
Medical staffing companies cut doctors’ pay while spending millions on ads - hhs
https://www.propublica.org/article/medical-staffing-companies-cut-doctors-pay-while-spending-millions-on-political-ads
======
erentz
And one of those companies may now be entering bankruptcy after they were
looted by Private Equity and loaded up with $7 billion of debt.[1]

[1] [https://www.bloomberg.com/news/articles/2020-04-20/kkr-s-
env...](https://www.bloomberg.com/news/articles/2020-04-20/kkr-s-envision-
healthcare-said-to-consider-bankruptcy-filing)

------
downerending
I hear stories from a friend who works in a hospital (though not a doctor).
One of the striking parts is that there seems to be a real reluctance to
simply "just say no" to pay cuts by switching employers--certainly more so
than in tech.

Hate to say it, but the only signal that truly matters is leaving.

~~~
TeMPOraL
Medical world is small and job-hopping is not an accepted practice - in
contrast to the tech industry. Also, unlike in tech industry, some doctors are
unwilling to quit in protest because this decision would quite literally harm
or kill people. It's one thing to dump shoving shit for a nonsense web product
at one company to shove shit for a useless product at a different company that
pays better. It's another thing to transfer away from a hospital strapped for
cash and personnel, knowing that this will worsen the outcomes of the patients
currently under your care.

~~~
downerending
Not saying I like the situation, nor that that's how things _should_ be. Just
that without seeing a string of quits, generally organizations (private or
public) won't fix their salary problems.

(The one other related signal is hires, or lack thereof, but it's far weaker.)

If I'm wrong about that, I'd be curious to hear the theory.

~~~
TeMPOraL
Well, I agree with you that a string of quits would be a powerful signal,
perhaps powerful enough to change things. I was just trying to provide
questions individual doctors face that are somewhat unique to the medical
profession. I definitely do not like the current situation.

~~~
downerending
It's a bit more than academic for me personally. I'm not in that profession,
but am doing a job most would say is very important from a societal
perspective. I'm also paid _way_ under market, and I'd like my employer to fix
that. Realistically, though, that's not going to happen short of me quitting.
I haven't so far, though I may yet.

So, what's my employer to make of that? I might not be happy, but I'm still
here. From a capitalist perspective, I'm being paid enough to hold me in
position. So arguably my employer is getting my wage "just right", in that I'm
close to not taking it, but not actually leaving. Kudos to them.

This does cause a lot of secondary problems, but most of those are relatively
invisible to those making these decisions.

I don't have any good answers to this, but it does mean that many of the best
minds of our generation end up working on elaborate advertising platforms and
sometimes-dubious finance/trading applications.

~~~
TeMPOraL
> _It 's a bit more than academic for me personally._

I understand. It was academic to me until one of my close family members
became a doctor.

I have no good answers here either. What you say is correct: from a capitalist
perspective, the pay is just right. But it doesn't _feel_ right, relative to
everything else, and the result is that wages are roughly inversely correlated
with actual utility a job has for the society. This situation seriously sucks.

I also have a feeling this is related to a more general problem: using prices
to allocate scarce goods is an efficient mechanism. Those who care more are
willing to pay more for access to a good/service. This works great when those
prices are low relative to everyone's budget. It becomes an ongoing
humanitarian disaster when you get people priced out of access to food, water,
shelter or medical care - especially if the reason you're being priced out is
because wealthier people who care a little will still pay more than you can
when your life depends on it. It's like there's a "divided by all your wealth"
factor missing on the market, like we're operating in absolutes where we
should be using fractions.

Anyway, I hate that too.

------
corporateslave5
Call me crazy but doctors are over paid and given too much status in American
society. Before computers you need highly intelligent doctors with the ability
to hold huge amounts of medical knowledge in their heads at a minimum. Now you
can google most. The value of a doctor in our society is objectively going
down, the job is easier now more than ever. Not only that, the absurd rates of
mal practice need to be given a critical eye. We need transparency about
patient outcomes.

