7 ms·

Doctor fired from ER warns about effect of for-profit firms on U.S. health care

74 points by devy 5y ago

Vladimof 5y ago
deleted 5y ago
[deleted]
renewiltord 5y ago
Doctors are obsolete. There are too few of them and they have succeeded in stopping us from making more. The future is we just pay the doctor tax for a few of them and we leave the majority of care to NPs. In time we can create a new category of advanced NPs to substitute for doctors. And in time, we can add more training to substitute for surgeons and specialists. America will find that most Americans are suffering not because the care they get is bad but because they can’t get the care they need. In time, we will discover that going to a charlatan with a shady pharma hookup and a Wikipedia page is better than dying while you wait for your doctor. The future of health care is coming and it doesn’t look like this. All we have to do is get in front before doctors and their symbiotic hosts (hospital admin) lock down alternative paths to modern medicine.
- usednet 5y ago
  Easy to say that, harder to live it. Would you willingly choose to receive treatment from a less trained, less accurate NP? I wouldn’t, even if I had to wait longer.
  - newyankee 5y ago
    People without any affordable alternative will, and will be the first target markets.
  - ZeroGravitas 5y ago
    Why the assumption that they're worse? If the root cause of the problem is monopoly, then this is exactly analogous to the question of established monopolist vs startup. "No one ever got fired for choosing <current monopolist>" is fine if you're playing it safe but many people don't have that option and find, sometimes to their surprise, that the cheaper option is also better, due to the different incentives in play.
    - poirot2 5y ago
      This is an ill informed take. It’s common when someone doesn’t know what X role does from the outside to think they are interchangeable. Medical school takes candidates that are already on average much stronger than NP trainees and then trains them more rigorously. Further, the specific training pathway after medical/ nursing school is v different. NPs are trained in seeing ‘textbook’ or standard cases and a flowchart of management for them. Which is great if you are one of them. And since most people present ‘typically’ for that clinic you can use NPs to filter through people and get them seem quickly/ cheaply. However, they don’t have the toolkit to handle greater complexity that is outside the flowchart and don’t generally know how recognise when a standard flowchart approach to management shouldn’t apply. It’s rather tough to explain in lay terms other than via analogy - you’ve basically said all software engineers should be replaced by data analysts.
      - ZeroGravitas 5y ago
        No, it's like saying all programmers should be replaced by certified programmers who are all from good families and have 10 years of intense training at top schools and massive debt. You wouldn't trust some young immigrant or a long haired hippy kid who dropped out of college and started a business in his garage to provide your tech would you? Computers are complicated, we can't let amateurs in hoodies start doing things without some central control.
        lotsofpulp 5y ago
        NP/PA education is far less rigorous And requires far less hours than MD. Many more NP/PA schools have far more lax standards, and are probably better called diploma mills than MD schools. It is all probabilities, and I would rather bet on an MD. At least compared to the current incarnation of NP/PA.
  - renewiltord 5y ago
    That’s the wrong question. Would you rather suffer for want of a doctor or see someone else? We already know the answer. People seek them where they can get them. WebMD. Google. Fish mox on Amazon. Self-treatment is rife. If I had the choice I’d go to a doctor (and I always have the choice - my parents and cousins are surgeons). But I “go to the doctor” for something as mild as a contusion on my knee or the suggestion of sniffles or if I wake up with my eyes feeling a bit dry. The people who don’t have the choice don’t call the doctor when they can’t even get out of bed. It’s about all the people without a choice.
- newyankee 5y ago
  I concur, but it is a complicated problem. Weirdly I feel authoritarian regimes like China might actually show the path to success in Healthcare AI. This is because true success needs fast decision making/ unpopular tradeoffs that they can possibly execute better with lower regulatory barriers. However, most studies on US healthcare point more fingers at bloated hospital admins with perverse incentives more than Doctors.
- tluyben2 5y ago
