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

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

#71

Post by rayiner » Mon, Sep 30, 2019, 11:34 PM UTC

cududa wrote: post #67

jandrewrogers wrote: post #45

Earlier quoted context omitted.

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 wher…

Show some data on this, because by and large, people in rural America are absolutely poor. https://www.ers.usda.gov/topics/rural-economy-population/rur...

The story flips if you use the Supplemental Poverty Measure, which adjusts for cost of living: https://www.irp.wisc.edu/wp/wp-content/uploads/2019/01/Focus.... Rural poverty has consistently been similar to urban poverty, and was measurably lower during the great recession. Rural areas also have lower long-term poverty (where a family was poor for two successive measurement years). About 4% in 2016 for rural areas, versus 5.5% in urban areas.

The states with the lowest SPM poverty rates are midwestern states with large rural populations, like Iowa and Nebraska: https://en.wikipedia.org/wiki/List_of_U.S._states_and_territ.... (California's poverty rate is almost double those states'.)

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

#72

Post by vo2maxer » Mon, Sep 30, 2019, 11:35 PM UTC

chimi wrote: post #59

belltaco wrote: post #3

The decades long wait times for green cards for immigrant doctors is also hurting health care in rural America. https://money.cnn.com/2018/06/08/news/economy/immigrant-doct... https://www.wusa9.com/article/news/local/maryland/communitie... https://time.com/5299488/international-medical-graduates/

I believe the American Medical Association (AMA) lobbying congress to shut down medical schools and artificially limit residencies and thus the supply of doctors is a much bigger factor. A lot of people who are capable and motivated to be doctors for good reasons are shut out because doctors don't want there to be more doctors who will serve to limit their wage growth.

Why go through the costly process of training a physician, when in most healthcare a midlevel practitioner would provide appropriate evaluation and treatment? Also it seems that not all stakeholders in medicine are into restricting physician training[1]. (I come into the discussion with a physician’s perspective.)

[1] https://www.modernhealthcare.com/article/20140730/NEWS/30730...

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

#73

Post by opportune » Mon, Sep 30, 2019, 11:41 PM UTC

belltaco wrote: post #3

The decades long wait times for green cards for immigrant doctors is also hurting health care in rural America. https://money.cnn.com/2018/06/08/news/economy/immigrant-doct... https://www.wusa9.com/article/news/local/maryland/communitie... https://time.com/5299488/international-medical-graduates/

There are plenty of highly qualified Americans who do not get accepted into medical school each year. We need to make the AMA stop preventing medical school class sizes from increasing

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

#74

Post by haimez » Mon, Sep 30, 2019, 11:42 PM UTC

rayiner wrote: post #71

cududa wrote: post #67

Earlier quoted context omitted.

Show some data on this, because by and large, people in rural America are absolutely poor. https://www.ers.usda.gov/topics/rural-economy-population/rur...

The story flips if you use the Supplemental Poverty Measure, which adjusts for cost of living: https://www.irp.wisc.edu/wp/wp-content/uploads/2019/01/Focus... . Rural poverty has consistently been similar to urban poverty, and was measurably lower during the great recession. Rural areas also have lower long-term poverty (where a family was poor for two successive measurement years). About 4% in 2016 for rural areas,…

Sure, but during a recession no one is moving into those areas and a LOT of unemployed are moving AWAY from them. The metrics look good because they misrepresent what’s actually happening.

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

#75

Post by yourbandsucks » Mon, Sep 30, 2019, 11:45 PM UTC

chimi wrote: post #70

journalctl wrote: post #65

Earlier quoted context omitted.

Do you have sources for this? I see this claim a lot on HN.

https://www.washingtonexaminer.com/thanks-to-doctors-there-a... I also like this 45 minute lecture Milton Friedman gave to physicians telling them how they were making healthcare worse due to this type of lobbying by their representatives. https://www.youtube.com/watch?v=rWlk9HreE7U

Shouldn't Milton Friedman be complimenting them for pursuing their narrow interests and having faith that it will contribute to the optimal free market outcome?

When someone doesn't even buy their own brand..

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

#76

Post by lotsofpulp » Mon, Sep 30, 2019, 11:47 PM UTC

cpitman wrote: post #30

delinka wrote: post #22

Earlier quoted context omitted.

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

Keep in mind, people have to pay for these services. Pay doesn't go up in a vacuum.

Hence why all the talk about "cheap" cost of living is lacking. It's missing many quality of life components that many people value, resulting in its low nominal prices.

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

#77

Post by aaron695 » Mon, Sep 30, 2019, 11:50 PM UTC

anonytrary wrote: post #64

11,000mi^2 is quite a hyperbolic way of saying "nearest service within 100mi". It is also true that there's just one doctor for 1,150,000mi^3, but we typically don't talk about volumes since almost everything we do on earth is distributed over the surface.

Came to say sqrt(11000/3.14) = 60 (*2 worse case = 120)

But your (current) downvotes show people don't like it.... Funny how people see the world

Of course square miles shouldn't leap to a square design I guess, a mind deception when talking about 'square units' but equally a circle is wrong since the topography is dependant on roads which changes the space being discussed again. [edit] The sinuosity of roads is hard to find, rivers is not PI it seems as often discussed - https://www.theguardian.com/science/alexs-adventures-in-numb...

But all are fine for napkin maths.

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

#78

Post by vkou » Mon, Sep 30, 2019, 11:52 PM UTC

lazyasciiart wrote: post #58

It should be illegal for the government to detain people in areas with inadequate access to medical care. If they want to put immigration detention centers (or any prison) in the middle of nowhere, they should be required to pay for a doctor to be there too. And it isn't a case of 'well migrants cross the border in the middle of nowhere so it's their fault' - almost all immigrants held in this place are transferred f…

The cruelty isn't an unhappy, accidental by-product. It's the whole point of the policy.

This is what ~half the country endorses, by virtue of how it votes.

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

#79

Post by chimi » Mon, Sep 30, 2019, 11:55 PM UTC

yourbandsucks wrote: post #75

chimi wrote: post #70

Earlier quoted context omitted.

https://www.washingtonexaminer.com/thanks-to-doctors-there-a... I also like this 45 minute lecture Milton Friedman gave to physicians telling them how they were making healthcare worse due to this type of lobbying by their representatives. https://www.youtube.com/watch?v=rWlk9HreE7U

Shouldn't Milton Friedman be complimenting them for pursuing their narrow interests and having faith that it will contribute to the optimal free market outcome? When someone doesn't even buy their own brand..

He stays quite true to his brand in the video when he chastises them with a list of the many things they have done to destroy the free market in healthcare.

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

#80

Post by segmondy » Mon, Sep 30, 2019, 11:55 PM UTC

belltaco wrote: post #3

The decades long wait times for green cards for immigrant doctors is also hurting health care in rural America. https://money.cnn.com/2018/06/08/news/economy/immigrant-doct... https://www.wusa9.com/article/news/local/maryland/communitie... https://time.com/5299488/international-medical-graduates/

Have you ever thought about the fact that the issuing of green card to immigrant doctors is really hurting other countries? Other countries need doctors as much as America, there's a huge brain drain when green card is issued for immigrant doctors. BTW, I'm not saying that I'm for it or against it. I also want to point that that giving a migrant doctor green card is not guarantee that they can practice in the US. Passing the board and getting certified is really difficult and there are tons of doctors that come to the US with hope of practicing and end up driving a cab, becoming a nurse or doing some sort of odd jobs.