Doctors Unionize to Resist the Medical Machine • Hacker News Board

Re: Doctors Unionize to Resist the Medical Machine

#91

Post by neurotech1 » Mon, Jan 11, 2016, 1:26 AM UTC

hardcandy wrote: post #16

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…

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…

I know a couple of neurosurgeons who basically don't practice outside of federal/military facilities, and are covered by the Federal Tort Claim Act [0].

The salary is significantly less than a private practice neurosurgeon, but they don't have malpractice insurance or support staff costs.

In under-served and rural locations there are community clinics, also known as Federally Qualified Health Centers, and as part of the package, student loan repayment by the US government for the doctors. These doctors are usually civilian, and not in uniform (US Military or PHSCC). The repayment program is part of the National Health Service Corps[3].

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

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

[2] https://en.wikipedia.org/wiki/National_Health_Service_Corps

Re: Doctors Unionize to Resist the Medical Machine

#92

Post by mattmcknight » Mon, Jan 11, 2016, 1:31 AM UTC

digbyloftus wrote: post #72

sayhar wrote: post #65

Earlier quoted context omitted.

> They lobby, they control the supply of doctors, they restrict competition, and they even engage in price fixing It saddens me that those are your go-to ideas of what a union is. > The AMA was key in killing Truman's universal healthcare proposal starting in 1945. Actual unions have been pushing for universal healthcare for much earlier than I was born. On this front AMA has been the enemy of real organized labor fo…

I mean, the difference between "resist management giving themselves millions while cutting pay for workers" and "price fixing/restrict competition" is just an arbitrary, subjective distinction based on your opinion on how much money people should make. Either way the goal is to get more money for members of the group. If you don't think doctors deserve the inflated value the AMA has captured for them but think that o…

No True Scotsman Fallacy https://en.wikipedia.org/wiki/No_true_Scotsman

Re: Doctors Unionize to Resist the Medical Machine

#93

Post by crdoconnor » Mon, Jan 11, 2016, 1:45 AM UTC

digbyloftus wrote: post #72

sayhar wrote: post #65

Earlier quoted context omitted.

> They lobby, they control the supply of doctors, they restrict competition, and they even engage in price fixing It saddens me that those are your go-to ideas of what a union is. > The AMA was key in killing Truman's universal healthcare proposal starting in 1945. Actual unions have been pushing for universal healthcare for much earlier than I was born. On this front AMA has been the enemy of real organized labor fo…

I mean, the difference between "resist management giving themselves millions while cutting pay for workers" and "price fixing/restrict competition" is just an arbitrary, subjective distinction based on your opinion on how much money people should make. Either way the goal is to get more money for members of the group. If you don't think doctors deserve the inflated value the AMA has captured for them but think that o…

>I mean, the difference between "resist management giving themselves millions while cutting pay for workers" and "price fixing/restrict competition" is just an arbitrary, subjective distinction based on your opinion on how much money people should make.

Who would you prefer was paid more? Your doctor or his non-medical MBA manager?

Re: Doctors Unionize to Resist the Medical Machine

#94

Post by digbyloftus » Mon, Jan 11, 2016, 1:52 AM UTC

crdoconnor wrote: post #93

digbyloftus wrote: post #72

Earlier quoted context omitted.

I mean, the difference between "resist management giving themselves millions while cutting pay for workers" and "price fixing/restrict competition" is just an arbitrary, subjective distinction based on your opinion on how much money people should make. Either way the goal is to get more money for members of the group. If you don't think doctors deserve the inflated value the AMA has captured for them but think that o…

>I mean, the difference between "resist management giving themselves millions while cutting pay for workers" and "price fixing/restrict competition" is just an arbitrary, subjective distinction based on your opinion on how much money people should make. Who would you prefer was paid more? Your doctor or his non-medical MBA manager?

Whichever leads to the best, most efficient medical industry and provides myself as a consumer with the most value.

Re: Doctors Unionize to Resist the Medical Machine

#95

Post by hardcandy » Mon, Jan 11, 2016, 2:18 AM UTC

neurotech1 wrote: post #91

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…

I know a couple of neurosurgeons who basically don't practice outside of federal/military facilities, and are covered by the Federal Tort Claim Act [0]. The salary is significantly less than a private practice neurosurgeon, but they don't have malpractice insurance or support staff costs. In under-served and rural locations there are community clinics, also known as Federally Qualified Health Centers, and as part of…

Do you think we could maintain the current staffing level of nsx across the entire US with all their current responsibilities (level 1 trauma etc) if they averaged $200k/year each? How do you ask 2 or 3 surgeons to evenly share 24/365 call to keep a trauma center open at that comp level?

