > hive of a "retail" doctors office is designed to maximize > utilizaiton of the most expensive resource. It is not only cost, but even more important is speed and accuracy. > If people are serious about cutting medical costs, then the answer > isn't longer lines of communications, At the speed of light, office-to-lab down the hall is not a "longer line of commmunication" than office-to-lab in India. >...but restructuring work > flows in medical business. This includes standardizing and > automating information flows, and rethinking scheduling. And standardizing drug "names" with codes, etc. ,,,,,,, _______________ooo___(_O O_)___ooo_______________ (_) jim blair (jeblair@wisc.edu) Madison Wisconsin USA. This message was brought to you using biodegradable binary bits, and 100% recycled bandwidth. For a good time call: http://www.geocities.com/capitolhill/4834 >>>>Computer programming is now a glutted field but yet computer programmers >>>>are being imported in mass under the H-1b and L-1 visas. Indeed, the [quoted text clipped - 21 lines] > They require a skilled expert to decide if one indicates a positive hit for > cancer. Some US women have died because their Pap was mis-read. Right. The cost of one mis-read completely outstrips I-dunno-howmany correct reads at reduced cost ( whatever cost turns out to be - time, money, whatever). > So some hospitals and doctors outsource the data and get more accurate > results faster and cheaper than if they waited for the few overworked US > experts did the job. And that is fine, so long as it works - so long as there actually is a comparative advantage. > So is this "outsourcing" a GOOD thing? Would it be better to have US > workers do the job, even if it means waiting longer? If there is an actual comparative advantage, then it is better. If it's just management consultant razzle-dazzle, or some sort of misguided colonialist impulse, then it's not. > I assume that some day an electronic scanner and data processing program > will be able to provide an even faster, more accurate, and cheaper > evaluation of a Pap test. If (when?) this happens, it will have the same > effect as the outsourcing, only more so. Another example of where > oursourcing and new technology have the same effect. True, so long as it works. "It works" is not an easy thing. Salami slicing the Veracity of machines is way too much fun, I gotta say. >>When we look at staff at a wholly owned doctors office business, >>the majority appear to be clerical. Just how much margin can be [quoted text clipped - 3 lines] > > It is not only cost, but even more important is speed and accuracy. Neither speed nor accuracy can be improved by longer communications lines. Those must be offset by some other factor. Sounds from here like the factor is simple human availability, enanced by the fine educational opportunities on the Subcontinent. But all the VC guys with Subcontinental surnames in Silicon Valley are not reading X-rays, are they? They're making a whole lot more money.... >>If people are serious about cutting medical costs, then the answer >>isn't longer lines of communications, > > At the speed of light, office-to-lab down the hall is not a "longer line of > commmunication" than office-to-lab in India. Yes it is. I wish it were otherwise, but *absent some serious engineering to manage the process of managing the data*, it can be a whole lot. I understand that there's a great deal of formalism in medical data handling, but errors still happen, frequently. There's an entire industry of law-sharks that feed quite well on this. >>...but restructuring work >>flows in medical business. This includes standardizing and >>automating information flows, and rethinking scheduling. > > And standardizing drug "names" with codes, etc. Yup. > ,,,,,,, > _______________ooo___(_O O_)___ooo_______________ [quoted text clipped - 3 lines] > binary bits, and 100% recycled bandwidth. For a good > time call: http://www.geocities.com/capitolhill/4834 -- Les Cargill > Neither speed nor accuracy can be improved by longer > communications lines. Those must be offset by some other factor. [quoted text clipped - 19 lines] > frequently. There's an entire industry of law-sharks that > feed quite well on this. Having a radiologist on call at night, physically on the premises, is one thing, but most hospitals simply can't afford that. Next best solution, since the majority of radiographs are digital these days, is transmitting that radiograph data electronically during those after-hours periods. This is what the majority of hospitals do. They may have their own radiologists reading them on their computers at home, they may contract with another US-based radiology group in another city (or another state), or they may outsource that data offshore. In any of those cases, the engineering required is the same since all it requires is a broadband internet connection