19 ms·

The planning of U.S. physician shortages (2020)

216 points by flummox 3y ago

nine_zeros 3y ago
Most problems in a rich country like America are entirely created due to backwards, uneducated policies.
unnamed76ri 3y ago
[flagged]
- DangitBobby 3y ago
  Given the reach and power of the US government, you can trivially define most any problem as being due to a lack of or surplus of government involvement.
  - unnamed76ri 3y ago
    Given that the US gov is over $30 trillion in debt, it is hard to justify saying that there has been a lack of government. There’s been over $30 trillion too much government and they don’t appear to have any plans of slowing down.
    - NemoNobody 3y ago
      The Debt to GDP ratio hasn't changed much - it peaked at around 132% of GDP in 2021, due to the COVID spending and lower pandemic income. As of Dec 2022 it had dropped to 123% - 9% of the US GDP has been "repaid" in only a year. We are the richest country on earth - our budget is almost incomprehensible. The important thing to realize is that despite how high the debt number is, it's only ever been 132% of our GDP at its highest - roughly 16 months of the US economy. We could easily make it up by adding higher income tiers so ppl that earn $500k p/y are not taxed at the same percentage as ppl that earn $500 million. Trump's first day tax cuts for rich people added a lot to the debt - just look at how much they added to their bank accounts between 2019 and 2022 - trillions of dollars, literally. If there was no government there would only be the billionaires and their corporations - I need look no further than Google to understand how terrible a world that would be.
- pottertheotter 3y ago
  That’s an interesting take.
  - operatingthetan 3y ago
    It's a conservative cliche, except they actively work to subvert the federal government to ensure it becomes true.
    - unnamed76ri 3y ago
      You say my comment is a conservative cliche and then type out a progressive talking point. Most amusing.
      - operatingthetan 3y ago
        You are easily amused then.
- SomewhatLikely 3y ago
  Wherever a major problem existed in the past in the US, you can trace its solution back to the federal government almost every time. There's some truth in both statements, but neither is specific enough to be particularly useful.
  - whitemary 3y ago
    And you can trace the origins and overwhelming priorities of the Federal Government to bare brutal bourgeoise capitalism.
- deleted 3y ago
  [deleted]
DieBruderBauer 3y ago
discriminatory MCATs, brutal STEPS, insane Pre-Med curriculum, and more nonsense designed to cater to white elites who gamed the educational system and less to those who are genuinely trying to help the disenfranchised, unremembered, diverse and more. Hopefully one day, we'll make it as easy to become a doctor as it is to -- say -- become an Engineer.
- trustingtrust 3y ago
  I hope it’s not as easy to make a doctor as it is to make an engineer. I am an engineer dating a surgical resident who has to go through so much training that an engineer would never even come close to an engineer. The room for error is quite small. If it was as easy to make a doctor as an engineer I would lose faith in the medical system and would never want such a doctor opening me up.
  - carabiner 3y ago
    You're only referring to SWE, right? I've noticed that there are no bootcamps for becoming an aerospace engineer and getting a job at Boeing.
    - fma 3y ago
      And actual engineering disciplines you can't do jack squat unless someone w/ a PE license signs off on it and becomes legally liable. Meanwhile Tesla deploys OTA at will... Oh yeah - and why be a medical doctor, or a Professional Engineer when you can make more money with less debt without the legal liable...
  - wwweston 3y ago
    I agree we want medical personnel who are very well trained, certainly better than software engineers. I'm less clear about which aspects of the current medical education system produce effective training and which are more of a hazing run selecting for the privilege and determination to survive it.
  - brutusborn 3y ago
bruce511 3y ago
Planning and predicting highly variable systems is hard. Long-range interventions are especially risky given the possibilities for unexpected consequences and also the long lead times in fixing the problems. Central planning on resources has been especially rife with failed examples (the USSR being the all-in poster child.) As the article points out, the concept of central planning is orthogonal to who is providing the service. With heath care there are a range of national strategies (from fully private to fully public), and the impact of central planning (or lack thereof) can be seen across the board. So one should be careful of concluding that this is a party-political issue. It seems unrelated to left-right politics, and rather the result of central planning, predicting and modelling.
- whitemary 3y ago
  "Communist" Cuba has 64 physicians per 10K population, which is 2nd in the entire world for physicians per capita. https://en.m.wikipedia.org/wiki/List_of_countries_and_dependencies_by_number_of_physicians https://en.m.wikipedia.org/wiki/List_of_countries_and_depend... During the pandemic, they were sending droves of doctors to Europe. They offered to assist in NYC but Trump turned them away as our population dwindled. Famously, when a British cruise ship with ill passengers aboard was denied by ports in Florida, Cuba took them in and saved many lives.
  - alehlopeh 3y ago
    What’s with the scare quotes around communist? Sure they have a lot of doctors. And how many of those doctors are allowed to do business as a private practice? Or how many would be allowed to change careers if they wanted to? How many are allowed to spend their income at fancy places, where the currency they get paid in isn’t even accepted? Hate to break it to you, but “your” worldview is incredibly, laughably, misinformed.
    - the_mar 3y ago
      I’m not a fan of communism, but your worldview about it is also misinformed. People are allowed to change careers under communism: source I was born in USSR, my mother had many careers in the 70s and 80s. I’d give you the inability to work for a private practice, that is true, but I am not entirely convinced it’s all that beneficial to society. Lastly, Cuba can have some things better than the US, it doesn’t necessarily mean communism is a superior type of system. It just means that even a broken clock can show the right time
whitemary 3y ago
Socialism or Barbarism.
ftxbro 3y ago
they better change how it works, or we're going to be out here doing minor surgeries on ourselves with scalpel in one hand and watching youtube tutorial on our phone in the other, with gpt on speaker
- akiselev 3y ago
