Is the US health system collapsing?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Is it really good anywhere?

Last week there were big complaints in the UK about the NHS computer system that led to unfavorable health outcomes and deaths.

My friend couldn't find a PCP in Toronto for months.

Other countries are losing doctors to higher paying countries and don't produce enough specialists. People wait years for joint surgery, or months for oncology appointments.

How much of this is because medical science can do more so demand is higher for an increased number of treatments.

I don’t buy about medical science doing more because life expectancy is not impressive in the USA.
If I have to guess Scandinavian countries might be doing better.

Of course they’re doing more. In 1986, there were 9,000 kidney transplants in the US. In 2022, there were over 22,000.

That's a 6% increase year over year, which is not that impressive. There are currently over 100,000 people waiting for a kidney transplant in the US.

The relevance is that the population has increased 39% in that period whereas the number of surgeries has increased 144%. That’s just for kidney transplants. There are now 1.3 million knee and hip replacements per year in the US.

The ageing of the population plus demand for procedures which once did not exist means that the healthcare systems of many countries are under strain. In reality, there is already rationing of these services. In the US, I guess it’s those with the most money or best insurance who are at the front of the line. In countries with socialised medicine, it’s those on the waitlist the longest although there are tend to be funding inequities across different regions and naturally there are queue jumpers who can afford the private route.

[Anonymous]

In Canada, my family member waited for *seven months* for a biopsy of a suspected lymphoma. (Turned out to be a benign tumor so the person is still alive by sheer luck. Also, the biopsy was botched so another surgery is now needed.)

A different, elderly family member had surgery on the wrong kidney. Of course no one took responsibility.

We pay through the nose but at least DH got to an MRI machine within 48 hours of being sent there.

[Anonymous]

Anonymous wrote:In Canada, my family member waited for *seven months* for a biopsy of a suspected lymphoma. (Turned out to be a benign tumor so the person is still alive by sheer luck. Also, the biopsy was botched so another surgery is now needed.)

A different, elderly family member had surgery on the wrong kidney. Of course no one took responsibility.

We pay through the nose but at least DH got to an MRI machine within 48 hours of being sent there.

Which province?

[Anonymous]

Anonymous wrote:

Anonymous wrote:In Canada, my family member waited for *seven months* for a biopsy of a suspected lymphoma. (Turned out to be a benign tumor so the person is still alive by sheer luck. Also, the biopsy was botched so another surgery is now needed.)

A different, elderly family member had surgery on the wrong kidney. Of course no one took responsibility.

We pay through the nose but at least DH got to an MRI machine within 48 hours of being sent there.

Which province?

Ontario

[Anonymous]

Anonymous wrote:

Anonymous wrote:To the medical professionals and admins who have responded to this thread -

We can someone do - today - in the DMV to access better care?

Take a deuce on the lawns of some of your neighbors in Chevy Chase, Potomac, and Alexandria who all work for the whole insurance lobby, pharmaceutical lobby, AMA, and hospital lobby. The people right next to you in this area are the bottom of the barrel trash swamp rats ruining this country, destroying loves, and yes, are even killing lots of people by denying access to affordable medical care in this country. They're literally right next to you. Lobbyists should all be made public so we can see who is ruining the country.

This.

[Anonymous]

Anonymous wrote:Yes

And if Trump wins forget about pre existing conditions

Forget about health care period

Hello polio on a regular basis

This. Trump will literally take a dump on you if you are sick and boot you down the toilet.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Absolutely. I plan my exit daily.
- doctor

Another physician here. I transitioned to working federal for a salary and with an underserved population. It's not lucrative (obviously), but I can give top-notch care to people who appreciate it by learning to work the system for them.

Please think about federal service before hanging up the stethoscope for good. It is lovely to know you were providing SMART asthma 3 years before the specialist service for your state got on board.

Good care, decent work-life balance, and continuing to make a difference in the world with hard-earned skills. Never looked back.

Thank you!
Community Health RN working with underserved population.

[Anonymous]

Anonymous wrote:In Canada, my family member waited for *seven months* for a biopsy of a suspected lymphoma. (Turned out to be a benign tumor so the person is still alive by sheer luck. Also, the biopsy was botched so another surgery is now needed.)

A different, elderly family member had surgery on the wrong kidney. Of course no one took responsibility.

We pay through the nose but at least DH got to an MRI machine within 48 hours of being sent there.

Anonymous wrote:Which province?

