Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

How Being a Doctor Became the Most Miserable Profession

thedailybeast.com

Post reply on HN
Print view View original

31–40 of 147 posts

Re: How Being a Doctor Became the Most Miserable Profession

#31

Post by eldavido »

cwal37 wrote: post #28
clarkmoody wrote: post #19

Earlier quoted context omitted.

> give medical professionals more operational and financial freedom to run their practices using tried-and-true free-market principles I agree completely, but you forgot to add under what we believe: (5) "government has the solution for everything." At least that's what it feels like lately. The cynic in me says that the healthcare industry will continue to get worse for some time before it gets better, if ever. We m…

In countries with socialized healthcare systems, costs are much lower, as is the overall amount spent on healthcare. Americans actually display stunning recalcitrance towards this fact, and as a result we have an incredibly polarized debate which has led to a bastardized and amalgamated system comprised of several other, and often conflicting, constructs.

I actually agree with this (wrote the GP). If we could have either whole-hog free market or public option, I believe either would be better than what we have now.

I think integrated systems could help, where the financial and operational sides of healthcare are combined (e.g. Group Health in Seattle, or Kaiser). The key thing is to remove the conflict between the payer and operator -- it's just madness that we have a system where one party has 100% of the incentive to control costs, and the other is completely responsible for outcomes, cost be damned.

Re: How Being a Doctor Became the Most Miserable Profession

#32

Post by [deleted] »

tdees40 wrote: post #7

The biggest problem is just the AMA. They limit the number of doctors in America, so there are just too few. This drives up the salaries for the few doctors who live the tell the tale (but certainly don't want to go into primary care, when other more lucrative jobs are on offer), and drives up the hours for everyone. Making it easier to become a doctor would improve things immediately (especially given the recent res…

[deleted]

Re: How Being a Doctor Became the Most Miserable Profession

#33

Post by zavi »

tdees40 wrote: post #7

The biggest problem is just the AMA. They limit the number of doctors in America, so there are just too few. This drives up the salaries for the few doctors who live the tell the tale (but certainly don't want to go into primary care, when other more lucrative jobs are on offer), and drives up the hours for everyone. Making it easier to become a doctor would improve things immediately (especially given the recent res…

It would be interesting to see some data and in depth analysis on this subject to tell apart unfounded conspiracy claims from an actual problem that needs to be addressed.

Re: How Being a Doctor Became the Most Miserable Profession

#34

Post by FD3SA »

tdees40 wrote: post #7

The biggest problem is just the AMA. They limit the number of doctors in America, so there are just too few. This drives up the salaries for the few doctors who live the tell the tale (but certainly don't want to go into primary care, when other more lucrative jobs are on offer), and drives up the hours for everyone. Making it easier to become a doctor would improve things immediately (especially given the recent res…

The worst part about this set up is that increasing the number of doctors won't actually reduce healthcare costs, but paradoxically, increase them. This is because doctors in the USA make money through ordering tests and exams, rather than just spending face time with patients, as the article points out. There was an excellent Time [1] article on this phenomenon.

To make matters worse, Canada is suffering the effects of the American system. Doctors licensed in Canada are encouraged to go to the USA (particularly specialists), by the allure of much higher salaries. In order to prevent a vicious brain drain, the Canadian Medical Association must pay doctors as much as they can to stay and practice in the country. As such, Canadian healthcare costs have been skyrocketing due to specialist salaries soaring ever higher to compete with American rates.

Comparing physician salaries in the US and Canada with other commonwealth countries like Australia and the UK provides a clearer picture as to what is going on. The American healthcare system is completely and utterly FUBAR. It needs to be torn down and rebuilt based on a functioning healthcare system from another country.

1. http://time.com/198/bitter-pill-why-medical-bills-are-killin... (Unfortunately, it is now paywalled)

Re: How Being a Doctor Became the Most Miserable Profession

#35

Post by seanstickle »

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…

Point of clarification: physician assistants are qualified to diagnose, treat, and recommend courses of action related to health care.

Per the American Academy of Physician Assistants: "PAs perform physical examinations, diagnose and treat illnesses, order and interpret lab tests, perform procedures, assist in surgery, provide patient education and counseling and make rounds in hospitals and nursing homes. All 50 states and the District of Columbia allow PAs to practice medicine and prescribe medications."

http://www.aapa.org/the_pa_profession/what_is_a_pa.aspx

Disclaimer: I work for the Physician Assistant Education Association.

