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 research that makes it clear that nurse practitioners do just fine).
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.
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 government that is there all the time for us. For example, how about trying to bill Medicare for a surgery, when one phrase--one phrase-- is missing from the documentation, and I don't get a penny for a 4 hour surgery?
It would be interesting to see some data and in depth analysis on this subject to tell apart unfounded conspiracy claims from an actual problem that needs to be addressed.
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 for their triple bypass and not to go broke at the same time, what we get bankrupt hospitals and over-worked doctors.
Being more responsible about the way we apportion healthcare is the only reasonable option.
From a demand/supply perspective involving only patients and doctors, it seems correct. I actually have the similar thought. But can anyone provide more dimensions of this "market"?
The worst part about this set up is that increasing the number of doctors won't actually reduce healthcare costs, but paradoxically, increase them. This is because doctors in the USA make money through ordering tests and exams, rather than just spending face time with patients, as the article points out. There was an excellent Time [1] article on this phenomenon.
To make matters worse, Canada is suffering the effects of the American system. Doctors licensed in Canada are encouraged to go to the USA (particularly specialists), by the allure of much higher salaries. In order to prevent a vicious brain drain, the Canadian Medical Association must pay doctors as much as they can to stay and practice in the country. As such, Canadian healthcare costs have been skyrocketing due to specialist salaries soaring ever higher to compete with American rates.
Comparing physician salaries in the US and Canada with other commonwealth countries like Australia and the UK provides a clearer picture as to what is going on. The American healthcare system is completely and utterly FUBAR. It needs to be torn down and rebuilt based on a functioning healthcare system from another country.
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.
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 patient demand. Why not just hire more doctors, maybe lower salaries by increasing supply, and give them a healthier lifestyle? Maybe medical school prices would go down with additional scale.
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 appear to have done nothing to reduce the overall number of medical errors.
(I am in favor of reducing medical work hours myself, but these are some of the data-driven reasons that it will be very difficult, not to mention the structural reasons inherent to the current system of medical training.)
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't be at 100% every day.
So this is useful training, albeit at a cost. Although if they make a mistake that kills a patient during residency and learn they can't deal with the consequences of that, I suppose the earlier the better. They can of course move to less life and death specialties.
> Maybe medical school prices would go down with additional scale.
It seems like a bit of a chicken and egg problem. Medical school is already so expensive that the salaries are necessary in order for newly minted doctors to have the same disposable income after loan payments that, say, a programmer or chemical engineer who's 7 years younger has (4 years medical school + 3 years residency minimum). Who would make the sacrifices necessary to become a doctor, taking out massive loans, only for an income that won't sustain them comfortably?
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) health professionals must undergo expensive, lengthy, difficult courses of study and training, and (4) we reimburse for procedures, not pay for outcomes.
Given these incentives, it's not hard to see why doctors are some of the most overworked, stressed-out, and generally miserable professionals out there. They're at the nexus of a crushing conflict between keeping people healthy, a management system that demands more revenue (and remember that revenue=procedures, because we reimburse for procedures, so the only way to increase "productivity" is to do more, faster, with fewer breaks and longer shifts), and a legal regime which mandates DOCTORS perform procedures, and only after a lengthy course of study.
I believe the way forward is to shift the discussion away from procedures and more toward outcomes, and give medical professionals more operational and financial freedom to run their practices using tried-and-true free-market principles. I believe this outcome is inevitable, but will take a decade or more to surface, because it requires major shifts in how doctors and insurance companies think about billing, greater human trust in computers and recommendation systems, and a collective realization that the current state of healthcare is untenable.
> 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 lengthy course of study
Good reasons for this - it actually takes that lengthy course of study to safely perform many procedures, and, more importantly, to fix things when they go wrong.
NPs and PAs are helpful but based on the quality of care that I personally observe they should not function without physician oversight.
There is no escaping that medicine is an extremely complex field, and it is only getting more so. Not long ago, many of the people who today are restored to their usual state of health would simply have died. The sicker a patient is, the more complex and difficult to manage they are. By definition a doctor is the one who is able to do so.
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.
give medical professionals more operational and financial freedom to run their practices using tried-and-true free-market principles.
