13 ms·

I really expected that we'd see a change in my lifetime, that GPs in particular would be replaced by a lower-cost Watson descendant, with there being some other

I really expected that we'd see a change in my lifetime, that GPs in particular would be replaced by a lower-cost Watson descendant, with there being some other role for patient interaction, wet work, and data entry (perhaps just nurses). My mom worked for a GP for about 20 years, and it seemed to me that most of what made that guy a doctor was bedside manner + being able to remember a lot of things. But GPs often make astounding amounts of money while leaning heavily on their staff to actually handle patients and keep the business running. I thought it could help drugs get a little cheaper too, because there wouldn't be any point in the pharma companies sending out salespeople to do lunch seminars to convince the GPs to prescribe this or that drug (this still happens). Maybe this will still happen, but it doesn't seem imminent anymore.

Aeolun 5y ago
> GPs often make astounding amounts of money while leaning heavily on their staff to actually handle patients and keep the business running I’ve seen this in Japan (ish), but in the Netherlands it’s definitely the GP’s doing most of the job. The assistant just does bookings and waves me in when it’s my turn.
hiptobecubic 5y ago
I thought we'd have banned Dr lobbying by now, even without a technological revolution.
- bigbillheck 5y ago
  We haven't banned other kinds of lobbying, why would doctors be different?
- jac241 5y ago
  I thought we’d have banned software engineer lobbying by now, look how much harm they’re causing - https://www.healthline.com/health-news/social-media-use-increases-depression-and-loneliness https://www.healthline.com/health-news/social-media-use-incr...
- robotresearcher 5y ago
  Someone should persuade governments to ban lobbying. But who?
diognesofsinope 5y ago
American Medical Association (and other medical/pharma/health workers associations) > IBM
wiz21c 5y ago
> bedside manner + being able to remember a lot of things My impression is that accompanying a patient is super important, it helps to understand illness, to have a plan in case of more complex treatments, etc. Then my doctor has the ability to know me and gauge my health. She's also very good at probabilities and detecting when something really goes wrong. I'm sure that being able to do that require a lot more than numbers. (I'm studying data sciences, I trust them, but my guts tell me that diagnosis is in a whole different ballpark)
- chromatin 5y ago
  It also helps to have a relationship with a patient (or person). There are some people who will never, ever complain about anything. When they complain of severe abdominal pain, for example, you pull out all the stops immediately to figure out what's wrong, because it's probably really bad. On the other hand, there are hypochondriacs and people will low pain tolerance. While they can certainly also become seriously ill -- and one must never forget this -- the tempo and pace of workup and order of intervention is markedly different, absent other information that shifts the pretest probabilities.
  - Aeolun 5y ago
    > On the other hand, there are hypochondriacs That’s me. I really, really appreciate a GP that both understands that I’m not doing it on purpose, and can reassure me that nothing is wrong, or figure out that we actually do need more testing this time. Unfortunately it’s been years since I had one like that :/
  - KerrAvon 5y ago
    Sometimes a relationship is bad. If you think someone’s a hypochondriac, but in fact they’re unusually sensitive, you’ll dismiss a lot of what they say and that can be quite damaging over time. (Especially if they’re female https://www.health.harvard.edu/blog/women-and-pain-disparities-in-experience-and-treatment-2017100912562 https://www.health.harvard.edu/blog/women-and-pain-dispariti...). I wouldn’t eliminate GPs from the process, but many people actually would like to hear what the robots have to say about their medical conditions. Having second opinions of this sort available might lead to better patient outcomes.
oblio 5y ago
I assume that you're from the US? Those are both people problems. Tech can't solve many people problems, especially something as entrenched as healthcare. Isn't it huge, something like 10% of the US economy?
- FredPret 5y ago
  I thought to myself: no way can this be true. The US generates $21tr a year[1]. How can medical be $2.1tr a year? …turns out, it’s $2.7tr!!! [2] [1]www.tradingeconomics.com [2]https://www.statista.com/study/15826/health-care-and-social-assistance-in-the-us/ https://www.statista.com/study/15826/health-care-and-social-...
  - vasco 5y ago
    20% https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical#:~:text=U.S.%20health%20care%20spending%20grew,spending%20accounted%20for%2019.7%20percent https://www.cms.gov/Research-Statistics-Data-and-Systems/Sta....
    - FredPret 5y ago
      Absolutely bonkers. One of every five dollars goes to healthcare. To put this further into perspective: the US military budget is immense, as we know… and it clocks in at 3.7% of GDP [1] [1] https://www.statista.com/statistics/266892/military-expenditure-as-percentage-of-gdp-in-highest-spending-countries/ https://www.statista.com/statistics/266892/military-expendit...
      - philjohn 5y ago
        To put it even further into perspective, that's 2x as much as comparable western nations with single-payer, who have similar or better outcomes in most cases.
  - oblio 5y ago
    Why do you think nobody important (politicians, primarily) is really trying to solve those major healthcare problems? If politicians are willing to pork and barrel over a random soy farm employing 2000 people, for sure they're not going to throw away, say, 5% of the US GDP and possibly 5% of all employment in the US. I don't know how you're going to get out of it... [1] "There were 22 million workers in the health care industry, one of the largest and fastest-growing sectors in the United States that accounts for 14% of all U.S. workers, according to the Census Bureau’s 2019 American Community Survey (ACS)." https://www.census.gov/library/stories/2021/04/who-are-our-health-care-workers.html https://www.census.gov/library/stories/2021/04/who-are-our-h...
lotsofpulp 5y ago
