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There's a lot to unpack in 'hospitals/doctors.' Again, a more granular analysis will point you in the direction of the layers and layers of administration and

There's a lot to unpack in 'hospitals/doctors.' Again, a more granular analysis will point you in the direction of the layers and layers of administration and profiteering in the hospital rank and file. Have you seen this graph?: https://investingdoc.com/the-growth-of-administrators-in-health-care/ https://investingdoc.com/the-growth-of-administrators-in-hea... And again, very effective universal healthcare systems exist which remunerate physicians at the top end of the labour payment scale (and for good reason). Now with nurse practitioners and other 'mid-level providers' creeping into all areas of clinical medicine, Americans are unfortunately likely to find out the hard way why appropriately remunerating people who operate on those nearest and dearest to you at their most critical times, is a good idea.

neuro_image2 7y ago
Also, there should be some limits to who gets to do highly specialized things. And I want those people to be highly incentivized. One of my co-fellows was an IV league valedictorian and national level athlete. I'm pleased and grateful someone that talented, dedicated and driven to the point of obsession is diagnosing and treating neurological disease (and not, say, improving advertising algorithms for amazon or google).
- mtnGoat 7y ago
  Amen to this! Imagine if all the bright minds in SV, were looking to improve the world instead of enrich themselves and their overlords by any means necessary. However I don't think we should limit the number of anything, if are qualified and knowledgeable enough to do brain surgery, you should be allowed to. Not just because your family was rich enough to fund education or you were willing to foot the debt. Taking less profit out of education might help fix the doctor shortage.
  - neuro_image2 7y ago
    ' I don't think we should limit the number of anything, if are qualified and knowledgeable enough to do brain surgery, you should be allowed to.' Unfortunately that's just not how it works. I want the best people to do brain surgery(not everyone who can), just like if I'm running a formula one racing team, I really don't want every idiot who can barely drive a car cluttering the track.
    - mtnGoat 7y ago
      i said qualified and knowledgeable. try to stay on topic :)
- stale2002 7y ago
  > also, there should be some limits to who gets to do highly specialized things That limit exists. It is called supply and demand. There is no need to artificially limit this, if other people want to enter the market.
2skep 7y ago
Can I please ask you to consider the problems with the chart you have shared? The vertical axis is percent increase not actual increase. It is helpful to have that context before you load your argument on it.
- neuro_image2 7y ago
  Yes, I'm sure you would have noted: 1) That point is written very clearly just below the graph by the author. 2) It doesn't fundamentally change the argument. The rate of increase in the number of administrators has significantly outpaced the increase in physician numbers as costs have increased.
nradov 7y ago
There is no evidence that nurse practitioners and physician assistants deliver worse care than physicians for routine conditions.
- neuro_image2 7y ago
  So you're going to have a nurse practitioner look after your kids rather than a pediatrician (based on some corporate hospital sponsored BS research)? Good luck with that. The problem with this line of thought is sometimes patients arrive that look like they have routine conditions (ear infection) which turn out to be not so routine (otitis media with encephalitis or a nasopharyngeal carcinoma). Or do you think NPs know a lot about sub-speciality presentations based on their two years of training? People forget that physicians are the actual expertise in the hospital (there's a reason its 4 years med school plus a residency plus fellowships).
  - shigawire 7y ago
    It's very inefficient to have a physician do everything in a hospital. Their value is their knowledge and experience. So shunting off other parts of their work not requiring that full expertise to lower level providers will only lead to more people being treated effectively. I think treating mid-level providers as corporate BS is very reductive and both underestimates these healthcare workers and overestimates physicians.

neuro_image2 7y ago

Also, there should be some limits to who gets to do highly specialized things. And I want those people to be highly incentivized. One of my co-fellows was an IV league valedictorian and national level athlete. I'm pleased and grateful someone that talented, dedicated and driven to the point of obsession is diagnosing and treating neurological disease (and not, say, improving advertising algorithms for amazon or google).

mtnGoat 7y ago
Amen to this! Imagine if all the bright minds in SV, were looking to improve the world instead of enrich themselves and their overlords by any means necessary. However I don't think we should limit the number of anything, if are qualified and knowledgeable enough to do brain surgery, you should be allowed to. Not just because your family was rich enough to fund education or you were willing to foot the debt. Taking less profit out of education might help fix the doctor shortage.
- neuro_image2 7y ago
  ' I don't think we should limit the number of anything, if are qualified and knowledgeable enough to do brain surgery, you should be allowed to.' Unfortunately that's just not how it works. I want the best people to do brain surgery(not everyone who can), just like if I'm running a formula one racing team, I really don't want every idiot who can barely drive a car cluttering the track.
  - mtnGoat 7y ago
    i said qualified and knowledgeable. try to stay on topic :)
stale2002 7y ago
> also, there should be some limits to who gets to do highly specialized things That limit exists. It is called supply and demand. There is no need to artificially limit this, if other people want to enter the market.

2skep 7y ago

Can I please ask you to consider the problems with the chart you have shared? The vertical axis is percent increase not actual increase. It is helpful to have that context before you load your argument on it.

neuro_image2 7y ago
Yes, I'm sure you would have noted: 1) That point is written very clearly just below the graph by the author. 2) It doesn't fundamentally change the argument. The rate of increase in the number of administrators has significantly outpaced the increase in physician numbers as costs have increased.

nradov 7y ago

There is no evidence that nurse practitioners and physician assistants deliver worse care than physicians for routine conditions.

neuro_image2 7y ago
So you're going to have a nurse practitioner look after your kids rather than a pediatrician (based on some corporate hospital sponsored BS research)? Good luck with that. The problem with this line of thought is sometimes patients arrive that look like they have routine conditions (ear infection) which turn out to be not so routine (otitis media with encephalitis or a nasopharyngeal carcinoma). Or do you think NPs know a lot about sub-speciality presentations based on their two years of training? People forget that physicians are the actual expertise in the hospital (there's a reason its 4 years med school plus a residency plus fellowships).
- shigawire 7y ago
  It's very inefficient to have a physician do everything in a hospital. Their value is their knowledge and experience. So shunting off other parts of their work not requiring that full expertise to lower level providers will only lead to more people being treated effectively. I think treating mid-level providers as corporate BS is very reductive and both underestimates these healthcare workers and overestimates physicians.