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Old 20 November 2018, 08:51
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Question Shortage of medical personnel?

So after reading 8654Main and IronEriks posts in things yiubjate thread - is there straying to be a shortage of doctors and nurses? Many fed up with the bureaucracy, red tape, administers, ACA reforms, etc? Good friends of mine's wife, a CRNA, just left her very high paying job due to many of these factors. According to her, and she has been a nurse now for close to 25 years, the bickering, job dissatisfaction, BS one has to put up with now she has never seen higher. Causes for concern? Or just another day at the office?
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Old 20 November 2018, 10:17
Chesie Chesie is offline
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LP,
There is a lot of truth to the high burnout stories in medicine. Hospitals around the country have a lot of trouble retaining nurses for inpatient care, and 20-30% turnover annually is becoming the norm.

As far as doctors are concerned, there has been a dramatic shift towards jobs that have a better lifestyle and put less strain on the doctor and his/her family. There is already a shortage of general surgeons in most regions of the country (and the military, but I digress...), and this problem is going to reach a critical stage in the next 5 years. The average age of a practicing general surgeon is now 58, because more surgeons are retiring than entering the field.

As an academic surgeon, I get to teach medical students and residents the art and science of surgery. I don't remember the last time a surgery resident of mine finished residency and became a general surgeon. With mandated work hour restrictions, many surgery residents don't feel comfortable enough with their training to just go off and operate, and almost 90% of American surgery residents now pursue a fellowship in specialty surgical training. I think the reason for this is a combination of not enough training, and the feeling that doing a fellowship will provide better job security and more flexible hours. Being a general surgeon is a brutal lifestyle. No matter what call you share with your group/partners, you are still pretty much on call for your patients 24/7, if only because the mentality of most good surgeons is that you should take care of your patients whenever possible, and you don't want someone else doing it for you.

I love what I do for a living, but I set up my career well in advance, with the knowledge of how healthcare was going to change. I did a fellowship in bariatric surgery 12 years ago, and I have the luxury of being able to control how I practice medicine with a relatively free hand. The Army surgeon hat that I wear was a different itch that needed to be scratched, but it wasn't financially motivated, so I am not beholden to the government beyond what I want to contribute.

To answer your questions specifically, a lot of the job dissatisfaction in medicine stems from expectations exceeding reality. The people that bitch the most in medicine are the ones that would bitch about a lack of dicks, if it were raining pussy. I try to set expectations appropriately with my medical students and residents early on, and to teach them the art of flexing in the face of adversity. Some people are just better at it than others.

But... all things considered, it is harder for healthcare providers to enjoy their careers, with all the interference you enumerated. There is no free lunch any longer in medicine, and you do have to work harder for less. Talent always follows the money, and when the healthcare delivery in America starts to suffer, the pendulum will again swing back towards better quality physicians and care.

Regards,
Danny
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Old 20 November 2018, 10:21
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My wife is a physical therapist and complains about the amount of paperwork she has to do. She spends as much time doing that as treating patients and it has definitely taken the joy out of her job. She came close to walking away from it and working at an outdoor store. It would have been a huge pay cut, but you can’t put a price tag on happiness.
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Old 20 November 2018, 12:53
osubuckeye762 osubuckeye762 is offline
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A year ago we left Richmond, VA and relocated to Durham, NC so she could leave her job as a Speech Pathologist at the Richmond VA and take a more admin position at the Durham VA.

Prior to the Richmond, VA she worked at Walter Reed treating and working with soldiers that had suffered TBI's.

She was so burnout out and fed up with the BS, infighting and political bureaucracy that was taking away time working with the patients/soldiers/sailors/Airmen and Marines.

She loved working with the patients but due to the over whelming BS she threw in the towel.

At our last staff meeting, our director stated that there is a massive shortage of Forensic Pathologists across the US. If an individual wanted to pursue that field they could write their own ticket. The problem is the case loads are overwhelming especially with the onslaught of the opoid overdoses. We have three full time pathologists and one part time and they are overwhelmed.
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Old 20 November 2018, 14:09
8654maine 8654maine is offline
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Chesie hit it on the head.

If you think military folks bitch a lot, be a fly on the wall in the OR, ER or Clinic.

Medicine is still the best profession in the world (right up there with prostitution and human hunting).

It used to be cushy and well paid.

There will always be need for people who get paid to care/heal.

The expectations will be different.

BTW, my wife teaches college bio to nursing students. It is scary.

It always comes back to people.
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Old 20 November 2018, 16:22
Devildoc Devildoc is offline
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8654maine, #truth.

Nursing. There is a shortage, and there will be a worse shortage. Biggest problem is a large chunk of the workforce is nearing retirement. That includes academic nursing (i.e., nursing professors). That will limit enrollments in nursing schools. They are luring people into nurse education, but why would someone get a MSN or PhD and spend all that time and money, but make the same as a seasoned clinical nurse?

