A comment to my post on cashing in:
Very enlightening. Up to now, I assumed it was big pharma and greedy insurance companies that caused health care costs to skyrocket. The correct answer, as it turns out, is all of the above; everything connected to healthcare.
No offence to oldvet, this post isn’t an attack upon him, but is a classic case of supply and demand. The ED wants to open, but there is a shortage of qualified nurses. They have no choice if they want to stay in business- by law, an emergency room has to be open 24/7. So they have to:
- do whatever it takes to get qualified people to come in: that means paying enough to entice them or
- lower standards and risk medical errors
Since the US has a climate of legal liability, medical care is a field that has zero room for errors. People who can treat patients without making a single error are rare and in high demand. That means there is a bidding war for their time.
Skilled people cost money, which is why it costs $165 to have a plumber snake a drain. No one wants to look up while having a medical emergency and see the cheapest nurse caring for them- they want the best, or at least someone who is good at what they do.
It takes 3-4 years to train a basic nurse. More than 3/4 of those who begin the education don’t make it.
Then it takes another year to train for the ED specialty. Two more years before they reach a point of proficiency without needing guidance and supervision.
Of the nurses here who manage that seven year slog, just over ten percent are good enough to be board certified in emergency medicine. Only a quarter of those have two board certifications.
In other words, of the 257,000 actively licensed RNs in Florida, 17,000 are Emergency Room nurses. Of ED nurses, only about 2500 of them are board certified. Only about 800 of them have two certifications.
Are two specialties really needed? Certified Emergency Nurse, sure. How about a nurse certified in stroke care? Pediatrics? Trauma? Vascular access? Critical care? Each of those is a subspecialty that is needed in the ED on a daily basis.
Now consider that there are 477 licensed emergency departments in Florida, all competing for those nurses. Everyone wants the best, so those who have multiple certificates and degrees demand (and get) top dollar. My last employer had 162 ED nurses and still didnt have enough for their patient load. That drives up costs.
They only way to eliminate the nursing shortage is to either lower demand or increase supply. Lowering demand isn’t going to happen. Raising supply can be done in two ways:
- Raise pay
- Lower standards
In today’s legal climate, lowering standards would actually cost more in increased litigation caused by more medical errors. In the ED, 95% of patient care is performed by nurses. We write orders for imaging, lab work, and treatment. What kind of provider do YOU want at your side during your next medical emergency?
16 Comments
Steve · June 29, 2026 at 1:34 pm
You COULD lower quantity demanded, and if McCain hadn’t ratted out America, we would likely not have the increased demand of ObamaCrap. But politically, no, the “repeal and replace” Republican’ts hate Americans too much to go there.
Divemedic · June 29, 2026 at 1:55 pm
How would you do that? Get people to stop going to the ED?
Steve · June 30, 2026 at 8:05 pm
Have ICE assist at the front desk. You could also eliminate Medicaid. Around here, illegals and Medicaid are the majority of walk-in ER, most of whom use it as a primary care provider.
Rick T · June 29, 2026 at 1:57 pm
DM, how much of your workload is due to people treating the ED like their primary care provider? In other words, what percentage of the cases coming thru your doors should be turfed after triage?
Divemedic · June 29, 2026 at 2:54 pm
I would say at least half of any ED’S patients are people with complaints that are not emergencies, like: cough, flu symptoms, burning urination, headache, need a refill on medication, etc.
The ED rates patient emergencies 1-5, with 1 being the most serious. Less than 10% of all ED patients are 1. half are 4 or 5.
Brutus · June 29, 2026 at 5:51 pm
How many ED patients would you say are probably here illegally?
Divemedic · June 29, 2026 at 6:32 pm
It varies.
Steady Steve · June 29, 2026 at 5:59 pm
Would having a separate department that those half of non-emergency patients could be sent to after initial assessment be helpful? Something like an onsite urgent care? Yes, I know it would cost the hospital to set it up, but, I think it would be profitable as they wouldn’t have to hire top tier help. Better yet have an outside urgent care company set up a facility on hospital grounds. Or would this idea not work because it contains common sense, something management is averse to?
Divemedic · June 29, 2026 at 6:32 pm
EMTALA still requires that they see and are evaluated by a provider once they present to the ED
Elio · June 29, 2026 at 7:15 pm
Just some irrefutable math, nobody thinnks anymore, otherwise things might be different, change numbers to modernize re latest “statiscs”, but, the mind game on the non-thinkers, remains the samd
Consider a disease whose prevalence is one in a thousand. A test to detect the disease has a false positive rate of 5 percent. What is the chance that a person found to have a positive test result actually has the disease?
Assume that 1000 individuals are administered the test. Of these people, only 1 person has the disease, per the above. Of the other 999 people without the disease, 50 (mathematically the number is 49.95 = 50/999) will still test positive because of the test’s false positive of 5%. Therefore, 51 (mathematically the number is 50.95) people will test positive in a group of 1000 people. But only 1 person in those 51 people actually has the disease. Therefore, the chance that a person found to have a positive test result actually having the diseaese is 1/51 = 0.0196, or about 2%
With mammograms, false positive rates can be around 15%, depending on the radiologist.
It is publicized that the chances of a woman developing Breast Cancerin her lifetime in the US is presently about 1 out of 8. That’s 125 / 1000.
***** Let’s assume a woman begins getting annual mammograms at age 30, and continues until she’s about 72. That’s 42 years. 125 divided by 42 is about 3. This means that 3/1000 women who show up for a given mammogram, on average, will actually have breast cancer. ****** THOSE ARE YOUR ACTUAL CHANCES, JUST 3/1000.
