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The darker side of being a doctor (2017)

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Re: The darker side of being a doctor (2017)

#201

Post by nradov »

phren0logy wrote: post #107
robocat wrote: post #101

Earlier quoted context omitted.

> hospitals are so overloaded How do you suggest we limit the demand for healthcare?

In the US, anyone can walk into the emergency room for treatment, but people who don’t have insurance are very unlikely to participate in preventative care. The way to decrease demand For complicated and expensive interventions to preventable problems is to increase access to preventative care.

I support increasing access to preventative care, but I doubt that will do much to decrease demand. Currently about 92% of US residents have medical coverage, and that gives them free access to preventive care services which are proven to be a net benefit.

https://www.healthcare.gov/coverage/preventive-care-benefits...

But demand is increasingly driven by chronic medical conditions caused by lifestyle issues and local environments: obesity, substance abuse, sedentary lifestyles, toxin exposure, excess stress, lack of sunlight, etc. Those issues will have to be addressed through social policy rather than the healthcare system.

Re: The darker side of being a doctor (2017)

#202

Post by ndjshe3838 »

tejohnso wrote: post #192

> I had worked in a hospital where I was oncall 24/7, 12 days out of 14. I had fortnightly weekends off. Why would you do this? Some of the most basic labour jobs have better employment terms than this. > You might ask, why can’t you work less? It’s not as easy as that. If I decide to work less, who is going to cover the hospital? Yes, I did ask. But covering the hospital isn't your problem, that's a hospital managem…

Because they actually care about the patients and the work is critical?

You can’t just job hop like in tech?

It’s like everyone on this site views the whole world through a super narrow “tech worker” lense and assume every job works the same and everyone has the same motivations as people in tech

Re: The darker side of being a doctor (2017)

#203

Post by p1esk »

nradov wrote: post #190
triceratops wrote: post #108

Earlier quoted context omitted.

> The bottleneck right now in producing more US physicians is lack of Medicare funding for residency slots... Congress hasn't significantly increased funding in years. Much routine care can be delivered by Physician Assistants or Nurse Practitioners working under a Physician's supervision We should all accept a lower standard of care because hospitals can't find more funding to train doctors? What are all the $20 asp…

Where would you suggest that teaching hospitals find more funding? Most of them are non-profits, or operate as part of state or local government agencies. They have no ability to negotiate higher rates with Medicare/Medicaid and only limited ability to negotiate higher rates with private payers (typically set as a multiplier to the Medicare rate). Voters generally haven't been willing to raise taxes. There is probabl…

Are you talking about the same hospitals that tripled the administrators to doctors ratio in the last 50 years (don’t remember exact numbers)? Is that why we need to accept a lower standard of care?

P.S. wait, you went to a hospital to apply a bandaid after you fell off your bike? Are you serious? Perhaps that’s the real problem…

Re: The darker side of being a doctor (2017)

#204

Post by lukan »

CydeWeys wrote: post #197
game_the0ry wrote: post #176

Earlier quoted context omitted.

Have you? I’d love to hear that answer.

I have. Longer shifts with fewer turn-overs results in better patient outcomes.

And that makes sense, but only if there are enough breaks and downtime in between, and probably not if the doctors hasten from one patient to the other.

Could you link the studies?

Re: The darker side of being a doctor (2017)

#205

Post by sensanaty »

eclectic29 wrote: post #78

Thanks for sharing. This is so disheartening. The other day I was debating with my friends how a doctors life is so cool that they don’t have to go though grueling coding interviews every single time they want to change jobs, don’t have to prove themselves every single quarter, don’t have to be answerable to anyone or write performance reviews or be subjected to arbitrary rubrics. Boy, I was so wrong. Every processio…

I get what you mean, but doctors also go through a decade+ of medical school+being on rotation. Lots of devs out there (myself included) without even a bachelor's.

Same reason why classical engineering fields don't do anything like leetcode, those engineers are actually accredited.