and a telephone and there is no difference between sending the data across town, or across the Pacific ocean. It is entirely about the quality and cost of the professional services, has nothing to do with the engineering. HMc >I would bet that the shortage is caused by the unattractive nature compared >to other jobs that creates the shortage of healthcare workers here. I voice >that by saying that there was a transfer of RN's away from hospitals and >into more allied related jobs or home health. Some RN's simply left the >field. Garbage men get paid high wages because the work is distasteful to most people. If nurses earned a fair wage for what they do they'd be paid more. But health care corporations are under staffing, underpaying, and lobbying for guest labor and making the profession unappealing. >I personally wouldn't mind earning less if I could have some help vs earning >little higher wages without help. That only causes more problems. It's not >simply wages but working conditions that apply also. Yep but see when there really is a worker shortage employers actually improve working conditions to draw workers. Look at high tech firms in the 90s. there was a huge shortage and companies competed on benefits, working conditions and perks. Hospitals are actually in a race to the bottom. - - - - Just another albino black sheep > >I would bet that the shortage is caused by the unattractive nature compared > >to other jobs that creates the shortage of healthcare workers here. I voice [quoted text clipped - 7 lines] > underpaying, and lobbying for guest labor and making the profession > unappealing. Speaking of corporations that pay high, those are the ones who like to get what they pay for meaning they work your butt into the ground but you do get good pay. Working conditions are also important and not just simpy pay. They pay nurses well but they get rid of support staff and the nurse does everything with very little help. sheep > I don't know if anyone else has noticed this, but every time I open > the want ads, the amount of job openings in the health care field [quoted text clipped - 6 lines] > openings is because of RNs retiring or quitting their jobs due to low > pay... Where's that? I'm moving there. I'm in nursing school now, and we've been told that on graduation we can expect to make about 18 bucks an hour here in central NC, though the pay increases quite a lot after one to three years. --Patti >> I don't know if anyone else has noticed this, but every >> time I open [quoted text clipped - 24 lines] > > --Patti The pay is a lot higher in high rent areas...but not enough to compensate for the high rent. An RN here in the SF bay area gets about 35 dollars an hour... the next step up, a 'nurse practitioner' 60 to 80 dollars an hour. A one bedroom apt here though rents for 1500 dollars in an older building, 2,000 dollars and up in a newer or high rise building. The demand for RN's however will go up fast. there is already a shortage. My advice, get some added qualifications and skill sets to add to your resume. You have made a good career choice. that work cannot be moved offshore at least. Phil Scott > >> I don't know if anyone else has noticed this, but every > >> time I open [quoted text clipped - 42 lines] > > Phil Scott so a nurse practitioner working only 40 hrs a week at $80/hr ===> $167K a year, and with all the benefits paid for!! no malpractice insurance either... so is it true then that nurses are making more than doctors??? i know doctors are not hourly workers so they don't get paid by the hour... no wonder nursing schools are full... > so a nurse practitioner working only 40 hrs a week at $80/hr ===> $167K > a year, and with all the benefits paid for!! no malpractice insurance > either... so is it true then that nurses are making more than > doctors??? $167K is highly unlikely. A typical Nurse Practitioner or Physician Assistant with experience will be in the neighborhood of $75,000 - $85,000 per year. Might be a little higher on the coasts. Some specialized PA's, such as Orthopedic PA's might do considerably better, but even in that circumstance, $167,000 per year would be highly unusual. HMc >> so a nurse practitioner working only 40 hrs a week at >> $80/hr ===> $167K [quoted text clipped - 11 lines] > that circumstance, $167,000 per year would be highly > unusual. The nurse practitioner I met in 1995, 10 years ago, was getting 65 dollars an hour. Physicians assistant might describe a less skilled person in some areas. Phil Scott > HMc >> $167K is highly unlikely. A typical Nurse Practitioner or Physician >> Assistant with experience will be in the neighborhood of $75,000 - [quoted text clipped - 5 lines] > an hour. Physicians assistant might describe a less skilled person in > some areas. Highly unlikely. Certainly so for a Nurse Practitioner in clinical practice. PA's and NP's in clinical practice are