patrick.net

"Small Rant: The ER situation in the Bay Area is ridiculous."

This situation goes beyond the ER. I guarantee that if you call almost any type of doctor's office in the Bay Area, you will be put on hold, sometimes for 10 minutes or so before you can even speak to the receptionist. Also, if you need a new primary care doctor or OB-GYN, good luck.

I love how keep building medical centers without ERs. I can’t blame them - ERs are terribly unprofitable. If I were building a hospital, I’d try to leave it out as well.

They should charge me.

s/me/more

This situation goes beyond the ER. I guarantee that if you call almost any type of doctor’s office in the Bay Area, you will be put on hold, sometimes for 10 minutes or so before you can even speak to the receptionist. Also, if you need a new primary care doctor or OB-GYN, good luck.

Dentists too. All true.

But I bring up the ER example because typically I can wait 2 weeks to see the Dentist. On the other hand, I wouldn't want to wait 2 weeks to go to the ER. :)

I work for an HMO in the East Bay. Demand for docs is high, mostly because of high turnover. Working conditions are abusive, and coupled with high home prices, the results are not pretty. I see a revolving door of docs come and go constantly. I feel sorry for the ones who buy a home and have to sell it within a few months to a year.

I was re-reading Robert Shiller's book Irrational Exuberance and he made a surprising (to me) claim. He said that the last time there was a downturn in housing on both east and west coasts in the late 1980s housing peaked before the economy. In Boston housing turned down in 1988 well before the recession in 1990 while in Los Angeles the real estate market started worsening in 1989 before the start of the recession in 1990.

If the housing market turned down before the economy, it is un-likely that the slowing economy caused a depressed housing market. What Randy H said "...jobs and the housing market form a reflexive system..." may be true the causation may be in the other direction. Or another factor, say "animal spirits" for lack of a better term may cause buyers to be less optimistic about purchasing a home driving down prices. Homeowners, who subsequently feel less wealthy because of declining values of their biggest asset, may reduce spending causing a recession.

Will someone who remembers the 1980s explain which came first, the downturn in housing or the worsening in the economy?

Gavin

Two tech salaries combined (200k+) should enable a young family to get a reasonable townhouse with a comfortable mortgage, assuming with 10% - 20% down-payment.

Well, if an apartment in London can be sold for nearly $200M... Bay Area is not that over-rated yet.

"I see a revolving door of docs come and go constantly."

I see this with a lot of our young doctors. One of our doctors left and became a realtor. LOL

Food in London leaves a lot to be desired for.

I know of a Web 2.0 company just got their series A but some of the engineers are already leaving because their business model is so flawed, the VC just wanted to round out their portfolio.

Regarding the dot com cleansing of incompetent people, it goes both ways, I see many managers went to director/VP level easily during that time, some of them never got purged because of politics, the result is some very poorly managed departments.

The Mercury News used to run a lot of stories about laid off tech workers after the bust, funny if you read the story closely those people never really had a tech related job before. My favorite one is a lady who lamented that she was laid off and could not afford to buy an ibook for her daughter, I guess her HELOC was maxed out.

One kid I interviewed during the boom had a stamp on his hand (from going to clubs), I was hoping he at least tried to wash it off if he was serious about the job, and he said he had 3 interviews that day :)

Small Rant: The ER situation in the Bay Area is ridiculous. A friend of mine got really sick at 4am on a Wednesday and was told by an ER over the phone that all of them were on “divert”

eburbed,

A few points on this matter. The ER "divert" situation is common in most cities. Where I trained (Boston), there are literally 5 great, large hospitals with large ERs, and we regularly went "on divert" every few days. The issue is more complicated. There are a vast number of uninsured out there, and the ER is there "primary care doctor." This takes up time and resources. The closing of ERs is a problem too, and hospitals have no incentive whatsover to expand ERs, as they are money-losing propositions. Peter P's idea to charge more is untenable, since reimbursement is completely tied to Medicare standards (set by the government), and these guideline charges are being reduced every year.

The situation is a slow-motion disaster (much like the housing mess).

I believe mortgage rates are a greater factor than jobs in terms of bringing down home prices in the Bay Area. To see prices fall due to job loss, I think we would have to experience dot com bust part two in the near future. I just do not sense that level of sudden, palpable job loss in our near future in this area. Does anyone here believe we'll see that kind of job loss rate soon?

On the other hand, if the Fed raised the prime even a 1/4 pct., the ripple effect on RE is immediate. While a mortgage payment suddenly increases 10 to x%, most people do not experience a similar, sudden increase in their income, even if they have a 'good' job.

Add to that scenario the ARMs which will reset beginning this year and next.

