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but.. why?
by Solvency 2y ago
but.. why?
- ketzo 2y agoIt’s extremely beneficial to the people who are already doctors (dramatically increases salary, prestige, power), and that is a powerful group in most societies.
- sslayer 2y agoAlso, being a coveted occupation ensures that there will always be a pool of people fighting for it. Scarcity drives demand.
- alfiedotwtf 2y agoNot always. If I sell garden gnomes wearing knitted hats, but I only make three a year and sell to only people who drive yellow cars, I doubt I could earn a decent living off this
- bravura 2y agoDon’t be obtuse. You’re comparing garden gnomes with healthcare.
- alfiedotwtf 2y agoI mentioned garden gnomes as an example of how supply side economics and “scarcity drives demand” doesn’t work.
- bravura 2y agoThe post you replied to scoped their statement to „coveted“ applications. No one actually believes scarcity drives demand in all cases.
- seadan83 2y agoThe grammar of the sentence, as written, would really indicate otherwise. Written in the post: "Scarcity drives demand." (exact quote) The sub-text is that doctors are slightly corrupt and wish to be payed more, and therefore are incetivized to reduce the total number of doctors. After reading the travails of what this doctor is going through, that seems like a very callous take, insulting even.
- gopher_space 2y agoIt’d be callous and insulting if it was a reasoned position.
- seadan83 2y agoIDK if needs to be reasoned or not. I'm imagining someone making these comments to the author's face after having been read the article. The 'callous' part comes from disregarding everything in the article to go on some great tangent about the AMA and artificial scarcity of doctors. What's more, it seems that this article has triggered a reflexive anti-union stance, when it's more a hallmark of a place where capitalism does not work well. Why doesn't that hospital have more doctors? Surely, they could have found someone additional if they wanted. The hospital did not have to schedule every surgery as if they all required the average procedure time. The hospital could invest in better IT infrastructure and have software that was not a drag to use. Surely the hospital could have someone help the doctor not make 70+ calls over the course of a shift in addition to everything else they do. This blog post is not about a general scarcity of doctors; there's lots that could be done by the hospital investing in its staff and outcomes without hiring a single additional doctor.
- lazide 2y agoBeing a business means they have to optimize for profit (to at least some non trivial degree), or die. Many hospitals are run by non profit organizations to help reduce this problem. However even they cannot run at a loss overall for long. Bankruptcy doesn’t help anyone actually provide services, after all. Gov’t has different incentives - but then care is strongly controlled and limited by public policy, for better or worse. And an organization that is able to optimize to produce more value than they consume (aka is more profitable) can take more risks, expand better, have more capital to invest in training, equipment, etc, be more competitive in who they hire, and have better and more comfortable facilities if they want. And being a Dr. can be really miserable sometimes, and the training is also really hard and miserable. Some (surgeons, esp. plastic surgery) optimize for maximum $$ for misery, usually. Others (pediatrics) optimize for maximum ‘feel goods’ for misery, usually. Most others are somewhere in between. Either way, if they didn’t want/need the money, they’d be going to medicine sans frontiers or working in rural medicine eh?
- mkoubaa 2y agoDon't be a pain. All analogies are wrong, but they can still be illustrative
- FabHK 2y agoSo beneficial that they commit suicide?
- seszett 2y agoThe people who organise scarcity find it beneficial to themselves, but obviously it doesn't mean all doctors, or even most them, like this situation.
- chmod600 2y agoBut the article is about burnout. Surely that can't be great for existing doctors, either?
- rqtwteye 2y agoThey choose more money over avoiding burnout.
- throwaway2037 2y agoYou took the words right out of my mouth! Money is the elephant in the room here. Why doesn't the author quit surgery and start a small GP clinic? Oh, only half the pay? I see similar behaviour in law firms and investment banking.
- malfist 2y agoSo the answer to being overworked in a hospital is to quit, be overwhelming running your own business for half the pay? That doesn't make any sense. And not everyone has the capital or capacity to make their own business
- pc86 2y agoLet's not pretend we're talking about the difference between $30k and $60k/yr here. We're talking about $400k vs. $800k. "I'll only make half a million dollars a year if I do this" does not set oneself up to be a sympathetic character.
- patricius 2y agoI think it comes down to, if you read the history of the American Medical Association, that some doctors simply didn’t like a free market pushing down prices for their services.
- sambazi 2y agothen again, who does
- Zambyte 2y agoIn this case, people who rely on health services to live probably do.
- pc86 2y agoThe point was nobody likes their own salaries being depressed due to the free market. One difference is that doctors even under very free market conditions enjoy high salaries so it's comparatively pretty easy for them to set aside some money to lobby to tighten up that market - which gives them more money, which makes it even easier to ...