  Multimodal ChatGPT is already capable of generating diagrams for a DIY appendectomy (in the style of LEGO instructions!). Unfortunately, it completely hallucinates on the instructions on how to stitch oneself up afterwards, inevitably resulting in fatal internal bleeding. Thankfully it also forgot about anesthetic so I didn’t get that far.
  - deleted 3y ago
    [deleted]
paulddraper 3y ago
Doctor shortage, pilot shortage Frustrating to see these problems of purely human design.
- 93po 3y ago
  The doctor shortage is also specifically caused by doctors.
nemonemo 3y ago
I doubt US would be able to see a level of medical accessibility on par with many European countries. The medical education system has a perverse incentive to reduce the yearly graduates -- the less graduates there are, the more profits and prestiges each of the current members can garner (with arguably better trained graduates) -- and as shown in the article, they seem to have monopolistic capability for the throttling. And the incentive is only larger when people spend more disposable income for their healthcare, which has been the case. Maybe political powers may shift the direction a bit, but I do not see any evidence of a major course correction.
- lotsofpulp 3y ago
  There already has been. The solution was to pump out physician assistants (PAs) and nurse practitioners (NPs) that require a fraction of the training of a doctor to get licensed, and then have them practice medicine under the “supervision” of a doctor. Some states even went as far as giving people with no medical training the right to prescribe, such as naturopaths, whatever that means. So it is up to each person now to figure out how qualified the person giving them healthcare is. Also, doctors now have to contend with a handful of large payers. Their customers are mostly the federal/state government, or a handful of managed care organizations like UHC/Elevance/CVS/Cigna/Humana/etc. I would say doctors’ golden years of having a favorable negotiating position are behind them.
  - rcme 3y ago
    Hospitals have regional monopolies are are being consolidated by private equity companies. The doctors have way more leverage with the hospitals.
    - lotsofpulp 3y ago
      That is not what I have read. Doctors are having to join as employees of larger doctor groups, that are owned and operated by older doctors or private equity. Or they can join the local hospital system as a W-2 employee. Either way, they are up against big payers, so they have to also join big employer groups themselves. Or work in undesirable locations.
trashface 3y ago
The health care industry seems to be profiting off this by having more care provided by nurse practitioners and physician assistants but billing the insurers same as they would charge for M.D./D.Os.
- w10-1 3y ago
  Medicare and most insurance strictly control this. But the industry benefits from a constrained supply of doctors because it means less competition; laws ultimately require doctors to be in charge of a practice. Some laws are now even restricting the number of PA/NP's that can be supervised, but it's not a strong effect. Some states permit NP's to practice without a physician, but PA's all require a supervising physician.
  - in3d 3y ago
    Not all. Iowa: https://www.desmoinesregister.com/story/news/politics/2023/05/10/oversight-of-physician-assistants-in-iowa-loosened-under-new-law-reynolds/70201318007/ https://www.desmoinesregister.com/story/news/politics/2023/0... “With this move, Iowa joins five states that have removed the legally mandated relationship between physician assistants and doctors, according to the American Academy of Physician Associates.”
  - MauroIksem 3y ago
    PA's no longer require a supervising physician. Also why do people seem to think PAs and NPs are equivalent? PA's have 4x the clinical experience/ training that NPs have. 2000 hours vs 500 and MDs at 4000.
    - sarchertech 3y ago
      Depending on the specialty, 4000 hours is off by many multiples. And that’s on top of 2 extra years of classroom training.
    - poirot2 3y ago
      This implies PAs are at half the level of an MD but the difference is astronomical. Those 4000 MD hours are training to be a physician, the 2000 are training to be a PA which is a much simpler role. If PA school went to 8000h doing what they do currently to train wouldn’t get you near an MD (not to mention the talent of the intake, rigour of exams and depth/ breadth of knowledge required).
w10-1 3y ago
This article is based on reading (some) government reports, not on actual experience reports from medical schools, funding (which has increase), etc. Still, it's an important issue and set of data. It's not unreasonable given the training investment to err on the side of avoiding wasted education, and fill gaps with less-trained people. The physician/patient ratio is not a good measure of service availability. Some would say US doctors are more productive. The alternative is not more doctors, but more "advanced practice" providers - Nurse Practitioners and Physician Assistants (or Associates). Their numbers have increased dramatically, and they have taken over anything routine and many ancillary functions of complex cases. PA schools in particular have proliferated, and produced an over-supply of PA's, who depend entirely on having a supervising physician. NP's by contrast benefit from the long history of unionization in nursing, have taken over management in many cases, and restrict the supply at the school level. Overall they top out at what doctors start at, even with decades of experience. It's good for young professionals, but there's not a lot of headroom. As for dependence on foreign schools, the US has more foreign graduates in every field, and most have been hired into hospital systems as a way of combating medical practice groups. The independent medical practice groups almost completely died out, as hospital systems refused to contract out to practices, and instead hired doctors as employees so they could control costs. Recently with private equity targeting specific local monopolies, you're getting specialty practices in radiology, anesthesiology, cardiology (mostly stenting) and now even GI, where the same private equity firm coordinates everyone in a geographical area (and pursues a number of dark-billing practices). There may be small internal practice in the hospital for poor people to get middling care, but the good doctors go into the practice groups. Access to care comes down to logistics (terrible IT) and PCP's being used to reduce care. They hate it, which is why those who can avoid primary care. The other side of supply is loss. Doctors are leaving the profession at a high rate because they're not really doing medicine (and they can afford to leave). They need better systems and adjuncts and more sensitive administration.
the_d3f4ult 3y ago
