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How Being a Doctor Became the Most Miserable Profession

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Re: How Being a Doctor Became the Most Miserable Profession

#101

Post by judk »

nilkn wrote: post #38
SapphireSun wrote: post #15

I don't get why overworked personnel aren't regarded as a dire safety issue. There's a reason the FAA restricted the number of hours commercial pilots are allowed to fly per week without rest. http://www.usatoday.com/story/todayinthesky/2014/01/03/pilot... I met a resident the other day, and they routinely get four hours of sleep or less and worked for shifts that are insanely long that are basically dictated by pati…

> Maybe medical school prices would go down with additional scale. It seems like a bit of a chicken and egg problem. Medical school is already so expensive that the salaries are necessary in order for newly minted doctors to have the same disposable income after loan payments that, say, a programmer or chemical engineer who's 7 years younger has (4 years medical school + 3 years residency minimum). Who would make the…

So, Apple suppressing engineer wages indirectly made the medical profession more attractive for doctors!

Re: How Being a Doctor Became the Most Miserable Profession

#102

Post by riahi »

Retric wrote: post #98
riahi wrote: post #84

Earlier quoted context omitted.

I hate to make this a common refrain, but I make this same comment every time I see a comment like yours: The supply of doctors is not restricted by the AMA. The supply of doctors is determined by the number of residency spots available to new graduates; that number is entirely determined by the Centers for Medicare and Medicaid (CMS). Thanks to the Balanced Budget Act of 1997, Graduate Medical Education (GME) was dr…

Why exactly must the government pay for it? It seems obvious if it's a net cost it really should be paid for by the students. Also, if you could go to med school without an undergraduate degree you can increase the number of years a doctor could work thus lowering costs and increasing supply at the same time.

Well, someone has to pay the salaries of medical trainees. Who would you suggest do it?

Since the establishment of Medicare/Medicaid, CMS pays hospitals a set amount per year per resident. I suppose you could mandate that teaching hospitals be forced to foot the bill themselves, but most teaching hospitals have disproportionately high Medicaid and uninsured patient populations, so they aren't exactly swimming in cash.

Note: I'm editing my post, as you have edited yours.

Well, if you make students pay additional tuition / take loans for living expenses during residency training, then you can kiss goodbye the thought of ever fixing the doctor shortage. Think about what you're advocating here: Someone who just took out a $160k unsubsidized loan at 5.4% (variable) interest now has to increase his/her loan burden just. to. eat. for another 3-7 years while interest is accruing on that initial medical school balance. Does this seem like a sustainable system to you?

Man, I thought HN/Silicon Valley/Tech Industry was all up in arms at the unjustness of the unpaid internship...

Re: How Being a Doctor Became the Most Miserable Profession

#103

Post by [deleted] »

rflrob wrote: post #88

"Just processing the insurance forms costs $58 for every patient encounter, according to Dr. Stephen Schimpff, an internist and former CEO of University of Maryland Medical Center who is writing a book about the crisis in primary care." I'm curious how the arithmetic on that works out. The median pay for medical assistants is $14.12/hour [1], which means that assuming the assistant is handling the insurance form, tha…

[deleted]

Re: How Being a Doctor Became the Most Miserable Profession

#104

Post by DanBC »

jseliger wrote: post #11

Also relevant: I wrote "Why you should become a nurse or physicians assistant instead of a doctor: the underrated perils of medical school" ( http://jseliger.wordpress.com/2012/10/20/why-you-should-beco... ) based on watching the experience of my fiancée and her friends and peers. EDIT: In the essay I describe why it can become so hard to leave medicine after one has invested more than a year or two in med school bec…

Another explanation of the suicide rate: doctors have access to means and methods of completing suicide. They are also aware of techniques that make completed suicide more or less likely.

Re: How Being a Doctor Became the Most Miserable Profession

#105

Post by momerath »

vacri wrote: post #63
eldavido wrote: post #13

This is completely a story of industry structure and bad incentives, and how people react to them. Currently, in the United States, we believe all of the following things: (1) Human physicians, are the only qualified parties to diagnose, treat, and/or recommend courses of action related to health (not nurses, physician's assistants, computer programs, etc.), (2) everyone has a fundamental right to healthcare, (3) hea…

give medical professionals more operational and financial freedom to run their practices using tried-and-true free-market principles. They are not tried and true. A friend of mine worked as a QA engineer at my city's most prominent children's hospital (a minor power on the world stage). His thankless task was to find ways to improve communications between departments and curb the errors. It was simply not possible -…

I worked in a hospital, and saw similar things, but I think the moral of the story is that huge organizations operate internally more like a feudal oligarchy. They crystallize, regardless of the external market.

Re: How Being a Doctor Became the Most Miserable Profession

#106

Post by nathanvanfleet »

selmnoo wrote: post #44
[deleted] wrote: post #32

Earlier quoted context omitted.

