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  • Regarding the nursing shortage it has been unfortunate to see the strategy at one of the hospitals where I work. They resisted increasing rates when every other place was offering stipends. They seemed to think the prestige of working for a well respected name would continue to support low wages with increased risk. The excellent nurses we lost were replaced by more expensive locums, some who are ok but not most in my opinion. Now even the locums are in short supply and instead of increasing pay for existing staff RNs which would set an undesirable precedent they continue the course. The other issue what will not be addressed is there would be less of a shortage of RNs if the greedy universities had actual admission criteria and rigorous programing for nurse practitioners. The current state of admitting anyone with or without RN experience for an entirely virtual experience being led by inexperienced clinical staff is causing significant quality issues in addition to exasperating the RN shortage.

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    • Originally posted by Zaphod View Post
      They're paying more than they pay many docs, no way its normal. I
      The nurses are unionized and know how to extract money without putting themselves in a bad light. The idiotic docs ( myself included) will consider it a duty and honor to care for the sick COVID patients and put ourselves at risk taking on longer hours and more calls with no increase in pay, let alone get any overtime. No wonder the admins ride roughshod over us.

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      • Originally posted by StateOfMyHead View Post
        Regarding the nursing shortage it has been unfortunate to see the strategy at one of the hospitals where I work. They resisted increasing rates when every other place was offering stipends. They seemed to think the prestige of working for a well respected name would continue to support low wages with increased risk.
        This sounds like a lot of academic job situations we see posted.

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        • Originally posted by Kamban View Post

          The nurses are unionized and know how to extract money without putting themselves in a bad light. The idiotic docs ( myself included) will consider it a duty and honor to care for the sick COVID patients and put ourselves at risk taking on longer hours and more calls with no increase in pay, let alone get any overtime. No wonder the admins ride roughshod over us.
          "ride roughshod" would suggest leaving their home offices, which I didn't see during the pandemic, particularly during that time before the vaccine....

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          • Originally posted by Zaphod View Post

            Its not just money, there is some kind of federal program that makes it not bad for them. This has been going on forever, if it were the same pile of cash theyd just pay their own a little more but it isnt.

            There is something called the emergency nursing act etc....or something like that, and my wife just took some extra days for 40h/extra and she had to sign a different paper which was also some kind of nursing grant/program related thing.

            Its subsidized, no other way to think of it. Theyre paying more than they pay many docs, no way its normal. If it is, well then you can see how hospitals dont make money. But this has been going on for years and now its just more obvious. The smartest nurses have been doing only this from the beginning. Super high pay, and not even all of it is taxable.
            Would really need the grant/program identified and this tax break of which you speak.
            THIS is possible. Many government programs exist that the rules and regulations are easily circumvented legally.
            One example is Clean Vehicle programs.
            Intent: incentive replacement of aging truck fleets and heavy equipment with new “efficient vehicles”.
            Sounds good. Result was the “rebate” covered up to 90% of the cost. Paid in 60 days after purchase.
            A lot of red tape that was ineffective.
            The result is effective. You hardly see old tractors belching smoke or broke down on the roads. A $2m-$4m check is a large incentive for a small business. Courtesy of the EPA putting tax dollars to work. Every truck and equipment dealer used this program.
            I have no doubt that government grants for healthcare can and are exploited.

            The constraint on the trucks was the company needed to pay to pay cash upfront. Had to bypass traditional vehicle financing. Send me the cash and the company writes a check. Bingo! The hospital would be eligible for the grant as contractors, not employees. Under served/underprivileged programs even in the big urban areas. Details matter in grants. That cancelled check was worth $2m rebate.

            I wouldn’t place the blame on administrators for grant programs.

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            • At my job, not only are they paying the travel nurses multiple times what the full time staff make, but they are paying new hires substantially more and refusing to negotiate raises with the few good remaining nurses we have. Our nurse manager quit a month ago. The 35 bed unit is mostly run by travel nurses and RNs fresh out of school.