They are not tried and true. A friend of mine worked as a QA engineer at my city's most prominent children's hospital (a minor power on the world stage). His thankless task was to find ways to improve communications between departments and curb the errors. It was simply not possible - every doctor had their preferred provider, sometimes from merit, sometimes because they liked the shiny goodies that the sales reps brought.
All the individual systems interoperated very poorly, and none of the physicians would budge, and the hospital administration could not force their hand. Any time admin tried to regularise something, the affected physician would just state "If we make this change, children will die". It didn't matter that everyone at the table new that this was a total lie, because the official authority for that department (or speciality) was that specialist. They got their 'free market', being able to use their preferred products for each individual specialist, for personal preference at the cost of better overall treatment. The whole was very much less the sum of its parts.
Another friend became a sales rep for a pharma company. The rep she took over from was a fairly standard rep, but she was quite ethical, and would only allow her 'freebie' budget to be used on things that developed the practise. Some doctors already do this. Others were more like "ah, well, the ride is over with this rep". Some were absolutely outraged that she should dictate to them what this 'extra income' was spent on - how dare she suggest medical charts instead of football tickets?
I myself have personally seen a specialist in a field report on some clinical studies so badly that we technicians had to go to other specialists and get them redone. That specialist didn't get any more of that kind of work at our practise, but his utter incompetence was never followed up beyond "don't hire him again".
I guess the moral of the stories are that freedom to run practises as you see fit does not mean ethical (or even ethically neutral) behaviour, and that an environment where every physician uses their preferred products does not mean better care is delivered.
Point of clarification: physician assistants are qualified to diagnose, treat, and recommend courses of action related to health care.
Per the American Academy of Physician Assistants: "PAs perform physical examinations, diagnose and treat illnesses, order and interpret lab tests, perform procedures, assist in surgery, provide patient education and counseling and make rounds in hospitals and nursing homes. All 50 states and the District of Columbia allow PAs to practice medicine and prescribe medications."
> 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 may see complete nationalization because the government must swoop in and "save us" from the monster it has helped to create through misguided regulation.
>I believe the way forward is to shift the discussion away from procedures and more toward outcomes, and give medical professionals more operational and financial freedom to run their practices using tried-and-true free-market principles
Holy meaningless platitudes Batman. How do you have a system that is simultaneously profit driven and that allows everyone a fundamental right to healthcare? Short answer: you can't! You can either have a system that avoids treating the most expensive (free market), or you have a system that ensures a certain level of care for all (socialism), or you have some bastardized hybrid that costs ungodly amounts of money and does not serve the sick and poor well. (the system we have).
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 because of student loans; that may help explain the suicide issue: people who feel trapped may in turn feel like death is the only way out.
A surprisingly large number of doctors hit residency and realize they don't want to become doctors. In most professions that's not a tremendous problem, but in medicine the only way to pay back $100 – $250K in graduate student loans is by becoming a doctor.
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.
With Pay As You Earn a debtor won't pay more than 10% of AGI to federal student loans. Note that's AGI, not gross income, meaning you can contribute to retirement and not have it counted. Loans aren't as big of a constraint on career options as people make them out to be. Debtors are also willfully ignorant of these sorts of options and choose to instead destroy their lives paying debts that don't need to be paid.
To be clear, it's a huge problem, and we shouldn't have this sort of debt loads on those who want to educate themselves. It also weakens the broader economy and drives up professional services costs. But to say people are killing themselves because of student loans is a mistake.
Medicine is a very wide profession in itself, with lots of options for specialization in something that interests you somewhat. On top of that I am sure it is not too difficult to go into research that is only slightly related to medicine (I personally know a couple of people doing this).
Another explanation of the suicide rate: doctors have access to means and methods of completing suicide. They are also aware of techniques that make completed suicide more or less likely.
A consideration of the economics would suggest that any doc who trained in the last two decades isn't in it for the money - the ROI on an MD is far less than most other advanced degrees. If we wanted to be wealthy, with the grades and letters required to get into med school in the US, most of us could readily have chosen other professions. (Heck, some even walk away from startups, believe it or not).
My impression as someone in practice for more than a decade, who cares for a large number of docs, and has run a large clinic: It's really not the reimbursement. It's the combination of dealing with payers determined to deny treatment, massive requirements in terms of documentation and ongoing accreditation, and - in particular - constant pressure to spend less time with more patients. Then, we read posts like these which buy into conspiracy theories about how we're out to poison patients with expensive medications to line our pockets. The time problem in particular afflicts primary care docs the most, but even the surgeons complain about it.
