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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

#111

Post by humanrebar »

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 -…

Healthcare has been such a regulated industry in every aspect that anecdotes like these do little to discredit free markets.

Re: How Being a Doctor Became the Most Miserable Profession

#112

Post by hershel »

idiot900 wrote: post #70
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…

> greater human trust in computers and recommendation systems I am an MD and have a degree in CS. Expert systems are not remotely there yet for this purpose. On no planet would I trust care of my patients to a computer. Far too many subtleties involved in accurate diagnosis and treatment that are not encoded in a machine-readable format. > legal regime which mandates DOCTORS perform procedures, and only after a lengt…

There's some research that at least some expert systems("decision support system") implemented in the right culture do improve medical services[1].

But still due to huge resistance by doctors, who like the autonomy of the job, such systems are rarely used.

I could only imagine how rapidly such systems would improve if the backbone of medicine would be dependent on them, and enough revenue would be shifted towards them.

[1]http://www.ncbi.nlm.nih.gov/pubmed/24573664

Re: How Being a Doctor Became the Most Miserable Profession

#113

Post by nathanvanfleet »

HIbachikabuki wrote: post #87
idiot900 wrote: post #70

Earlier quoted context omitted.

> greater human trust in computers and recommendation systems I am an MD and have a degree in CS. Expert systems are not remotely there yet for this purpose. On no planet would I trust care of my patients to a computer. Far too many subtleties involved in accurate diagnosis and treatment that are not encoded in a machine-readable format. > legal regime which mandates DOCTORS perform procedures, and only after a lengt…

It's not that simple. A society cannot afford the triple-A gold standard of everything for everybody. Not everybody can live in a McMansion and not everybody can afford to have an MD/CS for their every single health need, no matter how minor or how routine. Tradeoffs have to be made. US medicine has been very successful at creating a guild system that's prevented lower-cost provision of care for decades, all under th…

I like people from the US who want to cut out people poorer from being helped by an MD because it's "impossible"; when so many other developed countries seem to manage with it just fine.

Re: How Being a Doctor Became the Most Miserable Profession

#114

Post by dataminer »

ams6110 wrote: post #86
rdmcfee wrote: post #14

In Canada our GPs are paid approximately $31 for a regular visit. They pay their overhead out of this $31 and still typically keep 65-70% of their billings. It's amazing that the billing costs in the US are a factor of magnitude higher.

What is the malpractice liability exposure for a Canadian doctor? In the US, malpractice insurance is a huge expense for most doctors, and for some specialties (e.g. obstetrics) it's very close to prohibitive.

Canadian doctors are protected taxpayer subsidized insurance called CMPA. Typical cost is 1/10th of what it costs in US.

http://en.wikipedia.org/wiki/Canadian_Medical_Protective_Ass...

Re: How Being a Doctor Became the Most Miserable Profession

#115

Post by cylinder »

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…

With Pay As You Earn a debtor won't pay more than 10% of AGI to federal student loans. Note that's AGI, not gross income, meaning you can contribute to retirement and not have it counted. Loans aren't as big of a constraint on career options as people make them out to be. Debtors are also willfully ignorant of these sorts of options and choose to instead destroy their lives paying debts that don't need to be paid.

To be clear, it's a huge problem, and we shouldn't have this sort of debt loads on those who want to educate themselves. It also weakens the broader economy and drives up professional services costs. But to say people are killing themselves because of student loans is a mistake.

Re: How Being a Doctor Became the Most Miserable Profession

#116

Post by cloverich »

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…

> but most make way more than $300k after only a handful of years of experience.

'Eh, not really [1]. Most will wind up in the upper $100k region (most being in some form of primary care). Not after a handful of years, but 4+ yrs college, 4+ yrs medical school, then bare minimum 3 year residency (with most 4+), with each step an order of magnitude more difficult.

> most doctors are sons and daughters of rich folks

Many are, but since we're in the anecdata game, none of my friends were.

