Why are doctors and nurses overworked?

[kenny]

I'm hoping doctors, nurses and other healthcare providers will speak up.


Icekid's comment about being overworked as a new doctor in the other thread got me wondering.
You'd think free enterprise and supply and demand would result in the right number of workers working the right number of hours making a satisfactory wage.
Why is the system broken?

If business is so good (they're too busy) why doesn't pay go up and attract more workers?
Do insurance companies mess things up, if so how?

 

[joflier]

Date: 3/22/2010 12:50:12 PM
Author:kenny
I''m hoping doctors, nurses and other healthcare providers will speak up.


Icekid''s comment about being overworked as a new doctor in the other thread got me wondering.
You''d think supply and demand would result in the right number of workers working the right number of hours making a satisfactory wage.

If business is so good (they''re too busy) why doesn''t pay go up and attract more workers?
Do insurance companies mess things up, if so how?

It''s nothing about supply and demand - it''s about the bottom $.

Their are plenty of people looking for work (at least around my area), but the employer''s just aren''t hiring. If anything, their cutting, putting a more substantial workload on the ones that remain. My employer cut my assistant, so now I have to answer phone calls and do the all the paperwork that she used to do. Usually I have enough time to make it work without any headache, but at the same time, I didn''t get a degree to be a secretary. Oh well. It''s a job and I''m blessed to have it.

 

[icekid]

Well, I would not say that nurses are "over-worked" though they certainly work incredibly hard. In my current ICU, they work eleven twelve hour shifts per month. Though they do often have to work odd hours as well!

But doctors are EXPECTED to work insane hours, it''s part of the code or something

On the rare occassion that I work an eight hour day, I''m running around giddy

Moreover, as training physicians we all work an incredible amount. My schedule is usually fairly reasonable in the 70-80 hour range. But the surgery residents easily work 100+++ hour weeks (which is actually now illegal.) Many primary care physicians work many, many hours just so they can simply make a reasonable salary.

It has little to do with supply/demand, except in fields where patients pay out of pocket like dermatology. Really, our government already controls physician compensation in a major way via medicare. Private insurance will only pay X amount more. However, in my field, we LOSE MONEY on each medicare patient we take care of because it reimburses only 1/3 of what private insurance does. Terrifying, IMO.

 

[elrohwen]

Date: 3/22/2010 12:57:15 PM
Author: joflier
It's nothing about supply and demand - it's about the bottom $.

Their are plenty of people looking for work (at least around my area), but the employer's just aren't hiring. If anything, their cutting, putting a more substantial workload on the ones that remain. My employer cut my assistant, so now I have to answer phone calls and do the all the paperwork that she used to do. Usually I have enough time to make it work without any headache, but at the same time, I didn't get a degree to be a secretary. Oh well. It's a job and I'm blessed to have it.

I think this is somewhat true. I don't know a lot of doctors and nurses personally, but a good friend is a PharmD at a local hospital. Some people have quit, but the hospital is refusing to hire new pharms because of budget issues. So she's currently working way more hours than ever before to make up for the missing people. I imagine it's a similar situation with some nurses and doctors.

 

[Lynnie]

I'm a nurse, so I can really only comment on the 'nurse' aspect of things.

I work 3 12-hour night shifts a week. I work night shift for the 20% pay differential.

Prior to March of 2009, overtime was available, which I took advantage of regularly. Our unit (telemetry/ISICU combo) was staffed well - sometimes overstaffed, IMO.

We have 22 beds on our unit, and we're usually full. Our staffing numbers should be 7 nurses and 2 ancillary (technicians) at night. 2-4 patients per nurse, depending on the acuity of the patients. Our patient population is diverse - walkie/talkie patients, to quadraplegics, fresh kidney transplant patients straight from the OR... we have a pretty high nurse turnover rate, because of this (IMO).

In March of '09, the hospital drastically cut the nursing budget. No more OT, no raises that year. Fine. The economy was bad, we all understood, and were thankful to have jobs.

They also cut our numbers. Now we have 6 nurses and 1 ancillary at night. Sometimes 6 & 0, or 5 & 1.

Sometimes it's fine... but many nights I do feel overworked. Not necessarily underpaid - I feel I get paid well. But when you're used to having 2 or 3 patients, and you walk in to see you have 5, 2 of which are pretty acutely ill, it can be overwhelming. I've seen nurses cry from feeling overwhelmed.

The cause? I don't know. I think the insurance companies need to get their acts together. One company will reimburse the hospital 80%, while another will only cover 20% for the same test. The hospital 'eats' the rest (which is why they charge an astronomical amount for said test in the first place, IMO).

It's all about $$, like joflier said.

