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Outsourcing

There is a nationwide shortage of medical personnel. It is so bad in some specialties that pay is going through the roof. Emergency room nurses are making sky high bonuses in order to pick up extra days. Right now, if you are willing to pick up extra days, my hospital will pay you double time plus a bonus to come to work. Technicians like respiratory therapists are getting a bonus of $500 to come to work. Registered nurses are getting bonuses of $1,000 to $1,500.

I know nurses who are making $30,000 a month, although that is an extreme case. They are working more than 80 hours a week to do it, but it can be done. Most nurses are working 50 or so hours a week, and making somewhere around $13,000 a month. Even with that, we never have enough people.

These jobs are demanding jobs that require education, critical thinking skills, psychomotor skills, the ability to think quickly in stressful situations, and the ability to make life altering decisions in a fast paced environment. All with zero errors, hundreds of times per day, 12+ hours per day. Skills like that cost money. It’s money that hospitals are tired of paying.

So how are hospitals fixing it? They are importing nurses from the Philippines. The hospitals can force salaries lower by importing nurses from third world countries and paying them far less than their US counterparts. The average Filipino nurse makes less than $4,000 a month.

We have a mandatory meeting with management next week, where rumor has it we are being told that much of our staff will be replaced with foreign workers beginning in January.

This isn’t a slam on the nurses. They are well educated, with some of them even being licensed as doctors in their own country. What sucks is that you spend years becoming experienced and educated only to see your employer bring in people from other countries to do your job at a fraction of the pay.

24 replies on “Outsourcing”

If they do indeed import Filipino nurses, I hope it works out better than NYC with their Jamaican nurses.

That absolutely sucks and is 100% predictable. My own industry suffers as a result of this. Filipinos make up 1/3 of the world’s merchant seamen. My counterpart from the Philippines makes $500-1000 a month and will work an 8- 12-month contract, 12-16 hours a day, 7 days a week, and will have to reimburse his employer for travel costs if he leaves early. John McCain and Cheneys were huge investors of ADM, the company that was trying to open up all domestic waterways jobs to foreign workers. They’ve failed so far, but keep trying. It’s sad to see hospitals doing this. Can nurses unions strike over the H1B holders not making prevailing wage?

Moved to TX in 2000, Board of Nursing said the state was 50K nurses short, back then……has only gotten worse.

The Filipino/Indonesian nurses have a major strike against them – their culture wants to please. I can’t tell you how many surgeries have been delayed because the patient ate breakfast despite having a NPO (nothing by mouth) order. “But they were hungry”. So what’s the problem?? Insurance only pays for so much and an extra day waiting for surgery isn’t one of them.

I’ve also been awakened at 0550 from a nurse (Indonesian) asking “patient has a fever of 99.9. Please advise.” Ummm, definition of fever is > 100.4F. Not to mention that Tylenol and Ibuprofen were already ordered as needed….. but not given….

This has been happening in Central Florida since Hurricane Maria. Just substitute Philipinos with Puerto Ricans. They could not grasp the charting systems at all. We taught them to replace us.

It’s been that way in IT for a while. They replace Americans with someone over in Hyderabad or Alabang to work for half the salary or less and no benefits. Then months later try to hire Americans back to fix the problems the Sepoy IT guys created.

Gainesville, FL hospitals have been doing this since about 2000 or so, and it’s only gotten worse.

I’ve heard that HCA is especially bad about this.

No disrespect intended here DM, as I know healthcare is your bread and butter. Problem is, healthcare is toast, on account of multiple intractible problems. It is a racketeering and asset stripping operation, aided all the way by the govt and insurance companies. It is no longer concerned with good care (at the corporate and regulatory level) and only some – certainly not all – individual staff members are legitimately concerned with administering proper care. It is quite literally the blob, consuming everything in it path in the pursuit of profits and influence.

It is also true that Americans are, generally, terribly unhealthy. This has had the effect of increasing reliance on healthcare (and thereby profits) but as our bad habits really start killing us off in greater numbers, a lot of very profitable ongoing care (drugs especially) wilp evaporate.

Adding to healthcares problems is that trust in healthcare has been irreparably broken for some significant portion of the public in the wake of the covid response. The absolute non negotioable insistence on the use of ventilators, remedesivir, forced shitshots, and the monomaniacal denial of use for other standards of care that were proven to work have all piled up to reveal the visage of a Goddamnable monster.

