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‘Out here, it’s just me’: one doctor for 11,000 square miles
- neonate 7y agohttp://archive.is/GcW6Z http://archive.is/GcW6Z
- belltaco 7y agoThe decades long wait times for green cards for immigrant doctors is also hurting health care in rural America. https://money.cnn.com/2018/06/08/news/economy/immigrant-doctors-green-card-backlog/index.html https://money.cnn.com/2018/06/08/news/economy/immigrant-doct... https://www.wusa9.com/article/news/local/maryland/communities-losing-doctors-due-to-battle-over-green-cards/65-3755e73c-5148-48dd-b6ec-944ab47b7ed7 https://www.wusa9.com/article/news/local/maryland/communitie... https://time.com/5299488/international-medical-graduates/ https://time.com/5299488/international-medical-graduates/
- hestipod 7y agoFriend married a Russian cardiac surgeon, one with 20 years of experience, brilliant woman. She was not allowed to practice in the US without years of redoing residency and entry level exams and loads of money. She ended up changing careers as it was so much bother. Patients ended up losing out on a caring and bright provider.
- honkycat 7y agoThat is a feature, not a bug. Why would a well-paid, highly regulated profession allow people to come into their turf and undercut them? Not saying this is a GOOD thing. Merely pointing out that the system is working as intended.
- C4stor 7y agoIf the final user is losing, it's a bug.
- magashna 7y agoAt least in the IT world, there are lots of contractors sold on their certifications who end up being complete frauds. I'd like there to be some sort of way to prove your merit especially when you have people's lives in your hands.
- Nuzzerino 7y agoIn my experience being at the receiving end of many arrogant and unprofessional "doctors", having that medical license is far from proof of anything. If anything, the licensing requirement functions as little else than yet another barrier to competition, which ultimately harms the patients.
- marrone12 7y agoThere is no "undercutting" in health care. Vast majority of services are already priced out by insurance companies, there just aren't enough people to do all of them.
- ses1984 7y ago>...there just aren't enough people to do all of them. which factors into the economics of prices negotiated between providers and insurance companies.
- PopeDotNinja 7y agoThat sucks. There's probably a situation in the future where doctors, or at least surgeons, can work remotely. Russian doctor marries US citizen, logs into VPN in Russia from USA living room, performs Surgery with Nintendo remote.
- jermaustin1 7y agoA DBA I worked with a couple jobs ago was a surgeon in China. He immigrated in the mid 1980s. After he was told he would have to redo his med school, he also decided it wasn't worth it and instead "learned computers".
- jeegsy 7y agoIf there is already an over-supply of docs already in the country, I don't see how an influx of foreign doctors helps anyone.
- charlieflowers 7y agoSome smart business in a foreign country should start providing tele-medicine to the US for reasonable prices. We could send blood work overseas cheaper than the piracy prices of labcorp, for that matter. They could explain it legally as "not medical advice" to skirt any FDA laws, but provide world class health care in reality. It's a business model that could really work. The "skirt America's dumb self-inflicted crap" business model.
- lazyasciiart 7y agoThat would be illegal because they would need to be licensed as doctors in the state of the patient, nothing to do with the FDA. https://www.ruralhealthinfo.org/toolkits/telehealth/1/barriers https://www.ruralhealthinfo.org/toolkits/telehealth/1/barrie...
- miracle2k 7y agoMore likely, it would need to be legal in the country of the provider, and they would need to be out of reach of the US justice system, would seems doable in principle.
- lazyasciiart 7y agoSure - but it's hard to stay out of reach of the US justice system while staying easily accessible to patients by live video and internet payment in a low-cost-of-living area.
- chimi 7y agoI believe the American Medical Association (AMA) lobbying congress to shut down medical schools and artificially limit residencies and thus the supply of doctors is a much bigger factor. A lot of people who are capable and motivated to be doctors for good reasons are shut out because doctors don't want there to be more doctors who will serve to limit their wage growth.
- journalctl 7y agoDo you have sources for this? I see this claim a lot on HN.
- chimi 7y agohttps://www.washingtonexaminer.com/thanks-to-doctors-there-arent-enough-doctors https://www.washingtonexaminer.com/thanks-to-doctors-there-a... I also like this 45 minute lecture Milton Friedman gave to physicians telling them how they were making healthcare worse due to this type of lobbying by their representatives. https://www.youtube.com/watch?v=rWlk9HreE7U https://www.youtube.com/watch?v=rWlk9HreE7U
- yourbandsucks 7y agoShouldn't Milton Friedman be complimenting them for pursuing their narrow interests and having faith that it will contribute to the optimal free market outcome? When someone doesn't even buy their own brand..
