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Comment by freeAgent | Hacker News Reader

Trust me, they are all aware of this. The problem is that, for the majority of doctors now, they do not own or control their clinics. They are either: 1)employees of the health system or 2)partners or employees of a provider's group that essentially contracts with the system to provide doctors. The doctors themselves have no real control over how their clinics operate outside of contractual negotiations.

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The doctors are just cogs in a machine. The problem is that if your compensation is $200k-$1000k why would really want to tackle the issue.

Specialists make so much money they can hire a personal assistants to handle all the annoying things.

I know several pharmacists, one is highly intelligent and she is the only one who wants to get out of the field because healthcare in the US is toxic and profit driven.

Yeah, most of the time when patients send emails, they get responses from a nurse. At least at my wife's clinic, they do not always charge for emails. They only choose to charge when an email is asking something non-obvious or for the doctor to take some action that requires additional work/time outside of just reading and responding to an email.

That's the problem. The doctors should form employee owned co-ops and be sure profiteering administrators and suits aren't the ones running things.

That is basically scenario #2 (which is common), but for whatever reason they haven’t been very successful at pushing back against some of the changes that cause these issues. I don’t have much insight to offer there since I’m not at the negotiating table there.

I mean I think the answer is that good doctors do form employee-owned co-ops, which are often very successful and establish a great deal of trust in their community, but then when the time comes for them to retire they very understandably cash out and sell to the private organizations that proceed to run them for profit first.

I've been playing with the idea for a while that any time a company uses its name, it has to disclose its ownership (first the company at the top of the chain, then the ownership structure of that company). So like for example the company name "Gerber" would have to always be coupled with "owned by Nestle, a publicly traded company.", and "Dave Franklin, a Dentist in your Community You can Trust" would have to be coupled with "Owned by Private Equity Incorporated, mostly owned by pension funds".

This would make it easier to keep track of if the same company is just screwing you over and over again with different faces, while still allowing some value to remain to brands that are consistently good for customers.

You’d just end up with shell companies with vague names obfuscating that they are actually part of “ACME global megacorp”

actually, the problem is that Congress continues to LOWER physician reimbursement, but RAISE hospital reimbursement. When I became a surgeon in 2002, medicare paid $600 for me to take out a gallbladder. I had to pay my overhead (50%) so my take-home was $300. Today, in 2024, after price reductions, medicare pays $600.

That is why I have to be employed. I guarantee that after 22 years, office expenditures (rent, salaries, supplies, health insurance) would eat up the remaining $300. So taking care of Medicare patients would be charity. Medicare is 60% of my practice. Private insurance is 25%. Medicaid is 10% and unfunded is 5%.

Well, despite that physician-owned hospitals have better outcomes than profit-above-all-else hospitals run by MBAs, Congress outlawed future physician-owned hospitals in the Affordable Care Act (Obamacare).

The problem is that they do not care, and they are not incentivized to care.

My wife is a PCP and she does care and is endlessly frustrated by the BS. There’s just not anything she can do about it.

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