3 ms·

I agree that the US has less physicians and I agree that their proposed solution would work to quickly train/hire more physicians. However, the article failed t

I agree that the US has less physicians and I agree that their proposed solution would work to quickly train/hire more physicians. However, the article failed to show a relationship between number of physicians and quality of health outcomes in countries that would prove that this is a problem worth solving.

killjoywashere 5y ago
There are also other confounders, for example, the mass entry of women into the medical education system at the same time: they tend to seek part-time employment arrangements, so it takes some 1.x 2020 doctors to replace each 1970 doctor. Women as physicians are wonderful, wouldn't have it any other way, the point is the confounder wasn't accounted for.
- soldehierro 5y ago
  > they tend to seek part-time employment arrangements Do you have a source for that?
  - mlyle 5y ago
    "Tend to seek" is too strong of wording, but "seek part time employment at a significantly higher rate" is on target. E.g., the most recent source I can find is a 2019 survey: > Women physicians were significantly more likely to report not working full-time than men physicians (40 of 177 [22.6%] vs 6 of 167 [3.6%]; odds ratio [OR], 7.83; 95% CI, 3.22-19.04) https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2740777 https://jamanetwork.com/journals/jamanetworkopen/fullarticle...
hyperion2010 5y ago
That's because those data are already available elsewhere and also well known. In addition to lack of insurance, lack of access to primary care physicians means that the first time the medical systems sees a patient is in the ER. This is staggeringly inefficient. Add to this the fact that case managers are not physicians, and you wind up in a situation where there is often no one who actually has a general understanding of a patient's overall medical situation.
darth_avocado 5y ago
> the article failed to show a relationship between number of physicians and quality of health outcomes in countries that would prove that this is a problem worth solving. Anecdotally it absolutely is. Finding an appointment for even the most basic level of care is impossible. If you’re sick, if the level of care you receive today or after a week or two is the same and the outcomes are the same, for me as a patient, it matters if I can suffer a few days less. I cannot count the number of times I’ve just had to “wait it out”. This is absolutely dangerous because sometimes, even the smallest of the things like “a sniffle” can become life threatening if not treated on time.
- Invictus0 5y ago
  If you don't mind sharing, where are you living that finding a primary care appointment is impossible? During my recent battle with covid, I was able to get appointments with specialists in several fields in about 1 week or less, which I think was pretty reasonable. At the time I was living in Long Island, close to the Stony Brook University which I think makes the area a big hub for doctors.
  - screye 5y ago
    I had a minor dislocation in my shoulder. It took me 1 month to finally see an orthopaedic doctor and a couple more weeks before I could meet a physical therapist. Guess what, my pain was nearly all gone by that point. This is in Boston, one of the US medical meccas.
    - Invictus0 5y ago
      How many doctors offices did you reach out to? Did you try to find one on zocdoc?
      - screye 5y ago
        Only my primary care. It was a pretty major center in terms of associated doctors. The idea that someone would have to keep calling different doctors offices to find one that would take me is just as absurd as needing to wait 1 month.
snarf21 5y ago
We need a different kind of system for medical care. It has to be more like the dentist if we ever want to reduce costs on this side of the triangle. The MD should only see patients when absolutely necessary, the rest of the time a RN or CNA is completely fine. By having lower levels provide most of the care, we can change the economics and actually provide more care to people who don't get it now. A lot of this is of our own making. Trying to get into a dermatologist for a skin condition is really hard. They are all booked up on cosmetic customers that pay more and increase profits. We want urgent cares on every corner because it is more convenient to our schedule than scheduling with our primary. All this duplication of facilities and staffing have consequences. Care from lower level staff is coming more and more rapidly, it is the only way to somewhat limit costs against the bloat on the other side. For that, we really need reference based pricing but don't forget that one person's waste is another person's salary.
- 908B64B197 5y ago
  > The MD should only see patients when absolutely necessary, the rest of the time a RN or CNA is completely fine Today there are nurse practitioners with a four year undergrad in Nursing, 2-3 years of experience in hospital, and a 3 year full time masters degree (where fall and winter are spent in classroom and the summer term in the field). We are rapidly approaching the years of (relevant) schooling of an MD in family medicine...
  - nacho2100 5y ago
    This would be more believable position if nurse practitioners have ever been able to demonstrate equivalent medical knowledge to physicians, but when the best trained NPs were given the chance to take a watered down version of Step 3 which has a 97% MD pass rate with 1-3 weeks of casual studying, only 40% passed. The reality is an equivalent number of years does not equate the quality and rigor of the family medicine which is argueably one of the hardest specialties. This is notwithstanding the explosion of NP diploma mills with classes on lobbying and health care disparities who take any applicant with a pulse.
    - 5y ago

killjoywashere 5y ago

There are also other confounders, for example, the mass entry of women into the medical education system at the same time: they tend to seek part-time employment arrangements, so it takes some 1.x 2020 doctors to replace each 1970 doctor. Women as physicians are wonderful, wouldn't have it any other way, the point is the confounder wasn't accounted for.