basically on the same pay scale for primary care specialties. The money for "physician extenders" is in the surgical specialities and it is less common to find NP's in the operating room. Generally, Physician Assistants have a higher median salary than Nurse Practitioners. HMc > >> $167K is highly unlikely. A typical Nurse Practitioner or Physician > >> Assistant with experience will be in the neighborhood of $75,000 - [quoted text clipped - 15 lines] > > HMc Aren't nurse practitioners more educated than physician assistants? I've seen physician assistants who have just a bachelor's degree, whereas every nurse practitioner I know holds a master's degree. Besides, it seems that a nurse practitioner has more autonomy than a physician assistant. A nurse practitioner can set up shop anywhere by themselves, compared to a physician assistant who - by definition - assists a physician and is required by law to be supervised by a physician. I know many pharmacies will not honor a prescription written by a physician assistant unless it's countersigned by a supervising physician. Anyhow, I believe that if a patient wants to see a doctor and all they get is an assistant, then maybe the patient or whoever pays the bill should get a hefty discount (there is a big difference between a real M.D. and a less educated assistant, and everybody knows it...) > Aren't nurse practitioners more educated than physician assistants? > I've seen physician assistants who have just a bachelor's degree, [quoted text clipped - 10 lines] > between a real M.D. and a less educated assistant, and everybody knows > it...) There's little doubt that four years of med school plus three years of residency provides greater education than two years of NP school beyond a bachelor's degree. The rules governing NP practice vary state by state. The boards of nursing in each state set the licensure requirements and make rules regarding standard nursing practice, and also rules governing advanced practice nurses (like whether NPs can write prescriptions with or without supervision, and whether there are limitations to their Rx rights). Here in NC, NPs can write Rx under the supervision of a doc. The doc's name is on their Rx pad, but he/she doesn't have to sign. There are a few states that don't require NPs to have any physician supervision, and in other states they can't write scrips at all. PAs and other health pros aren't governed by the state boards of nursing. I'm not sure whose bailiwick that is, or what the rules are in their regard. --Patti > > Aren't nurse practitioners more educated than physician assistants? > > I've seen physician assistants who have just a bachelor's degree, [quoted text clipped - 28 lines] > > --Patti For comparison. They also actively seek summer replacements. The north is a fantastic for single women; and for kids. http://www.hlthss.gov.nt.ca/Careers/Nurses/nursejobs.asp >> >> $167K is highly unlikely. A typical Nurse Practitioner or Physician >> >> Assistant with experience will be in the neighborhood of $75,000 - [quoted text clipped - 37 lines] > between a real M.D. and a less educated assistant, and everybody knows > it...) Some states do require an advanced degree (MS) to be licensed as an NP. That doesn't translate to more salary, however. Nurse Practitioners are almost universally relegated to primary care roles since that's about the only training they get, whereas PAs do virtually anything in medicine - their training includes rotations in all of the major specialities. The scope of the PA's license generally encompasses anything their supervising physician is willing to accept responsibility for. NP's are more rigidly limited by their license. It would be unusual to ever find an NP in the Emergency Department taking primary care of emergencies, or in the Operating Room, for example, but those are common roles for PA's. And as is true in all of medicine, procedural specialties are more highly reimbursed and consequently PA's, especially surgical PA's, tend to get paid more than NP's, who are primary care only, even if they set up their own independant practice if that's allowed by their state. Most insurance companies don't pay as much for a patient being cared for by a PA or NP as they do for seeing a real doctor in a primary care role. And my PA can't bill as high a surgical assist fee from some (not all) insurance companies as one of my partner's can. The difference, if there is one, is not that great, however. An MD assistant would bill (or insurance companies typically reimburse) 17% of the surgeon's fee, whereas a PA might only be able to bill 12-15%. Anyway, that direct reimbursement doesn't represent my PA's real value to me - her value is that I can scrub out and start the next case while she is closing the first one, or that she can see my post-op patients (which we don't get paid for) which frees my schedule to see new