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I’m a doctor — and I’ll say it proudly: the AMA deserves every royalty they collect, and probably more. They’ve done more to protect the integrity of American m

I’m a doctor — and I’ll say it proudly: the AMA deserves every royalty they collect, and probably more. They’ve done more to protect the integrity of American medicine than any other institution. Without them, we’d be working 80 hours a week and still struggling to afford a one-bedroom apartment — just like doctors in France, where a cardiologist makes less than a dental hygienist in Ohio. People don’t realize how bad it is out there. In some countries, doctors are taking public buses to work, skipping lunch to see 50 patients before noon, and retiring with the same savings as a schoolteacher. Meanwhile, patients complain that a 15-minute consultation in the U.S. costs $300. You’re not paying for the time — you’re paying for the privilege of certainty, of safety, of knowing your doctor passed through the most rigorous, exclusive system in the world. And who built that system? The AMA. They’ve helped ensure that American medical training remains second to none. Not just in quality, but in difficulty. The years of unpaid labor, the crushing debt, the endless exams — it’s not a flaw, it’s a filter. Without those standards, the profession would lose its weight, its dignity. If becoming a doctor were simply a matter of competence and compassion, we’d all be wearing name tags and making $60,000 a year. But thanks to the AMA, we’ve maintained the sanctity of the white coat. We’ve ensured that when a patient walks into an American clinic, they know they’re not seeing someone who just slipped through the cracks. They’re seeing someone who’s been tested, refined, and yes — financially punished enough to demand respect. Let’s not pretend this work is trivial, either. Just last week I diagnosed a UTI, prescribed a $4 antibiotic, and quite literally saved someone’s life — that’s a bargain at $500. If I’d been compensated based on the value of that outcome, I’d be driving home in a McLaren, not a Lexus. And let’s be clear: this system doesn’t just benefit doctors. Everyone in medicine — from PAs to NPs to specialists — benefits from the professional ecosystem the AMA has helped shape. We’re not just providers. We’re institutions. So yes, I’ll keep paying my AMA royalties. I’m paying to be part of something that still means something. I’m paying for the architecture that keeps American medicine elite, untouchable, and worth every penny. And if someone wants to pay $100 for a doctor visit? There are countries for that. You just might have to bring your own stethoscope.