We're not getting raises this year, either. And our health benefit premiums went up. So I'm actually bringing home less than I did in 2008. And will continue to do so until at least the summer of 2011.

On another note, ICEKID - I really don't know how you guys do it. I couldn't imagine 100 hour weeks. Mad props.

I really don't know what else to say. I wish I understood more about the subject.

I do know that nurses fresh out of school are having trouble finding jobs.

 

[Karl_K]

3 12s a week is pretty standard for nurses here.
My Niece a nurse was working one place where she was working 6-12s for weeks at a time because they were understaffed.
She got burned out and found another job within a hour of looking and was hired at a large raise the first place she called.

Who is not hiring is the hospitals and are working the ones that are there way to long and way to much.
Since they pay the most and are considered the only places with advancement potential they get a lot of people applying for each job but it leaves a hole elsewhere they cant easily fill.
They choose to be understaffed then complain about closing beds because they don''t have nurses....

The 3 local nursing schools are turning out nurses at a rapid pace but it don''t keep up.

Nurses here are making good money but they earn every penny of it and are getting burned out.
Yes they on average are very overworked here and patient care has suffered.

 

[iluvcarats]

Nurses and Drs are overworked because people don''t stop getting sick. My dh is a dr. He is up at 5:30 every morning and home anywhere between 6 and midnight, unless he has to stay there all night. When he was a resident he worked 120 hour weeks. He doesn''t do what he does just for the money, like most Americans seem to think. He likes helping people and he finds his work interesting. It must be a pretty good feeling to tell someone that they are cancer free. He still takes medicare, but like Icekid said, it doesn''t make them any money, it actually costs them money. I think we will have more people insured with less docs to administer the care.

 

[beadchick]

I am so happy someone started this thread. I, too, am a resident. We do work pretty hard. And with the health care changes, it will get worse for us. I have such a hard time when people talk about how much physicians make and how well we are doing. I get paid three grand a month (well, less than that take home), and I borrowed in the HUNDREDS OF THOUSANDS of dollars to go to school. I could have an amazing house for what has been spent on my brain.

Every once in a while, a patient will make a comment about how well doctors are doing. If they are doing so well, why are my 40 and 50 year old attendings still making loan payments? Think about it, we borrow $250,000 to go to school. There are set up costs in the tens of thousands for a medical practice. We pay approx $30,000 per year for malpractice insurance. If you make $150,000 per year ''take home'', and take off about 30% for taxes, thats $105,000. Divide by 12. You get $8750 per month. Take off $2500-3000 that you pay per month for loan re-payment (that''s on the 30 year plan, folks). You now have $5750 per month. Oh, yeah, and we still have to pay for OUR health insurance, retirement plans, mortgages, and monthly living expenses.

Essentially, its not a lot of money. But, it sure is a lot of time. I just hope that when Congress has said its peace this year, I''m still going to get a paycheck!

 

[allycat0303]

Well, I''m a resident and I''m overworked because that''s the number of jobs required to finish my job. We see our patients at 6:30 AM. We then head off to the OR and operate on patients. In between cases we try to get the things done that we talked about in the morning. Check labs, liasion with other services, follow on tests. Then when we are done operating we go through all of the patients again. And then there are days when we are on call because as young doctors in training we have to take care of the patients overnight and see any new patients in the emergency room.

It''s a crazy life. And nothing like Grey''s Anatomy, which is what many of the patients ask me. Even my sister who is a family medicine resident (and in the field of medicine) is convinced that as a surgery resident, my life is like the TV show. It really isn''t.

 

[sparklyheart]

Date: 3/22/2010 12:50:12 PM
Author:kenny
I'm hoping doctors, nurses and other healthcare providers will speak up.


Icekid's comment about being overworked as a new doctor in the other thread got me wondering.
You'd think free enterprise and supply and demand would result in the right number of workers working the right number of hours making a satisfactory wage.
Why is the system broken?

If business is so good (they're too busy) why doesn't pay go up and attract more workers?
Do insurance companies mess things up, if so how?

There is so much that goes into this whole topic...

The highlighted part made me laugh. You would think that makes sense but one of the problems comes when business people are running healthcare and they don't understand the inner workings.

I've worked in two hospitals.. One is run by a nurse and a doctor. They are well-staffed, paid well, always have needed supplies, are always able to have procedures when needed, etc. Managers and supervisors are a constant visible presence.

The other one is run by business professionals who know how to run a business...get the most work done for the fewest dollars with the fewest resources. "The suits" walk through the hospital with big smiles on their faces as they show off their place to outsiders..managers come around to clean up the place first, of course..then they say hi and move along. That's the extent of their interactions within the hospital. As long as patients get admitted and discharged and receive good care then that's what matters, not the workload or the hours.