Part of the issue is the burnout factor. You can argue if it is worse in the post-ACA world, but I don't think that's the issue. But increased burdensome accreditation, regulation, and bureaucracy is. People are making medical decisions who are businessmen. All the alphabet agencies (including Magnet) have a hand in shaping nursing practice, and most, not in a good way.

Part of the problem is self-induced: we have striven to put nurses everywhere so that nurses work at the bedside for a year or two and decide to move on to something easier on the body and mind. There are clinical (i.e., bedside) nurses, but there are also nurse educators, nurse clinicians, nurse coordinators, project coordinators, research nurses, nurse managers, nurse facilitators, nurse navigators....those are the ones that have not gone to grad school. If we got rid of half of those specialty jobs (and I am currently in one while I am in grad school), there would be plenty of bedside nurses, and no clinical shortage.

I alternately love my profession and hate it, but if I had to do it all over again, I probably wouldn't.
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Old 20 November 2018, 17:52
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Radiology (the slide of the medical industry I work in) is going to be in this discussion soon, and probably is in a few geographic areas. I've read that close to half of radiologists are 55 years or older. That's going to bring some massive turnover issues just staffing to demand, and other issues in quality/experience with the replacements. All the while, turn around times on studies in ERs and even for outpatients will take hits along the way.

This is all after the general discontent in reduced incomes that's being felt by constriction on payor contracts and MACRA starting to turn Medicare dollars into a bone for dogs to fight over...but I suppose that's in any medical specialty.
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Old 20 November 2018, 18:21
Gsniper Gsniper is offline
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I'm pretty sure I ran one radiologist out of the business. I went for a back issue, not expecting an x-ray, but had to get one. 20 something smoking hot chick doing the pics says drop your pants to your knees, leave your underwear up. The look on her face was priceless when I told her I was commando, and no, I don't mean it was a look of anticipation
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Old 20 November 2018, 18:39
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litepath litepath is offline
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Originally Posted by Gsniper View Post
I'm pretty sure I ran one radiologist out of the business. I went for a back issue, not expecting an x-ray, but had to get one. 20 something smoking hot chick doing the pics says drop your pants to your knees, leave your underwear up. The look on her face was priceless when I told her I was commando, and no, I don't mean it was a look of anticipation
hahahaa. . ..good one!
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Old 20 November 2018, 19:11
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Originally Posted by Gsniper View Post
I'm pretty sure I ran one radiologist out of the business. I went for a back issue, not expecting an x-ray, but had to get one. 20 something smoking hot chick doing the pics says drop your pants to your knees, leave your underwear up. The look on her face was priceless when I told her I was commando, and no, I don't mean it was a look of anticipation
Those are just the rad techs, not a radiologist proper. While it isn't easy to lose a good tech, it's not miserably difficult to replace in the current market like a fully trained and experienced MD or DO is once they retire, or take a different job somewhere.
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Old 20 November 2018, 18:38
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litepath litepath is offline
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Chesie is dead-nuts right. As is 8654maine. No matter what is stated in this thread, it's always about people.

Sloth in any way it can be imagined is encountered on a daily basis in the Heath Care System. It is ugly to behold and ugly to listen to on the phone. It is a huge energy drain for anyone simply trying to accomplish a task, or their job.

1. Sloth; explains itself.

2. Empire Builders; They and their position requires you to hold them in certain esteem to get what you want or need.

3. Quarter-Pounder-people; the people promoted because they could not do a job because of their sloth. Soon after they get this position they become #2.