Re: The darker side of being a doctor (2017)

#206

Post by [deleted] »

tejohnso wrote: post #192

> I had worked in a hospital where I was oncall 24/7, 12 days out of 14. I had fortnightly weekends off. Why would you do this? Some of the most basic labour jobs have better employment terms than this. > You might ask, why can’t you work less? It’s not as easy as that. If I decide to work less, who is going to cover the hospital? Yes, I did ask. But covering the hospital isn't your problem, that's a hospital managem…

[deleted]

Re: The darker side of being a doctor (2017)

#207

Post by hollerith »

tmpz22 wrote: post #59
hollerith wrote: post #47

Earlier quoted context omitted.

That explains why doctors like the status quo. Insurers like it, too, because expensive tests and expensive procedures must be ordered by a doctor (at least if insurance is going to pay for it) and if the patient gives up on getting in to see a doctor, then the insurer does not need to pay for the expensive test or expensive procedure. In the US, employers like it, too, because they end up paying the insurance premiu…

And the schools prefer it (at least in the US) - limited highly paid doctors means they can charge exorbitant tuition.

I would've thought that the medical schools care about revenue, which is course can be increased both by raising tuition and by increase number of students.

Re: The darker side of being a doctor (2017)

#208

Post by mewpmewp2 »

catlikesshrimp wrote: post #164
rr808 wrote: post #152

Earlier quoted context omitted.

I think its similar worldwide. Like I said my brother quit. Its also true that IT people are ridiculously overpaid. Both problems will inevitably revert to the mean.

Not everywhere though. The life of a doctor is much better in Costa Rica, even in public institutions. The extra time is paid. And the syndicates are strong (which has worked well) The doctors in Nicaragua, the neighboring country, is as described in your comment, except the economy of the whole country is in shambles, and they also have to "voluntarily" participate in "government" political activities. Oh, and since…

But Costa Rica has one of the longest wait times for non emergency surgeries.

https://www.oecd-ilibrary.org/sites/f8ac5867-en/index.html?i...

So high wait times there doesn't sound entirely perfect either.

Re: The darker side of being a doctor (2017)

#209

Post by georgeburdell »

jajko wrote: post #135
rr808 wrote: post #125

Earlier quoted context omitted.

An associated problem is that bright people from rural or poor areas who are really passionate about being a doctor dont get the right grades to get in. Middle class kids in cities get in because its a good career but dont really like it that much and definitely dont want to work outside their city. My brother worked as a doctor until his thirties then quit, such a waste of training.

In Switzerland, at least for the french part, most of the doctors are not Swiss anymore. It literally became white collar immigrant job. Wife is one of those and sees the problem very clearly due to speaking about this with both (those few) swiss colleagues and the rest - its simply not attractive career path for locals, too much suffering and risk for relatively little reward. Those bright enough go to law, IT and s…

Potentially controversial opinion, but perhaps it is exactly the immigrants who are enabling the dysfunction to continue? I imagine tougher decisions would have been made to balance doctor quality of life with patient outcomes without immigrants taking whatever abuse the current system throws at them.

Re: The darker side of being a doctor (2017)

#210

Post by cqqxo4zV46cp »

georgeburdell wrote: post #209
jajko wrote: post #135

Earlier quoted context omitted.

In Switzerland, at least for the french part, most of the doctors are not Swiss anymore. It literally became white collar immigrant job. Wife is one of those and sees the problem very clearly due to speaking about this with both (those few) swiss colleagues and the rest - its simply not attractive career path for locals, too much suffering and risk for relatively little reward. Those bright enough go to law, IT and s…

Potentially controversial opinion, but perhaps it is exactly the immigrants who are enabling the dysfunction to continue? I imagine tougher decisions would have been made to balance doctor quality of life with patient outcomes without immigrants taking whatever abuse the current system throws at them.

Ah, yes. Literal victim blaming.
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