Being a physician is a horrible career move right now. As a former Math/CS major turned eye surgeon, I can't help but think about how much easier my life would be had I stuck with tech. It's hard to understand exactly how hard the job is until you've lived it. I saw 40 patient's in clinic today in 8 hours without lunch or any kind of downtime and then spent 2 hours at the hospital because a patient needed an emergent procedure. They might go blind despite my efforts and I have to live with that. I also may get sued, if they're feeling spicy, despite going to heroic lengths to help this person. My son was asleep before I got home. There's just no reason to do the job when you can get the same compensation working remotely in tech. Looking through the "Who's Hiring" thread is soul-crushing. Physician salaries are the only ones that do not grow relative to inflation and have decreased year-on-year relative to inflation for decades. I do believe that the rigorous training model leads to a higher quality of care and much deeper understanding of the disease process. But, why would anyone want to do the job? It's just not worth the liability anymore. That said, is anyone hiring an ophthalmologist with CS and Math degrees?
- SamoyedFurFluff 3y ago
  > That said, is anyone hiring an ophthalmologist with CS and Math degrees? I’m surprised you can’t leverage this into a product role or a consulting role for startups in the medical space. You know shit about med systems!!
  - SongofEarth 3y ago
    It can be really hard to leverage this combination of skills, the demand for cross-discipline talents is usually much lower than for a single skill set, but also much deeper when the demand exists, it's going to take some serious searching to find a match but likely it's worth it. There was HN post about working with radiologists when building a AI diagnosis company: https://news.ycombinator.com/item?id=36111596 https://news.ycombinator.com/item?id=36111596 May be try talk to some similar AI companies is a good idea, at this time the pay can be really good.
  - throwaway173738 3y ago
    In the US medical device companies usually have a board of practitioners to give advice about the state of the art and the challenges with existing practice in the field. You can also start building your own device or system and plan to sell it, but you should find someone to consult on how to lobby the FDA and CMS as early as possible, because some devices get stuck in De Novo or PMA for years, and that’s a big risk to take. You’ll also need to have a long term plan for how the company will grow as you get closer to regulatory approval. A “product role” in these companies is very heavy on managing regulatory approval and making sure the company doesn’t get sued.
benignslime 3y ago
[dead]
pcrh 3y ago
A similar phenomenon occurred in the UK, where under fears of "medical unemployment", the British Medical Association argued against increasing medical school places [0]. The attitude persists even today, where the BMA advocates that medical school entries should be limited to the number of specialty training places that follow basic training, so as to avoid the risk of doctors becoming unemployed or under-employed. As a consequence the UK has a dearth of doctors, and those who are trained are over-worked. The government tries to alleviate the situation somewhat by recruiting from overseas. [0] https://www.bmj.com/content/348/bmj.g2398 https://www.bmj.com/content/348/bmj.g2398
- was_a_dev 3y ago
  While this is a problem. The single largest issue that isn't properly being disscussed (especially during the strikes) is retention. The NHS is a leaking bucket of highly skilled doctors and nurses. Anecdotally, my wife is a doctor at a large tertiary hospital. Asking all the completing Foundation junior doctors what their career plans are, 80% of them have obtained either an Australian or New Zealand Visa and were securing jobs abroad. No one skilled and smart enough wants to stay in the UK.
  - poirot2 3y ago
    Completely true. Killer stats on this: 1 in 7 U.K. trained doctors work abroad The number of GP training places are up 2000 and number of qualified GPs hasn’t changed due to poor retention. I could go on and on. U.K. medicine is a shitshow of poor pay and poor retention. Even the cheap imported doctors are only staying a short time due to the chaos of the system and better ops back home once NHS training is on your CV
    - pcrh 3y ago
      The main justifiable complaint by junior doctors is that of being over-worked. Unfortunately the OP and the link above suggest that this is a problem partly self-inflicted by the profession itself. There isn't a great risk of emigration by UK-trained doctors, as evidenced by an over-subscription for training places. Further, OECD data show that when adjusted to average national salaries, the pay scales for clinicians in the UK are competitive with the main destinations, including Australia, Canada and NZ [0]. A large part of the solution would appear to be increasing undergraduate medical education and further professional training slots. This would need increased government funding as well as agreement from professional bodies. [0] https-//www.oecd.org/health/recent-trends-in-international-migration-of-doctors-nurses
supahfly_remix 3y ago
> Physician salaries are the only ones that do not grow relative to inflation and have decreased year-on-year relative to inflation for decades. Medical insurance has been increasing faster than inflation for a while now. Are only insurance companies getting this extra money? Are at least some medical professionals getting a cut?
1letterunixname 3y ago
I'd take a giant stab in the dark suggesting there maybe a surplus of dermatologists but not enough oncologists, endocrinologists, or neurotolaryngological surgeons.
wrp 3y ago
What is a nutshell explanation of how healthcare got to the overall shortage state? (For the USA, but curious about other countries.) In the past 20 years, costs have shot up, doctors are seeing many more patients, and quality of care seems to have generally declined. Where have the resources gone? In the 1990s my GP had time to shoot the breeze for 20 minutes or more. Now I get a 5-minute diagnosis on the run, after scheduling months in advance.
- Dalewyn 3y ago
  Grossly insufficient pay for the work concerned. This applies to everywhere, US and otherwise. Unless you are a saint given existence upon this mortal plane instead of the high heavens, there are simply no objectively good reasons for ordinary men to pursue a career in medical.
  - wrp 3y ago
    I get how low wages could cause personnel shortages, but how does the tremendously rising cost of medical come out of this? I would expect the causation to be rising costs => stalled wages => personnel shortages.
  - wnolens 3y ago
    Nursing, I agree. But as a doc in the USA? It's THE highest status you can achieve on title alone, and comes with a paycheck in the top 1-5% guaranteed for almost 100% of entrants.
- lotsofpulp 3y ago
