The planning of U.S. physician shortages (2020) • Hacker News Board

Re: The planning of U.S. physician shortages (2020)

#291

Post by lostlogin » Sat, Jun 03, 2023, 7:12 PM UTC

whimsicalism wrote: post #260

2b3a51 wrote: post #116

Earlier quoted context omitted.

UK: there was a proposal to introduce weekend surgery to make better use of operating theatres. The problem is staffing the facilities. Lead times on training people are long. And in UK the training process is not cheap and has significant up-front costs for the people being trained. Nurses as well as surgeons. We used to have bursaries to cover the cost of training for nurses, but, austerity and all.

If you are unable to supply enough surgeons for the surgeries people actually need, something has gone terribly wrong with your price signaling mechanism. Perhaps this is a problem with the UK system.

> Perhaps this is a problem with the UK system.

It’s a problem everywhere isn’t it? There aren’t enough surgeons and the price is too high.

Re: The planning of U.S. physician shortages (2020)

#292

Post by HyperSane » Sat, Jun 03, 2023, 7:15 PM UTC

feraloink wrote: post #44

HyperSane wrote: post #37

Earlier quoted context omitted.

If being a doctor is so incredibly hard then why are they allowed to practice after not sleeping for so long?

You're right. It's been noticed. There are regulatory initiatives (in the U.S.) to address that for doctors. Also for pilots of passenger aircraft.

No, it really hasn't. In 2016 the ACGME increased the consecutive hour limit from a bad 16 to a completely ridiculous 28. The difference between rest requirements for truckers and pilots compared to doctors is just absurd. And it is even worse because doctors should know better than most how sleep deprivation affects people.

Re: The planning of U.S. physician shortages (2020)

#293

Post by sarchertech » Sat, Jun 03, 2023, 7:34 PM UTC

haldujai wrote: post #197

candiddevmike wrote: post #191

Earlier quoted context omitted.

It's interesting that places value seniority and experience so much more in medicine vs tech. Things change daily in both fields--new procedures, new findings--yet tech seems to have far more ageism. Why is an older doctor so much more valuable than an older developer?

I wouldn't say they're valued, the compensation is (with some nuance) based on a work-unit/fee-code which is the same for all of us. The academic component goes up for relevant physicians like it does for any professor-type role. Doctors work longer mostly because you can't fire them unless they're negligent/incompetent (for various reasons including that most are self-employed/contractors either individually or as a…

When it comes to value, when my wife interviews for a job (she’s a physician) they fly her out and spend a day taking her to see the sights, so they convince here how great the city is. Then they take her out to a fancy dinner and woo her some more.

When I interview at a new job as a very senior engineer (and relatively well known I in my area), I get to jump through 7 rounds of interviews where someone asks me the equivalent of medschool exam questions.

If I’m lucky my connections might let me whittle the interview rounds down to 5.

There may be 20 people in any given tech stack/industry who are valued the way my wife is by employers.

Re: The planning of U.S. physician shortages (2020)

#294

Post by haldujai » Sat, Jun 03, 2023, 7:37 PM UTC

lostlogin wrote: post #289

haldujai wrote: post #151

Earlier quoted context omitted.

I only know 1-2 NZ radiologists but I understand the system there is egregiously underpaid. Medicare/insurance reimbursement rates for MRI (the professional fee component) are less than Canada (a system I know). We scan outpatients near 24/7 on some of our magnets in Canada, the ones we don’t are because we don’t have MRI technologists to staff the shifts (the more expensive part as they have unions with labour laws,…

I haven’t heard radiologists complain about their pay here, they seem pretty well paid. The techs are paid nicely too, though that will depend on the employer. I’m surely misunderstanding you - you aren’t saying techs cost more than radiologists in Canada are you? Doing those hours with outpatients is very impressive, though I hope to never be involved in such things. Weekends are bad enough!

Just for clarity I don't mean to suggest at all that radiologists aren't paid well-enough (other than in private equity sweatshops but I feel like that's the case for any industry they buy into).

