Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

The planning of U.S. physician shortages (2020)

niskanencenter.org

Post reply on HN
Print view View original

271–280 of 377 posts

Re: The planning of U.S. physician shortages (2020)

#271

Post by NemoNobody »

mportela wrote: post #196
nemonemo wrote: post #40

Earlier quoted context omitted.

My experience with PAs and NPs have been mixed. I would still prefer MD doctors if I have a choice. Now that there are many reasonably good medical education systems outside US, why doesn't US just open more to those international MDs? I would prefer those MDs to NPs or PAs. Maybe doctors' golden years have been passed, but I don't think that necessarily means more accessibility to quality cares.

Your are extremely optimistic to think the US will make immigration easier anytime soon.

We won't but we should.

We should take everyone that can get here - everytime. It's like tryouts - want to be an American? Get here.

A person that chooses to leave their country for the idea of another knowing full well the arduous journey ahead and the struggles all immigrants face everywhere - all so they can maybe have a life they like, deserves to be an American... if they can get here.

That's the test - or so it should be.

We are the descendants of those that said "f*ck this" - we should want everyone with that mentality to come here, always.

That mentality is what being an American is.

...plus China and India have a billion people MORE than us - 100 million immigrants wouldn't catch us up. Most people do have kids tho - even if your a Trumper you should understand that not all of the immigrant children will continue to require government assistance - most will go get jobs, go to school, start families and all of that creates wealth and prosperity.

Even if it takes 2 generations for the US to recoup the expenses incurred providing for the 1st generation of immigrants or refugees - the country still wins exponentially.

Nothing is more valuable than people.

Re: The planning of U.S. physician shortages (2020)

#272

Post by cfu28 »

mportela wrote: post #196
nemonemo wrote: post #40

Earlier quoted context omitted.

My experience with PAs and NPs have been mixed. I would still prefer MD doctors if I have a choice. Now that there are many reasonably good medical education systems outside US, why doesn't US just open more to those international MDs? I would prefer those MDs to NPs or PAs. Maybe doctors' golden years have been passed, but I don't think that necessarily means more accessibility to quality cares.

Your are extremely optimistic to think the US will make immigration easier anytime soon.

Well: https://www.statnews.com/2023/05/18/doctors-trained-outside-...

Re: The planning of U.S. physician shortages (2020)

#273

Post by cfu28 »

MauroIksem wrote: post #58
lotsofpulp wrote: post #26

Earlier quoted context omitted.

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…

You're being disingenuous. PAs are required to have 2000 hours of clinical experience before they can sit for their licensing exam. NPs however only require 500 hours. MDs require 4000 hours.

Your numbers are way off, but even assuming they weren't, 1 hour of PA training is not the same as 1 hour of MD/DO training.

Re: The planning of U.S. physician shortages (2020)

#274

Post by ChainOfFools »

jimmydddd wrote: post #120
weatherlite wrote: post #105

Earlier quoted context omitted.

> There's just no reason to do the job when you can get the same compensation working remotely in tech. Looking through the "Who's Hiring" thread is soul-crushing. Physician salaries are the only ones that do not grow relative to inflation and have decreased year-on-year relative to inflation for decades. What ? Most U.S physicians make 300K + after residency with job security set for life. The real bright ones, the…

The job security issue is huge. Many of my tech and finance friends in their early 50's are getting pushed out of their jobs, while my physician friends in their 60's can keep their career as long as they want. A family member recently visited a dr. in his late 70's.

As someone in the midst of a difficult career pivot from tech to medicine, I confirm that this is the primary motivation for making the switch at this stage of my life.

Re: The planning of U.S. physician shortages (2020)

#275

Post by newZWhoDis »

electriclove wrote: post #193
schoolornot wrote: post #117

Very easy solution, allow every 4-year state college to have MD programs. Flood the market.

Yup, increasing the supply is the obvious solution but one that the medical cartel has actively lobbied against.

I’m glad to see others calling it what it is, “medical cartel” is the most accurate description I’ve seen for our system

Re: The planning of U.S. physician shortages (2020)

#276

Post by badpun »

gadflyinyoureye wrote: post #176
badpun wrote: post #118

Earlier quoted context omitted.

Some of those physicians (mostly young and female) take second jobs as prostitutes, because their baseline pay makes it hard to survive.

What? I would like some evidence of that.

Here's a (part of) PhD thesis covering this subject:

https://nsuworks.nova.edu/cgi/viewcontent.cgi?article=1166&c...

It speaks about how, since most people in Cuba have roughly equal (equally low) salaries, prostitution is present in all strata of society. Example citation from the link; a prostitute speaking: "We're all on a survival plan, no matter who you are, if you're a doctor, a philosopher, a teacher, we are all pretty much the same, we make the same money, 20 or 30 cuc a month is not enough at all."

Re: The planning of U.S. physician shortages (2020)

#277

Post by lr1970 »

pessimizer wrote: post #172
lr1970 wrote: post #78

Earlier quoted context omitted.

> But the Soviet Union nonetheless grew. Its growth rate was similar to that of the United States, but starting from a lower level (missing out on catch-up growth). ... Even though the system was not efficient, it wasn't disastrous by itself, only suboptimal. I am sorry but it is total BS. I grew up in late USSR and can attest that its economy was in free fall. Central planning was one big demotivator and major contr…

It would have been worse as a peasant under the tsar. Communism brought modernity to Russia and made it a world power.

> It would have been worse as a peasant under the tsar. Communism brought modernity to Russia and made it a world power.

