I don't see a solution that puts a swift end to this. The power asymmetry between employers and workers is so vast that situations like these are inevitable.

We can't continue to live in this fantasy where companies have so much power over workers and their futures. But changing this involves organizing labor, which is deeply stigmatized in the US.

Doctors are the strongest guild in USA. They have the legal power to enforce a chronic shortage of doctors. That's why why PAs were invented.

You're proving my point. If one of the most powerful labor groups in the economy is being subjected to ruthless firing for speaking out on critical health issues during a national crisis, then what does that say about the state of labor in the US in general?

Are they (Doctors) misunderstanding the environment? Surely in this particular case, firing the Doctor looks bad on the hospital. Leverage/PR is with the Doctor. Perhaps I am reading it wrong.

Negative PR is a poor tool to bring about meaningful change as it works very inconsistently. Zoom, Facebook, Equifax, etc. have all experienced sustained negative PR with little effect to their bottom line or operational structure. PR is also purchased, and companies spend heavily to rehab their image online.

Hospitals also are fairly well insulated from negative PR as well since they don't operate in a free market, which prevents patients from being able to choose to go elsewhere.

That the lack of ppe can't be that bad.

A cynical would say.

I think you're probably right about the guild part.

The chronic shortage of doctors? Well, that's because they're perhaps the strongest guild. The AMA puts a cap on the supply of doctors (via # of residency slots they allow). The PAs were invented so that another class of workers could do the work of doctors without jeopardizing the doctors' pay or status.

It appears that you are stating the exact same as the above comment, no?

I think the parent comment makes it seem like the guild is addressing a problem external to itself. My comment simply makes the causal link that the guild is solving a problem of its own making. A simpler solution would perhaps be to end/reduce the AMA monopoly. In that case, doctors would make less (as they do in the rest of the world), but the supply of doctors would be much higher.

I disagree - I think the comment is not implying the guild is addressing any problem at all and makes it quite clear that the guild is the cause of the problem.

They are not saying that doctors invented PAs to solve the chronic shortage, they're saying that doctors created the chronic shortage which necessitated policy intervention in the form of PAs.

I think you've just misread the comment and would find that it actually agrees strongly with what you said.

> The AMA puts a cap on the supply of doctors (via # of residency slots they allow)

This is factually untrue.[1]

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4978854/

Well, their guild is obviously not as strong, militant, nor organized as the power of hospitals if this is happening. Gesturing in the direction of their other control doesn’t disprove anything.

It’s worth noting that the AMA also is structured in such a way that gives undue influence to specialist physicians over GPs and ER docs (their representatives essentially get more votes over group policy decisions).

Doctors don’t enforce shortages. No one is stopping new medical schools from being created, it’s just not a trivial thing to do.

I’d actually argue that physicians haven’t yet fully grasped their power. Historically, many docs worked in independent clinics or small practice groups. That made them subject to antitrust law when teaming up to negotiate en masse against a large insurer, for example.

Today, with all of the consolidation over the past decade, many have become employees. This has made them less powerful in many ways... except, now they can unionize without any of those old antitrust concerns.

> Doctors don’t enforce shortages. No one is stopping new medical schools from being created, it’s just not a trivial thing to do.

USA could do like they do in tech and import already educated people. In tech we welcome that, in medicine that process requires the immigrant doctors to take additional years of study since medical doctors in USA have a post grad degree for no good reason.

Right plus the ama which enforces irrational wage by limiting supply. I worry more for the nurses.

We have a unionist running for president but the electorate doesn't seem to want that at the moment. I think we're witnessing another symptom of growing inequality. Several billionaires such as Ray Dalio have rightly remarked that this is a dangerous and potentially destabilizing development in our society. What is most troubling to me is that it appears we would rather blame others instead of trying to solve the underlying issues.

> We have a unionist running for president but the electorate doesn’t seem to want that at the moment.

I’d argue that Sanders’ lack of success in the polls is due more to voters’ perceived safety in choosing a moderate to beat Trump rather than disapproval of Sanders’ policies. Everyone has become a pundit and believes that the electorate will only tolerate a moderate while many of those same voters voice approval of progressive agenda items like Medicare For All.

Americans are seeing now more than ever just how much they’re valued when our system fails. Unfortunately, it’s going to result in hundreds of thousands and deaths and ruined futures for so many more.

If you're going to downvote save_ferris, at least have the decency to give a rebuttal?

The masks thing is not about a power asymmetry, it's about extended use protocols. There is a critical shortage of equipment, and the hospital has to make it last.

Now why hospitals are demanding that doctors keep quiet about the consequences of emergency operations under extended use protocols? That's an entirely separate issue. Those hospitals should be named and shamed.

But I completely understand restricting PPE to needed areas. The solution to that is to manufacture more PPE. But if we're not going to do that then extended use protocols are just military sense.

They can call in sick.

Calling in sick in medicine typically gets one of your peers called in instead, putting them at-risk instead of you for that shift.

