The League of Women Voters of Newton will hold a forum on Thursday, Oct. 18 from 8 – 9:30 a.m. at the Durant-Kenrick House (286 Waverley Ave, Newton) about the state ballot Question 1 regarding patient-to-nurse limits and the Newton ballot questions regarding the dispensation of marijuana. Attendees will have an opportunity to ask presenters from each side questions at the end of each presentation. RSVPs to [email protected] are appreciated.
You can also share your views on the nurse staffing ballot question in the comments section here on Village 14.
I’m uncomfortable having the state micro-manage staffing levels in a specific industry and job category. I’m even more uncomfortable enacting those staffing levels by referendum questions.
I’m voting no. The average voter (me) likely doesn’t understand the intricacies of hospital staffing and I don’t feel like it’s our place to dictate how they staff.
I am a physician and I’m voting no for the same reasons that Jerry and Mary cited.
I am voting yes because in my personal experience, the system is broken and somehow this applecart needs to be upended. I simply can’t see any other way of making that happen other than voting to force the issue. A referendum is the most imperfect way of dealing with the staffing issue, but it appears to be all we’ve got. To be very clear, the nurses we’ve dealt with are outstanding and caring individuals. That’s not the problem.
In the last 4 years, one of my adult sons has spent about 100 days as an inpatient in a world renowned Boston hospital and under no circumstances would we ever leave him alone on a ward except during the 11-7. In addition, he’s been in the ER on many occasions and would never leave him alone in the ER at any time of day or night.
This is how our lives play out when he’s hospitalized: my husband arrives at the hospital at around 8:30am, I arrive to relieve him at around 1:00, and his wife arrives at around 6:00 after work and stays until 9:30 or so. If I may be clear, we’re not “visiting” him – we’re there to make sure that he is getting the care he needs because the nursing load is not adequate to care for the needs of all the patients on the ward in a timely manner. When I walk up and down the ward hallway, I see the same thing in most rooms – people sitting for hours with a patient.
As for the ER, we’d never leave him alone at any time of the night or day. A year ago, we arrived in Maine at 4:00pm for a two week vacation. Ten minutes after we arrived, we got the call that he was headed for the hospital alone in an ambulance because his wife had to take care of their 6 month old son. We immediately got back in the car and returned to Boston and stayed in the ER with him all night until the surgeon could arrive at 8:00am. Then began the daily shifts, except that his wife was nursing his son, so the burden on us was greater. I am 70 and my husband is 72.
What’s going on in hospitals right now is not safe for anyone sick enough to be an inpatient. If anyone can provide me with a better solution to this problem moving into the future, I’ll vote no on Question 1. But the staffing problems that currently exist simply can’t continue and I don’t know of other action that can change the situation.
What is the cost of hiring all of the additional nurses? Payroll, benefits, infrastructure, support staff, supervisors, etc. The union backing this makes sense, but it also needs to be taken with a grain of salt as they have the most to gain. All of the added costs will be passed on to the insurance companies, patients, business owners, cities, towns, etc. Will this eventually lead to people not being able to afford insurance? Or business owners not being able to sustain staff levels due to insurance costs? I spent 5 months with a family member in a hospital downtown, so I know enough to know the challenges on both sides of this issue. Health Care reform is desparately needed, but this is not the way to do it. I will vote no.
I’m leaning no, while recognizing that there are plenty of issues with our current healthcare system that need to be addressed. Here’s why: automated data collection linked to artificial intelligence is still primitive today, but the pace of progress in the field is staggering. It will bring vast changes to labor markets that will challenge us as a society. Requiring nurse:patient ratios will help preserve jobs in the field, but it doesn’t take these big pending labor shifts into account.
The average CEO of a Big Pharma company makes $45 million a year.
One shot of Neulasta (that drug you see advertised on television all the time) costs
$10,000.
The drugs for one infusion of chemotherapy costs $15,000.
Let’s go after the real cost drivers of the high cost of healthcare. It’s not the nurses.
I’m voting yes for the reasons that Jane has eloquently stated. But I’m sure the industry (no side) will, as usual, pull out a win over labor with its multi-million dollar FUD campaign.
@Jane: When you write “I am voting yes because in my personal experience, the system is broken and somehow this applecart needs to be upended.” it sounds an awful lot like the rationale people used to justify their vote for Trump. It wasn’t that he was necessarily the right solution to the problems, but people saw Clinton as representing the status quo.
Well, as we can see with Trump, those kind of decisions have far reaching and often worse consequences than the original problem (i.e “the broken system.”)
Rather than just vote for something because it represents a shift from the status quo, I encourage you to decide if voting for Question 1 will solve the current problem, or just create additional problems.
@Randy: An independent analysis suggested if the question passes it will raise healthcare costs by nearly one billion dollars every year in the state. Thousands of non-nursing jobs will be lost, and smaller community hospitals will likely close.
Many nursing organizations (American Nurses Association, Mass Chapter of Emergency Nurses Association, Mass Chapter of Organization of Nurse Leaders, among others) oppose the measure. Although there is room for much improvement in our healthcare delivery and I am no fan of the status quo, I am going to vote no on question 1.
P.S. Passing question 1 will not reduce the salary of the insurance company CEO or the cost of the expensive chemotherapy infusions. It will only add costs. If you want to reduce the insurance company expenses best push for single payer healthcare and eliminate the need for private insurance companies. Question 1 will only worsen our healthcare costs, not improve them.
Ha, it’s quite a hoot that people are all of a sudden concerned about health care costs now, once the nurses step up for their piece of the pie. How about criticizing physicians’, administrators’, insurers’, or pharmaceutical executives’ astronomical compensation over the last 20 years?
The Health Policy Commission estimates were well under $1 billion ($646 million to $949 million) and were based on a number of questionable assumptions. Five out of six nurses support question one.
The “vote no” lawn signs that we see in our neighborhood are fairly consistently planted by health care administrators worried about how this could affect their lion’s share of health care profits. It’s once again an instance of self-proclaimed progressives abandoning their beliefs when their own self-interests are involved.
Ummm, @Michael– We are not “all of a sudden concerned about health care costs now”. We have been talking about this for decades. At least you’re candid about the real purpose of this initiative–nurses getting a (bigger) “piece of the pie”. Oh wait, I thought it was about patient safety?
