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> Just as I support the AMA for doctors Strong disagree: they’re the main entity responsible for limiting the available quantity of doctors/medical practitione

by DANmode 2mo ago

> Just as I support the AMA for doctors Strong disagree: they’re the main entity responsible for limiting the available quantity of doctors/medical practitioners available, and, well, they’re frankly not spending enough time with each patient per appointment. Not something to glance over - it’s a complete mishandling of the only formula that matters to the patient.

leereeves 2mo ago
> and, well, they’re frankly not spending enough time with each patient per appointment. Many doctors would agree with you. They're under enormous pressure to work faster from both non-medical administrators and non-medical reimbursement decision makers.
- DANmode 2mo ago
  Neither of those groups seem to be in a rush to buck the AMA workflows that lead to this.
  - forestrywat 2mo ago
    My company, my insurance company, my pharmacy insurance company, the required health startup I have to use, my doctor and I all get to decide whether I can take a commonly prescribed medicine that i need. Theres way way too many parties in that decision. The ama isn't the problem that's driving wedges between my doctor and me.
    - olyjohn 2mo ago
      Also my insurance-mandated 20 minute time limit on appointments. Then I can only ask about one thing in that 20 minutes. If I have another thing, I have to make another appointment for it, because that's the only way insurance will cover my visit.
      - DANmode 2mo ago
        Doctors have an ethical and professional responsibility to demand the appropriate amount of time to see patients - or walk. You have a personal responsibility to demand the appropriate amount of time to be seen by your provider - or walk.
    - DANmode 2mo ago
      As the only industry group of substantial size or true recognition by legislators, the AMA’s responsibility to lean on each level of this system (through direct lobbying or government intervention) is large, and largely being abdicated.
      - forestrywat 2mo ago
        Or... perhaps... capital interests are stronger.
        DANmode 2mo ago
        Perhaps they’re a lot of the same people.
        forestrywat 2mo ago
        I think that's possible. Maybe we should limit the ability of capital to exert power somehow.
        DANmode 2mo ago
        Any historically successful ideas? (Any ideas that have gained traction in other pleasant countries to live in?)
        forestrywat 2mo ago
        US had a marginal tax rate that went up to 90%. The nordics have strong progressive taxation. Wealth taxes too, like the ISF in France or the taxes in Switzerland or Spain. Wage compression, especially by increasing minimum wage alongside stronger social programs and support have shown to reduce inequality.
newsomix9xl 2mo ago
OK, doctors don't deserve collective bargaining rights? I'm not defending their profession. I'm drawing a parallel in rights. And limiting entry is great for wages. Flooding your profession with people lowers wages. A drivers union would do the same if they could: create and raise standards.
- ndriscoll 2mo ago
  Correct. "Collective bargaining" against society is called running a cartel. Having your cartel lobby the government to set the law to benefit it is called rent-seeking. They've caused massive damage to society, and limiting positions by quota is different from setting standards. I can't even draw an "imagine if we limited... " comparison because limiting access to doctors is already close to the worst case, obviously destructive thing to do. Maybe food? If instead of subsidizing farming to ensure we always overgrow and don't have famines, we capped farming, ensuring famines?
  - rightbyte 2mo ago
    Yes there need to be solidarity between members of unions otherwise it is just some feudal guild society.
- DANmode 2mo ago
  What is it called when they move past collective bargaining into being entrenched in law? What’s the opposite of flooding? …because that’s what their mandate has been since the 90s.
theotherzod 2mo ago
In the US, patient time is eroded by system/admin friction, I'm hoping that has entered public consciousness by now. from colleagues in the UK: their headline demand is “pay restoration,” but the underlying grievances are much broader: when understaffing becomes normal operating procedure, every absence is a freaking emergency. nights and on-call work are intense enough already; broken sleep and persistent overload should not be normal too. The AMA has taken protectionist positions before, including opposing expansion—fair criticism. But opposing expansion can also mean opposing inadequately funded or structured training. And, as the other commenter said—thank you—don’t physicians deserve to pool bargaining power like other workers? My point is: it has more and more directly to do with patients than it may seem - being able to do the work properly, with enough time and capacity for the clinical judgement we've been trained for to be fully deployed... leads to better patient outcomes and safety.
- DANmode 2mo ago
  You’ve underlined the problem. From the first week of school, you are all taught that the good doctor is the one that can stay awake and autopilot paperwork for 48+ hours. That’s a nonstarter - it’s simply broken from the beginning. > to be fully deployed... leads to better patient outcomes and safety. Respectfully: no. There is no other human resource-planning concept on the planet that says using 100% of resources all of the time, or running to failure, is the safest method for the customer (patient). You guys messed up; your members are noticing, but instead of spending time cleaning up your own house, you want to educate the public? No: get your stumbling behemoth of an “organization” under control, please.
  - theotherzod 2mo ago
    apologies for the confusion, by "fully deployed" I meant fully able to exercise clinical judgement - which requires adequate rest. If understaffing forces back-to-back night shifts and that becomes standard, well you clearly recognize the risk to patient safety just as well. My point is - putting hard limits and minimums on rest, forces staffing choices and this is something physician collective bargaining/organising can help with and it concerns you as a patient. Regarding "the good doctor" and accepting a near-constant state of fatigue... this is not a personal choice, and it shouldn't be treated as such (wrapped into the box of "the price of this qualification/profession" type of stories). From my experience and I don't claim to be the authority on understanding all aspects of this problem, it's 1. part structural - not enough people (AMA's anti-expansion positions really didn't help here, true) and high demand... and 2. part cultural: medicine has normalised "heroic" endurance which makes it convenient to focus on economics and not see fatigue for what it is - safety risk. The cultural narrative isn't exclusive to medicine. anyway, I hope community appreciates a perspective from the other side of that organisation, I was hoping to illustrate we ultimately share the same goal - better patient outcomes and safety.
watwut 2mo ago
> Strong disagree: they’re the main entity responsible for limiting the available quantity of doctors/medical practitioners available, People (especially conservatives) repeat this, but AMA was lobbying for more residencies for years and conservative party was always against.
- DANmode 2mo ago
  You seem to have this backwards. The AMA’s public-facing stance seems to be shifting since the 90s and 00s where they obviously wanted limits. They’re on paper as supporting expansions on 2021 and 2023. Decades are long.
- myroon5 2mo ago
  > AMA was lobbying for more residencies for years The AMA lobbies for more _subsidized_ residencies while downplaying that unsubsidized residencies also exist and could expand without waiting on more taxpayer funding
runamok 2mo ago
100%. A few relevant articles: https://www.openhealthpolicy.com/p/medical-residency-slots-congress https://www.openhealthpolicy.com/p/medical-residency-slots-c... and https://www.openhealthpolicy.com/p/best-of-open-health-congress-limits https://www.openhealthpolicy.com/p/best-of-open-health-congr... A snippet: > CMS residency funding was capped beginning in 1997 at 1996 levels, and has only been raised once since then in Section 126 of the Consolidated Appropriations Act of 2021. From 1987 to 1997 the number of residents grew by 20.6%, while from 1997 to 2007 the growth in residencies was only 8%. The 2021 law attempts to address several issues by slowly increasing residencies in specific underserved situations such as rural areas. This officially just began with 200 new residencies nationwide this year, climbing to 1,000 additional residencies per year in five years. It is only a drop in the bucket compared to the 140,000 resident doctors in the US in 2020, the majority of whom were federally funded. Using a rough estimate from Census population data for 2000 and 2020, there are at least 50 million, or 18%, more people in the nation today than when the law was passed, making the current change a rather small effort. > This growth in population without a corresponding growth in the doctors we train each year leads to higher salaries for doctors and higher costs for patients. More people are demanding the time of a similar number of doctors, driving up the price of doctor’s time, even before accounting for the US’ aging population.

