Monday, January 24, 2022

13% of US hospitals critically understaffed. Let's explore how this came to be, and what it might portend

Becker's Hospital Review provided the numbers regarding medical understaffing.

No matter how the hospitals, states and federal government try to spin it, and no matter how much crazy money is paid to travelling, temporary doctors, nurses or others to move them around to plug a few holes, the fact remains that a huge number of people have stopped working as medical professionals.

You cannot simply press some buttons and turn out new doctors, nurses, and various therapists no matter how many robots or 3D printers you have.

It takes a bare minimum of 11 years after high school to educate a doctor, and for a super specialist, it can take up to about 18 years.

In general, it take at least 3 years post high school to train a nurse, but most nurses now have a college degree and often some postgraduate education.

The federal health bureaucracy did not want to coin extra doctors or nurses, based on the bean-counter theory that each doctor generated a certain amount of tests, radiology procedures etc.--in other words, each doctor generates a few million dollars in medical costs yearly, much of which were costs to Medicare and Medicaid. Similarly, the system did not want extra hospital beds to exist, on the bean-counter theory that more beds will lead to more hospital admissions and costs to HHS.

Thus the US government has deliberately destroyed whatever medical surge capacity it may have had.  Furthermore, by destroying individual initiative and autonomy on the job, and turning doctors and nurses into obedient typists, it made  jobs in healthcare considerably less rewarding--resulting in many career changes and early retirements. 

The vaccine mandates for healthcare workers were simply the icing on the healthcare worker shortage cake. 

You can't tell me the economists in the Department of Health and Human Services weren't aware this would happen.  They deliberately made the job unpleasant by getting rid of transcriptionists.  A decent electronic medical record (EMR) system would not have required doctors or scribes (a new profession of paraprofessionals who type into the electronic medical record during doctor visits) to do all the typing.  The new EMRs could have been crafted to include dictated notes, just as the old medical chart incorporated dications fairly seamlessly into the record.  But they did not want to encourage free texting of the patient history--they wanted to standardize every visit.

The result was the dehumanization of the patient record, the loss of detail in the record, the degrading of patient care and the mechanization of the medical provider.

Who thought these were good things? I have a few hypotheses:

  • Those who wanted to get rid of the doctor patient relationship and have robots take over medical care?  Did they think that pitting patients and medical providers against each other during the Pandemic would further this goal?
  • Those who wanted to use the EMR for surveillance?
  • Those who thought reducing life expectancy would reduce costs to the federal government?
  • Those who believe in technocracy as if it is a religion, unable to see its inhumanity?

Did these people see the loss of doctors, nurses and other medical professionals over the vaccine mandates as another net good, reducing costs?

Who are these people?  Can they be identified?  Whose edicts are they carrying out? What is the end game?  

OTOH, their trashing of what was once the world's premier medical system does open up possibilities to create something better.

  • What do we need in order to rebuild a medical system that caters to the needs of people? 
  • Is the EMR a good tradeoff between efficiency and privacy, or should we go back to paper charts and take our patients' medical concerns off the internet?  
  • What do doctors and nurses need to learn during their training that is currently missing? 

A lot of people are asking these questions, and I welcome your input. 


Anonymous said...

What bothers me is that electronic records can't be made secure, so each person needs to assume they get read by government, foreign countries, coworkers, neighbors and families.

I've known people in law enforcement who access their police databases to read about former classmates, friends, etc. Same thing will happen with all the health records if/when they get on the dark web.

More concerning is that psychiatric and talk-therapy records are also electronic now. At least the Watergate break-in required physical access - they found a way around that difficulty.

Anonymous said...

I remember being asked by a medical assistant how much caffeine and alcohol I drink during a routine follow-up visit with my oncologist. I thought it was an odd question, being that I had been followed by this doctor for about 5 years by then. I ased the doctor about the random question, wondering if he was doing some sort of study. He brushed it off, saying that the EMR asked random questions from time to time. My first thought: Surveillance. Surveillance without my consent. Are we supposed to trust that the snoopers are truly deidentifying our private health information? Yeah, right. I wonder how much money the EMR vendor gets paid to share data with whoever wants it.

I can't say I would want to go back to deciphering doctor's (or nurses') handwriting in a paper chart, but I like the idea of a dictated section. In the end, I would want the patients' notes off the Internet, however that can be done.