> I’m surely misunderstanding you - you aren’t saying techs cost more than radiologists in Canada are you?

Individually not at all but in aggregate yes. Disbursements to nursing/techs/allied health (who are also the majority of employees to be fair) are somewhere around 60% of hospital expenditures in Ontario (noting physicians are not included in this budget).

It will vary from institution to institution (and union) but probably similar in most places, for MRI my last institution required 3 technologists per magnet (or 5 for 2 magnets) considering break rules, techs also got an after-hours premium so it worked out to something like $90/tech/hour. You'd also have to hire more as techs are employees so they get work-hour limits and time-off requirements (i.e. can't just offer "extra evening shifts" for those who want it, have to grow the pool) so add whatever employee overhead is (30%?).

The radiologist fee depends on the study type and duration but to keep it simple I'd expect to bill $150-300 for an hour worth of MRI scans on average. These get reported the next business day so there's no extra cost from the radiologist perspective and we can tolerate the added volumes so no need to hire (an average radiologist working hard can cover 2-3 magnets worth of cases in realtime).

For other modalities like ultrasound it's an even bigger gap, I'd expect to bill $30-60/technologist-hour worth of work.

Re: The planning of U.S. physician shortages (2020)

#295

Post by chaostheory » Sat, Jun 03, 2023, 7:40 PM UTC

bruce511 wrote: post #81

chaostheory wrote: post #61

Earlier quoted context omitted.

> Central planning in presence of hostile adversaries unrestricted by any ethical systems failed. This is what happens in any system that leans too much on central planning. What we’re witnessing is just entropy ie late stage capitalist society in decline due to too much power being centralized. It’s not exclusive to capitalist economies. Historically, it’s even worse in primarily socialist economies because there ar…

I don't know for sure, but I feel like you're possibly conflating socialism with communism? They are really quite different political models, although I'll grant you that both have a spectrum of examples. Equally capitalism, socialism and communism are all (somewhat) tangential to government organisation (single party, two party, multiparty, monarchy, dictator etc.) And I understand here that I'm painting with a very…

Communism is just late stage socialism. Besides even if they were two separate things, by design in socialism nearly everything is centrally planned. Corruption just spreads much faster in systems where you centralize power from the start ie you want the groups running the media, producing goods, and managing the laws to be separate entities

Re: The planning of U.S. physician shortages (2020)

#296

Post by giovannibonetti » Sat, Jun 03, 2023, 7:46 PM UTC

trentnix wrote: post #188

the_d3f4ult wrote: post #62

Being a physician is a horrible career move right now. As a former Math/CS major turned eye surgeon, I can't help but think about how much easier my life would be had I stuck with tech. It's hard to understand exactly how hard the job is until you've lived it. I saw 40 patient's in clinic today in 8 hours without lunch or any kind of downtime and then spent 2 hours at the hospital because a patient needed an emergent…

I've no doubt the stress of your work is immense and the constant threat of litigation (and the expense of the insurance to fight it) can be overwhelming. As a recipient of multiple eye surgeries (I had strabismus as a kid), I am grateful for competent professionals like you. But I think you buried the lede. In the 2010s I owned a high-end bicycle and sporting good store. It was 7 days of 10+ hours a day most weeks.…

> In the 2010s...

I don't know how things are in the US, but here where I live in Brazil, my doctor friends always tell me how in medicine things aren't anymore as rosy as they were before. It seems like there has been a large increase in the supply of physicians by universities and the younger generations face way stiffer competition to move up the professional ladder than before.

Re: The planning of U.S. physician shortages (2020)

#297

Post by [deleted] » Sat, Jun 03, 2023, 7:46 PM UTC

pknomad wrote: post #282

barry-cotter wrote: post #47

Earlier quoted context omitted.

If there are differences in outcomes between demographic groups some groups, like the SCOTUS, assume malice unless proven otherwise. See disparate impact or Griggs vs. Duke Power . Obviously the writers of the MCAT worked very hard to ensure Asians would get higher scores than any other group on them. The US is a country built in Asian supremacy.

