Speaker 1: You're listening to the Bloomberg Opinion podcast count US Saturdays
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Speaker 2: Welcome to Bloomberg Opinion. I'm Amy Morris. This week we'll
Speaker 2: look at the medical profession and why so many people
Speaker 2: are leaving. First, we take a look at the US
Speaker 2: nursing shortage and how an untapped resource could help relieve
Speaker 2: some pressure within the nursing industry. Then we'll shift to
Speaker 2: the doctor shortage in the UK. Why they're leaving the
Speaker 2: profession or at least leaving the country to practice elsewhere.
Speaker 2: Why is it so hard to be a doctor in
Speaker 2: the United Kingdom? Speaking of leaving your profession, we'll also
Speaker 2: look at the promise or the threat of AI and
Speaker 2: how unemployment insurance needs a huge do over if it's
Speaker 2: going to be prepared for the potential upcoming labor market disruption.
Speaker 2: But first, let's let's begin with the airline industry and
Speaker 2: consolidation deals gone unchecked for too long. Attorney General Merrick
Speaker 2: Garland himself spoke to the proposed merger between Spirit and
Speaker 2: Jet Blue.
Speaker 3: Our complaint alleges that Jet blues proposed three point eight
Speaker 3: billion dollar acquisition of Spirit violate Section seven of the
Speaker 3: Clayton Act. We allege that, if allowed to proceed, this
Speaker 3: merger will limit choices and drive up ticket prices for
Speaker 3: passengers across the country.
Speaker 2: Meanwhile, a judge has since ruled in favor of the
Speaker 2: Justice Department's efforts to unwind a deal between Jet Blue
Speaker 2: and American allowing the airlines to book each other's flights
Speaker 2: and link their reward programs, saying that it removed the
Speaker 2: incentive to be competitive and could lead to higher fares.
Speaker 2: But is this too little, too late? Brook Sutherland is
Speaker 2: a Bloomberg opinion columnist covering deals and industrial companies, and
Speaker 2: she joins us now, Brook, it is a pleasure. Thank
Speaker 2: you so much for taking the time with us today. First,
Speaker 2: let's just get down to the heat of the meat.
Speaker 2: How disciplined is airline antitrust scrutiny in the US?
Speaker 4: Well, historically not very disciplined. You know, there were a
Speaker 4: number of large murders in the industry, many of which
Speaker 4: were driven by bankruptcies. To be fair, and the thinking was,
Speaker 4: you know that by combining the airlines that you could
Speaker 4: strengthen the overall infrastructure, which was not a bad thought,
Speaker 4: but you did have a series of deals that led
Speaker 4: to a very highly consolidated industry. And the most recent
Speaker 4: large deal that happened was the combination of US Airways
Speaker 4: and the parent company of American Airlines AMR, which was bankrupt,
Speaker 4: and the Justice Department put up a bit of a
Speaker 4: fight of over that deal in twenty thirteen, but ultimately
Speaker 4: settled and allowed the transaction to proceed. Now we're seeing
Speaker 4: a very different stance, particularly from the Biden administration on
Speaker 4: antitrust overall, but particularly as it relates to airlines. And
Speaker 4: so JetBlue is really at the center of the latest push,
Speaker 4: and we'reing they had a marketing alliance with American Airlines
Speaker 4: that the Trump administration's Transportation Department actually allowed to proceed,
Speaker 4: but the Biden administration's Justice Department later came in ensued
Speaker 4: and said, actually the steal is anti competitive. A judge
Speaker 4: just ruled in the favor of the Justice Department. But
Speaker 4: Jet Blew is simultaneously also trying to buy Spirit Airlines,
Speaker 4: which the Justice Department is also taking issue with.
Speaker 2: Okay, so why now Why are they starting to pay
Speaker 2: attention now? Is it strictly who's in the White House
Speaker 2: or who has the majority on Capitol Hill? Is it
Speaker 2: all political or is there something more to it.
Speaker 4: I think that's part of it. I think it's also
Speaker 4: worth remembering the very extreme measures that the government went
Speaker 4: to to support the airline industry during the pandemic. The
Speaker 4: airlines got a lot of special dispensation that other industries
Speaker 4: that were hard hit by COVID did not get, and
Speaker 4: specifically in terms of payroll support, but also you know,
Speaker 4: there were loans made available to the airlines and also
Speaker 4: to the airspace manufacturers, although that industry didn't take the funds.
Speaker 4: And I think there's some expectation that, you know, the
Speaker 4: degree to which the tax payer propped up airline infrastructure,
Speaker 4: we would like to see a little bit better service.
Speaker 4: We would like to see this industry focus more on
Speaker 4: how it actually serves the customer. And I think that's
Speaker 4: raised some questions about airline habits that we've all long
Speaker 4: griped about but just sort of accepted as the status closed,
Speaker 4: things like families not being seated together, change fees, and
Speaker 4: you know, I think that's really focused a lot of
Speaker 4: attention on the airline industry's practices.
