<p>Everyone and their mother is now trying to find jobs in health care. It's interesting to note, that when you ignore the costs of having to pay for research of new medicines or technology, the biggest reason why health care costs are exploding is because of the workers themselves. </p>
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Some loud and whispered voices in medicine will say . we are not like those finance guys. We deserve our money; after all, we do good. American medical advances unquestionably do save lives. But I argue that medicine is still a learned profession, indeed still a service profession, and should perform as such. Asking the government to throw a lot more money medicines way in order to cover the uninsured is thinking like those in the failed financial sector. Comparative international experience shows that there is enough money already in our system to care for the basic medical needs of all of our people, if we spent it right. Government has a responsibility NOT to make the health care bubble even bigger. I believe that our long overdue Health System Reform must care for the basic healthcare needs of all of our people as a moral imperative derived from our national culture of common compassion. And, now is the time for those of us in the American medical profession to do our patriotic duty to rein in our many egregious and habit-addicted members and lead the rest of the bloated medical-industrial complex to cut back on its vast waste. We can help to get the US back on track economically to benefit us and our childrens children. But lets beware of the inevitable collateral damage that will result from the bursting of this bubble, and re-valuation of the healthcare industry at 60% current expenditures, and lets prepare for it. Or, will we learn that the American Disease-Medical-Industrial Complex has really been largely a sophisticated jobs program all along, and cannot change now since the already high US unemployment rate would rapidly reach double digits?
George D. Lundberg MD, is former Editor in Chief of Medscape, eMedicine, and the Journal of the American Medical Association. Currently Distinguished Consultant, Physicians Advocates, Berkeley, CA and Consulting Professor, Stanford University School of Medicine.
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<p>So what happens when the bubble bursts? Where do all the people that bought into the "we need more health care workers because of the aging baby boomer population" that subsequently lose their jobs go?</p>
<p>I am not so sure that the health care bubble is primarily a matter of labor. It’s complicated. The need for more nurses, aides and technicians will be up for a few decades, based on the oft-cited boomers’ becoming senior citizens,so that is certainly part of it. Many jobs in this sector do not require a BA, as the article above discusses.</p>
<p>But in our own experience, it would seem that legal liability is driving a lot of unnecessary and expensive tests and care, as is lack of coordination of care. These may be large factors in the “bubble.” The delivery system is going to have to change, and some efforts have begun in that direction, at least in our state. When delivery methods change, it is true that staffing may go down to some extent, because fewer tests and procedures will be done.</p>
<p>Other changes that may be involved in bursting the bubble might be more home care (versus nursing homes), and more hospice care (versus painful prolongation of life w/hospital care and technology). Both of these will decrease costs, but still require a lot of staffing, including aides and technicians.</p>
<p>To avoid further class inequalities, this and other articles recommend that some of these lower level medical personnel make more money and gain better status. These positive changes could perhaps mean more educational requirements at some point, which would then make the jobs harder to obtain. Right now, because aides are less expensive, it seems hospitals are relying more on aides and cutting more nurses.</p>
<p>Needless tests and the like are simply an indication of doctors either being good doctors or playing defensive medicine. What is cheaper, a $2k colonoscopy or a $100k cancer case?</p>
<p>Health care costs escalate for simple reasons. We are being overworked compared to our European peers and this leaves little time to unwind. So, we look for the ‘easy’ calorie fixes, eating out, obesity, no exercise, stress, etc. There’s also a food class warfare whereas the people who need the good basic foods can’t get them (find a Whole Foods or even any source of fresh veggies in downtown America, for example) so the lower incomes are commiting food suicide (voluntary or not)</p>
<p>Then, even with good insurance, the copays increase to cover gilded hospitals and the like, that run underutilized. Who’s paying for these? Why open a brand new gilded hospital when the one across the street is running @ 60-70%? are we afraid we’ll turn into Canada?</p>
<p>The final straw is overuse. If we’re paying this much out of pocket for health care you better believe we’ll milk it for what it’s worth. $230/tube for acne medicine for DD2, $300/month for Accutane for DD1, and the like.</p>
<p>So, employment and costs will continue their merry path until something gives. As the AMA et al wisely control the numbers, the non-MD employment will increase to improve ‘efficiency’ and ensure the MD’s do not spend a second more on non-MD tasks.</p>
<p>I work in healthcare administration and totally agree with compmom and turbo93. Healthcare as it is provided and paid for in this country is very complicated and about to get more complicated, if for no other reason than our population is aging and people are demanding that they receive as much health care as possible right up to the day they die.</p>