- chimi 7y agoHe stays quite true to his brand in the video when he chastises them with a list of the many things they have done to destroy the free market in healthcare.
- yourbandsucks 7y agoWhat a fragile free market. You're telling me that the free market requires willing selflessness of players to function? That sounds more like the ghost of Christmas than the invisible hand to me..
- opportune 7y agoThere are plenty of highly qualified Americans who do not get accepted into medical school each year. We need to make the AMA stop preventing medical school class sizes from increasing
- segmondy 7y agoHave you ever thought about the fact that the issuing of green card to immigrant doctors is really hurting other countries? Other countries need doctors as much as America, there's a huge brain drain when green card is issued for immigrant doctors. BTW, I'm not saying that I'm for it or against it. I also want to point that that giving a migrant doctor green card is not guarantee that they can practice in the US. Passing the board and getting certified is really difficult and there are tons of doctors that come to the US with hope of practicing and end up driving a cab, becoming a nurse or doing some sort of odd jobs.
- trianglem 7y agoThat's not America's concern. We're looking for the best and the brightest.
- Bombthecat 7y agoIs the green card attached with the rule, that you need to work umin rural area? Otherwise those people would just do what everyone would do. Work in a big city / hospital etc..
- honkycat 7y agoThis is happening on my home town. The hospital has been scaling back more and more. What was once a thriving hospital now only has 3 doctors. Not due to demand, but because there are not enough doctors. Doctors do not want to live in a podunk town, no matter how much the hospitals are willing to pay.
- SolaceQuantum 7y agoTheoretically if the podunk town is willing to pay 5x, 10x, 100x, etc. A doctor would definitely take up that. Hell, I would do software development in a podunk town for a million dollar salary. Maybe even a 750k salary.
- rohit2412 7y agoYeah that's a dynamic I can't understand. Most software professionals talk about relocating away from the cities the first chance they get, but everybody else is rushing to the same cities that only software developers seem to be able to afford. This dynamic extends beyond usa. Even in India, doctors command high salaries in rural areas, often 2-3x what they can in metropolitan cities.
- novok 7y agoI think people are more talking about working towns and cities that aren't SF levels of prices, which can be non rural towns of +100k people.
- aflag 7y agoThe software engineers talk about it, but they never do it. Romanticising about moving to a simpler place is very different from actually doing it. A developer is even more relocatable than the doctor. You can still work for a major company and you still have the big city market open to you, even if you live in a small town. Whereas for a doctor it's a major career change.
- RandallBrown 7y ago"Most" is probably not the case at all. I have several friends who talk about moving somewhere cheaper, but way more of them are perfectly happy to live in an awesome city with lots of stuff to do.
- castratikron 7y agoThe picture at the end of the article says it all, "No services next 74 miles". If you choose to live in rural US, you are signing up for this kind of lifestyle; you're on your own. As long as that's advertised I don't see a real problem. If you need health care then you should live near health care. Don't expect the same level of support in rural MN as you would get in NYC.
- EliRivers 7y agoI understand a lot of poor people in these regions lack the resources to move to more populated areas. Would you support a federal or state rehousing program to enable that? It's a genuine question; should the US taxpayer pony up so poor people trapped in rural areas can move to population centres and enjoy the benefits thereof?
- roflchoppa2 7y agoStates could offer something like that if they need more people to work in certain sectors. It would be cool to see it tie into education system too.
- mjevans 7y agoI would rather this be a federal level program as often the solution would involve moving people to new states.
- kgermino 7y agoI absolutely would. One of the best things we can do for poor people - and for the economy as a whole - is getting them physical access to better jobs. If people are trapped in an economically dead area the few grand it would take to support them moving to a more vibrant area is a pittance, especially compared to the cost of bringing jobs and services to rural areas. I'm absolutely opposed to forcing people to move, but if they want to I have no problem spending a bit to help them. (For reference I tend libertarian-ish)
- 7y ago
- beerandt 7y agoObamacare set rules that require large scale-out to be affordable, especially billing and electronic medical records. This is why so many smaller practices, even in large cities, had no choice but to be absorbed by local hospitals or merge with competitors; they couldn't afford that cost of regulation on their own. This also means that in areas lacking a certain critical mass of patients, practicing medicine won't make financial sense.
