5 ms·

What you are writing about is aspirational utopian fantasy. What I wrote is harsh reality informed by two decades of being elbow deep in bodily fluids. You ma

What you are writing about is aspirational utopian fantasy. What I wrote is harsh reality informed by two decades of being elbow deep in bodily fluids. You may not like it, but you aren’t getting the best physician just because you developed some far out ideas how the best talent in the world must fix your problems. Guess what, physicians are free people too, even free to refuse any patient for any reason. They just want top dollar, and move where the pay is best, that’s all. You wouldn’t move for a 10x higher salary? You would deny everything that would bring to your family?

seibelj 4y ago
[flagged]
fzeroracer 4y ago
What you've mentioned is objectively wrong and has nothing to do with reality. The US is not leading in healthcare outcomes or anything of the sort. And even then, there's more to life than just strictly salary. Things like retirement benefits, socialized healthcare, safety nets etc all contribute to reasons why this occurs. Also as a side note: US doesn't have a physician surplus: It has a physician shortage. By your logic, we should see no issue in finding physicians, doctors etc because they should all want to relocate to the US where the salary is the highest.
- forum_ghost 4y ago
  Anyone who keeps talking about averages or statistical outcomes does not understand the first thing about medicine: there is no averages. Because of deep sub-specialization you only have an agglomeration of outliers that are really good at what they do, and then the plankton, just like in every profession. You can either have someone that knows exactly what he’s doing, or someone who rarely does it. A large part of medicine is guesswork, and you want someone who’s seen enough to be doing the guessing. There is no shortage of physicians if you have the money. You can see the absolute best physician of your choice literally tomorrow if you have enough money to name a hospital wing. They’ll just see you while they eat their lunch, or come in an hour earlier. The shortage you are talking about, is a shortage of competent, qualified saints willing to forego compensation after spending a decade in training to treat the poor. If your expectation is that the top talent should for peanuts - do you really think there can be no shortages? You are literally asking for saints and miracles. P.S. >there's more to life than just strictly salary. Things like retirement benefits, socialized healthcare, safety nets etc all contribute to reasons why this occurs. $2-3 million/year solve all of the above. There is more to life, but 90% of every graduating class are there for money, nothing less.
  - fzeroracer 4y ago
    No, I'm talking about a very literal shortage of physicians in the US. Not a shortage of saints or whatever tangent you're going on. The US has a physician shortage. I will repeat under your argument there should be no physician shortage in the US because the US has among the highest salaries for physicians. This should not happen by the argument you keep repeating. The fact that someone can see a physician tomorrow with enough money is irrelevant because with enough money they are no limited to the US. Experts are not located entirely within the US, hence why many millionaire/billionaires will travel for medical aid because other countries might have people with more expertise in XYZ. The rest of your comment is completely irrelevant to the argument I'm making.
    - forum_ghost 4y ago
      >This should not happen by the argument you keep repeating. you do not understand how the industry works. salaries are high because the supply is constrained. supply is capped. by residency availability. doctors, like many others, don't want to live in some areas, and supply ends up being unevenly distributed. In any major US metro, you can see a cardiologist TOMORROW. Don't even have to be a millionaire. https://www.merritthawkins.com/uploadedFiles/MerrittHawkins/Content/Pdf/mha2017waittimesurveyPDF.pdf https://www.merritthawkins.com/uploadedFiles/MerrittHawkins/... Let me guess, next will be "but muh AVERAGES"? You can remain average. Best of luck.
      - deleted 4y ago
        [deleted]
      - dang 4y ago
        Can you please edit the swipes out of your comments? You've posted good things but unfortunately they're interspersed with hostile/inflammatory bits, and we're trying to avoid the latter here. It's not what this site is for, and it destroys what it is for. https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html
        4y ago
pishpash 4y ago
- forum_ghost 4y ago
