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A fourth of U.S. health visits now delivered by non-physicians

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Re: A fourth of U.S. health visits now delivered by non-physicians

#131

Post by s1artibartfast »

nextaccountic wrote: post #100
lolinder wrote: post #81

Earlier quoted context omitted.

But why aren't more residencies paid for through other channels? I wasn't under the impression that medical residents were solely a drain on hospital resources—my sense was they did a lot of the smaller tasks to free up licensed physicians to do more. At some point, if there aren't enough CMS-funded residencies and there aren't enough licensed doctors, wouldn't hospitals just start hiring more residents? The article…

maybe it's because the industry isn't really interested in having more MDs?

You would think hospitals would be because they pay the high cost for doctors.

I think rather it is a collective action problem.

Hospitals don’t want to invest 150k per resident to have that person leave the day they are done. It is common for doctors to do residency where they can and then move.

A better option would be for the fed to cut residency funding entirely and have hospitals pool resources themselves.

Re: A fourth of U.S. health visits now delivered by non-physicians

#132

Post by preommr »

bitcurious wrote: post #128
SOLAR_FIELDS wrote: post #70

Earlier quoted context omitted.

A recent occurrence I will share related to this was having to convince my doctor that I had Lyme disease. I Googled the symptoms, saw the trademark bullseye, and of course concluded that I had Lyme disease. It was right where I got the tick bite, 8 weeks later. My doctor refused to believe me. He told me to see a dermatologist about it, thinking it was some skin rash, even though it was exactly where the tick had bi…

It’s intuitive that a patient who can spend an order of magnitude more time on his self care, and can self-articulate their symptoms, can occasionally self-diagnose better than a doctor. It’s not intuitive that a clinician with 4 years training and the same 30 minute window to diagnose you would do better than a physician with 12 years training.

The point is that it's easier for a service provider to spend 1-2 hours (or across multiple people) when they don't have to spend 12 years of training with high attrition rates. Both because it's more affordable, and because there's less scarcity.

Re: A fourth of U.S. health visits now delivered by non-physicians

#133

Post by codeTired »

kortilla wrote: post #94
outlace wrote: post #28

MD here. I'm of two minds about this. On the one hand, obviously there's a bit of defensiveness since I went through 12 years of school and training to be an independent physician (4 years college, 4 years medical school, 4 years residency) and I've definitely seen subpar care from other "providers" (not a fan of the term) with less training. The wide variety of different "providers" is also confusing to patients who…

The system is completely broken with you taking 12 years to train. It means that: - you are expected to learn way too much and only have a surface understanding of a lot of things (see tick example from sibling comment) - your time is very valuable so you can’t put any time effort into patients at all to try to deeply understand anything that doesn’t pass your “known expertise” classifier. My son has back pain that m…

I’m so fed up with doctors it’s not even funny.

I’ve had positive test showing nerve damage. Doctor messages me saying all my tests were fine. I message them in the portal pointing out one of tests showing insufficient sweating means small fiber neuropathy. They confirm I am correct. Then, I have to tell them what meds to prescribe, that the dosage is too small. It was like pulling nails.

I have seen physicians at top facilities in the US. Some are better some are there for prestige and paycheck.

We need to collect symptoms using words and visual representation, not everyone will know what tingling feels like. I welcome AI.

Also, if you search an illness and look for support groups you will quickly find handful of “recommended” physicians in a country.

Re: A fourth of U.S. health visits now delivered by non-physicians

#134

Post by s1artibartfast »

kortilla wrote: post #97
WirelessGigabit wrote: post #66

Earlier quoted context omitted.

It could be more of explaining the total duration and cost of how long they went to college. If it's required to have an undergrad I believe one can mention it, even if the undergraduate isn't required. Like in Belgium you need to have a masters for certain government jobs, but it's not relevant in which field.

Then why not include high school? Unless the degree was exclusive to medicine, including it is bullshit. MDs have a glorified 4 year masters and an on the job training program not significantly different than what it takes to become a PE.

But you can become a PE without a masters. Would you say that PEs the only requirement for PE is 2 year Mentorship?