[deleted]

> To pay this off in 10 years, the monthly payment would be on the order of $3400. Once employed, hospitals agree on some arrangement in which they help pay sometimes up to as much as 50% of their loans (HRSA alone pays $170k in loan repayment to primary care docs for 5 years of service in a shortage area). And I don't know what kind of doctors you guys have been hanging out with, but most make way more than $300k af…

Yes, and who is complaining about how inner city minorities can't pay their medical school bills. Answer is that they never had the resources to get into it no matter how interested they were in it. So this sounds more of a tiny violin "wish I became a banker, like my dad" sort of thing.

Re: How Being a Doctor Became the Most Miserable Profession

#107

Post by will_work4tears »

commandar wrote: post #49
[deleted] wrote: post #32

Earlier quoted context omitted.

[deleted]

>Granted, the salary will probably hit $200k with some years of experience More if they're specialty and/or surgical. One of the side effects of most hospitals being organized as non-profits is that they have to disclose the compensation level of their five highest-compensated, non-board/officer employees. I know at my hospital (mid-size, 250k metro area, ~$35k median income) that number ranges from $750k-1.2M. Grant…

I dunno, I saw some statistics that put the median salary of a GP at 130k. That's in the Seattle Metro area too. Certainly some of the top make much more, but there are obviously programmers that make 400k too, but I can't expect that myself, or say that if you are a programmer you'll likely make that much.

Re: How Being a Doctor Became the Most Miserable Profession

#108

Post by Retric »

riahi wrote: post #102
Retric wrote: post #98

Earlier quoted context omitted.

Why exactly must the government pay for it? It seems obvious if it's a net cost it really should be paid for by the students. Also, if you could go to med school without an undergraduate degree you can increase the number of years a doctor could work thus lowering costs and increasing supply at the same time.

Well, someone has to pay the salaries of medical trainees. Who would you suggest do it? Since the establishment of Medicare/Medicaid, CMS pays hospitals a set amount per year per resident. I suppose you could mandate that teaching hospitals be forced to foot the bill themselves, but most teaching hospitals have disproportionately high Medicaid and uninsured patient populations, so they aren't exactly swimming in cash…

If there doing useful work that offsets the need to supervise them then the patents should foot the bill for the net benefit. If there not doing useful work then there is no need to pay them.

Edit: As to fixing the shortage IMO remove the need for undergraduate education and you add 3+ years to a doctors career and lower costs. However, my point is you can have a sliding scale where they might make nothing for 3 months, minimum wage for 3 months, on up to full pay at year 7. Or however the cost/benefit equation works out such that there is no need for a subsidy.

Re: How Being a Doctor Became the Most Miserable Profession

#109

Post by philsnow »

nine_k wrote: post #55
mentalhealth wrote: post #27

Earlier quoted context omitted.

It's extremely difficult to study the effects of sleep deprivation on the rate of medical error, but several studies have shown that the highest numbers of medical errors occur during handoffs between shifts. Reducing the frequency of those handoffs by increasing shift length reduces the total number of detectable medical errors. Additionally, the work hour restrictions placed on residents over the last few years app…

Longer shifts does not mean that doctors can't have longer sleep that 4 hours. Let doctors have 16 or even 18-hour long shifts interleaved with days without shifts at all, for sleeping and some [light] paperwork.

This is, I believe, how firefighters work: long shifts of oncall where they live in the firehouse, separated by longer periods of non-work (rest, sleep, whatever).

Re: How Being a Doctor Became the Most Miserable Profession

#110

Post by riahi »

Retric wrote: post #108
riahi wrote: post #102

Earlier quoted context omitted.

Well, someone has to pay the salaries of medical trainees. Who would you suggest do it? Since the establishment of Medicare/Medicaid, CMS pays hospitals a set amount per year per resident. I suppose you could mandate that teaching hospitals be forced to foot the bill themselves, but most teaching hospitals have disproportionately high Medicaid and uninsured patient populations, so they aren't exactly swimming in cash…

If there doing useful work that offsets the need to supervise them then the patents should foot the bill for the net benefit. If there not doing useful work then there is no need to pay them. Edit: As to fixing the shortage IMO remove the need for undergraduate education and you add 3+ years to a doctors career and lower costs. However, my point is you can have a sliding scale where they might make nothing for 3 mont…

Removing the need for undergrad does nothing to increase the supply. I also fail to see how it reduces costs. Everything is bottlenecked at the residency step.

Current billing rules do not allow for additional reimbursement just because a trainee took care of a patient. You're basically saying the hospital should foot the bill. Fine. That's a valid argument, but then you've got the problem of convincing hospitals to open up residency slots to train more doctors (and pay for them) instead of just hiring a PA/NP or two.

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