There is a woman about to give birth at Brigham and Women’s. Let’s hurry and have a referendum on how many nurses should be in the room, how many doctors, whether or not the birth should be natural or a Cesarean section, and the type (if any) and dosage of anesthesia.
Yes, I am being sarcastic.
From 14 CFR 121.391 – Flight attendants:
“For airplanes having a seating capacity of more than 100 passengers – two flight attendants plus one additional flight attendant for each unit (or part of a unit) of 50 passenger seats above a seating capacity of 100 passengers”.
Does anybody have a sarcastic comment on government regulating the flight attendant/passenger ratio?
I am not opposed to the government regulating the ratio, but it doesn’t seem like it’s something that should be decided by voters.
I recognize that there are generally two sides to every story and this question is probably no exception. But as the charges and rhetoric heat up, I’ve been moved more and more to support the YES position and I’m now going to go to the wall to support it. A lot of it has to do with the high regard I have for nurses on the front line with direct patient care and because those who know me are familiar with my borderline phobia with public policy positions that are based on either fear or intimidation. Here are three major thoughts.
1. The slick ads for the NO side are a total turnoff for me and I hope for most other voters. They are fear driven and devoid of much real substance. To hear these ads, you’d think that emergency rooms will be closing in droves and that those that remain open will be horribly crippled. They leave a clear impression that you, your parents or your kids will be left for hours on a gurney to die or suffer life threatening ill effects. The not too subtle inference is that it is you or your family that will be left out in the cold if Question I is approved. The last shot of the emergency room door slamming shut sums it all up. This reminds me so much of the totally fear driven ads that swamped the airwaves six years ago in opposition to doctor assisted suicides in Massachusetts. Your children were going to pull the plug on you to get an early inheritance,or the powers that be might choose to shoot you to the great beyond before you are ready simply to cut the costs for treatment. Euthanasia for the elderly would become a standard operating procedure. It went on and on. Of course, the results of doctor assisted suicide in other states demonstrated that none of this overkill has ever taken place. In the case of Question 1, the state of California has had a patient limit plan in place for the past several years. It is somewhat different than what is being proposed in Question 1, but I’ve found no evidence that it’s resulted in anything like the scary scenario that’s being projected for the NO side. The Massachusetts Nurses Association argues that it’s been quite successful in many respects. I’m not certain if their rosy picture is entirely accurate, although I suspect it’s pretty much on the money. What I’m more certain of is that what the NO side is peddling is simply not corroborated by evidence from California. We would have heard a retinue of horror stories if they had occurred.
2. Some have argued in this post that the challenge of safe limits for nurses is real, but shouldn’t be settled in a referendum. I agree and so do probably a lot of nurses on the front lines for YES on Question 1. They didn’t come to this decision lightly because they knew full well that they would be heavily outgunned and brutally outspent by a medical industrial complex that would have a broad list of supplementary interests on their side. The Massachusetts Nurses Association claims they took this step because their attempts to address this issue by more conventional means were frustratingly unsuccessful.
3. There seems to be some subtle and not too subtle push back in some of the comments against the Nurses Union even being involved in this process. There may be comfort for some in placing total trust in the consultants and hospital administrators, but this misses a broader point. The strongest advocates for Question 1 have been the nurses that directly take care of patients. I’m not certain that 81 % of these front lines nurses support Question 1 as the MNA claims, or if the figure is higher or lower, but I’m almost certain that it is a solidly high majority of the nurses who labor daily in the trenches. They see the problems and the dislocations first hand. They have high credibility on this and a lot of substance to share because as the old saying goes, they walk the walk every day in large and small hospitals throughout the Commonwealth.
Bob,
“Impact of Nurse-to-Patient Ratios: Implications of the California Nurse Staffing Mandate for Other States” report is available here: https://dpeaflcio.org/programs-publications/issue-fact-sheets/impact-of-nurse-to-patient-ratios-implications-of-the-california-nurse-staffing-mandate-for-other-states.
Among its principle findings:
Lower nurse-to-patient ratios significantly lowered the likelihood of a patient’s death.
When nurses’ workloads were in line with California-mandated ratios, nurses’ burnout and job dissatisfaction were lower, and nurses reported consistently better quality of care.
Referendum is a terrible tool for making this kind of decisions, but leaving them to the free market is worse. No matter how competitive, the free-market healthcare objectively dictates that:
-Pharmaceutical and medical equipment companies want us to get sick to support continually their growing business.
-Insurance companies want those of us who are sick to die, so they can retain a healthy pool of subscribes.
-Doctors and hospitals want to treat us with the most profitable to them stuff.
Alas, the Newton democrats rejected the single-payer model when they overwhelmingly voted against Sanders in 2016 primaries.
At the end of my first post, I said if someone could provide a better solution to the problem of understaffed wards in hospitals, I’d gladly vote No on Q1. I’m still waiting. I see not a scintilla of a thought given to solving a problem that places very sick people in unsafe situations. Single payer a solution? Great. Let’s get it done. I wouldn’t consider voting for a candidate who didn’t support single payer healthcare. But I’m also realistic about the political situation we live in – single payer isn’t happening any time soon.
Newton Newbie-That was quite a leap from a yes vote to improve the nurse/patient ratio in order to improve patient safety to it being like a vote for Trump. This is a fixable MA state problem that no one will address, so nurses did what was the only option left to them – get it on the ballot. If Q1 passes, you can bet the legislature and/or the healthcare industry will intervene and at long last come up with a better solution than leaving patients screaming in their rooms with the door closed, or lined up in the hallway of the ER for hours on end with no one attending to them because it’s understaffed.
The organizations that oppose Q1 do not represent nurses who work in the trenches as the MNA does. The American Nurses Association and the other organizations that oppose this ballot question represent nurses who work in management or are not based in MA.
As for who’s supporting or opposing this question, a drive around the city tells the same old Newton story. The No signs are in the neighborhoods with substantially larger homes and the Yes signs are in the yards with more modest homes.
Michael Singer – This is all about patient safety. Plain and simple. Fewer nurses on a floor mean less effective care for patients. I don’t know how a healthcare provider can deny that. I’ve seen the unsafe conditions over and over again for nearly five years now, and seen too many patients left to suffer alone. The situation is a mess and needs to be addressed and it needs to be addressed now.
