6 ms·

“Ninety percent of doctors I know are fed up with medicine.”

32 points by czik 18y ago

jraines 18y ago
Yeah, my dad, a family practice physician for 20 years, would confirm this. His monthly overhead costs (in a tightly run physicians' group) are mind blowing and he has working hours and a sleep schedule that would stupify this 25 year old. He could work a quarter of the hours and make more money just doing ER work, but feels an obligation to his patient base. But there are many other doctors making that choice or choosing lucrative niche specialties, and who can blame them? There's almost no economic and lifestyle incentive to become a general practitioner anymore. Also, any time you have a complicated system that no one believes in, people are going to try to game it. So you have some doctors billing Medicare these huge sums for a patient coming in with a runny nose, and this further discourages the honest doctors.
dazzawazza 18y ago
If they want they can come and work in the British NHS. A good GP here can get £100,000 a year. Of course you'll have to put up with the MRI taking weeks unless it's an emergency but it seems better then what that doctor suffered. I think the biggest difference here is that although people in the UK moan a lot about the National Health Service they do respect the doctors and staff and value their input to society. Who doesn't benefit from feeling respected and valued?
- streety 18y ago
  Probably not such a good idea. We can barely find enough positions for the doctors trained in this country.
  - dazzawazza 18y ago
    ahh, but there are a lot of openings for GP's. Our medical students all want to be brain surgeons and don't seem to realise that without GP's most people would be dead before needing a brain surgeon.
hugh 18y ago
Couldn't they find more than one guy to interview for this article? One guy who happens to be a friend of the writer?
jcdreads 18y ago
This article, while greatly interesting, isn't really hacker news. Unless we're talking about really, really sloppy doctors. Perhaps this would fit better at reddit instead.
- steveplace 18y ago
  But this is hacker news. This is screaming business opportunity. If you can create a service to remove the hassle of running a practice, you're golden.
- mechanical_fish 18y ago
  Spoken like a person who has never had to answer the question "why are you an engineer when the big money, the prestige, and the long-term career prospects are all in medicine or law"? Sometimes it's useful to remember that other fields have Dilberts, too.
deleted 18y ago
[deleted]
- mechanical_fish 18y ago
  go work for McKinsey or something. Out of the frying pan, into... another frying pan. I have friends who worked for McKinsey, BCG, etc. My observation: High pressure, long hours, continuous travel which eventually drives you crazy. (Travel sounds like fun, until you realize that business travel consists of the insides of hundreds of airports, limos, hotel rooms, and conference rooms and not much else. And it really is continuous -- four days out of every week, except for the lucky folks who make it into the coveted Wall Street office where the commute is only a few blocks. Ever wonder why every ad at every airport seems to be targeted at management consultants? Wonder no more...) Lots and lots and lots of diplomacy and office politics (which is your primary task). You'll wear out a lot of ties. Not to mention the first-order problem: There is a right time and a wrong time to get that job. The time right after you get your MBA is a good time. Thanks to a fad (which, I believe, began in the nineties) for hiring fresh new Ph.D.s, the time right after you get your Ph.D. is a good time. I'm not sure that there are many other good times. I'm guessing that "right after you burn out on medicine" is not a good time.
  - antidaily 18y ago
    Consulting: a pie eating contest where the reward is more pie.
baha_man 18y ago
"For me it's an endless amount of work that I can never get through to do it properly". Hands up anybody who's prepared to admit that this doesn't apply to their job, and they have plenty of time to do everything expected of them to their complete satisfaction.
kingkongrevenge 18y ago
Over half of doctors are glorified con-artists. The MO of modern American medicine is to sucker in trusting patients and write prescriptions and perform procedures at great cost that empirically do not work. The doctors are feeling frustrated because the jig is up. There are too many of them and society can't afford the con game anymore.
- msg 18y ago
  I downvoted because there are a lot of assertions here without sources or context. My anecdotal experience, where my wife is in the doctor's office routinely due to Hashimoto's disease, is that your mileage may vary. We went to an immunologist who sat on his hands and waited for several months for her thyroid to get enough out of whack before he ordered more testing. We've had several incompetent doctors who failed to diagnose conditions that harmed her health and the health of our son. On the other hand, since we've moved and had to find new doctors, we've gotten some really helpful doctors who really know their business and have been clearing up longstanding immune problems. The right doctors have really been great for us, the wrong doctors have really been bad. The first close citation I found for your argument was here: http://www.washingtonpost.com/wp-dyn/content/article/2007/12/03/AR2007120301771.html http://www.washingtonpost.com/wp-dyn/content/article/2007/12... There was a study that most doctors have high standards, but they would fail to report colleagues who didn't meet those standards. However, they appear to claim that reporting would not solve the problem, just lead to its own set of headaches. I would say that America needs to follow the money to get to the bottom of this problem. The prices of medical care just aren't commensurate with the costs anymore. Ease the financial pressure and the whole system will probably improve.
  - kingkongrevenge 18y ago
