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Comment by postexitus | Hacker News Reader

No. There is no area of medicine where a boost in productivity will cause doctors to have idle time. The wait times may decrease, throughput may increase, diagnosis accuracy may improve, even costs may decrease (press x to doubt) but no, there will never be a case where we will need less radiologists.

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Which may take us to a sort of “Jevens Paradox” kind of place except for medical care.

Like there are times already where I’ve put off or not sought medical care because of the hassle involved.

If I could just waltz into the office and get an appointment and have an issue seen to same day I would probably do it more often.

Wonderful insight that I'd never considered. Talk to almost anyone in America and they'll tell you about a health issue that they or their family are deferring due to lack of access. Waiting months or years to simply talk to a specialist, let alone find one that can help, is sadly the norm. Patients rightly feel it's a waste of their time so won't even seek treatment.

Remove that barrier to access and we won't see a shiny new streamlined medical system but rather a flood of new patients requiring even more bureaucracy to manage.

100% why I bothered to stick w/ OneMedical after the Amazon acquisition. I tried to get a "New Dr/New Patient" appointment with any local doctor I could find that took my insurance, and the closest I could get was 3 weeks away.

I'm not worried about medical folks having "time to clean" any time soon.

To be clear, we also need more medical professionals in general -- they're not keeping up with the population and it's making us all less healthy. Three to six months, or more, in the SF bay area for some critical appointments is really unacceptable, but there's not really an option given supply and demand.

I'm sure this will all get better with captain brainworms at the helm.

>> No. There is no area of medicine where a boost in productivity will cause doctors to have idle time. The wait times may decrease, throughput may increase, diagnosis accuracy may improve, even costs may decrease (press x to doubt) but no, there will never be a case where we will need less radiologists.

I dont think this is how market participants may think about it. If costs decrease, some group of radiologists will drop out of the market. We may not "need" less radiologists, but we're signaling we need less of them by not paying them as much as before.

Much like I still "need" a photographer, but short of weddings, I'm not willing to pay as much as before. I may well acquire a photogrpher for a portrait, but it would have to be priced competitively to a selfie.

You're making the common mistake of thinking that healthcare is some sort of normal market subject to simple supply-and-demand economics rules. The reality that supply is heavily constrained by CMS funding for residency slots, prices are (mostly) fixed by a few large payers, and patient demand is effectively infinite. There is a serious shortage of radiologists already and it's getting worse as the population grows older and sicker. If AI tools make radiologists more productive then more imaging studies will be ordered.

>> supply is heavily constrained by CMS funding for residency slots

I keep hearing this argument. Then I look at an Insurance Explanation of Benefits statement. A Radiologist might make $1-2k/day in billings. If you are in a balance-billing state, whatever insurance doesnt pay gets forward billed to the patient. On a standard 252 day workyear, that is $250-500k/yr in billings. The average resident salary is 70k, lets assume 100k with benefits.

Of course there is plenty of overhead, but from the math i'm seeing, the average Radiology Resident is a 150-400k net revenue center. Is the overhead really greater than 150-400k/yr/resident?

What am I missing, why would a profit center need "CMS funding"? From what my doctor friends tell me, the real bottleneck is the unwillingness of AMA and ABR to open up more radiology residency spots (artificial supply constraint) with "CMS funding" a boogeyman and red herring.

Contrary to what your doctor friends might have told you, the AMA has no power to restrict the number of residency slots. They are a private membership organization with no regulatory or accreditation authority. At one time they did lobby Congress to restrict graduate medical education funding but have since reversed that position.

https://savegme.org/

A minority of funding does come from sources other than CMS. Teaching hospitals are largely free to add more residency slots if they want to. The fact that most hospitals don't do this indicates that GME programs are largely unprofitable.

You cannot bill for a resident's work, without an attending signing off on it.

I like residents, I actually started a new radiology residency program.

They are a net drain on productivity in radiology, due to the teaching obligations

>> You cannot bill for a resident's work, without an attending signing off on it.

Isnt that the case for almost every industry? I was a management consultant and our Partner signed off on the work before billing clients. Architects bill clients, but only when the lead architect signs off on the plans. Same for civil engineers. Same for magazines where the editor signs off on most major pieces.

Faster CPUs, better screens, helpful IDEs, heck even Gen-AI itself did not reduce the need for software engineers let alone decrease the costs. As mentioned in another comment, The Jevons Paradox implies that in certain industries, increased productivity may actually lead to more consumption (therefore propping up the demand / cost) despite not being intuitive so.

The only industries that has observed the opposite effect I can think of so far are translators and stock photographers. Maybe also proof readers - but is that gen Ai or did spellcheckers already kill that branch?

Software engineers could spread out into new areas and find new things to do. Unless I am mistaken, the work of radiologists is more defined.

> Unless I am mistaken, the work of radiologists is more defined.

When I had cancer I had to go to an Interventional Radiologist. Never heard of it before. But they use X-Ray in real-time (flouroscopy?) to guide surgery. Pretty neat.

> Software engineers could spread

This is key. Radiologists that can program (or software engineers that do medicine) make a massive difference.

When someone explains what they want and it’s built for them, you get a very different product to that built by the user.

I want more radiologists that can write software please.

I'm a radiologist that can program!

I've authored and contributed to several open source projects over the years, and I'm currently doing a deep dive in CAD/CAM after buying a CNC machine.

I help my practice where I can, and have written a little utility to make generating reports easier, but I would have to quit my job if I was trying to take on the absolutely enormous task of radiology computer aides diagnosis. And I need my job!

> I would have to quit my job if I was trying to take on the absolutely enormous task of radiology computer aides diagnosis

I think about this sort of thing every so often. The difference one person can make by creating a decent piece of software might be one of the best ways of getting a return on investment (in human hours, if not in money).

>> The only industries that has observed the opposite effect I can think of so far are translators and stock photographers. Maybe also proof readers - but is that gen Ai or did spellcheckers already kill that branch?

Voice-over performers. Sketch artists. Audiobook actors. Tutors (see: https://www.google.com/finance/quote/CHGG:NYSE?window=5Y)

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