consults. These are not things that a NP could do for me. The rules of practice/scope of license also vary by state. In most, neither PA's nor NPs have to have their orders or prescriptions co-signed. HMc > Some states do require an advanced degree (MS) to be licensed as an NP. > That doesn't translate to more salary, however. Nurse Practitioners are [quoted text clipped - 28 lines] > > HMc By the way, there are other areas of Advanced Practice Nursing beyond Nurse Practitioner. Perhaps the best-known of these are Certified Registered Nurse Anesthetists (CRNA). They are a different kettle of fish altogether. In many states, they (like NP's) can practice independantly and don't require physician supervision. *Unlike* NP's it would not be even remotely unusual for a CRNA to be getting paid well over $100,000 per year. HMc > > Some states do require an advanced degree (MS) to be licensed as an NP. > > That doesn't translate to more salary, however. Nurse Practitioners are [quoted text clipped - 37 lines] > > HMc And then there are the real heroes: the nurse's who ran the Arctic nursing stations prior to the 80s. They did everything. I mean "everything", and were scathingly contemptuous of the newly-minted physicians doing a rotation in the north for northern services who would be flown in for clinics a week out of 52. I've seen those young men examining a patient, with the nurse watching them, and then privately and desperately asking her what he should do and how he should do it. Those women were formidable. They had it all over the physicians, but for pay, and status. Now: http://www.wildmed.com/newsletter/on_his_own.html > And then there are the real heroes: the nurse's who ran the Arctic > nursing stations prior to the 80s. They did everything. I mean [quoted text clipped - 5 lines] > should do it. Those women were formidable. They had it all over the > physicians, but for pay, and status. Sure. Practical knowledge/experience is often more important than formal education/theoretical knowledge. That scenario has numerous corollaries in a wide variety of professions over hundreds of years; the Platoon Sergeant vs his brand-new 2nd Lieutenant, the experienced surgical PA vs his/her supervising surgeon just out of residency. Nothing new or particularly revelatory about any of that. HMc > > And then there are the real heroes: the nurse's who ran the Arctic > > nursing stations prior to the 80s. They did everything. I mean [quoted text clipped - 14 lines] > > HMc When it comes to new techniques and both are inexperienced then education and theoretical knowledge is very much relevant. Unfortunately you run into "you can't teach old dogs new tricks" comes into place. Experience vs evidenced based medicine is at odds. As a teacher, I have problem with both groups and can see the good and the bad from both. When something new comes along I have trouble with the old experienced people picking it up and when something classically old is seen then the inexperienced have trouble seeing it. > When it comes to new techniques and both are inexperienced then education > and theoretical knowledge is very much relevant. [quoted text clipped - 6 lines] > seen > then the inexperienced have trouble seeing it. Yes. Thank god for you Robert. You're the glue that holds the whole system and its benighted participants together. HMc > > When it comes to new techniques and both are inexperienced then education > > and theoretical knowledge is very much relevant. [quoted text clipped - 11 lines] > > HMc Just saying some of us get it from all sides. The young have the excuse of being inexperienced and the old are just buying time to retire and are on cruise control. >>When it comes to new techniques and both are inexperienced then education >>and theoretical knowledge is very much relevant. [quoted text clipped - 11 lines] > > HMc LOL! Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > >>When it comes to new techniques and both are inexperienced then education > >>and theoretical knowledge is very much relevant. [quoted text clipped - 15 lines] > > Steve It's too bad I don't work for a doctor or dentist. >>>>When it comes to new techniques and both are inexperienced then > [quoted text clipped - 29 lines] > > It's too bad I don't work for a doctor or dentist. As a profession, the stereotype is that dentists are pretty pathetic as employers. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > > >>When it comes to new techniques and both are inexperienced then > education [quoted text clipped - 21 lines] > > It's too bad I don't work for a doctor or dentist. Don't work for a doctor or dentist. My neighbor is a physician, his wife runs the office, and they've just gone through 6 medical assistants in 5 months. The suspicion is they're trying to avoid giving their employees benefits. > > > >>When it comes to new techniques and both are inexperienced then > > education [quoted text clipped - 26 lines] > assistants in 5 months. The suspicion is they're trying to avoid giving > their employees benefits. I think they were forced into laughing at bad jokes is what really did it. > > And then there are the real heroes: the nurse's who ran the Arctic > > nursing stations prior to the 80s. They did everything. I mean [quoted text clipped - 14 lines] > > HMc Interesting analogy: the military and medicine. Not part of this discussion but also interesting is that all of this, my story and the web story--the Twin Otter, the pilot, the medivac nurse, the nursing station nurse, and a third party to accompany, equipment, nursing station staff, flight deadhead: all paid for by Canada's universal healthcare system. > Interesting analogy: the military and medicine. Hierarchies exist everywhere, in almost every field of human endeavor. Occasional anomalies within those hierarchies are inevitable. HMc >>> >> $167K is highly unlikely. A typical Nurse Practitioner or Physician >>> >> Assistant with experience will be in the neighborhood of $75,000 - [quoted text clipped - 43 lines] >training they get, whereas PAs do virtually anything in medicine - their >training includes rotations in all of the major specialities. A member of my family is a PA. The first courses in her PA program (anatomy etc) were taken alongside the "real" medical students in medical school and were a little fast-paced, but her "rotations" during the second year were a joke. It consisted of keeping a journal while observing other people - for example, the orthopedic rotation was basically standing way in the back of the room (lest she got sprayed with blood and bone fragments or yelled at/insulted by the cranky old surgeon). Most of the time she didn't even get to talk to the doctor until the "final exam" where she sat down and he asked her where she went school, a few rudimentary questions about what she'd learned, what she thought of his office layout and staff, etc. But she did get to help deliver a baby one time, and sew up some kid who fell off the bike. At any rate, a PA's rotation is better than watching a video, but it's nothing like a med student's rotation or internship... Where she "practices" now, she does mostly physicals and colds and earaches and such. If somebody gets really "sick", she tells them to see the doctor... By law she has recertify every six years, and every day she has to fill out some log for her M.D. boss to review and sign before she goes home. It's a good easy job, because all the hard stuff gets passed on to your boss!!!! > On 11 Dec 2005 09:46:05 -0600, "Howard McCollister" > A member of my family is a PA. The first courses in her PA program > (anatomy etc) were taken alongside the "real" medical students in [quoted text clipped - 16 lines] > before she goes home. It's a good easy job, because all the hard stuff > gets passed on to your boss!!!! Just like any educational pursuit, there are good schools and bad schools. It appears that your family member went to one of the bad ones if that's representative of her experience. In good PA training programs, the students do the same 8 week rotations in the primary clerkship areas that the medical students do, and the duties that they are assigned are the same as the medical students. We have two PAs in our practice. Their duties and responsibilities bear no resemblance whatsoever to what you describe above, except the part about the hard stuff getting passed on to the boss. HMc >> On 11 Dec 2005 09:46:05 -0600, "Howard McCollister" > [quoted text clipped - 27 lines] >responsibilities bear no resemblance whatsoever to what you describe above, >except the part about the hard stuff getting passed on to the boss. Well, the PA I spoke of went to a fairly selective school. It seems there is quite a bit of variation in the PA business, and the only thing visible to the public is the fact that they passed their certification exam (which I understand has a high pass rate even among graduates of "lesser" schools). Let's just hope that our health care costs will go down because of these PAs taking care of more patients in routine and simple cases, and let's hope that doctors won't get lazy and insurance companies won't get greedy and tell people to see a PA whenever they're sick. I personally like PAs but a real doctor is always better (especially when a consumer is paying to see a doctor). > while observing other people - for example, the orthopedic rotation > was basically standing way in the back of the room (lest she got > sprayed with blood and bone fragments or yelled at/insulted by the > cranky old surgeon). Most of the time she didn't even get to talk to > the doctor until the "final exam" where she sat down and he I know Mark was talking about stereotypes but in that example lets just say that surgeons are somewhat different from other doctors. A hospital makes