  You get paid what you can negotiate, not what you deserve. Any politician that would propose serious enough cuts to physicians pay would suddenly find that their own GP has dropped him, and his oncologist forgot how treat the politician’s cancer. Sounds extreme? Happened several times in the US. If they’d succeeded, you’d just have waves of immigration to richer countries that can pay higher, called brain drain. The US has the financial resources to attract the best talent. Not just salaries, but resources mean you get to work on things you find interesting, and ignore things you don’t. Regarding “best”. I never said all US physicians are “best”. What I said was, that because of higher pay, the best talent can be appropriately rewarded in the US. How many public single payer systems can afford a physician that bills $10 million per year? More common than you think in the US. They are most certainly outliers, and not the average physicians. The issue is that due to super-specialization game that is medicine, anyone sufficiently experienced is going to be an outlier. Once it comes to something more involved than simple fracture, you want someone who does nothing but works on the specific issue you have, and preferably nothing else. Real example: triple board certified (max fax, ent, trauma) surgeon Kasey Li in the US bills something like 100k per operation. Top talent from Hollywood and top Silicon Valley execs go to him. you’ve seen his work multiple times on several personalities. There is literally not a single surgeon in Australia that is equally as well trained and as experienced as Li. He only works in one area and one issue only. He pioneered an entire new field, changed numerous lives, including some execs that frequent this board, lol. Who are you to decide how much he charges? You not even qualified to assess any his work to begin with, maybe 5-10 people in the world are.
jpgvm 4y ago
I don't see how it's fantasy if it already exists in my home country...?
- RGamma 4y ago
  ~Two decades of social atomisation and commercial brainwashing have left their traces...
- forum_ghost 4y ago
  What exists in Australia is exactly what the US has: private payers that get preferential access, and then Medicare for the poor/everyone else. People avoiding appointments they cannot afford. Psi service refusing to take Medicare patients. Unavailable pharmaceuticals in Australia that one can easily access in the US. You even have US-style HMOs. It’s just a US-lite system compared to Canada (which like Cuba outlaws private healthcare, but has a grey healthcare market because the public system is broke), and NHS(which is broke like Canada, but at least you can pay private). 1) Patients avoiding appointments due to costs, just like the US: “Almost impossible to get bulk billed’: patients avoid seeing doctors due to out-of-pocket costs” https://amp.theguardian.com/australia-news/2022/may/12/almost-impossible-to-get-bulk-billed-patients-avoid-seeing-doctors-due-to-out-of-pocket-costs https://amp.theguardian.com/australia-news/2022/may/12/almos... Private healthcare is better in Australia: 2) Private healthcare where cash suddenly trumps virtue-signalling on the internet. Paying cash money? Jump the queue! The poor can languish and die while on waitlists. “Public patients requiring elective surgery for cancer, heart conditions and other serious health issues face longer waiting times than their privately insured counterparts in public hospitals, according to a new report. ” https://thenewdaily.com.au/life/wellbeing/2017/12/06/private-patient-queue-jumping-claims/amp/ https://thenewdaily.com.au/life/wellbeing/2017/12/06/private... 3) Refusal of public patients. In some cases, physicians don’t even take any Medicare patients -at all-. Let’s take a rather relevant specialty for this thread, psychiatry: “Psychiatry costs in particular are prohibitive. One reader reported paying $300 for 20 minutes with a psychiatrist, while another said they paid $900 for the first session and $500 for subsequent sessions. Another reader said her one-hour psychiatry session cost $435, and the Medicare rebate “didn’t even cover half”. Another reader, Jamie, said she had paid $220 and received $76 back from Medicare, but that her initial appointment was $600.” Congrats! You are paying American rates! Good job Australia! https://amp.theguardian.com/australia-news/2021/apr/19/like-hunting-for-unicorns-australians-on-the-search-for-adequate-affordable-mental-healthcare https://amp.theguardian.com/australia-news/2021/apr/19/like-... My goodness, isn’t this a huge surprise! Highly trained people want to get paid even in Australia, news at 11. Who could’ve guessed. Money talks. It’s that simple. Why is that so hard to accept? Engineers used to move to Bay Area to get the best possible salaries, but we should suppress doctors who even as much attempt to move overseas for bigger pay checks, lol?