  >Where have the resources gone? In the 1990s my GP had time to shoot the breeze for 20 minutes or more. Now I get a 5-minute diagnosis on the run, after scheduling months in advance. See the population pyramid getting older and the general decline of healthiness / increase in proportion of people with health problems.
- deleted 3y ago
  [deleted]
- 3y ago
schoolornot 3y ago
Very easy solution, allow every 4-year state college to have MD programs. Flood the market.
- electriclove 3y ago
  Yup, increasing the supply is the obvious solution but one that the medical cartel has actively lobbied against.
  - newZWhoDis 3y ago
    I’m glad to see others calling it what it is, “medical cartel” is the most accurate description I’ve seen for our system
FrustratedMonky 3y ago
This is depressing. After recent medical scare that let me see the current level of medical treatment up close. I had though of leaving SWE to go into a medical field in order to help people. I'm in the US, and man, being in a hospital is really depressing, people are literally just dying for lack of help, being left behind. Or, maybe it's just more late stage capitalism, and I just happened to get a glimpse at how our society is choosing solve the problem of poor people, just put them down.
- shadowofneptune 3y ago
  If it's any help... It has been a lot of shit, a lot of brutality, but it is changing. It is difficult to sustain such an environment forever. Most of the mega-laws that got passed in the last few decades, if they ever were, have become unenforceable with how overloaded public services are in the... are we still calling them red states, cultural South, etc?. You have people in Indonesia, Argentina, US, etc. all talking to each other. Where there isn't formal education, informal education can actually take a decent place. The young across the world are more like each other than anyone would really admit. People who come to the US aren't really forced to learn the language to an unrealistic degree anymore, and that's good, really. The standards have been too high for a century. Things are so overloaded because turns out people do still need a law system, a health system. It shows a self-respect people didn't have 10 years ago. I could go on but, there is still hope.
RNCTX 3y ago
Perhaps designing a society around profit motives was a poor decision.
naveen99 3y ago
There is also planning of hospital bed shortages through certificates of need. https://en.wikipedia.org/wiki/Certificate_of_need https://en.wikipedia.org/wiki/Certificate_of_need anti kickback laws are also a double edged sword. https://en.wikipedia.org/wiki/Stark_Law https://en.wikipedia.org/wiki/Stark_Law But in the end, the usa has the healthcare system where doctors want to work and rich patients want to be treated given an option of any country.
- hedora 3y ago
  The rich people I know in the US do have an option of getting their healthcare from any other country, and that is what they often do.
  - NemoNobody 3y ago
    Yeah, rich people are "Global citizens" and utilize the entire work as we do the county we live in.
  - haldujai 3y ago
    They have it backwards, rich people come to the US for their treatment. It's not a coincidence that places like Mayo/Hopkins/MD Anderson all have buildings named after a gulf country sheikh. Top US institutions are definitely the best/most advanced in the world right now for cancer care and arguably overall, especially for weird and wonderful stuff. Affordability and accessibility is a different question.
linsomniac 3y ago
A physician shortage is not a good thing, but I'm closer to the nurses shortage; my wife is a nurse. Nurses get it from all sides: The healthcare administrators never put enough on duty, similarly they don't have enough CNAs helping them, and the patients and families can be pretty abusive. It's really a game of numbers: You should have 1 nurse for every X patients, and Y CNAs for every nurse. But the common story is that there are always games being played with increasing the number of patients and decreasing the number of CNAs, leaving nurses having to do more things for more patients. This directly, negatively impacts patient outcome.
- algkkb 3y ago
  I would've been a CNA out of high school instead of working retail if it would have paid me more than retail. Fact is, you're wiping ass for minimum wage and obviously not a lot of people are going to want do that. I'd say start with wages if I was addressing the issue.
truthseeker1 3y ago
I'm a physician as well (radiologist). I started practicing a few years ago, and I'm currently working part time and doing my masters in AI/data science. After a few years I hope to leave the field as well. It isn't because of lack of jobs (in fact, radiologist shortage is dire). It is because it is very stressful and demoralizing to be a physician in america, and the seemingly "high" pay does not make up for the downsides.
- arbuge 3y ago
  Can you explain how being a radiologist is stressful and demoralizing? Genuinely curious. I do know some radiologists and they certainly don't appear stressed to me. At least one of them works from home pretty much full time; not sure about the others.
  - truthseeker1 3y ago
    Medicine is a pretty high stakes career. You mess up and people can die. In radiology, we are expected to be near perfect (not miss important findings however subtle they might be) and make the right calls. This is difficult to do even with the training we have had. Part of it is just dealing with uncertainties. Did I make the right calls? Did I miss something subtle but important that might harm the patient - such as a subtle small nodule that 2 years later can become metastatic cancer? If so, am I going to get sued? You do that with every case, none which pay well at all. Medicare is the largest insurer in America and they pay around 4-5$ for a chest x ray or a wrist x ray or whatever joint x ray. A CT be it a cancer staging ct or trauma ct is valued at 40$. It can take a while to read if you really do your due diligence…meaning you compare to the past CTs to see how things have progressed, read history, take your time looking at the images. So it should take half an hour to read. Often times the prior imaging and clinical history isn’t even available. And if you work at big academic centers you are forced to read quickly. No physicians want to do a bad job but we are just cogs in wheels in the medical industry complex.
jl2718 3y ago
Imagine a world where computer use required a prescription from a limited number of licensed engineers. You have to pay to talk to them about your problem and they’ll set you up with an app to use for a week or two.
ChainOfFools 3y ago
Are you by chance asking this so you have some places to escape to when the looming eternal September event ( triggered by the change in reddit's API policies July 1st) suddenly drives a bunch of, well, reddit-level traffic from there to here?
sharts 3y ago
[flagged]