As far as ACA and its impact, there's no question it's a hack (and not a good one) - most economists not on the far right agree single payer would be optimal - but under the political circumstances, it was probably the best we could get.
Regardless, we'll move to a system where the majority of care isn't delivered by docs. Then we'll complain about it. But, it will be more cost-effective.
A comment here mentioned the absolute number of physicians in the United States, so I did some Googling and found a convenient website showing the number of physicians per 10,000 population in different countries. (The primary source for these data is studies by the World Health Organization, but the WHO website is not quite as user-friendly.) Note that in some countries the level of training and clinical experience to become a physician is much higher than in other countries.
Suicide rates are about 17.7 per 100,000 for men and 4.5 per 100,000 for women, and 11.3 overall. There are about 535,000 male physicians in the U.S., and 234,000 female physicians, and 66,000 of unreported gender. So the expected number of suicides would be 113 rather than 300.
I don't have a citation handy, but it's my understanding that doctors attempt suicide at a rate less than the general population but when they do make a suicide attempt they are more likely to succeed.
> 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 diagnosis for that matter. But that's an inherent risk in having something wrong with you that you need checked out.
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 the table the org could use to cross-subsidize non-payers.
You'll find this is happening in many industries. Despite that it lowers productivity and increases costs.
The problem is that management is filled with perverse incentives. It looks good on the books to have fewer employees - until you realize you have highly trained specialists spending hours per week working on paperwork or rushing their actual job and increasing long-term costs.
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.
I wonder how salaries for nurses and doctors compare in the US vs Canada. Do you happen to have any data on that (or know of a good government source for it in Canada)?
I know that compared to much of first world Europe, our nurses and doctors often make two to four times as much as their counter parts there. Wonder if that's true compared to Canada as well.
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.
Funny that the article links to http://www.dailymail.co.uk/news/article-2600319/Medicare-dat... which references the top paid doctors by medicare... I read an article last week saying that this data would be misinterpreted, as a lot of the "top paid" doctors actually are just like whole departments using the lead physician's billing code, and they don't actually get any of that money - and here we are.
There's no evidence that the profession causes doctors to commit suicide. It's not a stretch to hypothesize that people accepted to medical schools are self selecting for perfectionism and bipolar disorders.
"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.
Cost of employing someone is more than just their hourly rate * hours worked. For example, at one job where I was paid $26/hr, my time was billed at $48/hr--- and this was for a government agency internally billing itself, so there was no profit margin involved, just the cumulative cost of wages, benefits, and associated overhead.
I'll bet that the half of doctors who want out of the profession, are the ones who are exploited by the other half. Naturally the profession wants us to see doctors as selfless workers saving our lives, not as rentiers who are ruining us.
And now that Medicare payments will be tied to patient satisfaction—this problem will get worse.
That just sounds crazy. Can you imagine if your car insurance had to pay less if you complained about your mechanic? Not to mention that medicare is for the elderly who tend to have a lot to complain about anyway.
Can I pay my taxes based on my satisfaction with the government?
For fun, reread this article with "doctor" universally replaced by "teacher", and note the similarities. Then note that the doctor is probably taking home 4-5x the cash.
tdees40|12 years ago
Making it easier to become a doctor would improve things immediately (especially given the recent research that makes it clear that nurse practitioners do just fine).
riahi|12 years ago
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
mudil|12 years ago
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 government that is there all the time for us. For example, how about trying to bill Medicare for a surgery, when one phrase--one phrase-- is missing from the documentation, and I don't get a penny for a 4 hour surgery?
unknown|12 years ago
[deleted]
zavi|12 years ago
araftery|12 years ago
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 for their triple bypass and not to go broke at the same time, what we get bankrupt hospitals and over-worked doctors.
Being more responsible about the way we apportion healthcare is the only reasonable option.
pessimizer|12 years ago
https://www.youtube.com/watch?v=6lkvswrSRAE
unknown|12 years ago
[deleted]
unknown|12 years ago
[deleted]
LiweiZ|12 years ago
rdmcfee|12 years ago
wehadfun|12 years ago
FD3SA|12 years ago
To make matters worse, Canada is suffering the effects of the American system. Doctors licensed in Canada are encouraged to go to the USA (particularly specialists), by the allure of much higher salaries. In order to prevent a vicious brain drain, the Canadian Medical Association must pay doctors as much as they can to stay and practice in the country. As such, Canadian healthcare costs have been skyrocketing due to specialist salaries soaring ever higher to compete with American rates.
