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Why doctors are sick of their profession

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Re: Why doctors are sick of their profession

#161

Post by lmm »

jjoonathan wrote: post #31
jprince wrote: post #26

I think we're the new independent professionals. Nobody has required a license to "practice technology" (yet, but I suspect California will find a way eventually...) and so we can do our job anywhere, for any hours, for any pay. Until bureaucracy swallows us up(as it does all professions ultimately) we'll have our golden age too.

It won't be bureaucracy that kills us but rather the inevitable grind of economics. Once our industry stops growing and the supply of programmers has a chance to catch up with demand, our bargaining position weakens and the impact will be felt across the board. Those in corporations will find higher expectations (even longer hours), less respect, lower pay, and fewer benefits. Those who are "independent" will find it…

The supply isn't growing that fast, given how the demographics are going and how poor most teaching is. And demand continues to grow very rapidly. If software really does eat the world, I can easily see a future where the number of available programming jobs exceeds the total population.

Re: Why doctors are sick of their profession

#162

Post by jasonisalive »

toasted wrote: post #159
tarr11 wrote: post #40

Earlier quoted context omitted.

In which country do you work as an anaesthesiologist?

NZ

Keep in mind that, well-paid and satisfied specialists aside, there is another side to this picture - important to remember with state-run healthcare systems such as NZ, so often a poster child for socialist policy.

For example this IT department head of a major district health board who embezzled ~$17 million dollars over a period of 6 years, with which to buy, among other things, luxury vehicles.

http://www.odt.co.nz/news/tags/michael-swann-0

http://www.odt.co.nz/news/dunedin/32268/fake-invoices-made-p...

Can you imagine this sort of thing happening in a free market for healthcare? I can't.

Re: Why doctors are sick of their profession

#163

Post by Bootvis »

jasonisalive wrote: post #162
toasted wrote: post #159

Earlier quoted context omitted.

NZ

Keep in mind that, well-paid and satisfied specialists aside, there is another side to this picture - important to remember with state-run healthcare systems such as NZ, so often a poster child for socialist policy. For example this IT department head of a major district health board who embezzled ~$17 million dollars over a period of 6 years, with which to buy, among other things, luxury vehicles. http://www.odt.co.…

That's unfortunate but the bottom line for patients is that the NZ works excellently.

Sure, it sucks that someone committed fraud and got rich in a dishonest manner but preventing that is not the goal. In the end, this fraud doesn't really affect the healthcare given.

Re: Why doctors are sick of their profession

#164

Post by jval »

toasted wrote: post #38

Non-US anaesthesiologist here. I love my job and relish going to work each morning. I spend almost no time on non-clinical paperwork. I work reasonable hours, have some busy on-call shifts but am generally well supported by my department. I earn good money in the state system - enough to raise a family comfortably and have a nice house, but not silly money. I pay no malpractice insurance, but pay $400 annually to a n…

The problem is that the United States isn't a 'country' in the way the UK, or Denmark, or Australia is. The entire population of Denmark is 5.59 million, the size of a single second or third tier city in the US. Australia is 22 million, the size of the NYC metro area. You can socialise and centralise healthcare in countries on such a small scale, but it becomes exponentially more difficult to do in a country like the US (pop: 313 M).

The United States is an enormous country comprised of 50 separate state governments, where the powers of the federal government are extremely limited (both by the constitution itself, and by the fact that it is practically impossible to do anything at that kind of scale).

As a result, it is extremely hard to pass any sort of massive reforms. Can you imagine how difficult it would be to pass one single, uniform system of health care for all Europeans?

Talking about solutions that work well in smaller countries is all well and good, but the reality is you need different solutions if you want them to work at scale. It's the same reason why most of Facebook's backend is now written in C++ instead of PHP. It is much more painstaking to work with and harder to pick up but when you're building a huge system of interconnected parts you want something that isn't going to fall over and die suddenly.

The supposed chaos and gridlock of the US political system is a feature, not a bug. It's the reason why if you look at a list of the world's oldest nations the United States is right at the top, and is one of the largest.