The problem occurs when there just isn't enough staff. In addition to doing our nursing job, we are often left to be the social worker, case manager, housekeeper, etc just because those people are so busy as well..being on the front line, the one walking into the patient room, means we have to "fix" everything to keep the patients happy.. There have been so many days when I have been a charge nurse and I have spent the majority of the day dealing with problems that could easily be taken care of by someone else if they were available (arranging for home nursing, transport home, physician issues, etc).

The whole hospital is understaffed so we often have to share nurses and patient techs among other floors so that everything is equal.. that means we often run without techs so we have to do everything the patients need..there is no one to call to help you if you are busy.

As the economy worsens, fewer people go to their doctor because they can't afford it or they don't have insurance... so they wait out problems until they become so bad they can't handle it.. then they go to the hospital and ta-da! We are busting at the seams with patients!

I can't complain about the money.. I work part-time so the money is not nearly enough BUT that is my choice while I'm in school. If I were full-time, I would be doing more than well enough. I can honestly say that I get paid enough for what I do and others agree with me so I don't think that is causing us to have fewer nurses.. I really think the problem is in finding quality candidates who will stay in one place. The area I am in attracts a lot of new college grads who come to work, get married, have kids, and leave to be a SAHM. This is not to say anything bad AT ALL about those who do that.. that is just how it is and research done in the area has proven this..This makes it difficult to stay well-staffed if you have a high turnover after 2-3 years of employeement..

 

[LtlFirecracker]

Complex question....

Icekid is still in residency, and I was in residency not too long ago. Residents are the ones you hear about pulling the crazy 30 hour shifts. Part of it is just the culture. The older generation feels that working 100+ hour weeks is the only way you will learn what you need to know. I personally do not buy it, I have learned more in my first year of practice working 50 hour weeks than I have in my 3 years of residency, and seen rare things that I have read about, but never encountered in residency. However, when these people are writing your evaluations, it is hard to argue. The other part is the system. Residents are cheap labor. Since they are technically still in "training" the typical employee laws do not apply to them. So they don't need to be paid overtime like the nurses do. The hospital has the right to not renew a residents contract if they are not preforming to standards. If that happens, the resident is kind of screwed because it impossible to get a job without being fully trained in your speciality. Any resident who wants to keep their job quickly learns to never say no and always have a good attitude no matter how badly they are being treated.

Once you get out of residency, it really depends on what speciality you go into. In the city I trained in (as most), there were only a handful of pediatric surgeons for the whole city. So they lived lives as residents for their whole career. They took call, had to come in the middle of the night for surgery, than work the next day. This might be a supply and demand issue, as there are not that many fellowship positions for pediatric surgeons, but it also requires an insane amount of training (7+ residency years).

As a primary care doctor, you can have a little more control over your schedule. You can be an outpatient doc, a hospitalist, or one who does both (a dying breed by the way). The one who does both has to see patient's all day, and they the week they are "on call" they admit patients to the hospital. The biggest reasons primary care doctors are overworked is mainly due to the fact that reimbursement rates are so low, they need to see a high volume of patients to keep the clinic running from a financial standpoint. This means you only have 10-15 minutes a patient. This is not enough time to accomplish what you need to do, especially since a lot of primary care is counseling. What ends up happening is that the doctor feels like they can't help people, which is the whole reason they went into medicine. So the result is burn out which is a huge problem in the primary care field.

Some of the most competitive medical specialities for medical students are the specialities that allow good pay, fixed hours, and lots of procedures. Some examples would be ED. Even though the docs work odd hours, they do shift work, and once they get home, there is no pager to answer too. Derm is another big one, as they tend to only work during normal business hours and rarely do inpatient. Anesthesia is another speciality that allows shift work, and I found those doctors to be satisfied with their jobs. But the main reason they have shift work is because they need to keep track of lots of little complex details, as one small mistake can have horrific consequences.

 

[cara]

One contributing factor in the US is that almost all the residency spots are government funded, and residency is a required step in training doctors. Supply and demand feedback is a little ineffective at convincing legislators to shell out more for training doctors. This affects both the workload of residents themselves and the number of docs in each specialty.

The residents are basically labor with very limited bargaining power - they need to get through residency to be independently employable, they sign a contract to take whatever salary is offered through the match program that assigns incoming residents, they cannot negotiate their salary later nor their hours or working conditions nor is quitting a good option, and then teaching institutions have a cheap labor source on which they can pile the workload and call it 'training'. *Some* of it is training, but a lot of it is grunt work that could be done by non-medically trained staff. And certainly some residency programs have brutal brutal hours simply because they don't have enough residents to cover all the necessary work and institution doesn't want to pay for non-resident doctors to provide that care, as that would be way more expensive. This is part of why there is a new legal standard of 80-hr work weeks and maximum 30-hr shifts, and then exceptions for certain residency programs in certain specialties. (And even then, the legal requirements are often violated.)