by DANmode 2mo ago

leereeves 2mo ago

> and, well, they’re frankly not spending enough time with each patient per appointment. Many doctors would agree with you. They're under enormous pressure to work faster from both non-medical administrators and non-medical reimbursement decision makers.

DANmode 2mo ago
Neither of those groups seem to be in a rush to buck the AMA workflows that lead to this.
- forestrywat 2mo ago
  My company, my insurance company, my pharmacy insurance company, the required health startup I have to use, my doctor and I all get to decide whether I can take a commonly prescribed medicine that i need. Theres way way too many parties in that decision. The ama isn't the problem that's driving wedges between my doctor and me.
  - olyjohn 2mo ago
    Also my insurance-mandated 20 minute time limit on appointments. Then I can only ask about one thing in that 20 minutes. If I have another thing, I have to make another appointment for it, because that's the only way insurance will cover my visit.
    - DANmode 2mo ago
      Doctors have an ethical and professional responsibility to demand the appropriate amount of time to see patients - or walk. You have a personal responsibility to demand the appropriate amount of time to be seen by your provider - or walk.
  - DANmode 2mo ago
    As the only industry group of substantial size or true recognition by legislators, the AMA’s responsibility to lean on each level of this system (through direct lobbying or government intervention) is large, and largely being abdicated.
    - forestrywat 2mo ago
      Or... perhaps... capital interests are stronger.
      - DANmode 2mo ago
        Perhaps they’re a lot of the same people.
        forestrywat 2mo ago
        I think that's possible. Maybe we should limit the ability of capital to exert power somehow.
        DANmode 2mo ago
        Any historically successful ideas? (Any ideas that have gained traction in other pleasant countries to live in?)
        forestrywat 2mo ago
        US had a marginal tax rate that went up to 90%. The nordics have strong progressive taxation. Wealth taxes too, like the ISF in France or the taxes in Switzerland or Spain. Wage compression, especially by increasing minimum wage alongside stronger social programs and support have shown to reduce inequality.

newsomix9xl 2mo ago

OK, doctors don't deserve collective bargaining rights? I'm not defending their profession. I'm drawing a parallel in rights. And limiting entry is great for wages. Flooding your profession with people lowers wages. A drivers union would do the same if they could: create and raise standards.