Based on the 1/8 Breast Cancer rates in the US and 42 annual mammograms beginning at age 30, of 1000 women are administered a mammogram at their annual checkup, only 3 will actually have the disease. Of the other 997 women without the disease, 150 (mathematically the number is 149.55) will still test positive based on a test’s false positive rate of 15%. Therefore, 153 women will test positive in a group of 1000 people. But only 3 women in those 153 women actually have the disease. Therefore, the chance that a woman found to have a positive mammogram test result actually having the diseaese is about 3/153 = 0.0196. So, if you get a positive mammogram, it means there is only a 2% chance that you really have breast cancer.
Stated another way: A POSITIVE MAMMOGRAM TEST MEANS THERE IS A ABOUT 98% CHANCE THAT YOU DON’T HAVE Breast Cancer (depending on the skill of the radiologist).
Why take such a test with such poor results ????? Because your doctor and the media tell you to ????
You can try the above with different numbers for the false positive rate, but what you typically find is that mammography is essentially worthless, other than as a cash-generator and scare tactic, when compared to other methods such as thermography. If you get a positive result, there is always at least about a 90% chance that the mammogram is wrong.
Personally, I conclude that mammograms are a humiliating waste of time and money, and most women only have them performed out of FEAR.
Jester · June 29, 2026 at 6:56 pm
Well, I can say there are places that are called Urgent Care which is yeah I twisted my ankle. I got the sniffles, or a rash. VA side of things has the very same thing. But people are too ignorant or think they should not have to wait 1 minute to be seen. Those same people that don’t want to wait are the very same cause of their said waiting.
This is also not to get in to the costs beyond your labor.
Steve · June 30, 2026 at 8:20 pm
Don’t know about your region, but around here, Urgent Care is a lot faster. I don’t know where a compound fracture would fall on 1-5, but it was clearly 5 or 6 to the ER triage nurse. I finally got back from out of town, got to he ER waiting room about 2.5 hours after she did, took one look at the bloody towel my wife had dressed it with, and the pool of blood on the floor next to her, and went off on the nurse at the desk. Took her to Urgent, they stabilized, and they arranged for her to be immediately seen at a different ER.
F-ing DEI hires. Lawyer got a pretty good settlement out of it, but I guaran-damn-tee you the place is still staffed by DEI. Yeah, I’m a little bitter about it.
C · June 29, 2026 at 11:27 pm
Ha. I’m so much of a miserable I won’t go to the ER willingly. Somebody is going to have to drag my unconscious body there. If I come to before the lab work or imaging is done. I’m refusing treatment and crawling out if I have to. I don’t even care if I’ve sustained a gun shot. Let’s get that bleeding under control and see if my doctor can schedule an outpatient surgery.
Me: Hey Doc. I need a surgery asap.
Family Doc: What’s wrong with you?
Me; I’ve been shot.
Family Doc: You need to go to the ER!
Me: Are you paying for it?
Family Doc: No.
Me: That’s my response to your order.
If some poor bastards could lay out in No Man’s Land holding their guts in until the stretcher bearers arrive. Surely I can do the same. High chance of me dying. Meh. Life’s a bitch like that. It means one less patient for you nurses as well.
oldvet50 · June 30, 2026 at 7:26 am
First off – no offense taken. You basically helped make my point. Everything connected to healthcare, which more and more, includes litigation. We all used to want Cadillacs at Ford prices, we now demand Rolls Royces at that same price.
Near me, they have built stand-alone EDs – not urgent care – EDs. I wonder if they make any money transporting the admitted patients across town rather than upstairs like they used to?
Covid taught many of us the real goal of the medical industry and it isn’t to make you well – there’s no money in that!
Divemedic · June 30, 2026 at 9:13 am
Between 10 and 30 percent of ED patients are admitted. Teaching hospitals and trauma centers admit at the highest rate, and community hospitals at the lowest.
My ED admits around 10 percent.
Bo · June 30, 2026 at 8:56 am
There is a point you didn’t lay enough blame on, and that is Regulatory and Compliance requirements dictated by government, NGOs and ‘licensing bodies’.
In a lot of cases if you are going to run a function like Banking, Healthcare, construction, and others, you have a laundry list of “HOW” this is to be accomplished in order for you to be allowed to operate.
For instance if you are going to have an ER that is accredited and licensed (meaning you are allowed to PAY for insurance) you have a lot of minimum requirements to meet from staffing to security to accessibility (meaning handicap accessible etc).
You don’t necessarily get the option to open a non-ER clinic that is staffed by ‘less competent” professionals that might end up rendering a lower degree of care to a misidentified patient that should have gone to the ER.
You aren’t allowed to lower the requirements, only meet or exceed them. DM was clear about the cost of care, but he didn’t make it clear that the reason ERs need the best they can get is because they will be sued or lose their ability to operate period (and then likely be sued anyway for failing to provide a critical service to the community).
I see this all the time even in my IT world, where some really costly and often poorly considered decisions are made because there is a regulatory guideline that requires the business to operate inside a very restrictive framework because someone at the Good Idea Office made a rule without really understanding the secondary and tertiary effects. Not doing it is not an option because you can lose your business licenses, doing it hurts your bottom line because it does nothing to improve the businesses performance. You have no choice, this costs a LOT of wasted money and does have follow on effects to things most people never connect.
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