121–130 of 241 posts
The FAA enforces work limitations on pilots, but we schedule our health care workers like this? How are there not even civil cases against errors caused by this kind of administrative foolishness? Overworking doctors like this is insane.
The training for airline pilots is a lot less than for doctors. A couple thousand hours of flying, many of which can be paid work (like flying an add banner).
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The latest example from CMS is the Readmission Reduction program; https://www.medicare.gov/hospitalcompare/readmission-reducti... In general, Medicare pays a certain amount of money for a patient with a specific diagnosis. So if 70-year old woman X is admitted with condition Y, the hospital will receive $Z for treating her -- no matter what it costs. Hospitals don't love that since having patients in beds is expensiv…
Medicare is obviously a big part of healthcare, but is this same pay for performance happening with private insurance? How has the consolidation of hospitals impacted this? Has it become harder to negotiate these deals with massive hosptital networks?
It doesn't read, "You saw 100 patients at $100/patient, here's $10,000."
It's more like, "You saw 100 patients, here's your per-patient fee of $50. You prescribed 87% generic medicines, which for a doctor with your patient population in your area underperforms by 2 percentage points, this equates to a $1,400 bonus -- if you prescribed 91% generics, this bonus would be $2,500. Only one of your patients required an off-formulary medcine, your bonus here is $500."
There are a lot of competing interests right now, the formerly independent doctor groups are all merging together, insurance companies are merging, hospitals are merging. There's also a big push for risk-based reimbursement:
http://www.mckesson.com/bps/blog/riding-the-shifting-landsca...
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They actively pursue minimizing the number of medical school seats and their lobbying has been tightly aligned with Republican health care policies for decades. Check out Paul Starr's The Social Transformation of American Medicine
The limiting factor to creating more skilled physicians is not medical school admissions. It's residency training slots. Most residency training slots rely on federal government funding. Pretty much everyone, including the AMA, agrees that there is a looming undersupply of physicians. There may be disagreement on the best way to address the issue, but there is little disagreement among physicians about the fundamenta…
The AMA caters to a base that is not happy with the influx of IMGs and DOs. The AMA inflates their numbers by auto-enrolling every allopathic medical student. The AMA is equally unhappy that the government using large scale funding levers at the residency level to overwhelm their efforts to tighten supply. By using money and their exclusive access to legislate, the government creates such a Venturi effect that they suck up all the available MDs, and all the available graduates from two other pipelines: the DO programs and the IMGs.
In 2017, the dissatisfaction of the 85% of physicians who don't belong to the AMA is ultimately driven by too much work.
Source: am physician. Have worked primary care, seeing 40+ patients a day, now completing a specialist residency. My work as an underpaid primary care doc was enough to keep 3-5 people fully employed (reception, x-ray certified assistant (sometimes 2), office manager, owner) from 8 am to 10 pm 7 days a week, while sending overflow to others.
Every one of the 85% of physicians who aren't in the AMA declined to renew their membership at some point. Many align with other orgs: almost invariably their specialty's organization, which aligns with the AMA but they are more professionally beholden to (for CME, board certification, etc). Many try to offset the ill effects of the AMA by aligning with other orgs like PSR or MSF or their local public clinics.
But the AMA has a bunch of offices in DC, and has had people in those offices, paying mortgages in McLean or Chantilly, or Silver Spring, for a century. Those people are motivated to continue their mission of lobbying in support of the legal grip of allopathic medicine, long past their original call to arms (licensure laws to cleanse the field of snake oil salesmen).
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There's one big difference between software engineers and healthcare: regulation. A software engineer is hired for their skills (at least ostensibly). No one is required by law to hire someone with a specific degree and specific post-degree training and specific exams. Contrast this with healthcare. To do certain sorts of procedures, you have to hire a physician. Not because it's demonstrably necessary to have someon…
I'll just pick up on one piece of what you said, "meds from a psychologist." While I don't disagree that greed may be a part of it, unless that person's extra training involved a medical degree... that's truly been a crazy idea given the things that can go wrong even with "simple" medications, even when you know what questions to ask about other preexisting conditions and how to interpret the answers. The other thing…
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There's one big difference between software engineers and healthcare: regulation. A software engineer is hired for their skills (at least ostensibly). No one is required by law to hire someone with a specific degree and specific post-degree training and specific exams. Contrast this with healthcare. To do certain sorts of procedures, you have to hire a physician. Not because it's demonstrably necessary to have someon…
I have a hard time believing that the "free market" can solve healthcare given that the demand for it is more inelastic than pretty much any other product.