And this is the shitty part, nurses have to choose between their own safety and that of their coworkers/patients. I am extremely worried for some close friends of mine who are nurses and have either preexisting conditions or are older. Those administrators can either get on the floor with the same lack of PPE or STFU in my opinion, it's downright criminal what they are saying and I hope when this is over they will be held to account.

> Surely the public will be on the side of ...

What would lead you to believe that "will of the public" commands any agency at all? In a functioning democracy this would be a powerful force but we've had our democracy subverted by decades of corporate interests controlling more of our government at all levels.

The United States is a democracy in name only, it's a useful myth that keeps the public feeling safe but that illusion increasingly seems less useful.

I wouldn't hold my breath, no pun intended. Hospitals are in such shortage when you're dying you're not going to say "oh no I won't go to Hospital X because of their practices" during these sort of situations, it may literally be a proxy to a choice between life/death.

Hospitals are... businesses. They will prioritize their financial success over all else which is to be expected. This sort of press is bad for business, especially long term. They are not concerned with public health, they just happen to house a few people who care about public health.

Fortunately for medicial doctors, they're in such high demand that I don't think any sort of job security is an issue. Iff hospitals and state/federal governments are doing everything they can to obtain PPE (which I believe they are) then I can understand from a public health perspective why you dont want undue stress/panic across the masses (which may result in massive hoarding of PPE for themselves amongst other things), I think it's in the public's interest to know the situation so they may act even more carefully to try to prevent needing to go to hospitals to begin with.

Sometimes knowing about a problem doesn't help much about solving a problem and only causes mental stress--or leads to more problems (mass panic and injuries/fatalities due to this).

I somewhat suspect a lot of this slow rollout of self-isolation process also modeled out public reactions, increased 'escape' travel, hoarding, panicking, etc. and a lot of the rollout dates and gradual release of information of how bad the situation really would be was more planned out than is often suggested. Combined injuries/fatalities due to panic behaviors combined with infection vs slow rollout of isolation. The federal government has access to sophisticated modeling and they typically look at scenarios from a more holistic perspective not just epidemiological related deaths.

When you looked at all the initial data coming from China, we knew this was going to be bad but somehow pretended it wouldn't be and are slowly warming up to accepting the situation. Some of it may just be pure denial, "this cant happen to me" mentalities.

No sorry this is wrong.

It was pure incompetence that led to the slow rollout.

> How do we put a swift end to this nonsense?

Unions.

How would that work? Doctors go out on strike?

In the case, the doctors all go out with the masks as one and treat firing one as firing all of them.

Nice thing about unions, though, is with them it rarely reaches a point like that.

And if it did in this case or the next? The docs go on strike? C'mon, that would be saying "don't call my bluff."

Yes.

> How do we put a swift end to this nonsense?

I support emergency whistleblower legislation prohibiting any health care employer (perhaps any employer) from engaging and discrimination or adverse job actions on the basis of an employee's good-faith effort to make a non-negligent report in the public interest of a matter that has previously been reported through internal channels that the employee was aware of and were not overly burdensome.

> How do we put a swift end to this nonsense?

When every healthcare worker starts defying these types of rules. What are they going to do? Fire all of them?

I received emergency alert messages on all of my cellphones all night last night begging for healthcare workers to register at a state website to help. Whom the power lies with is clear.

It only lies with them in collective action. Any one individual has to look after their family and doesn't have much power. Now, if they all stop working, at the same time, then they have the power and the ability to protect their families at the same time.

Remember, the stimulus bill just passed by Congress provides for arguably robust unemployment benefits for those who lose employment because of COVID, including having to quarantine to protect one’s self.

I agree collective action is the path to long term success, but these workers should not feel a gun is being held to their head by health system administration.

but you don't get unemployment payments if you're fired

I am confident your unemployment claim will be processed if you were fired for refusing to work in hazardous conditions by your health system employer, as this would qualify as wrongful termination.

Like... military coming in and taking over of the hospital over concern of "public health"? Administration of these places should see an _immediate_ danger to their positions, otherwise I am failing to see possibilities for any swift action, sorry.

Grocery stores like HEB in Texas have also been preventing workers from wearing masks, even if they want to supply their own.

Doctors and nurses get to choose the hospitals they work for/with.

Unfortunately, new entrants to the hospital market are prevented by large state-sponsored moats, and most of the large incumbents are shady in similar ways, so the ability of the staff to choose employer based on ethics/practices is basically meaningless. More options for medical care and medical employment is the answer; the vast majority of people in society are not greedy/shady.

Fix one, and you fix the other. You might also bring prices down, too. (Caveat: it's not "swift", as you requested.)

> Doctors and nurses get to choose the hospitals they work for/with.

Not always or completely even. Medical residents and fellows enter a legally binding contract to work at the hospital they match with as part of the application process, and opting to change hospitals during one’s program is nigh impossible.

"Choice" and the "US Healthcare Industry" are two words that shouldn't be used in the same sentence. If you think you have choice in this system either as a caregiver or a carereceiver, then you are under the sad delusion that those are beads the emperor has hanging between his legs.

A lot of doctors move across country borders for their careers.

Ethics/practices vary a lot between countries, and it only takes a small percentage of professionals moving away from one country to a better one to motivate change.