usrusr 2y ago
Are you suggesting that the quality of treatment depends on the conveyance the doctor used to get to work? Have you even been to France, to dig into just one example?
deleted 2y ago
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refulgentis 2y ago
I can't put it better than this comment: doctors will love the AMA, no matter what it does. Their software vendor charging an $18/month is a pittance. It dictates school credentials and # of seats, keeping doctors supply-constrained. This works out from a doctor's perspective. It guarantees $400K/year or whatever you want to negotiate (ex. $280K/year for working 2 weeks on 2 weeks off, or $500/hour for 4 days for 2 weeks so the other 2 weeks, you can pick up locums shifts 2 hours away for $700/hr). They also keep doctors informed that without this, they'd be conscripted to work 80 hour weeks for $70K. (all of this is also why there's a long-term secular shift towards nurses, the second thing my doctor friends will do after being defensive about pay is complain about the low standards of education in nursing) average schoolteacher salary according to Google
- jrh3 2y ago
  The AMA keeps the quacks out, to say the least. I know this is not a popular stance on HN.
  - refulgentis 2y ago
    > The AMA keeps the quacks out, to say the least. I'm sure it does! That's a very important function I am grateful. > I know this is not a popular stance on HN. You think so? I think keeping quacks out of medicine is popular. shrugs
    - jrh3 2y ago
      No, the AMA, though not perfect, is an excellent organization that benefits our healthcare.
- wffurr 2y ago
  >> they'd be forced to work 80 hour weeks for $70K. (average schoolteacher salary). That’s crazy and a terrible reason for the AMA. The correct way to solve this problem, for both schoolteachers and doctors, is with a union.
  - 2y ago
manfre 2y ago
Thank you for sharing the perspective of some doctors. You'll likely get down votes because it comes across as condescending and elitist.
- eitally 2y ago
  I didn't downvote because I think diverse perspective is important, but the OP's comment is condescending and elitist: it declares that US doctors and the system they operate within is superior to the doctors and medical systems of every other country. This is clearly false.
banqjls 2y ago
Hard to tell if this is a troll or not. If it isn’t: we have to govern for the majority, not for the minority.
vitaflo 2y ago
Yeah except for the fact I have to wait 3 months to see you to even pay that $300 for that 15 mins. Certainly there’s a middle ground where there are enough doctors to meet demand while not having them below the salary of school teachers.
- n4r9 2y ago
  The situation in the UK is currently considered pretty bad by the public, but you can get free on-the-day appointments with qualified doctors who are paid roughly the equivalent of headteachers. Privatisation, middle-men, and private monopolies create a lot of inefficiency.
- nradov 2y ago
  Then you should support the AMA's lobbying efforts to remove the bottleneck in residency programs. https://savegme.org/about https://savegme.org/about
tmpz22 2y ago
My sibling is a MS3 so know my question is not meant to be as antagonistic as it sounds. What is the lesser evil - poor working conditions and financial outcomes for the healthcare system or prohibitively expensive treatments for patients? Are patient outcomes of French healthcare that much worse than the United States (and other public health systems such as that in the UK)? Are the wait times as egregious as the headlines make them out to be? I believe the data supports your points, and there is a lot of data. But I also think the AMA and other institutions need a huge amount of improvement that will likely be very painful to implement - hopefully opioids won't be overprescribed for that pain management. Thank you for your comment and for bringing expertise and meaningful experience to this discussion.
jrh3 2y ago
Thank you for sharing this side of the story so well. The truth is that the AMA keeps the quacks out and standards high.
- tcmart14 2y ago
  I don't know if I would go that far. Every time my wife goes to a specialist, they just declare her a medical mystery and move on. Our primary care doctor is awesome though. My wife spent years going to different doctors trying to figure out what was going on with her back. For years, different doctors would just tell her, "you must just be starting your period or something." 5 years of that, she finally found a doctor who actually looked at her and listened to her, did some testing and came back with an answer that she has some arthritis.
- gcheong 2y ago
  Dr. Oz is a huge quack but also a very accomplished doctor, how did he get past the AMA? https://pmc.ncbi.nlm.nih.gov/articles/PMC6167233/ https://pmc.ncbi.nlm.nih.gov/articles/PMC6167233/
natpalmer1776 2y ago
And yet they do nothing for the auxiliary staff that the medical industry demands to provide the unskilled labor that often play a critical role in patient outcome. Please do me a favor (yes, me, the stranger on the internet) and look up how much a CNA makes at your local hospital, and compare that to the cost of living for your area. Now check how much your facilities staff makes. I know you’re talking about the AMA, and I know my grievances are not necessarily well directed at that organization, but I’m at a loss as to where change for these critical workers will come from if not the physicians who hold the most leverage against the bean counters. Turning patients to prevent bed sores, emptying catheters, providing the most basic of care all falls down to the CNA in a modern clinical setting, who in my wife’s firsthand experience makes less than a barista at Starbucks. Literally, she left her CNA job doing all of the above and more, to make more as a Barista. Your auxiliary staff is critical in preventing hospital acquired infections, and ensuring adequate care is provided for vulnerable patients who cannot assist themselves. If you get the opportunity, go to your nearest oncology ward and interview some of the CNA staff about their experience as a CNA. Ask them how often a nurse is available to assist with turning a bariatric patient. There is a world of exploitative labor below you, supporting the high profit margins of the American medical system.
sarora27 2y ago
Gatekeepers going to gate keep. American doctors overprescribe EVERYTHING. From unnecessary tests to unnecessary surgeries & even unnecessary pharma (see Opiod crisis), a majority of MDs are looking out for their wallet first. Of course you love the AMA. They artificially keep supply of doctors low so you can justify the exorbitant costs for a 15 minute consultation. It's no surprise that the state of tech in US Healthcare is also so poor. When you're so busy sitting on your high horse about your education, you dgaf about the actual experience for the patient. You say the AMA keeps folks from seeing someone who just 'slipped through the cracks' but completely ignore the fact that many folks will complete their medical education training in the Carribbean and then do residency in the US. The worst part, post-residency, it's almost impossible to know where a physician went to medical school because they obfuscate and deflect to where they did their residency. Also the arrogance surrounding foreign medical professionals in this comment is astounding. Most doctors around the world want to focus on helping their patient actually heal. American doctors just treat symptoms.
- monkburger 2y ago
  It’s easy to paint with broad strokes, but sweeping generalizations rarely capture the full picture. Not all of us “gatekeep” or overprescribe, we follow evidence-based guidelines and clinical judgment. When a patient presents with nonspecific fatigue and unintended weight loss, for instance, ordering a CBC, CMP, TSH, and A1C isn’t "unnecessary" it’s standard of care to rule out anemia, metabolic derangements, thyroid dysfunction, or early diabetes. That’s not about revenue.. it’s about ruling out high-risk pathology before it escalates. As for the AMA, it’s far from perfect, but it doesn’t define the ethos of every practicing clinician. Many of us—regardless of where we trained—are here because we care deeply about patient outcomes, not profit. I don’t dismiss international medical graduates; I’ve worked alongside phenomenal ones. What matters to me isn’t where someone studied, but how they think, how they treat, and whether they practice medicine with integrity. Healthcare needs reform, no doubt—but assuming every U.S. physician is complicit in systemic issues is reductive. Most of us are doing the best we can within a deeply flawed system.