Re: Doctors Unionize to Resist the Medical Machine

#96

Post by CPLX » Mon, Jan 11, 2016, 2:29 AM UTC

digbyloftus wrote: post #72

sayhar wrote: post #65

Earlier quoted context omitted.

> They lobby, they control the supply of doctors, they restrict competition, and they even engage in price fixing It saddens me that those are your go-to ideas of what a union is. > The AMA was key in killing Truman's universal healthcare proposal starting in 1945. Actual unions have been pushing for universal healthcare for much earlier than I was born. On this front AMA has been the enemy of real organized labor fo…

I mean, the difference between "resist management giving themselves millions while cutting pay for workers" and "price fixing/restrict competition" is just an arbitrary, subjective distinction based on your opinion on how much money people should make. Either way the goal is to get more money for members of the group. If you don't think doctors deserve the inflated value the AMA has captured for them but think that o…

Unions primarily engage in collective bargaining with the employers of their members. The AMA is not a union.

Re: Doctors Unionize to Resist the Medical Machine

#97

Post by digbyloftus » Mon, Jan 11, 2016, 2:43 AM UTC

CPLX wrote: post #96

digbyloftus wrote: post #72

Earlier quoted context omitted.

I mean, the difference between "resist management giving themselves millions while cutting pay for workers" and "price fixing/restrict competition" is just an arbitrary, subjective distinction based on your opinion on how much money people should make. Either way the goal is to get more money for members of the group. If you don't think doctors deserve the inflated value the AMA has captured for them but think that o…

Unions primarily engage in collective bargaining with the employers of their members. The AMA is not a union.

Very likely to be true and I wont disagree! I'm not actually even from the US so I'm unfamiliar with their scope. I disagree with the person I'm replying tos reasoning more than anything. Their objection was of a different nature than yours.

Re: Doctors Unionize to Resist the Medical Machine

#98

Post by veritas3241 » Mon, Jan 11, 2016, 2:43 AM UTC

acveilleux wrote: post #25

parennoob wrote: post #21

With the whole "Everyone Should Learn to Code" movement taking on so much steam, I cannot help but wonder why there isn't a similar "More People Should Learn to Do Basic Diagnosis" movement. We need a shit ton more Nurse Practitioners and "basic" doctors to diagnose and treat minor ailments, so doctors who have gone to 6-year plus medical school can spend time on the more serious ailments.

Some of it is a perception issue, no one wants anything but the very best for their loved ones. So nurse practitioners, while great in theory, are only acceptable for others... Of course if you live in the boonies, a nurse here is a heck of a lot better than a doctor 4h away.

Similar line of reasoning happens with anesthesiologists versus nurse anesthetists (CRNA). Most anesthesia is administered by a CRNA with a anesthesiologist overseeing most, but there's been pushback b/c it cuts into the salaries of the anesthesiologists.

Re: Doctors Unionize to Resist the Medical Machine

#99

Post by secondtimeuse » Mon, Jan 11, 2016, 2:46 AM UTC

falsestprophet wrote: post #45

douche wrote: post #33

Earlier quoted context omitted.

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.

People are accustomed to having foreign physicians, other-than-white physicians and certainly other-than-Anglo-Saxon physicians. Nearly 30% of US primary care physicians trained abroad. Source: http://www.nytimes.com/2010/08/12/health/12chen.html Only 8.7% of the US are descended from the English (Anglo-Saxons) Source: http://www.census.gov/prod/2004pubs/c2kbr-35.pdf That said, the US could easily recruit physicians…

Good luck with that, considering europe already gets huge number of physicians from India.

http://www.ndtv.com/indians-abroad/india-biggest-exporter-of...

Re: Doctors Unionize to Resist the Medical Machine

#100

Post by carbocation » Mon, Jan 11, 2016, 3:02 AM UTC

JamesBarney wrote: post #67

carbocation wrote: post #60

Earlier quoted context omitted.

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).

This is because the U.S spends 2.6 times as much on health care per capita as the united kingdom.

And if you paid physicians $0, the US would still spend about 2.4 times as much on health care per capita as the United Kingdom. In the context of this thread, this is the relevant point.