ndriscoll 2mo ago
Correct. "Collective bargaining" against society is called running a cartel. Having your cartel lobby the government to set the law to benefit it is called rent-seeking. They've caused massive damage to society, and limiting positions by quota is different from setting standards. I can't even draw an "imagine if we limited... " comparison because limiting access to doctors is already close to the worst case, obviously destructive thing to do. Maybe food? If instead of subsidizing farming to ensure we always overgrow and don't have famines, we capped farming, ensuring famines?
- rightbyte 2mo ago
  Yes there need to be solidarity between members of unions otherwise it is just some feudal guild society.
DANmode 2mo ago
What is it called when they move past collective bargaining into being entrenched in law? What’s the opposite of flooding? …because that’s what their mandate has been since the 90s.

theotherzod 2mo ago

In the US, patient time is eroded by system/admin friction, I'm hoping that has entered public consciousness by now. from colleagues in the UK: their headline demand is “pay restoration,” but the underlying grievances are much broader: when understaffing becomes normal operating procedure, every absence is a freaking emergency. nights and on-call work are intense enough already; broken sleep and persistent overload should not be normal too. The AMA has taken protectionist positions before, including opposing expansion—fair criticism. But opposing expansion can also mean opposing inadequately funded or structured training. And, as the other commenter said—thank you—don’t physicians deserve to pool bargaining power like other workers? My point is: it has more and more directly to do with patients than it may seem - being able to do the work properly, with enough time and capacity for the clinical judgement we've been trained for to be fully deployed... leads to better patient outcomes and safety.

DANmode 2mo ago
You’ve underlined the problem. From the first week of school, you are all taught that the good doctor is the one that can stay awake and autopilot paperwork for 48+ hours. That’s a nonstarter - it’s simply broken from the beginning. > to be fully deployed... leads to better patient outcomes and safety. Respectfully: no. There is no other human resource-planning concept on the planet that says using 100% of resources all of the time, or running to failure, is the safest method for the customer (patient). You guys messed up; your members are noticing, but instead of spending time cleaning up your own house, you want to educate the public? No: get your stumbling behemoth of an “organization” under control, please.
- theotherzod 2mo ago
  apologies for the confusion, by "fully deployed" I meant fully able to exercise clinical judgement - which requires adequate rest. If understaffing forces back-to-back night shifts and that becomes standard, well you clearly recognize the risk to patient safety just as well. My point is - putting hard limits and minimums on rest, forces staffing choices and this is something physician collective bargaining/organising can help with and it concerns you as a patient. Regarding "the good doctor" and accepting a near-constant state of fatigue... this is not a personal choice, and it shouldn't be treated as such (wrapped into the box of "the price of this qualification/profession" type of stories). From my experience and I don't claim to be the authority on understanding all aspects of this problem, it's 1. part structural - not enough people (AMA's anti-expansion positions really didn't help here, true) and high demand... and 2. part cultural: medicine has normalised "heroic" endurance which makes it convenient to focus on economics and not see fatigue for what it is - safety risk. The cultural narrative isn't exclusive to medicine. anyway, I hope community appreciates a perspective from the other side of that organisation, I was hoping to illustrate we ultimately share the same goal - better patient outcomes and safety.

watwut 2mo ago

> Strong disagree: they’re the main entity responsible for limiting the available quantity of doctors/medical practitioners available, People (especially conservatives) repeat this, but AMA was lobbying for more residencies for years and conservative party was always against.

DANmode 2mo ago
You seem to have this backwards. The AMA’s public-facing stance seems to be shifting since the 90s and 00s where they obviously wanted limits. They’re on paper as supporting expansions on 2021 and 2023. Decades are long.
myroon5 2mo ago
> AMA was lobbying for more residencies for years The AMA lobbies for more _subsidized_ residencies while downplaying that unsubsidized residencies also exist and could expand without waiting on more taxpayer funding

runamok 2mo ago

100%. A few relevant articles: https://www.openhealthpolicy.com/p/medical-residency-slots-congress https://www.openhealthpolicy.com/p/medical-residency-slots-c... and https://www.openhealthpolicy.com/p/best-of-open-health-congress-limits https://www.openhealthpolicy.com/p/best-of-open-health-congr... A snippet: > CMS residency funding was capped beginning in 1997 at 1996 levels, and has only been raised once since then in Section 126 of the Consolidated Appropriations Act of 2021. From 1987 to 1997 the number of residents grew by 20.6%, while from 1997 to 2007 the growth in residencies was only 8%. The 2021 law attempts to address several issues by slowly increasing residencies in specific underserved situations such as rural areas. This officially just began with 200 new residencies nationwide this year, climbing to 1,000 additional residencies per year in five years. It is only a drop in the bucket compared to the 140,000 resident doctors in the US in 2020, the majority of whom were federally funded. Using a rough estimate from Census population data for 2000 and 2020, there are at least 50 million, or 18%, more people in the nation today than when the law was passed, making the current change a rather small effort. > This growth in population without a corresponding growth in the doctors we train each year leads to higher salaries for doctors and higher costs for patients. More people are demanding the time of a similar number of doctors, driving up the price of doctor’s time, even before accounting for the US’ aging population.