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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

#81

Post by JamesBarney »

hardcandy wrote: post #49
ZanyProgrammer wrote: post #42

Earlier quoted context omitted.

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.

Out of curiosity then, what would you consider appropriate salaries for GPs, general surgeons, and specialized surgeons like neurosurgeons, orthopods, or ENT? Keeping in mind that medical school costs an extra $250k (whether in debt to sallie mae or paid for by mom and dad), and the post-bac education timelines are 7 years for GPs (4+3), 9 years for surgeons (4+5), and 11 years for neurosurgeons (4+7).

Right now the price is set by a government granted monopoly which determines supply. Many people here believe a more correct way to decide this is through the free market.

Re: Doctors Unionize to Resist the Medical Machine

#82

Post by mikeyouse »

nostromo wrote: post #3

For what it's worth, people have been calling the AMA a union by another name for several decades. http://www.forbes.com/sites/johngoodman/2014/09/03/the-docto... They lobby, they control the supply of doctors, they restrict competition, and they even engage in price fixing: https://www.washingtonpost.com/business/economy/how-a-secret... They shape a lot of medical legislation, for example killing the Affordable Care…

The AMA doesn't restrict the number of doctors really either.. that's an old trope that isn't really true. The number of doctors is restricted by the number of residency slots available, which is restricted by congressional funding since they're all paid for via Medicare. If congress were serious about increasing the number of doctors, they could pass a bill tomorrow authorizing more money for new residency programs.

We've dramatically increased the number of medical students but haven't kept up in residency spots.

NEJM lays it out:

http://www.nejm.org/doi/full/10.1056/NEJMp1306445?viewType=P...

Re: Doctors Unionize to Resist the Medical Machine

#83

Post by zanny »

andrewpi wrote: post #7
potatote wrote: post #6

One thing that I never understood about the US medical education is the requirement of the bachelor's degree (pre-med) before applying for most med schools. In my home country and many others, you can directly apply to med school. Now that the college costs are quite considerably expensive, four-additional year of college studies simply adds to the cost of becoming a doctor and therefore, the newly minted doctors exp…

I actually prefer the US system in that it potentially provides doctors with a more well-rounded education.

Once upon a time in a fantasy land called... the 1970s? most people thought a high school diploma was a well rounded education.

If you are going to bring up costs of college, you also need to bring up why college is expected to replace high school.

Re: Doctors Unionize to Resist the Medical Machine

#84

Post by kasey_junk »

pragone wrote: post #11
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…

> 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…

Do you have a source for that 25% number. Eveeytime I've looked before it was closer to 10% which is still high, but other industries have similar rates.

Re: Doctors Unionize to Resist the Medical Machine

#85

Post by rz2k »

XorNot wrote: post #23
andrewpi wrote: post #7

Earlier quoted context omitted.

I actually prefer the US system in that it potentially provides doctors with a more well-rounded education.

Ah yes, the moral duty American colleges feel for ensuring a rounded education at the low low price of tens of thousands of dollars per year.

Running a democratic country is expensive, but better than any of the alternatives!

Re: Doctors Unionize to Resist the Medical Machine

#86

Post by dmix »

stephenboyd wrote: post #74

> The basic accounting problem for hospitalists is that they are not a profit center. That is, when they treat patients, the amount a hospital can bill Medicare and insurance companies is typically less than what the hospital must pay them. The opposite is true for other specialists, like surgeons. The rest of the article focused on peoples' emotional reactions, but that paragraph is key. Medicare, Medicaid, and the…

> it's a dysfunctional system that can only be fixed by an even more dysfunctional system

Indeed, the health industry is probably one of the worst places for capitalism/markets to rule. Not that I believe unionization and a further regulated industry is the answer either.

While I'll defend markets to death in most other areas, there are admittedly a few industries where it the corrective benefits of competition/market pricing just doesn't make sense. Healthcare is the perfect example of where abiding strictly by these incentives create perverse side-effects which ultimately create a net-negative environment for the industry and the consumers.

Living in Canada has given me perspective on this matter, where our public health insurance system functions very well without markets.

It's a shame politics drives everyone to think they should be purists on each matter. Sometimes the data and emotional experience will demonstrates otherwise. Or worse, politics often create a muddled middle-of-the-road compromise, easily manipulated by either-side's special interests.

It takes quite a bit of self-delusion to believe a particular economic theory should be applied uniformly everywhere when results show otherwise.

Re: Doctors Unionize to Resist the Medical Machine

#87

Post by cglace »

marshray wrote: post #4
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…

My doctors usually spend less than 5 minutes talking to me and 10 minutes hunting and pecking at the computer. Some offices will have other staff do much of the data entry, but it doesn't seem to result in the doctor any spending more time with me.

The hospital system my dad works for just got all the doctors scribes to take the data entry burden off of them.

Re: Doctors Unionize to Resist the Medical Machine

#88

Post by neurotech1 »

pragone wrote: post #11
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…

> 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…

Which college/medical school cost that much?

In either Federally Qualified Health Centers [0], or other federal/military hospitals, the Federal Tort Claim Act [1] basically covers the malpractice insurance. There other programs that allow non-profit medical centers limited coverage under the FTCA.

[0] https://en.wikipedia.org/wiki/Federally_Qualified_Health_Cen...

[1] https://en.wikipedia.org/wiki/Federal_Tort_Claims_Act

Re: Doctors Unionize to Resist the Medical Machine

#89

Post by gameshot911 »

knughit wrote: post #78
merqurio wrote: post #27

Earlier quoted context omitted.

I know, I hope my Background as MD and CS plus the idea we had will make it different. We are working on something similar to an IDE :)

Congratulations in advance for when EPIC buys your company and then ruins your product.

Epic doesn't acquire.

Re: Doctors Unionize to Resist the Medical Machine

#90

Post by JamesBarney »

ryanSrich wrote: post #76
ZanyProgrammer wrote: post #42

Earlier quoted context omitted.

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.

For some perspective. A 22 year old college graduate can make $175k per year in total comp with a CS degree working for Facebook or Google. To repeat that. A 22 year old with a BS degree can make $175k per year with absolutely no experience whatsoever.

For some more perspective :).

A $175,000 is close to top compensation in our field. The average software engineer(obviously not just out of school) earns around $96,000. The average GP earns $211,000 and the average specialist earns $411,000.

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