ER closures and limited staffing

[Mad Mike]

I have nurse friends and they'd had it back in Sept-Oct...
OR Nurses getting re-assigned to COVID wards was not what they were expecting...and the added stress and promise that you won't get good $$ compensation in the near future means, well.. i can just find something else elsewhere if i'm this capped.
You know how some people say "if you don't like the job then find something else" well.. they're at the find something else stage

I have a lot of freshly minted nurses around me - a daughter, both sons dating nurses and 3 of my neices are nearly ready for final RN exams this year.

COVID was very difficult for every hospital nurse -- heavy PPE requirements, challenges with vacation scheduling, and constant pressure to do OT.

One of the biggest reasons emerg departments are overloaded is family doctors and walkin clinics are shifting loads to ERs. Hospitals are not efficient at managing sniffles, and booboos -- the paperwork, triage, examinations, and post-processing are the same for an elbow scrape and a broken arm. My daughter spent 2 years managing patient queues and flow in a busy ER, she tells me that despite staff educating patients that a walk-in or simple rest or cleanup of a scrape would be the best course of action, virtually all parents want to wait and get services from a doctor. She estimated at one point, 80% of the traffic were non-emergency cases.

Nurses are paid less, work more, and carry higher levels of responsibilities, than cops, paramedics, firefighters & teachers. On an hourly basis police, paramedics, and firefighters earn 50% more / hr, teachers are double. Many nurses leave public health care for private care -- it's easy to get 50% more, and specialized nurses can get 3x what they can make in a hospital.

 

[LePhillou]

I have a lot of freshly minted nurses around me - a daughter, both sons dating nurses and 3 of my neices are nearly ready for final RN exams this year.

COVID was very difficult for every hospital nurse -- heavy PPE requirements, challenges with vacation scheduling, and constant pressure to do OT.

One of the biggest reasons emerg departments are overloaded is family doctors and walkin clinics are shifting loads to ERs. Hospitals are not efficient at managing sniffles, and booboos -- the paperwork, triage, examinations, and post-processing are the same for an elbow scrape and a broken arm. My daughter spent 2 years managing patient queues and flow in a busy ER, she tells me that despite staff educating patients that a walk-in or simple rest or cleanup of a scrape would be the best course of action, virtually all parents want to wait and get services from a doctor. She estimated at one point, 80% of the traffic were non-emergency cases.

Nurses are paid less, work more, and carry higher levels of responsibilities, than cops, paramedics, firefighters & teachers. On an hourly basis police, paramedics, and firefighters earn 50% more / hr, teachers are double. Many nurses leave public health care for private care -- it's easy to get 50% more, and specialized nurses can get 3x what they can make in a hospital.

We'd think that now that we have a better understanding of covid and measures and a big majority of people have some protection against it that Family Physicians would start seeing people again..heck even hop on a zoom call!

The system is crumbling down and the pillars of that system aren't being compensated appropriately to take that pressure

 

[Evoex]

I have a lot of freshly minted nurses around me - a daughter, both sons dating nurses and 3 of my neices are nearly ready for final RN exams this year.

COVID was very difficult for every hospital nurse -- heavy PPE requirements, challenges with vacation scheduling, and constant pressure to do OT.

One of the biggest reasons emerg departments are overloaded is family doctors and walkin clinics are shifting loads to ERs. Hospitals are not efficient at managing sniffles, and booboos -- the paperwork, triage, examinations, and post-processing are the same for an elbow scrape and a broken arm. My daughter spent 2 years managing patient queues and flow in a busy ER, she tells me that despite staff educating patients that a walk-in or simple rest or cleanup of a scrape would be the best course of action, virtually all parents want to wait and get services from a doctor. She estimated at one point, 80% of the traffic were non-emergency cases.

Nurses are paid less, work more, and carry higher levels of responsibilities, than cops, paramedics, firefighters & teachers. On an hourly basis police, paramedics, and firefighters earn 50% more / hr, teachers are double. Many nurses leave public health care for private care -- it's easy to get 50% more, and specialized nurses can get 3x what they can make in a hospital.

I’d agree with almost everything except pay. Nurses should easily be in that high 80s low 90s club before OT. A maxed out constable is on par.

Even if what I say is true, they are certainly more overworked vs cops snoozing in cruisers or handing out tickets to E bikes…wait even that’s not happening.

 

[GreyGhost]

We'd think that now that we have a better understanding of covid and measures and a big majority of people have some protection against it that Family Physicians would start seeing people again..heck even hop on a zoom call!

The system is crumbling down and the pillars of that system aren't being compensated appropriately to take that pressure

Alternative view with the same facts is family docs need a huge kick in the ass. Dont want to work, dont get paid.

 

[nobbie48]

Further derail.

It isn't just medical. I had dinner with an ex client a couple of days ago.