I’m torn. If this were closer to the California law, I’d vote for it. But it sets more rigid ratios with less flexibility and less time for implementing them. I agree that we need stronger limits than we currently have and wish our legislators had done their jobs to create good regulations.
Unfortunately, I don’t think there are enough nurses out there un- or under-employed to be able to quickly hire enough to meet the required ratios, and the regulation as written for the ballot question doesn’t give enough flexibility for times of crisis.
@Jane – I’m very sorry to hear that your son’s having such serious health problems. Sending healing thoughts his way.
@Jane: I stand by my comparison and maintain your arguments in support of Question 1 are NOT dissimilar from those explaining their vote from Trump.
You wrote “the system is broken and somehow this applecart needs to be upended. I simply can’t see any other way of making that happen other than voting to force the issue. A referendum is the most imperfect way of dealing with the staffing issue, but it appears to be all we’ve got.”
Trump supporters didn’t necessarily love Trump (at least at first), but felt he was the only way to “send a message” and reject the “politics as usual” status quo.
You wrote “This is a fixable MA state problem that no one will address, so nurses did what was the only option left to them – get it on the ballot. If Q1 passes, you can bet the legislature and/or the healthcare industry will intervene and at long last come up with a better solution.”
It seems to be an acknowledgement that this isn’t really a great solution to a problem, but just a way to force the legislature to do a better job regulating. Well, if the system is broken, as it may be in many ways, don’t count on the system (or in your words the legislature and/or healthcare industry”) to fix it.
The legislature has repeatedly shown itself to be dysfunctional and ineffective. The “healthcare industry” is not some monolithic force but many competing interests. You have providers (doctors, nurses, etc..), hospitals, insurance companies, drug companies, and on and on and on. You expect they are going to come together to solve a problem?
Passing question 1 will simply introduce a whole new problem into an already far from perfect system. Think back as to when voters approved a ballot question in 2002 mandating all children be taught in English. It had disastrous consequences on all the english language learner students in the Commonwealth. Yes, the legislature eventually fixed it, but not until November 2017, fifteen years later!
I am very sorry that you and your loved ones have had first hand experience with the imperfections of the system. But I firmly believe that approving Question 1 will not solve this problem, but only move us further away from the goal of affordable, accessible, and high quality healthcare for all.
Front line nurses have been voted “the most trusted profession” for years on end! Believe us now! Vote yes on Question 1!
Nurses have no say in current nurse/patient care numbers and politicians aren’t willing to risk support from big money healthcare business to write a bill! The law protecting ICU staffing has made a huge difference in the care of the critically ill. The acuity of all patients admitted to hospitals is worse- we need to have maximums to protect patient care and safety!
The word “government” was a bright idea on the opposition’s big money campaign but the fact is their are limits set on many things in our lives: day cares, schools, nursing homes, buses, hours physicians work, hours pilots fly, doggie boarding!
Don’t be fooled by the big money hospital association-
Vote Yes on Question 1!
Newton Newbie – I respectfully ask you to refrain from associating me in any context with Trump, especially on this very painful day.
@Jane: I’m sorry, I didn’t mean it to be an ad hominum attack and wasn’t associating YOU with Trump. My only point, however clumsy it was made, was that in my opinion those supporting Question 1 are looking to upend the status quo and less concerned about the consequences of what passing the ballot question will actually be. In my head that was similar to the rationale many Trump voters expressed. But Trumpism has nothing to do with this ballot question and I didn’t mean to in any way conflate them.
Bottom line. This is an Unfunded mandate and we should not allow the state to determine how hospitals should staff their units and floors versus the people who are administering these health care facilities. Staffing decisions need to be made by clinicians at the facilities who can account for patient acuity and available staff, not by external regulations.
“Bottom line” – I like that.
Final conclusion. Health care costs are high because American physicians collect absurdly high, unjustifiable salaries compared to their international peers, accept payoffs from the pharmaceutical industry to prescribe unnecessary medications, and invest in imaging and diagnostic facilities to which they sleazily refer an excessive number of patients in order to make a profit. Add to this a layer of profit and administration that few civilized countries allow, and you come up with the $60bil in MA healthcare spending. This initiative would increase annual spending going into the next year by 1%. Meanwhile, thanks to the greed of physicians and investors, spending will continuously grow by a CAGR of more than 3% year after year. The people who are complaining about the impact of this initiative on spending ignore the actual figures.
@Michael. Wow–sounds like you really hate doctors!!! Let me explain a few things. In other countries young people can become practicing doctors by age 25-27. The government pays for their education and gives them a government job.
That’s not how it works in the US. Here, aspiring physicians have to start with 4 years of college and 4 years of medical school. The tab: maybe $300,000 after some financial aid. Today, many medical students also need to do 1-4 years of extra research to qualify for the speciality they want. So by the time they finish medical school, they’re 26-30 years old and $300,000 in debt. Next they become interns where they work 80-hour weeks (or more), they are lucky to have 1 day off a week, everybody treats them like crap, and they earn maybe $60,000 that year. Then they have 2-6 more years as residents. They’ll spend a lot of nights and weekends in the hospital. If they decide to get married or have kids, some weeks they will barely see their families. They’ll make up to $70,000 a year around Boston. By the time they finish residency they’re 29-37 and still have about $300,000 in debt if they kept up with the interest payments. But training doesn’t always end there. Many need to do an additional 1-2 years of fellowship to learn their subspecialty. When they finally take their first “real job” as attending physicians, they are all in their 30s. They have incredibly busy schedules. Many take calls on nights and weekends. They have all kinds of licenses, certificates, training, and paperwork they have to maintain with the state, federal government, professional boards, hospitals, and insurers. Those requirements alone cost thousands of dollars and several days of uncompensated work each year.
At last, when doctors are in the 40s are start to earn six-figure salaries, society and the IRS immediately classify them as “the evil 1%”. They land in the highest tax bracket and fork over about half of their paycheck in income tax and payroll tax. Never mind that these doctors went deeply into debt and deferred many years of income (and freedom, or family, or happiness) to arrive at that point.