Speaker 2: That's what I wanted to get into when you were
Speaker 2: talking about where the focus should be. Are these the
Speaker 2: types of deals they need to be focusing on the
Speaker 2: Jet Blue and Spirit merger.
Speaker 4: I mean, it's it's difficult to sit here with the
Speaker 4: benefit of twenty twenty hindsight. But you know, the reason
Speaker 4: why that Jet Blue was pursuing this alliance with American
Speaker 4: Airlines and the takeover Spirit Airlines is that it feels
Speaker 4: like not just the airline industry, but the overall aerospace
Speaker 4: sector is so consolidated that the only way that it
Speaker 4: can really compete is by doing these transactions. And what
Speaker 4: I mean by that is that, you know, it struggles
Speaker 4: to compete with the likes of Delta and United, which
Speaker 4: you know, have a lot of airplanes, have a lot
Speaker 4: of market share, but it also can't get the plane
Speaker 4: that it wants to grow because we have very deep
Speaker 4: rooted supply chain issues in the aerospace manufacturing industry, which
Speaker 4: by the way, is also very consolidated, where we have
Speaker 4: a duopoly essentially for large aircraft, basically a duopoly for
Speaker 4: airplane engines. You know, we now have two major aircraft lessers.
Speaker 4: I think that the overall system is maybe the root
Speaker 4: of the problem, not just these specific deals, but the
Speaker 4: anti trust regulators are doing what they can to chip
Speaker 4: away what they see as an overly consolidated sector.
Speaker 2: So what will this mean then for future deals? Is
Speaker 2: this new found attention going to put a damper on those?
Speaker 4: I think, in my opinion, this Jet Blue takeover Spirit
Speaker 4: was sort of the last possible deal that could be done.
Speaker 4: And if you remember, there's actually a fight over this asset.
Speaker 4: Spirit originally had a deal with Frontier that would have
Speaker 4: combined the two ultra low cost airlines, and then Jet
Speaker 4: Blue came in and tried to buy Spirit and ultimately
Speaker 4: won the right to do so. But you know, I
Speaker 4: don't know what other major consolidation could happen antitrust being
Speaker 4: one big reason for that, and also just sheer scale
Speaker 4: of the bigger players that are involved here. And so
Speaker 4: this was really sort of the last big deal, and
Speaker 4: I think that's why you're seeing Jet Blue compete so
Speaker 4: aggressively for it.
Speaker 2: I wondered about the engine makers and the manufacturers and
Speaker 2: how this all extended beyond the airlines and to the customer.
Speaker 2: As you said, summer is here. Everybody is chomping at
Speaker 2: the bit to get out of the house and to travel.
Speaker 2: I mean, what's the like.
Speaker 4: You know, the airlines are trying really hard to invest
Speaker 4: in resilience, and they have repeatedly actually dialed back their
Speaker 4: capacity plans over the course of last year as it
Speaker 4: became clear that they were just did not have the
Speaker 4: resources that they needed to meet all this demand. But
Speaker 4: also this year they're really trying to be more disciplined,
Speaker 4: and that means offering fewer seats. Of course, the flip
Speaker 4: side of that for the consumer is that when there's
Speaker 4: fewer seats to be had, you end up paying more
Speaker 4: for the right to fly on a plane. But the
Speaker 4: airlines are doing what they can. I just think that
Speaker 4: it's a system issue as well, and we're not really
Speaker 4: seeing any kind of breakthrough in the logjam on the
Speaker 4: air States supply side. And you know, these airlines would
Speaker 4: like to get more planes, they would like to fly
Speaker 4: more and really capitalize on this demand, and you just
Speaker 4: really can't. And one interesting side effect of that has
Speaker 4: been that it's actually completely jammed up the business model
Speaker 4: of the low cost carriers. You think of that as
Speaker 4: you know, typically being a business model built on nickel
Speaker 4: and diming customers, but it's also built on growth, and
Speaker 4: the way that it works is that they outgrow the
Speaker 4: increase in their cost. Well, you can't do that if
Speaker 4: you can't get airplanes. And there's also a shortage of pilots,
Speaker 4: and you have the big airlines competing very aggressively to
Speaker 4: hire those pilots and willing to pay what they need
Speaker 4: to to attract that talent. And so, you know, I
Speaker 4: hope that it's better than last year in terms of
Speaker 4: the travel experience, but I am nervous that it won't be.
Speaker 2: I'm really curious where this may wind up, what the
Speaker 2: endgame is, because I understand that consolidation may be seen
Speaker 2: as the boogeyman at this point, even though the consolidation
Speaker 2: has been going on for so long. Just basically from
Speaker 2: what you've educated me with, it looks like it's been
Speaker 2: going on for so long that stopping one small deal
Speaker 2: here or one medium sized deal there is not really
Speaker 2: the answer what can be done at this point.
