4 ms·

There aren’t enough doctors or specialists. So what to do? The answer for most shouldn’t be “alternative medicine” where any whacko “treatment” is an appropriat

There aren’t enough doctors or specialists. So what to do? The answer for most shouldn’t be “alternative medicine” where any whacko “treatment” is an appropriate stand in.

teeray 2y ago
But the answer is also not “the traditional system is perfect, just under-provisioned.” The additional doctors aren’t coming. They’re too expensive to train and they don’t want to be primary care doctors when they can finally practice. We need self-service means to augment the few doctors we have so that the system can continue to function.
- lotsofpulp 2y ago
  The primary care doctor role is in the process of being supplanted by nurse practitioners and physician assistants.
  - bobmcnamara 2y ago
    Ah yes, the perpetual margin chasing enshitification of healthcare.
    - ghaff 2y ago
      And while we're at it, companies should probably only hire PhDs from elite schools as developers because you never know when that sort of (supposed) expertise might be needed.
      - bobmcnamara 2y ago
        Hiring doctors is exactly what the local hospital needs, and can no longer do after being bought out by a megacorp. NP: "if it gets worse go to the ER" Thanks...I guess.
  - ghaff 2y ago
    I got an appointment at a pharmacy "instant clinic" when I was traveling because I had a persistent cough I couldn't see to throw. COVID test was negative but that doesn't necessarily mean much these days. Got an appointment in less than a day. The nurse practitioner probably gave me a more thorough look over (absent labs) than my primary care would have. Gave me an inhaler prescription probably as much to do something other than tell me to just continue the OTC medication I was already taking. Sure, in an ideal world, we'd probably have a next-day MD appointment for everyone. But there's a ton of stuff when an ER or physician isn't really called for.
    - 9991 2y ago
      Not sure what your point is. It sounds like the instant clinic was functionally no different than doing nothing at all.
      - ghaff 2y ago
        You don't see any benefit to having a trained/licensed professional taking vitals and making a diagnosis--even if that diagnosis is basically "you'll get better"? And the inhaler was actually helpful. And if the other option was to spend the day in a NYC ER I'd probably have passed. I'm not a hypochondriac and maybe in a pre-COVID world I'd just have assumed I was "fine" but having a second opinion seemed warranted given the option. I've also been in an ER when the diagnosis from an infectious disease specialist (after some really bad lab work and high fever) was basically go home, rest, and drink plenty of fluids when his assessment (of a fairly serious tropical disease) took a month to be confirmed from a lab in Paris. So we just basically self-diagnose and assume it will all just get better?
        quantumwoke 2y ago
        A wrong diagnosis may be more harmful than you realize - if they are wrong (and they often are) it can lead to death/permanent disability.
        2y ago
verticalscaler 2y ago
There's no shortage of whacko treatments in mainstream medicine nowadays. Very unfortunate and dangerous. One thing you plausibly could do is attempt medical tourism, if nothing else, your perspective will improve.
hoseja 2y ago
The shortage of doctors is an artificial guild monopoly.
Almondsetat 2y ago
This is why I don't understand the AI hate. We literally don't have enough people becoming doctors, AI-assisted Healthcare would be stealing jobs from basically nobody
- black_puppydog 2y ago
  It would detract from any real answer, like making medical/care work more attractive. This might be a very European perspective from me but the people I know who work anywhere close to medicine are doing so despite the pay and working conditions. At the exception of the top of the pyramid, typically occupied by old white men with a horrifically antiquated world view and inflated egos.
  - mnau 2y ago
    Why isn't it a "real answer". Any time our civilization had a shortage of something, we increased efficiency by offloading work to machines. Blood count tests used to be done by people actually counting cells. Now, it's all machines, likely even in a very poor countries.
  - inglor_cz 2y ago
    "white men" Please don't add racial and gender resentments into an already bad problem. Neither the US nor Europe has enough medical professionals to drag arbitrary racial and gender demands into the mix. And without old doctors in general being willing to work even though they could enjoy their retirement, many places in Europe would have no healthcare left. Which doesn't bode well for 2040 or 2050.
- pjc50 2y ago
  What is the process for making AI acceptably reliable for medical use? Is it just drastically reducing the standard of "reliable"? Who is liable for AI medical errors?
