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The Dark Side of Doctoring

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Re: The Dark Side of Doctoring

#81

Post by kendallpark »

This is a problem in medical school as well. I can't tell you how many anonymous posts have been popping up on r/medicalschool lately about being depressed, isolated, lonely, and/or suicidal.

Missouri just passed the first bill of its kind to try and combat mental health issues in med school.

http://krcgtv.com/news/local/medical-student-suicide-prompts...

> The bill, also known as the Show-Me Compassionate Medical Education Act would establish a committee to study mental illness, suicide and depression in the state's six medical schools. The bill would also prohibit any medical school from restricting a study on the mental health of its students.

The absolute disturbing part is right here:

> While lawmakers debated the legislation, Frederick said the deans from each of the state's medical schools sent him a joint letter expressing opposition to his proposed law.

In other recent news, Saint Louis University fired their med school dean that was the absolute champion of promoting the mental health of SLU's students.

http://news.stlpublicradio.org/post/slus-medical-school-remo...

Furthermore, as part of the licensing process, you are asked whether you were diagnosed with a mental illness in the past. There will likely be an investigation if you say yes and it could impact your career.

This stigmatizes mental illness within the profession and keeps people from seeking help when they need it.

Re: The Dark Side of Doctoring

#82

Post by hkmurakami »

nkurz wrote: post #79
hkmurakami wrote: post #71

Earlier quoted context omitted.

> And if you pay the lawyers a little more, they can probably even figure out how to avoid paying capital gains on the distributed assets if they are below $10 million. Capital gains costs bases are currently "stepped up" during the estate transfer. No need to pay anything to lawyers. If your estate is below $10.5M (or thereabouts, I forget what the exact number is since it's now inflation adjusted), you won't be lia…

Yes, but I think the trickiness is combining this with the combination of revocable and irrevocable trusts that "protects" the assets from Medicare. Although it's possible that in the case I'm aware of, it's NY state and city rules that required the additional layers. My main point is that the current system is designed so that it can be gamed by those with the money to pay the lawyers, and the lawyers have enough in…

Ah I see. There are a variety of irrevocable trusts that move assets to a separate legal identity from the original owner of the assets (ex: charitable grantor trusts that are used by the Waltons often). This would reduce the size of the estate for both estate tax and medicare purposes.

In the past, transferring assets to such a trust entailed gift tax, but since the estate tax and lifetime gift tax exemption are now bundled together, you can basically "use" the estate tax exemption to fund this irrevocable trust "for free". As a result your personal assets plummet, you name your heirt the beneficiaries of the irrevocable trust, and you (the parent) can take advantage of medicare fully as you describe.

The drawback to this strategy is that you do lose real flexibility in controlling your assets. Also, the legality of this widespread practice is definitely in a gray zone and carries future legal risk. Transferring a significant portion of one's assets to such a complex instrument is definitely not advised.

Re: The Dark Side of Doctoring

#83

Post by epmatsw »

markroseman wrote: post #17
aabajian wrote: post #6

It's worth noting that the incredible success of Epic EMR software is because it tightly controls all of the administrative billing issues, NOT because it makes clinician's lives easier. There are endless check boxes in Epic and each site has its own interface. It's a huge mess and difficult to navigate...but arguably still better than the other vendors.

Absolutely it's about the administrative end and not patient care. We've got a situation in our regional health authority (Vancouver Island, BC, Canada) where they're trying to roll out a significant update/expansion to their EMR (Cerner-based) in the hospital in Nanaimo. Despite immense pressure, some docs have been now suspended for refusing to use it and switching back to paper, despite the massive increase in tim…

This is a pretty shocking opinion to see expressed. Like, you may as well have said "A bunch of developers at decided to go back to C89 because writing code in Rust was too slow, plus did you see the bugs in its borrow checker?" . Do you really believe that paper is a safer alternative?

Re: The Dark Side of Doctoring

#84

Post by yakult »

According to my GP, selection for doctors include psychiatric profiling designed to select for the most compassionate. While I can see why the hospitals would want this - compassionate doctors are good PR -this seems to be a case of misaligned incentives. Those with less compassion would suffer less and cope better when surrounded by death and suffering on a daily basis. On the whole, this probably means they'll do a better job, too.

Re: The Dark Side of Doctoring

#86

Post by llimllib »

pixelmonkey wrote: post #18

My wife is a medical resident and the issues described by this doctor are absolutely pervasive in residency. The strange part is, the overwork also seems to be pervasive among the attending physicians who have been out of residency for decades. Not just the residents. As a tech founder analyzing the system from the outside, I think this writer has nailed the core issue: "... a doctor is just one of the many commoditi…

My wife is now an attending, and all I can say is Amen.