Speaker 4: I mean, I think that's sort of the issue, is
Speaker 4: that you know, you can't really go back and do
Speaker 4: all of these other deals at this point. I mean,
Speaker 4: it would be a complete mess to try to unravel
Speaker 4: the degree of consolidation that's taken place up and down
Speaker 4: this supply chain. And so I think the argument from
Speaker 4: the side of the anti trust regulators is, well, you
Speaker 4: have to start somewhere. But I think to your point,
Speaker 4: as an airline consumer, I don't know that this is
Speaker 4: necessarily going to change what you experience when you go
Speaker 4: to the airport, And you know, I think it sort
Speaker 4: of begs deeper questions of just what exactly anti trust
Speaker 4: regulators want to be. You know, I think it's very
Speaker 4: interesting that in another highly consolidated industry, the railroad industry,
Speaker 4: we had a big deal that did get approved. Now
Speaker 4: it's a separate regulator that is independent from the Justice
Speaker 4: Department and the Biden administration, but they decided that because
Speaker 4: that industry is so consolidated, the only way to allow
Speaker 4: new competition is by letting these smallest players combine. Well,
Speaker 4: that's exactly the argument that JetBlue is making here that
Speaker 4: for them to be able to really take on the
Speaker 4: big airl lines and introduce new routes offer customers better
Speaker 4: options that are pricing, they need more scale. So it's
Speaker 4: an argument that's resonating in one camp of the regulatory
Speaker 4: regime and not in another.
Speaker 2: Is there any red flag or any milestone that you
Speaker 2: are looking for in the next quarter, Perhaps that may
Speaker 2: be coming up. That's happening with the airline industry.
Speaker 4: I think we're going to be looking to see what
Speaker 4: American Airlines and Jet Blue do with this decision they're
Speaker 4: ruling by the district judge against their alliance. They do
Speaker 4: have an opportunity to appeal, and it will be interesting
Speaker 4: to see if they take that. It's worth noting that
Speaker 4: this partnership has been in existence for basically two years now,
Speaker 4: so it is not an insignificant task to try to
Speaker 4: unravel this, and they have invested a lot in setting
Speaker 4: this up. And then the next thing to watch is
Speaker 4: what happens, you know, as far as the Justice departments
Speaker 4: challenge to the Jet Blue Spirit deal.
Speaker 2: All right, Brooke, thank you so much for taking the
Speaker 2: time with us. We appreciate it. Brooks Sutherland is a
Speaker 2: Bloomberg opinion columnist covering deals and industrial companies, and coming up,
Speaker 2: we'll look at the nursing shortage the US and one
Speaker 2: idea that just might help. You're listening to Bloomberg Opinion.
Speaker 1: You're listening to the Bloomberg Opinion podcast. Catch us Saturdays
Speaker 1: at one and seven pm Eastern on Bloomberg dot Com,
Speaker 1: the iHeartRadio app, and the Bloomberg Business App, or listen
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Speaker 2: You're listening to Bloomberg Opinion. I'm Amy Morris, and we're
Speaker 2: taking a look at two pressing issues for the United
Speaker 2: States and how they might be able to connect for
Speaker 2: the greater good. The US nursing workforce is losing good workers.
Speaker 2: One hundred thousand workers have quit or retired during the pandemic.
Speaker 2: Another eight hundred thousand have signaled an intent to leave
Speaker 2: within the next four years. But there is a pool
Speaker 2: of healthcare workers that remains untapped. Immigrants. New York Governor
Speaker 2: Kathy Hochel is calling on the federal government to expedite
Speaker 2: work visas forms awaiting asylum cases to be processed. They're
Speaker 2: eager to work, they want to work.
Speaker 5: They came here in search of work and a new future, and.
Speaker 6: They can become part of our economy and part of
Speaker 6: our communities.
Speaker 2: New York Governor Kathy Hokel. Now, let's get more details
Speaker 2: on this from Bloomberg opinion editor Rachel Rosenthal. She is
Speaker 2: also a member of the editorial board covering healthcare. Rachel,
Speaker 2: it's a pleasure. Thank you for taking the time with
Speaker 2: me today, and let's talk about those numbers. One hundred
Speaker 2: thousand leaving the profession, another eight hundred thousand talking about Yeah,
Speaker 2: I'm probably gonna leave too. Give us some perspective about
Speaker 2: what that means and what would that illustrate to you.