<p>BTW - a report was released last week that says that health care in Texas has gotten more expensive since it enacted tort reform, not less. People like to point to malpractice as a driven for higher costs - and it probably plays some role, though smaller than most people think. Big roles include the fact that we have a fee for service model, meaning the more health care you provide, the more money you make, so there is zero incentive to provide more cost-efficient healthcare…why would you…so you can make less money? That would be like asking Apple to sell less iPhones so people can save more of their incomes. </p>
<p>Also, patient demand for the latest and great technology, drugs and procedures plays a huge role in our healthcare costs, particularly because patients don’t necessary pay directly for those services, instead relying on insurance to pick up the tab.</p>
<p>Getting back the OP’s assertion that there might be a bubble in health care jobs. I really doubt it. The average of age of heathcare workers in this country is pretty high. Many doctors and nurses are over the age of 50. Heck, most of the doctors I know are on the cusp of retirement. We truly believe that we are going to be running into severe shortages. Maybe not in every position but in a lot. Training physicians, nurses and other allied health professionals is very complicated because it demands a lot of hands-on training and is hard to provide. We have a hard time recruiting for a lot of very specialized jobs right now.</p>
<p>The health care job bubble has already burst. Nursing schools are churning out new nurses who can’t find jobs. Hospitals don’t want to pay the cost of training nurses, so they are only hiring people with experience. And, in looking at the jobs offered, almost all are part time or per diem so hospitals don’t have to pay benefits. Most nurses I know are working 2 jobs to make one full time job, but they have no benefits. It’s unfortunate that healthcare is moving in this direction, because it decreases continuity of care and you have people working who are not invested in their jobs. Ultimately, patient care will suffer. This is a very disturbing trend in healthcare. I personally don’t know if I would encourage my children to go into healthcare at this time.</p>
<p>That’s because a lot of people are putting off retirement due to the financial crisis and healthcare, like all industries, has seen a decrease in demand (for elective procedures). Eventually, they will have no choice but to retire. Half of our physician leaders at my hospital are 70 years old. These are people who would have already retired except they don’t feel like they can afford to, since they lost so much in the stock market. </p>
<p>I’ve worked in this industry for nearly 25 years. My money is still on healthcare for long-term jobs prospects.</p>
<p>I’ve also worked in this industry for 25 years and the trend I see is not pretty. In the NY metro area, there are very few full time jobs advertised. While I understand what you are saying about an aging workforce, the reality is that hospitals are not looking to hire full time workers. It’s more cost effective for them to hire part timers. When we are talking about encouraging kids to go into one field or another, I would not encourage my kids to go into a field where they won’t be able to obtain full time work. It’s taking new nursing grads a year to find a job. And, again, a lot of the time it’s part time work.</p>
<p>Good post MomLive. I found the New Yorker article particularly good. One of the biggest myths out there is the feeling that tort reform will decrease medical costs. Does anyone really think the malpractice insurance rates will decrease? Or if they did, medical care would cost less? Most health care workers are not practicing defensive medicine, but trying to give comprehensive care for the benefit of the patient. High cost technology is used because it’s available. The fear of being sued is quite frightening, not because of the cost of the court settlement, but because of what it does to your career, the time it takes away from patient care, the cost of the lawyer, and the fear that you made a mistake that was harmful to the patient. </p>
<p>On NPR this AM, there was a newscast about the 3 D mammogram which is supposedly more accurate. Buying such equipment is expensive but the expert stated that the money should be spent because “it was the right thing to do for the patient.” Yet, we haven’t determined if finding breast cancer early really does save lives. </p>
<p>Yes, long-term employment is still rosy for the future of health care. But, the AMA effectively lobbies to control costs such that MD’s receive the bulk of the money allocated to health care workers (despite the fact that other allied health care workers do the same job). Most other health care workers can make a decent living, but salaries will be flat and there is not much incentive for advancement.</p>
<p>It’s not just nurses either. Pharmacists are having difficult times trying to find jobs now because there are simply too many schools pumping out too many PharmD degrees:</p>
<p>It’s only a matter of time until the pool of labor for RNs, PharmDs, NPs, PAs, etc, etc. becomes so large that hospitals and health care networks no longer have to employ full time staffs and can just run their entire operations on temps or part timers. That way they can save huge amounts of labor costs by not having to provide their own workers with health care or retirement benefits.</p>
<p>I can appreciate this…every market, every region is different just like the housing market varies from city to city. Some areas currently suffer from nursing shortages. In our area nurses, even just of out school, can find jobs but there’s not a major shortage. On the other hand, a friend (with an master’s in environmental engineering!) went back to college to get her lab tech degree and she said a lot of her classmates had a hard time getting jobs right out the door.</p>
<p>I attend a lot of national conferences on healthcare administration and the perception of a looming shortage is quite strong. You see in it every presentation. Of course with healthcare reform everything is going to change and who knows what the future holds. :)</p>