I have no idea how likely it is that the Fed will raise the prime, but I think it is a more likely scenario than dot com bust part two. ARM resets are a given but there too, it cannot be known a priori how many borrowers in that category indeed stretched themselves to a point at which a fractional change in their rate puts that 'For Sale' sign up. Furthermore, a rate adjustment in and of itself does not necessarily mean a lowering of home prices. What lowers the price of homes is a supply which is much greater than the demand, coupled with other factors such as the direction in which the prime rate is heading and job confidence.

I work for a small, private software consulting firm. We have more work than we can handle. Somebody here said the key to riding out the bust/booms of Bay Area employment is to have a genuine, marketable skill set. I think our company falls into that category. I don't have anxiety about our outlook for '07 or '08. Beyond that, my crystal ball gets fogged over.

Excellent topic choice btw.

eburbed said :
I wouldn’t want to wait 2 weeks to go to the ER.

Wimp!

I work in IT for a healthcare provider and I agree 100% with Shabba. It's almost impossible to attract people from out of state, because there is just no way we can compensate someone for the cost of living differential, meaning housing. Unlike Google or web 2.0 start-ups in Silly Valley, a company like mine has no stock options to use to lure workers. All we can afford to do is pay decent wages and benefits (as Shabba said, not great --just comparable to IT salaries in any other state).

While you can still rent in CA fairly cheaply, most people from other states are accustomed to owning and are *not happy* to settle for becoming renters again --the old cultural pro-ownership bias again. Btw, I use the term "cheaply" in the relative sense. Rents here are only "cheap" compared to purchasing costs, but not "cheap" at all compared to renting in other states (and what you get for the money).

Prognosis for healthcare industry: cloudy. Hiring is a bit looser than it was a couple years ago, when it was very tight. However, healthcare costs are rising much faster than inflation --even 'true' non-hedonically adjusted inflation. At some point something has to give, which probably means more cost-cutting (i.e, layoffs) for the industry.

By the way, I've worked in IT for ten years now for a number of different outfits, and I can tell you that not *every* IT worker is a mouth-breathing idiot or youngster making 2 HaHas/year. I know there were a lot of real-life stories of 20-something dot.com millionaires in the late 90s, and there were a fair amount of mouth-breather types who got into lower-rung jobs they weren't qualified for. That said, I think some of the comments I've seen here grossly exaggerate the magnitude of both trends. The 'house-cleaning' that's gone on in the IT industry in recent years is good thing, I agree --cleans out the dead wood and leaves a core of good, qualified people. But to say that the entire IT industry here is/was populated by Ferrari-driving, supermodel-dating Gen-Y'rs or mouth-breathing former burger-flippers is just ludicrous. Either that, or all the companies I've worked for have been far more conservative than average.

There are a vast number of uninsured out there, and the ER is there “primary care doctor.” This takes up time and resources.

Can't hospitals charge a $100 cover-fee for non-critical cases?

Peter P

$100 is a rounding error.

$100 is a rounding error.

Just to deter ER abuses?

Two tech salaries combined (200k+) should enable a young family to get a reasonable townhouse with a comfortable mortgage, assuming with 10% - 20% down-payment.

That's sort of impossible - if everyone makes $200k, by definition the bar would have to be higher.

Where I trained (Boston), there are literally 5 great, large hospitals with large ERs, and we regularly went “on divert” every few days. The issue is more complicated.

Thanks for the clarification. I thought this was BA specific - guess not.

There was recently someone on NPR who talked about how our health care system is the next major catastrophe - and that if we fixed it, we'd be a lot more ready for the next terrorism attack as well as a bonus.

Too bad we spent it on hospitals in Iraq.

As for Peter P's idea, in NYC, I believe they call it "Wallet Triage" - where ambos from private hospitals SUPPOSEDLY check to see if you have health insurance. If you do, they take you to their hospital. If you don't they take you to a public hospital. Regardless of distance. SUPPOSEDLY.

There are a vast number of uninsured out there, and the ER is their “primary care doctor.” This takes up time and resources. The closing of ERs is a problem too, and hospitals have no incentive whatsover to expand ERs, as they are money-losing propositions. Peter P’s idea to charge more is untenable, since reimbursement is completely tied to Medicare standards (set by the government), and these guideline charges are being reduced every year.

The situation is a slow-motion disaster (much like the housing mess).

I agree - and this topic really deserves its thread to do it justice. Let's also not forget the elephant in the waiting room: millions of uninsured illegal aliens. Does anyone out there, liberal, conservative or moderate, honestly believe the ER situation out there would be as bad as it is today (esp. in major border/gateway states like CA) if the illegal population had not exploded over the last 20 years?

danville woman and lunarpark,

My take on the doctor hiring issue is this: MDs are perhaps the one profession where job opportunity and salaries are hardly dictated by geography. What I mean is that tech workers, IBankers, lawyers (at large law firms wanting big bucks) have to work at hubs of technology, commerce, and again commerce or government, respectively. Doctors are needed everywhere (obviously), and the compensation doesn't get better in big cities. If anything, it's worse because of supply and demand - more docs want to live in cities, there's a relative oversupply, and rural practices have to offer more to hire docs. Nowhere, except maybe NYC, is this contrast magnified more than in the Bay Area. As a result, it is difficult to hire MDs in the specialties at the low-end of the pay scale - primary care docs, pediatricians and the like. There seem to be plenty of plastic surgeons, orthopedists, dermatologists etc here, on the other hand.