I don’t trust the system, haven’t in years, and never will again. I am not alone in my distrust and avoidance of interaction with the medical system, and the numbers of us who feel the same is growng constantly. There are things worse than dying, and so I have no problem with avoiding getting caught up in the system.

Finally, it is simple math that will destroy the HC industry. It is demanding an ever greater share of GDP, including what is taken out of an individuals pocket, while demand constantly outstrips supply, and the administrative level of the the industry is clearly intent on destroying it by both the actions they are taking, and those they refuse to take. American style healthcare as it presently exists is hopelessly fucked. I doubt it will be replaced by anything better, but it will collapse under its own weight, as it cannot continue to parasitize the entire economy to the eventual exclusion of all else. So, in a sense, it is a self-solving issue.

Issues like the importation of cheaper, substandard staff are simply the sorts of things that happen in the death throes of a doomed industry.

Kind of like how plumbers charged me $400 to tell me nothing was wrong with my pipes, but a week later they still were failing to drain?
Yeah, I take offense at that. Were we as a profession duped by falsified research? Yep. Does that mean we are all criminals? Nope.
Was I working in the COVID unit and holding the hands of people as they died? Sure was.
That doesn’t make me complicit. That doesn’t make me incompetent.
The problem that you have is when the government allows this sort of thing so companies can make tons of money on snake oil cures. That isn’t going to be fixed by allowing healthcare companies to import thousands of Filipino workers at half the pay.

And to be clear, I don’t hold you personally complicit. You are a cog in the machine, so am I in a sense. We all have to do something for livelihood. Too many have been robbed of that, by greedy fuckers who run big corporate entities. First they ran up the price (for profits) by exploiting insurance and buying off the regulatory apparatus. Then they pissed off the good people who would and could do the job. Then when they couldn’t find anymore decent people to sign on for the abuse they were dishing out, they did the only thing left, and found a new pool of slaves to abuse and exploit. I saw the other day Apple is moving much production from China to Vietnam. Same shit, different third world country.

BTW, I’ve never charged a customer $400 on a service call just to tell them “no trouble found” and I find it shameful that there are unscrupulous assholes in my line of work who do that. They are part of the reason I’m so busy, because they only get to fuck a customer that way once, and then the customer finds someone else to call.

But, you are focusing too heavily on my criticism of the covid response, and I understand you have a different perspective from being on the inside, than I have as an external observer. That is only a part of this issue. The bigger problem is systemic, and clearly you recognize that by the last paragraph of your response.

Oscamacare was a patch on a dying system, because it was going to be unable to continue being as profitable without the compulsory purchase of “health insurance”. The big picture re: covid response was that it was also used to pump up flagging profits again.

Healthcare was roughly 5% of GDP in the 70’s when I was born, and now constitutes a bit more than 20% of GDP. It continues to grow, and it is self evident it cannot keep growing the dollar amount it squeezes out of the total economy, as it will consume every available dollar until no one can pay for it at all. Then it crashes and burns. It is, second only to government, the ultimate bubble. Collapse is an inherent feature. This isn’t your fault or mine, it is a function of how the market for healthcare has been so badly perverted.

And clearly, irrespective of my personal opinions and feelings (or yours) over the quality of the overarching covid response, there are a lot of people who no longer trust the system. They didn’t come to that mindset because an outspoken prick like me did some shit posting on a blog. They saw something they didn’t like in their personal and direct interaction with healthcare, and thereby made a decision to develop an unfavorable opinion. Outcomes of covid care played a big role in that (and again, I’m not laying blame on you here) because the govt and administrative level of healthcare forced shit that we now know has poor odds of a successful outcome (for profits and avoiding legal pitfalls, apparently) and mounted an unprecedented effort to suppress and discredit things that did work.

Getting back to the core issue of your OP, yes, they are going to fuck you like they’ve fucked so many other sectors (IT as one notable example) of the workforce by importing less skilled and less expensive labor. It is bullshit, and I feel badly for those, like you, who are genuinely decent sorts doing a tough and generally thankless job. This too is a systemic defect of healthcare, and more generally of the American economy. Can it be fixed? Not now, we are too deep into the shit to claw our way out cleanly.