Most doctors were at the top of their college class. I know you don’t like it, but we live in a meritocracy where smart hardworking kids like that are going to make six-figure salaries whatever they decide to do. I think most of our doctors deserve every penny of their six-figure salaries. They deserve those salaries a lot more than any professional athlete, entertainer, or banker.
@A Humble Physician. You wrote
“In other countries young people can become practicing doctors by age 25-27. The government pays for their education and gives them a government job.
That’s not how it works in the US”.
That’s exactly the point. Shouldn’t it work in the US the same way? Why other wealthy countries spend about half as much per person on health and report higher levels of patient satisfaction?
Could you also address what Michael said about accepting payoffs from the pharmaceutical industry and investing in imaging and diagnostic facilities?
And how do you justify a regular radiologist making half a million without ever facing the patients?
@AHP, let me explain a few things to you before you canonize yourself and your colleagues with sob stories about their great selfless sacrifice, victimization by the IRS, and how they all deserve to be guaranteed millionaires decades sooner than everyone else in society.
Less than 250 miles away from here, there’s a country where the government does not pay for medical students’ education. Yet physicians’ salaries there are significantly lower than in the United States. For example, a Canadian orthopedic surgeon earns less than half the average net income of an orthopedic surgeon in the United States.
Yet here in America, there are multiple opportunities for medical students to achieve loan forgiveness, especially if they are inclined to provide primary care and/or work in underserved communities.
Alas, only a small proportion of American med school graduates opt to serve in these programs and the majority choose instead to become highly-compensated specialists, at huge expense to the American healthcare system – despite evidence that patient outcomes in countries with a lower proportion of specialists are equal to and in some cases superior to patient outcomes in the United States.
I certainly don’t hate doctors and I believe that they are entitled to a reasonable return on the investment that they made in their educations, but unlike yourself I don’t believe that their lifetime ROI should be orders of magnitude higher than foreign physicians’.
And I don’t believe that physicians should receive any compensation from pharmaceutical or equipment companies, and I don’t believe that physicians should be allowed to invest in overpriced imaging and diagnostic equipment to which they will refer their own patients. The argument could be made that these two sleazy, dishonest industry practices alone account for more than the increased spending incurred by the passage of Question 1. And that argument becomes even easier when you include the external cost of physicians’ reckless overprescription of Oxycontin at the behest of Purdue Pharma over the last decade.
It doesn’t sound like they’re on your radar screen, but this referendum is actually about making sure we spend a fair and safe amount on nurses, many of whom can probably offer up similar stories of student debt, time away from their families, physically grueling schedules, etc. (Actually, one element of the nurses’ stories that’s probably considerably different from yours – they’re not able to empathize with your war stories of IRS seven-figure audits.)
As for your assertion that:
Spoken unlike a valedictorian (it’s not true).
Oh, man, Humble Physician, you had to go there. I was really loving your explanation, totally agree with you, and then you come out with this…
“We live in a meritocracy where smart hardworking kids like that are going to make six-figure salaries whatever they decide to do.”
Teachers are smart, hardworking; journalists are smart, hardworking; most nurses are smart, hardworking (and I surely hope you believe that); a lot of people are really smart and really hard working and will never make six-figures.
Channel your inner Aretha – R-E-S-P-E-C-T . All I’m asking for is (just a little bit, just a little bit) of respect…
You may be a smart, hard working physician, but you’re going to have to remove the Humble from your V14 name for now. Words matter.
First of all let’s get the fake news that
The League Of Women Voters are
“Non Partisan” out of the way. The LOWV is fiercely partisan and have been for years. For anyone who still believes they aren’t
please Google – Brett Kavanaugh / LOWV. Nuff said. Obama
made a deal with the devil( the insurance companies), and then cynically castigated them for passing their confiscatory, punitive rate increases on
to the self employed, self insured, and small business owners like myself when he knew all along that they would have to. Anyone that made even a cursory effort, like myself, to change plans soon found out that YOU COULD NOT KEEP YOUR DOCTOR, PERIOD. That’s a fact, not fake news, sadly.
Until about a year or two ago, the Tufts Health Plan CEO who presided over my years long annual rate increases was none other than celebrated, wealthy Democrat one per center
James C Roosevelt Jr. The same James C Roosevelt Jr. who carried Hillary Clinton’s water as a member of the Democratic Senatorial Campaign Committee when she ran in 2008. Talk about a bad actor! I’ve seen Newton pols cavorting with Roosevelt at various Obama events in Boston over the years. They know who they are.
Who needs Trump to destroy the middle class when powerful and not so powerful Democrats are doing a fantastic job without him? With the high cost of insurance I’m already paying, i’d prefer to have proper nurse staffing thank you very much. Anyone who has spent anytime in or around hospitals knows that it is the nursing staff that keeps the trains moving at all.
Health care is in the process of exploding like no other expense we have, and when you get a look the cost of your insurance and medical related expenses in the coming years, you will be concerned. Very concerned. Once you get a gander at what others pay – those who don’t
have carve outs, set asides or waivers-
your head with explode like a science fiction movie. Only it won’t be a movie
@Anatoly – Canadian university tuition is much lower than it is in the U.S. Canadian med students do not end up with the mountains of debt that Americans do.
@AHP – you really know how to undercut yourself. You said a lot of thoughtful true things, then ended by being arrogant and self-important.
@Everyone – the vast majority of physicians are not getting bribes from drug companies and making fortunes off of running tests and imaging. The doctors I know, both as friends and colleagues (I’m a statistician doing medical research) are caring individuals who work their tails off for their patients and work long hours. This is especially true for internists, pediatricians, infectious disease docs and many others who aren’t in the most expensive specialties.
We can discuss question #1 without denigrating doctors or nurses or anyone else.
I am also voting yes. Like @Jane Frantz, this is based on personal experience. I was the caregiver and guardian for a relative with Alzheimer’s Disease for 7 years. She had Alzheimer’s Induced seizures which left her in a Postictal state a few times a month. This resulted in frequent hospitalizations. Almost every time, one nurse had 11-12 patients. My aunt had to be fed, but the nurses were too busy to do that, so if I wasn’t there, her sandwich sat uneaten. I would get there as soon as I could to see her food sitting there, untouched, many times from multiple meals. Every nurse told me s/he had too many patients to give my aunt the care she needed.
Meredith,
“About half of U.S. doctors received payments from the pharmaceutical and medical device industries in 2015, amounting to $2.4 billion”.