216 points by flummox 3y ago

nine_zeros 3y ago

Most problems in a rich country like America are entirely created due to backwards, uneducated policies.

unnamed76ri 3y ago

[flagged]

DangitBobby 3y ago
Given the reach and power of the US government, you can trivially define most any problem as being due to a lack of or surplus of government involvement.
- unnamed76ri 3y ago
  Given that the US gov is over $30 trillion in debt, it is hard to justify saying that there has been a lack of government. There’s been over $30 trillion too much government and they don’t appear to have any plans of slowing down.
  - NemoNobody 3y ago
    The Debt to GDP ratio hasn't changed much - it peaked at around 132% of GDP in 2021, due to the COVID spending and lower pandemic income. As of Dec 2022 it had dropped to 123% - 9% of the US GDP has been "repaid" in only a year. We are the richest country on earth - our budget is almost incomprehensible. The important thing to realize is that despite how high the debt number is, it's only ever been 132% of our GDP at its highest - roughly 16 months of the US economy. We could easily make it up by adding higher income tiers so ppl that earn $500k p/y are not taxed at the same percentage as ppl that earn $500 million. Trump's first day tax cuts for rich people added a lot to the debt - just look at how much they added to their bank accounts between 2019 and 2022 - trillions of dollars, literally. If there was no government there would only be the billionaires and their corporations - I need look no further than Google to understand how terrible a world that would be.
pottertheotter 3y ago
That’s an interesting take.
- operatingthetan 3y ago
  It's a conservative cliche, except they actively work to subvert the federal government to ensure it becomes true.
  - unnamed76ri 3y ago
    You say my comment is a conservative cliche and then type out a progressive talking point. Most amusing.
    - operatingthetan 3y ago
      You are easily amused then.
SomewhatLikely 3y ago
Wherever a major problem existed in the past in the US, you can trace its solution back to the federal government almost every time. There's some truth in both statements, but neither is specific enough to be particularly useful.
- whitemary 3y ago
  And you can trace the origins and overwhelming priorities of the Federal Government to bare brutal bourgeoise capitalism.
deleted 3y ago
[deleted]

DieBruderBauer 3y ago

discriminatory MCATs, brutal STEPS, insane Pre-Med curriculum, and more nonsense designed to cater to white elites who gamed the educational system and less to those who are genuinely trying to help the disenfranchised, unremembered, diverse and more. Hopefully one day, we'll make it as easy to become a doctor as it is to -- say -- become an Engineer.

trustingtrust 3y ago
I hope it’s not as easy to make a doctor as it is to make an engineer. I am an engineer dating a surgical resident who has to go through so much training that an engineer would never even come close to an engineer. The room for error is quite small. If it was as easy to make a doctor as an engineer I would lose faith in the medical system and would never want such a doctor opening me up.
- carabiner 3y ago
  You're only referring to SWE, right? I've noticed that there are no bootcamps for becoming an aerospace engineer and getting a job at Boeing.
  - fma 3y ago
    And actual engineering disciplines you can't do jack squat unless someone w/ a PE license signs off on it and becomes legally liable. Meanwhile Tesla deploys OTA at will... Oh yeah - and why be a medical doctor, or a Professional Engineer when you can make more money with less debt without the legal liable...
- wwweston 3y ago
  I agree we want medical personnel who are very well trained, certainly better than software engineers. I'm less clear about which aspects of the current medical education system produce effective training and which are more of a hazing run selecting for the privilege and determination to survive it.
- brutusborn 3y ago

bruce511 3y ago

Planning and predicting highly variable systems is hard. Long-range interventions are especially risky given the possibilities for unexpected consequences and also the long lead times in fixing the problems. Central planning on resources has been especially rife with failed examples (the USSR being the all-in poster child.) As the article points out, the concept of central planning is orthogonal to who is providing the service. With heath care there are a range of national strategies (from fully private to fully public), and the impact of central planning (or lack thereof) can be seen across the board. So one should be careful of concluding that this is a party-political issue. It seems unrelated to left-right politics, and rather the result of central planning, predicting and modelling.

whitemary 3y ago
"Communist" Cuba has 64 physicians per 10K population, which is 2nd in the entire world for physicians per capita. https://en.m.wikipedia.org/wiki/List_of_countries_and_dependencies_by_number_of_physicians https://en.m.wikipedia.org/wiki/List_of_countries_and_depend... During the pandemic, they were sending droves of doctors to Europe. They offered to assist in NYC but Trump turned them away as our population dwindled. Famously, when a British cruise ship with ill passengers aboard was denied by ports in Florida, Cuba took them in and saved many lives.
- alehlopeh 3y ago
  What’s with the scare quotes around communist? Sure they have a lot of doctors. And how many of those doctors are allowed to do business as a private practice? Or how many would be allowed to change careers if they wanted to? How many are allowed to spend their income at fancy places, where the currency they get paid in isn’t even accepted? Hate to break it to you, but “your” worldview is incredibly, laughably, misinformed.
  - the_mar 3y ago
    I’m not a fan of communism, but your worldview about it is also misinformed. People are allowed to change careers under communism: source I was born in USSR, my mother had many careers in the 70s and 80s. I’d give you the inability to work for a private practice, that is true, but I am not entirely convinced it’s all that beneficial to society. Lastly, Cuba can have some things better than the US, it doesn’t necessarily mean communism is a superior type of system. It just means that even a broken clock can show the right time

whitemary 3y ago

Socialism or Barbarism.

ftxbro 3y ago

they better change how it works, or we're going to be out here doing minor surgeries on ourselves with scalpel in one hand and watching youtube tutorial on our phone in the other, with gpt on speaker

akiselev 3y ago
Multimodal ChatGPT is already capable of generating diagrams for a DIY appendectomy (in the style of LEGO instructions!). Unfortunately, it completely hallucinates on the instructions on how to stitch oneself up afterwards, inevitably resulting in fatal internal bleeding. Thankfully it also forgot about anesthetic so I didn’t get that far.
- deleted 3y ago
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paulddraper 3y ago

Doctor shortage, pilot shortage Frustrating to see these problems of purely human design.

