I have thought that we should make entering the medical professions much easier. In order to become a nurse, you usually need a 4 year degree. This has two issues:
1. This is way to much time in the classroom. Much of that coursework simply isn't necessary.
2. You have people that would be good nurses piking other programs because they can't get passing marks in classes that are irrelevant to day to day nursing.
Binding what are essentially professional programs to the academy is a mistake. Don't get me wrong, I love the academy. But we need nurses.
At least in the US, nursing does not require a 4 year degree. You can become an RN with an associates degree. A 2 year nursing degree has one of the highest returns on investment of any training program (especially if you go to community college). Ivy Tech CC in Indiana and WGU both have nursing programs with great returns. Keep in mind, nursing is not an easy path and has a super high burnout rate. It's a tough and demanding job.
Other professions with a great return on training are HVAC, electrician, plumber, robotics/logic systems (CAM, conveyors, etc.). These are especially high paying if you focus on commercial and industrial.
A lot of people are surprised to learn the the average wage for both plumbers and electricians is ~30 bucks an hour, then that’s in exchange for body breaking work. A small subset earn more, but it’s not the norm.
Union electricians and plumbers make good money, and the non-union shops that do commercial work have to pay close to union wages plus some fringes to get enough manpower. I pay $100/hr for a union journeyworker electrician in a metro area of ~3 million, $106
for a foreman, and $112 for a general foreman. Both of those include fringes, the split is about 55/45 or so. The contracts are for three-year terms with raises every year.
Residential construction is a whole different ballgame that I’m unfamiliar with, but I’d imagine that’s where the average gets dragged down.
Because.. that’s what the union charges my employer per hour for an electrician? I don’t have a choice lol
Cincinnati is a rust belt city with depressed wages (no offense to anyone that lives there, but it’s the truth), my market is higher income (Minneapolis/St Paul) where a journeyworker makes $57/hr on the check instead of $38/hr like in Ohio, which is 1.5x (!!) higher.
Well sure, my questions is why is the Union charging over double what seems to be 90th quartile for electricians in small to mid sized MSAs and only a bit more than the 90th quartile on high COL cities.
I suspect the electrician they send over isn’t just pocketing $100/h on wages.
> Well sure, my questions is why is the Union charging over double what seems to be 90th quartile for electricians in small to mid sized MSAs and only a bit more than the 90th quartile on high COL cities.
The union is charging that because *that is what’s in the contract that was signed by the union and the local union contractors after negotiation. Electricians get paid a lot where I live because it’s a wealthy growing area that people want to live in, and not a dying rust belt city.
> I suspect the electrician they send over isn’t just pocketing $100/h on wages.
Did you read the post I wrote initially?
I give the breakdown of how much of the money I pay to the union goes to the worker on his paycheck (55%) with the rest going to insurance, taxes, union dues, pension, etc (fringe benefits, which are 45%)
> Did you read the post I wrote initially?
I give the breakdown of how much of the money I pay to the union goes to the worker on his paycheck (55%) with the rest going to insurance, taxes, union dues, pension, etc (fringe benefits, which are 45%)
I misread that intitially.
At the end of the day, anytime this topic comes up, there’s an oddly large discrepancy between the anecdotes and the BLS data.
Even half of that $100 puts these electricians in the 90th quartile for hourly wages in that MSA. So they’re either sending there most expensive guys or I’m misreading misinterpreting the BLS data.
Union electricians make up the bulk of commercial electricians, with the rest being non-union. Non-union electricians dominate the residential market, and that’s who brings the average wage down, along with the year 1 to year 5 apprentices.
Industrial electrician around here start at 30 - 35 for 2 years as a trainee then go to 40. That's top 10% income for low cost of living area. It's not unusual to hit 100k with no school debt at a young age.
Industrial automation technician I have worked with makes north of 300k but he is traveling all over the world to do it.
Reminds me of when I lived in a shit meth town. Dead economy, propped up entirely by a single military base. Lots of drugs and violence. Most people I knew there worked a shitty low skilled job and sold meth.
One guy I knew had it in his head he could just go back to school for welding and make 6 figures. Of course that didn’t work out. Turns out the local CC doesn’t have anything for underwater welding. Welding programs for sure, but mostly designed to funnel workers into local, lower paying positions that need filled.
I have a suspicion this push towards blue collars jobs is just another learn to code grift.
So are you hoping to be treated by nurses who are worse academically than the ones we have now?
Or are you hoping that "others" will be treated by them while increased supply depresses wages for the good ones that you think will treat you?
Also being a nurse is a very hard job, most people wouldn't last a year as an ER nurse in the US.
We make them take classes like organic chemistry where they have to memorize the reaction of various metal catalysts. Calculus. Physics. These are all two semester classes that are considered hard in undergrad. And yet the nurse will never ever use what they learn in these classes outside them. They aren’t the ones synthesizing the drugs.
Some jobs that are basically nurse will go through standard biology major sequence (usually if there isn’t a more focus prehealth major offered). Physicians assistant is an example. PA school happens after undergrad. A lot of people going to med school end ul taking standard biology majors. Arguably they should have been able to drop all those undergrad prerequisites and spend more time getting clinical hours vs toiling on ochem. As a crude input filter, medical schools often expect you to volunteer for these hours shadowing workers in the medical system even though you have to find the time yourself on top of a full major load that doesn’t account for these extracurricular expectations.