Source: https://www.cbsnews.com/news/doctors-receive-money-gifts-from-drugmakers-pharmaceutical-companies
@Meredith – just in case it’s of interest to you or anyone else: you’re right, tuition is cheaper in Canada but the total costs of university attendance aren’t, particularly if you assume any debt.
Example: although University of Toronto Medical School in-province tuition is CAD$25,061 vs. USD$$34,600 for in-state students at UMass Medical, on-campus housing for graduate students is limited and rent in Toronto will cost more than twice what a dorm will cost in Worcester, while other charges will be similar.
But interest rates on Canadian loans will be much higher – a fixed rate of Canadian prime (currently 3.7%) +5.
So: yes, Canadian students do end up with similar mountains of debt as do most American students. Especially since they typically receive less money from their parents than American students do.
And even if you were to adjust for tuition, the premium of US doctors’ salaries to Canadian doctors’ salaries is many times higher than any other profession requiring a post-secondary education.
All this to say: an American physician making twice the salary of a Canadian physician is not justified based on the investment that each has made in her education.
@Anatoly,
“By far, the majority of general payments were for food and beverages, which became common practice after the pharmaceutical industry placed self-imposed restrictions on its marketing in 2002, Larkin and Dudley said. Because of this, the average per-doctor value of general payments is around $200. “It’s a very common practice for a pharma rep to show up with a box of sandwiches or a stack of pizzas” for the doctors to share with staff…””
I doubt most doctors are greatly influenced by pizza or sandwiches. I agree that the larger payments are a concern. I am not denying that some MDs make money off of tests, etc. and agree that’s a serious conflict of interest. I stand by my statement that the vast majority of doctors are caring hard-working people. Unlike some people here, I see no contradiction between that and saying that we need better nurse-to-patient ratios in our hospitals.
Meredith,
The next paragraph states: “Those payments and gifts very likely encourage doctors to prescribe pricey brand-name drugs and devices pushed by sales representatives, a second study argues”. Pizza or sandwiches? Everybody can do some reading on the subject for themselves, and everybody has their own personal experience, at least I do. AHP chose to avoid this topic in her post, and I was interested in her opinion. That’s it.
Hospitals today are extremely understaffed. I’d have to be severely sick or injured before I’d “agree” to stay in one. That said, if I were incapacitated, I’d want to be certain that there are enough nurses staffing the place to ensure my well-being.
Bottom line, I want a nurse who can answer my (or a loved one’s) call bell in a timely fashion and not be bogged down with tons of other sick patients. It could be a matter of life and death. I’m with the “real” nurses and voting “Yes”
Two questions for Michael. What do you do for a living? Have you ever taken a microeconomics class?
@Michael:
Your numbers are inaccurate.
UMass Medical School tuition AND fees for in-state MA resident: $68,174
UToronto Medical tuition AND fees for Canadian residents: USD $21, 134 (CD$27,411)
Additionally you only need to complete 3 years undergraduate to be eligible to apply to Canadian medical school but need 4 years undergraduate to apply to US medical school.
(sources:
https://www.umassmed.edu/financialaid/currentstudents/tuition-and-fees-new-students/
https://www.md.utoronto.ca/current-fees)
@Michael: Also, your statement that doctors in US make twice their Canadian counterpart seems inaccurate as well.
Average internal medicine salary in Toronto: USD$205,512 (CD$266,540)
Average internal medicine salary in Boston: USD $181,302
It would seem in Canada doctors incur substantially less debt in completing their education but ultimately earn more than their US counterparts.
Sources: https://ca.indeed.com/salaries/Internal-Medicine-Physician-Salaries
https://www.indeed.com/salaries/Internal-Medicine-Physician-Salaries,-Boston-MA
@NN:
You’re kidding, right?
The UMass figure includes room and board, transportation, equipment, instruments, and miscellaneous.
The UofT figure does not – that’s only tuition and a small “incidental fee” for student services and athletics.
In order to apply for a Canadian med program you need to be in your final year of undergraduate studies, i.e. the fourth year for most Canadian students.
The three-year threshold is offered primarily for Québec students who will complete their undergraduate degree in three years, following two years of CÉGEP studies (i.e. 5 years of post-secondary, undergraduate studies).
@NN,
Your salary assertions only popped up after I posted my comment – in response to that, I hate to break it to you, but indeed.com is not an accurate source of salary information. There’s plenty of genuine academic research on the income differences between physicians around the world, some of which is alluded to in this National Post article.
https://nationalpost.com/news/canada/canadian-doctors-still-make-dramatically-less-than-u-s-counterparts-study
This is an interesting discussion from all sides. I’m leaning toward agreeing with Meredith’s points.
Upper management at hospitals and some doctors’ income ratio to other workers in the medical field are grossly inflated. Some doctors’ ratios are not. I and other members of my family require the knowledge the uber-specialists have to treat certain conditions. I also know many overworked and round-the-clock physicians. I don’t see the relevance of those facts and question 1.
Nurses are smart, hardworking, caring individuals, who are most likely in debt. They deserve to be paid accordingly.
There is a huge problem with nursing ratios. Hospitals need to hire more nurses. But I am not certain this ballot initiative is a solution.
These are the things that I am struggling with to determine how I vote.
1. What Jerry said.
2. The fine.
3. Prohibition from changing support staff levels.
4. Prohibition from temporarily suspension in an unofficial emergency. (i.e. Car accident, fire in a building)
5. Unrealistic January, 2019 starting date.
6. Prohibition from changing ratios as technology advances.
7. Unfunded mandate. The money has to come from somewhere and it won’t be from upper management.
8. Standards of nursing hires may change.
9. Unintended consequences.
Additionally, loved ones will still need to be with those either in the ER or staying overnight in the hospital.
In 2014, ballot initiatives were put forward in MA to mandate nursing ratios in ICU’s but before the vote, a compromise was reached and the initiatives were withdrawn. Hoping for any new compromise after the vote is not a good reason to vote yes.
California’s law is the only comparison and there it appears to be working well for the nurses but overall there is very little difference in patient care, possibly because other staffing levels were changed.
The differences from CA’s law matter. Some good, some not so much.
