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How Being a Doctor Became the Most Miserable Profession

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Re: How Being a Doctor Became the Most Miserable Profession

#81

Post by LordHumungous »

hga wrote: post #24
SapphireSun wrote: post #15

I don't get why overworked personnel aren't regarded as a dire safety issue. There's a reason the FAA restricted the number of hours commercial pilots are allowed to fly per week without rest. http://www.usatoday.com/story/todayinthesky/2014/01/03/pilot... I met a resident the other day, and they routinely get four hours of sleep or less and worked for shifts that are insanely long that are basically dictated by pati…

One solid reason is the same reason sleep deprivation is used in basic training. Most doctors, will, at some point in their life, have to make life and death decisions when they're operating far from 100% ... or at least that was true back in the days when they'd take calls at any hour of the day (as late as the '70s). Less dire, they have office hours they must keep unless they're really sick, and they certainly won…

So... possibly put real patients at risk on a regular basis in order to train doctors for hypothetical situations that they may face at some point in their career? That doesn't sound like a solid justification to me.

Re: How Being a Doctor Became the Most Miserable Profession

#82

Post by idiot900 »

eldavido wrote: post #74
idiot900 wrote: post #70

Earlier quoted context omitted.

> greater human trust in computers and recommendation systems I am an MD and have a degree in CS. Expert systems are not remotely there yet for this purpose. On no planet would I trust care of my patients to a computer. Far too many subtleties involved in accurate diagnosis and treatment that are not encoded in a machine-readable format. > legal regime which mandates DOCTORS perform procedures, and only after a lengt…

> I am still waiting to meet a patient who comes to the hospital and prefers to have their care rendered by non-physician providers over physicians, or would even settle if there were an option. Attach a price tag to each and find out. Maybe someone who couldn't afford a $500 consultation with an MD could settle for a $250 or $100 consultation with a PA, or an expert system. You really don't know until you experiment…

True, that is the experiment to do.

It is not without ethical concern though. Unfortunately, most patients are not sufficiently informed about medicine to make a rational market choice. (Indeed, outside my specialty, I am not really either, and would seek the advice of a trusted physician friend, which is a luxury most don't have.)

For example, the PA and expert system would not reliably know when they are in over their heads and require an MD. Some subset of people would suffer serious injury or death through no fault of their own other than not having had the information necessary to allocate their funds in a manner most benefiting their interests.

Re: How Being a Doctor Became the Most Miserable Profession

#83

Post by jjoonathan »

cwal37 wrote: post #28
clarkmoody wrote: post #19

Earlier quoted context omitted.

> give medical professionals more operational and financial freedom to run their practices using tried-and-true free-market principles I agree completely, but you forgot to add under what we believe: (5) "government has the solution for everything." At least that's what it feels like lately. The cynic in me says that the healthcare industry will continue to get worse for some time before it gets better, if ever. We m…

In countries with socialized healthcare systems, costs are much lower, as is the overall amount spent on healthcare. Americans actually display stunning recalcitrance towards this fact, and as a result we have an incredibly polarized debate which has led to a bastardized and amalgamated system comprised of several other, and often conflicting, constructs.

International comparison: http://healthcarereform.procon.org/view.resource.php?resourc...

Administrative overhead of government vs private insurance: http://healthcarereform.procon.org/view.resource.php?resourc...

Re: How Being a Doctor Became the Most Miserable Profession

#84

Post by riahi »

tdees40 wrote: post #7

The biggest problem is just the AMA. They limit the number of doctors in America, so there are just too few. This drives up the salaries for the few doctors who live the tell the tale (but certainly don't want to go into primary care, when other more lucrative jobs are on offer), and drives up the hours for everyone. Making it easier to become a doctor would improve things immediately (especially given the recent res…

I hate to make this a common refrain, but I make this same comment every time I see a comment like yours:

The supply of doctors is not restricted by the AMA. The supply of doctors is determined by the number of residency spots available to new graduates; that number is entirely determined by the Centers for Medicare and Medicaid (CMS). Thanks to the Balanced Budget Act of 1997, Graduate Medical Education (GME) was dramatically slowed due to decreases in Medicare funding of residency positions. [1]

As long as we require physicians to be US trained and to have completed a US residency, the bottleneck will be GME funding. To fix that, the AMA or any other concerned citizen can lobby Congress for an increase.

[1]: http://jama.jamanetwork.com/article.aspx?articleid=182532

Re: How Being a Doctor Became the Most Miserable Profession

#85

Post by ams6110 »

cwal37 wrote: post #28
clarkmoody wrote: post #19

Earlier quoted context omitted.

> give medical professionals more operational and financial freedom to run their practices using tried-and-true free-market principles I agree completely, but you forgot to add under what we believe: (5) "government has the solution for everything." At least that's what it feels like lately. The cynic in me says that the healthcare industry will continue to get worse for some time before it gets better, if ever. We m…

In countries with socialized healthcare systems, costs are much lower, as is the overall amount spent on healthcare. Americans actually display stunning recalcitrance towards this fact, and as a result we have an incredibly polarized debate which has led to a bastardized and amalgamated system comprised of several other, and often conflicting, constructs.

How do outcomes compare?

