> "My cap is 15 patients in one day," Nuila says. "That's compared to some of my colleagues in the private world, who I've heard admit up to 24 patients in one night, or don't carry a cap."
Learning from my spouse who is a current medical resident -- some attendings admit and discharge more patients than the capacity because their bonuses are tied to that. That is a twisted incentive and it is in conflict with ACGME's guidelines of not letting residents handle more than 10 patients at a time. The attending/hospitalist at my wife's hospital makes $420K/year + bonus (it's near Miami, FL). They work 8-hours shift for 7 days and then rest 7 days. If one chooses to, s/he can moonlight at another place (a senior friend of my wife works for a hospital in Palmdale, CA and another one nearby for 7 days each; she easily bags $600K/year; she is raking in money when she can work this much while buying houses, and she plans to work half as much in a few years).
I also wonder if hospitals like "The People's Hospital" make patients sign waiver to not sue them. At my wife's hospital, some of the patients (and/or their families) are obviously angling for lawsuit and are always looking for excuses to do that. That legal/liability burden (among may other things like doctor's salaries; bloated administration; etc.) is part of the reasons why hospital bills are exorbitant.
That's actually a little bit surprising to me. I have some family friends who are doctors (one's a dermatologist, the other an internist). They each pay somewhere around $50k per year in malpractice insurance premiums. Now sure, in the grand scheme of things, the 50k extra your doctor demands is likely not transformative for health care costs, but I also wouldn't imagine it is nothing.
In a transparent market, the theory of 'reduce costs' -> 'cheaper healthcare' might hold, but the healthcare market is anything but transparent. If my doctor can save money on something, he's not going to pass in on to me in the form of lower costs. Why would he? I don't pay my doctor! Three months after I visit him, I get a bill from my insurer for some co-pay that's a tiny fraction of what the doctor billed them.
I'm assuming the savings were happily eaten by doctors' wages/hospital shareholders/admins/insurers. Meanwhile, the patients got to deal with gems like this[1] doctor.
Healthcare seems to be much like rent in a supply-constrained environment, in that it is doing its best to siphon up all surplus funds sloshing around the economy.
[1] https://www.propublica.org/article/dr-death-christopher-dunt... - the hospitals didn't care that he was butchering his patients, because they get money per surgery performed, not per successful surgery performed. The patients had no recourse, thanks to tort reform. The doctor himself didn't care. He shuffled around from hospital to hospital (who welcomed a rainmaker that brings more business in with open arms), maiming people, until his negligence reached criminal levels.
Did training doctors get any cheaper? If not, then a doctor will try their hardest to get out of debt as soon as possible. Just think, their friends who aren't doctors already have a house by the time they graduate with a few hundred thousand in debt and no house to show for it.
You want cheaper healthcare? Make becoming a doctor cheaper.
Learning from my spouse who is a current medical resident -- some attendings admit and discharge more patients than the capacity because their bonuses are tied to that. That is a twisted incentive and it is in conflict with ACGME's guidelines of not letting residents handle more than 10 patients at a time. The attending/hospitalist at my wife's hospital makes $420K/year + bonus (it's near Miami, FL). They work 8-hours shift for 7 days and then rest 7 days. If one chooses to, s/he can moonlight at another place (a senior friend of my wife works for a hospital in Palmdale, CA and another one nearby for 7 days each; she easily bags $600K/year; she is raking in money when she can work this much while buying houses, and she plans to work half as much in a few years).
I also wonder if hospitals like "The People's Hospital" make patients sign waiver to not sue them. At my wife's hospital, some of the patients (and/or their families) are obviously angling for lawsuit and are always looking for excuses to do that. That legal/liability burden (among may other things like doctor's salaries; bloated administration; etc.) is part of the reasons why hospital bills are exorbitant.