- jdc 7y agoWhat are the specific requirements? Perhaps there's another way to reduce costs.
- beerandt 7y agoSustaining the infrastructure and support to maintain electronic medical records is probably the biggest. There are so many problems with the current systems that it's hard to know where to start. But related to the context of the article: You can't spread that cost out as a stand alone doctor practicing on rural areas. On top of this is added cost of data entry compared to old paper charts, the cost of training staff to be able to do it efficiently, and the extra time it takes doctors to keep notes and sign-off on electronic charts. Check out some of the recent articles on physician burn-out, especially in emergency medicine, family practice, and general practice. Doctors are deciding it's not worth the hassle, financially or psychologically. Edit: a couple of recent related articles on the topic: https://blogs.scientificamerican.com/observations/electronic-health-records-and-doctor-burnout/ https://blogs.scientificamerican.com/observations/electronic... https://fortune.com/longform/medical-records/amp/ https://fortune.com/longform/medical-records/amp/
- lazyasciiart 7y agoIt should be illegal for the government to detain people in areas with inadequate access to medical care. If they want to put immigration detention centers (or any prison) in the middle of nowhere, they should be required to pay for a doctor to be there too. And it isn't a case of 'well migrants cross the border in the middle of nowhere so it's their fault' - almost all immigrants held in this place are transferred from another ICE detention center (https://trac.syr.edu/immigration/detention/201509/WTXDFTX/tran/ https://trac.syr.edu/immigration/detention/201509/WTXDFTX/tr...)
- arcticbull 7y agoYes this sounds criminally negligent.
- vkou 7y agoThe cruelty isn't an unhappy, accidental by-product. It's the whole point of the policy. This is what ~half the country endorses, by virtue of how it votes.
- ddingus 7y agoNot really. Voters need options to vote for. Money in politics constrains those considerably. Blaming people just does not speak to the mess well enough to be productive.
- ddingus 7y agoApparently, my earlier message did not resonate: To be absolutely clear, this mess we are in is a function of money in politics, voters not seeing a choice they feel good about, and a general trend toward more authoritarian norms. In any election, voters can and will do one of the following: Vote Major Party Vote other No Vote In the last election, a large number of Americans did not have a choice they felt worthy of a vote. Blaming them does all of us ZERO good. Fear, blame and shame politics do not work to GOTV. We can have a discussion about how we got here, and I think that makes sense to do. It's too easy to just "blame the stupid people", as if that's all there is to any of this.
- gumby 7y agoPff, everything is within driving distance. n Australia they have to fly: https://en.wikipedia.org/wiki/Royal_Flying_Doctor_Service_of_Australia https://en.wikipedia.org/wiki/Royal_Flying_Doctor_Service_of...
- anonytrary 7y ago11,000mi^2 is quite a hyperbolic way of saying "nearest service within 100mi". It is also true that there's just one doctor for 1,150,000mi^3, but we typically don't talk about volumes since almost everything we do on earth is distributed over the surface.
- aaron695 7y agoCame to say sqrt(11000/3.14) = 60 (*2 worse case = 120) But your (current) downvotes show people don't like it.... Funny how people see the world Of course square miles shouldn't leap to a square design I guess, a mind deception when talking about 'square units' but equally a circle is wrong since the topography is dependant on roads which changes the space being discussed again. [edit] The sinuosity of roads is hard to find, rivers is not PI it seems as often discussed - https://www.theguardian.com/science/alexs-adventures-in-numberland/2015/mar/14/pi-day-2015-pi-rivers-truth-grime https://www.theguardian.com/science/alexs-adventures-in-numb... But all are fine for napkin maths.
- brown9-2 7y agoVery odd that this article never mentions that Texas has refused to expand Medicaid under the ACA.
- selimthegrim 7y agoLouisiana did, it’s hardly giving us a comparative advantage to Texas - see https://www.theadvocate.com/acadiana/news/business/article_aec4dfc0-d661-11e9-9d88-1f67861da349.html https://www.theadvocate.com/acadiana/news/business/article_a...
- jeegsy 7y agoHow would Medicaid expansion have helped with doctor shortages in rural areas?