Doctor shortage, pilot shortage
Frustrating to see these problems of purely human design.
The planning of U.S. physician shortages (2020)
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Re: The planning of U.S. physician shortages (2020)
#22Planning and predicting highly variable systems is hard. Long-range interventions are especially risky given the possibilities for unexpected consequences and also the long lead times in fixing the problems. Central planning on resources has been especially rife with failed examples (the USSR being the all-in poster child.) As the article points out, the concept of central planning is orthogonal to who is providing t…
"Communist" Cuba has 64 physicians per 10K population, which is 2nd in the entire world for physicians per capita. https://en.m.wikipedia.org/wiki/List_of_countries_and_depend... During the pandemic, they were sending droves of doctors to Europe. They offered to assist in NYC but Trump turned them away as our population dwindled. Famously, when a British cruise ship with ill passengers aboard was denied by ports in F…
What’s with the scare quotes around communist? Sure they have a lot of doctors. And how many of those doctors are allowed to do business as a private practice? Or how many would be allowed to change careers if they wanted to? How many are allowed to spend their income at fancy places, where the currency they get paid in isn’t even accepted?
Hate to break it to you, but “your” worldview is incredibly, laughably, misinformed.
Re: The planning of U.S. physician shortages (2020)
#23I doubt US would be able to see a level of medical accessibility on par with many European countries. The medical education system has a perverse incentive to reduce the yearly graduates -- the less graduates there are, the more profits and prestiges each of the current members can garner (with arguably better trained graduates) -- and as shown in the article, they seem to have monopolistic capability for the throttling. And the incentive is only larger when people spend more disposable income for their healthcare, which has been the case. Maybe political powers may shift the direction a bit, but I do not see any evidence of a major course correction.
Re: The planning of U.S. physician shortages (2020)
#24discriminatory MCATs, brutal STEPS, insane Pre-Med curriculum, and more nonsense designed to cater to white elites who gamed the educational system and less to those who are genuinely trying to help the disenfranchised, unremembered, diverse and more. Hopefully one day, we'll make it as easy to become a doctor as it is to -- say -- become an Engineer.
Medical school and residency are incredibly hard things. So you could make getting admitted to them easier sure but you’d be setting people up to fail if they can’t pull 80 hour weeks and manage information overload when they get there.
Re: The planning of U.S. physician shortages (2020)
#25discriminatory MCATs, brutal STEPS, insane Pre-Med curriculum, and more nonsense designed to cater to white elites who gamed the educational system and less to those who are genuinely trying to help the disenfranchised, unremembered, diverse and more. Hopefully one day, we'll make it as easy to become a doctor as it is to -- say -- become an Engineer.
I hope it’s not as easy to make a doctor as it is to make an engineer. I am an engineer dating a surgical resident who has to go through so much training that an engineer would never even come close to an engineer. The room for error is quite small. If it was as easy to make a doctor as an engineer I would lose faith in the medical system and would never want such a doctor opening me up.
I agree we want medical personnel who are very well trained, certainly better than software engineers.
I'm less clear about which aspects of the current medical education system produce effective training and which are more of a hazing run selecting for the privilege and determination to survive it.
Re: The planning of U.S. physician shortages (2020)
#26I doubt US would be able to see a level of medical accessibility on par with many European countries. The medical education system has a perverse incentive to reduce the yearly graduates -- the less graduates there are, the more profits and prestiges each of the current members can garner (with arguably better trained graduates) -- and as shown in the article, they seem to have monopolistic capability for the throttl…
There already has been. The solution was to pump out physician assistants (PAs) and nurse practitioners (NPs) that require a fraction of the training of a doctor to get licensed, and then have them practice medicine under the “supervision” of a doctor.
Some states even went as far as giving people with no medical training the right to prescribe, such as naturopaths, whatever that means.
So it is up to each person now to figure out how qualified the person giving them healthcare is.
Also, doctors now have to contend with a handful of large payers. Their customers are mostly the federal/state government, or a handful of managed care organizations like UHC/Elevance/CVS/Cigna/Humana/etc.
I would say doctors’ golden years of having a favorable negotiating position are behind them.