    > there are a lot of assertions here without sources or context. I don't have time to build the full case. The nutshell version is that modern medicine is dominated by pharmaceuticals. Doctors are largely in the pill dispensing business. Problem is, the pills don't work. Spend more than fifteen minutes reading about the cholesterol and statin racket for just one example, and this is a huge billion dollar thing. It's a big chunk of what doctors do to earn a living. My familiarity with the business comes from the software side of pharma sales. For another example read about long term efficacy of many kinds of chemo and heart surgery. The stuff just doesn't really work, but it sure costs a lot. Doctors are something like the fifth leading cause of death. Malpractice is rife. Modern medicine is great for trauma, injuries, and various acute diseases. But the financial reality of health care is that most of the spending and most of what doctors do is about lifestyle diseases, and the treatments are useless. They give pills and order tons of tests for people who should really just be told that there's nothing to be done other than better diet and exercise, or maybe bed rest. They also blow millions on people who are simply in the process of dying, mostly of old age, and the treatments are empirically known to do nothing.
iamelgringo 18y ago
I've worked as an ER nurse for 15 years. I make it a habit to ask MD's that I know whether they would become a doctor if they had to do it all over again, and the vast majority tell me, "No". Adjusted for inflation, MD's salaries haven't gone up for over 20 years, in fact, they've decreased over the past 10 years: http://www.hhnmag.com/hhnmag_app/jsp/articledisplay.jsp?dcrpath=HHNMAG/Article/data/12DEC2007/071211HHN_Online_Morrison&domain=HHNMAG http://www.hhnmag.com/hhnmag_app/jsp/articledisplay.jsp?dcrp... And, if Bush's medicare cuts go through and aren't postponed, many of the good doctors are going to be leaving 12-15 years of schooling behind and looking for a different career.
- hobbs 18y ago
  I've heard the same from the lawyers I know as well. Suddenly, being an IT professional doesn't seem that bad...
patrickg-zill 18y ago
I know of no other field where you intensively train someone for years, then make them do routine paperwork that takes up 25% or more of their time. Do commercial jet pilots have to sign the purchase order for the jet fuel? That is the equivalent kind of paperwork that doctors have to do.
- nradov 18y ago
  Most of the routine coding, billing, scheduling, and ordering paperwork is done by clerical staff. It's still inefficient, but most physicians aren't doing it themselves. A lot of the paperwork (or computer work now) that physicians do is for documenting procedures. While that may take up a significant percentage of time (don't know if it's +/- 25%), it's crucial for patient care to have a complete and accurate medical chart.
- ovi256 18y ago
  They have a problem, we have an opportunity guys. Help automatise their paperwork and procedures! Nice big market, and clients with deep pockets. Do it right, and it'll spread virally, as they'll recommend your product to their collegues. Now, I could not tell you in what form and how this automatisation would work. Some standardizing (of data sharing etc) would help too. And furthermore, you would help them HELP people.
  - nradov 18y ago
    There are dozens, maybe hundreds, of companies already doing this. If you have a good idea then go ahead and try, but you'll find that the sales cycle is slow, competition is fierce, and the pockets aren't all that deep. There are a variety of existing standards for data sharing from organizations like HL7, HITSP, IHE, ANSI, NCPDP, etc. The standards work but many vendors don't fully support them yet. And sharing healthcare data means you also have to enable your customers to comply with HIPAA privacy regulations as well as (sometimes) more restrictive state rules.
  - noonespecial 18y ago
    We've traveled this road fairly extensively as well. You will almost certainly find that you will have countless ideas on how to improve things. The better the idea, and the more it will help, the less likely it is that you will be allowed to do it. Implementing good ideas requires change. I can't think of many fields where change is more resisted than medicine.
dividendium 18y ago
Maybe we need to redefine the problem. Some of the suggestions below were about automating the paperwork. Why not automate the treatment? I mean consider how unscalable it is to have a doctor, an actual person, see each patient. At most they can get through one patient every 15 minutes. A doctor normally looks at a patient, asks them a few questions to rule out certain conditions and then prescribes a pill or requests a test for more information. Sounds like the perfect kind of job that software can do if it knew the parameters. The hard part is training the software, so you'd need doctors to perform treatments in a way that a computer can understand it (codified in some way) and then you need patients to report back on whether or not that treatment worked. There's your business opportunity and a real opportunity to help people, both the doctors and the patients.
- nradov 18y ago
  Sounds good. This will be practical just as soon as you invent an AI smart enough to make it through medical school and pass the boards.
  - yummyfajitas 18y ago
    All the AI needs to do to be medically useful is obey the samurai principle: meet/exceed the effectiveness of a doctor on some subset of patients, and `raise GoSeeARealDoctorException` on the rest. I'm sure regulators/politicians/medical establishment won't like it. But the technical problem isn't all that bad (and has actually been solved by machine learning for a few use cases).
copenja 18y ago
My uncle is a surgeon and he complains about the same things: Overheads are getting huge, profits are shrinking, etc. Meanwhile, however, he lives in a friggin mansion. Seriously,a mansion. Not saying this is the common case, just one observation.
TheWama 18y ago
There are some young approaches to solving this problem. One I just discovered today is Qliance, a low-cost version of boutique care, dubbed "direct primary care." No insurance needed or accepted (thus no coding or paperwork), ~$50 a month, same or next-day appointments, 24hr access to care, they take their own xrays for free and dispense their own medicine at cost, &c. Aside from making workloads managable (800 patients instead of 2-3000), the really interesting part is how this does away with the perverse incentives of insurance payments (which reward procedures rather than health, and which turns primary care into 10 minute referral-fests, rather than actual care), as well as sets up other good incentives, which reward the doctors for keeping the patient healthy (healthy patients don't need to spend a bunch of time in your office) and so on. His talk is really interesting: http://health.scribemedia.org/2008/01/21/garrison-bliss-pioneer-medical-practice/ http://health.scribemedia.org/2008/01/21/garrison-bliss-pion...