Speaker 5: You know, I think this has been an ongoing issue
Speaker 5: for decades. The nursing workforce has been in a shortage
Speaker 5: really since the beginning of time. You know, it's this
Speaker 5: is one of the few professions that the Labor Department
Speaker 5: has signaled that is in a perpetual shortage, and that
Speaker 5: hasn't changed. So what we're seeing right now is sort
Speaker 5: of the confluence of lots of factors. You know, we
Speaker 5: had the pandemic, and then we had several rounds of
Speaker 5: flu and RSV, and you know, while the rest of
Speaker 5: the world moved on, the healthcare workforce was left to
Speaker 5: pick up the pieces, and so they're still living in
Speaker 5: a workforce and a reality that's been hollowed out by
Speaker 5: the pandemic. So a lot of what we saw during
Speaker 5: the pandemic is a lot of older workers quit or
Speaker 5: retired early, fearful of getting sick. They have not come
Speaker 5: back yet in mass numbers, you know. And then we're
Speaker 5: also seeing on the other end, younger workers getting you know,
Speaker 5: really stressed by the new and onerous working conditions, you know,
Speaker 5: ratios of patients that they are not equipped to handle.
Speaker 5: So they're just fleeing the nursing the nursing workforce, and
Speaker 5: so what we're seeing is increased demand for services and
Speaker 5: a workforce that isn't really equipped to handle it.
Speaker 2: What is the history of immigrants within the US healthcare system?
Speaker 2: You write about this in your column on the Bloomberg terminal,
Speaker 2: and it's a connection that I had never made before.
Speaker 5: There's a long history of immigrants coming into the US,
Speaker 5: starting back actually in the early twentieth century, even before
Speaker 5: the US had a very strong relationship with the Philippines,
Speaker 5: after you know, the Spanish American War, and you know,
Speaker 5: I think there was this what ended up happening was
Speaker 5: US you know, military who was in the Philippines were
Speaker 5: they were developing these nursing schools, and so a lot
Speaker 5: of Filipino nurses would be sent to the US for training,
Speaker 5: and it sort of snowballed from there. The first nursing
Speaker 5: visa is actually in nineteen fifty two, and then it
Speaker 5: has evolved since. But what I think has happened is
Speaker 5: instead of having a specific visa for healthcare workers, there's
Speaker 5: been union objections to and various other hurdles to having
Speaker 5: it just a healthcare specific visa. So what ended up
Speaker 5: happening was healthcare workers are reliant on the overall employment
Speaker 5: based immigration category and so they're kind of, you know,
Speaker 5: in there alongside other folks who are in the backlog.
Speaker 5: And what we found is that, you know, the majority
Speaker 5: of the immigrants who end up having ability to work
Speaker 5: in the US are recipients of green cards as opposed
Speaker 5: to work visas.
Speaker 2: Yeah, I want to dig into that a little bit
Speaker 2: more because you talk about it in depth in your
Speaker 2: column how the green card system is impacting this and
Speaker 2: it's not always in a good way.
Speaker 5: Right. So there's a top of one hundred and forty
Speaker 5: thousand employment based green cards, and that has been unchanged
Speaker 5: since nineteen ninety. Obviously, the workforce has grown since then,
Speaker 5: our healthcare needs have changed since since then, so there's
Speaker 5: a reasonable argument to raise that number now, as we
Speaker 5: know immigrationses on immigration, we've gotten close several occasions in
Speaker 5: the past decades, but it's been extraordinarily difficult, and there
Speaker 5: are folks who raise legitimate concerns about how an influx
Speaker 5: of immigrants can affect wages and working conditions. But I
Speaker 5: think what's needed is a more flexible number that can
Speaker 5: reflect our demands.
Speaker 2: Part of the equation is the health of the American people.
Speaker 2: We are older, we are fatter, We are simply not
Speaker 2: as healthy as we could be or should be. We
Speaker 2: need more nurses, and that doesn't really even factor in COVID.
Speaker 2: We were just talking earlier this week about the aging population.
Speaker 2: The number of people over the age of sixty five
Speaker 2: has skyrocketed in the past ten years, and the nurses
Speaker 2: are not there for them.
Speaker 5: Yeah, I think you know it's immigration is not the
Speaker 5: only answer, you know. One of the astonishing things that
Speaker 5: I found throughout my research, and I've written on this previously,
Speaker 5: are just the fact that you have folks who want
Speaker 5: to go to nursing school and become nurses, and yet
Speaker 5: nursing schools are not equipped to handle that demand. So
Speaker 5: they don't have the faculty, they don't have the clinical
Speaker 5: training sites, and so about ninety thousand qualified applications are
Speaker 5: turned away each year. So we've got domestic problems as well.