elcritch 2y ago
I really hope this is a troll. If not it at least showcases the attitude that’s wrong with much of the American medical system. > Without those standards, the profession would lose its weight, its dignity. If becoming a doctor were simply a matter of competence and compassion, we’d all be wearing name tags and making $60,000 a year. Ah yes, the American dignity of a fat paycheck based on gate keeping. > Let’s not pretend this work is trivial, either. Just last week I diagnosed a UTI, prescribed a $4 antibiotic, and quite literally saved someone’s life — that’s a bargain at $500. Let’s be fair, a nurse can do that too. Really ChatGPT probably could do that now. ChatGPT deserves a McLauren now! Actually Alexander Fleming, Howard Florey, and Ernst Chain deserve more credit for discovering and then mass producing the first antibiotic penicillin. Which btw they didn’t patent because they believed it should help people.
- ninetyninenine 2y ago
  That’s precisely why ChatGPT must be banned immediately and without exception. It’s not just about automation—it’s about preservation of the divine art of diagnosing strep throat with an air of sanctified superiority. You see, in America, we don’t just let anyone wield a stethoscope. No, we demand a decade of gladiatorial combat through organic chemistry, physics, and at least three near-death experiences in med school. Because how else can we be absolutely certain that someone’s IQ is sufficiently astronomical to distinguish between a cold and an alien parasite invasion? In some other countries, you can become a doctor without even crying during an MCAT. Without even seeing a benzene ring! How, pray tell, can you trust a person to perform heart surgery if they’ve never solved a Schrödinger equation while sleep-deprived? In America, we value Quality—capital Q, trademark pending. Misdiagnosis? Impossible. Our doctors are forged in the fires of molecular orbital theory and 700-page biochemistry textbooks. And yet… ChatGPT dares to show up, diagnose your flu, and not order a $12,000 MRI just for fun? It’s an affront to civilization itself. Give it a McLaren? Nay. Give it a muzzle.
y-c-o-m-b 2y ago
Is this a serious post? I can't tell. > Meanwhile, patients complain that a 15-minute consultation in the U.S. costs $300. You’re not paying for the time — you’re paying for the privilege of certainty, of safety, of knowing your doctor passed through the most rigorous, exclusive system in the world. > But thanks to the AMA, we’ve maintained the sanctity of the white coat. We’ve ensured that when a patient walks into an American clinic, they know they’re not seeing someone who just slipped through the cracks. They’re seeing someone who’s been tested, refined, and yes — financially punished enough to demand respect. Nonsense. Then how do you explain why so many people complain about having visits that yield no diagnosis, no treatment plan, or outright gaslighting by physicians? All the publications in recent times of misdiagnosis and malpractice? The stories on this here on HN and the media have been countless; including my own experience where probably 9 out of 10 visits for me are effectively worthless, especially if they're within a specialty (neurology for example).
monkburger 2y ago
What? The AMA is not what it was. What are you, a PGY3?
novia 2y ago
> Just last week I diagnosed a UTI, prescribed a $4 antibiotic, and quite literally saved someone’s life — that’s a bargain at $500. Hmm.. would the patient not have been able to tell that they had a UTI without your intervention? As I understand it, with UTIs, time is of the essence. You want to get the patient treated very quickly before the infection can spread to the bladder. What if the patient developed symptoms on Friday at 3 pm and wasn't able to get a doctor until Monday morning? I know it's not that life threateningly urgent to treat, but $500 plus time in excruciating discomfort is not a bargain when the treatment is a simple $4 antibiotic. I guarantee that by Friday night the patient would have known what was wrong with them, as well as the standard treatment.
pc86 2y ago
There is no reason the federal government needs to pay resident salaries. There is no reason residents need to make $50k/yr in NYC. There is no reason medical school needs to cost $400,000 for someone to make $200k/yr as a family med doc. Who gives a shit about the dignity of the profession? The AMA gate keeps medical schools and residency slots "to maintain the dignity of the profession" while people wait weeks or months to see a physician who hasn't cracked a journal open in 20 years and just refers them to a specialist anyway. I'm not saying doctors shouldn't make a lot of money, they absolutely should. There should also be twice as many of you. Med school slots are not limited by how many qualified people want to be doctors, they're limited by bureaucratic bullshit. Plenty of people meet all your ridiculous requirements and more yet don't become doctors simply because the seats are full.
- ninetyninenine 2y ago
  I hear what you’re saying, and of course, there’s always room to improve the system. But let’s not pretend economics doesn’t exist. If there were twice as many of us, we simply wouldn’t be worth as much. Not because we’d be less capable — but because value is determined not just by skill, but by rarity. Flood the market with physicians, and suddenly, the decade I spent sacrificing my youth, relationships, and financial sanity becomes… just a long, expensive hobby. We didn’t endure that gauntlet so that healthcare could be as available as tap water. Yes, med school is expensive. Yes, resident salaries are lean — especially in NYC. But that’s part of the process. It creates a kind of gravity around the profession. It filters out those unwilling to bear the cost of commitment. You say plenty of people are qualified. I don’t doubt that. But the profession is not merely about who can do it — it’s about who is willing to pay to do it, in every possible way. And as for doctors who haven’t cracked open a journal in 20 years — well, isn’t that the beauty of the system? They don’t have to. The structure itself protects them. We’ve built an ecosystem where even if a physician isn’t on the cutting edge, the mere fact that they exist — credentialed, licensed, and allowed to operate within this curated bottleneck — means they remain valuable. If the goal is universal access, then yes, by all means, widen the gates. But just know: the moment everyone can see a doctor anytime, anywhere, the profession stops being a calling — and starts being customer service. And I didn’t sign up to wear a headset. So no — there shouldn’t be twice as many of us. There should be just enough that when you finally get an appointment, it means something.
in_cahoots 2y ago
I can literally drive to a CVS, spend $10 on a test, and self-diagnose a UTI by peeing on a stick. And if I go to urgent care there is a 0% chance I’ll actually see an MD for an UTI. I couldn’t think of a worse example of how your supposed eliteness is valuable.
- robertlagrant 2y ago
  > I can literally drive to a CVS, spend $10 on a test, and self-diagnose a UTI by peeing on a stick It's knowing to do that in a case that isn't obvious that's the hard bit. Once you've decided to check for UTI, yes, it's an easy self-test.
  - CamperBob2 2y ago
    Any LLM could have told me to do that. And yes, LLMs are frequently wrong. Do you really want to go there, Doctor...?
    - robertlagrant 2y ago
      I'm not a doctor. LLMs might be frequently wrong, but they don't hallucinate that badly.
      - CamperBob2 2y ago
        Yeah, I'm not disagreeing with you. Just pre-emptively putting that out there to answer the inevitable "B...b...b...but unlike people, AI sometimes makes stuff up!" response from nervous gatekeepers.
        robertlagrant 2y ago
