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Comment by neuro_imager | Hacker News Reader

Actually, its interventional cardiology for heart attacks and neurointerventional surgery/interventional neuroradiology(NIR) for strokes. (Not IR which cover non-neurological and non-cardiological interventional procedures).

I'm a NIR and most of us are not paid per surgery/intervention. Also these interventions tend to be loss leaders in terms of hospital reimbursements. Funding for stroke centres can be profitable but that's a very long discussion.

In addition, at least 7 randomized clinical trials have shown the benefit of thrombectomy in acute stroke (actually something of a modern medical technological miracle).

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I find that surprising. What's the typical compensation model? Salary or hourly?

Almost anyone at a hospital or university setting is on salary.

Private practice can be another story, and perhaps there your argument would be more compelling. But many physicians, surgeons, specialist go into private practice to get out of bureaucracy, or, increasingly nowadays with providers who do not take insurance, to avoid the endless paperwork and hassling of insurance.

Most people get into medicine for the right reasons; to help other people.

Salary (unless you're moonlighting - which is less common, and overall less attractive).

Why do you presume that our intentions are nefarious when you have no idea what you're talking about?

I don't at all presume nefarious intentions. As if physicians don't try to make money. My original comment was a tongue in cheek defense of the status quo because I took offense at the comment that surgeons just like to keep cutting. Sure, I'm "just" a veterinarian, but I like to cut as little as possible.

I do know that doctors like to keep it moving. Surgeons like to start early and finish early. Nobody wants to get bogged down in a specific procedure. As far as profitability (or cost recovery, whatever euphemism) is concerned, doing several short procedures beats one longer procedure, even when surgery time is billed by the minute.

You ignore the fact that many doctors leave the strict employ of the hospital for a private practice that still bills through the hospital. While they are still salaried, they also get a profit share, usually divvied out on productivity. There is no one model. But you're right, I have no idea how it's typically done in IR, NIR, IC etc.

For the sake of completeness, I'll expand:

It's rarely up to the interventionalist if and when they will treat a stroke. There are clear guidelines on treating these patients (which mostly take place at comprehensive stroke centres), mostly defined by the neurology service, which functions somewhat independently. These guidelines have been expanding as newer evidence has shown a role in wider time windows but this point remains the same. There is very little opportunity for an individual interventionalist to increase his patient volume independently (at least for ischemic stroke).

I agree in principle with most of the points you make, although I think perverse incentives are largely a function of the US healthcare system in general rather than the domain of any particular specialty.

In specific relation to the original article, I'm extremely doubtful that combing two anti-thrombotic agents would be a miraculous therapeutic regime for treating stroke but I'd be happy to be proved wrong by a legitimate trial. However, I'd worry that we'd be sacrificing patients that could otherwise be treated if we assigned them to an arm of a trial that precludes established therapy.

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