> a public scandal will erupt surrounding well-paid medical professionals sitting around doing nothing

I don't think that's true. Increasing the amount of nurses means simply increasing the amount of care. If you have twice as many nurses, you'll have twice as much care for your patients. No way nurses would be sitting around doing nothing.

That's not how healthcare works. That it is does not function that way is why free-at-point-of-use public healthcare systems are capable of working.

Not sure why you're being downvoted, but the idea that doubling nurses doubles the amount of patient care shows an ignorance of the healthcare system. "Patient care" is a nebulous term and needs to be further defined in that statement. Do you now get two catheters instead of one? Or get your vitals taken twice as often? Both double patient care but only one is relevant.

I could definitely imagine nurses having twice as much time to carefully read my charts, or twice as much time to sleep at night and be well rested so they don't fuck things up, or being able to come by and help with something twice as quickly

That would provide better patient outcomes, I agree. Whether hiring more nurses translates to actually doubling that, is another question. To be clear, I'm not saying that increased staff is not part of the solution; it's just been my experience that it's rarely the sole part (or often even the majority part) of the solution.

It's because it would actually double the amount of care on most floors, because they're usually at 60% of the staffing they need as a start because they've been able to get away with that for years.

That doesn't really answer the question. "it would actually double the amount of care". It would double the amount of staff hours. How those staff hours are used is a measure of patient care and not all hours are equally relevant to the patient.

As an example, if we assume you are a software engineer and you double your work hours, will you double your code output? Probably not, just like it's not a 1:1 translation of nurse hours to patient care.

Comments like this are showing just how much you don't understand maintaining a service level based care, and are stuck in thinking in terms of producing a product.

Combined with willfully ignoring that basically all floors are intentionally understaffed and have been for years.

I can tell you from my years in healthcare that many of the people who think they know how the system works only have a very myopic understanding and they usually are the one's who have the most confidence that their simple solution will fix the problem. Unfortunately, there's a lot of nuance in complex systems like healthcare.

We probably agree about the staffing levels to an extent, but I would be curious to hear the staffing estimation methodologies used in your experience.

Yeah, I agree. You sound like many healthcare admins I've worked with and for.

I'm not sure its the flex in this argument you think it is.

I wasn't healthcare admin and most of my department was staffed with nurses. But we were very data oriented and it helped buffer us from emotional responses to problems.

I have no doubt your emotionally detached analysis decided the floors were adequately/overstaffed since the nurses hadn't all quit yet or gone on strike.

I mean they clearly are still working there, they can always do a bit more to cover right?

I think you are are either misinterpreting my stance or transferring an argument from your personally experience. Also, you may want to revisit the HN guidelines[1]

My position is not that they were always adequately staffed, but that in my experience increasing staffing did not fix the problems as expected because the problems were rooted in more systemic issues. As I've stated elsewhere staffing may be part of the solution but rarely a panacea. Also, my stance is that fixing the systemic issues will help them do less non-patient-centered work so they can focus more on being a healthcare provider, where they are the most valuable.

[1]https://news.ycombinator.com/newsguidelines.html

Thank you for your thoughtful responses, you seem to be the only person here with experience trying to solve the actual problem in a data driven way

At the rate that healthcare charges in the US, hospitals can more than afford to keep X+1 or +2 needed nurses around in three 8-hour shifts. They just don't.

Not even close. Most hospitals have trouble staying afloat as is. And there are disciplines within nursing, so you'd have to overstaff by quite a bit more such that closer to 2x is a backup but leads back to the GP's point.

They employ on-call, PRN, contract nurses, etc to fill in the gaps which mostly works in non-pandemic situations.

Reading threads like this really hammers home most of HN have never worked in health care. Hospitals BARELY make their budget. 1% over cost of doing business is considered a really good year for my institution.

Also if I never have to hear people complain about bloated admin budgets in education and healthcare ever again it’ll be too soon. Those admins aren’t sitting around on their thumbs—they’re dealing with the ridiculous legal and administrative system the insurance companies and government have created. Those people are absolutely critical for the institution to exist.

This seems to be highly bifurcated, like so much in the US, between the haves and the have-nots. But overall I don't think it's fair to say "Hospitals BARELY make their budget." As usual, the whole system is broken. There are some hospitals with a wealthy customer base with full-ride insurance who can bill obscene amounts and profit massively, and then there are some hospital systems with uninsured and underinsured customer bases who are just scraping by.

I looked up my local hospital network, UCHealth (Colorado, there are many UCHealths it would seem), and their EBITDA in 2021 was 16.6%. Mayo Clinic posted 1.2 billion dollars in _operating profit_ in 2021, and also have a gigantic investing arm with several billion dollars under management.

Then we look at networks like Spectrum in Michigan, who posted only a 3.6% margin, or Henry Ford, with a negative operating margin offset by investment income, and it becomes clear that _some_ hospitals barely make their budget while _others_ rake in dollars.