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Absolutely it's about the administrative end and not patient care. We've got a situation in our regional health authority (Vancouver Island, BC, Canada) where they're trying to roll out a significant update/expansion to their EMR (Cerner-based) in the hospital in Nanaimo. Despite immense pressure, some docs have been now suspended for refusing to use it and switching back to paper, despite the massive increase in tim…
This is a pretty shocking opinion to see expressed. Like, you may as well have said "A bunch of developers at decided to go back to C89 because writing code in Rust was too slow, plus did you see the bugs in its borrow checker?" . Do you really believe that paper is a safer alternative?
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Couldn't agree with you more re RACS, I attended their 'gala ball' at the end of their ACS last year and was sickened by the pomp and bullshit. The (female) RCS president, visiting from England, also appeared weirded out by the pomp (and that the RACS had not had a female president). Having said that within both organisations there are people who strongly and fiercely advocate for innovation and change, but you are r…
I don't know too much about the RACS etc (father was a radiologist but can't recall him complaining about their equivalent in Aus too much, though it's likely the same). If you have to be a member of this, and that's government mandated, then them profiting from that arrangement is a blatant monopoly isn't it?
I actually attended the ICOSET conference for 2 days prior to the ACS and there was much discussion over it.
For example, compared to the US situation, where surgical training is run by the universities, surgical accreditation is done by the Board Examinations, and the ACS is essentially just a bit of a union/membership organisation (You can not pass your boards and practice surgery in the US although it cant be good for your insurance), RACS is both trainee selector and accreditor.
There is talk about accreditation being devolved (Macquarie University Hospital is apparently trying to do a course for Neurosurgery) and the Orthopaedics guys left the RACS a few years ago to start their own body (but with similar principles, ie they select trainees and accredit). The MUH model seems interesting but has it's own problems because rumour is they want to charge ~$150k to do their training course. So essentially we have the americanisation of our quaternary training, which I don't agree with.
It's hard to see a real way forward; and even if another organisation came around and said they were going to start training surgeons, they have a couple problems: getting surgeons to say that they are happy to be the Trainers for them and getting hospitals to allow that organisation to train them.
A similar problem exists with the RACGP and it's (my opinion) much better, more nimble and beneficial to the Australian Population Australian College of Rural and Remote Medicine. ACRRM has been steadily building up to become a formidable training force for GPs particularly in rural and remote australia wityh a focus on TRUE generalism, ie GPs that run scope lists, minor surgery, obstetrics and aesthetics. The RACGP has a firm focus on city GPs and City training despite a desperate need for ACRRM/rual generalists. RACGP this year has put the state governments over a barrel and said that trainees must now do X amount of time in a big city, and that rural training is not going to count for as much; with the result that current ACRRM trainees may not make cutoffs in terms of time worked in city practices and fail to achieve their final qualifications. So basically RACGP is making moves to push ACRRM out of the way by introducing changes that benefit it over ACRRM.
all terribly interesting/boring, depending on how much you care about petty politics :)
Perhaps the solution to the unreasonable demands placed on Doctors/Surgeons is moving forward with A.I, Stem Cell research, Robotic surgery, etc. Technology should relieve some of the pressure.
To apply AI at the start of the process makes a lot of sense -- reduce/eliminate errors at the start and allow doctors and their time to be better used.
[1] http://www.nydailynews.com/news/world/ibm-watson-proper-diag...
[2] http://www.businessinsider.com/ibms-watson-may-soon-be-the-b...
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It's well known within the medical field that being a doctor is really really tough. It takes a lot of smarts and grueling years in residency before you officially become a doctor. However it also pays incredibly well. Even moreso for specialities and surgeons, who can make over 200k a year even in low cost of living areas. Despite the difficulties of being a doctor it's harder to get into medical school than ever. T…
It pays well because supply is constrained and demand is inelastic. It isn't clear how much the grueling training actually factors in to limiting the supply.
My wife is a medical resident and the issues described by this doctor are absolutely pervasive in residency. The strange part is, the overwork also seems to be pervasive among the attending physicians who have been out of residency for decades. Not just the residents. As a tech founder analyzing the system from the outside, I think this writer has nailed the core issue: "... a doctor is just one of the many commoditi…
It's well known within the medical field that being a doctor is really really tough. It takes a lot of smarts and grueling years in residency before you officially become a doctor. However it also pays incredibly well. Even moreso for specialities and surgeons, who can make over 200k a year even in low cost of living areas. Despite the difficulties of being a doctor it's harder to get into medical school than ever. T…