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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

#91

Post by joshlegs »

eldavido wrote: post #65
joshlegs wrote: post #43

> In fact, physicians are so bummed out that 9 out of 10 doctors would discourage anyone from entering the profession. OP missed a perfect headline opportunity: "9 out of 10 doctors recommend not becoming a doctor." But seriously, we wonder what's wrong with healthcare. I seriously believe it's because of the lawsuit-happy nature of patients nowadays. Yeah, something could go wrong during your surgery, or your diagno…

Anecdotally, nonpayment is a much bigger problem than lawsuits. I remember listening to the CEO of Carle, a large Central Illinois healthcare chain, talking about this, and saying that "we expect to collect 60 cents of every dollar we bill". It's a revenue optimization problem -- the goal is to collect the most revenue overall. Set prices too high and people/insurance goes elsewhere, too low and you leave money on th…

so what you're saying is no matter how the healthcare system is designed, the healthy (or maybe just wealthy?) always end up paying for the rest?

Re: How Being a Doctor Became the Most Miserable Profession

#92

Post by chimeracoder »

thecage411 wrote: post #89
mudil wrote: post #68

Earlier quoted context omitted.

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 regul…

> But in your example Medicare is just a really big insurance company

I agree that there are better examples of government regulation directly impacting medical practice, but this example illustrates the power of a monopsony[0].

To overgeneralize, the same way that monopolists (single suppliers) can exercise power over purchasers in ways that we might deem unfair, monopsonists (single consumers) can exercise power over suppliers in ways that we may also deem unfair or harmful.

These effects are not limited to Medicare patients or providers, by the way. It's not hard to make the case that customers who can choose between Comcast and Verizon FiOS are harmed by the fact that cable companies are regional monopolies in most other markets.

Similarly, even if you have a private insurance plan, there are a number of ways that you are affected by Medicare's policies indirectly, in ways that you would not if they weren't such a big player.

[0] https://en.wikipedia.org/wiki/Monopsony

Re: How Being a Doctor Became the Most Miserable Profession

#93

Post by idiot900 »

HIbachikabuki wrote: post #87
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…

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 th…

> It's not that simple. A society cannot afford the triple-A gold standard of everything for everybody.

The society in question has not realized it.

> 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.

Even the bottom rungs of the doctors in the "guild system" are not very good - lowering standards even more is very hard to agree with when push comes to shove. Especially there is no guarantee that this will actually lower costs to society.

But I guess this is what will have to happen, at least in primary care, because that is a miserable field that I am incredibly glad I didn't go into. I hope that at least some kind of care turns out to be better than none at all.

Re: How Being a Doctor Became the Most Miserable Profession

#94

Post by karmajunkie »

araftery wrote: post #51
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 disagree. The problem is frankly that we've come to expect too much from modern medicine. Doing a triple bypass surgery on a 90-year-old is expensive, plain and simple. Yes, we can save his life, but we have to be willing to pay the cost—and we aren't. Medicare is a monopsony. They represent such a large share of patients for many practices that they set their own prices. And when people expect medicare both to pay…

I don't know any cardiologists who would perform that kind of surgery on a 90yo.

Re: How Being a Doctor Became the Most Miserable Profession

#95

Post by karmajunkie »

erikcw wrote: post #46
jseliger wrote: post #11

Also relevant: I wrote "Why you should become a nurse or physicians assistant instead of a doctor: the underrated perils of medical school" ( http://jseliger.wordpress.com/2012/10/20/why-you-should-beco... ) based on watching the experience of my fiancée and her friends and peers. EDIT: In the essay I describe why it can become so hard to leave medicine after one has invested more than a year or two in med school bec…

A similar phenomenon is at work with law students. Granted law school is shorter than an MD program at only 3 years -- but can still result in $150k of student loan debt.

This is true of almost all terminal degrees today. Higher education is such a corrupt industry, feeding those at the top of the pyramid by making promises to prospective students they are fully aware are unrealistic.

Re: How Being a Doctor Became the Most Miserable Profession

#96

Post by GFK_of_xmaspast »

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…

Bet you're pretty happy to have the government there with barriers to entry for your profession tho, keeping supply down.

Re: How Being a Doctor Became the Most Miserable Profession

#97

Post by judk »

commandar wrote: post #49
[deleted] wrote: post #32

Earlier quoted context omitted.

[deleted]

>Granted, the salary will probably hit $200k with some years of experience More if they're specialty and/or surgical. One of the side effects of most hospitals being organized as non-profits is that they have to disclose the compensation level of their five highest-compensated, non-board/officer employees. I know at my hospital (mid-size, 250k metro area, ~$35k median income) that number ranges from $750k-1.2M. Grant…

Those top 5 have nothing to do with doctor salaries. The top 5 at any software company of 1000+ engineers to better than that.

Re: How Being a Doctor Became the Most Miserable Profession

#98

Post by Retric »

riahi wrote: post #84
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 dr…

Why exactly must the government pay for it? It seems obvious if it's a net cost it really should be paid for by the students.

Also, if you could go to med school without an undergraduate degree you can increase the number of years a doctor could work thus lowering costs and increasing supply at the same time.

Re: How Being a Doctor Became the Most Miserable Profession

#99

Post by judk »

mentalhealth wrote: post #27
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…

It's extremely difficult to study the effects of sleep deprivation on the rate of medical error, but several studies have shown that the highest numbers of medical errors occur during handoffs between shifts. Reducing the frequency of those handoffs by increasing shift length reduces the total number of detectable medical errors. Additionally, the work hour restrictions placed on residents over the last few years app…

By having more doctors working less intensely for overlapping shifts, they can take more time to complete handoff documentation and conversations properly, and have fewer handoffs (by taking on fewer patients after the first half of their shift)

Re: How Being a Doctor Became the Most Miserable Profession

#100

Post by cwal37 »

ams6110 wrote: post #85
cwal37 wrote: post #28

Earlier quoted context omitted.

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?

Here's some basics:

http://www.commonwealthfund.org/~/media/Files/Publications/I...

Essentially, we excel in a couple very specific things, like survivorship of breast cancer. We're middle of the pack in some things, like general cancer survivorship. And we're the worst by quite a bit in others, like chronic diseases. Basically, I would say we're not getting our $'s worth.

Here's some Commonwealth Fund info if you don't want to trust some random white paper.

http://en.wikipedia.org/wiki/Commonwealth_Fund

Oh, and if you want something from an organization with a known bias: http://www.rand.org/content/dam/rand/pubs/working_papers/201...

Key abstract quote: "But one key finding emerges – the US ranks poorly on all indicators with the exception of self-reported subjective health status."

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