Maybe people should be able to go straight into medschool with an associates or hs diploma

Re: A fourth of U.S. health visits now delivered by non-physicians

#135

Post by codeTired »

robomartin wrote: post #16
penjelly wrote: post #7

canadian anecdote: i havent seen my GP ever . He just oversees resident (student doctors). Ive had chronic health issues for 3 years now without much relief, despite having been to the doctors office 20+ in that time. Most of the time they deflect me from specialist care.

> Ive had chronic health issues for 3 years now without much relief, despite having been to the doctors office 20+ in that time. This is the problem with all of these systems that try to violate the laws of physics (aka: free market economics). They invariably results in substandard care, if you receive care at all. Keeping people alive isn't the same thing as actually solving problems with quality care. This is my b…

Should people who are not able to work not have any insurance options? Or do you think everyone should pay $1k a month?

Should insurance companies be allowed to have $1 million maximums and kick off people during their cancer treatment?

Let’s hear some prices from your wife’s botique?

You are barking at the wrong tree. US healthcare system is shit because there is too many mouths of middleman to feed.

Re: A fourth of U.S. health visits now delivered by non-physicians

#136

Post by robomartin »

brewdad wrote: post #106
srj wrote: post #37

Earlier quoted context omitted.

Your per person figures seem low to me, and you're calling it profitability but then taking expenses out of that. Is that an industry term? Where does that number come from? I would think at least before expenses it would be quite high as medical visits cost hundreds if not thousands of dollars.

This person has an argument but confuses so many basic terms that it gets lost. Revenues are not profits and profits don't include expenses. I'd be happy to read a cleaned up version but right now it's just a confusing mess.

> This person has an argument but confuses so many basic terms that it gets lost. Revenues are not profits and profits don't include expenses.

No. I think you might be confused.

I laid it out clearly. The basic profit has to do with the cost of an MD, PA, medical assistant and front office people interacting with the patient. In other words, the most basic labor cost layer. This is easier to quantify because you can count the minutes each person devotes to that patient.

The other costs are different. These are the business, office, insurance and other general operating costs that apply to the entire practice. In a back of the napkin calculation it is much easier to first subtract basic labor costs from the income per patient and then apply the other stuff in bulk.

I just tried to run through a ridiculously basic calculation to illustrate the point. That was not intended to be a accurate accounting report.

This is a complex multivariate problem. A simple example can't do anything but glace at the problem and, hopefully, inspire people to research and understand. ACA, Medicare, Medicaid and other aspects of our medical system have made things worse over time, not better. Having more people covered isn't equivalent to more people having access to good healthcare.

There are so many issues, for example, the fact that Medicare isn't insurance at all after 55, it's a loan! ACA shoved millions of people into Medicare. In a few years, we might start hearing of states seizing people's estates to pay for the money they owe under Medicare. It's crazy --absolutely insane-- that nobody talks about this and the media did not do their job and educate people as to the realities of this horrid system.

https://www.dhcs.ca.gov/services/Pages/TPLRD_ER_cont.aspx

Re: A fourth of U.S. health visits now delivered by non-physicians

#137

Post by dataflow »

syedkarim wrote: post #63
outlace wrote: post #28

MD here. I'm of two minds about this. On the one hand, obviously there's a bit of defensiveness since I went through 12 years of school and training to be an independent physician (4 years college, 4 years medical school, 4 years residency) and I've definitely seen subpar care from other "providers" (not a fan of the term) with less training. The wide variety of different "providers" is also confusing to patients who…

Why do you include your undergraduate degree as part of your medical training? I've asked dozens of doctors (and lawyers) about the relevance of their college/undergraduate education to their day-to-day work and none have said it was critical, most have said it was not relevant, and some have had completely non-medical majors (music and physics). Of course, maybe it's different for you, which is why I ask.

> Why do you include your undergraduate degree as part of your medical training?

Was the comment edited after you posted this? Because I don't see them saying this was part of their training at all. They wrote "12 years of school and training", and this is the school part.

Re: A fourth of U.S. health visits now delivered by non-physicians

#138

Post by ttymck »

bitcurious wrote: post #128
SOLAR_FIELDS wrote: post #70

Earlier quoted context omitted.