        > Just pre-emptively putting that out there to answer the inevitable "B...b...b...but unlike people, AI sometimes makes stuff up!" response from nervous gatekeepers. You're misusing the word gatekeeper, if there is even a good use for it. Requiring a driving test isn't gatekeeping. Or rather it is, but gatekeeping is an obtuse complaint.
rqtwteye 2y ago
“ They’ve helped ensure that American medical training remains second to none. Not just in quality, but in difficulty. The years of unpaid labor, the crushing debt, the endless exams — it’s not a flaw, it’s a filter. Without those standards, the profession would lose its weight, its dignity. If becoming a doctor were simply a matter of competence and compassion, we’d all be wearing name tags and making $60,000 a year. But thanks to the AMA, we’ve maintained the sanctity of the white coat. We’ve ensured that when a patient walks into an American clinic, they know they’re not seeing someone who just slipped through the cracks. They’re seeing someone who’s been tested, refined, and yes — financially punished enough to demand respect.” But somehow the system doesn’t manage to sort out doctors who are alcoholics, repeatedly injure patients and don’t listen to patients. I like this paragraph too “ If becoming a doctor were simply a matter of competence and compassion, we’d all be wearing name tags and making $60,000 a year.” Competence and compassion should be the number one criteria for a doctor. Not having a chip on their shoulder because they survived an abusive system.
peppers-ghost 2y ago
I just went to the doctor yesterday and had a 3 hour wait for them to tell me I need to see a specialist that won't see me for 4 months and in that time I'm waiting I could suffer serious consequences. At least the white coats maintained their sanctity though.
- ninetyninenine 2y ago
  Ah, a three-hour wait followed by a four-month delay to see a specialist — I understand your frustration. But please try to appreciate what that delay represents: you are being granted access to a system so refined, so in demand, that even suffering must wait its turn. That’s not failure. That’s prestige. In many countries, you could see a doctor same-day — perhaps even speak to them casually at a pharmacy window. But here, in the U.S., your care is being prepared with intention. Like a reservation at a five-star restaurant, your health is being considered by professionals with the rare luxury of selectivity. It takes time to deliver care at this level. You wouldn’t expect to walk into the Louvre and demand a private tour on the spot, would you? And let’s not forget: you’re not just being seen by a person. You’re being seen by someone who survived organic chemistry, board exams, 80-hour work weeks, and a system designed to crush the spirit of all but the most committed. You’re being evaluated by individuals whose very presence in the room adds measurable value to the atmosphere. Yes, it might feel like you’re waiting. But behind the scenes, the machinery of excellence is turning slowly, beautifully. It’s not just about treating illness. It’s about upholding the dignity of care — care that has been pre-aged, curated, and rationed for maximum significance. And this message — this small moment of clarity — is my gift to you. Normally, it would be bundled with a billing code, perhaps tied to a 99213 modifier and sent through three layers of insurance review. But today, I offer it freely. You’re welcome.
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  - Y_Y 2y ago
    This satire is too good to be detectable at a glance, I can only hope it doesn't get greyed out of existence.
ramblenode 2y ago
I'm leaning toward this being top-notch satire, but I can't be entirely sure---and that's a good thing. > Without those standards, the profession would lose its weight, its dignity. If becoming a doctor were simply a matter of competence and compassion, we’d all be wearing name tags and making $60,000 a year.
- amanaplanacanal 2y ago
  Yeah they're definitely trolling us.
- lcnPylGDnU4H9OF 2y ago
  Sufficiently advanced satire is indistinguishable from fundamentalist ravings, so says Poe. But this comment has me solidly believing it's satire: https://news.ycombinator.com/item?id=43495692 https://news.ycombinator.com/item?id=43495692. Not that I can't believe someone would really think that way, just that the odds of them being an actual psychopath who doesn't see what they're saying seem lower than the odds of a non-psychopathic person taking the opportunity to make a joke.
RhysU 2y ago
> You’re not paying for the time — you’re paying for the privilege of certainty, of safety, of knowing your doctor passed through the most rigorous, exclusive system in the world. Certainly. But how many 9's do we actually need and why are we paying for so many more 9's than that? Most of the time, I know when my kid needs antibiotics for an ear infection. I didn't go through any exclusive gamut for that single 9.
watwut 2y ago
> In some countries, doctors are taking public buses to work I am programmer who earns quite a lot and takes public bus to work, because why wouldn't I? > The years of unpaid labor, the crushing debt, the endless exams — it’s not a flaw, it’s a filter. Without those standards, the profession would lose its weight, its dignity. That is ridiculous argument. I would be fine with idea that they learn better if this or that, but this here would make me think you are being sarcastic if you was not serious in the rest of the post.
emacsen 2y ago
Let's take what you said apart a bit; - Doctors take busses to work: I lived in NYC and regularly saw doctors take public transportation. I also saw lawyers take public transportation, and many other professionals do the same. Why not doctors? - "in France where a cardiologist makes less than a dental hygienist in Ohio." As someone who lived briefly in France, and who grew up with a French parent, this is either untrue, or requires a lot of context in this apples to kiwis comparison. Show me data, and also don't forget to count all the income streams a physician in France has, and the fact that they don't carry the same debt as an American doctor, and compare their income to a dental hygienist in the same region of France. - Meanwhile, patients complain that a 15-minute consultation in the U.S. costs $300. You’re not paying for the time — you’re paying for the privilege of certainty, of safety, of knowing your doctor passed through the most rigorous, exclusive system in the world. Between my wife and myself, we've lived in five countries. The skill of doctors in the US is not any better than doctors of the non-US countries we've lived. The idea that US doctors are "the best in the world" is just nationalistic. I worked in the US medical billing industry, and the idea that the US system is efficient or even fair is completely bizare to me. I current reside in Canada, where I regularly argue the health care system is broken, but compared to the US, it's still heads and tails better for the vast majority of Canadians. The Canadian system needs major reform to bring it to the level of eg a European nation, but the US is cruel. It's cruel to patients, who are regularly prevented from getting care due to financial issues. It's cruel to require patients pay so much in fees, and risk bankruptcy due to their health. It's cruel to doctors too, to force them to work with the sword of Damocles over their heads of crippling debt, an inhumane insurance system, endless amounts of paperwork, stressful schedules, etc. The cause of this miserable state in the US is clear, and has been for at fifty years. Oh and I saw the doctor earlier this week for a followup. I didn't bring my own stethoscope. I also didn't bring a credit card.
- vunderba 2y ago
  Agreed. Much like the vast majority of people that boldly claim "X Country" has the greatest Y in the world, it's unlikely this person has lived (for any significant duration) in any other country besides X. Having spent many years in Taiwan along with standard doctor appointments and even surgery, I found the medical care in Taipei to be just as comparable as any of the doctors I've seen in the west.
Suppafly 2y ago
It's impossibly hard to tell if this is satire or serious.
amanaplanacanal 2y ago
And yet actual health outcomes are worse than some of those other countries. Are you kidding here?
credit_guy 2y ago
You Sir are at least the equal of Sacha Baron Cohen. Thank you.
deleted 2y ago
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usrusr 2y ago