seibelj 4y ago

[flagged]

fzeroracer 4y ago

What you've mentioned is objectively wrong and has nothing to do with reality. The US is not leading in healthcare outcomes or anything of the sort. And even then, there's more to life than just strictly salary. Things like retirement benefits, socialized healthcare, safety nets etc all contribute to reasons why this occurs. Also as a side note: US doesn't have a physician surplus: It has a physician shortage. By your logic, we should see no issue in finding physicians, doctors etc because they should all want to relocate to the US where the salary is the highest.

forum_ghost 4y ago
Anyone who keeps talking about averages or statistical outcomes does not understand the first thing about medicine: there is no averages. Because of deep sub-specialization you only have an agglomeration of outliers that are really good at what they do, and then the plankton, just like in every profession. You can either have someone that knows exactly what he’s doing, or someone who rarely does it. A large part of medicine is guesswork, and you want someone who’s seen enough to be doing the guessing. There is no shortage of physicians if you have the money. You can see the absolute best physician of your choice literally tomorrow if you have enough money to name a hospital wing. They’ll just see you while they eat their lunch, or come in an hour earlier. The shortage you are talking about, is a shortage of competent, qualified saints willing to forego compensation after spending a decade in training to treat the poor. If your expectation is that the top talent should for peanuts - do you really think there can be no shortages? You are literally asking for saints and miracles. P.S. >there's more to life than just strictly salary. Things like retirement benefits, socialized healthcare, safety nets etc all contribute to reasons why this occurs. $2-3 million/year solve all of the above. There is more to life, but 90% of every graduating class are there for money, nothing less.
- fzeroracer 4y ago
  No, I'm talking about a very literal shortage of physicians in the US. Not a shortage of saints or whatever tangent you're going on. The US has a physician shortage. I will repeat under your argument there should be no physician shortage in the US because the US has among the highest salaries for physicians. This should not happen by the argument you keep repeating. The fact that someone can see a physician tomorrow with enough money is irrelevant because with enough money they are no limited to the US. Experts are not located entirely within the US, hence why many millionaire/billionaires will travel for medical aid because other countries might have people with more expertise in XYZ. The rest of your comment is completely irrelevant to the argument I'm making.
  - forum_ghost 4y ago
    >This should not happen by the argument you keep repeating. you do not understand how the industry works. salaries are high because the supply is constrained. supply is capped. by residency availability. doctors, like many others, don't want to live in some areas, and supply ends up being unevenly distributed. In any major US metro, you can see a cardiologist TOMORROW. Don't even have to be a millionaire. https://www.merritthawkins.com/uploadedFiles/MerrittHawkins/Content/Pdf/mha2017waittimesurveyPDF.pdf https://www.merritthawkins.com/uploadedFiles/MerrittHawkins/... Let me guess, next will be "but muh AVERAGES"? You can remain average. Best of luck.
    - deleted 4y ago
      [deleted]
    - dang 4y ago
      Can you please edit the swipes out of your comments? You've posted good things but unfortunately they're interspersed with hostile/inflammatory bits, and we're trying to avoid the latter here. It's not what this site is for, and it destroys what it is for. https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html
      - 4y ago

