Discussing commodification of patients in AMCAS

[vrazzles]

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Hey guys!

I worked as a CNA in a rural long term care facility, right at the time that it was transitioning from being a community-owned facility to a facility owned by a massive corporate entity. During this transition I saw patient care standards lower significantly to increase the profits of this entity. CNAs were more frequently underscheduled, policies changed to forbid 2 CNAs from wash a patient together (even if this patient was overweight, in the late stages of dementia, and a fall risk), and other examples.

I felt powerless to do anything and few people would listen to me because I was "just a CNA". This experience gave me insight into the profit aspect of healthcare and just how easily patient lives can be commodified to push the profit ceiling. It also showed me how important it is for doctors to advocate for their patients within the structure of a health care system and ensure that lives are placed before the dollar.

Does this sound OK? I don't want to come across as a naive, uninformed millennial.

@LizzyM @gyngyn @getdown

 

[deleted480308]

Hey guys!

I worked as a CNA in a rural long term care facility, right at the time that it was transitioning from being a community-owned facility to a facility owned by a massive corporate entity. During this transition I saw patient care standards lower significantly to increase the profits of this entity. CNAs were more frequently underscheduled, policies changed to forbid 2 CNAs from wash a patient together (even if this patient was overweight, in the late stages of dementia, and a fall risk), and other examples.

I felt powerless to do anything and few people would listen to me because I was "just a CNA". This experience gave me insight into the profit aspect of healthcare and just how easily patient lives can be commodified to push the profit ceiling. It also showed me how important it is for doctors to advocate for their patients within the structure of a health care system and ensure that lives are placed before the dollar.

Does this sound OK? I don't want to come across as a naive, uninformed millennial.

@LizzyM @gyngyn @getdown

So who pays for it all? That’s the followup question you need to be ready to answer

 

[Goro]

Hey guys!

I worked as a CNA in a rural long term care facility, right at the time that it was transitioning from being a community-owned facility to a facility owned by a massive corporate entity. During this transition I saw patient care standards lower significantly to increase the profits of this entity. CNAs were more frequently underscheduled, policies changed to forbid 2 CNAs from wash a patient together (even if this patient was overweight, in the late stages of dementia, and a fall risk), and other examples.

I felt powerless to do anything and few people would listen to me because I was "just a CNA". This experience gave me insight into the profit aspect of healthcare and just how easily patient lives can be commodified to push the profit ceiling. It also showed me how important it is for doctors to advocate for their patients within the structure of a health care system and ensure that lives are placed before the dollar.

Does this sound OK? I don't want to come across as a naive, uninformed millennial.

@LizzyM @gyngyn @getdown

A caveat: The PS is not to be a screed against health care delivery in the US.

 

[Catalystik]

Hey guys!

I worked as a CNA in a rural long term care facility, right at the time that it was transitioning from being a community-owned facility to a facility owned by a massive corporate entity. During this transition I saw patient care standards lower significantly to increase the profits of this entity. CNAs were more frequently underscheduled, policies changed to forbid 2 CNAs from wash a patient together (even if this patient was overweight, in the late stages of dementia, and a fall risk), and other examples.

I felt powerless to do anything and few people would listen to me because I was "just a CNA". This experience gave me insight into the profit aspect of healthcare and just how easily patient lives can be commodified to push the profit ceiling. It also showed me how important it is for doctors to advocate for their patients within the structure of a health care system and ensure that lives are placed before the dollar.

Does this sound OK? I don't want to come across as a naive, uninformed millennial.

@LizzyM @gyngyn @getdown

In what context did you want to use this reflection?

 

[vrazzles]

So who pays for it all? That’s the followup question you need to be ready to answer

It's less "who pays it" and more "what loss of profit margin is acceptable to ensure quality patient care". The Medicare subsidies for for the long term care residents did not change when the ownership switched hands. One entity was simply more willing to see smaller profit margins.

 

[vrazzles]

In what context did you want to use this reflection?

In the context of explaining what one of my most valuable activities taught me about the role of physicians as patient advocates and leaders of health care reform in the face of certain entities being willing to put patient care on the backburner in favour of increased profit margins.

 

[vrazzles]

A caveat: The PS is not to be a screed against health care delivery in the US.

I do not intend for it to be. However, I do think that my experiences provided me with insight on the (often conflicting) forces between patient care and profit margins and that this is (and should be) an important discussion in today's society.

 

[deleted480308]

It's less "who pays it" and more "what loss of profit margin is acceptable to ensure quality patient care". The Medicare subsidies for for the long term care residents did not change when the ownership switched hands. One entity was simply more willing to see smaller profit margins.

Do you know what those margins were? Before and after?

What happens if the reimbursement declines to the point that the snf closes and now those patients don’t have care?

What margins are acceptable to you if you design the system? How much should a company be allowed to make? How much should a doctor? How little are you willing to make to ensure you don’t contribute to this commoditization you decry?

 

[Goro]

I do not intend for it to be. However, I do think that my experiences provided me with insight on the (often conflicting) forces between patient care and profit margins and that this is (and should be) an important discussion in today's society.

So far, from what you're written, I think you're treading on very htin ice.

But once you have your PS draft, have some clinicians or med students here eyeball it.