Re: The planning of U.S. physician shortages (2020)
#27The health care industry seems to be profiting off this by having more care provided by nurse practitioners and physician assistants but billing the insurers same as they would charge for M.D./D.Os.
Re: The planning of U.S. physician shortages (2020)
#28discriminatory MCATs, brutal STEPS, insane Pre-Med curriculum, and more nonsense designed to cater to white elites who gamed the educational system and less to those who are genuinely trying to help the disenfranchised, unremembered, diverse and more. Hopefully one day, we'll make it as easy to become a doctor as it is to -- say -- become an Engineer.
I hope it’s not as easy to make a doctor as it is to make an engineer. I am an engineer dating a surgical resident who has to go through so much training that an engineer would never even come close to an engineer. The room for error is quite small. If it was as easy to make a doctor as an engineer I would lose faith in the medical system and would never want such a doctor opening me up.
It’s not that medicine should be _easier_ or _as easy_ as engineering, it just needs to be easier than the status quo.
This is theoretically an easy change, since most complaints are about the unnecessary bureaucracy and not the pedagogy itself. Doesn’t matter how simple the solution is, it’s practically hard because the bureaucracy has so many incentives to make the process harder.
Re: The planning of U.S. physician shortages (2020)
#29Planning and predicting highly variable systems is hard. Long-range interventions are especially risky given the possibilities for unexpected consequences and also the long lead times in fixing the problems. Central planning on resources has been especially rife with failed examples (the USSR being the all-in poster child.) As the article points out, the concept of central planning is orthogonal to who is providing t…
I feel like we are going too far. Central planning in presence of hostile adversaries unrestricted by any ethical systems failed. And by what measures has “free market” has proven itself as successful? You can come up with your measures of success and others will propose measures of shortcoming. Others will even dispute the claim the American-led west is anything different from a centrally planned set of cooperating…
Central planning, in this context, is not the same as political philosophy. So be careful not to conflate the two.
Central planning does happen in free-market economies all the time, at various levels. An HOA for example is a hyper-local example of central planning. The larger the scale the stronger the lever, and hence the more variable the result.
The "free market" brings all kinds of its own oroblems of course - I'm not arguing for the elimination of planning - but long-range planning at national scales, is hard.
Re: The planning of U.S. physician shortages (2020)
#30discriminatory MCATs, brutal STEPS, insane Pre-Med curriculum, and more nonsense designed to cater to white elites who gamed the educational system and less to those who are genuinely trying to help the disenfranchised, unremembered, diverse and more. Hopefully one day, we'll make it as easy to become a doctor as it is to -- say -- become an Engineer.
I hope it’s not as easy to make a doctor as it is to make an engineer. I am an engineer dating a surgical resident who has to go through so much training that an engineer would never even come close to an engineer. The room for error is quite small. If it was as easy to make a doctor as an engineer I would lose faith in the medical system and would never want such a doctor opening me up.
I'm a physician, pathologist specifically. But also did a surgical internship. My dad is an engineer, my undergrad is in Physics and I spent years on ships in engineering and weapons departments.
Yes, the room for error can be incredibly small. A surgeon might cut out a breast cancer that's 5 to 10 cm on a side. The margin, the distance between the cancer and the edge of the surgeon's incision, might be negative by 1 cell. The cancer might be 1 cell away from having been left in the patient's body. The room for error in medicine is in some ways disturbingly small, in others it is incredibly large. Factor of 10 errors are so common they are a standard outcome measure in trainee fatigue studies. Ask your SO about ACDF. Imagine driving screws essentially blindly, without tapped holes, a few millimeters away from a spinal nerve root, with an 8" torx driver. On 3 hours sleep, after standing on your feet for the last 7 hours. An engineer, hell, a carpenter, would have measured the system extensively, set up a jig, and spec'd the entire process, soup to nuts.
From that perspective the margins for error, in absolute terms can be, and often are, enormous. Which is what lets them run on 3 hours of sleep for months. In that setting, sleep-deprived, no exercise, terrible food, compounded by relentless moral injury, yes, it seems like the margins are miniscule. But a good cabinet maker, electrician, or pharmacist takes more care in many aspects of their work, in absolute terms.