Re: How Being a Doctor Became the Most Miserable Profession

#86

Post by ams6110 »

rdmcfee wrote: post #14

In Canada our GPs are paid approximately $31 for a regular visit. They pay their overhead out of this $31 and still typically keep 65-70% of their billings. It's amazing that the billing costs in the US are a factor of magnitude higher.

What is the malpractice liability exposure for a Canadian doctor? In the US, malpractice insurance is a huge expense for most doctors, and for some specialties (e.g. obstetrics) it's very close to prohibitive.

Re: How Being a Doctor Became the Most Miserable Profession

#87

Post by HIbachikabuki »

idiot900 wrote: post #70
eldavido wrote: post #13

This is completely a story of industry structure and bad incentives, and how people react to them. Currently, in the United States, we believe all of the following things: (1) Human physicians, are the only qualified parties to diagnose, treat, and/or recommend courses of action related to health (not nurses, physician's assistants, computer programs, etc.), (2) everyone has a fundamental right to healthcare, (3) hea…

> greater human trust in computers and recommendation systems I am an MD and have a degree in CS. Expert systems are not remotely there yet for this purpose. On no planet would I trust care of my patients to a computer. Far too many subtleties involved in accurate diagnosis and treatment that are not encoded in a machine-readable format. > legal regime which mandates DOCTORS perform procedures, and only after a lengt…

It's not that simple. A society cannot afford the triple-A gold standard of everything for everybody. Not everybody can live in a McMansion and not everybody can afford to have an MD/CS for their every single health need, no matter how minor or how routine. Tradeoffs have to be made.

US medicine has been very successful at creating a guild system that's prevented lower-cost provision of care for decades, all under the concern of "it'll lower the standards of patient care." End result has been millions of people who can't afford medical care at all.

One anecdote: for a time I was splitting living in the UK and the US and had health care experiences in both places. It was fascinating to see the differences in treating my (very ordinary) health issues. One time I came down with a mild rash that rebounded a few times before it finally went away. In the UK, the GP looked at the rash, punctured the pustules with little pokey thing so they'd drain, and they cleared up in a few days. In the US, the dermatologist wheeled in a big machine filled with liquid nitrogen and froze the pustules; they went away in a few days after that too. End result the same; cost to administer - orders of magnitude different. In the US, it seems like there's no medical treatment that we can't make more expensive by requiring more specialists with more years of training, using ever more expensive machines and medications.

I love modern medicine. My dad's a retired doctor and I almost became an MD myself. But the system we've created has costs out of control while simultaneously creating worse societal health outcomes than other countries.

Re: How Being a Doctor Became the Most Miserable Profession

#88

Post by rflrob »

"Just processing the insurance forms costs $58 for every patient encounter, according to Dr. Stephen Schimpff, an internist and former CEO of University of Maryland Medical Center who is writing a book about the crisis in primary care."

I'm curious how the arithmetic on that works out. The median pay for medical assistants is $14.12/hour [1], which means that assuming the assistant is handling the insurance form, that works out to just over 4 hours per patient encounter. There might be some fixed costs (filing space, for instance, is not free), and some costs associated with communicating with the insurance company, but it's really not obvious to me how any of those can add up to $58/visit.

[1] http://www.bls.gov/ooh/healthcare/medical-assistants.htm

Re: How Being a Doctor Became the Most Miserable Profession

#89

Post by thecage411 »

mudil wrote: post #68
tdees40 wrote: post #7

The biggest problem is just the AMA. They limit the number of doctors in America, so there are just too few. This drives up the salaries for the few doctors who live the tell the tale (but certainly don't want to go into primary care, when other more lucrative jobs are on offer), and drives up the hours for everyone. Making it easier to become a doctor would improve things immediately (especially given the recent res…

I am a doctor, an anesthesiologist. I don't like AMA. But to blame AMA is a complete nonsense. (AMA really is just an insurance and loan agency, just like AARP.) The real problem is government regulation of our profession, of the whole clinical process, and of devices and medications. Those of you who go up in arms when government sticks its nose in your internet business, should imagine how it is to deal with the go…

I don't think your example is very strong. It's not exactly clear what you mean by government "sticks its nose in your internet business" but for most that probably means regulation. But in your example Medicare is just a really big insurance company; if a private sector insurance company denied your claim for some stupid reason would you complain about the private sector? I'm sure there are examples of onerous regulations that would make a better example?

Re: How Being a Doctor Became the Most Miserable Profession

#90

Post by [deleted] »

dfc wrote: post #76
selmnoo wrote: post #44

Earlier quoted context omitted.

> To pay this off in 10 years, the monthly payment would be on the order of $3400. Once employed, hospitals agree on some arrangement in which they help pay sometimes up to as much as 50% of their loans (HRSA alone pays $170k in loan repayment to primary care docs for 5 years of service in a shortage area). And I don't know what kind of doctors you guys have been hanging out with, but most make way more than $300k af…

> True, but as it turns out, most doctors are sons and daughters of rich folks > (at least that's what sister tells me, who's doing her residency now). Lets pretend that anecdata is useful and assume that it is generalizable to the entire population of med students. Do you think the prevalence of rich kids is alarming? Possibly an indication that something needs to change in the financing of healthcare or healthcare…

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