1. No fine. (What incentive do hospitals have?)
2. Support staffing levels were made to offset expenses.
3. Not having a fine will allow hospitals to temporarily suspend the ratios in emergencies.
4. Implementation was gradual taking 5 years.
5. Ratios can be adjusted as technology advances.
6. ER diversion. When ER’S are too busy (over the limit) ambulances can be diverted to another facility.
@Michael: You are correct in that I failed to notice the Umass tuition and fees included $8970 for rent. Subtracting that still gives an in-state price tag of $59,204 for MA residents.
That is still a lot more than the USD $21, 134 (CD$27,411) for U of Toronto.
And not to belabor it, but reading the requirements on U of T website it does seem as if only three years are needed before you can enroll (not just before you can apply).
@NN
An apple-to-apple comparison would be the raw tuition cost –
UMass: USD$34,600 in-state
UofT: CAD $25,600 in-province
Right now the exchange rate is 77 cents but as recently as 2013 the two currencies were at par, so it’s not reasonable to assume that the current exchange rate would hold over the course of a med school education. And as I said, rent and living expenses are going to be much higher in Toronto than Worcester, and student loan interest rates are higher in Canada. That’s why, at the end of the day, if you ever come across a young Canadian physician you’ll find that they’re burdened with similar debt loads as young American physicians.
Again, my point is that American physicians’ educational costs are not extraordinary and do not justify their excessive compensation levels, and if anybody’s concerned about limited financial resources for increased nurse staffing levels, please start by looking at the excessive compensation of physicians, administrators, and insurance executives.
@Michael: It seems both University of Massachusetts and University of Toronto are outliers. UMass is much cheaper than most US schools (for MA residents) and Univ of Toronto is more expensive than other Canadian schools. Here are the numbers for tuition only at some other US and Canadian schools, even though fees for books, other supplies, can easily be several thousand dollars more on top of that.
US schools:
BU medical school: $52,816
Tufts medical school $46,632
Harvard medical school $61,600
Canadian schools:
McGill University $3980 (CD$5156)
Dalhousie University $16,043 (CD$20784)
Memorial University (Newfoundland and Labrador’s University) $7,913 (CD$10,250)
I don’t know anyone that entered medicine for the money. You would be much better off going into finance, real estate development, or plumbing if your goal is to make a lot of money.
But this has REALLY gone off topic from original thread about question 1, which I believe has the potential to make healthcare costs much worse.
I am a nurse. I have seen 2 patients choke to death with their call lights on. Unable to be resuscitated. I have had a disoriented patient admitted with a new stroke walk home from the hospital when I was assigned 12 patients for 8 hours. When working in the ICU I would get transfers from the med-surg units who required ICU care because opportunities for earlier intervention were missed. On one occasion I recall the nurse telling me “I knew he needed more attention but I called the doctor and I just didn’t have the time.” I have seen a patient die in a restraint before they were made illegal. I worked more mandatory overtime shifts than I can count until it was made illegal, and even after, we were STILL mandated to stay past the end of the shift because the definition of “emergency” for the use of emergency mandatory overtime had not yet been established. That means I would arrive to work to be told on arrival how many nurses would not be allowed to leave at the end of the shift. There was no option to be too tired to work. If it was your turn, you stayed. That’s how it worked for us until the government stepped in.
I wish I could convey in a message the frustration and dismay I often feel at the end of a shift. When I have to tell the next nurse “all I know about her is she had all her meds and she’s breathing”, when I walk into someone’s room and they ask to go to the bathroom and inside I feel like crying because I know I don’t have time and I don’t want the patient to know that, and I know it takes longer to get someone else to do it than it takes to do it myself, how many times I know my patient needs to drink but he our she is at risk for aspiration and needs 1:1 assistance and I don’t have the time, how many times I have seen toothbrushes and tooth paste unopened days into an admission. How many times I have to leave someone who is scared, angry, confused… Because I don’t have the time to stay. Many times I do. It is my preferred way to administer my nursing care, with compassion. But then I leave late. No breaks, no lunches. Often working 12 hour shifts that go on for 14 hours. I spend the night trying to catch up. Patients wait to have call lights answered and pain medication administered and after 25 years at the bedside I can’t seem to figure out a good way to deliver the quality of care I must for my own peace of mind and complete it in the amount if time I have. I don’t think I’m doing it wrong. My colleagues tell me they would trust me with their own family members. I won’t do less. And you wouldn’t want me to if it was your beloved family member in that bed.
Some hospitals in the state have great staffing. And some have terrible staffing. The patients don’t know which are which and most don’t even know, until now, that it is something they ought to consider when choosing where to receive care.
I PROMISE you. This is not about a bigger piece of the pie. And if the hospitals that do not meet the ratios had made the choice to make your safety in this area a priority, There wouldn’t be a referendum question. This question is new to the voters but we nurses have been working on this, collecting signatures…. And stories…. For almost 20 years. Thank you for your time. I promise, regardless of the outcome, I will continue to provide the best care I possibly can, given the time I have.
Let’s get this thread back on track.
This question about legislating nurse staffing levels will be on the November ballot. How much doctors make, their debt and country comparisons have nothing to do with nurse staffing levels. It’s a disservice to nurses everywhere to use doctors’ salaries as a distraction from the issue.
Nurses are the front line in hospitals. They are at least as important to patient care, if not more – I would go with more in a hospital setting. Nurses triage patients in ERs and address urgent needs before a doctor sees patients for a short time. In inpatient settings, doctors come in once a day mainly to check in with nurses to see how their patients are progressing. Without nursing care, no one would survive a hospital stay.
Nurses work harder and longer than most doctors and receive less acknowledgement, respect and compensation. They understandably face burnout from being overworked and under appreciated – not by patients but by some administrators and doctors. They are the ones held responsible for patient care – or the lack thereof. Nurses do their best to carefully monitor patients but cannot do their jobs adequately when they are responsible for too many patients.
Nurse staffing levels must be increased to prevent burnout and improve patient care. For patient care improvement, they also need support staff and sub-speciatists to cover the areas of patient care not requiring a nurse.
Hospital administrators can find the money to address nurse staffing levels without cutting other valuable programs. It’s truly annoying to read the letters being circulated from hospital administrators to their employees. They range from tugging on heart strings about cuts that will have to be made to being mildly coercive – cutting jobs. These letter are no reason to vote “no.”