Comparing physician salaries in the US and Canada with other commonwealth countries like Australia and the UK provides a clearer picture as to what is going on. The American healthcare system is completely and utterly FUBAR. It needs to be torn down and rebuilt based on a functioning healthcare system from another country.
1. http://time.com/198/bitter-pill-why-medical-bills-are-killin... (Unfortunately, it is now paywalled)
pg_is_a_butt|12 years ago
[deleted]
SapphireSun|12 years ago
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 patient demand. Why not just hire more doctors, maybe lower salaries by increasing supply, and give them a healthier lifestyle? Maybe medical school prices would go down with additional scale.
mentalhealth|12 years ago
Additionally, the work hour restrictions placed on residents over the last few years appear to have done nothing to reduce the overall number of medical errors.
(I am in favor of reducing medical work hours myself, but these are some of the data-driven reasons that it will be very difficult, not to mention the structural reasons inherent to the current system of medical training.)
hga|12 years ago
So this is useful training, albeit at a cost. Although if they make a mistake that kills a patient during residency and learn they can't deal with the consequences of that, I suppose the earlier the better. They can of course move to less life and death specialties.
nilkn|12 years ago
It seems like a bit of a chicken and egg problem. Medical school is already so expensive that the salaries are necessary in order for newly minted doctors to have the same disposable income after loan payments that, say, a programmer or chemical engineer who's 7 years younger has (4 years medical school + 3 years residency minimum). Who would make the sacrifices necessary to become a doctor, taking out massive loans, only for an income that won't sustain them comfortably?
eldavido|12 years ago
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) health professionals must undergo expensive, lengthy, difficult courses of study and training, and (4) we reimburse for procedures, not pay for outcomes.
Given these incentives, it's not hard to see why doctors are some of the most overworked, stressed-out, and generally miserable professionals out there. They're at the nexus of a crushing conflict between keeping people healthy, a management system that demands more revenue (and remember that revenue=procedures, because we reimburse for procedures, so the only way to increase "productivity" is to do more, faster, with fewer breaks and longer shifts), and a legal regime which mandates DOCTORS perform procedures, and only after a lengthy course of study.
I believe the way forward is to shift the discussion away from procedures and more toward outcomes, and give medical professionals more operational and financial freedom to run their practices using tried-and-true free-market principles. I believe this outcome is inevitable, but will take a decade or more to surface, because it requires major shifts in how doctors and insurance companies think about billing, greater human trust in computers and recommendation systems, and a collective realization that the current state of healthcare is untenable.
idiot900|12 years ago
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 lengthy course of study
Good reasons for this - it actually takes that lengthy course of study to safely perform many procedures, and, more importantly, to fix things when they go wrong.
NPs and PAs are helpful but based on the quality of care that I personally observe they should not function without physician oversight.
There is no escaping that medicine is an extremely complex field, and it is only getting more so. Not long ago, many of the people who today are restored to their usual state of health would simply have died. The sicker a patient is, the more complex and difficult to manage they are. By definition a doctor is the one who is able to do so.
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.
vacri|12 years ago
They are not tried and true. A friend of mine worked as a QA engineer at my city's most prominent children's hospital (a minor power on the world stage). His thankless task was to find ways to improve communications between departments and curb the errors. It was simply not possible - every doctor had their preferred provider, sometimes from merit, sometimes because they liked the shiny goodies that the sales reps brought.
All the individual systems interoperated very poorly, and none of the physicians would budge, and the hospital administration could not force their hand. Any time admin tried to regularise something, the affected physician would just state "If we make this change, children will die". It didn't matter that everyone at the table new that this was a total lie, because the official authority for that department (or speciality) was that specialist. They got their 'free market', being able to use their preferred products for each individual specialist, for personal preference at the cost of better overall treatment. The whole was very much less the sum of its parts.
Another friend became a sales rep for a pharma company. The rep she took over from was a fairly standard rep, but she was quite ethical, and would only allow her 'freebie' budget to be used on things that developed the practise. Some doctors already do this. Others were more like "ah, well, the ride is over with this rep". Some were absolutely outraged that she should dictate to them what this 'extra income' was spent on - how dare she suggest medical charts instead of football tickets?