93po 3y ago
The doctor shortage is also specifically caused by doctors.

nemonemo 3y ago

I doubt US would be able to see a level of medical accessibility on par with many European countries. The medical education system has a perverse incentive to reduce the yearly graduates -- the less graduates there are, the more profits and prestiges each of the current members can garner (with arguably better trained graduates) -- and as shown in the article, they seem to have monopolistic capability for the throttling. And the incentive is only larger when people spend more disposable income for their healthcare, which has been the case. Maybe political powers may shift the direction a bit, but I do not see any evidence of a major course correction.

lotsofpulp 3y ago
There already has been. The solution was to pump out physician assistants (PAs) and nurse practitioners (NPs) that require a fraction of the training of a doctor to get licensed, and then have them practice medicine under the “supervision” of a doctor. Some states even went as far as giving people with no medical training the right to prescribe, such as naturopaths, whatever that means. So it is up to each person now to figure out how qualified the person giving them healthcare is. Also, doctors now have to contend with a handful of large payers. Their customers are mostly the federal/state government, or a handful of managed care organizations like UHC/Elevance/CVS/Cigna/Humana/etc. I would say doctors’ golden years of having a favorable negotiating position are behind them.
- rcme 3y ago
  Hospitals have regional monopolies are are being consolidated by private equity companies. The doctors have way more leverage with the hospitals.
  - lotsofpulp 3y ago
    That is not what I have read. Doctors are having to join as employees of larger doctor groups, that are owned and operated by older doctors or private equity. Or they can join the local hospital system as a W-2 employee. Either way, they are up against big payers, so they have to also join big employer groups themselves. Or work in undesirable locations.

trashface 3y ago

The health care industry seems to be profiting off this by having more care provided by nurse practitioners and physician assistants but billing the insurers same as they would charge for M.D./D.Os.

w10-1 3y ago
Medicare and most insurance strictly control this. But the industry benefits from a constrained supply of doctors because it means less competition; laws ultimately require doctors to be in charge of a practice. Some laws are now even restricting the number of PA/NP's that can be supervised, but it's not a strong effect. Some states permit NP's to practice without a physician, but PA's all require a supervising physician.
- in3d 3y ago
  Not all. Iowa: https://www.desmoinesregister.com/story/news/politics/2023/05/10/oversight-of-physician-assistants-in-iowa-loosened-under-new-law-reynolds/70201318007/ https://www.desmoinesregister.com/story/news/politics/2023/0... “With this move, Iowa joins five states that have removed the legally mandated relationship between physician assistants and doctors, according to the American Academy of Physician Associates.”
- MauroIksem 3y ago
  PA's no longer require a supervising physician. Also why do people seem to think PAs and NPs are equivalent? PA's have 4x the clinical experience/ training that NPs have. 2000 hours vs 500 and MDs at 4000.
  - sarchertech 3y ago
    Depending on the specialty, 4000 hours is off by many multiples. And that’s on top of 2 extra years of classroom training.
  - poirot2 3y ago
    This implies PAs are at half the level of an MD but the difference is astronomical. Those 4000 MD hours are training to be a physician, the 2000 are training to be a PA which is a much simpler role. If PA school went to 8000h doing what they do currently to train wouldn’t get you near an MD (not to mention the talent of the intake, rigour of exams and depth/ breadth of knowledge required).

w10-1 3y ago

This article is based on reading (some) government reports, not on actual experience reports from medical schools, funding (which has increase), etc. Still, it's an important issue and set of data. It's not unreasonable given the training investment to err on the side of avoiding wasted education, and fill gaps with less-trained people. The physician/patient ratio is not a good measure of service availability. Some would say US doctors are more productive. The alternative is not more doctors, but more "advanced practice" providers - Nurse Practitioners and Physician Assistants (or Associates). Their numbers have increased dramatically, and they have taken over anything routine and many ancillary functions of complex cases. PA schools in particular have proliferated, and produced an over-supply of PA's, who depend entirely on having a supervising physician. NP's by contrast benefit from the long history of unionization in nursing, have taken over management in many cases, and restrict the supply at the school level. Overall they top out at what doctors start at, even with decades of experience. It's good for young professionals, but there's not a lot of headroom. As for dependence on foreign schools, the US has more foreign graduates in every field, and most have been hired into hospital systems as a way of combating medical practice groups. The independent medical practice groups almost completely died out, as hospital systems refused to contract out to practices, and instead hired doctors as employees so they could control costs. Recently with private equity targeting specific local monopolies, you're getting specialty practices in radiology, anesthesiology, cardiology (mostly stenting) and now even GI, where the same private equity firm coordinates everyone in a geographical area (and pursues a number of dark-billing practices). There may be small internal practice in the hospital for poor people to get middling care, but the good doctors go into the practice groups. Access to care comes down to logistics (terrible IT) and PCP's being used to reduce care. They hate it, which is why those who can avoid primary care. The other side of supply is loss. Doctors are leaving the profession at a high rate because they're not really doing medicine (and they can afford to leave). They need better systems and adjuncts and more sensitive administration.