> Obviously the writers of the MCAT worked very hard to ensure Asians would get higher scores than any other group on them. I am not sure how you are coming to that conclusion. Look at the latest metrics on scoring. Sure, Asians overall tend to score higher on average on standardized exams (which really ought to be split into different sub-ethnic groups because there is a disparity there too) and I'm not seeing the a…

[deleted]

Re: The planning of U.S. physician shortages (2020)

#298

Post by truthseeker1 » Sat, Jun 03, 2023, 7:51 PM UTC

arbuge wrote: post #255

truthseeker1 wrote: post #254

I'm a physician as well (radiologist). I started practicing a few years ago, and I'm currently working part time and doing my masters in AI/data science. After a few years I hope to leave the field as well. It isn't because of lack of jobs (in fact, radiologist shortage is dire). It is because it is very stressful and demoralizing to be a physician in america, and the seemingly "high" pay does not make up for the dow…

Can you explain how being a radiologist is stressful and demoralizing? Genuinely curious. I do know some radiologists and they certainly don't appear stressed to me. At least one of them works from home pretty much full time; not sure about the others.

Medicine is a pretty high stakes career. You mess up and people can die. In radiology, we are expected to be near perfect (not miss important findings however subtle they might be) and make the right calls. This is difficult to do even with the training we have had. Part of it is just dealing with uncertainties. Did I make the right calls? Did I miss something subtle but important that might harm the patient - such as a subtle small nodule that 2 years later can become metastatic cancer? If so, am I going to get sued? You do that with every case, none which pay well at all. Medicare is the largest insurer in America and they pay around 4-5$ for a chest x ray or a wrist x ray or whatever joint x ray. A CT be it a cancer staging ct or trauma ct is valued at 40$. It can take a while to read if you really do your due diligence…meaning you compare to the past CTs to see how things have progressed, read history, take your time looking at the images. So it should take half an hour to read. Often times the prior imaging and clinical history isn’t even available. And if you work at big academic centers you are forced to read quickly.

No physicians want to do a bad job but we are just cogs in wheels in the medical industry complex.

Re: The planning of U.S. physician shortages (2020)

#299

Post by truthseeker1 » Sat, Jun 03, 2023, 7:52 PM UTC

savrajsingh wrote: post #157

wrp wrote: post #110

What is a nutshell explanation of how healthcare got to the overall shortage state? (For the USA, but curious about other countries.) In the past 20 years, costs have shot up, doctors are seeing many more patients, and quality of care seems to have generally declined. Where have the resources gone? In the 1990s my GP had time to shoot the breeze for 20 minutes or more. Now I get a 5-minute diagnosis on the run, after…

It seems doctors want to intentionally keep their supply low so their pay remains high.

Physicians don’t control the supply of physicians. The federal govt funds residency slots so they indirectly controls the supply.

Re: The planning of U.S. physician shortages (2020)

#300

Post by lostlogin » Sat, Jun 03, 2023, 8:01 PM UTC

haldujai wrote: post #294

lostlogin wrote: post #289

Earlier quoted context omitted.

I haven’t heard radiologists complain about their pay here, they seem pretty well paid. The techs are paid nicely too, though that will depend on the employer. I’m surely misunderstanding you - you aren’t saying techs cost more than radiologists in Canada are you? Doing those hours with outpatients is very impressive, though I hope to never be involved in such things. Weekends are bad enough!

Just for clarity I don't mean to suggest at all that radiologists aren't paid well-enough (other than in private equity sweatshops but I feel like that's the case for any industry they buy into). > I’m surely misunderstanding you - you aren’t saying techs cost more than radiologists in Canada are you? Individually not at all but in aggregate yes. Disbursements to nursing/techs/allied health (who are also the majority…

Thanks for this explanation.

My day job is staffing magnets, and the staffing levels you mention exactly match what I do.

The radiologists struggle to keep up with our output when we do MSK work or horrendous post treatment livers - I think we need you over here.