oaktrout

I care about savings to the patient and taxpayer if that's helpful. I just googled "average cost of emergency department CT scan", I agree that is not what Medicare would reimburse.

Please correct me if I'm wrong here: You save $45 on the professional services, but you still pay the same facility fee (~$1000), the CT scan still costs the same (~$5000), labs are still the same (~$110)... etc. So maybe you have saved ~1% seeing an NP, hence why I said "billed the same", although you are correct that they are not the exact same. Now imagine that a NP orders a CT scan that was unneeded 1% more often than a physician, at this point it costs more on average to see the NP.

With the Boeing engineers the outsourcing wasn't obviously an issue to individuals outside the system until the 737 MAX was grounded and 346 people were dead. Requiring such a sentinel event before the value of US engineering was known to the public suggests to me that it was not trivial for the Boeing engineers to prove their value.

Doctors are at a greater disadvantage as there is not likely to be a sentinel event that kills 189 people at once. Nothing about the US medical system is trivial.

Consider the private equity run emergency department in the article, I am sure that they could make more profit off of NPs and that doctors wouldn't save private equity costs. The article suggests that NPs are saving private equity money while costing patients and taxpayers more. Speaking of quality, why should private equity care about quality if it doesn't effect their bottom line?

Truly reddit is a place full of idiots on all sides, do you have specific criticisms of the study I posted though? Or specific criticisms of the study in the NPR article?

Truly it's a nuanced topic and you cannot say that across the board NPs cost more than physicians. I have no doubt that NPs and PAs can be cost saving when employed appropriately.

An issue with your first study is that some NP care was attributed to physicians (as a result of NPs billing under a physicians NPI), hence decision making that was done by an NP is being analyzed as if it was done by a physician. In the study I linked that wasn't have been an issue as they could see which patients were on which providers panel.

The study you linked on PAs is interesting, although it's an international one and ~24% of included studies were of PAs who did only one procedure (not really applicable to the discussion here). If you bring a PA into your practice to do only one procedure it's hard to envision that being much of an issue.

The NPR article itself links to a study that shows NPs cost more than physicians (in the emergency department), so it's not just one random study that shows they can cost more.

I think we could both post studies back and forth all day, maybe it makes more sense to look at things from first principles. If your ED visit is billed the same whether you are seen by an MD or NP, how would an NP go about saving you money? I hope that we can agree they will have less medical knowledge, so I don't see how they could order fewer studies / tests safely.

The AMA obviously has an agenda, but that doesn't that change the fact that non-physicians cost patients and taxpayers more money, hard to argue with the cms data.

Who cares if your doctor gets paid more if he is saving you and the taxpayers money. I guess it might make business sense from a hospital perspective, because physicians are more expensive to employee than NPs and hospitals don't have a business reason to save taxpayers or patients money.

I'm sure the high paid software engineers at boeing said something similar when jobs were being outsourced "we need more US engineers". Look at the software problems they had and tell me they were wrong.

Just like software engineers are best qualified to evaluate software quality, doctors know medicine better than anyone else. Just because they are incentivized to protect their job doesn't mean they are wrong.

There is some evidence in the primary care world that going to a NP for primary care costs more than going to a doctor: https://www.ama-assn.org/practice-management/scope-practice/.... In short, NPs order more tests without improving patient outcomes.

I have no doubt that it's the same in the ER. It takes training and knowledge to know what test you don't have to order. Do you really need a CT scan for your diarrhea?

That being said, I think there is definitely a role for NPs : low complexity and/or non-acute highly specialized care. The emergency department is not the environment for that.

I appreciate the response. Hard to draw many conclusions from that study for a number of reasons, but perhaps the greatest in my mind is highlighted near the end: "TCOVID-19 prevention measures (vaccination, isolation, and mask use) are likely highly correlated within households, and the identified risk factors might not be independent predictors of transmission".

Basically this article doesn't show that vaccines prevent transmission. It doesn't show they don't either, although that there wasn't a more dramatic effect is a negative finding in my opinion. I wish the authors had analyzes the AR in vaccinated vs unvaccinated household contacts.

I was under the impression that there is no data showing that the covid mrna vaccines reduce transmission. If you are aware of a source that says otherwise I would love to check it out.