I myself have personally seen a specialist in a field report on some clinical studies so badly that we technicians had to go to other specialists and get them redone. That specialist didn't get any more of that kind of work at our practise, but his utter incompetence was never followed up beyond "don't hire him again".
I guess the moral of the stories are that freedom to run practises as you see fit does not mean ethical (or even ethically neutral) behaviour, and that an environment where every physician uses their preferred products does not mean better care is delivered.
seanstickle|12 years ago
Per the American Academy of Physician Assistants: "PAs perform physical examinations, diagnose and treat illnesses, order and interpret lab tests, perform procedures, assist in surgery, provide patient education and counseling and make rounds in hospitals and nursing homes. All 50 states and the District of Columbia allow PAs to practice medicine and prescribe medications."
http://www.aapa.org/the_pa_profession/what_is_a_pa.aspx
Disclaimer: I work for the Physician Assistant Education Association.
clarkmoody|12 years ago
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 may see complete nationalization because the government must swoop in and "save us" from the monster it has helped to create through misguided regulation.
LordHumungous|12 years ago
Holy meaningless platitudes Batman. How do you have a system that is simultaneously profit driven and that allows everyone a fundamental right to healthcare? Short answer: you can't! You can either have a system that avoids treating the most expensive (free market), or you have a system that ensures a certain level of care for all (socialism), or you have some bastardized hybrid that costs ungodly amounts of money and does not serve the sick and poor well. (the system we have).
jseliger|12 years ago
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 because of student loans; that may help explain the suicide issue: people who feel trapped may in turn feel like death is the only way out.
A surprisingly large number of doctors hit residency and realize they don't want to become doctors. In most professions that's not a tremendous problem, but in medicine the only way to pay back $100 – $250K in graduate student loans is by becoming a doctor.
erikcw|12 years ago
cylinder|12 years ago
To be clear, it's a huge problem, and we shouldn't have this sort of debt loads on those who want to educate themselves. It also weakens the broader economy and drives up professional services costs. But to say people are killing themselves because of student loans is a mistake.
collyw|12 years ago
DanBC|12 years ago
cassowary37|12 years ago
tokenadult|12 years ago
http://kff.org/global-indicator/physicians/
rayiner|12 years ago
curtis|12 years ago
unknown|12 years ago
[deleted]
josephschmoe|12 years ago
joshlegs|12 years ago
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 diagnosis for that matter. But that's an inherent risk in having something wrong with you that you need checked out.
eldavido|12 years ago
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 the table the org could use to cross-subsidize non-payers.
alayne|12 years ago
josephschmoe|12 years ago
The problem is that management is filled with perverse incentives. It looks good on the books to have fewer employees - until you realize you have highly trained specialists spending hours per week working on paperwork or rushing their actual job and increasing long-term costs.
rdmcfee|12 years ago
It's amazing that the billing costs in the US are a factor of magnitude higher.
jstalin|12 years ago
adventured|12 years ago
I know that compared to much of first world Europe, our nurses and doctors often make two to four times as much as their counter parts there. Wonder if that's true compared to Canada as well.
ams6110|12 years ago
DatBear|12 years ago
rdmcfee|12 years ago
unknown|12 years ago
[deleted]
unknown|12 years ago
[deleted]
rflrob|12 years ago
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
unknown|12 years ago
[deleted]
dunmalg|12 years ago
analog31|12 years ago
sizzle|12 years ago
thefreeman|12 years ago
That just sounds crazy. Can you imagine if your car insurance had to pay less if you complained about your mechanic? Not to mention that medicare is for the elderly who tend to have a lot to complain about anyway.
Can I pay my taxes based on my satisfaction with the government?
GFK_of_xmaspast|12 years ago
aaronem|12 years ago
al2o3cr|12 years ago
There's also this: http://seattlepostglobe.org/2011/03/07/warnings-of-doctor-sh...
Dan_Nguyen|12 years ago
unknown|12 years ago
[deleted]
aaronem|12 years ago
"Extremist language" indeed, and true only in cases where the doctor can forbid the patient from going to another doctor.
baddox|12 years ago
In a competitive market of doctors, profit motive will tend to cause doctors to meet the demands of patients.