4 ms·

This is a symptom of a deeper problem in medicine, the subjugation of doctors. It used to be that doctors ran their own practices and were the Götter in Weiß, t

This is a symptom of a deeper problem in medicine, the subjugation of doctors. It used to be that doctors ran their own practices and were the Götter in Weiß, the gods in white lab-coats. What they said was what happened, and healing patients was their purpose. Now, however, doctors are cogs in a much larger healthcare system run by suits for purposes that one suspects have more to do with money than medicine. If computer workflows are optimized for the suits rather than the doctors, that’s a symptom of a problem whose other symptoms, like rampant price inflation, are yet worse.

zukzuk 1y ago
My company builds software for medical office assistants, and our clients are typically doctor-owned clinics. We have literally the same problem, but one step down the ladder. The doctors are making the purchasing decision, but MOAs are the direct users. And ironically enough, we have often run into the same problem. Doctors often don’t see the value in software that solves their subordinates’ problems.
- HaZeust 1y ago
  >"Doctors often don’t see the value in software that solves their subordinates’ problems." This was such a huge problem at my former company, Billit (getbillit.com), that our number 1 method on achieving clients was making such steep referral incentives for doctors, to their colleagues. We only needed one to make scale eventually happen, but the organic clients couldn't empathize with the workflows of their front desk - they didn't care.
resource_waste 1y ago
>doctors are cogs in a much larger healthcare system run by suits for purposes that one suspects have more to do with money than medicine. Is that actually accurate? The American Medical Association (the Physician cartel/trade association) bribes/lobbies about equal as hospitals/owners. They also legally reduce supply using their private, unelected, ACGME. If we use lobbying numbers, they are just as obsessed with money as the owners.
- kyouens 1y ago
  I am a doctor and I run a graduate medical education program. The constraining resource is generally funding, not limits imposed by ACGME. For example, my program is ACGME-approved for two trainees per year, but we have funding for one.
  - ambicapter 1y ago
    Who decides the funding?
    - kyouens 1y ago
      Funding is mostly controlled by the federal government, via Medicare and Medicaid, and if I am not mistaken the funding levels are set by Congress.
      - nradov 1y ago
        You are not mistaken. Contrary to the conspiracy theories you see on here about the AMA, lately they have been lobbying Congress to increase funding for residency programs because that is the primary bottleneck to producing new physicians. https://savegme.org/ https://savegme.org/
        lesuorac 1y ago
        So after studying for a decade a soon-to-be physician needs to go through a government funded job in order to qualify as a physician? Why don't the hospitals just pay the cost of their staff like every other apprenticeship program? (or add it into the list of student debt that doctor requires).
        nradov 1y ago
        Anyone who graduates from medical school with an MD / DO degree needs to complete several years of graduate medical education (residency) at a teaching hospital in order to become a physician legally authorized to practice medicine. Most residency slots are funded by Medicare, although some are funded by other sources. Teaching hospitals are usually run by non-profit corporations, or by state or local governments. While internal accounting is always a bit fuzzy and opaque they simply don't have the money to pay residents directly. Most residents generate less revenue than they cost to train. And hospitals don't have the freedom to raise prices to cover the cost of running residency programs. Thus the need for subsidies. If we force prospective doctors to take on even more debt then we'll likely end up with an even worse shortage. Current levels of student debt are already unsustainable, at least for many specialties.
FuriouslyAdrift 1y ago
At least in the US, many doctors (at least specialists) split off and created their own companies that then contract with the hospitals. A large chunk of people working in healthcare are all contractors, now, with all the overhead and friction that comes with that. The only true employees of most hospital systems are the finance people.
- korse 1y ago
  and facilities, cops, 'environmental services' etc. Hospitals employ plenty of people to keep the machine running. No one wants a localized rainstorm in a surgery bay.
- freedomben 1y ago
  Indeed, and something else many people don't know is that a lot of (mid to senior) doctors have ownership stake in the hospitals, or are part-owners of the building that the hospital leases, etc. So it's not a direct "owernship" relationship anymore, it's more like a stockholder who works (contracts) for the company, sometimes with a hop or two in the way. I'm not saying this is good or bad (it doesn't seem at all clear cut either way to me), but it is something I found really interesting
- jeffreyrogers 1y ago
  A lot of that is to get around laws that say corporations can't practice medicine. These are state-laws, not federal so in every state it's different.
tristor 1y ago
> Now, however, doctors are cogs in a much larger healthcare system run by suits for purposes that one suspects have more to do with money than medicine. Just one more way that private equity ruins the world.