Huh? There have been multiple levels of nursing for many decades, probably longer than you've been alive. At the lowest level a CNA or LPN doesn't even need an Associate's Degree.
In the 1980s 55% of registered nurses were working with diploma. It is down to 6% today. Bachelors or greater was 27% and is now over 70% today.
As your link points out, many states are continually raising the bar and many have already moved to a BSN minimum.
I'm probably dating myself, but there was a time when people started working occupational nursing programs while in high school and were licensed a few years later.
In the US, it's not worth going into because you have to put in hundreds of hours of clinicals which are unpaid, yet just as useful to the employer as a job. Unpaid internships are illegal, yet these are legal and mandatory.
CNAs (Certified Nursing Assistants) have low up-front training costs, but don't make a lot of money: an average of $19/hr [1]. So at least some of the less skilled work is being done with economic efficiency.
Cuts down on health costs but also increases life span, so you have the issue with the number of elderly citizens vs number of working citizens who can provide care. That needs to be tackled too somehow.
This is good to do for its own sake, but on a large scale it does not decrease health care costs: it makes people live longer, but they will still ultimately need the kind of end-of-life care where the majority of health care costs come from. Those costs don't go down for healthier people, and it might even increase health care spending on net if it takes people longer to die.
I know it’s easy to say but you do hear stories of families going to extraordinary lengths for an elderly loved one to give them a couple months of low quality of life. Is it the family trying to feel better or hoping for a miracle, or the patient themselves; I’m sure it’s both, but I can’t help but think if we were more comfortable with death, these really costly situations would go away and suffering would actually be reduced. I know it’s easy say and it sounds like I’m advocating for death, and in a way I am, but we all have to go. If your quality of life is so terrible… I’m also a hypocrite because I think that when it will be my turn or my parents’ and I have to decide, I’ll tell them to do everything possible within their directives.
Totally agree. Just in those cases where death in the next month is inevitable and significant suffering is guaranteed, I guess to me (right now) it’s more about acceptance and mercy.
That definitely increases outcomes and QALY but it only is cost neutral or saves costs if you also more tightly ration low-cost-effectiveness care down the road that ends up usually being near end-of-life, which is where A LOT of current spending is.
This is rational on a broad social level but is very difficult of a change to implement.
I think most of the increase in healthcare costs is coming from elderly people (because people are living longer). So while otherwise a good thing, I'm not sure that will help this particular problem.
If USPSTF has refused, either intentionally refused or through incompetence, to make a recommendation in its 40 year history that would have an outsize effect on preventive healthcare, then not only good riddance, but kick every single one its members out of academia and pull their licenses. I'm half surprised that National Propaganda didn't lament that the tens of thousands of millions AHRQ has given to academia wasn't enough for improved health outcomes.
My answer is more sympathy across the board. People are going to make mistakes. People are going to have a hard time. Both lead to more mistakes. Neither are reasons to give up.
On the money angle, I'm on board with the abundance crowd that I internalize as "be willing to spend money." Especially since most value is generated, and not necessarily discovered.
The main problem with Healthcare when it comes to costs is that it is to a certain extent labour intensive, is it not? This makes it difficult to reduce costs as wages rise over time.
The narrative is wrong - the wages are low while the working times are exhausting. Half of each trainee's leave each year, while the nurses that can actually endure this shit are going into pension in the next 10 years. And the money is spent on SAP systems who further take time from the already overworked nurses, because they now have to spent a ton of time entering data into a computer with no benefits.
Its not people getting sicker, its mismanagement. Source: Two nurses in family
Yeah, also over here in Finland the amount of money our public sector spends on stuff like Microsoft licenses is insane. Then there's lots of other craziness, like buying a very expensive and totally unsuitable American healthcare management system from Epic, and then spending lots of money on license fees and customizing it for local purposes (the end result also sucks, and is universally hated by healthcare staff).
I'm not sure whether it's a result incompetence, corruption or both, but massive amount of money is wasted on IT solutions that could be implemented more cheaply in-house, or at least by European companies.
Make that a discussion with the local politics. In theory at least, everybody will need healthcare in their lives and more so when aging. And we need a plan for that, not to act surprised (the way some leaders act surprised with gas dependency, or with immigration, or with...). Everything can have solutions, if it's not swept under the rug.
There is nothing more irrelevant than addressing large scale social issues in local politics. Besides not once in my life have I seen politics improve anything, politics seems to attract the dumbest and most self righteous types of people, who care about nothing but their self image. My time on earth is limited and much too precious to spent it in the company of politicians or just people invested in politics. No Thanks!
Absolutely. Especially the old think that they deserve unlimited funding, even when they have failed totally at creating the conditions which would make that funding possible and now their costs are spread over an ever declining population of young people.
Modern society is based on a pyramid scheme and the cancer of infinite growth. We will burn this planet to the ground to ensure that certain classes of people never lose.
What even is the solution? Expand the already massive healthcare sector further? Where does the money for that come from?