  - lukan 2y ago
    When you can choose between a well rested and competent doctor, everyone would choose that. But when you have to choose between a overworked and exhausted doctor, who gives you 10 seconds of slight attention, then I might choose the AI, mixed with my own judgement. Anyway, why not more of both? Better AI tools and more doctors?
michelb 2y ago
Why aren't there enough doctors or specialists? Especially in America it seems like a very profitable profession. Is it artificially limited?
- mindslight 2y ago
  Complete destruction of price signals due to the symbiotic relationship between "providers" and "insurance" cooperating to defraud patients. This is backed up by whatever corrupt laws allow "providers" to send arbitrary post-facto bills and even presumably enforce such nonsense "debts", rather than getting prosecuted for said fraud. Unfortunately most people taking notice of how broken the system is end up get fixated on the large figures on those fraudulent bills, and think single payer can do something to fix at least part of the system. But systematically, at best single payer would be tying the garbage bag off for tidy disposal, when what we actually need is for the sheer majority of medical care to have a functioning market that allows for patient agency.
- baggy_trough 2y ago
  Yes, by the guild of doctors.
- y-c-o-m-b 2y ago
  Becoming a medical professional is very expensive; tuition often going into the six-figures. Becoming a physician takes a good decade or more of your life. The entry process is very competitive and limited, with majority of applicants being rejected. IIRC the acceptance rates are below 50%. Once a person clears those hurdles however, they are now faced with a torrential abuse of corruption, racism, fraud, elitism, favoritism, etc. that they must overcome. Much of the medical field is like this unfortunately, it's not just doctors. Take for example this article about Duke's Nursing School and racism: https://archive.is/DIJ98 https://archive.is/DIJ98. From what I've heard through third-party, corruption at Duke is at an all-time high. This is just the stuff we hear about too, so I'm sure these problems affect all of the top-tier colleges that nobody reports so they don't get ejected from these programs.
- joelfried 2y ago
  4 years college taking some of the toughest courses there are to be ready for 4 years of medical school. After that 8 years of schooling then you have to go through the hazing ritual they call "residency". Residency varies depending on your specialty, from 3 to 7 more years[1] - during which time you're working 60-80 hour weeks [2]. So baseline if you're smart and hard working, you need to take the hardest college track from ages 18-22, medical school (22-26). Then work two jobs worth of hours as a trainee making well under 100k starting at age 27 and into your early 30s [3] so you can't save or pay down any of your debt from getting here. So if you choose to be a doctor, you have to: (a) dedicate to working your ass off at 18, (b) keep at it until you're in your early 30s, (c) start with massive debt I think it's actually pretty amazing that we have as many doctors as we do. [1] https://medschoolinsiders.com/medical-student/how-long-is-residency-by-specialty/ https://medschoolinsiders.com/medical-student/how-long-is-re... [2] https://www.ama-assn.org/medical-students/preparing-residency/what-residency https://www.ama-assn.org/medical-students/preparing-residenc... [3] https://www.inspiraadvantage.com/blog/how-much-do-medical-residents-get-paid https://www.inspiraadvantage.com/blog/how-much-do-medical-re...
anon291 2y ago
Having a test done is not a treatment. It is vital information about your own body. Better yet, if you have an issue and no doctor is listening to you and are willing to pay for the test, then your usage of the system simply means you're not doctor shopping. If you turn out to be right, then you can take the result and go to a doctor and get treatment. Otherwise, you can be satisfied. The artificial scarcity created by doctors gatekeeping is unnecessary. For example, I successfully diagnosed my own anemia disorder (thalassemia) this way. It's a simple test. I paid for it. The results are unequivocal. We can now stop giving me iron, thank you very much.
- blacksmith_tb 2y ago
  I would worry as much about kicking off a 'cascade of care'[1] where test findings cause more problems then they avert. 1: https://www.npr.org/sections/health-shots/2022/06/13/1104141886/cascade-of-care https://www.npr.org/sections/health-shots/2022/06/13/1104141...
aantix 2y ago
We are capable software engineers. We can learn new domains, assess risk, and evaluate trade-offs. This is our health. Self-research is love. It's advocating on your behalf.
- HeyLaughingBoy 2y ago
  > We are capable software engineers That is completely meaningless in this context.