Big misconception. Russian Empire just before the WWI (1913) was a dynamic growing economy. It was behind Germany and UK but it was in the middle of the pack of European countries. Bolsheviks totally ruined the country. People paid enormous price for the "modernization" that was already underway during the tsar. Bolshevik revolution of 1917 was a single worst calamity that happened to Russia in 20th century, even worse that nazi invasion of 1941.

Re: The planning of U.S. physician shortages (2020)

#278

Post by haldujai »

whimsicalism wrote: post #267
haldujai wrote: post #149

Earlier quoted context omitted.

The expensive labor isn’t physicians and infrastructure/capital expenditures aren’t the barrier either. It’s nursing costs and bed counts. Look at Canada for an example, we have unemployed surgeons and interventional radiologists/cardiologists with surgical backlogs > 1 year. We have the rooms, the hospital I trained at had 90 operating rooms but only 4 are funded for after-hours and on weekends, the rest run 8am-4am…

Research indicates the "unemployed surgeon" problem in Canada is more folklore than reality. [0] AFAICT, Canada has a shortage of physicians. [1] That unemployed people exist at all is not evidence that there is no labor crunch. [0]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5866140/ [1]: https://www.cbc.ca/news/politics/canada-turning-away-home-gr... That you are not running these rooms as much as possible indica…

From the Royal College (our specialty accreditation society)[0]:

> 11-18% of newly certified specialists cannot find work at the time of their certification.

> 75% of those who are continuing training do so because they think this will make them more employable.

[0] https://www.royalcollege.ca/ca/en/health-policy/building-med...

From your first reference:

> Traditional unemployment is rare; underemployment is not.

> Eleven per cent of the cohort described themselves as primarily locum surgeons. When asked why they did locums, the most common responses were “waiting for a job to open up at locum site” (46%) followed by “could not get the staff job that I wanted” (23%).

It's not unemployment in the traditional sense, in the medical community it looks like a liver surgeon (2 years of extra training) doing appendectomies in a small town or a neurosurgeon forced into only doing spine work (both need monitored beds +/- ICU). Or doing multiple fellowships until you find something.

Sure you can work as a locum (temp) or go to [very undesirable location doing general work] if you're in a specialty like general surgery that allows for that kind of practice environment. Tough luck if you're a cardiac surgeon/interventional cardiologist or oncologic subspecialist of any kind that needs high nursing support, inpatient beds and expensive instruments.

Note that these training positions are mostly all funded by the government in Canada and allocated based on their needs assessment (so it's not people choosing some unemployable niche by choice per se).

> AFAICT, Canada has a shortage of physicians.

We have a shortage of primary care physicians (because no one wants to do it), we have enough specialists by body count but no jobs/rooms for them (see underemployment points and how many go to the US).

> I have no idea how the Canadian medical system works.

Hospitals are run by the provincial governments. Physician compensation also comes from the same ministry but not out of the hospital's budget with "fixed professional fees" set by the single payer.

> That you are not running these rooms as much as possible indicates some failure in pricing/profit seeking

This has truth to it, the hospital's incentive is to prioritize their budget and they have little incentive to maximize throughput.

Due to funding nuances they're essentially incentivized to prioritize acute/emergent care (which gets some extra $) and have less throughput for things with consumables (like procedures) that come out of the hospital's budget.

It's pretty common for Canadian surgeons to admit someone to facilitate a surgery so we can use an "emergency OR room" even though they don't need the bed. Entirely wasteful but from the hospital's perspective the bed is paid for (we're constantly at capacity, there's no reality where a bed is unused) and a broken bone admitted unnecessarily doesn't cost anything extra as they don't particularly need nursing or have nearly as many consumable costs like a person hospitalized for acute illness.

Re: The planning of U.S. physician shortages (2020)

#279

Post by latency-guy2 »

epicureanideal wrote: post #256
TheCoelacanth wrote: post #183

Earlier quoted context omitted.

Last 10 years? You must be joking. Software engineer salaries have done much better than inflation over the past ten years. If yours personally hasn't, you should have been asking for a raise or looking for a new job. Over the past one year, they've probably done worse.

Do you have some statistics for this? Also, most of the inflationary damage was done in the last 3 years. Unless 10 years ago you started at a very low salary I don’t think they’ve gone up significantly after inflation. If you were already a senior engineer 10 years ago for example.

Use BLS. Compensation for the average employee profile of "Software Developer" has far exceeded inflation.

I can't remember the exact timeframe, but roughly 2016 - 2022, salary for the profile of Developer has gone from ~$86k to ~$130k mean. I think that beats inflation quite significantly.

Re: The planning of U.S. physician shortages (2020)

#280

Post by speakfreely »

Pigalowda wrote: post #162
haldujai wrote: post #150

Earlier quoted context omitted.

I remain optimistic that some people here are open to learning so I still try sometimes. - Also a radiologist who gets told I’m egregiously overpaid when [insert immature AI tech] can definitely do my job better.

I am not optimistic here. This is the lion’s den - I’m here to see what the predators have in store for us. Back in early residency it exposed me to CNN and real time object detectors and a co-resident and I made a little proof of concept app that detects ICD/PM on CXR. So I think there’s value to me here - just no value in proselytizing and apologetics. They don’t like us and are here to eliminate us.

> They don’t like us and are here to eliminate us.

Don't take it personally. They're even trying to eliminate themselves [0].

[0] https://github.com/features/copilot

Post reply on HN