If this ballot initiative passes, many nurses are concerned about what will happen when new patients either need to be admitted or arrive at the ER if the nurse/patient ratios are already met. Hospital administrators will certainly balk at paying a fine, although there’s no explanation in the ballot initiative (that I have found) of what type of offense costs what – up to $25,000.
Anyone with answers to “what happens when,” please enlighten me.
I found this letter particularly persuasive: I work with the author, Justin Precourt in a AMC hospital in Boston and wholeheartedly agree.
“In California, patient care has been constrained by nurse staffing rations
since 2004. In November, when citizens of Massachusetts go to vote, they
need to understand why Question 1 on mandated nursing staffing ratios is
wrong for nurses, for patients and for Massachusetts.”
“Every day, nurses across the commonwealth are making ongoing
judgments to determine what number of nurses they need in their units in
order to provide the best care possible to those patients and their families.
Nurse staffing is complex and nuanced, but nurses use their knowledge,
experience and expertise to make these decisions.”
“In truth, Question 1 was written and proposed by the Massachusetts
Nurses Association, a labor union, not a professional nursing
organization. They are not the voice for nursing practice and in truth only
represent about 23 percent of all Massachusetts nurses. The MNA has
positioned this bill as a driver of quality care, yet we all know
Massachusetts is already a recognized health care quality mecca in the
United States; we pride ourselves on this. In fact, Massachusetts hospitals
consistently rank far above California hospitals in quality metrics.’
“The reasons that supporters of Question 1 give do not make sense. You can
say it’s about staffing, yet our nurse staffing ranks with the best in the
nation. You can say it’s about money, yet our nurses are the second and
third highest paid in the nation. You can say it’s about employee
engagement, yet Massachusetts has five of the top 25 hospitals in the
nation that score highest on employee engagement. You can say it’s about
safety, yet we are constantly ranked among the top in the nation. You can
say it’s about burnout, yet we have some of the lowest turnover rates of
nurses in the nation.”
“What is this really about?”
“That is a question I cannot answer but know it is not about the issues as
they have been advertised.”
I found the above letter to be particularly unpersuasive, since Justin Precourt is effectively an administrator at Tufts Medical Center (“Executive Director for Patient Care Services”) and is simply repeating the same old official party line.
I’m always amazed at how easy it is to get people to swallow and repeat corporate mantra. I mean, here’s an individual who is well aware of how we got to this point over the last several years – through bullying, obstinacy, arrogance, and a total lack of respect on the part of Partners and other behemoths – yet he has no problem making statements like “what is this really about…I do not know!”
The Massachusetts Nurses Association is a labor union whose total membership is Massachusetts nurses. I hate to state the obvious, but really.
PS It’s particularly insulting to hear this from Tufts, which locked out its nurses and hired scabs for four days.
Sleazy letter from Tuft’s administrator.
The first statement about California is not true.
Yes, nurses make on-going judgements as to the staffing needs for good nursing care but these nurses cannot then hire the nurses they need. It goes through the beauracracy, finally getting a posting if the administration determines there is a need, HR interviews prospects and maybe a nurse is hired.
I already posted about the experience I had with my aunt, with nurses having 11-12 patients to care for. But this just happened to me yesterday: a dear friend who is older than I am fell, and is in the hospital. He is on dialysis, has heart disease and circulation problems. He is single with no kids and no surviving family; thus, he asked me to be his health care proxy. I printed out the form and filled it out, and brought it with me when I went to visit. We pushed the call button so I could introduce myself and give the staff the HCP. I waited TWO HOURS for a nurse to come (they did not know why the call button was pushed). The nurse apologized, saying she had 12 patients. I find this scary and worrisome.
Jane. I don’t know where you are getting your information but unlike public school teachers not all nurses belong to the MNA. In fact only 28% of them do in MA. It depends on the hospital they work in. Most of the hospitals I’ve worked in don’t have nurse unions, only some do.
Marti – It is not so easy to hire nurses these days. Massachusetts has a documented nursing shortage. It isn’t just a matter of hospitals not wanting to hire nurses, they aren’t out there to be hired, especially experienced ones. If this question gets approved, it will require hospitals to hire more nurses in a very short period of time (39 days) and the ones that are available to hire are less experienced which would make patients less safe.
@Lisa, while perhaps only 28% of nurses are MNA members, I do believe 100% of MNA members are nurses. I have worked at 4 hospitals since becoming a nurse in 1999. All of them were represented by the MNA. I think you will find that, of direct care nurses, a much larger percentage it’s represented by the MNA than 28%.
As far as the nurses making staffing decisions, these are generally not patient care nurses. These are administration nurses and I find it a bit offensive that they use that title in this argument. If they are truly interested in being transparent and honest they will refer to themselves as nurse administrators. But they choose to use the title RN in an attempt to argue on behalf of the hospital while benefiting from the trust the public has for the nurses who provide the care.
They are quite welcome to make your arguments, but should do so in full disclosure. Otherwise they undermine their own integrity, whether the public ultimately discovers this or not.
If one has to impersonate the opponent to gain high ground, they just might be on the wrong side of the debate.
In the hospitals that have nurses’ unions, what percent of the nurses belong to it? I don’t know the answer to the question, but to say that some hospitals don’t have a nurse’s union is hardly a good argument against the MNA. I’d call it a problem. As RN has pointed out, 100% of the members of the MNA are nurses.
Is it too late into this 59 comment thread to point out that nursing remains a predominantly female profession?
Lisa, even though the implementation date is January 1, in hospitals where nurses have contracts, the staffing ratio doesn’t take effect until the contracts expire.
I will vote yes.
If I hadn’t made that decision before reading Every Nurse’s post, I would have made it for sure afterwards.
After studying everything I could find to answer the questions I had, I am voting yes.
@Patricia,
“Every Nurse” may not be representative of all nurse’s experiences. According to story on WBUR this morning, only 15% of nurses in Massachusetts believe a ballot question is the best way to establish nurse staffing rules. Only a minority of nurses (41%) surveyed said the ratios spelled out in the ballot question are appropriate. 38% did not agree with many or all of the proposed ratios, and 20% didn’t know or didn’t say.
