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October 04, 2010

Dept. of Thinly Veiled Threats

Why, O why do I hear a sotto voce "...or else" lurking in the background?

Doctors, like most people, don’t love to work weekends, and they probably don’t enjoy being evaluated against their peers. But their industry can no longer afford to protect them from the inevitable. Imagine a drugstore open only five days a week, or a television network that didn’t measure its ratings. Improving the quality of health care and reducing its cost will require that doctors make many changes — but working weekends and consenting to quality management are two clear ones.

Who says either of these things is "inevitable"? In a market where the number of patients seeking care suddenly expands without a corresponding increase in the supply of doctors providing care, wouldn't the bargaining power of said patients tend to diminish? It's one thing if patients (you know, the consumers of health care) decide not to patronize doctors who don't want to work on weekends or submit to peer reviews

It's entirely another when government tells American workers that their industry can no longer "afford" for them to control their own hours or working conditions. When government pays the bill, it (rather than the end consumer) gains the whip hand over American businesses.

That doesn't strike me as a good thing for freedom of choice but then as we're constantly being told by our intellectual betters, we common folk don't really know what to do with all that freedom anyway....

Posted by Cassandra at October 4, 2010 11:01 AM

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Comments

Since when did doctors become federal employees?

Posted by: BillT at October 4, 2010 11:20 AM

Imagine the government telling teachers they must now teach on the weekends, too.

Comparing a private practice doctor's office to retail is stupid: it's apples and oranges. The store manager isn't on duty every single hour the store is open. If you need 24/7 care, there are places to do that: the ER (for REAL emergencies) and those little "urgent care" storefront clinics, where there is more than one doctor practicing...

Posted by: Miss Ladybug at October 4, 2010 11:32 AM

Actually, I was thinking that since the federal government insists on inserting itself into every facet of our daily lives and government workers already get paid far more than private sector workers, perhaps government officials are the ones who need to start working weekends and submitting to peer reviews!

Posted by: Cassandra at October 4, 2010 11:41 AM

"And then there are the economics of a $750 billion-a-year industry letting its capacity sit idle a quarter or more of the time."

Looks like "fiscal conservatism" falls by the wayside when the threat of having to operate like every other public safety related industry rears its ugly head.

Posted by: Craig at October 4, 2010 11:43 AM

And then there are the economics of a $750 billion-a-year industry letting its capacity sit idle a quarter or more of the time

You go, Craig. Get in there and tell them how to run their business!

Posted by: Cassandra at October 4, 2010 11:50 AM

I guess Craig didn't read (or ignored) what I said about a private practice vs. an actual hospital or 24 hour clinic...

Posted by: Miss Ladybug at October 4, 2010 11:58 AM

Come the People's Revolution, MLB, wise government bureaucrats will make all the trains run on time (and at lower cost, too!). If you doubt that, just look at what a marvelous job Congress does when it's allowed to run things. Also, we'll all be better off than we are when we're allowed to make our own decisions.

That worked so well for the Soviet Union and Eastern Germany.

Posted by: Cassandra at October 4, 2010 12:03 PM

Miss Ladybug,

The article doesn't compare private practice to retail.

Cassandra,

Congress always has "run things".

Posted by: Craig at October 4, 2010 12:11 PM

There are great number of things Congress does not run even today, Craig (your wildest fantasies aside).

Posted by: Reality: Now Starring as Craig's Bitch at October 4, 2010 12:14 PM

In my reality, medical services are much more than a business. They are a matter of life and death, as your article points out:

"for every 1,000 patients suffering heart attacks who were admitted to a hospital on a weekend, there were 9 to 10 more deaths than in a comparable group of patients admitted on a weekday."

Posted by: Craig at October 4, 2010 12:44 PM

I guess Craig didn't read (or ignored) what I said...

He ignored it. He ignores everything he can't answer.

"for every 1,000 patients suffering heart attacks who were admitted to a hospital on a weekend, there were 9 to 10 more deaths than in a comparable group of patients admitted on a weekday."

That's not only a statistically insignificant number, it isn't even a definite number. Was it nine, or was it ten? Sloppy research.

Posted by: BillT at October 4, 2010 12:54 PM

In my reality, medical services are much more than a business. They are a matter of life and death

Exactly. Which is why government must force these selfish b**tards to work weekends.

Only then will America be safe. Until, of course, I discover another Matter of Life and Death.

Posted by: Peter Orszag at October 4, 2010 12:55 PM

"Quality management." Now those are two words that will send a shiver down your spine when used in conjunction with government.

If i got the article correctly the hospital in question is a notoriously poor performer in costs and outcomes compared to other hospitals. My first thought would be to consider adapting what the others are doing. But no, we must have comprehensive reform and spread the new practices. Yeah, that's a sure fired ticket to success.

Also from the article, "if you can't measure it how do you improve it?" As Bill pointed out if they can't figure out the actual number of dead people, 9 or 10, then their "solutions" might be a little off too.

