In Part 1, we talked about what it feels like to be a patient in the American healthcare system—the waiting, the billing nightmares, and the uncomfortable reality that healthcare in this country is a business first. But the patient experience is only half the story. To understand why things feel broken, you have to look at the decisions being made behind the scenes.
“Serving the Community”
Hospitals will grandstand that their mission is to “serve the community.” However, I was always told it’s important to watch what someone does, not what they say.
When a hospital looks at its staffing ratios and determines they could cut their labor force by 15%, increasing patient-to-staff ratios and causing staff burnout and turnover—is that service to the community? When a hospital decides that high-quality meals aren’t the focus and it’s cheaper to buy from Sysco to service their cafeteria—is that service to the community? When every executive gets a bonus after saving the hospital millions of dollars by switching to a lower-quality health insurance plan for their own workers—is that service to the community?
Healthcare is a business, and everything is a line item. Make no mistake, you should receive care—but knowing that the care may come with risks driven by cost-cutting is definitely not something people should have to think about. Yet here we are.
What Workers See That Patients Don’t
When you’re a patient, you see your room, your nurse, maybe a doctor for a few minutes, and whatever’s on the whiteboard by your bed. What you don’t see is the nurse covering twice the patients they should be, the tech working with equipment that should have been replaced years ago, or the break room full of travelers because the hospital can’t retain its own permanent staff.
High traveler ratios on a unit aren’t a red flag by themselves—travel nurses and allied health workers are some of the most adaptable professionals in the industry. But when a hospital is relying on them to fill the majority of its positions, that tells you something about the work environment. People aren’t staying. And when people don’t stay, institutional knowledge walks out the door. The staff that remains is stretched thinner, new people are constantly onboarding, and the quality of care gets harder to maintain—no matter how talented the individuals are.
These aren’t things hospitals advertise. You won’t find “we cut staff by 15% last quarter” on their website next to the stock photo of a smiling nurse. But these decisions directly affect what happens when you press the call button—or pull that emergency cord.
So What Can You Actually Do?
There are a few options, at least on the insurance side. As healthcare expands, Americans have access to a wider range of options than they realize. I was in healthcare for five years before I knew crowdfunding health insurances were a thing. Although they don’t technically call themselves insurances by legal definition, there are more options today than just using your employer.
Unfortunately, on the hospital side, some patients only have access to one facility within miles. If you’re fortunate enough to have options, instead of defaulting to the closest one, you can look up reviews—like on Scrub Informer—to see if the hospital 25 miles away is actually a better option. A 25-mile drive to a smaller facility with a one-hour ED wait time might be worth it compared to a six-hour wait at a bigger hospital closer to home. Bigger does not always mean better in healthcare.
Check the reviews from the people who actually work there, not just the patients who visited once. Healthcare workers know which facilities are well-run and which ones are cutting corners. That’s insider knowledge that used to only travel by word of mouth. Platforms like Scrub Informer exist to make that information accessible to everyone.
The Bottom Line
Healthcare in America is a strange world of customer service, bureaucracy, and logistics. The amazing part is that anything gets done at all. There are incredible people—nurses, techs, therapists, doctors—doing extraordinary work every day inside a system that often works against them. The system isn’t broken because of the people providing the care. It’s strained because of the decisions being made above them.
As a patient, the best thing you can do is be informed. Understand that the system has incentives that don’t always align with your well-being. Ask questions. Research your options. Look at the data, read the reviews, and don’t assume that the closest or biggest hospital is automatically the best one for you.
And if you’ve had an experience—good or bad—share it. The more real information that’s out there, the better decisions all of us can make. That’s why we built Scrub Informer, and that’s why your voice matters.