Why I quit medicine

Things will start to change soon, there are some signs of this already. Healthcare remains heavily regulated, and because of this even for profit institutions are sometimes run as government institutions. This is most apparent in nursing facilities. Medicare is the predominant payor, and there's no reason for any facility to go beyond what medicare requires. Why invest in electronic records, etc? if medicare doesn't require it (although that's changing now). It's just an added expense.

But it's become apparent to policy makers that Medicare is getting more and more expensive, and some type of change is going to have be initiated. With private health insurance, it's the same picture. Costs are going up and more of these costs are being shifted to the insured (patients). Deductibles have gone up tremendously, and the days of the $5-$10 co-pay are almost gone.

The solution, in both cases although perhaps implemented in different ways, is going to have require the patient/insured to be responsible for paying for themselves directly. On the surface, it seems like a bad thing, but in the longer run it's a good thing. It brings into play what healthcare has been lacking - market forces. Almost all other industries have market forces in play, but not so much in healthcare. Go to a great surgeon, or go to an average one, they get paid the same. Why? It shouldn't be that way.

But once people have to pay more out of their own pocket, they are going to be far more careful about who they see. The level of service provided is going to matter. Ease of access is going to matter. Outcomes are going to matter. How about a refund if certain things don't turn out as promised?

And that's where there is going to be tremendous opportunities for startups. To provide technology for patients, and for doctors, hospitals, etc to provide a better level of service. All parties involved will be actively looking for these tools at some point.

Granted there are some regulatory hurdles, and HIPAA was really a poorly thought out piece of legislation, but as the startup community grows, there will be tools made available to navigate these hurdles as well.

Not sure if it's a viable idea with all those wireless transmissions.

My wife is an ER and ICU doc. I think you're crazy thinking this guy is getting into startups for financial reasons! Anyway:

1) She consistently asserts that handoffs are the most difficult and error-prone part of the job. They take up a large chunk of her time. Further, with work hour restrictions only getting stricter, the number of handoffs is only going up.

2) While face-to-face interaction is indeed crucial, surely there are improvements to be made! Let the doctors give crucial information face-to-face, secure in the knowledge that basic patient information is stored in a trustworthy system, and you should see less errors.

> they are very closed minded and it's hard to get change.

Obviously this is a huge obstacle! But even by your own argument, there are surely ways to improve, and an ex-doctor is the ideal candidate to figure out how to do so.

Story from a friend working at a manage healthcare company in the early 1990s.

The state published a set of anonymized data on patient care stays associated with workman's comp.

The company wrote code to correlate data from these scrubbed records (age, sex, treatment dates) with data it had, to identify the patients.

These days, much of healthcare business is oriented around data flows -- pharmaceutical dispensing machines which double as patient-data-and-dosing information capture devices. The drugs vendor is willing to sell the drugs at or near cost simply to capture the datastream and sell it back to the pharmaceutical companies.

There's very, very good reason to view EMR with strong suspicion.

Yeah... hackers are usually incredibly naive about compensation outside of their own world. For reference: http://www.medscape.com/features/slideshow/compensation/2011...

Bottom line: here in the US of A, your average doc (most certainly NOT an outlier) is making between $150k and $350k. Put that in your VC-backed pipe and smoke it.

(Debt? Between $150k-$200k for 4 years of med school. Post med school training, in the form of residency and fellowship, runs anywhere from 3-12 years and pays around the $50k mark. Basically, nobody went broke by becoming a doctor.)

Which means, of course, that the outliers can do very well. I have a friend who's Dad is an oral surgeon in the Eastern Shore of MD (what might be considered the "boonies" by some). He clears about $750k/year for a 35 hour work week. llimllib's wife above is probably around the $250k mark in the ER/ICU. If that ain't coin...

Anybody who thinks that somebody left medicine for the money knows very little about medicine.