4. (Elvis &) Common sense has left the building. If any statement describes the progress of the nursing profession better than this one, I'd love to hear it.

~~~~~~~~~~~~
What I got fed up with in order of importance TO ME.

a. Nursing as an entitled entity. Nursing is *trying to be seen* as professional and unfortunately stopped doing it's job.

b. Baby sitting druggies and out of their fucking mind -OH fuckers in the ICU. They only put them in the ICU because someone has to watch them-> No shit.
And while you watch them and drag them backintothebedandcallsecurityandonandon you cannot take care of Dr. C's patient who really is in the ICU for a fucking reason.

c. Missed being able to take proper-care of my patients (I'm too hyper-vigilant to babysit assholes while your loved one is in the room next door not being cared for). see#2.

d. The Sloth thing in the 1-4 enumerated above.

I first worked for the nursing dept at my local (here where I live) hospital from 1974-1976. With a road well traveled in between, didn't become a nurse or work as one until the 2000's.
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Last edited by litepath; 20 November 2018 at 18:43.
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Old 20 November 2018, 18:42
Gsniper Gsniper is offline
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My daughter is halfway thru nursing school. I sure hope she hasn't made a major mistake. She doesn't suffer fools well. She'll be 27 when she graduates, so at least she'll be a tad more mature than if she'd graduated at 20.
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Old 20 November 2018, 18:53
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litepath litepath is offline
I reckon so. . .
 
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Quote:
Originally Posted by Gsniper View Post
My daughter is halfway thru nursing school. I sure hope she hasn't made a major mistake. She doesn't suffer fools well. She'll be 27 when she graduates, so at least she'll be a tad more mature than if she'd graduated at 20.
Health Care has an unexpected dichotomy. At least it was for me.

My point being you can go to one facility and encounter some of the very things I mention. And even worse. Way worse.

And yet, take a 3 or 4 or 8 hour ride and find another facility that is so very different you'd think I was a damn liar. Some places are dialed in. Tight.
You'd think the shitty ones would want to learn from them. You'd be wrong.
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Old 20 November 2018, 19:02
8654maine 8654maine is offline
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My daughter is halfway thru nursing school. I sure hope she hasn't made a major mistake. She doesn't suffer fools well. She'll be 27 when she graduates, so at least she'll be a tad more mature than if she'd graduated at 20.
Tell her to stay with it.

Nursing is an honorable profession.

There are multiple opportunities.

The room for advancement is unparalleled.

There is high level of satisfaction as well as stress.

She will be able to find a job anywhere, anytime.

But have thick skin, and be able to sense when she is at danger (I'm speaking mostly from the ER world where nurses are abused physically and verbally on a continual basis).

And get a cop hubby (man, I see that combo everywhere!) ;-)
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Old 20 November 2018, 19:01
Gsniper Gsniper is offline
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I'm a bit apprehensive. She has EXTENSIVE experience as a patient at Duke, which is quite different than any other hospital I've ever been in (with the VA being the other end of the scale). I hope when she lands at Podunk Memorial she can handle the swing.
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Old 20 November 2018, 19:07
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litepath litepath is offline
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I'm a bit apprehensive. She has EXTENSIVE experience as a patient at Duke, which is quite different than any other hospital I've ever been in (with the VA being the other end of the scale). I hope when she lands at Podunk Memorial she can handle the swing.
She's young and can handle it I'll bet. All she needs is to be able to allow herself to move away from home if needed.

I'd recommend a teaching hospital. They tend to have better funding. And funding makes a difference.
She may have to be a bit away from y'all at home there, but not too far.
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Old 21 November 2018, 09:33
Devildoc Devildoc is offline
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I'm a bit apprehensive. She has EXTENSIVE experience as a patient at Duke, which is quite different than any other hospital I've ever been in (with the VA being the other end of the scale). I hope when she lands at Podunk Memorial she can handle the swing.
I have been a RN for almost 17 years. I have been a manager, educator, clinical nurse; now working on my MSN. I may or may not have "EXTENSIVE experience" as a nurse at Duke (ED, ICU, interventional radiology, hyperbarics). I also worked for the "light blue" down the street (ICU, flight); as much as I hate UNC-CH, it is an excellent hospital and I have no issues with having worked there.

If she has any questions or wants any insight--good, bad, and ugly--PM me and I will give you my email.

What @Jakers, said, I also hold disdain for the nursing profession, but have nothing but love and respect for my colleagues at the bedside. Well, most.

What @Litespeed said, is truth. A lot of older nurses, especially those in academia, like to talk the talk about teamwork but won't change a bed or empty a trashcan. Those people can kiss my ass.

What @BigNickT said, a lot of young nurses don't want to get their hands dirty. They have a plan: 1-2 years bedside, grad school, NP or CRNA. And THOSE fields are also undermanned so schools have lowered admission standards, so you are getting gas-passers and script-writers who are dumber than a box of rocks. My local school of higher education has an accelerated BSN program, so you have to have a degree to get in. Once you get in, they talk up the name of the school and tell you why you are the best. They are the worst. Lazy AND snobby. When I precept them I tell them they are already losers: not working in the field for which they already have a BA/BS, and they have to prove themselves to me.
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Old 20 November 2018, 19:20
Gsniper Gsniper is offline
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She's already lived away from home for a couple of years, not an issue. She's willing to move to get what suits her. She'll finish her RN in about 10 months, then will either start work or go the BSN route. Undecided at this point. As for the cop boyfriend, I don't think that's happening. After having a grunt for a Dad she went with a man that wears clean clothes and comes home with clean hands at the end of the day.
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Old 20 November 2018, 19:23
8654maine 8654maine is offline
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Originally Posted by Gsniper View Post
She's already lived away from home for a couple of years, not an issue. She's willing to move to get what suits her. She'll finish her RN in about 10 months, then will either start work or go the BSN route. Undecided at this point. As for the cop boyfriend, I don't think that's happening. After having a grunt for a Dad she went with a man that wears clean clothes and comes home with clean hands at the end of the day.
"Fastidious" is a disorder, not MANLINESS.

She'll dump him in 5 years.
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Old 20 November 2018, 19:27
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leopardprey leopardprey is online now
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"Fastidious" is a disorder, not MANLINESS.

She'll dump him in 5 years.
"I wasn't mean; I wasn't evil. I was nice. And let me tell you, a hesitant man is the last thing in the world a woman needs. She needs a lover and a warrior, not a Really Nice Guy."
John Eldridge - Wild at Heart.
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