Anonymous wrote:Ontario

That's really weird. Ontario's ADAP (the Accelerated Diagnostic Assessment Program) decreased the average time from initial referral to biopsy from 41 days to 17 days, including hematologic cancers like lymphoma. It's open to patients through primary doctors and emergency rooms.

I wonder what made your family member have an experience so drastically different than typical. Really sorry to hear it.

JCO Oncol Pract. 2023 Apr;19(4):e511-e519. doi: 10.1200/OP.22.00551. Epub 2023 Jan 19.
Impact of an Accelerated Diagnostic Assessment Program on the Timeliness of Cancer Diagnosis and Treatment

Purpose: The Accelerated Diagnostic Assessment Program (ADAP) manages patients with imaging abnormalities, with or without concomitant symptoms, where cancer is suspected. The ADAP is offered to primary care practitioners and emergency departments with cases triaged by a medical oncologist.

Methods: We performed a retrospective patient chart review of electronic medical records from January 2019 until June 2021 to validate the program. We collected information on the referral pathways, patient demographics, wait-times, and diagnostic results. T... The ADAP had decreased wait-times from referral to biopsy collection (17.6 days ± 10.7 [standard deviation (SD)]; n = 43) when compared with the control group (41.2 days ± 40.0 [SD]; n = 67; P < .001). ADAP patients with malignancies saw a treating specialist 7.6 ± 7.6 days [SD] after their follow-up appointment at the ADAP.

https://pubmed.ncbi.nlm.nih.gov/36657095/

[Anonymous]

^^PS: With a central provincial health care reimbursement system, all kinds of things can be tracked, monitored, and improved.

It's amazing what Canada has been able to do to reduce the time from certain lab abnormalities to diagnosis of inflammatory bowel diseases. That in particular is light years ahead of the US.

[Anonymous]

Anonymous wrote:I’m a nurse working in an acute care setting/hospital for major system in the area. It’s a hot mess. Covid exacerbated certain issues but it’s always been tenuous. Issues included but are not limited to the following:
-Health insurances fighting providers/patients to make $$.
-Lack of experienced nurses at the bedside-nurses are burning out. Many retired during COVID. Newer nurses won’t put up with certain conditions and/or want to go to NP school right away. A lot of inpatient units are staffed by green nurses. It’s not safe.
-Hospitals continue to fight against safe nurse-patient ratios. It’s not rocket science that too many patients to a nurse increase the chances of errors. Some hospital systems or areas in the country are better than others. The ratios in the South and in long term/nursing facilities are beyond unsafe.
-Physicians are also burned out. The workload is unsustainable for many and I can see that many are dipping out earlier than they used to ..
-Not arguing against PP who said hospital admins are under immense pressure. BUT…many admins are utterly out of touch. Also too many VPs and assistant directors of blah blah and not enough hands on staff. Again-very hospital dependent. I’ve worked in systems where they try and are engaged. And I’ve worked or heard of others where making $$ whilst everything around them is collapsing is the name of the game.
-Medication/supply shortages. Made worse by Covid but also natural disasters, etc that impact supply chain.
I could keep going but yeah, it sucks. If you go to Reddit-the nursing and teacher subreddits are eye opening…like canaries in the mine of what’s to come in this country.

What are "green nurses" ?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:In Canada, my family member waited for *seven months* for a biopsy of a suspected lymphoma. (Turned out to be a benign tumor so the person is still alive by sheer luck. Also, the biopsy was botched so another surgery is now needed.)

A different, elderly family member had surgery on the wrong kidney. Of course no one took responsibility.

We pay through the nose but at least DH got to an MRI machine within 48 hours of being sent there.

Which province?

Ontario

Weird. I have relatives in Ontario and this is not their experience. Ditto my relatives in a socialized medicine country in Europe. I think the "delays" and other criticisms are often overstated. Not that they don't exist but certainly that is not what I hear/see from relatives.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I’m a nurse working in an acute care setting/hospital for major system in the area. It’s a hot mess. Covid exacerbated certain issues but it’s always been tenuous. Issues included but are not limited to the following:
-Health insurances fighting providers/patients to make $$.
-Lack of experienced nurses at the bedside-nurses are burning out. Many retired during COVID. Newer nurses won’t put up with certain conditions and/or want to go to NP school right away. A lot of inpatient units are staffed by green nurses. It’s not safe.
-Hospitals continue to fight against safe nurse-patient ratios. It’s not rocket science that too many patients to a nurse increase the chances of errors. Some hospital systems or areas in the country are better than others. The ratios in the South and in long term/nursing facilities are beyond unsafe.
-Physicians are also burned out. The workload is unsustainable for many and I can see that many are dipping out earlier than they used to ..
-Not arguing against PP who said hospital admins are under immense pressure. BUT…many admins are utterly out of touch. Also too many VPs and assistant directors of blah blah and not enough hands on staff. Again-very hospital dependent. I’ve worked in systems where they try and are engaged. And I’ve worked or heard of others where making $$ whilst everything around them is collapsing is the name of the game.
-Medication/supply shortages. Made worse by Covid but also natural disasters, etc that impact supply chain.
I could keep going but yeah, it sucks. If you go to Reddit-the nursing and teacher subreddits are eye opening…like canaries in the mine of what’s to come in this country.