zukzuk 1y ago

My company builds software for medical office assistants, and our clients are typically doctor-owned clinics. We have literally the same problem, but one step down the ladder. The doctors are making the purchasing decision, but MOAs are the direct users. And ironically enough, we have often run into the same problem. Doctors often don’t see the value in software that solves their subordinates’ problems.

HaZeust 1y ago
>"Doctors often don’t see the value in software that solves their subordinates’ problems." This was such a huge problem at my former company, Billit (getbillit.com), that our number 1 method on achieving clients was making such steep referral incentives for doctors, to their colleagues. We only needed one to make scale eventually happen, but the organic clients couldn't empathize with the workflows of their front desk - they didn't care.

resource_waste 1y ago

>doctors are cogs in a much larger healthcare system run by suits for purposes that one suspects have more to do with money than medicine. Is that actually accurate? The American Medical Association (the Physician cartel/trade association) bribes/lobbies about equal as hospitals/owners. They also legally reduce supply using their private, unelected, ACGME. If we use lobbying numbers, they are just as obsessed with money as the owners.

kyouens 1y ago
I am a doctor and I run a graduate medical education program. The constraining resource is generally funding, not limits imposed by ACGME. For example, my program is ACGME-approved for two trainees per year, but we have funding for one.
- ambicapter 1y ago
  Who decides the funding?
  - kyouens 1y ago
    Funding is mostly controlled by the federal government, via Medicare and Medicaid, and if I am not mistaken the funding levels are set by Congress.
    - nradov 1y ago
      You are not mistaken. Contrary to the conspiracy theories you see on here about the AMA, lately they have been lobbying Congress to increase funding for residency programs because that is the primary bottleneck to producing new physicians. https://savegme.org/ https://savegme.org/
      - lesuorac 1y ago
        So after studying for a decade a soon-to-be physician needs to go through a government funded job in order to qualify as a physician? Why don't the hospitals just pay the cost of their staff like every other apprenticeship program? (or add it into the list of student debt that doctor requires).
        nradov 1y ago
        Anyone who graduates from medical school with an MD / DO degree needs to complete several years of graduate medical education (residency) at a teaching hospital in order to become a physician legally authorized to practice medicine. Most residency slots are funded by Medicare, although some are funded by other sources. Teaching hospitals are usually run by non-profit corporations, or by state or local governments. While internal accounting is always a bit fuzzy and opaque they simply don't have the money to pay residents directly. Most residents generate less revenue than they cost to train. And hospitals don't have the freedom to raise prices to cover the cost of running residency programs. Thus the need for subsidies. If we force prospective doctors to take on even more debt then we'll likely end up with an even worse shortage. Current levels of student debt are already unsustainable, at least for many specialties.

FuriouslyAdrift 1y ago

At least in the US, many doctors (at least specialists) split off and created their own companies that then contract with the hospitals. A large chunk of people working in healthcare are all contractors, now, with all the overhead and friction that comes with that. The only true employees of most hospital systems are the finance people.

korse 1y ago
and facilities, cops, 'environmental services' etc. Hospitals employ plenty of people to keep the machine running. No one wants a localized rainstorm in a surgery bay.
freedomben 1y ago
Indeed, and something else many people don't know is that a lot of (mid to senior) doctors have ownership stake in the hospitals, or are part-owners of the building that the hospital leases, etc. So it's not a direct "owernship" relationship anymore, it's more like a stockholder who works (contracts) for the company, sometimes with a hop or two in the way. I'm not saying this is good or bad (it doesn't seem at all clear cut either way to me), but it is something I found really interesting
jeffreyrogers 1y ago
A lot of that is to get around laws that say corporations can't practice medicine. These are state-laws, not federal so in every state it's different.

tristor 1y ago

> Now, however, doctors are cogs in a much larger healthcare system run by suits for purposes that one suspects have more to do with money than medicine. Just one more way that private equity ruins the world.