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My dad is a GP and ran a practice that at its height in the mid 00s had around 5000 patients, 4 doctors, a slew of nurses and probably 15 office staff. He worke

My dad is a GP and ran a practice that at its height in the mid 00s had around 5000 patients, 4 doctors, a slew of nurses and probably 15 office staff. He worked about 50-60 house a week and was ultra stressed out. Then in the early 10s he switched to this concierge model. Now he has 1 office staff/med assistant, 300 patients, and makes literally 4x what he made with the previous model. Insurance companies, along with declining pay and the gobbling up of private practice by giant medical corporations who treat doctors like low level employees are driving GPs away, and into specializations. If the government wants to stem this shit tide they need to tell insurance companies to get fucked, limit the intrusion of corporate bean counters, and give incentives like the cancellation of school debt to folks who go into GP. No number of highly paid specialists will ever replace GPs

Buttons840 3y ago
The medical industry employs about 15 to 20 percent of all active US workers [0]. Some people read that and think it's a good thing, "wow, such job creators", like measuring software accomplishment by the number of lines. No wonder my medical costs are so high. Every high premium and medical bill is my turn to personally support 20% of the nation. I wonder how much is left over for the doctor? This will be difficult to solve because "make the system simpler and fire lots of people" is painful and not politically popular. [0] https://www.census.gov/library/stories/2020/10/health-care-still-largest-united-states-employer.html https://www.census.gov/library/stories/2020/10/health-care-s...
- pnathan 3y ago
  I've had a lot of family time in the hospital systems in a relatively well-managed part of the US. And, I worked in the 'back office' of a medical system a while ago. Talking to billing people, etc, I came to the conclusion that "reform" with existing vested interests is... not going to happen. I don't know what a _good_ solution is, but I can imagine the least painful way is to have a parallel universe of MDs with a wholly different billing, licensing, board-certification regime. One interesting question is: why is one hospital's rate for procedure X different than another? how can providers work at different hospitals? The answer lies somewhere in the "it's a maze of subcontractor relationships", "it's a maze of one off insurance contracts"... It's a very good example of why vertical integration beats subcontracting. :)
pauldenton 3y ago
How about ending the AMA Cartel from limiting the supply of doctors, easing the requirements for foreign doctors to practice medicine in America, and far expanding the list of services that can be performed by a Nurse or trained technician?

Buttons840 3y ago

The medical industry employs about 15 to 20 percent of all active US workers [0]. Some people read that and think it's a good thing, "wow, such job creators", like measuring software accomplishment by the number of lines. No wonder my medical costs are so high. Every high premium and medical bill is my turn to personally support 20% of the nation. I wonder how much is left over for the doctor? This will be difficult to solve because "make the system simpler and fire lots of people" is painful and not politically popular. [0] https://www.census.gov/library/stories/2020/10/health-care-still-largest-united-states-employer.html https://www.census.gov/library/stories/2020/10/health-care-s...

pnathan 3y ago
I've had a lot of family time in the hospital systems in a relatively well-managed part of the US. And, I worked in the 'back office' of a medical system a while ago. Talking to billing people, etc, I came to the conclusion that "reform" with existing vested interests is... not going to happen. I don't know what a _good_ solution is, but I can imagine the least painful way is to have a parallel universe of MDs with a wholly different billing, licensing, board-certification regime. One interesting question is: why is one hospital's rate for procedure X different than another? how can providers work at different hospitals? The answer lies somewhere in the "it's a maze of subcontractor relationships", "it's a maze of one off insurance contracts"... It's a very good example of why vertical integration beats subcontracting. :)

pauldenton 3y ago

How about ending the AMA Cartel from limiting the supply of doctors, easing the requirements for foreign doctors to practice medicine in America, and far expanding the list of services that can be performed by a Nurse or trained technician?