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Doctors Unionize to Resist the Medical Machine

nytimes.com

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Re: Doctors Unionize to Resist the Medical Machine

#51

Post by DanBC »

lordnacho wrote: post #38

Why do people insist on having objective criteria for performance when it's inherently subjective whether your care was any good? I've seen this with the NHS in the UK. They have a bunch of numbers they have to make, but what do the numbers actually mean? What happens when people end up gaming the system, because the rules tell them to?

> objective [...] subjective

They should be trying to capture the subjective stuff too. See, for example, the Friends and Family test which is everywhere. Service Use Experience Committees also try to capture the subjective stuff. Complaints department mostly deal with subjective stuff. Healthwatch independently deal with mostly subjective stuff too. There's a wide range of subjective stuff that's measured using things like PLACE (Patient Led Assessment of the Care Environment) or 15 Steps Challenge.

But people paying the money tend to like things that are more directly measurable. They might have CQUINs (Commissioning Quality through Innovation (or something like that) to ask people to implement 15 steps challenge, without worrying too much about what the results are.

> They have a bunch of numbers they have to make, but what do the numbers actually mean? What happens when people end up gaming the system, because the rules tell them to?

I dislike the focus on numbers, but if you compare areas where they have strict numbers (4 hour A&E limit) and areas where they don't (access to talking therapy) you see that most (it was national scandal when it dropped to 85%) people who attend A&E are triaged and then treated + released or admitted into hospital within four hours versus, well, untold wait. Very recently (or maybe it's not in place yet) there's an 18 week limit for access to community based psychological therapies, so it'll be interesting to see if it makes a difference.

> What happens when people end up gaming the system, because the rules tell them to?

Various regulators and scrutineers hate that, and they have some power to drive change. Or NHS England / DoH force change. Some hospitals were transferring people to an observation ward from A&E, rather than treating them or admitting them into hospital. That got stopped pretty quick.

Re: Doctors Unionize to Resist the Medical Machine

#52

Post by HillRat »

hardcandy wrote: post #26
Dr_tldr wrote: post #13

Earlier quoted context omitted.

And yet, when Texas put a cap on medical malpractice awards, the cost of medical care didn't go down at all. Surely you have a good explanation for that and you're not just repeating discredited talking points for personal gain.

You're incorrect, the cost of medical care is measurably lower as a result of tort reform in Texas. And maybe more importantly, accessibility of care has increased. You see price reflected in at least two places: 1) the variable in the formula for medicare reimbursements that reflects practice environment costs, and 2) more visibly, in Obamacare rates for the State of Texas, which would be significantly higher in the…

Your first link claims that "doctors have flocked to [Texas]," but -- if physician supply is a key metric of the success of tort reform -- the evidence shows that there was no net effect on supply[1]. On the other hand, we have had high-profile if anecdotal cases, such as the Duntsch case (a neurosurgeon who left a trail of mutilated patients in his wake and was called a "sociopath" by a colleague who filed a formal complaint against him, and yet who kept his hospital privileges), in which tort reform made patient recovery effectively impossible. While there were certainly reasonable corrections to be made to the medical tort system to protect providers against inappropriate damages, the post-reform landscape appears to indemnify providers and institutions against even the most grotesque abuses of medical ethics.

[1] http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2047433

Re: Doctors Unionize to Resist the Medical Machine

#53

Post by jostmey »

lvs wrote: post #48
c3534l wrote: post #9

Doctors are already paid absurd salaries in the US and the barriers to entry already high. As much as we all hate dealing with insurance companies, when I lost my insurance and had to pay for things out of pocket, the difference between what they charged me and what they would have charged an insurance company was obscene. Insurance companies actually do a pretty good job of reducing the costs of medical care, althou…

If you think MD salary increases are even a tiny speck of the driving force for cost increases in US healthcare, you know less than nothing about the topic.

Ah, then I must have a negative amount of knowledge about the subject.

Re: Doctors Unionize to Resist the Medical Machine

#54

Post by EliRivers »

ZanyProgrammer wrote: post #42
hardcandy wrote: post #16

Earlier quoted context omitted.

What do you consider to be ''absurd salaries''? A friend of mine is a hard working (50 hours/week) 35 year old GP in San Francisco and makes about $175k all-in, which is about the same as the average base + cash bonus (excluding options) of all our white collar friends (mostly software developers, but also some in finance and other fields). He left medical school with about $50k in student debt (very low relative to…

How is 175K not absurd? Only a white collar engineer in SF would say that's a piddly salary. Wake me up when your doctor friend has to commute in from Stockton.