  I pick my own treatment and medicine already for 20 years; it is not hard. If you have something you are unsure about, ask your gp for a specialist visit (that is what they do as well); otherwise, tell your doctor what to prescribe. Since 15 years, I just send the doctor office and email, they return a doc signed by the doctor and I can go to the specialist or pick up my prescription with it. GPs are not wizards; they were nice for social contact; outside that they just give you something that could work and hope it goes away; otherwise they will give you something else or send you on to a specialist. I can do that myself and an AI or crowd sourced diagnoses can do that too I believe. Doesn’t need to cost 25-50$ per consult either.
- zeagle 5y ago
  "Advanced NPs to substitute for doctors": I suspect future you describe is one driven by a private equity race to extract profit by lowering costs NOT to provide affordable or better care for more individuals.
- affyboi 5y ago
  Doctors undergo a lot more and far more rigorous training than NPs, which is reflected in their efficacy. https://pubmed.ncbi.nlm.nih.gov/32362078/ https://pubmed.ncbi.nlm.nih.gov/32362078/ https://onlinelibrary.wiley.com/doi/full/10.1111/acem.14077 https://onlinelibrary.wiley.com/doi/full/10.1111/acem.14077 https://pubmed.ncbi.nlm.nih.gov/28734486/ https://pubmed.ncbi.nlm.nih.gov/28734486/ https://pubmed.ncbi.nlm.nih.gov/21291293/ https://pubmed.ncbi.nlm.nih.gov/21291293/ https://pubmed.ncbi.nlm.nih.gov/10861159/ https://pubmed.ncbi.nlm.nih.gov/10861159/ I also wouldn’t say that doctors are symbiotic with their hospital admins — the ones I’ve worked with seemed to really dislike the admins. Simple solution seems to be to open up a lot more residency spots and not drop the rigor/licensing/clinical experience that we currently require for doctors.
- schoolornot 5y ago
  NPs are doing independent practice in some states and are charging MD rates. The issue isn't the number of doctors, it's the cost for average Joe to get treated without being charged three days of wages for a 7 minute consult.
rapjr9 5y ago
So according to the article the administration intentionally ignored Federal law (a physician must be available 24/7 in Level II trauma centers) to increase profits. Couldn't the ER leader have just reported them to the FBI? Maybe he was trying to go through the appropriate channels first? Should not the FBI be investigating this hospital now?
- porknubbins 5y ago
  Probably not the FBI but the relevant regulatory agency possibly. Being a whistleblower comes with its own set of risks though.
  - netizen-936824 5y ago
    Yes, we have learned that whistleblowers are persecuted and prosecuted
  - DiabloD3 5y ago
    Don't know why this is being downvoted. The FBI is the incorrect part of the Federal government to contact (I suspect you want the HHS instead) and US whistleblower laws do not protect whistleblowers sufficiently and becoming one is a very risky thing to do.
adamredwoods 5y ago
Brovont won the court settlement, which is a good thing, because it shows physicians can potentially challenge these unethical situations. Another article criticizing contract management groups: https://today.tamu.edu/2021/08/20/hospital-outsourcing-often-prioritizes-profit-over-patients/ https://today.tamu.edu/2021/08/20/hospital-outsourcing-often...
Gortal278 5y ago
Non-profit hospitals are just are blood sucking
- marviel 5y ago
  Can you explain what you mean, and how that is true?
pilotneko 5y ago
For-profit hospitals do not improve care. There is simply no way to remove money from patient care pathways and improve outcomes.
Qem 5y ago
US should take lessons from Cuba in this area. With much less resources they managed to create a health care system that is not a total wreck, and actually good. It's a solvable problem.
- walkhour 5y ago
  Doctors in Cuba make $50 to $70 a month, I can only imagine how much the nurses are making. Given this I don't think there's a straightforward way of porting their system to the US. A US Doctor may make more money than the whole staff of a hospital in Cuba. It's amazing how affordable things are when labour is dirt cheap. That being said the US could start by augmenting immigration from healthcare professionals, like it happens in many other sectors, engineering being one them. Too bad lobbies will never allow this.
  - Qem 5y ago
    Well, between doctors making $70 a month and being charged 54,000$ for a COVID test in a ER, surely there is a lot of room for adjustement. https://www.usatoday.com/story/news/health/2021/09/30/texas-man-charged-54000-covid-test-hospital/5927347001/ https://www.usatoday.com/story/news/health/2021/09/30/texas-...
    - jbritton 5y ago
      Wow. My whole life I have thought hospital billing was absolutely insane, and this is a great example. I don’t know why a good lawyer hasn’t filed a massive class action lawsuit for billing fraud. Why does the government do nothing about this. I think most people just think the billing is the correct amount, and it seems to me to be off 10x to 100x.

