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The Dark Side of Doctoring

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Re: The Dark Side of Doctoring

#191

Post by maxerickson »

wfo wrote: post #189
pdonis wrote: post #140

Earlier quoted context omitted.

The demand for food is also pretty inelastic, yet the free market seems to handle that fine.

No actually it does not. The government subsidizes food production and food for the poor HEAVILY. Also food is cheap and plentiful to create. And most importantly, food is easy to steal; the one important factor in a functioning free market libertarians tend to forget about is the natural control at the bottom, for the poor: if the poor need something in order to survive and can't afford it, they act as a check on gr…

One of the motivations for Medicaid expansion in the ACA was to reduce the number of no-pay emergency room visits.

Re: The Dark Side of Doctoring

#192

Post by jghn »

dikdik wrote: post #96
pc2g4d wrote: post #45

So... because the supply of doctors is restricted but demand for doctors grows proportionally to the population, the amount of work per doctor gradually increases and doctors, persuaded by their ethical obligation of care, put up with it as long as possible until they snap. Yeah? I just recently had a friend completely burn out of medicine, sell his house, and start traveling the world. He was brilliant, a good docto…

A lot of physicians either push to restrict the supply of docs or look at this "issue" and do nothing about it. They do not want their wages to decrease by opening up the market (have had physician friends say this to me in words that make it sound less terrible). Cuba decided they wanted more physicians, so they invested in them to the point that they could use them as an export. If we have a shortage of doctors (wh…

Anecdote but I've worked with many MDs in my career and most of them very publicly express an "I got mine" attitude and scoff at any attempt to increase numbers or make the process less crushing

Re: The Dark Side of Doctoring

#193

Post by Para2016 »

riahi wrote: post #74
killjoywashere wrote: post #35

Earlier quoted context omitted.

There are ~30,000 PGY-1 spots and only about 18,000 allopathic medical school graduates. (1) All the native allopaths and all the osteopaths together can't fill all the residency spots. We inhale foreign medical graduates. (1) Pages v and 14: http://www.nrmp.org/wp-content/uploads/2017/04/Main-Match-Re...

This is a bit more nuanced than this. There's 31,757 positions offered. However, if you are applying into a specialty, you apply simultaneously for a PGY1 and PGY2 position, so those people are being double counted. As a result, you need to subtract 2,677 advanced positions from the 31k positions, yielding 29,080 PGY1 + PGY2. There are 18,539 US MD applicants, but with the merger of the ACGME and COCA, DO applicants…

I just wanted to reply to this comment with the NRMP match data for 2016. It's a pdf that we all use when applying for residency. Perhaps some people might find the information regarding each specialty's available positions/applicant number/median scores/etc helpful.

https://www.nrmp.org/wp-content/uploads/2016/09/Charting-Out...

Re: The Dark Side of Doctoring

#194

Post by themantalope »

paulcole wrote: post #120
themantalope wrote: post #98

Earlier quoted context omitted.

>It is wasteful to pay him a doctor's salary to answer phones. This is something I don't understand. I'm a medical student, and the amount of time I've seen wasted watching older physicians type notes is staggering. Just have them dictate the notes and hire a secretary. Perhaps for legal/liability reasons doctors need to write their own notes but it's just such a waste of time, and we pay a lot for it.

>we pay a lot for it. Do we really though? I'm assuming a doctor is a salaried position so the more busy work they get the more hours they work? Doesn't this mean their time becomes less valuable?

It really depends. Some are completely salaried positions. Some physicians are completely private so what they earn is directly tied to how much they work. Even those who are salaried often have some kind of compensation or bonus for extra work. And even if they are salaried, having physicians type notes is not making the best use of their training and time.

Re: The Dark Side of Doctoring

#195

Post by mfukar »

karpodiem wrote: post #49
pixelmonkey wrote: post #18

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…

Western medicine has turned into a ponzi scheme. The verifiable proof of this is to have an elderly family member in a nursing home who goes through the usual monthly trips to the hospital from 'falling'. While Medicare covers almost all of it, it became so nauseating to read the outrageous EOB totals that I tried to put a end to it - I requested that unless the on call nurse (after hours) or physician (during busine…

I think you mean medical care in the USA. The schemes health providers resort to over there are world-renowned.

