4 ms·

I've also done some work trying to get people to implement different models of care outside of the traditional institutions, and getting physicians on board is

I've also done some work trying to get people to implement different models of care outside of the traditional institutions, and getting physicians on board is just a big hurdle. As a group they are pretty conservative and risk averse, hugely busy, and there aren't a lot of places where they congregate, online or otherwise, so outreach is a bit of hand to hand combat. I have an untested hypothesis that one of the best ways to get physician mindshare is actually through think pieces in publications like the new yorker or new york times -- just the kind of articles Atul Gawande writes. The physicians that I know read these articles much more actively than they use linked in (most dont) or any other online community

entee 8y ago
Another (darker) perspective: they don’t want to lose money. Healthcare in the US is expensive in no small part because we pay more for things (duh). One of those things is physician time. Primary care physicians in the US make $60K more a year than comparable nations [1]. Dirty secret of healthcare: “efficiency” translates to “I make less money” for almost everyone in the system, very much including doctors. All will protest and justify their cost, all will make good arguments in the individual case. In the aggregate though, we pay people too much (among many many other issues). [1] https://jamanetwork.com/journals/jama/article-abstract/2674671 https://jamanetwork.com/journals/jama/article-abstract/26746...
- aaavl2821 8y ago
  I agree that profit motive is underappreciated and often is the real reason for consolidation, formation of ACOs, etc (many ACOs dont form for getting share of cost savings, rather they try to increase volume through partnerships). However I think it's odd to point out primary care as a culprit. Prices in the US are higher across the board, so just highlighting primary care salaries doesnt tell the whole story. Better metrics are 1) ratio of average salary of specialists to primary care and 2) total supply of specialists compared to primary care. The US lags on both metrics [2] Hospital care is the number one driver of spend in the US (over 30% of spend) [1]. A day at a hospital in the US is twice as much as in comparable countries (can dig up source if interested). Pretty sure the U.S. spends more on inpatient care as % of total spend than other countries. US is middle of the pack in terms of drug spend as % of total HC spend. Hospitals have increasingly been buying primary care and specialty practices. When an independent practice gets bought by a large system, they can instantly charge more for the same procedure, bc they're now under the large system's contracts with payers. Literally nothing changes but negotiating leverage. If you want to find a big cause of healthcare spend inefficiency in the US, look there [1] https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html https://www.cms.gov/Research-Statistics-Data-and-Systems/Sta... [2] https://www.milbank.org/2017/07/getting-primary-care-oriented-measuring-primary-care-spending/ https://www.milbank.org/2017/07/getting-primary-care-oriente...
  - coredog64 8y ago
    Then lets break out the wrecking ball, because most US hospitals are organized around the idea of private rooms that require more equipment, more real estate, and more staff.
- siculars 8y ago
  Physicians, and others, pay for their medical education in the US. How do physicians pay for their education in other countries or is it paid for them by their governments?
  - lotsofpulp 8y ago
    Also, the doctors I know basically give up their 20s and early 30s in the American system. But that might be due to existing doctors making sure supply stays low so their prices stay high, and so they can do that by making credentialing lengthy and difficult.

entee 8y ago

Another (darker) perspective: they don’t want to lose money. Healthcare in the US is expensive in no small part because we pay more for things (duh). One of those things is physician time. Primary care physicians in the US make $60K more a year than comparable nations [1]. Dirty secret of healthcare: “efficiency” translates to “I make less money” for almost everyone in the system, very much including doctors. All will protest and justify their cost, all will make good arguments in the individual case. In the aggregate though, we pay people too much (among many many other issues). [1] https://jamanetwork.com/journals/jama/article-abstract/2674671 https://jamanetwork.com/journals/jama/article-abstract/26746...

aaavl2821 8y ago
I agree that profit motive is underappreciated and often is the real reason for consolidation, formation of ACOs, etc (many ACOs dont form for getting share of cost savings, rather they try to increase volume through partnerships). However I think it's odd to point out primary care as a culprit. Prices in the US are higher across the board, so just highlighting primary care salaries doesnt tell the whole story. Better metrics are 1) ratio of average salary of specialists to primary care and 2) total supply of specialists compared to primary care. The US lags on both metrics [2] Hospital care is the number one driver of spend in the US (over 30% of spend) [1]. A day at a hospital in the US is twice as much as in comparable countries (can dig up source if interested). Pretty sure the U.S. spends more on inpatient care as % of total spend than other countries. US is middle of the pack in terms of drug spend as % of total HC spend. Hospitals have increasingly been buying primary care and specialty practices. When an independent practice gets bought by a large system, they can instantly charge more for the same procedure, bc they're now under the large system's contracts with payers. Literally nothing changes but negotiating leverage. If you want to find a big cause of healthcare spend inefficiency in the US, look there [1] https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html https://www.cms.gov/Research-Statistics-Data-and-Systems/Sta... [2] https://www.milbank.org/2017/07/getting-primary-care-oriented-measuring-primary-care-spending/ https://www.milbank.org/2017/07/getting-primary-care-oriente...
- coredog64 8y ago
  Then lets break out the wrecking ball, because most US hospitals are organized around the idea of private rooms that require more equipment, more real estate, and more staff.
siculars 8y ago
Physicians, and others, pay for their medical education in the US. How do physicians pay for their education in other countries or is it paid for them by their governments?
- lotsofpulp 8y ago
  Also, the doctors I know basically give up their 20s and early 30s in the American system. But that might be due to existing doctors making sure supply stays low so their prices stay high, and so they can do that by making credentialing lengthy and difficult.