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

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

#61

Post by chaostheory »

DSingularity wrote: post #15
bruce511 wrote: post #6

Planning and predicting highly variable systems is hard. Long-range interventions are especially risky given the possibilities for unexpected consequences and also the long lead times in fixing the problems. Central planning on resources has been especially rife with failed examples (the USSR being the all-in poster child.) As the article points out, the concept of central planning is orthogonal to who is providing t…

I feel like we are going too far. Central planning in presence of hostile adversaries unrestricted by any ethical systems failed. And by what measures has “free market” has proven itself as successful? You can come up with your measures of success and others will propose measures of shortcoming. Others will even dispute the claim the American-led west is anything different from a centrally planned set of cooperating…

> 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 are much less divisions of power from the start, where as in capitalist systems this happens over time. For this reason, the same decline happens much faster in primarily socialist systems.

The main flaw in thinking that socialism is better than capitalism, despite the clear results in the 20th century, is missing the fact that corrupt sociopaths don’t just disappear just because you changed the economic and political system; they adapt.

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

#62

Post by the_d3f4ult »

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 procedure. They might go blind despite my efforts and I have to live with that. I also may get sued, if they're feeling spicy, despite going to heroic lengths to help this person. My son was asleep before I got home.

There's just no reason to do the job when you can get the same compensation working remotely in tech. Looking through the "Who's Hiring" thread is soul-crushing. Physician salaries are the only ones that do not grow relative to inflation and have decreased year-on-year relative to inflation for decades.

I do believe that the rigorous training model leads to a higher quality of care and much deeper understanding of the disease process. But, why would anyone want to do the job? It's just not worth the liability anymore. That said, is anyone hiring an ophthalmologist with CS and Math degrees?

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

#63

Post by SamoyedFurFluff »

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…

> That said, is anyone hiring an ophthalmologist with CS and Math degrees?

I’m surprised you can’t leverage this into a product role or a consulting role for startups in the medical space. You know shit about med systems!!

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

#65

Post by ch4s3 »

codersfocus wrote: post #57
ch4s3 wrote: post #52

Earlier quoted context omitted.

I'm not sure how they could have assisted with anything, they basically have no medical supplies[1][2][3][4]. And before you bring it up, no medical supplies aren't covered by the embargo, they get a special exemption since the 90s. [1] https://havanatimes.org/cuba/medicine-shortages-a-challenge-... [2] https://www.reuters.com/world/americas/cuban-diaspora-sends-... [3] https://www.sabcnews.com/sabcnews/south-african…

There's a US law that says any ship that docks with Cuba can't dock with the US. Considering that modern shipping relies on big ships making many port calls, this law restricts Cuba's access to stuff like medical supplies.

You can still sell food and medicine[1]. There’s a regular liner service and DHL takes packages to Cuba.

[1] https://2001-2009.state.gov/p/wha/rls/fs/2001/fsjulydec/2612...

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

#66

Post by bruce511 »

scythe wrote: post #35
bruce511 wrote: post #6

Planning and predicting highly variable systems is hard. Long-range interventions are especially risky given the possibilities for unexpected consequences and also the long lead times in fixing the problems. Central planning on resources has been especially rife with failed examples (the USSR being the all-in poster child.) As the article points out, the concept of central planning is orthogonal to who is providing t…

>Central planning on resources has been especially rife with failed examples (the USSR being the all-in poster child.) This assertion is greatly exaggerated. It's certainly true that the centrally planned economy of the USSR didn't grow as quickly as peer countries with similar levels of economic development. The typical contrast is the much faster growth of Japan versus the Soviet Union in the late twentieth century…

Clearly there are multiple factors in play, and it is simplistic of me to pin all the failings of the USSR on central planning. (Which is the essence if my root post, planning is hard and only one small part of the political environment.)

Clearly geographical, climate, and population dynamics (Not to mention war damage) of the US , USSR and Japan post WW2 are enormously varied.

>> the government stopped subsidizing medical schools

That's part of it, yes. The other part and perhaps more damaging part, is the moratorium on creation of new schools, and the measures to actively reduce the ability of hospitals to offer residency positions.

Given a finite money supply the feds have to pick winners and losers for receiving money. However introducing policy, beyond money, has more impact on outcomes.

The libertarians would argue that the policies caused the shortage, not the lack of money. (As evidenced by the US citizens training outside the country.)

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

#67

Post by Tanjreeve »

ch4s3 wrote: post #54
bruce511 wrote: post #38

Earlier quoted context omitted.

Again, it's best not to align planning to political methodologies. Cuba has success stories. That isn't a vote for communism. Equally, another "communist" state (China) is doing very well and while there is a lot of planning there, there is also a lot of free-market. Again, not a vote for communism. I use communist in quotes here because Chinese communism is different to communism as practiced in the USSR. Just like…

Cuba actually has a terrible health system that lacks even basic medical supplies like aspirin and antibiotics[1]. The state department and in the past MSF have called their medical missions modern day slavery[2][3]. There are also a lot of questions about the quality of Cuban medical training[4]. [1] https://cuba.miami.edu/business-economy/a-close-look-at-cuba... [2] https://www.reuters.com/article/us-usa-cuba-traff…

The first three articles are various flavours of FUD and vague assertions of coercion of the usual kind of "flood the field" BS everyone is used to from MSM.

The fourth link you provided "asks questions" but then the actual conclusion is that their trainings fine and people are spouting FUD and they'll need some extra focus on country specific problems.

""" Results South African students trained in Cuba have had beneficial experiences which orientate them towards primary health care and prevention. Their subsequent training in South Africa is intended to fill skill gaps related to TB, HIV and major trauma. However this training is ad hoc and variable in duration and demoralizing for some students. Cuban-trained students have stronger aspirations than those trained in South Africa to work in rural and underserved communities from which many of them are drawn.

Conclusion Attempts to assimilate returning Cuban-trained students will require a reframing of the current negative narrative by focusing on positive aspects of their training, orientation towards primary care and public health, and their aspirations to work in rural and under-served urban areas. Cuban-trained doctors could be part of the solution to South Africa’s health workforce problems. """

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

#68

Post by [deleted] »

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…

[deleted]

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

#69

Post by biohax2015 »

jimt1234 wrote: post #48
lotsofpulp wrote: post #26

Earlier quoted context omitted.

There already has been. The solution was to pump out physician assistants (PAs) and nurse practitioners (NPs) that require a fraction of the training of a doctor to get licensed, and then have them practice medicine under the “supervision” of a doctor. Some states even went as far as giving people with no medical training the right to prescribe, such as naturopaths, whatever that means. So it is up to each person now…

I hate that this shift is being driven almost entirely by profit motives, but I also wonder if this is such a bad thing. I love my doctor; she's been my doctor for 25 years. However, I sometimes wonder what real value she provides. All she ever does is send me to a specialist. Couldn't a PA or NP do the same thing?

Your doctor has significantly more education and training than a PA or NP.

The additional cost of seeing a doctor would quickly be recouped by the reduction in unnecessary / inaccurate referrals that would come from a lesser-trained medical professional.

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

#70

Post by pcrh »

A similar phenomenon occurred in the UK, where under fears of "medical unemployment", the British Medical Association argued against increasing medical school places [0].

The attitude persists even today, where the BMA advocates that medical school entries should be limited to the number of specialty training places that follow basic training, so as to avoid the risk of doctors becoming unemployed or under-employed.

As a consequence the UK has a dearth of doctors, and those who are trained are over-worked. The government tries to alleviate the situation somewhat by recruiting from overseas.

[0] https://www.bmj.com/content/348/bmj.g2398

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