>that GPs in particular would be replaced by a lower-cost Watson descendant It is happening. They are called physician assistants and nurse practitioners, "supervised" by a doctor. I assume going forward, they will take more and more of the usual pink eye/ear infection/flu and other common work that does not require 6 to 8 years of post bachelor education.
- tryptophan 5y ago
  It's happening because hospital corporations love them. Corps can pay less, and since they have a tenth of the education, they order tons of profitable tests, consults, and scans because they don't know otherwise.
  - plucas 5y ago
    This is a mischaracterization of P.A.s (well, not the being-paid-less bit). Do you know any personally?
    - SkyPuncher 5y ago
      He's exaggerating significantly, but the core point is true. pAs and NPs will be the future of hospital care.
    - jac241 5y ago
      It's a mischaracterization for PAs because doctors only have ~7.5x minimum more clinical training and not 10x, 15000 clinical hours (for med school + family medicine, the shortest residency program) vs 2000hrs. Ask any radiologist you know what they think about the imaging orders from NPs and PAs and that will give you your answer.
  - RHSeeger 5y ago
    It's worth noting that the higher tiers of nurses have at least a masters degree, and like more time working than a doctor spends in residency. They are highly trained/skilled professionals.
cube00 5y ago
> But GPs often make astounding amounts of money while leaning heavily on their staff to actually handle patients and keep the business running. The private ones might the ones in the public system at least in my country need to see a patient every 10 minutes to keep their heads above water.
- nradclif 5y ago
  What country are you from, if you don’t mind me asking?
  - InvertedRhodium 5y ago
    I'm in New Zealand and it's not too far from what was described.
  - flipchart 5y ago
    I've heard Canada is like that. I've had similar experience in South Africa, even in private health care, but I definitely had the impression that my doctor somewhat cared about me, especially after going to them for a few years
  - kilburn 5y ago
    I'm from Spain and my wife is a family doctor. It really is like that here too.
  - fqye 5y ago
    It is so in China and it is every 5 minutes in most cases. Precisely because of this, I chose doctors from good public hospitals because of their super rich experiences instead of fancy private hospitals.
- james-redwood 5y ago
  This is more or less the case in many European countries. Less so here in the UK, but approaching there rather quickly due to astoundingly poor management by various successive governments. It’s tough back in South Africa as well, and they pay their doctors extraordinarily well.
herval 5y ago
> what made that guy a doctor was bedside manner + being able to remember a lot of things That sounds like a lot of professions, engineering management included :-)
dukeofdoom 5y ago
Bribing politicians is far more profitable. Never thought my own prime minster would become a pfizer sales rep...but here we are.
Brybry 5y ago
The American medical system is truly bizarre. I've been to private practices where every day at lunch or near end of day there would be some drug rep with food for all the staff. And a psychiatrist that had stacks of free samples of drugs. Even contact lenses are marketed with free samples.
- listenallyall 5y ago
  Everyone talks about the relationship between drug reps and doctors like it's the most incestuous, evil, corrupt thing. How else are doctors, especially those who are 10, 20 years removed from their residency, supposed to learn about new treatments and medicines? Alexa, what is best current treatment for a duodenal ulcer? You think a doctor is going to spend his limited downtime perusing the PDR (which no longer exists, and was always heavily influenced by the drug manufacturers anyway)? Sure, there may be some excesses (although the truly major perks like entire vacations dressed up as a "conference" no longer exist), but I would much rather have doctors be aware of new drugs and yes, subject to marketing pitches, than have these drugs languish (eventually leading to drugs not being created) because nobody knows about them.
  - nextaccountic 5y ago
    > How else are doctors, especially those who are 10, 20 years removed from their residency, supposed to learn about new treatments and medicines? With some other mechanism that doesn't have major conflicts of interest? Like, I don't know, attending to actual courses, like any other profession that requires continuing training.
    - listenallyall 5y ago
      Who is teaching the courses? Where do they get their info? Given the very limited oversight of "continuing education", it's trivial for Merck or Pfizer to ensure their advocate teaches the class or records the online seminar -- with zero requirement that they disclose that fact. At least when a drug rep visits the office and buys lunch, you know the source.
kijin 5y ago
> there wouldn't be any point in the pharma companies sending out salespeople to do lunch seminars to convince the GPs to prescribe this or that drug Right, but there would be a lot of point in making deals with whoever builds Watson-like devices, to turn them ever-so-slightly more likely to prescribe one drug over another or make one diagnosis over another. It might even be cheaper than hiring and sending out a bunch of salespeople.
snarf21 5y ago
There is no need to market to Doctors now when they market directly to consumers who go demand they get the new medicine. If we want to reduce costs, we need to move to lower level providers like a LPN or CRNP. Most people coming into a GP have the flu or an ear infection or .... and that can be handled by them. There will be one MD and to handle complicated cases and to supervise. We've already switched so that intake is done by CNA making $15/hour. In the US at least working at FAANG pays far more than being a GP.
- chromatin 5y ago
  > In the US at least working at FAANG pays far more than being a GP. Not just FAANG, either. The assertion by grandparent poster that GPs are "astoundingly" well paid is bonkers.
  - jbullock35 5y ago
    "Astoundingly" is vague. According to the Bureau of Labor Statistics, the mean salary of "family and general practitioners" in May 2020 was $214,370 [1]. This figure includes salaries from GPs throughout the country (i.e., not just in the Bay Area). You can also look at median salaries. According to the BLS, all ten of the occupations with the highest median incomes in the U.S. are medical occupations [2]. "Family medicine physicians" are 10th on this list. [1] https://www.bls.gov/ooh/healthcare/physicians-and-surgeons.htm#tab-5 https://www.bls.gov/ooh/healthcare/physicians-and-surgeons.h... [2] https://www.bls.gov/ooh/highest-paying.htm https://www.bls.gov/ooh/highest-paying.htm