Are you suggesting that the quality of treatment depends on the conveyance the doctor used to get to work? Have you even been to France, to dig into just one example?

deleted 2y ago

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refulgentis 2y ago

I can't put it better than this comment: doctors will love the AMA, no matter what it does. Their software vendor charging an $18/month is a pittance. It dictates school credentials and # of seats, keeping doctors supply-constrained. This works out from a doctor's perspective. It guarantees $400K/year or whatever you want to negotiate (ex. $280K/year for working 2 weeks on 2 weeks off, or $500/hour for 4 days for 2 weeks so the other 2 weeks, you can pick up locums shifts 2 hours away for $700/hr). They also keep doctors informed that without this, they'd be conscripted to work 80 hour weeks for $70K. (all of this is also why there's a long-term secular shift towards nurses, the second thing my doctor friends will do after being defensive about pay is complain about the low standards of education in nursing) average schoolteacher salary according to Google

jrh3 2y ago
The AMA keeps the quacks out, to say the least. I know this is not a popular stance on HN.
- refulgentis 2y ago
  > The AMA keeps the quacks out, to say the least. I'm sure it does! That's a very important function I am grateful. > I know this is not a popular stance on HN. You think so? I think keeping quacks out of medicine is popular. shrugs
  - jrh3 2y ago
    No, the AMA, though not perfect, is an excellent organization that benefits our healthcare.
wffurr 2y ago
>> they'd be forced to work 80 hour weeks for $70K. (average schoolteacher salary). That’s crazy and a terrible reason for the AMA. The correct way to solve this problem, for both schoolteachers and doctors, is with a union.
- 2y ago

manfre 2y ago

Thank you for sharing the perspective of some doctors. You'll likely get down votes because it comes across as condescending and elitist.

eitally 2y ago
I didn't downvote because I think diverse perspective is important, but the OP's comment is condescending and elitist: it declares that US doctors and the system they operate within is superior to the doctors and medical systems of every other country. This is clearly false.

banqjls 2y ago

Hard to tell if this is a troll or not. If it isn’t: we have to govern for the majority, not for the minority.

vitaflo 2y ago

Yeah except for the fact I have to wait 3 months to see you to even pay that $300 for that 15 mins. Certainly there’s a middle ground where there are enough doctors to meet demand while not having them below the salary of school teachers.

n4r9 2y ago
The situation in the UK is currently considered pretty bad by the public, but you can get free on-the-day appointments with qualified doctors who are paid roughly the equivalent of headteachers. Privatisation, middle-men, and private monopolies create a lot of inefficiency.
nradov 2y ago
Then you should support the AMA's lobbying efforts to remove the bottleneck in residency programs. https://savegme.org/about https://savegme.org/about

tmpz22 2y ago

My sibling is a MS3 so know my question is not meant to be as antagonistic as it sounds. What is the lesser evil - poor working conditions and financial outcomes for the healthcare system or prohibitively expensive treatments for patients? Are patient outcomes of French healthcare that much worse than the United States (and other public health systems such as that in the UK)? Are the wait times as egregious as the headlines make them out to be? I believe the data supports your points, and there is a lot of data. But I also think the AMA and other institutions need a huge amount of improvement that will likely be very painful to implement - hopefully opioids won't be overprescribed for that pain management. Thank you for your comment and for bringing expertise and meaningful experience to this discussion.

jrh3 2y ago

Thank you for sharing this side of the story so well. The truth is that the AMA keeps the quacks out and standards high.

tcmart14 2y ago
I don't know if I would go that far. Every time my wife goes to a specialist, they just declare her a medical mystery and move on. Our primary care doctor is awesome though. My wife spent years going to different doctors trying to figure out what was going on with her back. For years, different doctors would just tell her, "you must just be starting your period or something." 5 years of that, she finally found a doctor who actually looked at her and listened to her, did some testing and came back with an answer that she has some arthritis.
gcheong 2y ago
Dr. Oz is a huge quack but also a very accomplished doctor, how did he get past the AMA? https://pmc.ncbi.nlm.nih.gov/articles/PMC6167233/ https://pmc.ncbi.nlm.nih.gov/articles/PMC6167233/