You said "The same people who refuse the vaccine take unknown substances in 'supplements' which have no regulation at all. It makes no sense. Explain it." I replied to that point directly.

The "outrage over vaccines and not other things" is in part because the mrna vaccines are new technology. People are hesitant to try something totally new on themselves.

I can explain it. Tylenol has been around since 1955 and is only demonstrably toxic in overdoses. The mrna based vaccines have been only used for the past couple years, hence long term side effects are unknown.

Not everyone who refuses the vaccine takes supplements. Your comparison is like saying "why don't you take this research chemical ('molly'), you smoke cannabis already".

Agree. Also, was that the cost of hospice or of all her medical care?

If you're including rent in the cost, did grandma have a home that she sold? Would she have been paying that much in rent anyway if she wasn't sick? Would it have been cheaper if she didn't live in one of the nations more expensive cities?

I would argue the video in question is none of those things (not demeaning, not in public, not without permission, etc).

Who cares if he did it to make himself more famous? He helped 1000 blind people see. Celebrities who get famous from sex tapes get less flack.

Imagine if we encouraged this sort of behavior and Instagram was full of people helping others instead of people showing their ass.

Creating cards is great, but for those seriously deep in the anki game (eg 20,000 active cards or 20 new cards per day for years straight), there isn't enough time to create all the cards you need to learn and pre-made decks are king.

I imagine if you need to learn that much material but the pre-made deck isn't there, this gpt integration might be very helpful.

Citation for your pancreatic cancer claim? I am skeptical, or perhaps we have different definitions of better.

Arguably more chronic conditions might point to US health care being better. These individuals with multiple chronic conditions might not be alive except for high quality US medicine.

It also argues that we suck at primary prevention, but that's a whole different can of worms.

Couldn't get that report to run on my phone, but there is an older linked study here that noted 57% of NCAA football programs were profitable: https://christopherlee.com/college-athletics-by-the-number/.

Also, even if the programs themselves aren't profitable that doesn't mean they don't make a net profit to the college through increased admissions. Lots of college students want to go to a school where they can tailgate and watch a football game.

The NCAA also may have an incentive to say that football isn't profitable, historically they have avoided paying athletes.

I agree especially with #1. You can see the children that were never told no and never challenged. They fail spectacularly when mom and dad aren't their to hold their hand in the real world.

Lol at not letting them use a tablet as much as they want being abuse. Maybe their room is clean and their grades are good but they aren't developing social skills because the tablet is their only hobby.

IMO, part of parenting is making choices for kids because their brains aren't developed enough to understand the consequences. As a 7 year old, I want cake now, I don't care that I will be obese later.

Many people get a rash when a viral illness (epstein barr comes to mind) is treated with amoxicillin. This is not an amoxcicillin allergy.

The question is where do you draw the line? Hypothetical: the smell of flowers makes me sick, it's possible to garden indoors. I want you to remove your outdoor garden and grow your flowers indoors only. Is that fair?

Covid infection outcomes exist on a continuum from death to harmless. There is also "long-flu", and I'm sure there are persistent responses to other respiratory viruses, so long covid isn't totally novel.

If you're scared for your health the best thing you can do is be healthy, eat right, exercise, don't smoke, etc.

I would say it's not so clear, and it's open for debate until hospitals open up their books.

Yes residents need to be supervised, but one doctor can supervise many residents seeing many more patients than they could alone. If hospitals didn't have residents they would have to hire more doctors.

Also consider that a resident costs less to employ than a nurse and that the hospital bills for all the work residents do.

Finally, doctors in teaching hospitals tend to be payed less than doctors in non-teaching hospitals.

One advantage that gas stoves have is that they don't need electricity to cook, so if your batteries or generators fail, you can still prepare a meal while you wait for the power to be restored.

Assuming you can afford solar panels and a battery and they are not damaged in the storm and you don't go too long without sunny weather and ...

More specifically I would say that's how caffeine tolerance works.

I enjoyed the article but found it to be a little wordy and difficult to skim to find what I was looking for. Most systematic reviews and meta-analysis convey more information in less text. I personally prefer to get to straight to the facts, say more with less.

To be clear, on my read there were no difference as far as downsides, it seemed to improve the mental health of the parents and it taught the babies to return to sleep without needing intervention from the parents, which I would argue are major upsides.