  - snarf21 5y ago
    Additionally, a GP has med school plus residency. A Stanford CS grad will start higher than most GPs with only a bachelors degree.
    - erosenbe0 5y ago
      Mediocre GP makes 200k cash in Omaha or any average city and has choice among many employers and systems. Stanford CS represents top talent and moreover does not make 200k cash in Omaha, and can only make the big bucks at a fixed number of entities in fixed locations with fixed hierarchies and systems.
chromatin 5y ago
> I really expected that we'd see a change in my lifetime, that GPs in particular would be replaced by a lower-cost Watson descendant, with there being some other role for patient interaction, wet work, and data entry (perhaps just nurses). Perhaps this indicates a major gap in your visibility into and understanding of modern medical practice? > My mom worked for a GP for about 20 years, and it seemed to me that most of what made that guy a doctor was bedside manner + being able to remember a lot of things. "being able to remember a lot of things" -- Yes, absolutely. This is an area where AI-assisted decision support (like Watson) could be, and I hope will be, extremely valuable. OTOH, you also rightly recognize bedside manner -- as anyone who has been a patient or a patient's family caregiver will attest, this is an essential component of core, and I think likely also the healing process. We won't get this from a machine until there is a true general purpose AI, at which point I expect an AI singularity anyway. But consider that there are other factors of the practice of general medicine that you haven't even touched upon. For example, liability: In the office you envision, where Watson/AI makes medical decisions and these are executed by other roles like nursing, where does ultimate responsibility (and legal liability) lie? Remember that Watson outputs probabilities -- suppose the following: Chance of disease X: 89% Chance of disease Y: 10% Chance of disease Z: 1% If disease X, intervention A has an 80% probability of success. However, if disease Y, intervention A has an 80% probability of harm. (before you object that this is contrived, this represents a realistic situation I encountered recently, where intervention A is high dose steroids) Now, will we put the onus on the patient to select an intervention? I don't think that would be very popular. While I certainly do not advocate paternalism, when faced with difficult decisions quite many people openly defer to their physician. > But GPs often make astounding amounts of money I suppose this could be true for some definitions of "astounding," but it's generally accepted that GP/"primary care physician" pay is essentially the lowest of all specialties , which is a major contributor to lack of access to primary care in industrialized countries (while you'll not have a hard time finding a private pay dermatologist, for instance) ANd on top of this, we are posting on HN where a mid level software engineer total comp can EASILY outpace the average US primary care physician salary. > while leaning heavily on their staff to actually handle patients and keep the business running. Do not all professionals and business executives rely on highly trained staff as force multipliers? This is a fundamental principle of the advancement of human economies. It is grossly inefficient to operate with individuals as "jack of all trades" when they can instead each become specialized to support a bigger or broader goal. By "leaning heavily on their staff to actually handle patients and keep the business running" are you suggesting that the primary care physician should be performing check-in, insurance verification, rooming, vitals measurement, blood draw, medication administration etc? That is a certain recipe for massively decreased throughput and shortages/decreased access to primary care. > I thought it could help drugs get a little cheaper too, because there wouldn't be any point in the pharma companies sending out salespeople to do lunch seminars to convince the GPs to prescribe this or that drug (this still happens). This has been massively curtailed for 20+ years, at least in the US. I am not sure about other countries. But overall I think this is a seriously minor portion of the (exorbitant) price of medications in industrialized countries. In any case, I doubt it would make much of an impact on utilization in most contexts, as insurance/health plans/prescription benefits have already implemented fairly strict guidelines-based formularies and coverage tiers (again, at least in the US -- I can't speak to other industrialized countries, although I expect they are similar or even more strict) (edit: another poster points out all the direct to consumder drug advertising -- I agree - this probably has a much bigger influence in 2022; ad budgets are absolutely insance) > Maybe this will still happen, but it doesn't seem imminent anymore. Here we agree. I am certain we'll see AI-assisted physician decision support, but (a) the physician won't go away and (b) I think it'll be an unfortunately long ways in the future.
ricardobayes 5y ago
I thought the same, but as I grow older, I believe people would reject this. Even a subpar human GP would be much more accepted than a computer. That's not necessarily true in some societies though, e.g. Japan probably would accept it. That said, I would probably focus on fixing the system first in a way that a significant percent of population doesn't need to order fish medicine off amazon to get treatment.
- CodeGlitch 5y ago
  I wouldn't mind seeing a computer first before a GP. A lot of the time a GP will say something like "here try these tablets and come back in a week". The true worth of a GP is the follow-up appointments and understanding conditions over time.
- Bombthecat 5y ago
  I'm not so sure, sure the first generation might throw a tantrum, but the next generation will a accept it... Much like cars or trains..
- Scoundreller 5y ago
  > I thought the same, but as I grow older, I believe people would reject this. At some point, the (possibly subpar) GP will be a costlier decision (whether in dollars/time/frustration). Just like grocery stores having 10 self-checkouts and 1 cashier.
vasili111 5y ago
