The darker side of being a doctor (2017) • Hacker News Board

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

#491

Post by nradov » Mon, Apr 15, 2024, 2:52 PM UTC

DonnyV wrote: post #488

nradov wrote: post #260

Earlier quoted context omitted.

You're dreaming. Commercial payer organizations have low profit margins, especially since the Affordable Care Act (Obamacare) instituted an 85% minimum medical loss ratio. Some of them already operate as non-profits. Eliminating them wouldn't free up nearly enough funding to make "Medicare for All" work with a mere 4% income tax increase. Do the math.

"low profit margins" Health insurers raked in more than $41 billion of profits in 2022. https://penncapital-star.com/uncategorized/americans-suffer-... .

You appear to be confusing margins with absolute amounts. Eliminating all health insurance profits wouldn't be sufficient to close the gap on your "Medicare for All" proposal, not even close. I'm not necessarily opposed to a single payer system, but you need to do the math and be realistic about costs.

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

#492

Post by Zenzero » Mon, Apr 15, 2024, 3:24 PM UTC

zelphirkalt wrote: post #482

Zenzero wrote: post #476

Earlier quoted context omitted.

Imagine telling a doctor how to be a doctor because they "happen to know someone who works in a hospital". Oh how I would love to have you shadow me on the floor for a week. > If you think the tool is "fisher-price", then why haven't you told the people, who came up with the solution? Because they react just like you did. You perfectly demonstrated why I moved over to the software side. The doctors I work with are si…

Now you make yourself look like a bitter person, since according to you all the software developers in the world will react a certain way and nothing can be done, except you, the holy doctors, showing the devs how to do their job, by becoming developers yourselves! Meanwhile talking about hubris ... All the while you could not be bothered to document things and not telling someone who tries to help, where their solut…

It is clear that what what I just said is being distorted for preserving ego. That does not lead to productive conversation. If this is an active area of interest of yours I would advise you to listen to subject matter experts instead of attempting to lecture them.

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

#493

Post by thundergolfer » Mon, Apr 15, 2024, 3:35 PM UTC

candiddevmike wrote: post #159

thundergolfer wrote: post #34

Earlier quoted context omitted.

Though significant restrictions on supply do exist, the problem does not seem to be nearly as bad in Australia as in the USA [1]. In Australia there's ~15 medical graduates per 100k vs ~8 in USA. The doctors in Australia are still definitely overworked though. A decent number of the people I went to school with became doctors in Australia, and though we work roughly the same number of hours (~60-70hrs/week), my work…

Why do you work that many hours?

For fun.

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

#494

Post by rtaylorgarlock » Mon, Apr 15, 2024, 3:57 PM UTC

nradov wrote: post #454

pc86 wrote: post #428

Earlier quoted context omitted.

Which is pointless without also increasing the number of medical student slots.

The AMA doesn't control the number of medical student slots either. They have no regulatory or accreditation authority. Medical schools are free to add more students, and several entire new medical schools have opened in the past few years. https://www.deborahgutmanmd.com/blog/new-medical-schools-upd... The immediate bottleneck really is in residency programs. Every year, some students graduate with an MD/DO degree b…

Exactly: I want to see more/newer data on residency programs and placement rates per resident (MD, DO, IMG), because last I checked, residency spots (and the bottleneck created by limited Medicare funding, which I find interesting considering the profit created by residents) were the primary bottleneck; medical schools have every incentive to open new spots as quickly as humanly possible considering the ludicrous pricing they charge. We're firmly into 'money printer' territory for medical schools and their cost of operation.

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

#495

Post by malfist » Mon, Apr 15, 2024, 4:15 PM UTC

pc86 wrote: post #431

malfist wrote: post #379

Earlier quoted context omitted.

So the answer to being overworked in a hospital is to quit, be overwhelming running your own business for half the pay? That doesn't make any sense. And not everyone has the capital or capacity to make their own business

Let's not pretend we're talking about the difference between $30k and $60k/yr here. We're talking about $400k vs. $800k. "I'll only make half a million dollars a year if I do this" does not set oneself up to be a sympathetic character.

In what world is your typical surgeon paid $800k/yr?