A recent occurrence I will share related to this was having to convince my doctor that I had Lyme disease. I Googled the symptoms, saw the trademark bullseye, and of course concluded that I had Lyme disease. It was right where I got the tick bite, 8 weeks later. My doctor refused to believe me. He told me to see a dermatologist about it, thinking it was some skin rash, even though it was exactly where the tick had bi…

It’s intuitive that a patient who can spend an order of magnitude more time on his self care, and can self-articulate their symptoms, can occasionally self-diagnose better than a doctor. It’s not intuitive that a clinician with 4 years training and the same 30 minute window to diagnose you would do better than a physician with 12 years training.

Would they do worse?

Re: A fourth of U.S. health visits now delivered by non-physicians

#139

Post by x-complexity »

AaronM wrote: post #110
slily wrote: post #107

Earlier quoted context omitted.

You have a point but need to drop the identity politics bullshit. Since when are women "underserved"? Men are far more likely to "tough it out" i.e. refuse to see a doctor when they have symptoms of illness, so by your logic they are the "underserved minority" in terms of gender. Claiming women are disadvantaged in literally everything ever is a groundless cliché. The racial angle may be less false (though not for th…

https://physicians.dukehealth.org/articles/recognizing-addre... https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2825679/?itid=l... https://www.americanbar.org/groups/crsj/publications/human_r...

> https://physicians.dukehealth.org/articles/recognizing-addre...

The article uses a survey about personal opinions as the source for its judgement. Right in the first paragraph (emphasis mine):

> A *survey* conducted in early 2019 by TODAY found that more than one-half of women, compared with one-third of men, *believe* gender discrimination in patient care is a serious problem. One in five women *say they have felt* that a health care provider has ignored or dismissed their symptoms, and 17% say they feel they have been treated differently because of their gender—compared with 14% and 6% of men, respectively.

This does not address GP's complaint regarding men being more likely to refuse to see a doctor in the first place. Does patient gender discrimination occur in the medical space? Probably. But nothing in this article addresses GP's claim of "Men are far more likely to 'tough it out' i.e. refuse to see a doctor when they have symptoms of illness".

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> https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2825679/?itid=l...

This journal article discusses gender disparities regarding coronary heart disease (CHD) diagnoses, with doctors believing that their male diagnoses are more confident than their female diagnoses.

Disregarding the fact that the article still doesn't address GP's aforementioned complaint, the sample size used (n=128) is too small to make a firm judgement, with the ideal being at least n > 1000 to reduce potential statistical noise. The study also doesn't disprove the possibility of men being overdiagnosed with CHD.

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> https://www.americanbar.org/groups/crsj/publications/human_r...

This article addresses lower quality of healthcare received by minorities as opposed to white people. No links or direct references to cited studies/articles are given anywhere within the article, and the one time they do reference a source is to a book ("Just Medicine: A Cure for Racial Inequality in American Healthcare (2015)"), with no page citations to the aforementioned book made in the article. This article also doesn't address the GP's complaint at all.

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Personal opinion:

This type of shotgun-style link posting is a variant of the Gish Gallop, wherein the link poster forces participants to "do the research" via the cited links, only to waste their time by not directly addressing the concerns and complaints of the parent comment.

AaronM, at least spend a few minutes to find articles supporting:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6560804/

https://archive.is/fF4ND (Source: https://www.nytimes.com/2023/03/03/well/live/men-doctor-visi...)

https://www.cdc.gov/nchs/data/series/sr_13/sr13_149.pdf (page 17)

And opposing GP's claim:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3104816/

Re: A fourth of U.S. health visits now delivered by non-physicians

#140

Post by kortilla »

s1artibartfast wrote: post #134
kortilla wrote: post #97

Earlier quoted context omitted.

Then why not include high school? Unless the degree was exclusive to medicine, including it is bullshit. MDs have a glorified 4 year masters and an on the job training program not significantly different than what it takes to become a PE.

But you can become a PE without a masters. Would you say that PEs the only requirement for PE is 2 year Mentorship? Maybe people should be able to go straight into medschool with an associates or hs diploma

Yes
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