AI cannot replace doctors. It can help doctors a lot but not replace.
- Aeolun 5y ago
  That just means we need a general artificial intelligence to do it. We don’t have those now, but I wouldn’t say never.
- colinmhayes 5y ago
  Of course AI could replace doctors. Some people will always prefer the bedside manner a person provides, but many others won't care, and AI will eventually do a good job at imitating a good doctor's bedside manner.
  - Firmwarrior 5y ago
    The only way AI is going to replace doctors is if medical technology advances to the point where you can repair a human as well as you can repair a machine (or someone invents AGI, I guess) There are just too many unknowns and fiddly things going on with human bodies edit: Haha, I guess Tex's sibling comment makes a good point though..
    - kbelder 5y ago
      I don't think we've got to the point where AI can repair a car. Humans are more complicated by a decent factor.
  - telxosser 5y ago
    Machine learning could beat my doctor right now. "Using Random Forest Algorithm for Breast Cancer Diagnosis" https://ieeexplore.ieee.org/document/8644835 https://ieeexplore.ieee.org/document/8644835 Most of what the doctor is doing is a type of modern shamanism though. Person doesn't feel good, so the doctor orders a useless test, test comes back negative so the person feels better. Then we complain health care cost too much. 10 full blood panel samples a year with other bio-metric data and a data set of 20 million people to do classification on would crush the doctor over time. This bullshit health system though makes it impossible to have any real innovation at a mass scale. We will never have personal higher frequency medical data in my lifetime that would actually hugely improve the system and cut most of the cost out.
throwthere 5y ago
Yeah like most businesses the owner his staff to help out. I’m curious what you think GPs actually make, because in the US it’s not astronomical. Watson went after the wrong problem— doctors don’t comprise huge amounts of healthcare spending. It’s a recurring issue, tech thinks they have a solution and in reality the devs don’t have a good grasp on the actual landscape they’re playing in.
0xbadcafebee 5y ago
Medicine is a business. Its incentive is profit, not patient outcome. Everybody knows the problems with medicine and the solutions are straightforward. But they don't result in more profits, only better patient outcomes. So you only get advances when it increases profit. Come up with a way for better patient outcomes to result in higher profits and you'll see advances in patient care real damn fast.
- jac241 5y ago
  Please list some of the solutions, because from where I am (actually in a hospital) all I see are people who care about patient outcomes.
  - 0xbadcafebee 5y ago
    1. Stop charging so much. People aren't seeking treatment because they're afraid of the bills. I have other solutions, but there's no point in listing them because nobody will implement them (for the same reason that one won't be: profits over patients)
crispyambulance 5y ago
> most of what made that guy a doctor was bedside manner + being able to remember a lot of things. Sure, that, and recognizing patterns and adjusting medication and being able to use good judgement for when to escalate to a referral for a specialist. But that's a lot! I actually go to a teaching hospital for my primary care. It means I get seen by residents, and almost always also by very experienced teaching doctors. It ends up meaning that I get more time and attention by people who are actively learning and trying hard to do the right thing. The trade-off is there's no long-term trust relationship, but I am OK with that. I've also experienced care from elderly family doctors who run a "one-man-band" with a nurse and a receptionist, they're nice but I think I get better care at a teaching hospital.
PragmaticPulp 5y ago
> My mom worked for a GP for about 20 years, and it seemed to me that most of what made that guy a doctor was bedside manner + being able to remember a lot of things. That’s exactly right, but there’s nothing wrong with that. A good doctor’s memory of patients spanning decades of a career and all of the various treatments that they did or did not respond to is very valuable. It’s a good thing that they offload as much as possible to other people so they can focus on doing what they do best.
- geofft 5y ago
  I think the comment above, most charitably read, is that a lot more people would have access to high-quality healthcare if you could put this work on robots instead of people, because computers excel at storing data and looking it up accurately and following predetermined rules. There would be fewer cases of people going to their doctor and being told "oh, it's nothing" when it actually is a specific, rare, and urgent problem. And then they would end up going to a human specialist to figure out how to fix that problem.
throwawayboise 5y ago
I mean, I won't even use the self-service kiosk at McDonald's. I sure as hell am not going to interact with a computer for my medical care.
- zoomablemind 5y ago
  > ...I won't even use the self-service kiosk at McDonald's As lame as it may be, but I just used the McDo kiosk for the first time. Why? I'm a very infrequent customer at McDo and have 0 knowledge of options and combos, but also remember the mutual annoyance when previously asking for menu details from a min-wage clerk. In a perverse way, the kiosk gives that power to choose back to me, the customer. At the same time relegating the supposedly more able humans to even less meaningful role. This worked quite right in this case. I can see this approach applicable as well for some medical need that could be mapped onto a sequence of a "few" choices. This could be resulting in some assistive pre-screening report. Well, that's the stuff the assistants do at the beginning of a doctor visit. Not that different from a slot-operated scales of ancient times. But in the end, I still want to see an immediate human responsibility in such transaction. By the same token, a GP won't be leaning heavily on such "assistive report" and would still go on and ask all of the questions again, as trained, as allotted, as billed. Each doctor visit begins as a custom solution, no matter how cookie-cutter it turns out to be at the end. That's what we expect and that's what it ends up being billed to us.
jakey_bakey 5y ago
The hard part is knowing what things you need to remember