There aren’t enough doctors or specialists. So what to do? The answer for most shouldn’t be “alternative medicine” where any whacko “treatment” is an appropriate stand in.

teeray 2y ago

But the answer is also not “the traditional system is perfect, just under-provisioned.” The additional doctors aren’t coming. They’re too expensive to train and they don’t want to be primary care doctors when they can finally practice. We need self-service means to augment the few doctors we have so that the system can continue to function.

lotsofpulp 2y ago
The primary care doctor role is in the process of being supplanted by nurse practitioners and physician assistants.
- bobmcnamara 2y ago
  Ah yes, the perpetual margin chasing enshitification of healthcare.
  - ghaff 2y ago
    And while we're at it, companies should probably only hire PhDs from elite schools as developers because you never know when that sort of (supposed) expertise might be needed.
    - bobmcnamara 2y ago
      Hiring doctors is exactly what the local hospital needs, and can no longer do after being bought out by a megacorp. NP: "if it gets worse go to the ER" Thanks...I guess.
- ghaff 2y ago
  I got an appointment at a pharmacy "instant clinic" when I was traveling because I had a persistent cough I couldn't see to throw. COVID test was negative but that doesn't necessarily mean much these days. Got an appointment in less than a day. The nurse practitioner probably gave me a more thorough look over (absent labs) than my primary care would have. Gave me an inhaler prescription probably as much to do something other than tell me to just continue the OTC medication I was already taking. Sure, in an ideal world, we'd probably have a next-day MD appointment for everyone. But there's a ton of stuff when an ER or physician isn't really called for.
  - 9991 2y ago
    Not sure what your point is. It sounds like the instant clinic was functionally no different than doing nothing at all.
    - ghaff 2y ago
      You don't see any benefit to having a trained/licensed professional taking vitals and making a diagnosis--even if that diagnosis is basically "you'll get better"? And the inhaler was actually helpful. And if the other option was to spend the day in a NYC ER I'd probably have passed. I'm not a hypochondriac and maybe in a pre-COVID world I'd just have assumed I was "fine" but having a second opinion seemed warranted given the option. I've also been in an ER when the diagnosis from an infectious disease specialist (after some really bad lab work and high fever) was basically go home, rest, and drink plenty of fluids when his assessment (of a fairly serious tropical disease) took a month to be confirmed from a lab in Paris. So we just basically self-diagnose and assume it will all just get better?
      - quantumwoke 2y ago
        A wrong diagnosis may be more harmful than you realize - if they are wrong (and they often are) it can lead to death/permanent disability.
        2y ago

verticalscaler 2y ago

There's no shortage of whacko treatments in mainstream medicine nowadays. Very unfortunate and dangerous. One thing you plausibly could do is attempt medical tourism, if nothing else, your perspective will improve.

hoseja 2y ago

The shortage of doctors is an artificial guild monopoly.

Almondsetat 2y ago

This is why I don't understand the AI hate. We literally don't have enough people becoming doctors, AI-assisted Healthcare would be stealing jobs from basically nobody

black_puppydog 2y ago
It would detract from any real answer, like making medical/care work more attractive. This might be a very European perspective from me but the people I know who work anywhere close to medicine are doing so despite the pay and working conditions. At the exception of the top of the pyramid, typically occupied by old white men with a horrifically antiquated world view and inflated egos.
- mnau 2y ago
  Why isn't it a "real answer". Any time our civilization had a shortage of something, we increased efficiency by offloading work to machines. Blood count tests used to be done by people actually counting cells. Now, it's all machines, likely even in a very poor countries.
- inglor_cz 2y ago
  "white men" Please don't add racial and gender resentments into an already bad problem. Neither the US nor Europe has enough medical professionals to drag arbitrary racial and gender demands into the mix. And without old doctors in general being willing to work even though they could enjoy their retirement, many places in Europe would have no healthcare left. Which doesn't bode well for 2040 or 2050.
pjc50 2y ago
What is the process for making AI acceptably reliable for medical use? Is it just drastically reducing the standard of "reliable"? Who is liable for AI medical errors?
- lukan 2y ago
  When you can choose between a well rested and competent doctor, everyone would choose that. But when you have to choose between a overworked and exhausted doctor, who gives you 10 seconds of slight attention, then I might choose the AI, mixed with my own judgement. Anyway, why not more of both? Better AI tools and more doctors?