most of it's money from surgeries and surgeons basically get to run the hospital. This tends to give some surgeons "an attitude" and although this is an n=1, most of the insults have come from surgeons. As to the stereotypes most good surgeons are known for their hands and not their brains. This was told to me by another doctor friend early on. We had one family member have surgery done on the wrong foot and all the surgeon could say was that the foot would have needed surgery in the future anyways. There was a PA who recommended putting a mark on the body part you want surgery done on before surgery to let the surgeon know which body part needs the surgery. Most surgeons are pretty decent but it only takes a few to spoil it for the rest. > There was a PA who recommended putting a mark on the body part you > want surgery done on before surgery to let the surgeon know which body part > needs the surgery. It's my understanding that this (patient marking his/her operative site) is standard practice at many hospitals now. http://www.jcaho.org/about+us/news+letters/sentinel+event+alert/sea_6.htm >> while observing other people - for example, the orthopedic rotation >> was basically standing way in the back of the room (lest she got [quoted text clipped - 17 lines] >Most surgeons are pretty decent but it only takes a few to spoil it for the >rest. I knew a woman who passed away not long ago because somebody had left a sponge in her chest (problem was discovered by her regular doctor, but too late). Maybe somebody in the operating room forgot to count. > I knew a woman who passed away not long ago because somebody had left > a sponge in her chest (problem was discovered by her regular doctor, > but too late). Maybe somebody in the operating room forgot to count. JCAHO keeps statistics on how this happens. More likely they counted incorrectly, either before or after (I believe they're supposed to count once before and twice after), or they counted correctly but were unsure of themselves and were afraid to tell the surgeon. There's also a study on the relationship between OR errors like this and the reluctance of OR staff (techs and nurses) to bring problems to the attention of the surgeon. If I recall correctly, the study found that surgeons who make OR staff feel entirely comfortable reporting potential errors are far less likely to sew up a patient with foreign bodies inside. I was exposed to the journal article in a nursing school class, but I don't recall the title and I can't find it on Google Scholar. Here's a link including some statistics on sponge/instrument errors. http://64.233.161.104/search?q=cache:WQbYXed13fYJ:www.patientsafety.gov/TIPS/Doc s/TIPS_SeptOct04.doc+protocol+sponge+instrument+count&hl=en > My advice, get some added qualifications and skill sets to add > to your resume. You have made a good career choice. that > work cannot be moved offshore at least. Don't bet on that: http://www.hindu.com/thehindu/holnus/006200512101115.htm >> My advice, get some added qualifications and skill sets to >> add [quoted text clipped - 5 lines] > > http://www.hindu.com/thehindu/holnus/006200512101115.htm fascinatin' ain't it? Engineering has already gone that way extensively... lately though there has been a faint reversal (not much but some), of hiring back out of work US engineers. I guess the powers that be have decided that they didnt want to have to rely exclusively on the Islamic/ muslim nations to build and operate our infrastructure given. These seem happy with depending on communist china to build much of our military electronics. Thats hot. This fast developing trend of sending US medical patients to india and china will increase dramatically as our own US govt cannot afford pay its lush pensions and 100% medical care to a retired civil service that outnumbers working civil service two to three to one. Already behind the scenes in most state of calif offices is an army of green card people (not at the front desks where they meet the public, but in the back offices..). It will not however be possible to fly that much long term care to India, so the demand for nurses in the US will continue to increase...but yes, this move to outsource patients will cut into their pay rates...also there is little impediment to using green card nurses in the US, that is already pervasively comon, mostly from the Philipines as it stands now. My personal solution after getting an up close and personal look at what US medicine has to offer ..was to study up on preventive and restorative measures and avoid the entire disaster as long as possible. That has worked out well so far, at age 64 I am one of the worlds oldest flat track motorcycle racers...and sharp too. Phil Scott > > My advice, get some added qualifications and skill sets to add > > to your resume. You have made a good career c |
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