Aeolun 5y ago

> GPs often make astounding amounts of money while leaning heavily on their staff to actually handle patients and keep the business running I’ve seen this in Japan (ish), but in the Netherlands it’s definitely the GP’s doing most of the job. The assistant just does bookings and waves me in when it’s my turn.

hiptobecubic 5y ago

I thought we'd have banned Dr lobbying by now, even without a technological revolution.

bigbillheck 5y ago
We haven't banned other kinds of lobbying, why would doctors be different?
jac241 5y ago
I thought we’d have banned software engineer lobbying by now, look how much harm they’re causing - https://www.healthline.com/health-news/social-media-use-increases-depression-and-loneliness https://www.healthline.com/health-news/social-media-use-incr...
robotresearcher 5y ago
Someone should persuade governments to ban lobbying. But who?

diognesofsinope 5y ago

American Medical Association (and other medical/pharma/health workers associations) > IBM

wiz21c 5y ago

> bedside manner + being able to remember a lot of things My impression is that accompanying a patient is super important, it helps to understand illness, to have a plan in case of more complex treatments, etc. Then my doctor has the ability to know me and gauge my health. She's also very good at probabilities and detecting when something really goes wrong. I'm sure that being able to do that require a lot more than numbers. (I'm studying data sciences, I trust them, but my guts tell me that diagnosis is in a whole different ballpark)

chromatin 5y ago
It also helps to have a relationship with a patient (or person). There are some people who will never, ever complain about anything. When they complain of severe abdominal pain, for example, you pull out all the stops immediately to figure out what's wrong, because it's probably really bad. On the other hand, there are hypochondriacs and people will low pain tolerance. While they can certainly also become seriously ill -- and one must never forget this -- the tempo and pace of workup and order of intervention is markedly different, absent other information that shifts the pretest probabilities.
- Aeolun 5y ago
  > On the other hand, there are hypochondriacs That’s me. I really, really appreciate a GP that both understands that I’m not doing it on purpose, and can reassure me that nothing is wrong, or figure out that we actually do need more testing this time. Unfortunately it’s been years since I had one like that :/
- KerrAvon 5y ago
  Sometimes a relationship is bad. If you think someone’s a hypochondriac, but in fact they’re unusually sensitive, you’ll dismiss a lot of what they say and that can be quite damaging over time. (Especially if they’re female https://www.health.harvard.edu/blog/women-and-pain-disparities-in-experience-and-treatment-2017100912562 https://www.health.harvard.edu/blog/women-and-pain-dispariti...). I wouldn’t eliminate GPs from the process, but many people actually would like to hear what the robots have to say about their medical conditions. Having second opinions of this sort available might lead to better patient outcomes.

oblio 5y ago

I assume that you're from the US? Those are both people problems. Tech can't solve many people problems, especially something as entrenched as healthcare. Isn't it huge, something like 10% of the US economy?

FredPret 5y ago
I thought to myself: no way can this be true. The US generates $21tr a year[1]. How can medical be $2.1tr a year? …turns out, it’s $2.7tr!!! [2] [1]www.tradingeconomics.com [2]https://www.statista.com/study/15826/health-care-and-social-assistance-in-the-us/ https://www.statista.com/study/15826/health-care-and-social-...
- vasco 5y ago
  20% https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical#:~:text=U.S.%20health%20care%20spending%20grew,spending%20accounted%20for%2019.7%20percent https://www.cms.gov/Research-Statistics-Data-and-Systems/Sta....
  - FredPret 5y ago
    Absolutely bonkers. One of every five dollars goes to healthcare. To put this further into perspective: the US military budget is immense, as we know… and it clocks in at 3.7% of GDP [1] [1] https://www.statista.com/statistics/266892/military-expenditure-as-percentage-of-gdp-in-highest-spending-countries/ https://www.statista.com/statistics/266892/military-expendit...
    - philjohn 5y ago
      To put it even further into perspective, that's 2x as much as comparable western nations with single-payer, who have similar or better outcomes in most cases.
- oblio 5y ago
  Why do you think nobody important (politicians, primarily) is really trying to solve those major healthcare problems? If politicians are willing to pork and barrel over a random soy farm employing 2000 people, for sure they're not going to throw away, say, 5% of the US GDP and possibly 5% of all employment in the US. I don't know how you're going to get out of it... [1] "There were 22 million workers in the health care industry, one of the largest and fastest-growing sectors in the United States that accounts for 14% of all U.S. workers, according to the Census Bureau’s 2019 American Community Survey (ACS)." https://www.census.gov/library/stories/2021/04/who-are-our-health-care-workers.html https://www.census.gov/library/stories/2021/04/who-are-our-h...

lotsofpulp 5y ago

>that GPs in particular would be replaced by a lower-cost Watson descendant It is happening. They are called physician assistants and nurse practitioners, "supervised" by a doctor. I assume going forward, they will take more and more of the usual pink eye/ear infection/flu and other common work that does not require 6 to 8 years of post bachelor education.