What are "green nurses" ?

Are you not from US? Green means new/inexperienced.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:It isn’t collapsing. It has collapsed.

100%

When someone goes to the ER with chest pains & is waiting in the waiting room for 9 hrs instead of immediately being taken to triage, it's a broken system.

When an elderly person is diagnosed with having had a stroke in the ER & discharged with orders to follow up with a neurologist within 7 days, but the earliest appointment you can get them is 8 months out, the system is broken. My sibling and I sat calling with our mom to try to get my dad an appointment & this was the result. We have him on a dozen different waitlists but we're still 4 months away from his appt. Terrifying.

A friend went through something similar in finding a Derm. Her Derm couldn't get her in until FEBRUARY 2025 and she had a worrisome spot appear that was rapidly changing. After finding none that could get her in, she went the concierge Derm route. Luckily she had the funds to do so, but what about those who can't go that route? We're going to get to the point where those without the funds to seek alternate treatments get sicker or die while waiting.

The medical schools and accreditation boards keep doctors in low supply to keep wages up.

And to keep the profession prestigious.

I don't fully understand the med school to residency to post-residency path, but I do know that in the 80s there was concern about too many doctors, and in the 1990s the number of admissions to med school was deliberately reduced. Residency is (I think) mostly funded by Medicare part A, with a small percentage funded by states.


Mid-posting, I found this: https://www.medicaleconomics.com/view/match-day-2023-a-reminder-of-the-real-cause-of-the-physician-shortage-not-enough-residency-positions

Instead of relying on training shortcuts, the physician shortage can be immediately alleviated by unfreezing residency funding. But Congress has failed to act, despite the introduction of multiple bills addressing the issue over the last 17 years. Legislation proposed by U.S. Senator Bill Nelson (D-FL) in 2007 and again in 2009 did not pass committee hearings, with critics arguing that the bill targeted non-primary care training. Similar bills have been reintroduced nearly every year since 2011, with the most recent legislation sponsored by Senator Robert Menendez (D-NJ) in 2021.

The current version of the bill, the Resident Physician Shortage Reduction Act of 2021, which would fund 14,000 residency positions over seven years, is the tenth attempt to lift the 1997 freeze on residency positions. Despite the bipartisan support of over two hundred House members and a third of Senators, Congress has not yet acted. While Congress did allocate funding for 1,000 residency positions (200 per year) as part of the Consolidated Appropriations Act of 2021, critics note that the slots are tied up in Medicare red tape.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:In Canada, my family member waited for *seven months* for a biopsy of a suspected lymphoma. (Turned out to be a benign tumor so the person is still alive by sheer luck. Also, the biopsy was botched so another surgery is now needed.)

A different, elderly family member had surgery on the wrong kidney. Of course no one took responsibility.

We pay through the nose but at least DH got to an MRI machine within 48 hours of being sent there.

Which province?

Ontario

Weird. I have relatives in Ontario and this is not their experience. Ditto my relatives in a socialized medicine country in Europe. I think the "delays" and other criticisms are often overstated. Not that they don't exist but certainly that is not what I hear/see from relatives.

I posted Ontario's formalized fast tracking process for suspected cases of cancer above.

I'd never doubt someone's lived experience. I think it's also good to look at how it works for most people, so I'm glad to hear from your family's perspective, too.

[Anonymous]

Anonymous wrote:Is it really good anywhere?

Last week there were big complaints in the UK about the NHS computer system that led to unfavorable health outcomes and deaths.

My friend couldn't find a PCP in Toronto for months.

Other countries are losing doctors to higher paying countries and don't produce enough specialists. People wait years for joint surgery, or months for oncology appointments.

How much of this is because medical science can do more so demand is higher for an increased number of treatments.

You know where it is good? Thailand - extremely high quality health care, easy to get, not that expensive. Jordan, Spain, Turkey, South Africa - all really good and affordable.