32 points by czik 18y ago

Yeah, my dad, a family practice physician for 20 years, would confirm this. His monthly overhead costs (in a tightly run physicians' group) are mind blowing and he has working hours and a sleep schedule that would stupify this 25 year old. He could work a quarter of the hours and make more money just doing ER work, but feels an obligation to his patient base. But there are many other doctors making that choice or choosing lucrative niche specialties, and who can blame them? There's almost no economic and lifestyle incentive to become a general practitioner anymore. Also, any time you have a complicated system that no one believes in, people are going to try to game it. So you have some doctors billing Medicare these huge sums for a patient coming in with a runny nose, and this further discourages the honest doctors.

dazzawazza 18y ago

If they want they can come and work in the British NHS. A good GP here can get £100,000 a year. Of course you'll have to put up with the MRI taking weeks unless it's an emergency but it seems better then what that doctor suffered. I think the biggest difference here is that although people in the UK moan a lot about the National Health Service they do respect the doctors and staff and value their input to society. Who doesn't benefit from feeling respected and valued?

streety 18y ago
Probably not such a good idea. We can barely find enough positions for the doctors trained in this country.
- dazzawazza 18y ago
  ahh, but there are a lot of openings for GP's. Our medical students all want to be brain surgeons and don't seem to realise that without GP's most people would be dead before needing a brain surgeon.

hugh 18y ago

Couldn't they find more than one guy to interview for this article? One guy who happens to be a friend of the writer?

jcdreads 18y ago

This article, while greatly interesting, isn't really hacker news. Unless we're talking about really, really sloppy doctors. Perhaps this would fit better at reddit instead.

steveplace 18y ago
But this is hacker news. This is screaming business opportunity. If you can create a service to remove the hassle of running a practice, you're golden.
mechanical_fish 18y ago
Spoken like a person who has never had to answer the question "why are you an engineer when the big money, the prestige, and the long-term career prospects are all in medicine or law"? Sometimes it's useful to remember that other fields have Dilberts, too.