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

#496

Post by fennecfoxy » Mon, Apr 15, 2024, 4:25 PM UTC

Main problems: lack of public healthcare (and only being for-profit instead) and lack of government enforcements around public healthcare.

Same thing in the UK with dental (and Doctors); clinics prefer to take private patients over NHS patients because they make more money that way.

Easily solved, the government just needs to 1: require a certain number or threshold of accepted patients per week to be public (and any contacts are submitted with type to government to track, same as passport travel) 2: apply harsher labour laws to clinics to prevent them from forcing their staff to work ridiculous overtime to make more money and cover availability 3: allow more medical students and have no idiotic unfair restrictions.

Medical industries are critical to modern society and I definitely think that there should be no limited number of places, any student that passes entrance exams should get minor scholarships to help pay for/promote this position.

We're all important to the economy but at the end of the day all comes down to medical staff when any of us get sick, no matter which industry we work in ourselves.

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

#497

Post by nojvek » Mon, Apr 15, 2024, 8:56 PM UTC

d0gsg0w00f wrote: post #407

nojvek wrote: post #368

> I went into medicine knowing that I will have to sacrifice much for the sake of my patients. What I am realising is that today in modern medicine, a doctor is just one of the many commodities in this complex industry. It’s no longer about the patient. It’s about the business of hospitals. Patient satisfaction officers, Theatre Utilisation officers, Patient Flow Coordinators. These are all business roles. I have to…

Re pilots vs doctors: pilots would be the equivalent of elective surgery, i.e., it can wait. There are so few doctors that getting a tired doctor is "better than nothing" as you have a greater chance of survival if you get mediocre care vs no care at all and certain death.

Right. And we have so few doctors because we artificially cap the number of doctors instead of letting free market dictate how many doctors we can have.

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

#498

Post by yoyonamite » Mon, Apr 15, 2024, 9:03 PM UTC

Zenzero wrote: post #420

zelphirkalt wrote: post #330

Earlier quoted context omitted.

The problems are aversion to technology in places, unwillingness to adopt new (human) protocol/processes, entrenched proprietary technology, that does not adhere to standardized formats. Say you want to save a report for a patient for the next shift. That report needs to enter a computer system. If there is a system for that, it will most likely be a very expensive overpriced proprietary solution with expensive suppo…

> The problems are aversion to technology in places, unwillingness to adopt new (human) protocol/processes, entrenched proprietary technology, that does not adhere to standardized formats. It is not. This is a classic example of assuming the problem exists within the realm of your current understanding. The stereotype of people in medical roles not wanting/liking/understanding technology is wrong. What we don't like…

If you don't mind me asking: Do you see a solution, technical or otherwise, to this problem?

My guess is there are limits to knowledge transfer that's difficult, if not impossible, to overcome.

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

#499

Post by adammarples » Mon, Apr 15, 2024, 9:28 PM UTC

SamBam wrote: post #374

galahad_ wrote: post #261

Earlier quoted context omitted.

Because you can't just set a higher number of students per year, for more students you have to create more facilities first. It's not like IT, where you can learn everything pretty well basically just with a study program, books and online lectures. As a medical student you have to do a lot of practical stuff with things that you don't get at home.

That would be the university's decision, then, not a state-mandated cap.

I have asked my doctor friend about this and it's because university courses are tied to actual hospital placements and training, there's really a limited amount of students that can properly train to be doctors because they do half of it on a ward. That's the reason there's such an expansion now of Physicians Assistants, which are like doctors but missing half the training.

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

#500

Post by aiilns » Mon, Apr 15, 2024, 10:12 PM UTC

BrandoElFollito wrote: post #323

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.

Hey, there is a reason you can use Internet and this is us :) It is not that IT is overpaid, it is that doctors are underpaid - at least in France. We are the world champions of strikes and yet, somehow, doctors rarely go on strike. I do not know why. They also know where they are going, it is not like they discover the world of medicine after 8 or 10 years. I am happy that they are people who want to help others, bu…

> We are the world champions of strikes and yet, somehow, doctors rarely go on strike. I do not know why.

When talking about public healthcare, strikes mean little. State won't care unless the strike is massive enough to attract media attention. Hospitals can't close down, a "safe" minimum of workers must care for patients so not a big problem for the state generally.