tryptophan 5y ago
It's happening because hospital corporations love them. Corps can pay less, and since they have a tenth of the education, they order tons of profitable tests, consults, and scans because they don't know otherwise.
- plucas 5y ago
  This is a mischaracterization of P.A.s (well, not the being-paid-less bit). Do you know any personally?
  - SkyPuncher 5y ago
    He's exaggerating significantly, but the core point is true. pAs and NPs will be the future of hospital care.
  - jac241 5y ago
    It's a mischaracterization for PAs because doctors only have ~7.5x minimum more clinical training and not 10x, 15000 clinical hours (for med school + family medicine, the shortest residency program) vs 2000hrs. Ask any radiologist you know what they think about the imaging orders from NPs and PAs and that will give you your answer.
- RHSeeger 5y ago
  It's worth noting that the higher tiers of nurses have at least a masters degree, and like more time working than a doctor spends in residency. They are highly trained/skilled professionals.

cube00 5y ago

> But GPs often make astounding amounts of money while leaning heavily on their staff to actually handle patients and keep the business running. The private ones might the ones in the public system at least in my country need to see a patient every 10 minutes to keep their heads above water.

nradclif 5y ago
What country are you from, if you don’t mind me asking?
- InvertedRhodium 5y ago
  I'm in New Zealand and it's not too far from what was described.
- flipchart 5y ago
  I've heard Canada is like that. I've had similar experience in South Africa, even in private health care, but I definitely had the impression that my doctor somewhat cared about me, especially after going to them for a few years
- kilburn 5y ago
  I'm from Spain and my wife is a family doctor. It really is like that here too.
- fqye 5y ago
  It is so in China and it is every 5 minutes in most cases. Precisely because of this, I chose doctors from good public hospitals because of their super rich experiences instead of fancy private hospitals.
james-redwood 5y ago
This is more or less the case in many European countries. Less so here in the UK, but approaching there rather quickly due to astoundingly poor management by various successive governments. It’s tough back in South Africa as well, and they pay their doctors extraordinarily well.

herval 5y ago

> what made that guy a doctor was bedside manner + being able to remember a lot of things That sounds like a lot of professions, engineering management included :-)

dukeofdoom 5y ago

Bribing politicians is far more profitable. Never thought my own prime minster would become a pfizer sales rep...but here we are.

Brybry 5y ago

The American medical system is truly bizarre. I've been to private practices where every day at lunch or near end of day there would be some drug rep with food for all the staff. And a psychiatrist that had stacks of free samples of drugs. Even contact lenses are marketed with free samples.

listenallyall 5y ago
Everyone talks about the relationship between drug reps and doctors like it's the most incestuous, evil, corrupt thing. How else are doctors, especially those who are 10, 20 years removed from their residency, supposed to learn about new treatments and medicines? Alexa, what is best current treatment for a duodenal ulcer? You think a doctor is going to spend his limited downtime perusing the PDR (which no longer exists, and was always heavily influenced by the drug manufacturers anyway)? Sure, there may be some excesses (although the truly major perks like entire vacations dressed up as a "conference" no longer exist), but I would much rather have doctors be aware of new drugs and yes, subject to marketing pitches, than have these drugs languish (eventually leading to drugs not being created) because nobody knows about them.
- nextaccountic 5y ago
  > How else are doctors, especially those who are 10, 20 years removed from their residency, supposed to learn about new treatments and medicines? With some other mechanism that doesn't have major conflicts of interest? Like, I don't know, attending to actual courses, like any other profession that requires continuing training.
  - listenallyall 5y ago
    Who is teaching the courses? Where do they get their info? Given the very limited oversight of "continuing education", it's trivial for Merck or Pfizer to ensure their advocate teaches the class or records the online seminar -- with zero requirement that they disclose that fact. At least when a drug rep visits the office and buys lunch, you know the source.

kijin 5y ago

> there wouldn't be any point in the pharma companies sending out salespeople to do lunch seminars to convince the GPs to prescribe this or that drug Right, but there would be a lot of point in making deals with whoever builds Watson-like devices, to turn them ever-so-slightly more likely to prescribe one drug over another or make one diagnosis over another. It might even be cheaper than hiring and sending out a bunch of salespeople.

snarf21 5y ago

There is no need to market to Doctors now when they market directly to consumers who go demand they get the new medicine. If we want to reduce costs, we need to move to lower level providers like a LPN or CRNP. Most people coming into a GP have the flu or an ear infection or .... and that can be handled by them. There will be one MD and to handle complicated cases and to supervise. We've already switched so that intake is done by CNA making $15/hour. In the US at least working at FAANG pays far more than being a GP.