deleted 18y ago

[deleted]

mechanical_fish 18y ago
go work for McKinsey or something. Out of the frying pan, into... another frying pan. I have friends who worked for McKinsey, BCG, etc. My observation: High pressure, long hours, continuous travel which eventually drives you crazy. (Travel sounds like fun, until you realize that business travel consists of the insides of hundreds of airports, limos, hotel rooms, and conference rooms and not much else. And it really is continuous -- four days out of every week, except for the lucky folks who make it into the coveted Wall Street office where the commute is only a few blocks. Ever wonder why every ad at every airport seems to be targeted at management consultants? Wonder no more...) Lots and lots and lots of diplomacy and office politics (which is your primary task). You'll wear out a lot of ties. Not to mention the first-order problem: There is a right time and a wrong time to get that job. The time right after you get your MBA is a good time. Thanks to a fad (which, I believe, began in the nineties) for hiring fresh new Ph.D.s, the time right after you get your Ph.D. is a good time. I'm not sure that there are many other good times. I'm guessing that "right after you burn out on medicine" is not a good time.
- antidaily 18y ago
  Consulting: a pie eating contest where the reward is more pie.

baha_man 18y ago

"For me it's an endless amount of work that I can never get through to do it properly". Hands up anybody who's prepared to admit that this doesn't apply to their job, and they have plenty of time to do everything expected of them to their complete satisfaction.

kingkongrevenge 18y ago

Over half of doctors are glorified con-artists. The MO of modern American medicine is to sucker in trusting patients and write prescriptions and perform procedures at great cost that empirically do not work. The doctors are feeling frustrated because the jig is up. There are too many of them and society can't afford the con game anymore.

msg 18y ago
I downvoted because there are a lot of assertions here without sources or context. My anecdotal experience, where my wife is in the doctor's office routinely due to Hashimoto's disease, is that your mileage may vary. We went to an immunologist who sat on his hands and waited for several months for her thyroid to get enough out of whack before he ordered more testing. We've had several incompetent doctors who failed to diagnose conditions that harmed her health and the health of our son. On the other hand, since we've moved and had to find new doctors, we've gotten some really helpful doctors who really know their business and have been clearing up longstanding immune problems. The right doctors have really been great for us, the wrong doctors have really been bad. The first close citation I found for your argument was here: http://www.washingtonpost.com/wp-dyn/content/article/2007/12/03/AR2007120301771.html http://www.washingtonpost.com/wp-dyn/content/article/2007/12... There was a study that most doctors have high standards, but they would fail to report colleagues who didn't meet those standards. However, they appear to claim that reporting would not solve the problem, just lead to its own set of headaches. I would say that America needs to follow the money to get to the bottom of this problem. The prices of medical care just aren't commensurate with the costs anymore. Ease the financial pressure and the whole system will probably improve.
- kingkongrevenge 18y ago
  > there are a lot of assertions here without sources or context. I don't have time to build the full case. The nutshell version is that modern medicine is dominated by pharmaceuticals. Doctors are largely in the pill dispensing business. Problem is, the pills don't work. Spend more than fifteen minutes reading about the cholesterol and statin racket for just one example, and this is a huge billion dollar thing. It's a big chunk of what doctors do to earn a living. My familiarity with the business comes from the software side of pharma sales. For another example read about long term efficacy of many kinds of chemo and heart surgery. The stuff just doesn't really work, but it sure costs a lot. Doctors are something like the fifth leading cause of death. Malpractice is rife. Modern medicine is great for trauma, injuries, and various acute diseases. But the financial reality of health care is that most of the spending and most of what doctors do is about lifestyle diseases, and the treatments are useless. They give pills and order tons of tests for people who should really just be told that there's nothing to be done other than better diet and exercise, or maybe bed rest. They also blow millions on people who are simply in the process of dying, mostly of old age, and the treatments are empirically known to do nothing.

iamelgringo 18y ago

I've worked as an ER nurse for 15 years. I make it a habit to ask MD's that I know whether they would become a doctor if they had to do it all over again, and the vast majority tell me, "No". Adjusted for inflation, MD's salaries haven't gone up for over 20 years, in fact, they've decreased over the past 10 years: http://www.hhnmag.com/hhnmag_app/jsp/articledisplay.jsp?dcrpath=HHNMAG/Article/data/12DEC2007/071211HHN_Online_Morrison&domain=HHNMAG http://www.hhnmag.com/hhnmag_app/jsp/articledisplay.jsp?dcrp... And, if Bush's medicare cuts go through and aren't postponed, many of the good doctors are going to be leaving 12-15 years of schooling behind and looking for a different career.

