The AMA is indeed a fierce lobby - just not for physicians. They are widely regarded as a shill for hospital interests rather than doctors or medical professionals.
Wages in healthcare have decreased Year-Over-Year relative to inflation since at least the 90's. Productivity has increased in terms of the number of patients seen / day.
This has nothing to do with "knowing how to use a computer."
Looking at a screen while you check through dozens of flags and billing related documentation instead of looking at the patient is much less personable.
I'm a physician. To understand why this is true you have to understand that the software is not intended to the make the physicians jobs easier or more efficient. The point of modern EMR's is to take every patient encounter and generate a list of billable codes that maps onto the encounter in such a way that insurance companies are less likely to send it back. The stuff like checking medication interactions is just tacked on as an afterthought. Through this lens everything else makes more sense.
Neither of the things you mention detract from his point. Just because the companies are headquartered outside of the US doesn't mean that they aren't developing drugs with the intention of recouping their R&D costs (and then some) from the US market due to our uniquely broken healthcare system.
>There aren't enough software engineers to create the software the world needs.
I think you mean "to create the software the market demands." We've lost a generation of talented people to instagram filters and content feed algorithms.
This is an interesting perspective, but your view seems very narrow for some reason. If you’re arguing that there are many forms of computation or ‘intelligence’ that are emergent with collections of sentient or non-sentient beings then you have to include tribes of early humans, families, city-states and modern republics, ant and mold colonies, the stock market and the entire earths biosphere etc.
I'm an ophthalmologist. I look at irises all day. People's irises change over the course of their life. Sometimes dramatically if they have some kind of pathology. Are they updating their model periodically? What keeps someone from getting locked out of their crypto gains if they develop an iris nevus or have cataract surgery or start on flomax?
Fair point. There's some data showing patient outcomes are worse when managed by overworked residents-in-training, but I think you're referring to outcomes post-residency. i.e. Physicians should squeeze as much training as possible into the allotted years. This is reasonable, especially for surgical specialties where procedural reps are a commodity for trainees.
I'd be more open to this line of reasoning if physician's salaries had kept pace with inflation over the last 30 years and if if we hadn't tacitly accepted a much, much lower standard of training in the form of DNPs, CRNAs and PAs who are now practicing independently in a lot of regions. You can't demand that people make extraordinary sacrifices without extraordinary compensation.
For contrast, most European countries have a much longer post-residency training process that is more humane. Caveat being that students enter medical school directly from high school and don't have student loans.
It's also worth pointing out that in the US a LOT of those 100 hours are not spent in direct patient care. They're spent doing chores ('scut') that are not directly tied to patient care. Think: Calling insurance companies for prior authorization for your supervisor or filling out FMLA paperwork for one of your supervisors' patients. As a resident you don't have the ability to say "no" to these tasks.
They’re not ‘getting a cut’ unless they directly own the clinic. What you’re seeing is a cost-cutting measure increasing the bottom line for whoever owns the clinic. Physicians are forced to agree to ‘supervise’ midlevels as a condition of their employment these days.
This is an uninformed take. A relatively small fraction of our healthcare dollars (~7%) are going to ‘providers’ i.e. doctors and nurse practitioners. I don’t have a source handy but this is easily searchable.
Most of the spiraling healthcare costs are attributable to administrative bloat, hospital profits, insurance companies and pharmaceutical profits. What you’re suggesting would just result in lower quality care in general and has effectively already been implemented with the rise of ‘supervised’ and unsupervised mid-level providers. I.e. NPs, PAs, CRNAs etc. It hasn’t resulted in any decrease in healthcare costs for the patient.
Let me give you some context for insight. If I see a patient in clinic for an intravitreal injection my fee will be $150-250 before overhead, the pharmaceutical company will be paid by medicare or private insurance around ~ $2000 for the drug that I inject. Double that for a bilateral injection.
If I operate at a hospital, my fee is $5-600. The hospital bills medicare a $4000 facilities fee plus additional fees for anesthesia, consumables etc. to the tune of over $10000 per eye.
