3 ms·

There is just way more money in being a specialist. I don’t really understand why specialists like radiologists or anesthesiologists make >500k by default While

There is just way more money in being a specialist. I don’t really understand why specialists like radiologists or anesthesiologists make >500k by default While primary doctors make much less. In Germany the medical associations set reimbursements rates per specialty. I assume it’s similar in the US. Simple solution: balance reimbursements towards primary care. But I assume there is a powerful lobby with deep pockets that will fight such a change.

Nasrudith 6y ago
The assumptions are incorrect. Medical associations may influence supplies to some degree but they don't set the price. Supply, demand, and what the market may bear do. There are also really several different healthcare systems. The government can set say VA rates and medicare to some degree. The sort of balancing done is encouraging more family doctors. Radiology and anesthesiology are also two "cash cows" of procedures. All of internal medicine wants radiology for tests and needs anesthesiologists if surgical remedies are required. Primary care pays less because it requires less additional training than the specialties. Although some specialties aren't higher - Children's Oncology for instance.
- spaetzleesser 6y ago
  I was thinking about this: https://en.wikipedia.org/wiki/Specialty_Society_Relative_Value_Scale_Update_Committee https://en.wikipedia.org/wiki/Specialty_Society_Relative_Val... "Supply, demand, and what the market may bear do." I agree about "what the market may bear". Normal supply and demand market ideas really don't apply to a lot of medical areas.
naveen99 6y ago
Medicare had been cutting radiology reimbursements for a while, to the point radiology had almost a 100 unfilled residency spots in the us a few years ago. Radiologists are being paid the bottom of market clearing rates. You pay them much less than what they make now, and you will have a severe shortage quickly.
- PhantomGremlin 6y ago
  It makes utterly no sense to become a radiologist in the USA. Of all the specialties, it's one of the easiest to "offshore". Just send the data to Elbonia and have someone there examine it. There was a company hyped on Wall Street doing this a number of years ago, but my Google skills are lacking and I can't seem to find it any more. IIRC they were sending the data to civilized countries such as New Zealand (great for time shifting if for nothing else). So maybe they just weren't competitive with Elbonia. Here's a similar comment someone made on HN a few days ago: https://news.ycombinator.com/item?id=23882138 https://news.ycombinator.com/item?id=23882138 Here's the first Google hit on "remote radiology": https://argusrad.com/8-remote-radiology-benefits/ https://argusrad.com/8-remote-radiology-benefits/ 8 Benefits of Remote Radiology includes: REDUCES COST NO SHORTAGE OF RADIOLIGISTS Why waste years specializing when some "scab" can undercut you? Welcome to the global race to the bottom!
  - naveen99 6y ago
    Intellectual curiosity, wanting to improve the standard of health care... Why learn relativity and quantum mechanics when some one can undercut you ? there just aren’t that many people willing and capable.
curryst 6y ago
A big part of it is that nurses have been granted authority to do more procedures/prescriptions, and are now overlapping with doctors. For healthy people, a nurse practitioner could probably fulfill all of your standard medical needs. You can see the effects of this in the clinics popping up inside a lot of grocery stores in the US. They have nurses on staff who can do standard procedures like flu shots, strep tests, common cold treatment etc. And to me, it seems, the outcomes are effectively the same. You get your tests, if it comes back as something known, they prescribe you meds. If not, they advise you to go to the hospital or a specialist.

Nasrudith 6y ago

The assumptions are incorrect. Medical associations may influence supplies to some degree but they don't set the price. Supply, demand, and what the market may bear do. There are also really several different healthcare systems. The government can set say VA rates and medicare to some degree. The sort of balancing done is encouraging more family doctors. Radiology and anesthesiology are also two "cash cows" of procedures. All of internal medicine wants radiology for tests and needs anesthesiologists if surgical remedies are required. Primary care pays less because it requires less additional training than the specialties. Although some specialties aren't higher - Children's Oncology for instance.

spaetzleesser 6y ago
I was thinking about this: https://en.wikipedia.org/wiki/Specialty_Society_Relative_Value_Scale_Update_Committee https://en.wikipedia.org/wiki/Specialty_Society_Relative_Val... "Supply, demand, and what the market may bear do." I agree about "what the market may bear". Normal supply and demand market ideas really don't apply to a lot of medical areas.

naveen99 6y ago

Medicare had been cutting radiology reimbursements for a while, to the point radiology had almost a 100 unfilled residency spots in the us a few years ago. Radiologists are being paid the bottom of market clearing rates. You pay them much less than what they make now, and you will have a severe shortage quickly.

PhantomGremlin 6y ago
It makes utterly no sense to become a radiologist in the USA. Of all the specialties, it's one of the easiest to "offshore". Just send the data to Elbonia and have someone there examine it. There was a company hyped on Wall Street doing this a number of years ago, but my Google skills are lacking and I can't seem to find it any more. IIRC they were sending the data to civilized countries such as New Zealand (great for time shifting if for nothing else). So maybe they just weren't competitive with Elbonia. Here's a similar comment someone made on HN a few days ago: https://news.ycombinator.com/item?id=23882138 https://news.ycombinator.com/item?id=23882138 Here's the first Google hit on "remote radiology": https://argusrad.com/8-remote-radiology-benefits/ https://argusrad.com/8-remote-radiology-benefits/ 8 Benefits of Remote Radiology includes: REDUCES COST NO SHORTAGE OF RADIOLIGISTS Why waste years specializing when some "scab" can undercut you? Welcome to the global race to the bottom!
- naveen99 6y ago
  Intellectual curiosity, wanting to improve the standard of health care... Why learn relativity and quantum mechanics when some one can undercut you ? there just aren’t that many people willing and capable.

curryst 6y ago

A big part of it is that nurses have been granted authority to do more procedures/prescriptions, and are now overlapping with doctors. For healthy people, a nurse practitioner could probably fulfill all of your standard medical needs. You can see the effects of this in the clinics popping up inside a lot of grocery stores in the US. They have nurses on staff who can do standard procedures like flu shots, strep tests, common cold treatment etc. And to me, it seems, the outcomes are effectively the same. You get your tests, if it comes back as something known, they prescribe you meds. If not, they advise you to go to the hospital or a specialist.