Speaker 5: What I think where I think immigrants can fit in is,
Speaker 5: you know, if they have they're already trained, they have
Speaker 5: foreign qualifications. I'm not saying they could you know, necessarily
Speaker 5: be ready to go on day one, but theoretically, you know,
Speaker 5: if they recredential take the appropriate licensing exams, they should
Speaker 5: be qualified to work in the US. So those are
Speaker 5: folks who might be outside the US right now. There
Speaker 5: are also a lot of folks who've come to the
Speaker 5: US or already here from you know, from existing Green card,
Speaker 5: family based and are just working below their potential. Maybe
Speaker 5: they're working as an assistant or a made or even
Speaker 5: in domestic help and they were a nurse previously, and
Speaker 5: they just they are not in the workforce right now
Speaker 5: because they haven't maybe there's a language barrier, and they
Speaker 5: haven't been able to take the appropriate licensing exams. So
Speaker 5: there are there's a whole the nursing workforce. There's a
Speaker 5: really big range for you know, of skill levels that
Speaker 5: are needed. And so I think there's folks who are
Speaker 5: on the sidelines who could probably step in if they
Speaker 5: have the appropriate, expedited pathways to recredential and to get
Speaker 5: into the US workforce.
Speaker 2: Other than having to jump through hoops of fire to
Speaker 2: get into the healthcare workforce, which would apply to many
Speaker 2: people across the board. Did you find in your research
Speaker 2: that there is a resistance specifically to skilled foreign workers
Speaker 2: in the US.
Speaker 5: I think there's always a degree of anxiety about foreign workers.
Speaker 5: I think, you know, there's you know, cultural barriers, there's
Speaker 5: some degree of xenophobia in certain pockets, and there are
Speaker 5: legitimate concerns about how that effect you know, when you
Speaker 5: increase the supply of workers, what does that impact have
Speaker 5: on wages? However, I think in this case, we really
Speaker 5: need bodies in the workforce. And you know, what we
Speaker 5: saw during COVID was, you know, hospitals that were desperate
Speaker 5: for workers were turning to contract nurses who are just
Speaker 5: exorbitantly expensive, you know, and a huge proportion of hospitals
Speaker 5: costs were going to labor. They always have, but it's
Speaker 5: just skyrocket and now some hospitals could afford it, a
Speaker 5: lot of hospitals couldn't. And so what was ended up
Speaker 5: happening is you had this really vicious cycle where folks
Speaker 5: were leaving, so you know, these hospitals became more reliant
Speaker 5: on this more expensive pool of labor, and like the
Speaker 5: dynamics just got really out of wack. I think for
Speaker 5: the more stable salaried workforce, it was very destabilizing.
Speaker 2: So bottom line, immigration reform could theoretically help alleviate the
Speaker 2: nursing crisis. In addition to finding ways to streamline to
Speaker 2: allow people to get into nursing school people who do want.
Speaker 5: To contribute, there needs to be fixes on the domestic side.
Speaker 5: There need to be fixes to immigration policy. These things
Speaker 5: together can help restore a workforce that has been hollowed
Speaker 5: out by the pandemic.
Speaker 2: Bloomberg Opinion editor Rachel Rosenthal also covers healthcare and speaking
Speaker 2: of healthcare, why the UK may be a terrible place
Speaker 2: to be a doctor. We'll talk about that just ahead.
Speaker 2: But don't forget. We're also available as a podcast on Apple, Spotify,
Speaker 2: or your favorite podcast platform. This is Bloomberg Opinion.
Speaker 1: You're listening to the Bloomberg Opinion podcast. Catch us Saturdays
Speaker 1: at one and seven pm Eastern on Bloomberg dot Com.
Speaker 1: The iHeartRadio app and the Bloomberg Business app, or listen
Speaker 1: on demand wherever you get your podcasts.
Speaker 2: This is Bloomberg Opinion, I may Mee Morris. The UK
Speaker 2: is exp eperiencing a physician shortage. While the whole world
Speaker 2: is going through something of a healthcare crunch. We're all
Speaker 2: aging and there is increased demand. The UK is experiencing
Speaker 2: something even more intense. We welcome Terrees. Ralphael Therees is
Speaker 2: a columnist for Bloomberg Opinion covering healthcare and British politics,
Speaker 2: and she's going to bring us up to speed on
Speaker 2: some of these issues. Let's just start with the doctor
Speaker 2: shortage in the UK. How does that compare to things
Speaker 2: that we've seen here in the US, like the shortage
Speaker 2: of nurses or the worldwide crunch in healthcare.
Speaker 6: Yeah, so you're absolutely right to draw comparisons, because there
Speaker 6: are shortages of doctors, particularly general practitioners in most advanced
Speaker 6: countries right now, in the US, France and Germany, even
Speaker 6: the Nordic countries, and that's part of a even broader
Speaker 6: shortage in healthcare generally. The UK, as I wrote in
Speaker 6: this piece, has got all of those problems on steroids
Speaker 6: because the National Health Service is a taxpayer funded service,
Speaker 6: free at the point of delivery, so all healthcare that
Speaker 6: isn't private, which is a growing share, but let's set
Speaker 6: that aside goes through the NHS, and they're around one
Speaker 6: hundred and twenty four thousand healthcare vacancies in England. Lots
Speaker 6: and lots of nursing radiographers, but at least nine thousand
Speaker 6: of these are doctors, and that probably understates the problem.
