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Physician salaries are less than 10% the cost of healthcare. You could eliminate their salary entirely and it'd have no meaningful difference on the cost of hea

Physician salaries are less than 10% the cost of healthcare. You could eliminate their salary entirely and it'd have no meaningful difference on the cost of healthcare. There is _absolutely_ an artificial supply limitation, but that's increasingly being worked around by the use of PA and NP providers. Doctors essentially become managers for PA and NPs. My wife is a physician. Actual, scientific diagnosis is a ridiculously small part of her job. Most of her time is taken up on "soft problems". Writing notes for continuity/quality of care. Justifying medical decisions for billing purposes. Advocating with insurance and healthcare administrators. Discussing treatment plans and options with patients. More notes. Well, really, most of her time is taken up with notes. It's really the only way for her to capture all of the soft variables. Writing notes is a bit like coding. LLM/AI can help solve the problem, but ultimately you still need to go through them piece-by-piece to ensure they're correct.

whimsicalism 2y ago
Unlike the other comment defending current medical practice, this one I absolutely agree with. I do not think that physician salaries are the major drivers of healthcare cost. I do think that occupational licensing reform would help bring down cost, but agree it is only a relatively small factor. However I do think that in the process of engaging in wage protectionism (and there is absolutely no question that doctors do this) there is a ton of consumer surplus that is being lost and not captured by either patient or provider. For instance, in the case of the melanoma AI, that is a casualty of the wage protectionism (+ medical conservatism + FDA failure) - the value there isn't being captured by doctors, it is just disappearing into thin air and tons more people will just have undiagnosed melanomas.
- SkyPuncher 2y ago
  > I do think that occupational licensing reform would help bring down cost I actually think this is the only way to bring costs down. Most providers, equals more competition. More competition leads to innovation and all around better outcomes. Interestingly, a lot of states are starting to express their frustration with physician supply shortages by expanding rights for NPs and PAs. I think over the next 20 years, we're going to see MD/DO roles transition to largely supervisory roles with NPs and PAs doing most of the work. Much more akin to manager/IC type of roles we see in STEM type fields.
throwaway2037 2y ago
Where is the other 90% spent?
- SkyPuncher 2y ago
  This is a newer report that now has physician services pegged at 14.5% of cost: https://www.ama-assn.org/about/research/trends-health-care-spending https://www.ama-assn.org/about/research/trends-health-care-s.... That is higher than the 8% the NYTimes quoted in this 2021 article (which I was basing my argument on): https://www.latimes.com/opinion/story/2021-09-14/dont-blame-doctor-pay-for-the-high-cost-of-u-s-healthcare https://www.latimes.com/opinion/story/2021-09-14/dont-blame-... That AMA-ASSN article has a nice pie chart breaking down the high level categories of total health care spending. Though, this isn't particularly useful for understanding why your individual healthcare might cost so much. This article is looking at nation-state level trends, including things like public health activities and nursing home costs. Labor does make up a massive part of healthcare costs (I've seen it quoted as much as 60%), but that includes every person in the healthcare field. Physicians, nurses, techs, administrators, billing, construction/maintenance staff, security, etc, etc, etc,
coryrc 2y ago
She makes so much money per minute, why does she not pay for a note taker to be by her side all day taking notes, allowing her to see more patients? That's sort-of what a NP is, but without the doctor in the room and only if she were reviewing their notes after. (I know some doctors who this is a sensitive subject so I haven't asked them yet).
- SkyPuncher 2y ago
  Notes are kind of a poor term for what these documents actually are. To the lay person, notes are what you take during a meeting or lecture. A sort a annotation of what happened. Notes in medicine are essentially a treatment plan that includes justification and context for that treatment plan. It's essentially the physician's thinking on how they're treating a patient. A lot of patient care centered specialties (as opposed to surgery or technical specialties, like radiology) are seeing a shift towards NP and PAs. The physician will be legally responsible for the actions of one or more NPs. They'll review their work and ensure their plans are correct.

whimsicalism 2y ago

Unlike the other comment defending current medical practice, this one I absolutely agree with. I do not think that physician salaries are the major drivers of healthcare cost. I do think that occupational licensing reform would help bring down cost, but agree it is only a relatively small factor. However I do think that in the process of engaging in wage protectionism (and there is absolutely no question that doctors do this) there is a ton of consumer surplus that is being lost and not captured by either patient or provider. For instance, in the case of the melanoma AI, that is a casualty of the wage protectionism (+ medical conservatism + FDA failure) - the value there isn't being captured by doctors, it is just disappearing into thin air and tons more people will just have undiagnosed melanomas.

SkyPuncher 2y ago
> I do think that occupational licensing reform would help bring down cost I actually think this is the only way to bring costs down. Most providers, equals more competition. More competition leads to innovation and all around better outcomes. Interestingly, a lot of states are starting to express their frustration with physician supply shortages by expanding rights for NPs and PAs. I think over the next 20 years, we're going to see MD/DO roles transition to largely supervisory roles with NPs and PAs doing most of the work. Much more akin to manager/IC type of roles we see in STEM type fields.

throwaway2037 2y ago

Where is the other 90% spent?

SkyPuncher 2y ago
This is a newer report that now has physician services pegged at 14.5% of cost: https://www.ama-assn.org/about/research/trends-health-care-spending https://www.ama-assn.org/about/research/trends-health-care-s.... That is higher than the 8% the NYTimes quoted in this 2021 article (which I was basing my argument on): https://www.latimes.com/opinion/story/2021-09-14/dont-blame-doctor-pay-for-the-high-cost-of-u-s-healthcare https://www.latimes.com/opinion/story/2021-09-14/dont-blame-... That AMA-ASSN article has a nice pie chart breaking down the high level categories of total health care spending. Though, this isn't particularly useful for understanding why your individual healthcare might cost so much. This article is looking at nation-state level trends, including things like public health activities and nursing home costs. Labor does make up a massive part of healthcare costs (I've seen it quoted as much as 60%), but that includes every person in the healthcare field. Physicians, nurses, techs, administrators, billing, construction/maintenance staff, security, etc, etc, etc,

coryrc 2y ago

She makes so much money per minute, why does she not pay for a note taker to be by her side all day taking notes, allowing her to see more patients? That's sort-of what a NP is, but without the doctor in the room and only if she were reviewing their notes after. (I know some doctors who this is a sensitive subject so I haven't asked them yet).

SkyPuncher 2y ago
Notes are kind of a poor term for what these documents actually are. To the lay person, notes are what you take during a meeting or lecture. A sort a annotation of what happened. Notes in medicine are essentially a treatment plan that includes justification and context for that treatment plan. It's essentially the physician's thinking on how they're treating a patient. A lot of patient care centered specialties (as opposed to surgery or technical specialties, like radiology) are seeing a shift towards NP and PAs. The physician will be legally responsible for the actions of one or more NPs. They'll review their work and ensure their plans are correct.