pishpash 4y ago

forum_ghost 4y ago
You get paid what you can negotiate, not what you deserve. Any politician that would propose serious enough cuts to physicians pay would suddenly find that their own GP has dropped him, and his oncologist forgot how treat the politician’s cancer. Sounds extreme? Happened several times in the US. If they’d succeeded, you’d just have waves of immigration to richer countries that can pay higher, called brain drain. The US has the financial resources to attract the best talent. Not just salaries, but resources mean you get to work on things you find interesting, and ignore things you don’t. Regarding “best”. I never said all US physicians are “best”. What I said was, that because of higher pay, the best talent can be appropriately rewarded in the US. How many public single payer systems can afford a physician that bills $10 million per year? More common than you think in the US. They are most certainly outliers, and not the average physicians. The issue is that due to super-specialization game that is medicine, anyone sufficiently experienced is going to be an outlier. Once it comes to something more involved than simple fracture, you want someone who does nothing but works on the specific issue you have, and preferably nothing else. Real example: triple board certified (max fax, ent, trauma) surgeon Kasey Li in the US bills something like 100k per operation. Top talent from Hollywood and top Silicon Valley execs go to him. you’ve seen his work multiple times on several personalities. There is literally not a single surgeon in Australia that is equally as well trained and as experienced as Li. He only works in one area and one issue only. He pioneered an entire new field, changed numerous lives, including some execs that frequent this board, lol. Who are you to decide how much he charges? You not even qualified to assess any his work to begin with, maybe 5-10 people in the world are.

jpgvm 4y ago

I don't see how it's fantasy if it already exists in my home country...?

RGamma 4y ago
~Two decades of social atomisation and commercial brainwashing have left their traces...
forum_ghost 4y ago
What exists in Australia is exactly what the US has: private payers that get preferential access, and then Medicare for the poor/everyone else. People avoiding appointments they cannot afford. Psi service refusing to take Medicare patients. Unavailable pharmaceuticals in Australia that one can easily access in the US. You even have US-style HMOs. It’s just a US-lite system compared to Canada (which like Cuba outlaws private healthcare, but has a grey healthcare market because the public system is broke), and NHS(which is broke like Canada, but at least you can pay private). 1) Patients avoiding appointments due to costs, just like the US: “Almost impossible to get bulk billed’: patients avoid seeing doctors due to out-of-pocket costs” https://amp.theguardian.com/australia-news/2022/may/12/almost-impossible-to-get-bulk-billed-patients-avoid-seeing-doctors-due-to-out-of-pocket-costs https://amp.theguardian.com/australia-news/2022/may/12/almos... Private healthcare is better in Australia: 2) Private healthcare where cash suddenly trumps virtue-signalling on the internet. Paying cash money? Jump the queue! The poor can languish and die while on waitlists. “Public patients requiring elective surgery for cancer, heart conditions and other serious health issues face longer waiting times than their privately insured counterparts in public hospitals, according to a new report. ” https://thenewdaily.com.au/life/wellbeing/2017/12/06/private-patient-queue-jumping-claims/amp/ https://thenewdaily.com.au/life/wellbeing/2017/12/06/private... 3) Refusal of public patients. In some cases, physicians don’t even take any Medicare patients -at all-. Let’s take a rather relevant specialty for this thread, psychiatry: “Psychiatry costs in particular are prohibitive. One reader reported paying $300 for 20 minutes with a psychiatrist, while another said they paid $900 for the first session and $500 for subsequent sessions. Another reader said her one-hour psychiatry session cost $435, and the Medicare rebate “didn’t even cover half”. Another reader, Jamie, said she had paid $220 and received $76 back from Medicare, but that her initial appointment was $600.” Congrats! You are paying American rates! Good job Australia! https://amp.theguardian.com/australia-news/2021/apr/19/like-hunting-for-unicorns-australians-on-the-search-for-adequate-affordable-mental-healthcare https://amp.theguardian.com/australia-news/2021/apr/19/like-... My goodness, isn’t this a huge surprise! Highly trained people want to get paid even in Australia, news at 11. Who could’ve guessed. Money talks. It’s that simple. Why is that so hard to accept? Engineers used to move to Bay Area to get the best possible salaries, but we should suppress doctors who even as much attempt to move overseas for bigger pay checks, lol?