chromatin 5y ago
> In the US at least working at FAANG pays far more than being a GP. Not just FAANG, either. The assertion by grandparent poster that GPs are "astoundingly" well paid is bonkers.
- jbullock35 5y ago
  "Astoundingly" is vague. According to the Bureau of Labor Statistics, the mean salary of "family and general practitioners" in May 2020 was $214,370 [1]. This figure includes salaries from GPs throughout the country (i.e., not just in the Bay Area). You can also look at median salaries. According to the BLS, all ten of the occupations with the highest median incomes in the U.S. are medical occupations [2]. "Family medicine physicians" are 10th on this list. [1] https://www.bls.gov/ooh/healthcare/physicians-and-surgeons.htm#tab-5 https://www.bls.gov/ooh/healthcare/physicians-and-surgeons.h... [2] https://www.bls.gov/ooh/highest-paying.htm https://www.bls.gov/ooh/highest-paying.htm
- snarf21 5y ago
  Additionally, a GP has med school plus residency. A Stanford CS grad will start higher than most GPs with only a bachelors degree.
  - erosenbe0 5y ago
    Mediocre GP makes 200k cash in Omaha or any average city and has choice among many employers and systems. Stanford CS represents top talent and moreover does not make 200k cash in Omaha, and can only make the big bucks at a fixed number of entities in fixed locations with fixed hierarchies and systems.

chromatin 5y ago

> I really expected that we'd see a change in my lifetime, that GPs in particular would be replaced by a lower-cost Watson descendant, with there being some other role for patient interaction, wet work, and data entry (perhaps just nurses). Perhaps this indicates a major gap in your visibility into and understanding of modern medical practice? > My mom worked for a GP for about 20 years, and it seemed to me that most of what made that guy a doctor was bedside manner + being able to remember a lot of things. "being able to remember a lot of things" -- Yes, absolutely. This is an area where AI-assisted decision support (like Watson) could be, and I hope will be, extremely valuable. OTOH, you also rightly recognize bedside manner -- as anyone who has been a patient or a patient's family caregiver will attest, this is an essential component of core, and I think likely also the healing process. We won't get this from a machine until there is a true general purpose AI, at which point I expect an AI singularity anyway. But consider that there are other factors of the practice of general medicine that you haven't even touched upon. For example, liability: In the office you envision, where Watson/AI makes medical decisions and these are executed by other roles like nursing, where does ultimate responsibility (and legal liability) lie? Remember that Watson outputs probabilities -- suppose the following: Chance of disease X: 89% Chance of disease Y: 10% Chance of disease Z: 1% If disease X, intervention A has an 80% probability of success. However, if disease Y, intervention A has an 80% probability of harm. (before you object that this is contrived, this represents a realistic situation I encountered recently, where intervention A is high dose steroids) Now, will we put the onus on the patient to select an intervention? I don't think that would be very popular. While I certainly do not advocate paternalism, when faced with difficult decisions quite many people openly defer to their physician. > But GPs often make astounding amounts of money I suppose this could be true for some definitions of "astounding," but it's generally accepted that GP/"primary care physician" pay is essentially the lowest of all specialties , which is a major contributor to lack of access to primary care in industrialized countries (while you'll not have a hard time finding a private pay dermatologist, for instance) ANd on top of this, we are posting on HN where a mid level software engineer total comp can EASILY outpace the average US primary care physician salary. > while leaning heavily on their staff to actually handle patients and keep the business running. Do not all professionals and business executives rely on highly trained staff as force multipliers? This is a fundamental principle of the advancement of human economies. It is grossly inefficient to operate with individuals as "jack of all trades" when they can instead each become specialized to support a bigger or broader goal. By "leaning heavily on their staff to actually handle patients and keep the business running" are you suggesting that the primary care physician should be performing check-in, insurance verification, rooming, vitals measurement, blood draw, medication administration etc? That is a certain recipe for massively decreased throughput and shortages/decreased access to primary care. > I thought it could help drugs get a little cheaper too, because there wouldn't be any point in the pharma companies sending out salespeople to do lunch seminars to convince the GPs to prescribe this or that drug (this still happens). This has been massively curtailed for 20+ years, at least in the US. I am not sure about other countries. But overall I think this is a seriously minor portion of the (exorbitant) price of medications in industrialized countries. In any case, I doubt it would make much of an impact on utilization in most contexts, as insurance/health plans/prescription benefits have already implemented fairly strict guidelines-based formularies and coverage tiers (again, at least in the US -- I can't speak to other industrialized countries, although I expect they are similar or even more strict) (edit: another poster points out all the direct to consumder drug advertising -- I agree - this probably has a much bigger influence in 2022; ad budgets are absolutely insance) > Maybe this will still happen, but it doesn't seem imminent anymore. Here we agree. I am certain we'll see AI-assisted physician decision support, but (a) the physician won't go away and (b) I think it'll be an unfortunately long ways in the future.

ricardobayes 5y ago

I thought the same, but as I grow older, I believe people would reject this. Even a subpar human GP would be much more accepted than a computer. That's not necessarily true in some societies though, e.g. Japan probably would accept it. That said, I would probably focus on fixing the system first in a way that a significant percent of population doesn't need to order fish medicine off amazon to get treatment.

CodeGlitch 5y ago
I wouldn't mind seeing a computer first before a GP. A lot of the time a GP will say something like "here try these tablets and come back in a week". The true worth of a GP is the follow-up appointments and understanding conditions over time.
Bombthecat 5y ago
I'm not so sure, sure the first generation might throw a tantrum, but the next generation will a accept it... Much like cars or trains..
Scoundreller 5y ago
> I thought the same, but as I grow older, I believe people would reject this. At some point, the (possibly subpar) GP will be a costlier decision (whether in dollars/time/frustration). Just like grocery stores having 10 self-checkouts and 1 cashier.

vasili111 5y ago

AI cannot replace doctors. It can help doctors a lot but not replace.