~~~
jac241
Call me crazy but software engineers are over paid. All they do is Google for
answers on stack overflow and copy and paste the code. You used to need highly
intelligent engineers who could hold all the APIs in their head at a minimum.
Now you can just Google for the documentation.

~~~
husarcik
As someone who is getting their MD next year, I'd have to agree with jac241.
It took me a weekend to understand and setup a kubernetes cluster yet it's
taken me three years to even know the bare basics of medicine. Maybe it's a
situation of you don't know what you don't know. Sure, you can Google symptoms
but have you seen thousands of patients to know if you're right? On the tech
side, I know how to setup a kubernetes cluster but do I know what to do when
things go wrong? Most likely not.

~~~
jac241
M2 here. This site never gives doctors the benefit of the doubt and has some
of the worst takes on the profession. Every thread where physicians get
brought up you can count on someone saying they're overpaid, can EASILY be
replaced by a google search, are using the AMA to limit the supply of doctors,
etc. The AMA can't even prevent nurse practitioners from getting full practice
authority to use their 500 hours of training to harm patients, how exactly are
they limiting supply. For a site and a profession that values data and
research so much, a lot of people on this site do zero research on the US and
other countries' healthcare systems, how physicians and midlevels get paid,
what factors are increasing healthcare costs before denigrating physicians as
greedy and useless.

People just have no idea what goes into training a physician. Even after 2
full years of studying medicine I feel like I don't know anything, the field
is that huge. I assume some of the bad takes are due to most people on this
site being young and only ever interfacing with the healthcare system whenever
they get strep throat. Sure someone can Google that you need to treat strep
throat with antibiotics (maybe they'll even pick the right one!), but make
sure to warn them about post strep glomerulonephritis. Oh what's that, and why
do I need to warn them about that and not rheumatic fever...

~~~
husarcik
Yeah, I've definitely seen that on HN and it can be very frustrating that's
for sure. Unless you've been in the system, it is very hard to understand why
some things are the way they are.

Side note: I hope your second year is going well. I know they've had a lot of
changes for USMLE because of coronavirus. Stay safe, and feel free to reach
out if you ever have questions about med school or just want to chat. :)

------
danans
IMO, the most fascinating thing about this report is that it exposes a fight
between two groups: 1) traditional health insurance companies 2) private
equity backed provider groups, both of whom would be opposed to universal
single payer healthcare as a right.

It almost reads like a turf war over which industry subgroup has more right to
the unusually high healthcare costs paid by Americans, driven by demand for
profits from shareholders, which probably indirectly includes someone like me
who has a 401k.

This fight has been going on for a very long time though. One reason (among
many) that large medical provider groups started forming in the US more than a
decade ago was to increase their leverage against insurance companies, who
they felt were undercompensating them - small medical practices have little
more leverage with insurance companies than consumers on the open insurance
market. At some point these larger medical groups attracted the attention of
private equity investors, who themselves demand a return on investment.

In the end it seems like the loser here is the healthcare consumer, who will
pay the higher costs of this system, especially those without significant
capital in for-profit healthcare related enterprises.

~~~
tartoran
How do we get rid of all this layer of inneficiency? Must be possible but
nobody is talking about getting rid of this but "fixing" it. Fixing may not be
possible or too expensive. As consumers we should avoid paying as few middle
man as possible. Today I just found out my health insurance is,of course,
going up.

~~~
fzeroracer
The only way to get around this inefficiency is in my opinion to move towards
single-payer and circumvent the system entirely. Otherwise you'd have to
excise all of the rent-seeking parasitical behavior in our current system
which I don't think is possible.

Even if you attempted to make the costs of things more transparent to
consumers, there's an inherent information asymmetry between a consumer and a
insurer due to the economy of scale. There's also a lot of things a consumer
can't know until it's too late.

~~~
toomuchtodo
If your Congressional representative does not support Medicare For All (single
payer), run against them in the next election cycle or donate & volunteer for
a competitor who does. That is all that is getting in the way of policy
implementation, having enough votes to pass the bill in the House and the
Senate. We'll get there!

I'm working on a site that will obtain attestation from Congressional reps as
to their support for M4A, and for those who don't attest support, campaign
funding will be funneled to competitors of said representatives who do.

[https://www.congress.gov/bill/116th-congress/senate-
bill/112...](https://www.congress.gov/bill/116th-congress/senate-
bill/1129/text) (S.1129 - Medicare for All Act of 2019)