Another issue is that there is no requirement that doctors distribute themselves according to need. Sounds counter-intuitive or even anti-market, I know, but in some specialties or regions of the country the workload for a doctor can be unbearable and stressful. Docs are human and usually both want to provide needed care and have a reasonable quality of life for themselves. So they often will avoid specialties where they would have to work 100+ hr weeks and never see their families or avoid moving to areas of the country with so few doctors that they would be swamped swamped swamped. Which is a negative feedback loop, if docs avoid those areas, they remain understaffed and those that are there have higher workloads.

One person I know is a family medicine doc and (I thought) was a true believer in providing care to underserved populations. Moved himself and his wife to a rural western area and joined a practice with 2 other doctors where they provide most of the medical care for a huge, sparsely populated region. They man the local hospital, so he's on call every third night. He sees as many patients as he can during the day, makes house calls and emergency runs when needed, easily working 80+ hrs a week (this is not as a resident) and there is always more he could be doing. It would be easier if they could get another doc (or two!) to share the practice, but no one wants to move there even though the pay is reasonable and cost of living low. Its in the middle of nowhere, and his wife is largely raising their small child by herself. So he's had enough, and is looking to move back east, retrain a bit into a different specialty where he can work more reasonable hours also for decent pay, see his daughter grow up and keep his marriage intact. Just one example.

 

[studyer83]

Supply is manipulated by the AMA. The slots at med schools and residencies are tightly regulated and vastly undersupply the market. This monopoly is part of the reason the AMA objects to physician extenders. I''m not arguing for a decrease/increase in physician salaries, which are manipulated by non-market forces other than pure supply. Simply pointing out that there is an artificial shortage, for which we all pay -- the overworked doctors, the cost of the monopoly rent, etc.

 

[janinegirly]

so healthcare thread is gone?

 

[Arkteia]

We worked totally crazy hours in residency. One weekend I was so sleepy from the previous night on call that I fell off the stairs in my house and broke an ankle. Well, I still had to attend, first in a wheelchair, then on crutches. I was always told that when I become a physician, I can reap the fruits of hard labor.

Now I am a child psychiatrist, and by definition, it means more demand. Yet I make less money than my two colleagues who are adult psychiatrists because many insurance companies would not pay for a 30-minute visit and it is virtually impossible to see a patient and his parent in 15 minutes. Also, I prefer to have two separate appointments: one for a child, one for his parents, as the first intake. Nothing irritates kids as much as sitting there listening to their parents'' complaints. On the other hand, there may be something in the family history that a kid may not need to know, or parents do not want him to know. Family visits are not paid as well as meeting with a patient.
My waiting list is quite long - one, sometimes two months. If a patient is referred by the doctor I know, I would usually tell the doctor to give my cell phone number to the patient so that I could schedule an earlier appointment for him, as a courtesy to the doctor. Which usually means that I have to come at work one hour earlier or leave one hour later.
I used to work as a contract doctor at a hospital, where the percentage of medicaid, medicare or ininsured patients was very high. Some patients had no money at all so the hospital would write off the bill as a charity. Naturally, I would do the same, although I could not write it off as a business loss. Most of my time was spent on dictations, writing notes and phone calls. Often I had to come back in the evening after I''d finish my practice to do the dictations. We were on call one, sometimes two weekends a night and would sometimes take night calls.

I just burned out. Now I admit my own patients and follow them at the hospital, and it is much easier, but I often start my private practice day so early that I simply have no time to follow them and ask one of my colleagues to take care of them for me at the hospital. (They usually do a very good job).

I now work 10 hours a day, 4 days a week and stay home one day a week because it is my 6-year old''s short day and I want to spend the rest of the day with him.

I think we are facing a major problem with OBGYN. I do not know how many people realize it , but most of OB doctors have at least one lawsuit filed against them, sometimes many more. Irregardless of how the matter was settled, it raises their insurance premiums sky-high. Consequently, many of them leave OB as soon as they accrue decent GYN practice. Finding a good OB will soon become a major problem.

I had my second child born via C-section. My OB was vacationing, and it was an emergency C-section. The doctor covering his practice had 6 that day! (It was just a very bad day). My son had a nick on his cheek (it needed 3 stitches). Many people outside the medical fiend would sue, and technically there were grounds for a lawsuit, but I talked my husband out of it. She did her best job, my son''s Apgar scores were good, and the only person really benefitting from a lawsuit would be a lawyer. I do not know whether the mistake was hers or the resident''s who assisted her that night. Probably his, because they put in 80-100 hours per week.