EDIT: Sorry - not saying the US's healthcare system is the best it can be and didn't make that clear enough. Just saying that comparing it to other countries won't help as the US has a unique political reality.

Re: Why doctors are sick of their profession

#165

Post by jasonisalive »

Bootvis wrote: post #163
jasonisalive wrote: post #162

Earlier quoted context omitted.

Keep in mind that, well-paid and satisfied specialists aside, there is another side to this picture - important to remember with state-run healthcare systems such as NZ, so often a poster child for socialist policy. For example this IT department head of a major district health board who embezzled ~$17 million dollars over a period of 6 years, with which to buy, among other things, luxury vehicles. http://www.odt.co.…

That's unfortunate but the bottom line for patients is that the NZ works excellently. Sure, it sucks that someone committed fraud and got rich in a dishonest manner but preventing that is not the goal. In the end, this fraud doesn't really affect the healthcare given.

NZ works excellently.

That is a pretty big claim... Have you ever actually lived in NZ and experienced the realities of paying for this system via taxes and claiming its services? Have you monitored the incessant demands for more services at better quality, the incessant complaints about being over-worked and underfunded, the endless criticisms and debates about inefficiency, long wait times, burdensome bureaucracy, poor outcomes, and unhappy doctors?

Outright fraud and corruption is just the tip of the iceberg of problems that naturally develop when a society decides to sever the act of consumption from the actual purchase of a service.

Re: Why doctors are sick of their profession

#166

Post by hvidgaard »

jval wrote: post #164
toasted wrote: post #38

Non-US anaesthesiologist here. I love my job and relish going to work each morning. I spend almost no time on non-clinical paperwork. I work reasonable hours, have some busy on-call shifts but am generally well supported by my department. I earn good money in the state system - enough to raise a family comfortably and have a nice house, but not silly money. I pay no malpractice insurance, but pay $400 annually to a n…

The problem is that the United States isn't a 'country' in the way the UK, or Denmark, or Australia is. The entire population of Denmark is 5.59 million, the size of a single second or third tier city in the US. Australia is 22 million, the size of the NYC metro area. You can socialise and centralise healthcare in countries on such a small scale, but it becomes exponentially more difficult to do in a country like the…

I can understand the political barriers to socialized healthcare in the US, for starters it would require a federal tax.

However, I am not buying the scale argument. What exactly makes it hard to scale? The only argument I've heard is that managing all doctors and hospitals, but that is trying to control everything, something that never works when you try to scale out, and isn't necessary either.

If anything the scale enables you to build large and very specialized hospitals that only deal with one particular aspect, e.g. cancer, and do some serious research as well.

Re: Why doctors are sick of their profession

#167

Post by jval »

hvidgaard wrote: post #166
jval wrote: post #164

Earlier quoted context omitted.

The problem is that the United States isn't a 'country' in the way the UK, or Denmark, or Australia is. The entire population of Denmark is 5.59 million, the size of a single second or third tier city in the US. Australia is 22 million, the size of the NYC metro area. You can socialise and centralise healthcare in countries on such a small scale, but it becomes exponentially more difficult to do in a country like the…

I can understand the political barriers to socialized healthcare in the US, for starters it would require a federal tax. However, I am not buying the scale argument. What exactly makes it hard to scale? The only argument I've heard is that managing all doctors and hospitals, but that is trying to control everything, something that never works when you try to scale out, and isn't necessary either. If anything the scal…

Politics is all about the money. Obviously administration is worse at scale too, but it comes down to political will in having the money to do it.

The way you keep a political union together without having it break apart is by limiting the amount of things the members of the union have to share. If you start taxing rich states and funnelling the money over to poor states, you give people a reason to want to break out of the union. Ultimately people only stay if they're getting a good deal.

Taxpayers in New York will definitely be happy if their money goes into the military, as having a New York rather than a US military wouldn't work. But to have all their money go into universal healthcare in Idaho would just piss them off, because people in Idaho can pay for that themselves. That's why healthcare is largely a state matter in the US - you'll find some states have great healthcare, others don't.

I'm not saying the US can't do it better (they clearly can), I'm just saying comparisons with other countries are useless because they don't take into account the unique political realities of the United States.