Speaker 6: So we know that by twenty thirty and estimated one
Speaker 6: in four GP posts are are going to be vacant.
Speaker 6: And there are a number of reasons for that that
Speaker 6: you know. One of them is the doctor workforce is aging.
Speaker 6: But I think the real crisis for the NHS is
Speaker 6: not just an aging workforce. So they can't train enough doctors,
Speaker 6: they can't recruit enough doctors, and many who are in
Speaker 6: the workforce are retiring or leaving early, or cutting back
Speaker 6: their hours or move took places like sunny Australia where
Speaker 6: they make more money.
Speaker 2: In your column on the Bloomberg Terminal, you explain how
Speaker 2: there are several factors you just itemized a few things
Speaker 2: just in that answer there that have impacted this and
Speaker 2: it's all seeming to happen all at once. What's the
Speaker 2: impact here? What are you seeing.
Speaker 6: Coming out of COVID. What we saw with the NHS
Speaker 6: was a massive backlag of cases, so everything from cancer
Speaker 6: screenings to hip replacements. That backlog is now seven point
Speaker 6: four million procedures. So it's just enormous. People are having
Speaker 6: to wait very long periods of time before they get treated.
Speaker 6: That's put a lot of pressure on doctors. We've seen
Speaker 6: burnout rates sore. But doctors and medical staff have already
Speaker 6: been through the COVID period, which was enormously stressful. They're
Speaker 6: already dealing with great staff shortages, and so what's happening
Speaker 6: is you're having all of those pressures from COVID now
Speaker 6: compounding with workforce shortages, and then on top of that,
Speaker 6: there are really serious retention issues to do with pay,
Speaker 6: to do with work conditions. And one of the things
Speaker 6: I focus on my piece is how that has filtered
Speaker 6: through to the situation for junior doctors. And these are
Speaker 6: doctors who qualify it's sort of in the first eight
Speaker 6: years eight nine years of qualification. They're a huge part
Speaker 6: of the workforce, or nearly half of all hospital doctors
Speaker 6: and their pay and conditions are really among you know,
Speaker 6: the most problematic, and so a lot of them are
Speaker 6: just leaving or they're not specializing. So you know, these
Speaker 6: are all building up to a whole set of pressures
Speaker 6: on the healthcare system. But really, what doctors tell me
Speaker 6: is that it is just a miserable time to be
Speaker 6: a doctor in Britain. I mean, you know, you can
Speaker 6: exempt some of the very senior doctors who's who have
Speaker 6: a lot of you know, flexibility and have accumulated income
Speaker 6: over the years, but for these young doctors, it's pretty tough.
Speaker 2: Was this a problem before COVID and the before time times?
Speaker 2: Was this starting to simmer to the surface and become
Speaker 2: an issue. Was it exacerbated by COVID?
Speaker 6: It was definitely exacerbated by COVID. I think one of
Speaker 6: the reasons that's the case is because the way the
Speaker 6: training system works in Britain, the senior doctors provide clinical
Speaker 6: training for junior doctors. So when they're in medical school.
Speaker 6: The medical school in Britain you do right out of
Speaker 6: high school, so you have five or six years of
Speaker 6: medical training and some of that is in hospital and
Speaker 6: clinical environments, and the senior doctors do the training. And
Speaker 6: because of the pressures of COVID, the backlog from COVID
Speaker 6: and the general workforce shortages, these senior doctors don't have
Speaker 6: the time, they don't have the energy, they're out of
Speaker 6: bandwidth to do the training. So the junior doctors are
Speaker 6: telling me, we go into the hospitals, we have nobody
Speaker 6: to learn from. The senior surgeons are too busy or
Speaker 6: they don't have time, and people have left, and the
Speaker 6: doctors say, we can't pass on the knowledge the junior doctors.
Speaker 6: Some of them are leaving, some of them are not
Speaker 6: choosing to specialize. So the system itself, which is relied
Speaker 6: on this community of older and younger workers working together,
Speaker 6: is breaking down. And that's that's what It's a deeply
Speaker 6: structural problem, and they're just no easy fixes, particularly with
Speaker 6: so many junior doctors going to places like Australia or
Speaker 6: New Zealand.
Speaker 2: And we are talking with Bloomberg Opinion columnists Terrees Raphael
Speaker 2: about why UK's doctors shortage has reached such a critical stage.
Speaker 2: You've mentioned a couple of times the doctors going not
Speaker 2: just to different neighborhoods, not just to different areas, but
Speaker 2: to entirely different countries. How are other countries taking note
Speaker 2: of this and responding?