It’s the same economics that create food deserts in some places and Whole Foods in others. Or how banks don’t exist in poorer neighborhoods despite being profitable on others. There is no incentive to allow one to subsidize the other. It happens with health networks that are mission based but otherwise, not usually. Try balancing out your research with the taxpayer funded public hospitals, it’s a train wreck.

> bill obscene amounts and profit massively

Profit how? Your 2 examples of UCHealth and Mayo Clinic are both non-profits.

Non-profits generally use substantial income in excess of revenues for expansion, just like many for-profit organizations. Excess revenues can also be absorbed in salary and other compensation or cost increases, usually top down of course. The main difference is that non-profit organizations are prohibited by law from making distributions to owner-shareholders. They can spend excess revenues in any number of other ways, starting with the furniture for example.

How badly is the entire industry mismanaged if hospitals have to charge thousands-to-millions of dolllars for treatments? There is no possible way that is just barely supporting facilities+medical staff+reasonable administration+liabilities if other countries can do it at tiny fractions of our price.

Instead, the story as I've heard it seems to be similar to education: massive administrative overhead permitted by fundamentally broken insurance billing.

Sure I may not know healthcare but they really need to fix their shit.

I agree it needs a reboot but it’s highly politicized and the things they reform usual cause more and more administrative burdens and thus costs.

The sad truth is labor in America is incredibly expensive. Healthcare is extremely labor intensive. And everything else is expensive too. We don’t pay the came cost from the source for things like drugs, medical supplies, etc. A thing that cost $100 in another country costs $1000 in the US. That’s from the manufacturer who can control what price they charge. It’s capitalism doing it’s thing. But we also have a ton of middle men. Insurance, brokers, wholesalers, distributors, and on and on. All of who need a margin of profit and maintains some level of administration overhead. So when people here say administrators and too bloated and over paid, it’s really the supply chain that is deep and prices that are uncontrolled.

Even parts of this thread exemplifies how difficult it is to get agreement on what the problem/solution even is. People are complaining that healthcare is too expensive others saying nurses need to be paid more or have hospitals increase staffing. These ideas are in complete opposition.

Hospitals have been paying 4x staff rates for travel nurses for multiple years now, though.

I’ve never seen that even before the pandemic. 1.5x-2x is normal for all the usual reasons a contractor cost more. Taxes, benefits, agency that needs a margin, etc.

I’m guessing if you’ve seen that is hyper localized to some place/issue.

1.5x isn't a real increase in staff rates if all it accounts for is taxes and benefits that the employer covers for regular employees anyway. It is like certain government employees who complain about being paid too little when the actual cost of their compensation in many cases is through the roof.

The situation is so bad that regulation or standard practices encouraging employers to document compensation figures instead of quasi-mythical salary figures would do a lot of good to reduce confusion in this area.

All in, it's still averages about 20-30% more expensive in a normal operating environment (before pandemic and all the subsequent issues). This is significant on the largest expense line item and considering it's controllable to a degree.

You can pay people fixed monthly salary + overtime hours. You don’t need to cut their hours and their pay, though that’s often the choice that employers make.

Exactly, choosing to cut hours or pay due to a lull in business is a choice made by the employer. It's not like these hospitals are sputtering along right at the fringe of solvency and one bad choice will bankrupt them - private health providers tend to make pretty comfortable profit margins and the fact that they can pay such outrageous surge prices for travel nurses is a pretty clear proof of how much they have to spare.

Many hospitals literally are sputtering along right at the fringe of solvency. This is particularly a problem with non-profit hospitals in poor and rural areas. Summer have shut down in recent years, and the pandemic is accelerating that trend.

https://www.beckershospitalreview.com/finance/12-latest-hosp...

Some hospitals are sputtering right along, and a list of 12 isn't a great piece of evidence that those hospitals (many of which are run by regional organizations which are essentially consolidating patient pools into a central location) are being run effectively - especially if these hospitals are paying 10k/week for travel nurses.

If there's a location that isn't profitable to operate a hospital in then the hospital will probably fail. America is the country still clinging to market-driven healthcare services and the market can be a cruel mistress.

And all that doesn't at all erode the fact that nurses are paid pauper's wages at extremely profitable hospitals - some tech companies are going out of business, some probably closed their doors today... that doesn't mean that all engineers are expected to work for 60hrs/week at $15/hr.

That article was just a recent example. If you search around you can find many other hospitals which have closed down or gone through bankruptcy in recent years.

https://www.gpb.org/news/2022/04/08/wellstar-closing-er-hosp...

https://www.post-gazette.com/opinion/editorials/2022/04/04/c...

In 2020 the US median salary for an RN was $75K. That was well above the median household income. Hardly pauper's wages.

Most hospitals are not extremely profitable. In fact the majority are run by governments or non-profit organizations.

https://www.kff.org/other/state-indicator/hospitals-by-owner...

Tech companies will pay engineers as little as they can get away with. Expectations have nothing to do with it. Wages are set by the market.