natpalmer1776 2y ago

And yet they do nothing for the auxiliary staff that the medical industry demands to provide the unskilled labor that often play a critical role in patient outcome. Please do me a favor (yes, me, the stranger on the internet) and look up how much a CNA makes at your local hospital, and compare that to the cost of living for your area. Now check how much your facilities staff makes. I know you’re talking about the AMA, and I know my grievances are not necessarily well directed at that organization, but I’m at a loss as to where change for these critical workers will come from if not the physicians who hold the most leverage against the bean counters. Turning patients to prevent bed sores, emptying catheters, providing the most basic of care all falls down to the CNA in a modern clinical setting, who in my wife’s firsthand experience makes less than a barista at Starbucks. Literally, she left her CNA job doing all of the above and more, to make more as a Barista. Your auxiliary staff is critical in preventing hospital acquired infections, and ensuring adequate care is provided for vulnerable patients who cannot assist themselves. If you get the opportunity, go to your nearest oncology ward and interview some of the CNA staff about their experience as a CNA. Ask them how often a nurse is available to assist with turning a bariatric patient. There is a world of exploitative labor below you, supporting the high profit margins of the American medical system.

sarora27 2y ago

Gatekeepers going to gate keep. American doctors overprescribe EVERYTHING. From unnecessary tests to unnecessary surgeries & even unnecessary pharma (see Opiod crisis), a majority of MDs are looking out for their wallet first. Of course you love the AMA. They artificially keep supply of doctors low so you can justify the exorbitant costs for a 15 minute consultation. It's no surprise that the state of tech in US Healthcare is also so poor. When you're so busy sitting on your high horse about your education, you dgaf about the actual experience for the patient. You say the AMA keeps folks from seeing someone who just 'slipped through the cracks' but completely ignore the fact that many folks will complete their medical education training in the Carribbean and then do residency in the US. The worst part, post-residency, it's almost impossible to know where a physician went to medical school because they obfuscate and deflect to where they did their residency. Also the arrogance surrounding foreign medical professionals in this comment is astounding. Most doctors around the world want to focus on helping their patient actually heal. American doctors just treat symptoms.

monkburger 2y ago
It’s easy to paint with broad strokes, but sweeping generalizations rarely capture the full picture. Not all of us “gatekeep” or overprescribe, we follow evidence-based guidelines and clinical judgment. When a patient presents with nonspecific fatigue and unintended weight loss, for instance, ordering a CBC, CMP, TSH, and A1C isn’t "unnecessary" it’s standard of care to rule out anemia, metabolic derangements, thyroid dysfunction, or early diabetes. That’s not about revenue.. it’s about ruling out high-risk pathology before it escalates. As for the AMA, it’s far from perfect, but it doesn’t define the ethos of every practicing clinician. Many of us—regardless of where we trained—are here because we care deeply about patient outcomes, not profit. I don’t dismiss international medical graduates; I’ve worked alongside phenomenal ones. What matters to me isn’t where someone studied, but how they think, how they treat, and whether they practice medicine with integrity. Healthcare needs reform, no doubt—but assuming every U.S. physician is complicit in systemic issues is reductive. Most of us are doing the best we can within a deeply flawed system.

elcritch 2y ago

I really hope this is a troll. If not it at least showcases the attitude that’s wrong with much of the American medical system. > Without those standards, the profession would lose its weight, its dignity. If becoming a doctor were simply a matter of competence and compassion, we’d all be wearing name tags and making $60,000 a year. Ah yes, the American dignity of a fat paycheck based on gate keeping. > Let’s not pretend this work is trivial, either. Just last week I diagnosed a UTI, prescribed a $4 antibiotic, and quite literally saved someone’s life — that’s a bargain at $500. Let’s be fair, a nurse can do that too. Really ChatGPT probably could do that now. ChatGPT deserves a McLauren now! Actually Alexander Fleming, Howard Florey, and Ernst Chain deserve more credit for discovering and then mass producing the first antibiotic penicillin. Which btw they didn’t patent because they believed it should help people.

ninetyninenine 2y ago
That’s precisely why ChatGPT must be banned immediately and without exception. It’s not just about automation—it’s about preservation of the divine art of diagnosing strep throat with an air of sanctified superiority. You see, in America, we don’t just let anyone wield a stethoscope. No, we demand a decade of gladiatorial combat through organic chemistry, physics, and at least three near-death experiences in med school. Because how else can we be absolutely certain that someone’s IQ is sufficiently astronomical to distinguish between a cold and an alien parasite invasion? In some other countries, you can become a doctor without even crying during an MCAT. Without even seeing a benzene ring! How, pray tell, can you trust a person to perform heart surgery if they’ve never solved a Schrödinger equation while sleep-deprived? In America, we value Quality—capital Q, trademark pending. Misdiagnosis? Impossible. Our doctors are forged in the fires of molecular orbital theory and 700-page biochemistry textbooks. And yet… ChatGPT dares to show up, diagnose your flu, and not order a $12,000 MRI just for fun? It’s an affront to civilization itself. Give it a McLaren? Nay. Give it a muzzle.

y-c-o-m-b 2y ago

Is this a serious post? I can't tell. > Meanwhile, patients complain that a 15-minute consultation in the U.S. costs $300. You’re not paying for the time — you’re paying for the privilege of certainty, of safety, of knowing your doctor passed through the most rigorous, exclusive system in the world. > But thanks to the AMA, we’ve maintained the sanctity of the white coat. We’ve ensured that when a patient walks into an American clinic, they know they’re not seeing someone who just slipped through the cracks. They’re seeing someone who’s been tested, refined, and yes — financially punished enough to demand respect. Nonsense. Then how do you explain why so many people complain about having visits that yield no diagnosis, no treatment plan, or outright gaslighting by physicians? All the publications in recent times of misdiagnosis and malpractice? The stories on this here on HN and the media have been countless; including my own experience where probably 9 out of 10 visits for me are effectively worthless, especially if they're within a specialty (neurology for example).