Speaker 6: I think the medical workforce is going to be an
Speaker 6: increasingly global workforce and provided that regulations allow for doctors
Speaker 6: to move. So in the US it's quite hard for
Speaker 6: British doctor to move to the US to take certain exams,
Speaker 6: I guess. But Australia makes it very easy. They are
Speaker 6: recruiting aggressively. There are recruitment companies based in London that
Speaker 6: facilitate these transfers. They make it easier, they pay more,
Speaker 6: the conditions are better, there's more flexibility, the weather's nicer,
Speaker 6: let's base it. That is, I think puts an added
Speaker 6: pressure on the UK to say, what you know, it's
Speaker 6: not just a recruitment issue. They can't. They're expanding the
Speaker 6: medical school places a bit, but their limits to what they.
Speaker 2: Can do there.
Speaker 6: They're bringing in foreign doctors, huge numbers of foreign doctors,
Speaker 6: mainly from Southeast Asia, from Africa, but even that is
Speaker 6: not plugging the whole, but losing doctors to Australia and
Speaker 6: New Zealand. Some go to Canada summer into Europe, but
Speaker 6: mainly it's English speaking countries that allow them to transfer
Speaker 6: their qualifications easily and you know, provide better paying conditions.
Speaker 2: Could we see a time when there is such a
Speaker 2: critical doctor shortage that it would make even routine appointments
Speaker 2: near impossible.
Speaker 6: I mean, I think we're already seeing that in the UK.
Speaker 6: People who can afford private insurance tend to get it
Speaker 6: through their companies or or you know, with their savings.
Speaker 6: We're hearing increasingly and I senior doctors I've spoken to
Speaker 6: have said, you know, they're they're moving more to private practice,
Speaker 6: or some of them are cutting their NHS hours, which
Speaker 6: means less availability. So we're getting a two tier system. Still,
Speaker 6: the private sector is still much much smaller than the NHS,
Speaker 6: but it's growing. The NHS is having to itself rely
Speaker 6: on private providers for certain services, so I think they
Speaker 6: will have to find some structural changes. It will come
Speaker 6: with retaining the doctors they have. That is an absolute must,
Speaker 6: but there's not a lot of money in the exchequer.
Speaker 6: We're seeing Britain now being projected to potentially go into recession.
Speaker 6: So these are problems where one thing cascades into another
Speaker 6: and the solutions are not you know, there aren't quick fixes.
Speaker 6: They will probably need to some of the structural issues.
Speaker 6: But yes, it's already having an impact. It's hard to
Speaker 6: get doctor's appointments in Britain.
Speaker 2: Yeah, I wanted to ask what the answer would be
Speaker 2: in what the government's role would be, but it sounds
Speaker 2: like no matter what that is, this isn't something that's
Speaker 2: going to be fixed in months or even just a
Speaker 2: year or so.
Speaker 4: Now.
Speaker 6: I mean, there are some things they could do in
Speaker 6: quite short order that would make a difference. So the
Speaker 6: flexibility that the pay structures are quite rigid. They could
Speaker 6: improve the flexibility on pay. Could they could improve how
Speaker 6: these doctors are paid. These junior doctors are paid very little.
Speaker 6: They come out with enormous debt and it's a long
Speaker 6: period of time before they can really ramp up their income.
Speaker 6: They can make work conditions, you know, junior doctors telling
Speaker 6: me they have to pay for their scrubs, they have
Speaker 6: to pay to access the doctor's mess, they have to
Speaker 6: pay for parking. They don't have visibility on their schedules,
Speaker 6: so they don't know how much money they can afford
Speaker 6: to pay and rent. These things are you know, they're
Speaker 6: small things that add up and create stresses in their
Speaker 6: li and I think they can. It almost needs a
Speaker 6: private sector style corporate HR approach that says, we care
Speaker 6: about our workforce, we want them to be effective. What
Speaker 6: can we do to make their lives a little bit
Speaker 6: easier and that would help on the margins. And then
Speaker 6: they're bigger issues that need to be addressed to do
Speaker 6: with just the sustainability of the funding structure and what
Speaker 6: the NHS is.
Speaker 2: But yeah, tires, we're going to continue to follow this
Speaker 2: with you. Thank you so much for taking the time
Speaker 2: with us.
Speaker 6: Appreciate it great to speak to you. Amy.
Speaker 2: Bloomberg Opinion columnists Terrees Raphael covering healthcare and British politics.
Speaker 2: You're listening to Bloomberg Opinion. I'm Amy Morris. We've talked
Speaker 2: a lot here at Bloomberg about AI and its impact
Speaker 2: on industries across the board. It threatens or promises, depending
Speaker 2: on your point of view, to disrupt and transform the
Speaker 2: labor market from law firms to newsrooms, and that means
Speaker 2: unemployment insurance may also have to be refashioned. Bloomberg Opinion
Speaker 2: columnist Katherine Edwards joins us, Historically we have seen disrupts
Speaker 2: in the labor market before, has unemployment insurance been able
Speaker 2: to keep up.