FWIW Hoover's waterfront marina / restaurant in Nanticoke, not far from Port Dover if you're out for a ride.

He's late 50's and would be a shoe-in to take on supervisory work at a heavy industry site but why should he?

Make a bit more $$ but he's debt free and his kids will be through uni in a few years. Why take on the responsibility of trying to keep a plant running at peak efficiencey when the bean counters won't give you the money to do the job.

Spare parts are seen by the accountants as money sitting on a shelf. Then a 600 HP motor goes down and the supervisor gets blamed for the loss in production. Home Depot doesn't carry 600 HP motors. The manufacturers of the motors and similar equipment don't want inventory either so delivery can be months.

As the existing supervisors age out, the experienced older workers don't apply for the headaches so eager young newbies take the jobs and chaos takes over. As chaos continues consultants are brought in, adding another layer of mismanagement.

Short term profit at any cost to appease the shareholders.

I did a lot of work with him and his colleagues before I retired. He mentioned a coworker that retired at 60 and died at 66 from cancer. More people that have their finances in order may be seeing the reality.

 

[Mad Mike]

I’d agree with almost everything except pay. Nurses should easily be in that high 80s low 90s club before OT. A maxed out constable is on par.

Even if what I say is true, they are certainly more overworked vs cops snoozing in cruisers or handing out tickets to E bikes…wait even that’s not happening.

1 my daughter's high school buddies, 2 are nurses, 1 a cop, 2 teachers, one a firefighter. The cop did a 3 year police foundations course and made the sunshine list at 24. Paramedic 4 year university Sunshined in year 1. The teacher and firefighter are close, both work about 1000hrs a year at about $80/hr. One cardiac peids hospital nurse at $42/hr on a 2500 hour work year, another a 9-5 contract home care nurse at $65/hr + company car.

Life's not always fair, but for a young person all these high paying jobs are accessible.

 

[mimico_polak]

Just came back from camping and we had a few nurses in the group. They indicated something that I never considered.

ICU beds and longer term care beds are 40-50% full not with injured people but with older people that just don’t want to die.

Older people that were taken out of long term care homes during COVID by families working from home, and then dropped at the hospital as WFH is ending and people could no longer care for them.

No space in long term care so they’re taking up resources at the hospitals instead, and being cared for by nurses instead of them working to maintain care for those injured and needing care urgently.

She’s a 25 year veteran at the hospital here so I’m fairly confident in listening to what she says. She said the only reason she hasn’t left is the golden handcuffs of retirement pension, but is seeing the younger nurses leaving in droves and making the same or better money working for private (OHIP covered) clinics instead.

 

[GVH]

I got to experience the ER Saturday at 5 am. Surprisingly not a sole in the waiting room but many in the beds coming by ambulance. By 9 am walk-in waiting area lined up outside. the waiting room stayed constant even to Monday morning. During the 8am-8pm a nurse for every 2 patients 8pm-8am one nurse for 5-6 patients. Very helpful over worked nurse that graduated in May this year. He was not happy and leaving. Private sector job. Talking $25 k signing bonus. No beds in the cardiac ward so still in ER tonight. Far to many people coming in with the patients. Mom dad three kids for one sick feeling kid. then nurses dealing with whole family.

 

[ReSTored]

No space in long term care so they’re taking up resources at the hospitals instead, and being cared for by nurses instead of them working to maintain care for those injured and needing care urgently.

We've known for years (probably decades) that patients waiting for LTC or Home Care take beds in acute care hospitals. Toronto Star article today says there are about 4,800 patients in hospital today that should be discharged home or to LTC.

So question is why Liberal or PC governments of the day have not adequately funded HC to increase capacity or provided more $$ to fund LTC beds to resolve these problems. Governments saying we've increased funding by $XX dollars is meaningless if it means there are still 4,800 people sitting in beds that should be occupied by people lying on a stretcher in the ER. Yes, I know a cardiac bed is not the same as a bed occupied by a potential LTC patient, but you get the point I hope.

Demographics are changing and there will be more elder patients requiring LTC and / HC in the next 5 - 10 years, so this problem will only get worse. Will new LTC beds announced by DF resolve this issue? Not clear to me. I have not heard of any planned increases to Home Care funding, so good luck if you're in hospital wanting to return home, but unable to because there is no one available to change your dressing.

 

[mimico_polak]

Thanks for the clarification @ReSTored. That lines up with what our nurse friend said also. 'The population is getting older, and there's nowhere for these people to go. So they come to the hospital and wait for a spot, or wait to die as their families can't, or won't, take care of them at home.'

It's a sad state of affairs, and embarrassing, for a government to let their population age in such a manner. There should be outrage over unspent billions, and wasted billions, on frivolous electioneering projects instead of dealing with the aging population.

But that doesn't get people riled up, it doesn't sell papers, and it sure as hell does not affect anyone ... until it's their turn.