Re: The Dark Side of Doctoring

#196

Post by stickfigure »

throwaway5752 wrote: post #148
seanp2k2 wrote: post #130

Earlier quoted context omitted.

200k is also on the low end. A friend of mine just finished her residency and is making almost twice that now. I did some on-site PC service for a few doctors in a job about a decade ago. They literally all had 911s and mansions. Anecdotal sure, but from what I've seen, doctors here are loaded. Anesthesiologist always seemed like the best gig....you work a few days a week, set up your schedule months ahead of time, b…

It's great until a patient dies and you have to inform their families. You are keeping a living being in a state between life and death chemically while they are undergoing massive trauma. Do you know how much their malpractice insurance is? It's not just hard work to become a doctor. It's hard work and sustained excellence. You don't just put in the hours, you have consume an enormous amount of information and are t…

You are keeping a living being in a state between life and death chemically while they are undergoing massive trauma.

Why can't this be automated?

Re: The Dark Side of Doctoring

#197

Post by Melchizedek »

The bourgeoisie has stripped of its halo every occupation hitherto honored and looked up to with reverent awe. It has converted the physician, the lawyer, the priest, the poet, the man of science, into its paid wage laborers.

Karl Marx

Re: The Dark Side of Doctoring

#198

Post by Retric »

rayiner wrote: post #92
karpodiem wrote: post #49

Earlier quoted context omitted.

Western medicine has turned into a ponzi scheme. The verifiable proof of this is to have an elderly family member in a nursing home who goes through the usual monthly trips to the hospital from 'falling'. While Medicare covers almost all of it, it became so nauseating to read the outrageous EOB totals that I tried to put a end to it - I requested that unless the on call nurse (after hours) or physician (during busine…

Everything is really easy if you hand-wave away the facts: https://www.cdc.gov/media/releases/2016/p0922-older-adult-fa... . Elderly Americans experience about 29 million falls per year, which costs Medicare $31 billion. At about $1,000 per fall that seems quite reasonable. 27,000 older Americans die from falls each year. In an institutional setting like a nursing home, the rate of death per fall is even higher. $700…

29,000,000 / 27,000 = ~1,074 falls per death. ~At 1,000$ per fall that's ~1,000,000$ per death which seems reasonable on average.

However, medical expenses are top heavy. Some of those falls probably cost 200,000+$ because they cause long term medial issues. If a faculty is spending ~1,000+$ on an a median fall their average is going to be much higher than that. Which is a sign they really are providing unnecessary procedures.

Re: The Dark Side of Doctoring

#199

Post by arjie »

EvanAnderson wrote: post #23
drewg123 wrote: post #21

It seems like we have an undersupply of physicians. My understanding is that the AMA limits medical school admissions[1] in order to keep salaries artificially high. This naturally leads to overwork in addition to high salaries. [1] http://www.usatoday.com/news/health/2005-03-02-doctor-shorta...

Here's the go-to that I send people to when this comes up: https://skeptics.stackexchange.com/questions/4561/does-the-a...

Classic. They moved a big ship and then tried to move it back and hysteresis took hold. This is what unions do. They're like giants without brains, pulling and pushing levers they do not understand. They're driven by short-term fear and reactive behaviour. The fact that they hold any sort of power here is an outrage.

It's quite clear to me what needs to be done here. America needs to import medical professionals. They're out there, they're needed here.

Re: The Dark Side of Doctoring

#200

Post by arjie »

drewg123 wrote: post #50
maxerickson wrote: post #28

Earlier quoted context omitted.

The why is complicated, it seems obvious enough that more doctors would be a good thing. Or at least, more practitioners. We don't need doctors with huge amounts of training to do every evaluation.

True, but the AMA seems to fight enabling other professions (nurses, pharmacists) from taking on roles traditionally held by doctors. I rather wish software engineering had a professional association with the lobbying power of the AMA.

It would be a damned nightmare. The practitioners are dying of overwork, their patients are dying due to being treated by people who can barely stand after 36-hr days, and meanwhile the professional association comes up with a worker wellbeing plan.

Incompetence on a national scale.

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