the_d3f4ult 3y ago

Being a physician is a horrible career move right now. As a former Math/CS major turned eye surgeon, I can't help but think about how much easier my life would be had I stuck with tech. It's hard to understand exactly how hard the job is until you've lived it. I saw 40 patient's in clinic today in 8 hours without lunch or any kind of downtime and then spent 2 hours at the hospital because a patient needed an emergent procedure. They might go blind despite my efforts and I have to live with that. I also may get sued, if they're feeling spicy, despite going to heroic lengths to help this person. My son was asleep before I got home. There's just no reason to do the job when you can get the same compensation working remotely in tech. Looking through the "Who's Hiring" thread is soul-crushing. Physician salaries are the only ones that do not grow relative to inflation and have decreased year-on-year relative to inflation for decades. I do believe that the rigorous training model leads to a higher quality of care and much deeper understanding of the disease process. But, why would anyone want to do the job? It's just not worth the liability anymore. That said, is anyone hiring an ophthalmologist with CS and Math degrees?

SamoyedFurFluff 3y ago
> That said, is anyone hiring an ophthalmologist with CS and Math degrees? I’m surprised you can’t leverage this into a product role or a consulting role for startups in the medical space. You know shit about med systems!!
- SongofEarth 3y ago
  It can be really hard to leverage this combination of skills, the demand for cross-discipline talents is usually much lower than for a single skill set, but also much deeper when the demand exists, it's going to take some serious searching to find a match but likely it's worth it. There was HN post about working with radiologists when building a AI diagnosis company: https://news.ycombinator.com/item?id=36111596 https://news.ycombinator.com/item?id=36111596 May be try talk to some similar AI companies is a good idea, at this time the pay can be really good.
- throwaway173738 3y ago
  In the US medical device companies usually have a board of practitioners to give advice about the state of the art and the challenges with existing practice in the field. You can also start building your own device or system and plan to sell it, but you should find someone to consult on how to lobby the FDA and CMS as early as possible, because some devices get stuck in De Novo or PMA for years, and that’s a big risk to take. You’ll also need to have a long term plan for how the company will grow as you get closer to regulatory approval. A “product role” in these companies is very heavy on managing regulatory approval and making sure the company doesn’t get sued.

benignslime 3y ago

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pcrh 3y ago

A similar phenomenon occurred in the UK, where under fears of "medical unemployment", the British Medical Association argued against increasing medical school places [0]. The attitude persists even today, where the BMA advocates that medical school entries should be limited to the number of specialty training places that follow basic training, so as to avoid the risk of doctors becoming unemployed or under-employed. As a consequence the UK has a dearth of doctors, and those who are trained are over-worked. The government tries to alleviate the situation somewhat by recruiting from overseas. [0] https://www.bmj.com/content/348/bmj.g2398 https://www.bmj.com/content/348/bmj.g2398

was_a_dev 3y ago
While this is a problem. The single largest issue that isn't properly being disscussed (especially during the strikes) is retention. The NHS is a leaking bucket of highly skilled doctors and nurses. Anecdotally, my wife is a doctor at a large tertiary hospital. Asking all the completing Foundation junior doctors what their career plans are, 80% of them have obtained either an Australian or New Zealand Visa and were securing jobs abroad. No one skilled and smart enough wants to stay in the UK.
- poirot2 3y ago
  Completely true. Killer stats on this: 1 in 7 U.K. trained doctors work abroad The number of GP training places are up 2000 and number of qualified GPs hasn’t changed due to poor retention. I could go on and on. U.K. medicine is a shitshow of poor pay and poor retention. Even the cheap imported doctors are only staying a short time due to the chaos of the system and better ops back home once NHS training is on your CV
  - pcrh 3y ago
    The main justifiable complaint by junior doctors is that of being over-worked. Unfortunately the OP and the link above suggest that this is a problem partly self-inflicted by the profession itself. There isn't a great risk of emigration by UK-trained doctors, as evidenced by an over-subscription for training places. Further, OECD data show that when adjusted to average national salaries, the pay scales for clinicians in the UK are competitive with the main destinations, including Australia, Canada and NZ [0]. A large part of the solution would appear to be increasing undergraduate medical education and further professional training slots. This would need increased government funding as well as agreement from professional bodies. [0] https-//www.oecd.org/health/recent-trends-in-international-migration-of-doctors-nurses

supahfly_remix 3y ago

> Physician salaries are the only ones that do not grow relative to inflation and have decreased year-on-year relative to inflation for decades. Medical insurance has been increasing faster than inflation for a while now. Are only insurance companies getting this extra money? Are at least some medical professionals getting a cut?

1letterunixname 3y ago

I'd take a giant stab in the dark suggesting there maybe a surplus of dermatologists but not enough oncologists, endocrinologists, or neurotolaryngological surgeons.

wrp 3y ago

What is a nutshell explanation of how healthcare got to the overall shortage state? (For the USA, but curious about other countries.) In the past 20 years, costs have shot up, doctors are seeing many more patients, and quality of care seems to have generally declined. Where have the resources gone? In the 1990s my GP had time to shoot the breeze for 20 minutes or more. Now I get a 5-minute diagnosis on the run, after scheduling months in advance.