 

[Georg3__]

Just came back from camping and we had a few nurses in the group. They indicated something that I never considered.

ICU beds and longer term care beds are 40-50% full not with injured people but with older people that just don’t want to die.

Older people that were taken out of long term care homes during COVID by families working from home, and then dropped at the hospital as WFH is ending and people could no longer care for them.

No space in long term care so they’re taking up resources at the hospitals instead, and being cared for by nurses instead of them working to maintain care for those injured and needing care urgently.

She’s a 25 year veteran at the hospital here so I’m fairly confident in listening to what she says. She said the only reason she hasn’t left is the golden handcuffs of retirement pension, but is seeing the younger nurses leaving in droves and making the same or better money working for private (OHIP covered) clinics instead.

Yup. See this everyday.

Many of these folks should be going into long term care homes but not enough room.

 

[Mad Mike]

Just came back from camping and we had a few nurses in the group. They indicated something that I never considered.

ICU beds and longer term care beds are 40-50% full not with injured people but with older people that just don’t want to die.

Older people that were taken out of long term care homes during COVID by families working from home, and then dropped at the hospital as WFH is ending and people could no longer care for them.

No space in long term care so they’re taking up resources at the hospitals instead, and being cared for by nurses instead of them working to maintain care for those injured and needing care urgently.

She’s a 25 year veteran at the hospital here so I’m fairly confident in listening to what she says. She said the only reason she hasn’t left is the golden handcuffs of retirement pension, but is seeing the younger nurses leaving in droves and making the same or better money working for private (OHIP covered) clinics instead.

My daughter was here for the weekend, we talked alot about the challenges with nursing. She confirmed a few things that have been bantered around here.

Family doctors. They are paid the same for telephone consults as for in-person consults. As a result, they are slow to return to their offices and clinics. WFH limits their work, they are referring copious amounst of basic healthcare work to emergency wards. Sniffles, boo-boos, pink eyes, and pretty much anyone who is ill with routine stuff.

Outsourced nursing. OHIP funds private care that use a lot of nurses, they pay these operators a lot more per hour than hospital nurses. The private care operators pay about 50% more to their nurses as independent contractors. Contract nurses often work MF/9-5, earn a higher hourly rate, and get to write off car, telecom, and home office expenses -- but generally get no employment benefits. For a young nurse this can mean 75% more income, it's sucking nurses out of bedside care.

COVID Backlogs. Backlogs in surgery have put many facilities into overdrive to catch up, and placed more patients into hospital care as their health degrades while waiting. Oncology, cardiac, and ortho patients lines are longer than airport security queues.

Solutions? Reduce telephone visit pay by 50% to get doctors back into their offices.

Revise OHIP-funded contract care / private nursing rates so as to put pay on par with hospital bedside.

Increase hospital nurse pay-rates to match teachers, police, firefighters, and paramedics.

Dramatically increase PSW support for nurses. PSW ranks can be built faster as the training and certification bar is far lower. PSWs can offload a lot of the nurses work so they can focus on high value practices.

 

[mimico_polak]

My daughter was here for the weekend, we talked alot about the challenges with nursing. She confirmed a few things that have been bantered around here.

Family doctors. They are paid the same for telephone consults as for in-person consults. As a result, they are slow to return to their offices and clinics. WFH limits their work, they are referring copious amounst of basic healthcare work to emergency wards. Sniffles, boo-boos, pink eyes, and pretty much anyone who is ill with routine stuff.

Outsourced nursing. OHIP funds private care that use a lot of nurses, they pay these operators a lot more per hour than hospital nurses. The private care operators pay about 50% more to their nurses as independent contractors. Contract nurses often work MF/9-5, earn a higher hourly rate, and get to write off car, telecom, and home office expenses -- but generally get no employment benefits. For a young nurse this can mean 75% more income, it's sucking nurses out of bedside care.

COVID Backlogs. Backlogs in surgery have put many facilities into overdrive to catch up, and placed more patients into hospital care as their health degrades while waiting. Oncology, cardiac, and ortho patients lines are longer than airport security queues.

Solutions? Reduce telephone visit pay by 50% to get doctors back into their offices.

Revise OHIP-funded contract care / private nursing rates so as to put pay on par with hospital bedside.

Increase hospital nurse pay-rates to match teachers, police, firefighters, and paramedics.

Dramatically increase PSW support for nurses. PSW ranks can be built faster as the training and certification bar is far lower. PSWs can offload a lot of the nurses work so they can focus on high value practices.

The doctors that refuse to see patients in person burns me, and our family personally. You want to see a doctor but wait 2-3 weeks for a 10min call (that is typically 1hr later than expected).

Then they get pissy when you call another clinic, see a doctor, and get taken care of within a few hours. And they threaten to drop you as a patient.