monkburger 2y ago

What? The AMA is not what it was. What are you, a PGY3?

novia 2y ago

> Just last week I diagnosed a UTI, prescribed a $4 antibiotic, and quite literally saved someone’s life — that’s a bargain at $500. Hmm.. would the patient not have been able to tell that they had a UTI without your intervention? As I understand it, with UTIs, time is of the essence. You want to get the patient treated very quickly before the infection can spread to the bladder. What if the patient developed symptoms on Friday at 3 pm and wasn't able to get a doctor until Monday morning? I know it's not that life threateningly urgent to treat, but $500 plus time in excruciating discomfort is not a bargain when the treatment is a simple $4 antibiotic. I guarantee that by Friday night the patient would have known what was wrong with them, as well as the standard treatment.

pc86 2y ago

There is no reason the federal government needs to pay resident salaries. There is no reason residents need to make $50k/yr in NYC. There is no reason medical school needs to cost $400,000 for someone to make $200k/yr as a family med doc. Who gives a shit about the dignity of the profession? The AMA gate keeps medical schools and residency slots "to maintain the dignity of the profession" while people wait weeks or months to see a physician who hasn't cracked a journal open in 20 years and just refers them to a specialist anyway. I'm not saying doctors shouldn't make a lot of money, they absolutely should. There should also be twice as many of you. Med school slots are not limited by how many qualified people want to be doctors, they're limited by bureaucratic bullshit. Plenty of people meet all your ridiculous requirements and more yet don't become doctors simply because the seats are full.

ninetyninenine 2y ago
I hear what you’re saying, and of course, there’s always room to improve the system. But let’s not pretend economics doesn’t exist. If there were twice as many of us, we simply wouldn’t be worth as much. Not because we’d be less capable — but because value is determined not just by skill, but by rarity. Flood the market with physicians, and suddenly, the decade I spent sacrificing my youth, relationships, and financial sanity becomes… just a long, expensive hobby. We didn’t endure that gauntlet so that healthcare could be as available as tap water. Yes, med school is expensive. Yes, resident salaries are lean — especially in NYC. But that’s part of the process. It creates a kind of gravity around the profession. It filters out those unwilling to bear the cost of commitment. You say plenty of people are qualified. I don’t doubt that. But the profession is not merely about who can do it — it’s about who is willing to pay to do it, in every possible way. And as for doctors who haven’t cracked open a journal in 20 years — well, isn’t that the beauty of the system? They don’t have to. The structure itself protects them. We’ve built an ecosystem where even if a physician isn’t on the cutting edge, the mere fact that they exist — credentialed, licensed, and allowed to operate within this curated bottleneck — means they remain valuable. If the goal is universal access, then yes, by all means, widen the gates. But just know: the moment everyone can see a doctor anytime, anywhere, the profession stops being a calling — and starts being customer service. And I didn’t sign up to wear a headset. So no — there shouldn’t be twice as many of us. There should be just enough that when you finally get an appointment, it means something.

in_cahoots 2y ago

I can literally drive to a CVS, spend $10 on a test, and self-diagnose a UTI by peeing on a stick. And if I go to urgent care there is a 0% chance I’ll actually see an MD for an UTI. I couldn’t think of a worse example of how your supposed eliteness is valuable.

robertlagrant 2y ago
> I can literally drive to a CVS, spend $10 on a test, and self-diagnose a UTI by peeing on a stick It's knowing to do that in a case that isn't obvious that's the hard bit. Once you've decided to check for UTI, yes, it's an easy self-test.
- CamperBob2 2y ago
  Any LLM could have told me to do that. And yes, LLMs are frequently wrong. Do you really want to go there, Doctor...?
  - robertlagrant 2y ago
    I'm not a doctor. LLMs might be frequently wrong, but they don't hallucinate that badly.
    - CamperBob2 2y ago
      Yeah, I'm not disagreeing with you. Just pre-emptively putting that out there to answer the inevitable "B...b...b...but unlike people, AI sometimes makes stuff up!" response from nervous gatekeepers.
      - robertlagrant 2y ago
        > Just pre-emptively putting that out there to answer the inevitable "B...b...b...but unlike people, AI sometimes makes stuff up!" response from nervous gatekeepers. You're misusing the word gatekeeper, if there is even a good use for it. Requiring a driving test isn't gatekeeping. Or rather it is, but gatekeeping is an obtuse complaint.

rqtwteye 2y ago

“ They’ve helped ensure that American medical training remains second to none. Not just in quality, but in difficulty. The years of unpaid labor, the crushing debt, the endless exams — it’s not a flaw, it’s a filter. Without those standards, the profession would lose its weight, its dignity. If becoming a doctor were simply a matter of competence and compassion, we’d all be wearing name tags and making $60,000 a year. But thanks to the AMA, we’ve maintained the sanctity of the white coat. We’ve ensured that when a patient walks into an American clinic, they know they’re not seeing someone who just slipped through the cracks. They’re seeing someone who’s been tested, refined, and yes — financially punished enough to demand respect.” But somehow the system doesn’t manage to sort out doctors who are alcoholics, repeatedly injure patients and don’t listen to patients. I like this paragraph too “ If becoming a doctor were simply a matter of competence and compassion, we’d all be wearing name tags and making $60,000 a year.” Competence and compassion should be the number one criteria for a doctor. Not having a chip on their shoulder because they survived an abusive system.

peppers-ghost 2y ago

I just went to the doctor yesterday and had a 3 hour wait for them to tell me I need to see a specialist that won't see me for 4 months and in that time I'm waiting I could suffer serious consequences. At least the white coats maintained their sanctity though.