Crash and burn of basically everything, followed by a rebuilding – if such is even possible – with an eye towards killing off any subversive fucker who tries to implement the kind of rot-inducing policies that will once again destroy things from the inside is all that’s really left.

As a retired software developer, let me just say “Welcome to the party, pal”. We have been squeezed by H-1B visa holders from India and elsewhere for years.

I do contract pharmaceutical consulting and get 6 – 12 emails and calls per day from India et all for positions that are either low pay ($35/hr all inclusive in San Fran) or for skills not listed on my CV. I have had legitimate US agencies tell me that H1Bs showed up with no experience for the position but had another person do the pharma job interview. That is one of the reasons companies are requiring Teams, Skype, etc. interviews. If you put or change your CV/resume on Monster expect dozens of H1B calls/emails and request from H1B agencies/people to be added to your Linkedin profile. The H1Bs calling have no ideal about the positions they are “selling”, no idea of the cost of living is in the US, have language issues and the Indian women calling speak so softly you have to ask them to repeat 2, 3 or more times. I have been contacted by as many 5 different H1B agents for the same position from the same agency within 24 hours. The US companies HR departments are feeding the positions to H1B agencies to save $$$. One of my fellow consultants was working with a competent Indian coworker. He discovered that the companies they were both working through were being paid the same rate for their services. But the working H1B was being paid less that a third what the agency was being paid. So H1B agencies screw their own people. I believe the H1B agencies are just an upgrade of the SCAM “Microsoft/Apple/etc. Help Desk” calls aimed at old people.

>>What sucks is that you spend years becoming experienced and educated only to see your employer bring in people from other countries to do your job at a fraction of the pay.

Welcome to IT

All Americans are being Replaced.
They are Deleting the US and is rightfull citizens.

Know your HVT’z.

Ya think? 🙂

My hospital bullied 350 out of 600+ holdouts into getting the Clot Shot.
We lost 25% of the ER, and half the ICU over that when they punched out of the profession for good, and we still haven’t replaced them.

Meanwhile, every single vaxxed person in my ED: nurses, doctors, techs, and ancillary staff, has contracted COVID at least 2x apiece after vaxxed and boostered, whereas I’ve been forced to test twice weekly since they granted the 300 or so hardcore vaxx holdouts – including me – blanket exemptions (because otherwise the hospital would’ve had to close) on any grounds requested, and I haven’t been sick a single day since COVID broke out, not with COVID, nor with anything else.

Regarding Divemedic’s OP points, the current deal hereabouts is doubletime +$500/shift, indefinitely, and we’re still short pretty much until Hell Freezes Over. (Looking at this month’s schedule, we’re 30-40% short for nurses just on my shift every night all month. Overall, we’re 50% short any given day.) Overtime city, baby and we still don’t get enough pick-ups to run the department, and the same, plus COVID out-sicks in the hospital means we’re holding ICU and tele patinets in the ER for 3-4-5 days, which closes the ED, and jams up every other hospital (out of 40) in the county, and Mondays, literally the entire county is overflowing with patients.

The “Check Engine” light is flashing red, and something is going to blow. We’ve told hospital manglement, but they can’t pull staff out of their asses either, so they just shrug, and wait for the inevitable meltdown.

We can’t hire new grads or experienced nurses fast enough, and 75% of the new grads can’t hack the ED, and fail out of training.

They’re not bringing in foreign workers, because they can’t even find American nurses who can do the job. Foreign nursing grads? No chance in hell. They’d kill people in about a day.

The Filipinos all end up at Kaiser, because they DGAF about outcomes, just costs, and 90% of them are Pinoy/pinay anyways. (Remember that when you sign up for Kaiser care. And unionized to boot! So they go on strike every couple of years, for more pay, and less work.)

If they tried replacing us here, everyone but the newly-hired would just walk out, and the corporation would fold and go bankrupt overnight, and those of us with a year’s experience or more at anything would all have jobs in about 5 minutes somewhere else, so it’s not even a consideration for them.

The only reason nursing salaries increased about 10 years ago was because they finally slammed shut the H-1B visa program, which was bringing in at least a 747-load of Turd World nurses every day 24/7/365/forever since the 1970s, just to Califrutopia.