Posted by: Allen at October 4, 2010 01:22 PM

They brought up retail, Craig:

"Doctors, like most people, don’t love to work weekends, and they probably don’t enjoy being evaluated against their peers. But their industry can no longer afford to protect them from the inevitable. Imagine a drugstore open only five days a week, or a television network that didn’t measure its ratings. Improving the quality of health care and reducing its cost will require that doctors make many changes — but working weekends and consenting to quality management are two clear ones.>"

Last time I checked, a drugstore is retail. Staffing a drugstore 7 days a week is a lot different than staffing a private practice 7 days a week.

Posted by: Miss Ladybug at October 4, 2010 01:31 PM

MLB, please refrain from confronting Craig with your so-called "Facts". As you ought to know by now, he is entitled to his own Facts.

For too long, greedy special interests, corporate fat cats and the evil Chinese toy-loving minions of the richest 1% have selfishly hoarded more than their fair share of information. But Change is coming. Soon Uncle Sam will be asking dangerously extremist types like yourself to help these needy Americans acquire their fair share of the nation's data supply.

Work with me here.

Posted by: I am the change I seek at October 4, 2010 02:02 PM

OK, Miss Ladybug, the article does indeed have one sole reference to a retail drugstore.

As you mention, the ER is for real emergencies. As the article mentions, patients admitted on the weekends do not fare as well as those admitted on the weekends.

You also mention Urgent Care. Urgent Care does offer convenience, but at a higher cost than visiting your own primary care physician.

Posted by: Craig at October 4, 2010 02:15 PM

Edit:

"As you mention, the ER is for real emergencies. As the article mentions, patients admitted on the weekends do not fare as well as those admitted on the weekends."

Should read:

"As you mention, the ER is for real emergencies. As the article mentions, patients admitted on the weekends do not fare as well as those admitted during the week."

Posted by: Craig at October 4, 2010 02:18 PM

My BIL works in an ER as a tech. Basically, he does the same stuff as a nurse in the ER, only he doesn't get paid as much... He tells interesting stories sometimes about people abusing the fact that an ER, by law, cannot turn anyone away. People coming in for things that aren't emergencies, criminal suspects trying to avoid going down to the jail (police must bring them to the ER if they claim illness/injury), people just looking for a fix. Problems with an ER aren't just about staffing (and I'd have to ask him if the ER is staff any differently over the weekend - he works weekends, nights, days, his schedule is always changing, and he doesn't get every holiday off, either). My cousin's wife who just had a baby has to interrupt her maternity leave to go work holiday shifts (she's a neo-natal nurse). I think hospitals staff ERs with personnel based on expected traffic, not based on a weekend/weekend set schedule. Now, how they decide WHO actually has to cover those "less desirable" weekend/holiday slots, I don't know.

Posted by: Miss Ladybug at October 4, 2010 02:51 PM

My former local med center's ER staffed weekends at a *higher* rate than during the week, because that's when all the action happened.

It's also the reason it moved out-of-town, because it couldn't afford to keep treating people who walked in with an injury -- real or imagined -- and then walked out again without paying. It was fairly common for their ambulance to respond to a 9-1-1 call only to discover the caller merely wanted a ride to the hospital to visit a relative, and didn't want to pay for a taxicab.

Posted by: BillT at October 4, 2010 03:53 PM

I loved that line about imagining "a television network that didn't measure its ratings".

I'm certain that the networks all "measure their ratings". But the trend line on those ratings is falling towards zero, and the suits can measure all they want to--but they don't seem able to stop the fall.

Posted by: Mike Myers at October 5, 2010 05:47 AM

"Improving the quality of health care and reducing its cost will require that doctors make many changes — but working weekends and consenting to quality management are two clear ones."

Or it will require that fewer doctors specialize and more go into general practice. Or it will require that more people become doctors. Those are also "two clear ones."

And *none* of them are the set-in-concrete sole options, and *none* of them are mandatory, despite the use of the verb "will"...

Posted by: BillT at October 5, 2010 06:32 AM

Well, we don't have Walter Contrite to prophesy gloom and doom any more.

He was the most trusted man in America. Now that Dan Rather is in retirement, where can we turn?

*sib*

Posted by: Cricket at October 5, 2010 08:06 AM

Oh good helk. *sob*.

Sheesh.

Posted by: Cricket at October 5, 2010 08:07 AM

Craig couldn't run an airplane into the ground if he tried.

Posted by: Ymarsakar at October 5, 2010 09:13 AM

...perhaps government officials are the ones who need to start working weekends and submitting to peer reviews!

They already subject to peer reviews, liberal superiority notwithstanding. Maybe we just need to have the elections more often, and have access to recall elections to fire the b*rds we learn that we hired in error.

Peer reviews: we already have those, too: they're called malpractice suits. And these are abused, also.

What will the liberal government do when, in response to government mandated work practices for doctors, folks stop being doctors in sufficient number? Re-institute the draft? Or ration health care? Or both?

Eric Hines

Posted by: E Hines at October 5, 2010 11:25 AM

Malpractice suits are more like peer reviews for lawyers. It's not like the jury gets paid for it.

Posted by: Ymarsakar at October 5, 2010 07:58 PM

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