michelb 2y ago

Why aren't there enough doctors or specialists? Especially in America it seems like a very profitable profession. Is it artificially limited?

mindslight 2y ago
Complete destruction of price signals due to the symbiotic relationship between "providers" and "insurance" cooperating to defraud patients. This is backed up by whatever corrupt laws allow "providers" to send arbitrary post-facto bills and even presumably enforce such nonsense "debts", rather than getting prosecuted for said fraud. Unfortunately most people taking notice of how broken the system is end up get fixated on the large figures on those fraudulent bills, and think single payer can do something to fix at least part of the system. But systematically, at best single payer would be tying the garbage bag off for tidy disposal, when what we actually need is for the sheer majority of medical care to have a functioning market that allows for patient agency.
baggy_trough 2y ago
Yes, by the guild of doctors.
y-c-o-m-b 2y ago
Becoming a medical professional is very expensive; tuition often going into the six-figures. Becoming a physician takes a good decade or more of your life. The entry process is very competitive and limited, with majority of applicants being rejected. IIRC the acceptance rates are below 50%. Once a person clears those hurdles however, they are now faced with a torrential abuse of corruption, racism, fraud, elitism, favoritism, etc. that they must overcome. Much of the medical field is like this unfortunately, it's not just doctors. Take for example this article about Duke's Nursing School and racism: https://archive.is/DIJ98 https://archive.is/DIJ98. From what I've heard through third-party, corruption at Duke is at an all-time high. This is just the stuff we hear about too, so I'm sure these problems affect all of the top-tier colleges that nobody reports so they don't get ejected from these programs.
joelfried 2y ago
4 years college taking some of the toughest courses there are to be ready for 4 years of medical school. After that 8 years of schooling then you have to go through the hazing ritual they call "residency". Residency varies depending on your specialty, from 3 to 7 more years[1] - during which time you're working 60-80 hour weeks [2]. So baseline if you're smart and hard working, you need to take the hardest college track from ages 18-22, medical school (22-26). Then work two jobs worth of hours as a trainee making well under 100k starting at age 27 and into your early 30s [3] so you can't save or pay down any of your debt from getting here. So if you choose to be a doctor, you have to: (a) dedicate to working your ass off at 18, (b) keep at it until you're in your early 30s, (c) start with massive debt I think it's actually pretty amazing that we have as many doctors as we do. [1] https://medschoolinsiders.com/medical-student/how-long-is-residency-by-specialty/ https://medschoolinsiders.com/medical-student/how-long-is-re... [2] https://www.ama-assn.org/medical-students/preparing-residency/what-residency https://www.ama-assn.org/medical-students/preparing-residenc... [3] https://www.inspiraadvantage.com/blog/how-much-do-medical-residents-get-paid https://www.inspiraadvantage.com/blog/how-much-do-medical-re...

anon291 2y ago

Having a test done is not a treatment. It is vital information about your own body. Better yet, if you have an issue and no doctor is listening to you and are willing to pay for the test, then your usage of the system simply means you're not doctor shopping. If you turn out to be right, then you can take the result and go to a doctor and get treatment. Otherwise, you can be satisfied. The artificial scarcity created by doctors gatekeeping is unnecessary. For example, I successfully diagnosed my own anemia disorder (thalassemia) this way. It's a simple test. I paid for it. The results are unequivocal. We can now stop giving me iron, thank you very much.

blacksmith_tb 2y ago
I would worry as much about kicking off a 'cascade of care'[1] where test findings cause more problems then they avert. 1: https://www.npr.org/sections/health-shots/2022/06/13/1104141886/cascade-of-care https://www.npr.org/sections/health-shots/2022/06/13/1104141...

aantix 2y ago

We are capable software engineers. We can learn new domains, assess risk, and evaluate trade-offs. This is our health. Self-research is love. It's advocating on your behalf.

HeyLaughingBoy 2y ago
> We are capable software engineers That is completely meaningless in this context.