Re: How Being a Doctor Became the Most Miserable Profession

#36

Post by thefreeman »

And now that Medicare payments will be tied to patient satisfaction—this problem will get worse.

That just sounds crazy. Can you imagine if your car insurance had to pay less if you complained about your mechanic? Not to mention that medicare is for the elderly who tend to have a lot to complain about anyway.

Can I pay my taxes based on my satisfaction with the government?

Re: How Being a Doctor Became the Most Miserable Profession

#37

Post by SapphireSun »

hga wrote: post #24
SapphireSun wrote: post #15

I don't get why overworked personnel aren't regarded as a dire safety issue. There's a reason the FAA restricted the number of hours commercial pilots are allowed to fly per week without rest. http://www.usatoday.com/story/todayinthesky/2014/01/03/pilot... I met a resident the other day, and they routinely get four hours of sleep or less and worked for shifts that are insanely long that are basically dictated by pati…

One solid reason is the same reason sleep deprivation is used in basic training. Most doctors, will, at some point in their life, have to make life and death decisions when they're operating far from 100% ... or at least that was true back in the days when they'd take calls at any hour of the day (as late as the '70s). Less dire, they have office hours they must keep unless they're really sick, and they certainly won…

I get that deprivation training can be helpful, but to be deprived nearly 100% of the time in a safety critical, fast paced environment? That's crazy. These guys aren't special forces (who I assume have in-field careers similar to pro-sports players), they're normal people trying to work at this for many decades.

If your goal is to reduce medical errors, create systems that don't depend on a single person's fluctuating energy level (e.g. have two doctors responsible for each patient, keep patient loads low enough that they can deal, automate as much as possible with computer systems (e.g. billing), and delegate to e.g. PAs for mundane diagnoses). Exhausted people make mistakes, can't work or think as quickly, are less creative, and are generally less happy. All the technology in the world won't help you if the key decision makers screw up at the wrong time.

After all, coffee does exist for those times when your natural energy level won't do it for you. ;)

Re: How Being a Doctor Became the Most Miserable Profession

#38

Post by nilkn »

SapphireSun wrote: post #15

I don't get why overworked personnel aren't regarded as a dire safety issue. There's a reason the FAA restricted the number of hours commercial pilots are allowed to fly per week without rest. http://www.usatoday.com/story/todayinthesky/2014/01/03/pilot... I met a resident the other day, and they routinely get four hours of sleep or less and worked for shifts that are insanely long that are basically dictated by pati…

> Maybe medical school prices would go down with additional scale.

It seems like a bit of a chicken and egg problem. Medical school is already so expensive that the salaries are necessary in order for newly minted doctors to have the same disposable income after loan payments that, say, a programmer or chemical engineer who's 7 years younger has (4 years medical school + 3 years residency minimum). Who would make the sacrifices necessary to become a doctor, taking out massive loans, only for an income that won't sustain them comfortably?

Re: How Being a Doctor Became the Most Miserable Profession

#39

Post by joe_the_user »

hga wrote: post #24
SapphireSun wrote: post #15

I don't get why overworked personnel aren't regarded as a dire safety issue. There's a reason the FAA restricted the number of hours commercial pilots are allowed to fly per week without rest. http://www.usatoday.com/story/todayinthesky/2014/01/03/pilot... I met a resident the other day, and they routinely get four hours of sleep or less and worked for shifts that are insanely long that are basically dictated by pati…

One solid reason is the same reason sleep deprivation is used in basic training. Most doctors, will, at some point in their life, have to make life and death decisions when they're operating far from 100% ... or at least that was true back in the days when they'd take calls at any hour of the day (as late as the '70s). Less dire, they have office hours they must keep unless they're really sick, and they certainly won…

It is a logical argument but it's far from "solid" given today's realities. Humans simply don't adapt to sleep deprivation and organized, constant sleep deprivation clearly is going to make decisions worse over time.

There's no justifiable reason to give a large, urban hospital an organization system fit to the battle field.

Re: How Being a Doctor Became the Most Miserable Profession

#40

Post by avoutthere »

baddox wrote: post #26
[deleted] wrote: post #9

[deleted]

> If doctors have the final say on all matters, they don't have a patient - they have a subject. In a competitive market of doctors, profit motive will tend to cause doctors to meet the demands of patients.

Unfortunately, the culture in the U.S. is taking us in exactly the opposite direction from medical competition.
Post reply on HN