If you want to lower healthcare costs a good start would be negotiating drug prices, repealing the clause in the ACA that bans physicians from owning hospitals, banning non-competes for healthcare professionals and getting rid of certificates of need that make it unnecessarily difficult to build outpatient surgery centers. In short, ideas that require a more nuanced understanding of our healthcare system.
I’m an ophthalmologist. The answer is that junior partners are brought on at a below-market-rate salary with the promise of future equity (usually under false pretenses) in the practice and a super restrictive non-compete agreement. The senior partners then take their golden parachute and sell-out the field and the junior partners to the PE finance bros. One then has to choose between selling their house, uprooting their family and taking the financial risk that comes with starting a practice in a new location (due to the non-compete) or continuing to work for the PE firm as they devolve to more and more unethical business practices. Eventually your choices are either go into solo practice or work for PE
I love this. Sounds like your kids are lucky to have such supportive parents. I’d love to share that kind of thing with my son. He’s only 2 though so who knows what he’ll be into.
I'm a medical sub-specialist. When I trained, my primary care mentors were simultaneously some of the smartest and most poorly compensated physicians in the system. I have to master a very narrow body of knowledge to function well. To make a good differential, a family medicine physician has to know a lot about everything. This skill saves the medical system tons of money by preventing unnecessary testing, lab work and specialist referrals. It also saves lives and dramatically increases patient quality of life. I can't emphasize enough how hard this is to do since, in the American system, you can be held liable for any missed diagnosis. You have to be sure that you're correct and it's much easier to just order everything and discharge the liability to a specialist.
Practicing primary care in this era is a nightmare. Like the article says - most clinics are run by PE or hospitals that push 'providers' to see a complex patient every 10 minutes while absorbing none of the liability for rushed, low-quality care. The compensation for these positions is now significantly less than most of the salaries that you see in the "Who's hiring?" threads on HN except with a tremendous amount of liability attached, a ton of customer service and a guarantee that your salary will go down relative to inflation.
The idea that NPs or PAs could just fill in the holes in our primary care system was always laughable to anyone who understands how medicine is actually practiced - to do the job well you need well trained, highly intelligent people. The punchline of the joke is that very few PAs/NPs ever intended to go into primary care and now the market is flooded with "Psych NPs" and "Derm NPs" pedaling Ritalin and botox.
Nothing will fix this problem short of a complete, ground-up rebuild of our healthcare system.
This isn't true for primary care. There are tons of open spots every year that are filled by International graduates or aren't filled at all. The problem is nobody wants to do this job.
> For a typical surgeon in the US, how common are lawsuits from patients?
Not very common. Pretty much everyone gets sued at some point in their career, but it's rare to break through the malpractice insurance ceiling. That said, it's always in the back of your mind and when it happens it messes with you psychologically.
>Do you have plans to run your own clinic (if not already doing so)? If so, >would this address some of your current issues (work hours, compensation) at the >risk of having to operate your own business?
It's complicated. While being your own boss has a lot of perks, the path to ownership is not straightforward anymore in the current era of private equity. Some of the things that suck are not related to the financial aspects.
Being a physician is a horrible career move right now. As a former Math/CS major turned eye surgeon, I can't help but think about how much easier my life would be had I stuck with tech. It's hard to understand exactly how hard the job is until you've lived it. I saw 40 patient's in clinic today in 8 hours without lunch or any kind of downtime and then spent 2 hours at the hospital because a patient needed an emergent procedure. They might go blind despite my efforts and I have to live with that. I also may get sued, if they're feeling spicy, despite going to heroic lengths to help this person. My son was asleep before I got home.
There's just no reason to do the job when you can get the same compensation working remotely in tech. Looking through the "Who's Hiring" thread is soul-crushing. Physician salaries are the only ones that do not grow relative to inflation and have decreased year-on-year relative to inflation for decades.
I do believe that the rigorous training model leads to a higher quality of care and much deeper understanding of the disease process. But, why would anyone want to do the job? It's just not worth the liability anymore. That said, is anyone hiring an ophthalmologist with CS and Math degrees?
The AMA is indeed a fierce lobby - just not for physicians. They are widely regarded as a shill for hospital interests rather than doctors or medical professionals.