Re: Why doctors are sick of their profession

#168

Post by ThomPete »

jval wrote: post #164
toasted wrote: post #38

Non-US anaesthesiologist here. I love my job and relish going to work each morning. I spend almost no time on non-clinical paperwork. I work reasonable hours, have some busy on-call shifts but am generally well supported by my department. I earn good money in the state system - enough to raise a family comfortably and have a nice house, but not silly money. I pay no malpractice insurance, but pay $400 annually to a n…

The problem is that the United States isn't a 'country' in the way the UK, or Denmark, or Australia is. The entire population of Denmark is 5.59 million, the size of a single second or third tier city in the US. Australia is 22 million, the size of the NYC metro area. You can socialise and centralise healthcare in countries on such a small scale, but it becomes exponentially more difficult to do in a country like the…

I agree that Denmark don't scale. But that doesn't mean that the current system we have in the US is good or that the insurance based version is by any metrics the best possible solution for the US. You could also think in states instead.

If you look at it from a purely financial point of view the problem of the US system is that when given the choice, younger people don't insure themselves because they are healthy and so don't participate in financing those who are sick by costing the system less.

As they grow older and get sicker they end up paying insane prices unless they are paid by employees and even there the quality of the insurance varies and you still have some really absurd pre-existing conditions rules etc. If you don't have an employer to back you up you are basically screwed.

Obama Care is an attempt at solving this issue. It's not single payer but it's closer and hopefully it will help improving the healthcare system for millions of those without either healthcare or proper healthcare.

Now in my mind there is a middle ground where you pay most of your healthcare yourself (the checkups, the sinus infection etc) but you don't end up in endless debt because you become sick, your kid gets born to early and have to stay at a neonathal facility, for a longer period of time and don't have the right insurance.

And having been through the system I must say that if people think it's less beucratic than say they Danish system (which is much more social in its approach) then they would be mistaken. The sheer number of interests involved in any single episode creates complexity way beyond what seems reasonable.

So agree it's not possible to take a small nation and apply what they do, but it is possible to look at the current system and realize that the healthcare system in the US is def not a feature but rather a system with plenty of room for improvement.

Re: Why doctors are sick of their profession

#169

Post by ianstallings »

alexqgb wrote: post #63
toasted wrote: post #38

Non-US anaesthesiologist here. I love my job and relish going to work each morning. I spend almost no time on non-clinical paperwork. I work reasonable hours, have some busy on-call shifts but am generally well supported by my department. I earn good money in the state system - enough to raise a family comfortably and have a nice house, but not silly money. I pay no malpractice insurance, but pay $400 annually to a n…

It's not true to say that the US, in general, ignores these systems when in fact, a significant portion of the US population pays very close attention to them and would like nothing more than to seem them implemented here. There is, however, a significant minority of really horrible, angry, violent, and generally racist people who feel deeply and ideologically threatened by the social contract on which these systems…

Such a bunch of bullshit hand wavy name calling tripe. I'd respond with eloquence but it's completely undeserved in this case. And to think you call others trolls. That in itself is humorous.

Re: Why doctors are sick of their profession

#170

Post by jval »

ThomPete wrote: post #168
jval wrote: post #164

Earlier quoted context omitted.

The problem is that the United States isn't a 'country' in the way the UK, or Denmark, or Australia is. The entire population of Denmark is 5.59 million, the size of a single second or third tier city in the US. Australia is 22 million, the size of the NYC metro area. You can socialise and centralise healthcare in countries on such a small scale, but it becomes exponentially more difficult to do in a country like the…

I agree that Denmark don't scale. But that doesn't mean that the current system we have in the US is good or that the insurance based version is by any metrics the best possible solution for the US. You could also think in states instead. If you look at it from a purely financial point of view the problem of the US system is that when given the choice, younger people don't insure themselves because they are healthy a…

Sorry - edited my post to make clearer the fact that I'm not saying the US's healthcare system is good. I just think that comparisons with other countries are futile. My comment was intended to be a general one about the way politics works in the US.
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