Don't forget that it's also standard to have accumulated hundreds of thousands of dollars by the age of 30. What are you, some kind of pathetic loser outside the Software Master Race making the median US salary of about 35000?

Re: Doctors Unionize to Resist the Medical Machine

#55

Post by colechristensen »

c3534l wrote: post #9

Doctors are already paid absurd salaries in the US and the barriers to entry already high. As much as we all hate dealing with insurance companies, when I lost my insurance and had to pay for things out of pocket, the difference between what they charged me and what they would have charged an insurance company was obscene. Insurance companies actually do a pretty good job of reducing the costs of medical care, althou…

>the difference between what they charged me and what they would have charged an insurance company was obscene

Those numbers you see are entirely imaginary.

Insurance companies don't pay them, individuals don't pay them, they're just artificially inflated prices used for negotiation.

They give a significant discount to people without insurance. Insurance companies individually negotiate (significant) discounts to this base price. It's inflated to make people think they're getting a better discount.

Re: Doctors Unionize to Resist the Medical Machine

#56

Post by trgn »

c3534l wrote: post #9

Doctors are already paid absurd salaries in the US and the barriers to entry already high. As much as we all hate dealing with insurance companies, when I lost my insurance and had to pay for things out of pocket, the difference between what they charged me and what they would have charged an insurance company was obscene. Insurance companies actually do a pretty good job of reducing the costs of medical care, althou…

Reading the Hippocratic Oath right now, it's painfully hilarious how far removed that pledge is from the way medicine is practiced right now

(taken from wikipedia)

"Whatsoever house I may enter, my visit shall be for the convenience and advantage of the patient;"

"I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug."

"I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick."

How quaint! That's what a Norman Rockwell painting would sound like if it came to life.

Re: Doctors Unionize to Resist the Medical Machine

#57

Post by Shivetya »

Best of luck with that union, it might win you a little reprieve but that profession is now more susceptible to foreign trained Doctors coming here to take their place.

Unions of professional workers are last resort actions. If you are at that point the chance has blown by to take corrective action, all they can do is slow it down.

Plus, if the ACA doesn't get axed next year hospitals and management companies won't be the biggest threat to their pay or number of patients they will see. The government will set rates and if they want to eat they are going to have to see more patients, if they even get them as there will be nurses who will step into those roles too

Re: Doctors Unionize to Resist the Medical Machine

#58

Post by serge2k »

douche wrote: post #33
induscreep wrote: post #28

I don't understand this about healthcare in the USA. Why not import a few thousand doctors from Asia through H1Bs, and drive down the cost of medical care? Remove artificial caps on licenses imposed by the AMA while at it.

Culturally, I suspect this would not go over well. There are a shocking number of people that would be less than impressed to be served by a doctor with a non-Anglo-Saxon last name, even if they spoke perfect English. Especially older people, who are the largest consumers of healthcare.

> Especially older people, who are the largest consumers of healthcare

the old bigots can learn to live with it.

Re: Doctors Unionize to Resist the Medical Machine

#59

Post by switch007 »

jraines wrote: post #2

All of this rings true from what I've heard my dad, a GP, complain about for years. It's hard for him to watch other doctors game the system to increase their earnings -- not only seeing more patients with unaccountably short sessions, but also up-coding their maladies and ordering unnecessary tests. In addition to the pressure of seeing more patients per day, they have all this new administrative bullshit (ironicall…

Similar story in the UK. My aunt, who works for the NHS (not a GP), has cried in the toilets a few times because she is forced to use bad software to the point of utter frustration, and she is not of the computer generation. There are ~10 people in her team in a simular situation. They should just have a dedicated person doing data entry in to the computer system.

Re: Doctors Unionize to Resist the Medical Machine

#60

Post by carbocation »

bradleyjg wrote: post #41
pragone wrote: post #11

Earlier quoted context omitted.

> Doctors are already paid absurd salaries in the US To put it in context, when I finish all my training, I will owe over $600,000. It's not the doctors being "paid absurd salaries" that makes medical care in this country expensive. It's lawyers - malpractice insurance can take upwards of 25+% of your income - and it's insurance companies, who have shareholders they are responsible to, and it's hospital administratio…

>> Doctors are already paid absurd salaries in the US >To put it in context, when I finish all my training, I will owe over $600,000. > It's not the doctors being "paid absurd salaries" that makes medical care in this country expensive. It's lawyers - malpractice insurance can take upwards of 25+% of your income - and it's insurance companies, who have shareholders they are responsible to, and it's hospital administr…

As of ~2012, physician compensation was something like 8.5% of healthcare spending in the USA. This means that in the United States, physician compensation is actually a smaller component of healthcare costs than it is in the UK (where it's ~10% of overall cost).
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