7 ms·

Regarding your first point, that's especially striking in the USA. There seems to be at least 4-5 assistants (nurses, secretaries...) for each doctor. Assistant

Regarding your first point, that's especially striking in the USA. There seems to be at least 4-5 assistants (nurses, secretaries...) for each doctor. Assistants check you in; you're left waiting in a room; after a seemingly random period of time, the doctor suddenly barges in, diagnoses you faster than the Flash, and leaves just as suddenly; assistants check you out. I get that it's very efficient to work this way, but I'm not sure I'll ever get used to it. My father, now long retired, used to be a family doctor back in France. He shared his office with 4 other family doctors + 1 secretary that they paid with their combined income to take care of their appointments. He used to spend 20 minutes in average with each client. One of his colleagues routinely spent 30 minutes. I should ask him about his churn. :)

jacquesm 9y ago
France has some of the best healthcare in the world. A family member was involved in a horrific truck/passenger bus accident in France near Metz and I spent the better part of a week in and out of their intensive care department visiting. I've never seen a hospital that I liked better. Everybody was so unbelievably nice and caring it was a huge improvement over what I'd seen elsewhere. http://krant.telegraaf.nl/krant/archief/20020319/fotos/bin.venster.metzsectie.jpg http://krant.telegraaf.nl/krant/archief/20020319/fotos/bin.v... It was a pretty bad accident (5 dead, 55 wounded of which 3 critical one of those criticals was my family) with lots of beds suddenly occupied by people not speaking French and a large multiple of that in foreigners roaming the corridors and yet they dealt with all that with grace and understanding.
- ThomPete 9y ago
  I do question the sustainability of the french system though and that of many other european systems. Its important to remember that in a state economy where healthcare is free or semi free it's operated as a cost center and thus has budgets that are politically mandated not determined by market demand at least not directly. This leads to a number of limitations on what kind of care patients can get what machines they can buy, what medicine etc. Not saying the US system is better but all systems have drawbacks.
  - jacquesm 9y ago
    Good point. I'm not too worried about France, they seem to have their priorities straight there, other countries are less stable. Especially in former Eastern European countries there are disasters happening right now, and many Western countries will have to come to terms with the cost of health care and attempting to take commerce out of it. NL had a very good system which got replaced by something much less efficient, ostensibly because the 'market' would have been better at making things efficient where the only real change is that healthcare is now much more expensive and options are as limited as they were before. Personally I feel a good society should take care of its sick, poor, elderly and inmates even if it costs but that's an opinion that seems to be out of fashion.
    - ThomPete 9y ago
      My personal suggestion for a good balanced system is that most people pay most of the cost for normal healthcare costs like going to the doctor for a checkup, most of the cost for one of things like a broken leg but that society pays for more serious and longer term situations like cancer, heart surgeries where you are supposed to stay at the hospital for a longer time. I.e. no one should be bankrupted because they get a serious illness. With regards to France healthcare system here is an article who seems to think it wont survive though. https://www.bloomberg.com/news/articles/2013-01-03/frances-health-care-system-is-going-broke https://www.bloomberg.com/news/articles/2013-01-03/frances-h...
      - jacquesm 9y ago
        Yes, those poor people with recreational broken legs really should pay for their own work. That's only about 25K or so in a bad case without further complications... /s
        ThomPete 9y ago
        Please read what I actually wrote instead of just knee-jerk reacting to your own prejudice. I said MOST people should pay MOST of the bill. Do you really think I am talking about those with least amount of money.
ThomPete 9y ago
Thats actually a very efficient way of doing things and they get through way more patients a day.
cm2187 9y ago
To me this looks like a basic productivity thing. Health services is the only sector that never industrialized, it's a craft industry. You have a highly educated, highly paid specialist in front of every client. It would be absurd (and uneconomical) to make him do the job of a receptionist in top of that.
arkades 9y ago
That's not a hierarchy thing. Docs are the chokepoint in the process. Overseers track very carefully how much time you spend, how productive you are, etc. and surround you with lower-wage employees to do every last thing except those responsibilities that you, by law, have sole power to do. My buddies are in latter years of residency and no one works <90 hrs/wk (including paperwork they have to finish when they get home, 'cause otherwise they'd never see their families). And that's despite running around like their hair is on fire. I assure you, it's not voluntary.
- peferron 9y ago
  Why are there so few doctors in the USA that they need a whole system around them to ensure they spend < 5 min in front of each patient?
  - arkades 9y ago
    After you graduate medical school you are required to undergo post-graduate education to receive your license. This post-graduate education system hasn't had an expansion of slots in over 20 years (the Balanced Budget Act of '96 put a frozen cap on the number of funded positions.) A number of positions are unfunded, and hospitals are trying to actively eliminate those (rather than grow the pool of physicians to meet demand.) The actual amount paid out for these slots has been repeatedly cut into as well, as part of various political wranglings. New med schools are opening every day, but they're an irrelevancy when the chokepoint is actually getting narrower. Additionally, docs are just the most expensive staff members. It's bad business to have someone who costs $10/hr doing work someone else can do for $5/hr. Hospital CFOs don't care if it makes patients feel like shit, and doctors feel like shit; they don't want to pay out the marginal $/hr.