74 points by devy 5y ago

Vladimof 5y ago

deleted 5y ago

[deleted]

renewiltord 5y ago

Doctors are obsolete. There are too few of them and they have succeeded in stopping us from making more. The future is we just pay the doctor tax for a few of them and we leave the majority of care to NPs. In time we can create a new category of advanced NPs to substitute for doctors. And in time, we can add more training to substitute for surgeons and specialists. America will find that most Americans are suffering not because the care they get is bad but because they can’t get the care they need. In time, we will discover that going to a charlatan with a shady pharma hookup and a Wikipedia page is better than dying while you wait for your doctor. The future of health care is coming and it doesn’t look like this. All we have to do is get in front before doctors and their symbiotic hosts (hospital admin) lock down alternative paths to modern medicine.

usednet 5y ago
Easy to say that, harder to live it. Would you willingly choose to receive treatment from a less trained, less accurate NP? I wouldn’t, even if I had to wait longer.
- newyankee 5y ago
  People without any affordable alternative will, and will be the first target markets.
- ZeroGravitas 5y ago
  Why the assumption that they're worse? If the root cause of the problem is monopoly, then this is exactly analogous to the question of established monopolist vs startup. "No one ever got fired for choosing <current monopolist>" is fine if you're playing it safe but many people don't have that option and find, sometimes to their surprise, that the cheaper option is also better, due to the different incentives in play.
  - poirot2 5y ago
    This is an ill informed take. It’s common when someone doesn’t know what X role does from the outside to think they are interchangeable. Medical school takes candidates that are already on average much stronger than NP trainees and then trains them more rigorously. Further, the specific training pathway after medical/ nursing school is v different. NPs are trained in seeing ‘textbook’ or standard cases and a flowchart of management for them. Which is great if you are one of them. And since most people present ‘typically’ for that clinic you can use NPs to filter through people and get them seem quickly/ cheaply. However, they don’t have the toolkit to handle greater complexity that is outside the flowchart and don’t generally know how recognise when a standard flowchart approach to management shouldn’t apply. It’s rather tough to explain in lay terms other than via analogy - you’ve basically said all software engineers should be replaced by data analysts.
    - ZeroGravitas 5y ago
      No, it's like saying all programmers should be replaced by certified programmers who are all from good families and have 10 years of intense training at top schools and massive debt. You wouldn't trust some young immigrant or a long haired hippy kid who dropped out of college and started a business in his garage to provide your tech would you? Computers are complicated, we can't let amateurs in hoodies start doing things without some central control.
      - lotsofpulp 5y ago
        NP/PA education is far less rigorous And requires far less hours than MD. Many more NP/PA schools have far more lax standards, and are probably better called diploma mills than MD schools. It is all probabilities, and I would rather bet on an MD. At least compared to the current incarnation of NP/PA.
- renewiltord 5y ago
  That’s the wrong question. Would you rather suffer for want of a doctor or see someone else? We already know the answer. People seek them where they can get them. WebMD. Google. Fish mox on Amazon. Self-treatment is rife. If I had the choice I’d go to a doctor (and I always have the choice - my parents and cousins are surgeons). But I “go to the doctor” for something as mild as a contusion on my knee or the suggestion of sniffles or if I wake up with my eyes feeling a bit dry. The people who don’t have the choice don’t call the doctor when they can’t even get out of bed. It’s about all the people without a choice.
newyankee 5y ago
I concur, but it is a complicated problem. Weirdly I feel authoritarian regimes like China might actually show the path to success in Healthcare AI. This is because true success needs fast decision making/ unpopular tradeoffs that they can possibly execute better with lower regulatory barriers. However, most studies on US healthcare point more fingers at bloated hospital admins with perverse incentives more than Doctors.
tluyben2 5y ago
I pick my own treatment and medicine already for 20 years; it is not hard. If you have something you are unsure about, ask your gp for a specialist visit (that is what they do as well); otherwise, tell your doctor what to prescribe. Since 15 years, I just send the doctor office and email, they return a doc signed by the doctor and I can go to the specialist or pick up my prescription with it. GPs are not wizards; they were nice for social contact; outside that they just give you something that could work and hope it goes away; otherwise they will give you something else or send you on to a specialist. I can do that myself and an AI or crowd sourced diagnoses can do that too I believe. Doesn’t need to cost 25-50$ per consult either.
zeagle 5y ago
"Advanced NPs to substitute for doctors": I suspect future you describe is one driven by a private equity race to extract profit by lowering costs NOT to provide affordable or better care for more individuals.
affyboi 5y ago
Doctors undergo a lot more and far more rigorous training than NPs, which is reflected in their efficacy. https://pubmed.ncbi.nlm.nih.gov/32362078/ https://pubmed.ncbi.nlm.nih.gov/32362078/ https://onlinelibrary.wiley.com/doi/full/10.1111/acem.14077 https://onlinelibrary.wiley.com/doi/full/10.1111/acem.14077 https://pubmed.ncbi.nlm.nih.gov/28734486/ https://pubmed.ncbi.nlm.nih.gov/28734486/ https://pubmed.ncbi.nlm.nih.gov/21291293/ https://pubmed.ncbi.nlm.nih.gov/21291293/ https://pubmed.ncbi.nlm.nih.gov/10861159/ https://pubmed.ncbi.nlm.nih.gov/10861159/ I also wouldn’t say that doctors are symbiotic with their hospital admins — the ones I’ve worked with seemed to really dislike the admins. Simple solution seems to be to open up a lot more residency spots and not drop the rigor/licensing/clinical experience that we currently require for doctors.
schoolornot 5y ago
NPs are doing independent practice in some states and are charging MD rates. The issue isn't the number of doctors, it's the cost for average Joe to get treated without being charged three days of wages for a 7 minute consult.