 

[vrazzles]

Do you know what those margins were? Before and after?

What happens if the reimbursement declines to the point that the snf closes and now those patients don’t have care?

What margins are acceptable to you if you design the system? How much should a company be allowed to make? How much should a doctor? How little are you willing to make to ensure you don’t contribute to this commoditization you decry?

I seem to have struck a nerve with you.

I am not aware of the exact profit margins, though this is a for-profit company that has had some pretty bad press in my state for cutting corners (and workers). I admit bias here.

Making "what if" statements on a long term functioning situation (the hospital had been functioning smoothly for over 20 years before being bought out) to justify reductions in patient care doesn't really resonate with me.

My job isn't to design the system. My (hopefully future) job will be to advocate for patients within that system to ensure that they get the best care they can and to challenge the system when I feel it is not benefiting society as a whole.

I have no set margins. I think that all of these are highly variable, depending on the company and its societal benefit. Same for individual careers. I will say that I have no problem with physician salaries being lowered if the debt load could also be eased. I'm a Peace Corps volunteer. I live on $200.00 a month teaching 60 hrs a week. As a non-surgeon I would be happy with 90k a year and as a surgeon 120k. I'm not doing this for the money.

I appreciate your points. I think I will stay away from this aspect of my experience.

I will focus more on being the only male CNA on a floor of mostly elderly conservative ladies, and the difficulties that I encountered winning their trust and being permitted to care for them.

 

[deleted480308]

I seem to have struck a nerve with you.

I am not aware of the exact profit margins, though this is a for-profit company that has had some pretty bad press in my state for cutting corners (and workers). I admit bias here.

Making "what if" statements on a long term functioning situation (the hospital had been functioning smoothly for over 20 years before being bought out) to justify reductions in patient care doesn't really resonate with me.

My job isn't to design the system. My (hopefully future) job will be to advocate for patients within that system to ensure that they get the best care they can and to challenge the system when I feel it is not benefiting society as a whole.

I have no set margins. I think that all of these are highly variable, depending on the company and its societal benefit. Same for individual careers. I will say that I have no problem with physician salaries being lowered if the debt load could also be eased. I'm a Peace Corps volunteer. I live on $200.00 a month teaching 60 hrs a week. As a non-surgeon I would be happy with 90k a year and as a surgeon 120k. I'm not doing this for the money.

I appreciate your points. I think I will stay away from this aspect of my experience.

I will focus more on being the only male CNA on a floor of mostly elderly conservative ladies, and the difficulties that I encountered winning their trust and being permitted to care for them.

I’m just pointing out the things that many adcoms will ask if you pontificate too hard. Whether or not they philosophically agree with you they will likely want to know if you have thought this through further than your initial statement

 

[vrazzles]

I’m just pointing out the things that many adcoms will ask if you pontificate too hard. Whether or not they philosophically agree with you they will likely want to know if you have thought this through further than your initial statement

I appreciate it. I do think that it's best that I stay away from anything to do with free market enterprise regardinf healthcare. No need to turn off ADCOMs when I can use other valuable aspects of the experience that are completely apolitical.

Thanks again!

 

[deleted480308]

I appreciate it. I do think that it's best that I stay away from anything to do with free market enterprise regardinf healthcare. No need to turn off ADCOMs when I can use other valuable aspects of the experience that are completely apolitical.

Thanks again!

Risk aversion is a good application strategy, good luck sir/ma’am

 

[Goro]

I’m just pointing out the things that many adcoms will ask if you pontificate too hard. Whether or not they philosophically agree with you they will likely want to know if you have thought this through further than your initial statement

I agree 100% with my young colleague. What I worry about is that you come off a too starry-eyed. Play up the advocacy part, and tie in what you learned from the Peace Corp. That EC alone is golden.

 

[getdown]

Hey guys!

I worked as a CNA in a rural long term care facility, right at the time that it was transitioning from being a community-owned facility to a facility owned by a massive corporate entity. During this transition I saw patient care standards lower significantly to increase the profits of this entity. CNAs were more frequently underscheduled, policies changed to forbid 2 CNAs from wash a patient together (even if this patient was overweight, in the late stages of dementia, and a fall risk), and other examples.

I felt powerless to do anything and few people would listen to me because I was "just a CNA". This experience gave me insight into the profit aspect of healthcare and just how easily patient lives can be commodified to push the profit ceiling. It also showed me how important it is for doctors to advocate for their patients within the structure of a health care system and ensure that lives are placed before the dollar.

Does this sound OK? I don't want to come across as a naive, uninformed millennial.

@LizzyM @gyngyn @getdown

I'm a little late to the party but I agree with what's been said above. It's a fine balance between using your example as a backdrop to talk about the advocacy role of a physician and coming off as overly critical to a system most already know will sacrifice patient care for profit. Like Goro and sb247 mentioned, I would suggest that you use your observation simply as a vessel to tell your story and focus more on the role of the physician. Something along the lines of "when I was a CNA my company did cost cutting measure that impacted patient care ... (don't go into detail)". Then talk about examples of patient advocacy from physicians that you saw and how you saw it impacting patients lives. Most importantly, how that played into the role of you wanting to be a physician. It'd also be good to tie into your own personal life if you or your family have ever experienced an advocacy issue as well.