Speaker 7: With this now, and honestly it started behind. Unemployment insurance
Speaker 7: was enacted on the federal level in nineteen thirty five,
Speaker 7: and by enacting on the federal level, I mean the
Speaker 7: federal government required states to create their own program, which
Speaker 7: is why we have this confederation of fifty three separate
Speaker 7: state and territory programs today. The first unemployment insurance program
Speaker 7: was enacted in Wisconsin in nineteen thirty two, but it
Speaker 7: was based on designs from the nineteen twenties, and what
Speaker 7: the designers decided was that the best way to prevent
Speaker 7: layoff and unemployment was to tax it. You make unemployment
Speaker 7: more expensive, and then employers are discouraged from sending people
Speaker 7: into unemployment and having quick layoffs. And so they created
Speaker 7: an experience rated tax where every time an employer lays
Speaker 7: someone off and that person claims unemployment, their tax goes up.
Speaker 7: This was meant to serve as a disincentive. They designed
Speaker 7: it off of workers compensation, where if a worker gets
Speaker 7: injured on the job, goes up, and this would make
Speaker 7: you prevent workers being injured and be more safe. And
Speaker 7: so they kind of took that logic of workers compensation,
Speaker 7: picked it up and applied it to unemployment. It didn't
Speaker 7: fit then, It certainly doesn't fit now.
Speaker 2: The way you're describing in it sounds like it has
Speaker 2: been historically this entire time, a reaction to what has
Speaker 2: already happened, and how do we plug the holes.
Speaker 7: It's never evolved to take into account almost anything we
Speaker 7: know about unemployment, even then, but particularly now, the nature
Speaker 7: of unemployment, the length of spells, the idea that a
Speaker 7: career could end, not that you could lose a job,
Speaker 7: but that you could lose a career as the market advances.
Speaker 7: It was never designed to think about these things, and
Speaker 7: it was never changed to take them into account. I mean,
Speaker 7: automation that has affected men has affected blue collar workers
Speaker 7: in manufacturing. Automation that has affected women has affected white
Speaker 7: collar workers in the office setting. Right, computers used to
Speaker 7: be women typists, Those were women. That type of automation
Speaker 7: it hasn't been even in terms of white collar blue collar,
Speaker 7: and it hasn't been even in terms of gender. And
Speaker 7: the labor market is cyclical, and so it's always going
Speaker 7: to be there's some new arrival, some new shock, where
Speaker 7: there's this new flavor of whatever tomorrow's recession or risk
Speaker 7: will bring. That's kind of the whole point of what's
Speaker 7: wrong with unemployment insurance is that not only has it
Speaker 7: not evolved, it doesn't really think about unemployment as something
Speaker 7: that cyclically arrives.
Speaker 2: Let's get to the bottom line of what your column
Speaker 2: was talking about then, because you were talking about some
Speaker 2: potential solutions. You mentioned triage and flexibility in how to
Speaker 2: engage that. Explain what you mean by that.
Speaker 7: I could describe unemployment insurance as one size fits all,
Speaker 7: but it's really one size fits few to none. Huh.
Speaker 7: If you are awarded unemployment insurance, it's a temporary benefit.
Speaker 7: It lasts a fixed number of weeks at a fixed
Speaker 7: dollar amount. Pandemic interruptions are very special changes to the
Speaker 7: program that all expired aside. But what we know about
Speaker 7: unemployment is that it is just really different based on
Speaker 7: who loses their job and how they lose their job. Right,
Speaker 7: someone who loses their job at twenty five and fifty
Speaker 7: five will have remarkably different unemployment experiences, and we know
Speaker 7: this ahead of time. Just like someone who loses their
Speaker 7: job when the unemployment rate is below four versus above
Speaker 7: ten will have really different labor market experiences. Unemployment insurance
Speaker 7: doesn't really take any of that into account. The idea
Speaker 7: for kind of how to approach this in the future
Speaker 7: is to build more flexibility into the program so that
Speaker 7: the benefit is more efficient and that it's tailored to
Speaker 7: the worker in the situation.
Speaker 2: Is this anywhere on anybody's radar at all?
Speaker 7: Well, unemployment insurance hasn't been reformed since nineteen thirty five,
Speaker 7: and it hasn't even really been maintained since the mid seventies.
Speaker 7: We only care about unemployment when the labor market is bad,
Speaker 7: So it's hard to say where momentum and policy interest
Speaker 7: would look like for unemployment because it's typically none.
Speaker 2: Catherwin Edwards is a Bloomberg Opinion columnist, a labor economist
Speaker 2: to end, an independent policy consultant, and that does it
Speaker 2: for this week's Bloomberg Opinion. We are produced by Eric Bolow,
Speaker 2: and you can find all of these columns on the
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