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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

#81

Post by segmondy »

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.

People didn't choose to live there, they have always lived there. Most people in rural US didn't pack up and move in the last few years but have been people that have been there for generations. Now it's easy to think they can just pack up and moving, but packing up and moving to an urban area is very expensive in the actual cost and with no guarantee that there's something that might be as stable as what you have in your rural area. Some of these people in those areas are the farmers that grow the foods that we eat btw, and they can't do their massive large scale farming in the city.

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

#82

Post by jandrewrogers »

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 link you provided appears to support my assertion. The vast majority of rural lands in the US have relatively low poverty rates, similar to non-rural poverty rates. A relatively small number of regions with extremely high poverty rates skew the national average, though only by a few percentage points, and in large parts of the US the poverty rates are effectively the same across rural and non-rural populations. Most of the rural US is not Appalachia. Maybe not wealthy but definitely middle class.

As noted at your link, many of the extremely poor rural areas skewing the averages are Native American reservations. How do you propose to make them relocate to cities?

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

#83

Post by ddingus »

vkou wrote: post #78
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.

Not really.

Voters need options to vote for. Money in politics constrains those considerably.

Blaming people just does not speak to the mess well enough to be productive.

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

#84

Post by evan_ »

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…

At least in Alabama, they've been releasing prisoners with medical conditions, so they don't have to treat them. When/if they get better they re-arrest them.

https://www.al.com/news/2019/09/alabama-sheriffs-release-sic...

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

#85

Post by yourbandsucks »

chimi wrote: post #79
yourbandsucks wrote: post #75

Earlier quoted context omitted.

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.

What a fragile free market.

You're telling me that the free market requires willing selflessness of players to function? That sounds more like the ghost of Christmas than the invisible hand to me..

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

#86

Post by rayiner »

haimez wrote: post #74
rayiner wrote: post #71

Earlier quoted context omitted.

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.

Actually the opposite is true: https://www.ers.usda.gov/webdocs/publications/90556/eib-200..... There was a significant rural to urban net migration during boom economies which slowed to zero during both the early 2000s recession and the 2008 recession. And in fact there was a small migration from urban back to rural during the last recession.

The unemployment rate in Iowa peaked at a little more than half the national unemployment rate in 2009-2010.

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

#87

Post by RandallBrown »

rohit2412 wrote: post #9
SolaceQuantum wrote: post #8

Earlier quoted context omitted.

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.

Yeah that's a dynamic I can't understand. Most software professionals talk about relocating away from the cities the first chance they get, but everybody else is rushing to the same cities that only software developers seem to be able to afford. This dynamic extends beyond usa. Even in India, doctors command high salaries in rural areas, often 2-3x what they can in metropolitan cities.

"Most" is probably not the case at all.

I have several friends who talk about moving somewhere cheaper, but way more of them are perfectly happy to live in an awesome city with lots of stuff to do.

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

#88

Post by chimi »

vo2maxer wrote: post #72
chimi wrote: post #59

Earlier quoted context omitted.

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...

We should go through the process of training more physicians, because every day in the USA many people are harmed, up to death, due to there not being enough physicians.

We need more midlevels too, I agree, though midlevels are not allowed to do everything doctors can do and are required to have many things approved by a doctor as well. So to increase midlevels would naturally require an increase in physicians.

I come to this from the perspective of someone being harmed by the way it is right now and I don't like being harmed.

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

#89

Post by refurb »

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..

When the system becomes so unworkable that the govt steps in and starts creating unfavorable rules for doctors, they were actually working against their own best interests.

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

#90

Post by refurb »

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?

You’re ignoring the back end where hospitals have to convince insurers to pay them that much.
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