- TeMPOraL 2y agoYeah, but why is the same situation present, and the same explanation given, in Poland, EU? Or, seeing from other comments, plenty other countries around the world? I'm seconding 'viraptor here - this isn't a good enough explanation. It doesn't stand up to scrutiny, and doesn't mesh well with day-to-day experience. Individual doctors I know seem to have very little influence over anything, and they're first in line to the protests about working conditions and pay.
- thaumasiotes 2y agoThere are a few factors: 1. Doctors have a lot of political influence because they are popular. This means they can get away with things that other industries mostly can't. 2. State provision of medical care corrupts the system, as I describe sidethread: https://news.ycombinator.com/item?id=40030452 https://news.ycombinator.com/item?id=40030452 One way to drive "medical costs" down is to ensure that the supply of medical care is low. This also drives prices up. This means that the incentives of the regulatory body are directly contrary to the incentives of the people supposedly benefiting from the regulation. (And doctors and hospitals are happy with this, because such a system boils down to telling them "we want you to do less work, but for more money".) 3. (Tangentially, note that the general model of "restrict supply, subsidize demand" is incredibly common. It's popular both ways; the first part helps a small but politically active and highly motivated group, and the second part pretends to help the populace in general.)
- viraptor 2y agoI'm not sure that's a good enough explanation. There's minimal if any impact from a given doctor on country wide policies, especially the ones funded by state. Junior doctors in the UK couldn't push basic improvements to both their working conditions and pay. That doesn't seem to match the idea that they can meaningfully influence the doctors intake numbers.
- jjackson5324 2y agoI don’t know about other countries but that’s absolutely the case for the US. The culprit is the AMA. > In the 20th century, the AMA has frequently lobbied to restrict the supply of physicians, contributing to a doctor shortage in the United States.[10][11][12] The organization has also lobbied against allowing physician assistants and other health care providers to perform basic forms of health care. The organization has historically lobbied against various of government-run health insurance. https://en.wikipedia.org/wiki/American_Medical_Association https://en.wikipedia.org/wiki/American_Medical_Association
- thaumasiotes 2y agoObviously, they are a big problem, but they're not the only problem. It is received wisdom among doctors that increasing the number of doctors causes medical costs to go up, and it is generally also the position of the state. The doctors are simply wrong; the state is correct from a pernicious point of view. Because the state is responsible for buying so much of the total supply of medical care, they generally view things from the perspective of "how much are we spending on the category 'medical care'?", rather than the perspective of how much any given treatment costs. Increasing the number of doctors lowers the cost of all treatments and is unambiguously good. However, it does raise the total amount of medical spending, which, in the eyes of the state, is bad.
- jjackson5324 2y agoSo you’re saying that increasing the number of doctors will result in more medical services being consumed which means higher costs for the gov? That’s the view of the government?
- anovikov 2y agoIn the U.S., sure. But in the UK status of a doctor is akin to that of a schoolteacher. Totally not a highly sought-after, profitable career like it is in the U.S.
- adaml_623 2y agoDoctors are paid a lot more than schoolteachers in the UK and in my experience are respected because of their profession. I think you're totally incorrect.
- MaxBarraclough 2y agoSeconded. My perception is that here in Britain, medical doctors are highly respected, and pretty well paid. This is different from the US, where medical doctors are highly respected and extremely well paid. Prestige is, of course, not a function of income alone. Plenty of software developers get paid at least as much as respected professors or top military brass. That doesn't mean they have equivalent prestige.
- dan-robertson 2y agoThis makes sense in the IS, and the AMA does indeed try to limit the number of graduating medical students. But in the UK most doctors will work for the state where they are all on the same pay scale (I think) so a lack of supply shouldn’t be expected to push up the price of labour much. One reason you could imagine is that the health trusts determine roughly how many student doctors they are able to train and then the government limits graduation rates based on this. But I don’t know if that’s the actual reason, and it could be a half-reason, eg the number was set a long time ago and not updated.
- pipes 2y agoAnd training doctors is very expensive. This is subsidised by the state through capped tuition fees. Plus to train a doctor you need enough doctors for junior doctors to train the junior doctors presumably.
- philwelch 2y agoIn the UK, the NHS primarily exists as a mechanism for rationing medical care. If you compare how much every industrialized country spends on medical care, there’s a very strong correlation with GDP—the richer a country is, the more money they spend on medical care, and the higher proportion of GDP goes to medical care. The UK is uniquely below this trendline, indicating a de facto policy of artificial rationing.
- emodendroket 2y agoWell, compare the trajectory of doctors to factory workers as career paths.
- darkclouds 2y ago[dead]