Not going to lose sleep over it, upper $100's is plenty to compensate for high debt in the long run. But to pretend its not extremely stressful for most is to be misinformed.

Lastly: > 5 years of service in a shortage area

After spending the last 2 years in a qualifying region (though not for that purpose); topping off 12 yrs of post-high school with another 5 living somewhere you'd rather not be (to be polite) is no small feat. Thats 35 yrs old before you get a shot at living and working somewhere reasonable.

[1] http://www.medscape.com/features/slideshow/compensation/2013...

Re: How Being a Doctor Became the Most Miserable Profession

#117

Post by selmnoo »

dfc wrote: post #76
selmnoo wrote: post #44

Earlier quoted context omitted.

> 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…

> True, but as it turns out, most doctors are sons and daughters of rich folks > (at least that's what sister tells me, who's doing her residency now). Lets pretend that anecdata is useful and assume that it is generalizable to the entire population of med students. Do you think the prevalence of rich kids is alarming? Possibly an indication that something needs to change in the financing of healthcare or healthcare…

Yes, clearly it is a problem that only the rich are able to have the resources to get ahead. But this is a much bigger problem than who's able to become a doctor and who's not, it has to do (imo) with the greater issues of society, like new parents being unable to provide high quality preschool education, mom and dad still working when kids are teenagers and need attention and guidance, and so on. I'm a fan of quasi-socialistic, progressive-taxing to ensure everyone gets the resources.

I'm from a brown immigrant family. Brown/Asian immigrants seem to be exceptions everywhere, in that they're usually poor starting out and still persevere and make it through medical schools and whatever else. My family now is doing quite okay, but is probably still below the average residency student's family. The way it looks to me (anecdata), the average residency student's family has a household income of 1mil+. My family's household income is barely 200k, so make of that what you will.

Re: How Being a Doctor Became the Most Miserable Profession

#118

Post by [deleted] »

riahi wrote: post #110
Retric wrote: post #108

Earlier quoted context omitted.

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…

[deleted]

Re: How Being a Doctor Became the Most Miserable Profession

#119

Post by riahi »

cylinder wrote: post #115
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…

With Pay As You Earn a debtor won't pay more than 10% of AGI to federal student loans. Note that's AGI, not gross income, meaning you can contribute to retirement and not have it counted. Loans aren't as big of a constraint on career options as people make them out to be. Debtors are also willfully ignorant of these sorts of options and choose to instead destroy their lives paying debts that don't need to be paid. To…

While it is true that PAYE is capped at 10% of AGI, if you have an average medical school debt and are making a resident's salary, your payment will be less than your interest accrued each month. PAYE does nothing to cap your interest.

Further, implying that Doctors are willfully ignorant of loan financing options is...interesting. All Federal borrowers are required to complete exit loan counseling upon graduation from medical school. That counseling includes discussion of the various repayment options (Standard, Extended, ICR, IBR, PAYE, and forbearance).

Re: How Being a Doctor Became the Most Miserable Profession

#120

Post by riahi »

mudil wrote: post #77
mudil wrote: post #68

Earlier quoted context omitted.

I am a doctor, an anesthesiologist. I don't like AMA. But to blame AMA is a complete nonsense. (AMA really is just an insurance and loan agency, just like AARP.) The real problem is government regulation of our profession, of the whole clinical process, and of devices and medications. Those of you who go up in arms when government sticks its nose in your internet business, should imagine how it is to deal with the go…

The Association of American Medical Colleges (www.aamc.org) sets number of medical students, and not AMA.

The number of medical students is wholly irrelevant to the conversation at hand. We currently have more residencies than medical students, so spots are filled by foreign medical grads.

However, in about 2-3 years, there will be more American medical students than there will be residency spots. Still have the same problem: the bottleneck in training is the residency.

So, blaming the AMA or AAMC for keeping medical student numbers down is pointless. They are not the final gatekeeper for the creation of doctors. Residency training is that gatekeeper.

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