Aeolun 5y ago
That just means we need a general artificial intelligence to do it. We don’t have those now, but I wouldn’t say never.
colinmhayes 5y ago
Of course AI could replace doctors. Some people will always prefer the bedside manner a person provides, but many others won't care, and AI will eventually do a good job at imitating a good doctor's bedside manner.
- Firmwarrior 5y ago
  The only way AI is going to replace doctors is if medical technology advances to the point where you can repair a human as well as you can repair a machine (or someone invents AGI, I guess) There are just too many unknowns and fiddly things going on with human bodies edit: Haha, I guess Tex's sibling comment makes a good point though..
  - kbelder 5y ago
    I don't think we've got to the point where AI can repair a car. Humans are more complicated by a decent factor.
- telxosser 5y ago
  Machine learning could beat my doctor right now. "Using Random Forest Algorithm for Breast Cancer Diagnosis" https://ieeexplore.ieee.org/document/8644835 https://ieeexplore.ieee.org/document/8644835 Most of what the doctor is doing is a type of modern shamanism though. Person doesn't feel good, so the doctor orders a useless test, test comes back negative so the person feels better. Then we complain health care cost too much. 10 full blood panel samples a year with other bio-metric data and a data set of 20 million people to do classification on would crush the doctor over time. This bullshit health system though makes it impossible to have any real innovation at a mass scale. We will never have personal higher frequency medical data in my lifetime that would actually hugely improve the system and cut most of the cost out.

throwthere 5y ago

Yeah like most businesses the owner his staff to help out. I’m curious what you think GPs actually make, because in the US it’s not astronomical. Watson went after the wrong problem— doctors don’t comprise huge amounts of healthcare spending. It’s a recurring issue, tech thinks they have a solution and in reality the devs don’t have a good grasp on the actual landscape they’re playing in.

0xbadcafebee 5y ago

Medicine is a business. Its incentive is profit, not patient outcome. Everybody knows the problems with medicine and the solutions are straightforward. But they don't result in more profits, only better patient outcomes. So you only get advances when it increases profit. Come up with a way for better patient outcomes to result in higher profits and you'll see advances in patient care real damn fast.

jac241 5y ago
Please list some of the solutions, because from where I am (actually in a hospital) all I see are people who care about patient outcomes.
- 0xbadcafebee 5y ago
  1. Stop charging so much. People aren't seeking treatment because they're afraid of the bills. I have other solutions, but there's no point in listing them because nobody will implement them (for the same reason that one won't be: profits over patients)

crispyambulance 5y ago

> most of what made that guy a doctor was bedside manner + being able to remember a lot of things. Sure, that, and recognizing patterns and adjusting medication and being able to use good judgement for when to escalate to a referral for a specialist. But that's a lot! I actually go to a teaching hospital for my primary care. It means I get seen by residents, and almost always also by very experienced teaching doctors. It ends up meaning that I get more time and attention by people who are actively learning and trying hard to do the right thing. The trade-off is there's no long-term trust relationship, but I am OK with that. I've also experienced care from elderly family doctors who run a "one-man-band" with a nurse and a receptionist, they're nice but I think I get better care at a teaching hospital.

PragmaticPulp 5y ago

> My mom worked for a GP for about 20 years, and it seemed to me that most of what made that guy a doctor was bedside manner + being able to remember a lot of things. That’s exactly right, but there’s nothing wrong with that. A good doctor’s memory of patients spanning decades of a career and all of the various treatments that they did or did not respond to is very valuable. It’s a good thing that they offload as much as possible to other people so they can focus on doing what they do best.

geofft 5y ago
I think the comment above, most charitably read, is that a lot more people would have access to high-quality healthcare if you could put this work on robots instead of people, because computers excel at storing data and looking it up accurately and following predetermined rules. There would be fewer cases of people going to their doctor and being told "oh, it's nothing" when it actually is a specific, rare, and urgent problem. And then they would end up going to a human specialist to figure out how to fix that problem.

throwawayboise 5y ago

I mean, I won't even use the self-service kiosk at McDonald's. I sure as hell am not going to interact with a computer for my medical care.

zoomablemind 5y ago
> ...I won't even use the self-service kiosk at McDonald's As lame as it may be, but I just used the McDo kiosk for the first time. Why? I'm a very infrequent customer at McDo and have 0 knowledge of options and combos, but also remember the mutual annoyance when previously asking for menu details from a min-wage clerk. In a perverse way, the kiosk gives that power to choose back to me, the customer. At the same time relegating the supposedly more able humans to even less meaningful role. This worked quite right in this case. I can see this approach applicable as well for some medical need that could be mapped onto a sequence of a "few" choices. This could be resulting in some assistive pre-screening report. Well, that's the stuff the assistants do at the beginning of a doctor visit. Not that different from a slot-operated scales of ancient times. But in the end, I still want to see an immediate human responsibility in such transaction. By the same token, a GP won't be leaning heavily on such "assistive report" and would still go on and ask all of the questions again, as trained, as allotted, as billed. Each doctor visit begins as a custom solution, no matter how cookie-cutter it turns out to be at the end. That's what we expect and that's what it ends up being billed to us.

jakey_bakey 5y ago

The hard part is knowing what things you need to remember