<p>I don’t get why the profit motive is so damn important in healthcare when the patients don’t get better results. </p>
<p>And that border town in Texas…how much do health professionals need to live a great life down there? I would expect the cost of living to be low in that border town…excluding health care costs.</p>
<p>Kaiser was mentioned in the same article. I think the costs of being a patient at Kaiser are approaching other the costs of other places…which I do find disappointing. Maybe, Kaiser performs fewer procedures though.</p>
<p>Well, for one thing it’s what allows us to buy bigger and better technology. And that’s what people demand. There was a thread last week about breast MRIs. We have one because patients demand it. We have 2 da vinci robots because patients demand it. We have a state of the art, touchy-feely birthing center because patients demand it. Just like any other business out there, it’s very competitive. Unlike every other business out there, we aren’t forced to compete on price (yet) because there is a third-party paying the bills (the insurance company). All this is going to change shortly as providers are going to be forced to manage the health of their patients on a fixed dollar amount…so it* will* eventually become about better results.</p>
<p>healthcare jobs disappearing? Unlikely…funny as i see no problem of recent nursing grads getting FT employment in NYC, at the very best institutions…same goes for the Philly area…perhaps in mediocre hospitals,costs are being cut,hence lack of hiring</p>
<p>Perhaps the post above about lack of " Job lisitings" is valid,but doesn’t mean the jobs aren’t there</p>
<p>Mom live…the patients demand the technology after they are told about the technology and because the patients believe their health outcomes will be better with the new technology…And patients believe this because they are told this…</p>
<p>Are patients demanding that they be treated in a similar fashion to that Texas town rather than be treated in a similar fashion to the Mayo Clinic?</p>
<p>I din’t think so…I think patients would choose the Mayo Clinic way over the Texas town way…if the patients had knowledge…which they don’t.</p>
<p>qdogpa, I have a friend whose daughter graduated from a well-respected university in Philly with a BA in nursing and just passed her boards. She is job-hunting in Philly and Boston and so far has had no success. Everyone wants to hire nurses with experience, and apparently there are enough of them to fill the openings.</p>
<p>I don’t have any answers but I am really enjoying reading this thread. Lots of good insights. Presidents have been talking about this problem for years but none of them have been able to solve it, and reading this thread shows why - it’s complicated, and some of the problems result from deeply held, but flawed, beliefs. More health care isn’t always better health care. A discussion about stopping treatment isn’t the same as a refusing someone care, but it could turn into a slippery slope. More testing doesn’t always lead to better treatments - although sometimes it does. Nothing is simple.</p>
<p>dstark’s point about imperfect knowledge is key. I was an economics major, and it drives me nuts when people try to say that health care is a market just like any other and should be allowed to operate as such. It’s not, for two reasons: 1) “Buyers” can’t walk away if the price is too high. You can’t choose not to treat a broken bone or leukemia. 2) Most of us don’t really know if the newest, latest machine or drug is truly more effective than the older version. Marketing leads us to believe that it is, and sometimes that’s true - but we don’t know so we can’t make an informed decision.</p>
<p>My daughter is hoping to become an Occupational Therapist. I suspect that’s a field that will continue to grow, as our capability to save stroke victims and victims of head injuries increases, and our population continues to age. Not to mention that OT is one of the less-expensive “treatments” out there. It probably helps that she is looking for a career that will allow her to work part-time, since she is hoping to have kids and a spouse with a full-time career. On the other hand, if she NEEDS to work full-time and get benefits and can’t find them…</p>
<p>Regardless of how health care goes, I figure funerals are the NEXT growth industry. Please forgive my dark humor there. </p>
<p>S-2 is considering post-BA vocational training related to the funeral industry. If he pursues it, he’d do it only on a part-time basis, because his college degree and ambitions are all in screenwriting and film. He says he’s not afraid of death, either on a physical or emotional level. He grew up with it around the kitchen table talk of his dad’s vocation (clergy). He’d view it as helping families, and a better “day job” for a creative individual than pouring coffee, moving furniture and the other minimum-wage things he’s done since graduation to make rent.</p>
<p>So true, Dstark. Patients are told a lot of things that may or may not be true. I’ve growth very skeptical of all the information that is pushed on to us via health care advocate organizations, researchers, drug companies, technology companies, the medical community and last, but certainly not least, the media.</p>
<p>The recent uproar over prostate cancer testing (PSAs) is the perfect example of a theory being pushed onto patients who have no way of ascertaining what is true and what is a hypothesis. All they hear is screen for cancer and get it removed asap - not understanding it’s more murkier and complicated than that. Often times, procedures, drugs, technology are approved based upon short clinical trials. Once they are on the market for many years, then longitudinal studies can be done to ascertain the long-term effects. That’s how we found out hormone replacement theory causes breast cancer. That’s how they have figured out that certain spine surgeries are useless. We are all participants in one big clinical trial every time we take a drug or have a procedure or use a new technology.</p>