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‘Out here, it’s just me’: one doctor for 11,000 square miles

washingtonpost.com

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Re: ‘Out here, it’s just me’: one doctor for 11,000 square miles

#41

Post by jdc »

beerandt wrote: post #39

Obamacare set rules that require large scale-out to be affordable, especially billing and electronic medical records. This is why so many smaller practices, even in large cities, had no choice but to be absorbed by local hospitals or merge with competitors; they couldn't afford that cost of regulation on their own. This also means that in areas lacking a certain critical mass of patients, practicing medicine won't ma…

What are the specific requirements? Perhaps there's another way to reduce costs.

Re: ‘Out here, it’s just me’: one doctor for 11,000 square miles

#42

Post by non-entity »

elsonrodriguez wrote: post #28
castratikron wrote: post #12

The picture at the end of the article says it all, "No services next 74 miles". If you choose to live in rural US, you are signing up for this kind of lifestyle; you're on your own. As long as that's advertised I don't see a real problem. If you need health care then you should live near health care. Don't expect the same level of support in rural MN as you would get in NYC.

> If you choose to live in rural US, you are signing up for this kind of lifestyle; you're on your own. Some people don't choose, and other people do choose, but more importantly: your food comes from the rural US and you should keep that in mind before being flippant about their fate.

How much of the food is from massive corporate farms, versus independent farmers though, I wonder

Re: ‘Out here, it’s just me’: one doctor for 11,000 square miles

#43

Post by mjevans »

roflchoppa2 wrote: post #20
EliRivers wrote: post #17

Earlier quoted context omitted.

I understand a lot of poor people in these regions lack the resources to move to more populated areas. Would you support a federal or state rehousing program to enable that? It's a genuine question; should the US taxpayer pony up so poor people trapped in rural areas can move to population centres and enjoy the benefits thereof?

States could offer something like that if they need more people to work in certain sectors. It would be cool to see it tie into education system too.

I would rather this be a federal level program as often the solution would involve moving people to new states.

Re: ‘Out here, it’s just me’: one doctor for 11,000 square miles

#44

Post by beerandt »

jdc wrote: post #41
beerandt wrote: post #39

Obamacare set rules that require large scale-out to be affordable, especially billing and electronic medical records. This is why so many smaller practices, even in large cities, had no choice but to be absorbed by local hospitals or merge with competitors; they couldn't afford that cost of regulation on their own. This also means that in areas lacking a certain critical mass of patients, practicing medicine won't ma…

What are the specific requirements? Perhaps there's another way to reduce costs.

Sustaining the infrastructure and support to maintain electronic medical records is probably the biggest. There are so many problems with the current systems that it's hard to know where to start.

But related to the context of the article: You can't spread that cost out as a stand alone doctor practicing on rural areas. On top of this is added cost of data entry compared to old paper charts, the cost of training staff to be able to do it efficiently, and the extra time it takes doctors to keep notes and sign-off on electronic charts.

Check out some of the recent articles on physician burn-out, especially in emergency medicine, family practice, and general practice. Doctors are deciding it's not worth the hassle, financially or psychologically.

Edit: a couple of recent related articles on the topic:

https://blogs.scientificamerican.com/observations/electronic...

https://fortune.com/longform/medical-records/amp/

Re: ‘Out here, it’s just me’: one doctor for 11,000 square miles

#45

Post by jandrewrogers »

EliRivers wrote: post #17
castratikron wrote: post #12

The picture at the end of the article says it all, "No services next 74 miles". If you choose to live in rural US, you are signing up for this kind of lifestyle; you're on your own. As long as that's advertised I don't see a real problem. If you need health care then you should live near health care. Don't expect the same level of support in rural MN as you would get in NYC.

I understand a lot of poor people in these regions lack the resources to move to more populated areas. Would you support a federal or state rehousing program to enable that? It's a genuine question; should the US taxpayer pony up so poor people trapped in rural areas can move to population centres and enjoy the benefits thereof?

In most cases, people live there because that is where their lives and family are, not because they are poor per se or "trapped". In fact, many of them are not poor by any constructive definition. These populations, while shrinking and aging, have productive lives often related to resource extraction industries such as farming and mining which are not going away. People are simply choosing to remain in the areas where they built their life.

Labor shortages are a critical problem in many of these communities. Young locals often move to the cities and rarely move back, and while automation has helped support the local industries it has not nearly covered the shortfall. Much of the working age labor that does move into these areas is either illegal immigrants or ex-convicts looking for a fresh start. Due to shortages, minimally skilled physical labor often commands 3-4x minimum wage in my experience.

It is a mistake to think that people want to be rescued from these areas. Maybe some do but most have reasons for living where they live.

Re: ‘Out here, it’s just me’: one doctor for 11,000 square miles

#46

Post by beerandt »

SolaceQuantum wrote: post #8
honkycat wrote: post #6

This is happening on my home town. The hospital has been scaling back more and more. What was once a thriving hospital now only has 3 doctors. Not due to demand, but because there are not enough doctors. Doctors do not want to live in a podunk town, no matter how much the hospitals are willing to pay.

Theoretically if the podunk town is willing to pay 5x, 10x, 100x, etc. A doctor would definitely take up that. Hell, I would do software development in a podunk town for a million dollar salary. Maybe even a 750k salary.

The best paying doctor jobs are in rural areas that can afford it. I believe the top paying EM (emergency medicine) positions last year were in the Dakotas. Think drilling boom-towns.

And it can easily be a 5x multiplier, sometimes more.

Re: ‘Out here, it’s just me’: one doctor for 11,000 square miles

#47

Post by disjhshava »

delinka wrote: post #22
CabSauce wrote: post #15

Earlier quoted context omitted.

They do literally pay almost 2x. And that's in towns where your dollar goes much, much further. It's effectively 5x. Doctors still don't want to go.

Guess it's time to offer 3x. It's how supply and demand work, right?

Ultimately, there are not enough doctors to meet demand. Raising wages will just move them around. The supply of doctors is inelastic due to limited residency slots.

Re: ‘Out here, it’s just me’: one doctor for 11,000 square miles

#48

Post by elsonrodriguez »

non-entity wrote: post #42
elsonrodriguez wrote: post #28

Earlier quoted context omitted.

> If you choose to live in rural US, you are signing up for this kind of lifestyle; you're on your own. Some people don't choose, and other people do choose, but more importantly: your food comes from the rural US and you should keep that in mind before being flippant about their fate.

How much of the food is from massive corporate farms, versus independent farmers though, I wonder

Even if the farm is corporate owned, you still need people to do the farming part, and those people can't telecommute.

Re: ‘Out here, it’s just me’: one doctor for 11,000 square miles

#49

Post by perl4ever »

beerandt wrote: post #44
jdc wrote: post #41

Earlier quoted context omitted.

What are the specific requirements? Perhaps there's another way to reduce costs.

Sustaining the infrastructure and support to maintain electronic medical records is probably the biggest. There are so many problems with the current systems that it's hard to know where to start. But related to the context of the article: You can't spread that cost out as a stand alone doctor practicing on rural areas. On top of this is added cost of data entry compared to old paper charts, the cost of training staf…

If computerizing a business makes it more expensive and labor intensive, someone's doing something wrong.

Re: ‘Out here, it’s just me’: one doctor for 11,000 square miles

#50

Post by driverdan »

novok wrote: post #27
driverdan wrote: post #21

Earlier quoted context omitted.

Good news for you, there are tons of remote software jobs that allow you to live wherever you want.

And pay two thirds less. The qualifier is equal pay.

I've never seen a remote job that paid two thirds less. Some do pay less based on location but many don't.
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