4 ms·

Doctors are the strongest guild in USA. They have the legal power to enforce a chronic shortage of doctors. That's why why PAs were invented.

save_ferris 7y ago
You're proving my point. If one of the most powerful labor groups in the economy is being subjected to ruthless firing for speaking out on critical health issues during a national crisis, then what does that say about the state of labor in the US in general?
- deskamess 7y ago
  Are they (Doctors) misunderstanding the environment? Surely in this particular case, firing the Doctor looks bad on the hospital. Leverage/PR is with the Doctor. Perhaps I am reading it wrong.
  - save_ferris 7y ago
    Negative PR is a poor tool to bring about meaningful change as it works very inconsistently. Zoom, Facebook, Equifax, etc. have all experienced sustained negative PR with little effect to their bottom line or operational structure. PR is also purchased, and companies spend heavily to rehab their image online. Hospitals also are fairly well insulated from negative PR as well since they don't operate in a free market, which prevents patients from being able to choose to go elsewhere.
- Bombthecat 7y ago
  That the lack of ppe can't be that bad. A cynical would say.
checktheama 7y ago
I think you're probably right about the guild part. The chronic shortage of doctors? Well, that's because they're perhaps the strongest guild. The AMA puts a cap on the supply of doctors (via # of residency slots they allow). The PAs were invented so that another class of workers could do the work of doctors without jeopardizing the doctors' pay or status.
- MiroF 7y ago
  It appears that you are stating the exact same as the above comment, no?
  - checktheama 7y ago
    I think the parent comment makes it seem like the guild is addressing a problem external to itself. My comment simply makes the causal link that the guild is solving a problem of its own making. A simpler solution would perhaps be to end/reduce the AMA monopoly. In that case, doctors would make less (as they do in the rest of the world), but the supply of doctors would be much higher.
    - MiroF 7y ago
      I disagree - I think the comment is not implying the guild is addressing any problem at all and makes it quite clear that the guild is the cause of the problem. They are not saying that doctors invented PAs to solve the chronic shortage, they're saying that doctors created the chronic shortage which necessitated policy intervention in the form of PAs. I think you've just misread the comment and would find that it actually agrees strongly with what you said.
- skue 7y ago
  > The AMA puts a cap on the supply of doctors (via # of residency slots they allow) This is factually untrue.[1] [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4978854/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4978854/
claudeganon 7y ago
Well, their guild is obviously not as strong, militant, nor organized as the power of hospitals if this is happening. Gesturing in the direction of their other control doesn’t disprove anything. It’s worth noting that the AMA also is structured in such a way that gives undue influence to specialist physicians over GPs and ER docs (their representatives essentially get more votes over group policy decisions).
ykevinator 7y ago
Right plus the ama which enforces irrational wage by limiting supply. I worry more for the nurses.
skue 7y ago
Doctors don’t enforce shortages. No one is stopping new medical schools from being created, it’s just not a trivial thing to do. I’d actually argue that physicians haven’t yet fully grasped their power. Historically, many docs worked in independent clinics or small practice groups. That made them subject to antitrust law when teaming up to negotiate en masse against a large insurer, for example. Today, with all of the consolidation over the past decade, many have become employees. This has made them less powerful in many ways... except, now they can unionize without any of those old antitrust concerns.
- username90 7y ago
  > Doctors don’t enforce shortages. No one is stopping new medical schools from being created, it’s just not a trivial thing to do. USA could do like they do in tech and import already educated people. In tech we welcome that, in medicine that process requires the immigrant doctors to take additional years of study since medical doctors in USA have a post grad degree for no good reason.

save_ferris 7y ago

You're proving my point. If one of the most powerful labor groups in the economy is being subjected to ruthless firing for speaking out on critical health issues during a national crisis, then what does that say about the state of labor in the US in general?

deskamess 7y ago
Are they (Doctors) misunderstanding the environment? Surely in this particular case, firing the Doctor looks bad on the hospital. Leverage/PR is with the Doctor. Perhaps I am reading it wrong.
- save_ferris 7y ago
  Negative PR is a poor tool to bring about meaningful change as it works very inconsistently. Zoom, Facebook, Equifax, etc. have all experienced sustained negative PR with little effect to their bottom line or operational structure. PR is also purchased, and companies spend heavily to rehab their image online. Hospitals also are fairly well insulated from negative PR as well since they don't operate in a free market, which prevents patients from being able to choose to go elsewhere.
Bombthecat 7y ago
That the lack of ppe can't be that bad. A cynical would say.

checktheama 7y ago

I think you're probably right about the guild part. The chronic shortage of doctors? Well, that's because they're perhaps the strongest guild. The AMA puts a cap on the supply of doctors (via # of residency slots they allow). The PAs were invented so that another class of workers could do the work of doctors without jeopardizing the doctors' pay or status.

MiroF 7y ago
It appears that you are stating the exact same as the above comment, no?
- checktheama 7y ago
  I think the parent comment makes it seem like the guild is addressing a problem external to itself. My comment simply makes the causal link that the guild is solving a problem of its own making. A simpler solution would perhaps be to end/reduce the AMA monopoly. In that case, doctors would make less (as they do in the rest of the world), but the supply of doctors would be much higher.
  - MiroF 7y ago
    I disagree - I think the comment is not implying the guild is addressing any problem at all and makes it quite clear that the guild is the cause of the problem. They are not saying that doctors invented PAs to solve the chronic shortage, they're saying that doctors created the chronic shortage which necessitated policy intervention in the form of PAs. I think you've just misread the comment and would find that it actually agrees strongly with what you said.
skue 7y ago
> The AMA puts a cap on the supply of doctors (via # of residency slots they allow) This is factually untrue.[1] [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4978854/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4978854/

claudeganon 7y ago

Well, their guild is obviously not as strong, militant, nor organized as the power of hospitals if this is happening. Gesturing in the direction of their other control doesn’t disprove anything. It’s worth noting that the AMA also is structured in such a way that gives undue influence to specialist physicians over GPs and ER docs (their representatives essentially get more votes over group policy decisions).

ykevinator 7y ago

Right plus the ama which enforces irrational wage by limiting supply. I worry more for the nurses.

skue 7y ago

Doctors don’t enforce shortages. No one is stopping new medical schools from being created, it’s just not a trivial thing to do. I’d actually argue that physicians haven’t yet fully grasped their power. Historically, many docs worked in independent clinics or small practice groups. That made them subject to antitrust law when teaming up to negotiate en masse against a large insurer, for example. Today, with all of the consolidation over the past decade, many have become employees. This has made them less powerful in many ways... except, now they can unionize without any of those old antitrust concerns.

username90 7y ago
> Doctors don’t enforce shortages. No one is stopping new medical schools from being created, it’s just not a trivial thing to do. USA could do like they do in tech and import already educated people. In tech we welcome that, in medicine that process requires the immigrant doctors to take additional years of study since medical doctors in USA have a post grad degree for no good reason.