soldehierro 5y ago
> they tend to seek part-time employment arrangements Do you have a source for that?
- mlyle 5y ago
  "Tend to seek" is too strong of wording, but "seek part time employment at a significantly higher rate" is on target. E.g., the most recent source I can find is a 2019 survey: > Women physicians were significantly more likely to report not working full-time than men physicians (40 of 177 [22.6%] vs 6 of 167 [3.6%]; odds ratio [OR], 7.83; 95% CI, 3.22-19.04) https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2740777 https://jamanetwork.com/journals/jamanetworkopen/fullarticle...

hyperion2010 5y ago

That's because those data are already available elsewhere and also well known. In addition to lack of insurance, lack of access to primary care physicians means that the first time the medical systems sees a patient is in the ER. This is staggeringly inefficient. Add to this the fact that case managers are not physicians, and you wind up in a situation where there is often no one who actually has a general understanding of a patient's overall medical situation.

darth_avocado 5y ago

> the article failed to show a relationship between number of physicians and quality of health outcomes in countries that would prove that this is a problem worth solving. Anecdotally it absolutely is. Finding an appointment for even the most basic level of care is impossible. If you’re sick, if the level of care you receive today or after a week or two is the same and the outcomes are the same, for me as a patient, it matters if I can suffer a few days less. I cannot count the number of times I’ve just had to “wait it out”. This is absolutely dangerous because sometimes, even the smallest of the things like “a sniffle” can become life threatening if not treated on time.

Invictus0 5y ago
If you don't mind sharing, where are you living that finding a primary care appointment is impossible? During my recent battle with covid, I was able to get appointments with specialists in several fields in about 1 week or less, which I think was pretty reasonable. At the time I was living in Long Island, close to the Stony Brook University which I think makes the area a big hub for doctors.
- screye 5y ago
  I had a minor dislocation in my shoulder. It took me 1 month to finally see an orthopaedic doctor and a couple more weeks before I could meet a physical therapist. Guess what, my pain was nearly all gone by that point. This is in Boston, one of the US medical meccas.
  - Invictus0 5y ago
    How many doctors offices did you reach out to? Did you try to find one on zocdoc?
    - screye 5y ago
      Only my primary care. It was a pretty major center in terms of associated doctors. The idea that someone would have to keep calling different doctors offices to find one that would take me is just as absurd as needing to wait 1 month.

snarf21 5y ago

We need a different kind of system for medical care. It has to be more like the dentist if we ever want to reduce costs on this side of the triangle. The MD should only see patients when absolutely necessary, the rest of the time a RN or CNA is completely fine. By having lower levels provide most of the care, we can change the economics and actually provide more care to people who don't get it now. A lot of this is of our own making. Trying to get into a dermatologist for a skin condition is really hard. They are all booked up on cosmetic customers that pay more and increase profits. We want urgent cares on every corner because it is more convenient to our schedule than scheduling with our primary. All this duplication of facilities and staffing have consequences. Care from lower level staff is coming more and more rapidly, it is the only way to somewhat limit costs against the bloat on the other side. For that, we really need reference based pricing but don't forget that one person's waste is another person's salary.

908B64B197 5y ago
> The MD should only see patients when absolutely necessary, the rest of the time a RN or CNA is completely fine Today there are nurse practitioners with a four year undergrad in Nursing, 2-3 years of experience in hospital, and a 3 year full time masters degree (where fall and winter are spent in classroom and the summer term in the field). We are rapidly approaching the years of (relevant) schooling of an MD in family medicine...
- nacho2100 5y ago
  This would be more believable position if nurse practitioners have ever been able to demonstrate equivalent medical knowledge to physicians, but when the best trained NPs were given the chance to take a watered down version of Step 3 which has a 97% MD pass rate with 1-3 weeks of casual studying, only 40% passed. The reality is an equivalent number of years does not equate the quality and rigor of the family medicine which is argueably one of the hardest specialties. This is notwithstanding the explosion of NP diploma mills with classes on lobbying and health care disparities who take any applicant with a pulse.
  - 5y ago