“Every Nurse” describes a problem. The question to ask is whether Ballot Question 1 solves the problem or simply creates new problems.
I realize that every story has two sides, but I’ve come down strongly enough for YES on Question 1 that I’ve volunteered to help put together a few phone banks, letters to the editor and related outreach activities. Anyone who would like to help can email me at —[email protected]—-
Here are a few supplementary, but hardly secondary points.
1. The shortage of nurses in Massachusetts and the chronic problems of unreasonably long hours and burnout by both those unionized and non-unionized nurses who actually take care of patients has been extensively documented. I doubt that any reputable source on either side of Question 1 will take issue with these findings.
2. The Massachusetts Nurses Association (MNA) is one of the main drivers for YES on Question 1. The MNA has been trying to get the State Legislature and medical establishment to address this problem for at least the past 2 decades. They have had little success. It’s their position that going the referendum route was the only remaining option to bring this seemingly intractable problem to the attention of voters.
3. There have been not too subtle charges by some opponents that the MNA is doing this solely for the benefit of its members and that they are indifferent or oblivious to the dire consequences to emergency rooms, entire hospitals and to huge numbers of people that need medical care, but won’t be able to get it. The MNA knows these are scare and fear tactics to direct attention away from chronic problems of understaffing and burnout that those in command have been unable or unwilling to solve.
4. The proposition that the MNA would launch a crazy suicide type campaign of destruction against hospitals and patients for their personal gain is ludicrous. The MNA has never charged that those on the other side are not also committed to patient care. It’s false and unbecoming to suggest that the courageous nurses who are leading the charge for YES on Question 1 would be any less committed since they have devoted their professional careers to keeping people healthy and alive.
New WBUR poll of 500 nurse today – 10/15 – found that:
– Only 48% f nurses support Question 1, while 45% plan to vote NO and 7% are undecided.
– About half of nurses surveyed say that if the ballot question passes and overall health costs rise, hospitals are likely to close units or close altogether.
– 71% of nurses surveyed say it’s very or somewhat likely that hospitals will pass the expense of Question 1 on to insurers, which means health insurance premiums will rise.
– Only 15% of surveyed nurses believe a ballot question is the best way to establish nurse staffing rules.
I am sure the ballot measure would alleviate the situation at some hospitals, but it’s a blunt tool. Other hospitals will be overstaffed with nurses who don’t have enough to keep them busy. I have worked in units, particularly those where stable patients stay for extended periods of time, where there is not much work after bedtime. Those extra nurses won’t be needed. And lest anybody retort that the ballot measure specifies the “ideal” staffing level, any engineer can tell you that if you choose a rigid number for a safety parameter, the “safer” that number is, the less efficient the system will be. Now, you might say that only safety matters and efficiency doesn’t. It that were true, then every patient should have his or her own nurse, or maybe two or three of them. Obviously we can’t afford that. So we need to be practical.
One commentator on this thread compared nursing floors to airplanes and suggested that if the FAA regulates the number of cabin crew, then the state should also regulate the number of nurses. But patients are not airline passengers; their needs are more varied and complicated. I am opposed to this measure because I believe that nurses, not legislators, are the best judges of staffing ratios. I also believe that nurses have more power than some commentators on this thread believe. If employers aren’t listening to nurses’ advice, those nurses should vote with their feet. After all, we are told there is a nursing shortage. Voters and politicians don’t understand patient care, they don’t know how to allocate nursing resources, and they have no business setting rigid, Soviet-style rules for our healthcare system.
Maybe nurses have to be honest with the public about where they work and what the ratios are at each hospital. Then the public can make an informed decision. It is my understanding that at MGH and BWH the nurses care for not more than 3 patients on days and evenings and 4 on nights. I hear that BIDMC is higher but I don’t know the numbers. I have heard from 2 nurses from Lahey, one who still works there and one who left not long ago, that they routinely take 6 patients at night and when needed go to 7. I hear from nurses at MWMC Framingham and Natick that the nurses there take up to 6 on days and 8 on nights. At NWH nurses take 4 on days and evenings, occasionally 5 if the census and staffing requires and up to 6 at nights. These numbers are for inpatient med-surg. I would love to hear if anyone knows the ratios at other hospitals.
And rather than letting nurses vote with their feet, I say let patients vote with their feet. That is who this bill is really about. Patients dont have a reliable way of knowing how many patienta their nurse will be assigned unless they happen to know a nurse who works in a particular hospital.
Hi @RN, all fair points. But it’s difficult to compare stuffing ratios across different hospitals. Patients at BWH and MGH, for example, tend to be more ill than those at community hospitals.
Actually, adult med-surg patients are not generally more complex at MGH and BWH. I gwt this information from nurses who work there. Certaily yes, in the step-down and Intemsive care units.
But patients are routinely sent from BWH ER to NWH and Faulkner (and I’m sure other partners hospitals) when BWH is “full” which generally means when their nurses have reached their staffing limits. Hospitals all have their own limits. We call it a “grid”. It is the hospital’s staffing plan. To a large extent, the patient population depends more on geography than complexity.
This line was in a recent news story about Senator Warren’s support of nurse staffing ratios before it was changed to reflect the truth.
“Nurses unions are split on the initiative. The Massachusetts Nurses Association has endorsed it. The larger American Nurses Association opposes it.”
The American Nurses Association (ANA) is not a union. They do not represent members in collective bargaining. Also, the ANA-Massachusetts (ANA-M) is not larger than the Massachusetts Nurses Association. It appears to have 1000-2000 members, while the MNA has more than 20,000 dues paying members.
The MNA, the state’s largest nurse’s union, separated itself years ago from the American Nurses Association (which was and is NOT a union) because of the ANA’s perceived anti-labor and pro-management posture.
Opponents of Question One are portraying themselves as representing the interests and opinions of laborers in what looks like a pretty conventional labor – management disagreement.
Unionized bedside nurses appear to be solidly supportive of Question One. Others, such as nurse-managers and nurse educators, and non-unionized bedside nurses may be split on the issue, but to date no one has adequately probed that divide. In other words, the nurses most impacted by Question One who are protected by their unions from management coercion are, just as one would expect, supportive of a law that would prevent their employers from assigning them too many patients at one time, while some unclear number or proportion of non-unionized and/or non-bedside nurses are not supportive of Question One.