ninetyninenine 2y ago
Ah, a three-hour wait followed by a four-month delay to see a specialist — I understand your frustration. But please try to appreciate what that delay represents: you are being granted access to a system so refined, so in demand, that even suffering must wait its turn. That’s not failure. That’s prestige. In many countries, you could see a doctor same-day — perhaps even speak to them casually at a pharmacy window. But here, in the U.S., your care is being prepared with intention. Like a reservation at a five-star restaurant, your health is being considered by professionals with the rare luxury of selectivity. It takes time to deliver care at this level. You wouldn’t expect to walk into the Louvre and demand a private tour on the spot, would you? And let’s not forget: you’re not just being seen by a person. You’re being seen by someone who survived organic chemistry, board exams, 80-hour work weeks, and a system designed to crush the spirit of all but the most committed. You’re being evaluated by individuals whose very presence in the room adds measurable value to the atmosphere. Yes, it might feel like you’re waiting. But behind the scenes, the machinery of excellence is turning slowly, beautifully. It’s not just about treating illness. It’s about upholding the dignity of care — care that has been pre-aged, curated, and rationed for maximum significance. And this message — this small moment of clarity — is my gift to you. Normally, it would be bundled with a billing code, perhaps tied to a 99213 modifier and sent through three layers of insurance review. But today, I offer it freely. You’re welcome.
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- Y_Y 2y ago
  This satire is too good to be detectable at a glance, I can only hope it doesn't get greyed out of existence.

ramblenode 2y ago

I'm leaning toward this being top-notch satire, but I can't be entirely sure---and that's a good thing. > Without those standards, the profession would lose its weight, its dignity. If becoming a doctor were simply a matter of competence and compassion, we’d all be wearing name tags and making $60,000 a year.

amanaplanacanal 2y ago
Yeah they're definitely trolling us.
lcnPylGDnU4H9OF 2y ago
Sufficiently advanced satire is indistinguishable from fundamentalist ravings, so says Poe. But this comment has me solidly believing it's satire: https://news.ycombinator.com/item?id=43495692 https://news.ycombinator.com/item?id=43495692. Not that I can't believe someone would really think that way, just that the odds of them being an actual psychopath who doesn't see what they're saying seem lower than the odds of a non-psychopathic person taking the opportunity to make a joke.

RhysU 2y ago

> You’re not paying for the time — you’re paying for the privilege of certainty, of safety, of knowing your doctor passed through the most rigorous, exclusive system in the world. Certainly. But how many 9's do we actually need and why are we paying for so many more 9's than that? Most of the time, I know when my kid needs antibiotics for an ear infection. I didn't go through any exclusive gamut for that single 9.

watwut 2y ago

> In some countries, doctors are taking public buses to work I am programmer who earns quite a lot and takes public bus to work, because why wouldn't I? > The years of unpaid labor, the crushing debt, the endless exams — it’s not a flaw, it’s a filter. Without those standards, the profession would lose its weight, its dignity. That is ridiculous argument. I would be fine with idea that they learn better if this or that, but this here would make me think you are being sarcastic if you was not serious in the rest of the post.

emacsen 2y ago

Let's take what you said apart a bit; - Doctors take busses to work: I lived in NYC and regularly saw doctors take public transportation. I also saw lawyers take public transportation, and many other professionals do the same. Why not doctors? - "in France where a cardiologist makes less than a dental hygienist in Ohio." As someone who lived briefly in France, and who grew up with a French parent, this is either untrue, or requires a lot of context in this apples to kiwis comparison. Show me data, and also don't forget to count all the income streams a physician in France has, and the fact that they don't carry the same debt as an American doctor, and compare their income to a dental hygienist in the same region of France. - Meanwhile, patients complain that a 15-minute consultation in the U.S. costs $300. You’re not paying for the time — you’re paying for the privilege of certainty, of safety, of knowing your doctor passed through the most rigorous, exclusive system in the world. Between my wife and myself, we've lived in five countries. The skill of doctors in the US is not any better than doctors of the non-US countries we've lived. The idea that US doctors are "the best in the world" is just nationalistic. I worked in the US medical billing industry, and the idea that the US system is efficient or even fair is completely bizare to me. I current reside in Canada, where I regularly argue the health care system is broken, but compared to the US, it's still heads and tails better for the vast majority of Canadians. The Canadian system needs major reform to bring it to the level of eg a European nation, but the US is cruel. It's cruel to patients, who are regularly prevented from getting care due to financial issues. It's cruel to require patients pay so much in fees, and risk bankruptcy due to their health. It's cruel to doctors too, to force them to work with the sword of Damocles over their heads of crippling debt, an inhumane insurance system, endless amounts of paperwork, stressful schedules, etc. The cause of this miserable state in the US is clear, and has been for at fifty years. Oh and I saw the doctor earlier this week for a followup. I didn't bring my own stethoscope. I also didn't bring a credit card.

vunderba 2y ago
Agreed. Much like the vast majority of people that boldly claim "X Country" has the greatest Y in the world, it's unlikely this person has lived (for any significant duration) in any other country besides X. Having spent many years in Taiwan along with standard doctor appointments and even surgery, I found the medical care in Taipei to be just as comparable as any of the doctors I've seen in the west.

Suppafly 2y ago

It's impossibly hard to tell if this is satire or serious.

amanaplanacanal 2y ago

And yet actual health outcomes are worse than some of those other countries. Are you kidding here?

credit_guy 2y ago

You Sir are at least the equal of Sacha Baron Cohen. Thank you.

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