the_d3f4ult

Wages in healthcare have decreased Year-Over-Year relative to inflation since at least the 90's. Productivity has increased in terms of the number of patients seen / day.

This has nothing to do with "knowing how to use a computer."

Looking at a screen while you check through dozens of flags and billing related documentation instead of looking at the patient is much less personable.

I'm a physician. To understand why this is true you have to understand that the software is not intended to the make the physicians jobs easier or more efficient. The point of modern EMR's is to take every patient encounter and generate a list of billable codes that maps onto the encounter in such a way that insurance companies are less likely to send it back. The stuff like checking medication interactions is just tacked on as an afterthought. Through this lens everything else makes more sense.

Neither of the things you mention detract from his point. Just because the companies are headquartered outside of the US doesn't mean that they aren't developing drugs with the intention of recouping their R&D costs (and then some) from the US market due to our uniquely broken healthcare system.

>There aren't enough software engineers to create the software the world needs.

I think you mean "to create the software the market demands." We've lost a generation of talented people to instagram filters and content feed algorithms.

This is an interesting perspective, but your view seems very narrow for some reason. If you’re arguing that there are many forms of computation or ‘intelligence’ that are emergent with collections of sentient or non-sentient beings then you have to include tribes of early humans, families, city-states and modern republics, ant and mold colonies, the stock market and the entire earths biosphere etc.

I'm an ophthalmologist. I look at irises all day. People's irises change over the course of their life. Sometimes dramatically if they have some kind of pathology. Are they updating their model periodically? What keeps someone from getting locked out of their crypto gains if they develop an iris nevus or have cataract surgery or start on flomax?

Fair point. There's some data showing patient outcomes are worse when managed by overworked residents-in-training, but I think you're referring to outcomes post-residency. i.e. Physicians should squeeze as much training as possible into the allotted years. This is reasonable, especially for surgical specialties where procedural reps are a commodity for trainees.

I'd be more open to this line of reasoning if physician's salaries had kept pace with inflation over the last 30 years and if if we hadn't tacitly accepted a much, much lower standard of training in the form of DNPs, CRNAs and PAs who are now practicing independently in a lot of regions. You can't demand that people make extraordinary sacrifices without extraordinary compensation.

For contrast, most European countries have a much longer post-residency training process that is more humane. Caveat being that students enter medical school directly from high school and don't have student loans.

It's also worth pointing out that in the US a LOT of those 100 hours are not spent in direct patient care. They're spent doing chores ('scut') that are not directly tied to patient care. Think: Calling insurance companies for prior authorization for your supervisor or filling out FMLA paperwork for one of your supervisors' patients. As a resident you don't have the ability to say "no" to these tasks.

They’re not ‘getting a cut’ unless they directly own the clinic. What you’re seeing is a cost-cutting measure increasing the bottom line for whoever owns the clinic. Physicians are forced to agree to ‘supervise’ midlevels as a condition of their employment these days.

This is an uninformed take. A relatively small fraction of our healthcare dollars (~7%) are going to ‘providers’ i.e. doctors and nurse practitioners. I don’t have a source handy but this is easily searchable.

Most of the spiraling healthcare costs are attributable to administrative bloat, hospital profits, insurance companies and pharmaceutical profits. What you’re suggesting would just result in lower quality care in general and has effectively already been implemented with the rise of ‘supervised’ and unsupervised mid-level providers. I.e. NPs, PAs, CRNAs etc. It hasn’t resulted in any decrease in healthcare costs for the patient.

Let me give you some context for insight. If I see a patient in clinic for an intravitreal injection my fee will be $150-250 before overhead, the pharmaceutical company will be paid by medicare or private insurance around ~ $2000 for the drug that I inject. Double that for a bilateral injection.

If I operate at a hospital, my fee is $5-600. The hospital bills medicare a $4000 facilities fee plus additional fees for anesthesia, consumables etc. to the tune of over $10000 per eye.

If you want to lower healthcare costs a good start would be negotiating drug prices, repealing the clause in the ACA that bans physicians from owning hospitals, banning non-competes for healthcare professionals and getting rid of certificates of need that make it unnecessarily difficult to build outpatient surgery centers. In short, ideas that require a more nuanced understanding of our healthcare system.

I’m an ophthalmologist. The answer is that junior partners are brought on at a below-market-rate salary with the promise of future equity (usually under false pretenses) in the practice and a super restrictive non-compete agreement. The senior partners then take their golden parachute and sell-out the field and the junior partners to the PE finance bros. One then has to choose between selling their house, uprooting their family and taking the financial risk that comes with starting a practice in a new location (due to the non-compete) or continuing to work for the PE firm as they devolve to more and more unethical business practices. Eventually your choices are either go into solo practice or work for PE

I love this. Sounds like your kids are lucky to have such supportive parents. I’d love to share that kind of thing with my son. He’s only 2 though so who knows what he’ll be into.