The worst part is that many doctors often defend and work to perpetuate the system, rather than organizing to make it sane. It is truly boggling.

Re: The Dark Side of Doctoring

#87

Post by wighty »

nkurz wrote: post #63
karpodiem wrote: post #49

Earlier quoted context omitted.

Western medicine has turned into a ponzi scheme. The verifiable proof of this is to have an elderly family member in a nursing home who goes through the usual monthly trips to the hospital from 'falling'. While Medicare covers almost all of it, it became so nauseating to read the outrageous EOB totals that I tried to put a end to it - I requested that unless the on call nurse (after hours) or physician (during busine…

We have two family members in an assisted car facility for almost eight years now, and between the two of them, they've tapped Medicare for just under $700K. Together, the sum of both their incomes throughout their entire working lives never totaled that amount. Oh, but it gets worse. It's bad enough that the government is being bilked for hundreds of thousands of dollars on behalf of those without the ability to pay…

House of God is indeed an interesting book and a good read. I read it during second year of my residency, and it is incredibly sad how the stuff that is talked about in the book has gotten worse in some ways, though better in others.

I'm actively against the "bowel run" mentality. I do my best to avoid even the CYA test ordering, though I'm not in the ED where this can be the most rife. I see first hand the "ponzi scheme" (though IMO it is not the correct term) of the system and I chose to go into primary care because I actively want to fix this in any way I can, and being a specialist was not the way I thought would be best to do this.

Re: The Dark Side of Doctoring

#88

Post by Kali909 »

kem wrote: post #66
pixelmonkey wrote: post #18

My wife is a medical resident and the issues described by this doctor are absolutely pervasive in residency. The strange part is, the overwork also seems to be pervasive among the attending physicians who have been out of residency for decades. Not just the residents. As a tech founder analyzing the system from the outside, I think this writer has nailed the core issue: "... a doctor is just one of the many commoditi…

There's one big difference between software engineers and healthcare: regulation. A software engineer is hired for their skills (at least ostensibly). No one is required by law to hire someone with a specific degree and specific post-degree training and specific exams. Contrast this with healthcare. To do certain sorts of procedures, you have to hire a physician. Not because it's demonstrably necessary to have someon…

.

> People do not grasp how much of this insanity is codified by law and rule, and when they are informed of it, they shrug it off in the name of "safety."

Not to make minimize the problem, but this feels a bit like privacy in IT (or lack thereof) due to government overreach.

People care much less about something when they are not directly impacted (or think they're not impacted).

Re: The Dark Side of Doctoring

#89

Post by wighty »

javiramos wrote: post #59
killjoywashere wrote: post #35

Earlier quoted context omitted.

There are ~30,000 PGY-1 spots and only about 18,000 allopathic medical school graduates. (1) All the native allopaths and all the osteopaths together can't fill all the residency spots. We inhale foreign medical graduates. (1) Pages v and 14: http://www.nrmp.org/wp-content/uploads/2017/04/Main-Match-Re...

Wow surprised to see that almost half of all PGY-1 residents are foreign-trained.

That's not true, see the reply above yours for a better explanation.

Re: The Dark Side of Doctoring

#90

Post by pdelbarba »

maxerickson wrote: post #60
pdelbarba wrote: post #36

Earlier quoted context omitted.

Depends on what you call training. 250 hours under a private (no payment allowed) licence, then you get your CPL. All of this is on your dime (average about $200/hr with instructor and such). The CPL phase work afterward (banner flying, flight instruction, etc) pays like garbage since the GA community is struggling significantly. To do airline work, you need minimum 1500 hours (ATP), then pilots have a sort of reside…

Doctors begin their professional training after 7 or 8 years of post secondary education. Much of the time, on their own dime. They also generally work hard enough in high school to get excellent grades (do flight instructors check transcripts or just if the check clears?). It's easy to imagine doing 250 hours over 3 or 4 years while doing something else most of the time.

To fly for the airlines you'll need a college degree, probably with a >3.0 GPA. I agree it's not as academically rigorous though (unless you count the USAF route). Also, most people I've seen do the 250 in as short a time as possible or go part 141 which is a sort of direct-to-CPL training program. Right now there's a shortage of airline pilots but traditionally, those 7-8 years you mention would be spent at a regional before you have a chance at making enough money to start to really service all the debt you undoubtedly have at that point.

Obviously they're pretty different career paths, but they're both effectively 'trades', in a more traditional sense, that require obscene amounts of training.

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