IBM’s Watson Health is sold off in parts

#1 - Funky/misleading statistics - Generally they claim that these NPs with uncomplicated patients do as well as physicians with complicated patients. It's not claiming that of any randomly selected patient, regardless of who they see, the outcome is the same. Therefore, if uncomplicated patients saw physicians, outcomes for the physicians could improve. In primary care managing hypertension or diabetes, this isn't as pertinent. For something like anesthesiology, it's more so counting how many times shit hits the fan, and brain cells die when the anesthesiologist takes time to be summoned.

#2 - They're not conserving expensive resources. Imagine a patient comes in with a lump on their hand. An NP might see a weird lump, order an MRI which gets read by a radiologist, refer to an orthopedic surgeon who specializes in the hand, who removes tissue to send to a pathologist, who determines it's a common benign tumor of the fascia. That's three physicians who spent much more time here! The patient no longer has use of their interphalangeal joints. The physician would probably try to shine a light through it, note the patient's Scandinavian ancestry and family history of plantar fasciitis, and tell them to live with it and come back if it changes.

No resources were saved here, but the patient's DASH score (disability of the arm, shoulder, and hand) is still 0 so the outcomes are the same.

This happens all the time.

#3 - Bad incentives - Medicaid would not in a million years cover this, but the game of medical pinball where patients bounce around through in-network referrals can funnel those with decent insurance into procedures. Especially when most people have poor health literacy. A hospital executive probably just splooged in his pants seeing how much money their loss-leader of primary care is driving to radiology and the surgical specialties where they actually make money.

#4 - It's insincere. All of this can be viewed as possibly successful when the midlevels are part of the healthcare _team_ and know their limitations. But the NP groups are increasingly pushing for independent practice and prescribing rights in state legislatures across the country. CRNAs require a physician supervisor... in many places, that doesn't necessarily need to be an anesthesiologist, and the surgeon performing the procedure can suffice. The AANA recently changed its name to the "American Association of Nurse Anesthesiology"... It used to be "Anesthetists". The CEO and president (two different people) of the American Nurses Association both refer to themselves as "Doctor" in a healthcare setting even though one holds a DNP and the other a PhD. It's pervasive.

If I had the ability to order my own tests, blood work, and adjust the dosages of my meds I could do it a hell of a lot better than the doctor I see every 6-12 months. Antibiotics are the some of the worst with this. The doc literally doesn’t even look at me, I just describe my symptoms and they go “yep sounds like an infection” — like Gods almighty you could be a web form. And it would would actually cost my insurance less which is even more infuriating.

Specialists I have found are actually useful and so I can’t really bring myself to hate that Tier 1 MDs act as a screen for people whose time is valuable.

+ People care about what other people are talking about. They like to fit in, like they're part of the cutting-edge.

+ Less experienced people have less…experience with the downsides of what they're reading about.

+ CS is no longer mostly people who care about computer science, in the same way that economics isn't only for people who want the understand economics. Tech salaries — especially engineers' — are super high, like investment bankers. So people study the respective fields as a means to an end.

+ Twitter is driven by VCs, tech press, and people marketing themselves. They're work themselves into circular frenzies all the time. Little of it matters. Almost none of them have any record of predicting what's next and a long, long record of being wrong. This is true of most people! But these are the spaces many people look to to see what is "wanted".

You seem to have good instincts. Don't be distracted by peers who work at "hot" startups or big named companies. Find something you believe should actually exist in the world and work on that. It will give you an intrinsic reward that money can't buy and status can't fill.