              When I did locum tenens last year I didn’t think it was that lucrative. Why is the market so much more distorted for the nurses? Did more of them burn out and quit health care? Why can’t I take an assignment in Indiana for double what I made in 2019? Do these grants and subsidies explain a large portion of the difference?

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              • Most states have posted nursing ratios and contracts probably will dictate staffing too. Not so for docs. Plus as stated above - docs are too willing to bend backwards and let hospitals get by financially at their own financial peril --

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                • CDC saying the first confirmed case of Omicron in the US is in California.

                  So far all I've seen in that those with this variant have very mild symptoms.

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                  • Originally posted by CordMcNally View Post
                    CDC saying the first confirmed case of Omicron in the US is in California.

                    So far all I've seen in that those with this variant have very mild symptoms.
                    Yeah most with fully vaccinated 6+months and no booster. Which is similar to Delta breakthroughs. These would be the largest buckets of travelers at the moment too so not surprised the N is all with this status as self-attest no symptoms and no pre-flight testing requirements for most vaccinated travellers.

                    What will be the most interesting to watch is how Omicron competes with Delta. Mu was of concern here in California given its evasion; but Delta crushed it.

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                    • Fingers crossed that the Omicron variant does cause milder disease than the Delta variant does. Even if there is some escape immunity, it would be a good thing for a more transmissible but less virulent variant to replace one that is less transmissible but causes more severe disease.

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                      • Originally posted by Lithium View Post
                        At my job, not only are they paying the travel nurses multiple times what the full time staff make, but they are paying new hires substantially more and refusing to negotiate raises with the few good remaining nurses we have. Our nurse manager quit a month ago. The 35 bed unit is mostly run by travel nurses and RNs fresh out of school.

                        When I did locum tenens last year I didn’t think it was that lucrative. Why is the market so much more distorted for the nurses? Did more of them burn out and quit health care? Why can’t I take an assignment in Indiana for double what I made in 2019? Do these grants and subsidies explain a large portion of the difference?
                        Our hourly rate for perm psych comes out to $150-200/hr plus benefits depending on productivity. We pay locums $250-340 plus expenses but the agency takes 1/4-1/3 of that. So it ends up being much more for us but not w ton more for the doc.

                        Where locums do clean up is doing overtime and holidays, b cause there's a 50% differential. Obviously perm staff doesn't get that.

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                        • Originally posted by FIREshrink View Post

                          Our hourly rate for perm psych comes out to $150-200/hr plus benefits depending on productivity. We pay locums $250-340 plus expenses but the agency takes 1/4-1/3 of that. So it ends up being much more for us but not w ton more for the doc.

                          Where locums do clean up is doing overtime and holidays, b cause there's a 50% differential. Obviously perm staff doesn't get that.
                          That sounds about right. I stopped doing locums once I got my hands on the agency’s contract and saw what their markup was. That should mirror how my pay was structured, but it wasn’t. I got the differential for holidays, but that’s only 6 days a year. No OT differential in the contract I had, but I think the agency cleaned up. At least now I know how to negotiate better if I ever do it in the future.

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                          • Originally posted by artemis View Post
                            Fingers crossed that the Omicron variant does cause milder disease than the Delta variant does. Even if there is some escape immunity, it would be a good thing for a more transmissible but less virulent variant to replace one that is less transmissible but causes more severe disease.
                            not if the healthcare system can't handle the volume of patients. I believe two of the israeli docs who tested positive for omi were boosted which leads me to think it will be hard for the unvaxxed to escape this one.

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                            • Originally posted by Jaqen Haghar MD View Post

                              Well. My father was never really a heathy guy....
                              Thank you for so eloquently sharing. I am sorry for your loss. May he rest in peace....

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                              • Originally posted by triad View Post

                                not if the healthcare system can't handle the volume of patients. I believe two of the israeli docs who tested positive for omi were boosted which leads me to think it will be hard for the unvaxxed to escape this one.
                                And both showed mild symptoms, along with every other case that I’ve read about so far. I hope that I’m right, since I believe covid is mutating into a more contagious but less virulent virus.
                                HikingDO
                                Physician
                                Last edited by HikingDO; 12-01-2021, 10:10 PM.

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