As for Peter P’s idea, in NYC, I believe they call it “Wallet Triage” - where ambos from private hospitals SUPPOSEDLY check to see if you have health insurance. If you do, they take you to their hospital. If you don’t they take you to a public hospital. Regardless of distance. SUPPOSEDLY.

I think you're thinking of the "wallet biopsy."

It is very simple. Those who oppose universal health care need to be comfortable with the reality that we MUST REFUSE CARE to at least some uninsured patients in non-life-threatening cases.

If we do not want to pay up, we cannot afford to be generous. Money does not grow on trees.

Though money can be printed by the Federal Reserve. But we all know that newly created liquidity only applies to home and/or home-related (plasma, SVU, etc) purchases.

Peter P,

In the PRC, denying any care to uninsured documentation-challenged pre-unionized guest workers is racist. If you do not wish to volunteer a goodly portion of your salary to these 'victims', then you must be considered both racist and selfish. Oh, and I completely agree about the trees --trees are for hugging.

--peace out

skibum - I agree.

We have a good number of orthopedic surgeons, but our caseload seems to be down in this area. Orthopedics are important to our business, as they are some of the best paying cases (on the insurance side of things).

I think you’re thinking of the “wallet biopsy.”

Maybe that's the Bahston term. :)

Both terms show up on the web - so we're both right. :)

In the PRC, denying any care to uninsured documentation-challenged pre-unionized guest workers is racist.

Did you mean DPRK (Democratic People's Republic of Kalifornistan)?

If you do not wish to volunteer a goodly portion of your salary to these ‘victims’, then you must be considered both racist and selfish.

I disagree. It is considered fine for someone not to volunteer money so long as someone else is taxed for the same cause.

Peter P,

Thanks for the correction --DPRK it is!
Did I really need to use the [saracsm on /off] tags, or was the tone obvious enough?

HARM, when sarcasm is the reality, tags are no longer needed.

"Two tech salaries combined (200k+) should enable a young family to get a reasonable townhouse with a comfortable mortgage, assuming with 10% - 20% down-payment."

You wont find that many women making that kind of cash. Second, marriage leads to kids (1 or 2, and as many as 3).
And then they become stay at home moms.
I seen way too much of this.

I know of a Web 2.0 company

Does anyone have any insight into KNOWNOW !!

You wont find that many women making that kind of cash.

Many wives earn more than their respective husbands. At least several people on this blog can attest to that.

Did you mean DPRK (Democratic People’s Republic of Kalifornistan)?

VELLLY NICE!

Does anyone out there, liberal, conservative or moderate, honestly believe the ER situation out there would be as bad as it is today (esp. in major border/gateway states like CA) if the illegal population had not exploded over the last 20 years?

Wouldn't that be easy to figure out? We just need to find a state that has few illegal immigrants and see what their ER situation is like.

Although I guess North Dakota/Montana aren't really urbanized either. Hm. Does Boston have a high illegal immigrant population?

Besides Google and Yahoo, can anyone name tech companies that treat their employees well?

It depends on what you mean by well.

Well as in comp?
Well as in free stuff?
Well as in cool culture?

You can't always have all of them.

FWIW, I've heard very very mixed stories from Apple. Real highs. Real lows.

If anything, it’s worse because of supply and demand - more docs want to live in cities, there’s a relative oversupply, and rural practices have to offer more to hire docs.

I hear that in a lot of rural areas, they depend on H1B visas to have doctors. Because American citizen doctors won't work there because the pay is too low and it suxors.

Classic. :)

Does Boston have a high illegal immigrant population?

Why, of course! They are generally Brazilian, Dominican, or Haitian, or Irish. (It's Boston, after all!)

I hear that in a lot of rural areas, they depend on H1B visas to have doctors. Because American citizen doctors won’t work there because the pay is too low and it suxors.

Again, it's a bit more complicated. The "traditional" path of the FMG (foreign medical grad) is the J1 visa, which requires time spent in an "underserved" area of the US (usually rural). There are more and more FMGs who are applying for and getting H1B visas, which have no such requirement. Maybe that's changing with all the news about the shortage of H1Bs.

The pay is generally better in these rural locations, although there is variation.

The company I work for makes things that go boom and things that track things that go boom. Business is good.