#'s can be hard to keep as an apples/apples comparison, as your above example illustrates. Some trends can be a little startling, if the #'s do actually track properly. There was an article in the Toronto Sun within the last 3 months - I don't recall the exact #'s, but over a period of something like 6 years, the head count for Hospital managers in Quebec went from something like 5,000 to over 10,000.
Different issue, but some structural problems need to be fixed, at least in Ontario. Keeping paramedics tied up sitting in Emergency with a patient is just a bandaid solution, pun intended. And, this paramedic scenario tends to add credence to the argument that hospitals need more workers/beds - if that means less managers (not zero), then perhaps that balance needs to be looked at more closely.
Rgds, D.
I have no direct knowledge of what goes on in PQ, however, rest assured "management" did not double in Ontario in the last 20 years. In fact, almost annually when planning for the upcoming budget year it was a case of - who can we fire - what program or service can be eliminated, how can we do something with less resources and last but not least how many beds do we need to close to balance the budget. Managers / programs were eliminated entirely. Managers were given greater span of control - looked after multiple departments. When that well ran dry the next step, in multiple hospital towns was total consolidation of one or more hospitals or at the least specialization of services. One hospital did Obstetrics, one did Trauma, one specialized in Orthopedics - in some cases only one Emergency etc etc. Managers were eliminated and those left were required to serve either two hospital corporations or manage at multiple sites. Presidents / CEO's became responsible for multiple sites.
A lot of things have changed, some for the better, some not. Family Physicians have for the most part resigned their hospital privileges - too much time and effort to drop by the hospital to see their patients compared for the financial remuneration. A lot have formed group practices and basically sit in their office, seeing patients from 8-4 or whatever. After office hours the answering machine basically says - "if you have a problem - go to Emerg". Often if you want to talk about more than one thing another appointment is required. For anything much more complicated than a sniffle, you will be referred to a Specialist. Sometimes this can be a good thing - if the patient can actually get an appointment in a timely fashion.
To deal with hospital inpatients, since the FP no longer comes in to see them, hospitals have had to actually hire physicians - often referred to as "Hospitalists" to provide the required in hospital care.
The thing with Paramedics waiting relates to a "transfer of care" issue. They can't just drive up, dump the patient onto an ER stretcher and drive off. ER's like a fire department require a minimum level of staff to open the doors, but after that the worst case will get first priority. Potentially staff can be called in for a disaster, but in many cases the solution is that less serious cases just wait until the ER Physician is available. If the ER Doc and RN's are too busy with a particular case(s) this transfer of care does not take place in a speedy fashion. ER Physicians often now represent a specialization. The days of the local FP doing a few shifts in ER are pretty well history. In many cases they have banded together and contract with hospitals to proved agreed levels of ER Physician staffing. In ON they bill OHIP for services rendered, however, if ER billed volume does not reach contracted levels, hospitals pay the difference.
Another "inefficiency" to a large extent related to GOV funding, or lack thereof, is when elderly patients are admitted for procedures, but when completed they are unable to return home and there are no beds available in the Chronic Care system. The hospital cannot discharge them without a place to go and as a result they become "bed blockers" taking up a bed that could otherwise be used to admit another acute care patient - perhaps one that has been camping in ER waiting for a bed to become available. As the population ages, unless additional Chronic Care facilities are built and funded this problem will only get worse. In a simplistic way, bed blockers can actually be good for business, since on the whole they usually require less resources than someone who is sicker.
Anyway, in my opinion, that was a long way to say that if every single "manager" was fired and somehow staff could totally look after themselves, savings would be minimal in relation to total healthcare expenditures.