hobbs 18y ago
I've heard the same from the lawyers I know as well. Suddenly, being an IT professional doesn't seem that bad...

patrickg-zill 18y ago

I know of no other field where you intensively train someone for years, then make them do routine paperwork that takes up 25% or more of their time. Do commercial jet pilots have to sign the purchase order for the jet fuel? That is the equivalent kind of paperwork that doctors have to do.

nradov 18y ago
Most of the routine coding, billing, scheduling, and ordering paperwork is done by clerical staff. It's still inefficient, but most physicians aren't doing it themselves. A lot of the paperwork (or computer work now) that physicians do is for documenting procedures. While that may take up a significant percentage of time (don't know if it's +/- 25%), it's crucial for patient care to have a complete and accurate medical chart.
ovi256 18y ago
They have a problem, we have an opportunity guys. Help automatise their paperwork and procedures! Nice big market, and clients with deep pockets. Do it right, and it'll spread virally, as they'll recommend your product to their collegues. Now, I could not tell you in what form and how this automatisation would work. Some standardizing (of data sharing etc) would help too. And furthermore, you would help them HELP people.
- nradov 18y ago
  There are dozens, maybe hundreds, of companies already doing this. If you have a good idea then go ahead and try, but you'll find that the sales cycle is slow, competition is fierce, and the pockets aren't all that deep. There are a variety of existing standards for data sharing from organizations like HL7, HITSP, IHE, ANSI, NCPDP, etc. The standards work but many vendors don't fully support them yet. And sharing healthcare data means you also have to enable your customers to comply with HIPAA privacy regulations as well as (sometimes) more restrictive state rules.
- noonespecial 18y ago
  We've traveled this road fairly extensively as well. You will almost certainly find that you will have countless ideas on how to improve things. The better the idea, and the more it will help, the less likely it is that you will be allowed to do it. Implementing good ideas requires change. I can't think of many fields where change is more resisted than medicine.

dividendium 18y ago

Maybe we need to redefine the problem. Some of the suggestions below were about automating the paperwork. Why not automate the treatment? I mean consider how unscalable it is to have a doctor, an actual person, see each patient. At most they can get through one patient every 15 minutes. A doctor normally looks at a patient, asks them a few questions to rule out certain conditions and then prescribes a pill or requests a test for more information. Sounds like the perfect kind of job that software can do if it knew the parameters. The hard part is training the software, so you'd need doctors to perform treatments in a way that a computer can understand it (codified in some way) and then you need patients to report back on whether or not that treatment worked. There's your business opportunity and a real opportunity to help people, both the doctors and the patients.

nradov 18y ago
Sounds good. This will be practical just as soon as you invent an AI smart enough to make it through medical school and pass the boards.
- yummyfajitas 18y ago
  All the AI needs to do to be medically useful is obey the samurai principle: meet/exceed the effectiveness of a doctor on some subset of patients, and `raise GoSeeARealDoctorException` on the rest. I'm sure regulators/politicians/medical establishment won't like it. But the technical problem isn't all that bad (and has actually been solved by machine learning for a few use cases).

copenja 18y ago

My uncle is a surgeon and he complains about the same things: Overheads are getting huge, profits are shrinking, etc. Meanwhile, however, he lives in a friggin mansion. Seriously,a mansion. Not saying this is the common case, just one observation.

TheWama 18y ago

There are some young approaches to solving this problem. One I just discovered today is Qliance, a low-cost version of boutique care, dubbed "direct primary care." No insurance needed or accepted (thus no coding or paperwork), ~$50 a month, same or next-day appointments, 24hr access to care, they take their own xrays for free and dispense their own medicine at cost, &c. Aside from making workloads managable (800 patients instead of 2-3000), the really interesting part is how this does away with the perverse incentives of insurance payments (which reward procedures rather than health, and which turns primary care into 10 minute referral-fests, rather than actual care), as well as sets up other good incentives, which reward the doctors for keeping the patient healthy (healthy patients don't need to spend a bunch of time in your office) and so on. His talk is really interesting: http://health.scribemedia.org/2008/01/21/garrison-bliss-pioneer-medical-practice/ http://health.scribemedia.org/2008/01/21/garrison-bliss-pion...