rapjr9 5y ago

So according to the article the administration intentionally ignored Federal law (a physician must be available 24/7 in Level II trauma centers) to increase profits. Couldn't the ER leader have just reported them to the FBI? Maybe he was trying to go through the appropriate channels first? Should not the FBI be investigating this hospital now?

porknubbins 5y ago
Probably not the FBI but the relevant regulatory agency possibly. Being a whistleblower comes with its own set of risks though.
- netizen-936824 5y ago
  Yes, we have learned that whistleblowers are persecuted and prosecuted
- DiabloD3 5y ago
  Don't know why this is being downvoted. The FBI is the incorrect part of the Federal government to contact (I suspect you want the HHS instead) and US whistleblower laws do not protect whistleblowers sufficiently and becoming one is a very risky thing to do.

adamredwoods 5y ago

Brovont won the court settlement, which is a good thing, because it shows physicians can potentially challenge these unethical situations. Another article criticizing contract management groups: https://today.tamu.edu/2021/08/20/hospital-outsourcing-often-prioritizes-profit-over-patients/ https://today.tamu.edu/2021/08/20/hospital-outsourcing-often...

Gortal278 5y ago

Non-profit hospitals are just are blood sucking

marviel 5y ago
Can you explain what you mean, and how that is true?

pilotneko 5y ago

For-profit hospitals do not improve care. There is simply no way to remove money from patient care pathways and improve outcomes.

Qem 5y ago

US should take lessons from Cuba in this area. With much less resources they managed to create a health care system that is not a total wreck, and actually good. It's a solvable problem.

walkhour 5y ago
Doctors in Cuba make $50 to $70 a month, I can only imagine how much the nurses are making. Given this I don't think there's a straightforward way of porting their system to the US. A US Doctor may make more money than the whole staff of a hospital in Cuba. It's amazing how affordable things are when labour is dirt cheap. That being said the US could start by augmenting immigration from healthcare professionals, like it happens in many other sectors, engineering being one them. Too bad lobbies will never allow this.
- Qem 5y ago
  Well, between doctors making $70 a month and being charged 54,000$ for a COVID test in a ER, surely there is a lot of room for adjustement. https://www.usatoday.com/story/news/health/2021/09/30/texas-man-charged-54000-covid-test-hospital/5927347001/ https://www.usatoday.com/story/news/health/2021/09/30/texas-...
  - jbritton 5y ago
    Wow. My whole life I have thought hospital billing was absolutely insane, and this is a great example. I don’t know why a good lawyer hasn’t filed a massive class action lawsuit for billing fraud. Why does the government do nothing about this. I think most people just think the billing is the correct amount, and it seems to me to be off 10x to 100x.