If they try that crap again hereabouts, congressweasels won’t be voted out, they’ll be leaving office via necktie parties and lamp posts, and they know it.

I pull an extra shift/week, because any more than that, Uncle gets all the overtime, and if he wants it, he can do the G–D—-d shifts.

But you know what the job entails, which is why I laugh my ass off all the way to the bank and a solid six-figure take-home after taxes every time some 80-IQ internet halfwit stuck mentally in the 1950s (we know who I’m talking about) thinks all we do is “juggle bedpans”. As if.

The docs and the patients know who really does the job, and saves their lives. Or not. And like undertakers, everybody I meet is a future client.

Registry and travel, pardner. Registry at any other nearby hospital(s) one shift a week is another $26K in your pocket each year, and you find all the good hospitals, and all the bad ones, and network a happy landing where they already now you when your current nursing job goes to sh*t – like they always do.

I preach that to the new grads religiously, because the only way you know the hospital loves you is in your paycheck, and loyalty goes one way, from you to them. They don’t GAF about you, and they’ll sh*tcan you in a hot minute for any reason or none at all. Write that on your hand in Sharpie, DM. For reals.

Best wishes.

Just transfer it all to Costco or Wal-Mart with a drive up window menu to pick out your health issue.
A clerk in Big Pharm logo attire will administer your treatment, thank you, please pull through.
O/T-Local hospital had to move the transgender care center away from the adult GP floor after some excellent razzing by vets and other oldsters, haven’t been since the COV-LARP started and won’t be going back.

There is no way to permanently avoid competing with humans outside your borders. Darwinistic survival of the fittest doesn’t stop just because Congress outlawed it.

International trade makes your country rich. Stop trade and you become poor, then become militarily uncompetitive, then get conquered from outside. ‘If goods don’t cross borders, armies will’

Please tell the class how someone in Trashcanistan or Sh*tholia will change your oil, fix you toilet, stock your shelves, or do CPR compressions. From Trashcanistan or Sh*tholia.

There is a fixed number of jobs that can be off-shored.
Try to onshore the workers, and eventually, you get the same reaction from displaced nationals pushed out by immigrants that you get if you drop a 20# block of sodium into a swimming pool.

But there’s always a politician willing to grab the hot stove and burn both hands. Again.

Wait and see.

https://en.wikipedia.org/wiki/New_York_City_draft_riots of 1863

The Emancipation Proclamation of January 1863 alarmed much of the white working class in New York, who feared that freed slaves would migrate to the city and add further competition to the labor market.

Golly, Whites were out-competed by Blacks. Those jobs belong to the existing workers, because Communism told them so.

Nothing like trying an apples-to-oranges comparison for mis-proving your point, and mischaracterizing the entire situation to boot.

For a bonus, the fact that they were initiated as riots over a military draft (hint: which was only on white men), and later co-opted for entirely other purposes, should have been a major clue-bat.

If you’re going to link to something, reading it is probably a good first step.

No one has yet explained how people in Trashcanistan are going to do the jobs of people here that can only be done in person, unless you first import them, and second, train them.

They have also not explained why, if they had the skills they’d require to compete where they are, they’d want to leave in the first place, since they’d be at the top of the food chains in their own countries.

And for bonus Retard Points (sorry, but there’s no nice way to say that), the riots were in 1863, but the first volume of Marx’s Das Kapital – the entire philosophical basis of communism – wasn’t published until 1867. Oops. (The second and third parts weren’t published until 1885 and 1894. So were the rioting mobs all also psychics, or what?) Thanks for the laugh, but that sort of bassackwards historical revisionism is quite simply recockulous, which is the step beyond ridiculous.

So the analysis offered is on the same level as that of folks who claim the moon landings were faked, which all miraculously trace back to months after the premiere of the cinematically awful Capricorn One in 1977, five years after we’d stopped landing men on the moon, which used that retarded idea as the plot basis, and then gained a life of its own amongst the lunatic fringe as serious conversation fodder.

https://www.youtube.com/watch?v=q2rVcxkbIQc

Hey! I enjoyed Capricorn One. That was a decent movie, and the book was even better.

I’ll have to take your word for it on the book.

The movie died at the box office. If not for VHS and DVD, it would be nothing but a dim memory.

And then the black helicopter contingent adopted it as gospel.

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