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I would imagine you started to lose money from around level 19, 20 or 21.
The advise most players give is to try and get get level 5 GPs, researchers etc. This is great at the start of the level, but at endgame costs far too much in salaries.
Items that go in rooms have no ongoing costs, so it is more cost effective to use those instead.
I very rarely train my staff above level 3, only in very specific circumstances. In meltdown for example my only level 5 staff were the 3 doctors that worked the 2 DNA Clinics. They had 1 x Genetics, 2 x Treatment and 2 x Diagnosis. The remaining staff remained at level 3.
Janitors and Assistants stay at level 2.
I have found that their comes a point in the game where the number of patients you treat cannot compensate the expenses you have.
The early game challange is queue management, the late game challange is expanding whilst showing restraint.
Most important, dont have more staff than you need. If you have two diagnostic rooms that aren't being used that much, a single nurse can handle both.
You want to make a ton of cash? Use marketing 3 month spurts to essentially lock in 90% of your patients to something easy to treat. Pharmacy campagins or clown campaigns can generate upwards of $300-500k a cycle. Just have enough treatment rooms.
Myself, I've had no problems making money. On like the 3rd map from when you start the game, I've spent nearly all starting cash with only a few thousand left in pocket and I've been in the situation where I've sweated bullets the minute I got my first "cash is low" warning after the first period's deductions came out. I've slowly bounced back, though.
I wouldn't necessarily scale back on the size of the rooms. People assisgned to them are happier and feel more important than being crammed into broom closets (as it were). I think it's reasonable to build rooms larger than normal (but not YUGE, unless you're making a ward!) simply because room size effects happiness, I think, and outweighs being unhappy due to small rooms (where you might have to constantly give them raises to offset this),
One of the gribes I have in this game is whether or not it is actually beneficial to having more than one Reception in the same physical building. It's impossible to tell if it makes a hospital efficient when the AI seems to struggle somewhat. For example, in the 3rd map, like I mentioned, I dropped 75k buying the 2nd building. I placed a reception, a bathroom, some vending machines of all sorts, plenty of entertainment, and my key room for having the expensive building: my Depans clinic, and, literally right next to the latter's room, a staff room. I\ve watched the assigned physician there leave the building just to go back to the Prime area to use THEIR staff room. I do not know why other than AI confusion, hence wondering if it's practical to have 2 receptions in Prime and one in the Expensive as I've mentioned.
Gettomg OT, sorry. I'd say that having the Gift Shop near the entrance where your reception area helps; lots of vending machines. At least 2 GP offices, 2 pharmacies, plenty of benches near all your offices. Did I mention lots of vending machines? And a YUGE Ward. I've heard some players say they've had more than one Nurse in the Ward with their own desk - I don't know if this is efficient or inefficient, I'm going to try. I place lots of beds in mine for a YUGE room, only one Nurse's station, and at least 3 scrreens to that patietns aren't queing just to change clothes. Benches right outsie of the Ward in case they are queing just to get inside. I find that at least 2 GP's office and 2 pharms is a good "pharm" especially when wierd diseases and flashing icons over patients: heads starts rolling in.
In all honestly, I've never run out of a problem making cash. Large rooms seems to offset any negagive mood for your staff so I hardly had to raise $ unless I'm feeling generious. Like I said, only real issue was overspending right before deductions happen across the board.
You basically are running into two problems:
1. Your staff is growing and or leveling up and now costs a lot. You also gave them raises. This includes janitors which should generally be kept to level 2-3.
2. Your hospital is high level and large enough that there are tons of patients. Half of these patients are rage quitting or dying, or simply not paying. This might be due to high prices set, though in my experience, most seem to pay at 200% prices as long as your reputation is maxed.
At the crux of the issue is that most patients are dying/rage quitting. This is because the bad AI gets bogged down with more than 50-100 patients so they start moving slower. This also affects staff. Which affects everything. Since they are taking longer, they are also slower to drink/eat/poop which affects happiness, and taking longer means they will die sooner. And being unhappy while being treated seems to also mean less likely to pay up, especially with high prices.
So essentially the game is becoming harder and harder to manage due to poor AI. You have to have perfect queues and perfect room designs to fight the slower and slower AI speed that occurs. Until you hit Level 30 which gives you about 250 patients + your staff size to deal with.
At this point you need to focus on single treatment that is easy to diagnose, which is basically pharmacy or some crap like clowns. Surgery for example takes way too long to treat even though it generates a ton of cash. Plus it takes 2 people, and it takes forever to raise surgeon skill (unless you send them to do GP work until they are maxed).
Cafes, gift shops, news agents, all filler and fluff that will harm more than it will help. $200 is nice but a luxury snack machine and drink machine gives $100 combined and serves 5x people faster. And yes, I've tested this with 8x of each to see if it can make back the cost. The biggest problem (other than losing money) is that you lose time because patients will go out of their way to the cafe or gift shop, instead of just hitting the arcade to remove bordom.
Like, in very early game, when I only have 2 or 3 GP office, and 1 pharmarcy, maybe 3 or 4 bed in wards, the patients starts to flow in. But when it goest to late game, where i have enough staff and rooms to handle more patient, it seems not much more patients is coming. I'm not sure if it is because i'm still in early stage (I just unlocked research) or it always does it?
It's seems clear, as you have pointed out, that the income isn't comparative to the earnings after a certain point in terms of staff promotion and wages.
Put simply, the pay-off you get for promoting them doesn't equate to higher earnings.
I'll also probably look trying the price increase and, I will admit, I have considered shutting down certain treatments due to the hit-miss performance. Surgery and Fracture Clinic is no small exception.
I always switch to 200% prices after I run a marketing campaign to max rep. Then the cure rate sustains me at max rep regardless of death rate.
So yeah, you should try 200%. If you dont want to run 200% or can't deal with it, push your food/drink/happiness items to 200%. They will more often pay for that.
Yeah the promotion costs a lot more, raise cost even MORE, and all that guarentees no change in cost of treatment other than higher cure chance.
The problem here is that staff will always start to complain about wages, you always need to have it light green or they will eventually complain. But you should never give wages until they do complain, etc.
# of patients depends mostly on the level of your hospital. If its low level (due to few rooms and staff) then you will never get more than X patients.
The game naturally pushes you to build more and more because illnesses will change what kind of diagnosis rooms you need, and you will find new illnesses need new treatment rooms which need more doctors, etc.
As long as you don't raise your hospital level, you won't get many more patients. Sometimes it actually makes sense to sell half your hospital to make it smaller so you can reach harder to hit goals like cure rate.
This! Definitely this!
this makes the game feel like its on rails
The more diagnosis rooms a patient goes through, the more money you get out of them before they finish their stay in treatment. This won't happen if you have a 100% diagnosis at entry. A good GP is important but he doesn't need to be perfect. GP 100% works perfectly in early levels but later on suddenly everybody's queuing at a treatment room instead of your GP office. And GPs are cheap.
Getting a cafe isn't a bad idea - what's a bad idea is getting rid of all your snack booths too. Every time somebody gets hungry, they have to go all the way to the cafe. Just have one cafe, with snacks and drinks available in each building for when people need a quick fix so that they don't need to go far.
The key to the game is variety.