the_d3f4ult

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.

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 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.

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.

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.

https://www.nrmp.org/wp-content/uploads/2023/03/Match-Rates-...

https://www.nrmp.org/wp-content/uploads/2023/03/Match-Rates-...

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.

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.

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?

None of your points are accurate here from my perspective. Personally, I was profitable within 3 months of my hiring. The longest I've heard of it taking for a physician to become profitable is around 6 months and that's going completely independent. The idea that a doctor is a money-loser for 2 years is absurd. The need for physicians so greatly outstrips demand that I don't see this applying even in large metropolitan areas.

To your second point. The way private practice used to work was a new physician would take a low initial salary in order to be offered the opportunity to become a partner in the practice. The assumption being that for the first few years the new physician is making the partners money. There are a lot of advantages to being a partner in a practice rather than being completely independent and it was worth a few years of a depressed salary in order to be able to purchase equity in an established practice.

What's much more common now is for senior partners to recruit young physicians and then flip their practice to an equity firm after binding them with a non-compete, essentially canibalizing the future of independent private practices in order to ensure themselves a nicer retirement.

Relevant to the discussion is the fact that equity firms, and to a lesser degree hospitals, must chase growth at all costs - inevitably driving up the cost of healthcare. I think this is something that we agree on.

The short answer is that non-competes take power away from independent physicians and give it to equity firms and hospitals. If you sincerely want to see independent physicians flourish then these need to go away as soon as possible. If you read the comments submitted to the FTC you'll see that my perspective is common.

Physicians do have to ask about vaccines and document the answer in order meet meaningful use requirements. Maybe this is what you experienced?

LASIK is safe, but when there are complications they're a big deal.

The mistake everyone seems to make is thinking that making a diagnosis is what makes medicine hard. It's not. e.g. An algorithm that can diagnose diabetic retinopathy from fundus photos 'as well as a specialist' makes for a good headline, but isn't particularly useful. Medicine is nothing like "House" in real life. AI should be leveraged to either improve efficiency or develop novel tools.

I'm a doctor. No. They don't. Dentists make more money and work less. Their training is rigorous, but generally shorter. They don't take call, don't work weekends and don't have any emergencies.