jacquesm 9y ago

France has some of the best healthcare in the world. A family member was involved in a horrific truck/passenger bus accident in France near Metz and I spent the better part of a week in and out of their intensive care department visiting. I've never seen a hospital that I liked better. Everybody was so unbelievably nice and caring it was a huge improvement over what I'd seen elsewhere. http://krant.telegraaf.nl/krant/archief/20020319/fotos/bin.venster.metzsectie.jpg http://krant.telegraaf.nl/krant/archief/20020319/fotos/bin.v... It was a pretty bad accident (5 dead, 55 wounded of which 3 critical one of those criticals was my family) with lots of beds suddenly occupied by people not speaking French and a large multiple of that in foreigners roaming the corridors and yet they dealt with all that with grace and understanding.

ThomPete 9y ago
I do question the sustainability of the french system though and that of many other european systems. Its important to remember that in a state economy where healthcare is free or semi free it's operated as a cost center and thus has budgets that are politically mandated not determined by market demand at least not directly. This leads to a number of limitations on what kind of care patients can get what machines they can buy, what medicine etc. Not saying the US system is better but all systems have drawbacks.
- jacquesm 9y ago
  Good point. I'm not too worried about France, they seem to have their priorities straight there, other countries are less stable. Especially in former Eastern European countries there are disasters happening right now, and many Western countries will have to come to terms with the cost of health care and attempting to take commerce out of it. NL had a very good system which got replaced by something much less efficient, ostensibly because the 'market' would have been better at making things efficient where the only real change is that healthcare is now much more expensive and options are as limited as they were before. Personally I feel a good society should take care of its sick, poor, elderly and inmates even if it costs but that's an opinion that seems to be out of fashion.
  - ThomPete 9y ago
    My personal suggestion for a good balanced system is that most people pay most of the cost for normal healthcare costs like going to the doctor for a checkup, most of the cost for one of things like a broken leg but that society pays for more serious and longer term situations like cancer, heart surgeries where you are supposed to stay at the hospital for a longer time. I.e. no one should be bankrupted because they get a serious illness. With regards to France healthcare system here is an article who seems to think it wont survive though. https://www.bloomberg.com/news/articles/2013-01-03/frances-health-care-system-is-going-broke https://www.bloomberg.com/news/articles/2013-01-03/frances-h...
    - jacquesm 9y ago
      Yes, those poor people with recreational broken legs really should pay for their own work. That's only about 25K or so in a bad case without further complications... /s
      - ThomPete 9y ago
        Please read what I actually wrote instead of just knee-jerk reacting to your own prejudice. I said MOST people should pay MOST of the bill. Do you really think I am talking about those with least amount of money.

ThomPete 9y ago

Thats actually a very efficient way of doing things and they get through way more patients a day.

cm2187 9y ago

To me this looks like a basic productivity thing. Health services is the only sector that never industrialized, it's a craft industry. You have a highly educated, highly paid specialist in front of every client. It would be absurd (and uneconomical) to make him do the job of a receptionist in top of that.

arkades 9y ago

That's not a hierarchy thing. Docs are the chokepoint in the process. Overseers track very carefully how much time you spend, how productive you are, etc. and surround you with lower-wage employees to do every last thing except those responsibilities that you, by law, have sole power to do. My buddies are in latter years of residency and no one works <90 hrs/wk (including paperwork they have to finish when they get home, 'cause otherwise they'd never see their families). And that's despite running around like their hair is on fire. I assure you, it's not voluntary.

peferron 9y ago
Why are there so few doctors in the USA that they need a whole system around them to ensure they spend < 5 min in front of each patient?
- arkades 9y ago
  After you graduate medical school you are required to undergo post-graduate education to receive your license. This post-graduate education system hasn't had an expansion of slots in over 20 years (the Balanced Budget Act of '96 put a frozen cap on the number of funded positions.) A number of positions are unfunded, and hospitals are trying to actively eliminate those (rather than grow the pool of physicians to meet demand.) The actual amount paid out for these slots has been repeatedly cut into as well, as part of various political wranglings. New med schools are opening every day, but they're an irrelevancy when the chokepoint is actually getting narrower. Additionally, docs are just the most expensive staff members. It's bad business to have someone who costs $10/hr doing work someone else can do for $5/hr. Hospital CFOs don't care if it makes patients feel like shit, and doctors feel like shit; they don't want to pay out the marginal $/hr.