I was under the impression that the province informed doctors they need to start seeing people in person again? I think most doctors get paid an annual fee for their patients, and not a per visit type of arrangement. So they have to pay out of that annual fee to another doctor if a patient goes to see them.

Basically doctors nowadays want healthy patients, that require zero effort, zero treatment, and zero issues. Healthy patients are the best patients. 100% of the payment, 0% of the work.

I'm going to call my doctor today for a foot pain.

 

[Georg3__]

The doctors that refuse to see patients in person burns me, and our family personally. You want to see a doctor but wait 2-3 weeks for a 10min call (that is typically 1hr later than expected).

Then they get pissy when you call another clinic, see a doctor, and get taken care of within a few hours. And they threaten to drop you as a patient.

I was under the impression that the province informed doctors they need to start seeing people in person again? I think most doctors get paid an annual fee for their patients, and not a per visit type of arrangement. So they have to pay out of that annual fee to another doctor if a patient goes to see them.

Basically doctors nowadays want healthy patients, that require zero effort, zero treatment, and zero issues. Healthy patients are the best patients. 100% of the payment, 0% of the work.

I'm going to call my doctor today for a foot pain.

There's ways family doctors get paid if they group together????

 

[GreyGhost]

There's ways family doctors get paid if they group together????

My understanding is if they are part of a group, if you see any doctor in that group, compensation is unaffected. If you go to an unaffiliated clinic, your doctor gets less money for each visit you make to an unaffiliated doctor. Presumably that money goes to the WIC that you visited.

 

[mimico_polak]

My understanding is if they are part of a group, if you see any doctor in that group, compensation is unaffected. If you go to an unaffiliated clinic, your doctor gets less money for each visit you make to an unaffiliated doctor. Presumably that money goes to the WIC that you visited.

That's how I understand it.

Let's say the doctor gets $1000/patient. If you go 1 time, or 10 times, they still get $1000.

But if you go to a different doctor / clinic (that's not affiliated) then doctor A has to pay out to doctor B from the $1000 'out of pocket'.

So doctor A gets upset because now he's not getting his full $1000, but $1000 - $100 (I don't know the number).

So basically doctor A brings on as many patients as he can, and then hopes majority of them are healthy patients so they keep getting paid...without actually putting in that work.

 

[Georg3__]

My understanding is if they are part of a group, if you see any doctor in that group, compensation is unaffected. If you go to an unaffiliated clinic, your doctor gets less money for each visit you make to an unaffiliated doctor. Presumably that money goes to the WIC that you visited.

ahh

 

[GreyGhost]

That's how I understand it.

Let's say the doctor gets $1000/patient. If you go 1 time, or 10 times, they still get $1000.

But if you go to a different doctor / clinic (that's not affiliated) then doctor A has to pay out to doctor B from the $1000 'out of pocket'.

So doctor A gets upset because now he's not getting his full $1000, but $1000 - $100 (I don't know the number).

So basically doctor A brings on as many patients as he can, and then hopes majority of them are healthy patients so they keep getting paid...without actually putting in that work.

Their compensation is capped too. Once they have xxx patients, they no longer get any more money. That's almost a good idea as you don't get a doctor that signs up far more patients than they have time to see but it leads to people unable to find a family doctor and doctors patient shopping for easy ones to fill the list.

FWIW, I think family doctor compensation sucks. Last I heard the total comp is ~300K but from that you subtract all expenses including office staff. That is another reason they group together to help spread those costs. For the amount of school required and knowledge we expect from them that's not great. I think family docs should have opportunity for more compensation and many of the specialists should have a huge cut. Could be revenue neutral.

EDIT:
I don't know if it is related to this thread or not but Orng was requested for another rider this morning and it was not available. That's at least twice in the past few days. Not sure if Orng is at lower capacity as well.

 

[crankcall]

Orng flies a route from Hamilton to TO almost constantly moving people . It’s a busy service .

Yes to everything MM typed in his replies to the group .

My wife is 1 yr off pensioning out . 30+ yrs paediatric specialty, labour & del, was part of the IV team and a trainer, did patient transfer flights . She will work 8 seconds past her deadline to grab her coffee mug. She could teach , or do any amount of contract work , but she will dead head geraniums at Terra nurseries instead. So F’d over by the province it’s truly sad .


Sent from my iPhone using GTAMotorcycle.com

 

[Mad Mike]

My understanding is if they are part of a group, if you see any doctor in that group, compensation is unaffected. If you go to an unaffiliated clinic, your doctor gets less money for each visit you make to an unaffiliated doctor. Presumably that money goes to the WIC that you visited.

That's how it was explained to me. My new Dr works in a shared practice setting, 7 of them. They take turns covering the 6-11PM shift -- kinda like a walkin but only open to their patients. They don't book appt in the evenings, so they are not busy -- in and out in a few minutes if I need a little doctoring.