Dalewyn 3y ago
Grossly insufficient pay for the work concerned. This applies to everywhere, US and otherwise. Unless you are a saint given existence upon this mortal plane instead of the high heavens, there are simply no objectively good reasons for ordinary men to pursue a career in medical.
- wrp 3y ago
  I get how low wages could cause personnel shortages, but how does the tremendously rising cost of medical come out of this? I would expect the causation to be rising costs => stalled wages => personnel shortages.
- wnolens 3y ago
  Nursing, I agree. But as a doc in the USA? It's THE highest status you can achieve on title alone, and comes with a paycheck in the top 1-5% guaranteed for almost 100% of entrants.
lotsofpulp 3y ago
>Where have the resources gone? In the 1990s my GP had time to shoot the breeze for 20 minutes or more. Now I get a 5-minute diagnosis on the run, after scheduling months in advance. See the population pyramid getting older and the general decline of healthiness / increase in proportion of people with health problems.
deleted 3y ago
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3y ago

schoolornot 3y ago

Very easy solution, allow every 4-year state college to have MD programs. Flood the market.

electriclove 3y ago
Yup, increasing the supply is the obvious solution but one that the medical cartel has actively lobbied against.
- newZWhoDis 3y ago
  I’m glad to see others calling it what it is, “medical cartel” is the most accurate description I’ve seen for our system

FrustratedMonky 3y ago

This is depressing. After recent medical scare that let me see the current level of medical treatment up close. I had though of leaving SWE to go into a medical field in order to help people. I'm in the US, and man, being in a hospital is really depressing, people are literally just dying for lack of help, being left behind. Or, maybe it's just more late stage capitalism, and I just happened to get a glimpse at how our society is choosing solve the problem of poor people, just put them down.

shadowofneptune 3y ago
If it's any help... It has been a lot of shit, a lot of brutality, but it is changing. It is difficult to sustain such an environment forever. Most of the mega-laws that got passed in the last few decades, if they ever were, have become unenforceable with how overloaded public services are in the... are we still calling them red states, cultural South, etc?. You have people in Indonesia, Argentina, US, etc. all talking to each other. Where there isn't formal education, informal education can actually take a decent place. The young across the world are more like each other than anyone would really admit. People who come to the US aren't really forced to learn the language to an unrealistic degree anymore, and that's good, really. The standards have been too high for a century. Things are so overloaded because turns out people do still need a law system, a health system. It shows a self-respect people didn't have 10 years ago. I could go on but, there is still hope.

RNCTX 3y ago

Perhaps designing a society around profit motives was a poor decision.

naveen99 3y ago

There is also planning of hospital bed shortages through certificates of need. https://en.wikipedia.org/wiki/Certificate_of_need https://en.wikipedia.org/wiki/Certificate_of_need anti kickback laws are also a double edged sword. https://en.wikipedia.org/wiki/Stark_Law https://en.wikipedia.org/wiki/Stark_Law But in the end, the usa has the healthcare system where doctors want to work and rich patients want to be treated given an option of any country.

hedora 3y ago
The rich people I know in the US do have an option of getting their healthcare from any other country, and that is what they often do.
- NemoNobody 3y ago
  Yeah, rich people are "Global citizens" and utilize the entire work as we do the county we live in.
- haldujai 3y ago
  They have it backwards, rich people come to the US for their treatment. It's not a coincidence that places like Mayo/Hopkins/MD Anderson all have buildings named after a gulf country sheikh. Top US institutions are definitely the best/most advanced in the world right now for cancer care and arguably overall, especially for weird and wonderful stuff. Affordability and accessibility is a different question.

linsomniac 3y ago

A physician shortage is not a good thing, but I'm closer to the nurses shortage; my wife is a nurse. Nurses get it from all sides: The healthcare administrators never put enough on duty, similarly they don't have enough CNAs helping them, and the patients and families can be pretty abusive. It's really a game of numbers: You should have 1 nurse for every X patients, and Y CNAs for every nurse. But the common story is that there are always games being played with increasing the number of patients and decreasing the number of CNAs, leaving nurses having to do more things for more patients. This directly, negatively impacts patient outcome.

algkkb 3y ago
I would've been a CNA out of high school instead of working retail if it would have paid me more than retail. Fact is, you're wiping ass for minimum wage and obviously not a lot of people are going to want do that. I'd say start with wages if I was addressing the issue.

truthseeker1 3y ago

I'm a physician as well (radiologist). I started practicing a few years ago, and I'm currently working part time and doing my masters in AI/data science. After a few years I hope to leave the field as well. It isn't because of lack of jobs (in fact, radiologist shortage is dire). It is because it is very stressful and demoralizing to be a physician in america, and the seemingly "high" pay does not make up for the downsides.

arbuge 3y ago
Can you explain how being a radiologist is stressful and demoralizing? Genuinely curious. I do know some radiologists and they certainly don't appear stressed to me. At least one of them works from home pretty much full time; not sure about the others.
- truthseeker1 3y ago
  Medicine is a pretty high stakes career. You mess up and people can die. In radiology, we are expected to be near perfect (not miss important findings however subtle they might be) and make the right calls. This is difficult to do even with the training we have had. Part of it is just dealing with uncertainties. Did I make the right calls? Did I miss something subtle but important that might harm the patient - such as a subtle small nodule that 2 years later can become metastatic cancer? If so, am I going to get sued? You do that with every case, none which pay well at all. Medicare is the largest insurer in America and they pay around 4-5$ for a chest x ray or a wrist x ray or whatever joint x ray. A CT be it a cancer staging ct or trauma ct is valued at 40$. It can take a while to read if you really do your due diligence…meaning you compare to the past CTs to see how things have progressed, read history, take your time looking at the images. So it should take half an hour to read. Often times the prior imaging and clinical history isn’t even available. And if you work at big academic centers you are forced to read quickly. No physicians want to do a bad job but we are just cogs in wheels in the medical industry complex.

jl2718 3y ago

Imagine a world where computer use required a prescription from a limited number of licensed engineers. You have to pay to talk to them about your problem and they’ll set you up with an app to use for a week or two.

ChainOfFools 3y ago

Are you by chance asking this so you have some places to escape to when the looming eternal September event ( triggered by the change in reddit's API policies July 1st) suddenly drives a bunch of, well, reddit-level traffic from there to here?

sharts 3y ago

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