Why doctors are sick of their profession

http://online.wsj.com/articles/the-u-s-s-ailing-medical-system-a-doctors-perspective-1409325361?mod=WSJ_hppMIDDLENexttoWhatsNewsSecond

by roye • 12 years ago

123 230 12 years ago

online.wsj.com

ihsanyounes90• 12 years ago

In my opinion(and general opinion), this is the most important job. Maybe we can find someone depressed(like in the article), but come on they save lives.

jmspring• 12 years ago

It is critical, but given sheer number of lives impacted daily, I rank teaching higher. Especially given the pay disparity.

gulfie• 12 years ago

Everyone dies, no one gets saved forever.

Plumbers and garbage men saved more lives in the past century than doctors. (so I hear)

nhstanley• 12 years ago

but come on they save lives.

I'm going to say something controversial here, but please bear with me. Your statement sort of encompasses several parts of this problem.

Some doctors are miracle workers (see [1] below), but most doctors are glorified auto mechanics. I don't say that to downplay the amount of intelligence/skill required for the job, but if you think of most doctors as "saving lives", then you obviously haven't spent a lot of time around doctors/clinics/hospitals.

Most doctors rarely save lives, and often when they do it wasn't them that really did the critical life saving steps, they're just the interface the sick person is interacting with. Most doctors deal with a series of inputs (symptoms and circumstances) and output a solution (diagnosis and remedy), which requires very little critical thinking on their part. Sick kids with the flu. Idiots that took too many drugs that need fluids, benzos, cypro, or an ice bath. People at mid-life who made shitty decisions for most of their lives and now need Lipitor/Coumadin/a treadmill/a gravestone.

The truth is most doctors get paid a lot because people erroneously assign to them the ethos of miracle workers, when most of them aren't. In fact, they often can't even do anything for their patients (see above, such kids with the flu, old people who've made shitty decisions their whole lives). The cures really come from researchers and pharma companies that come up with drugs and treatments for these incredibly difficult problems. If doctors deserve their paychecks, it's because they keep alive the illusion society wants. The illusion that when something is wrong, the doc will fix them up good. And indeed that's basically what the article is about. Doctors demand respect and to be paid to keep up the illusion and to deal with the bullshit.

[1] Obvious and important exceptions to this are ER docs and trauma surgeons, who indeed save lives. There are also clinical doctors, who work tirelessly with armies of researchers to try to find new cures for cancers, autoimmune and genetic disorders (among many other things). There are surgeons who come up with new procedures to reduce the invasiveness and trauma of procedures. These are the people that deserve the lion's share of the praise that goes towards doctors, and they should get the lions share of the money as well (some certainly do).

In this whole rant, I'm not trying to lay blame on doctors for the whole mess, because problems come from all sides, as I've hinted. Patients have unrealistic expectations of what doctors can do, the health industry is trying to low-ball doctors (not always without reason) to maximize profits, and many doctors who thought they would be genuinely helping people are realizing in reality that fate is largely decided before they even meet their patient (as a criminal lawyer friend put it, "90% of my client's case is decided before I ever meet him, but he wants me to work miracles!").

This is specifically why I didn't continue into medicine like so many of my friends. If you really want to help people, you don't become a regular doctor. You become a thoracic surgeon, or you do basic research, or you work in pharma, or you start a biotech. That's how you cure people. But no one will praise you for it.

jrapdx34• 12 years ago

Practicing medicine for decades gives me some "perspective" on the subject. No one in medicine is a "miracle worker", though many of us work hard to the job responsibly.

You are wrong. We do "save lives", and not just in the ED. Every day, if not as dramatically, immediately or even noticeably, our incremental toil helps patients progress bit-by-bit toward better health. Managing chronic, debilitating conditions really does enable patients to live longer and more fully.

You are also wrong regarding income. Doctors in the US are getting paid less and less, while expenses of practice go ever higher. My own income is probably less than most of the people I know in other professions.

The "mess" of the health care system (to the extent it is even systematic) is the result of the constant assault of corporations and governments at all cost to "reduce costs", but the result has been the degradation you and others notice.

The most conspicuous evil has been perpetrated by the insurance industry. For example, amazingly short-sighted insistence on paying for a "generic" medication $3/mo cheaper than the drug already working is an every day challenge. If patients don't get what is really needed, they wind up getting sicker, need more care, the result is more money spent, not saved.

The problem is that the industrialization of medicine makes it increasingly difficult to be helpful. People are not neat little uniform units produced in factories. People are enormously complex organisms that defy all rules we invent to "explain" illness and treatment. People are unique entities that require individual attention and customized approaches if true "health care" is going to be provided.

If doctors are given the resources, time and respect to do their work, I believe almost all will strive to do it right.

vacri5• 12 years ago

The truth is most doctors get paid a lot because people erroneously assign to them the ethos of miracle workers, when most of them aren't.

They get paid a lot because they have the training to both recognise and know what to do with the edge cases. Yes, the bulk of patients can be treated with the same steps, and the nursing staff can do most of that stuff without problem. But doctors are there to watch for the edge cases, and for odd cases, discuss it with their peers. Regular meetings where doctors go over uncommon issues patients are having - you may not see it when you're on the ward itself, but it's part of the process, spreading the diagnostic load, keeping skills up, and improving outcomes for the patient.

If you really want to help people, you don't become a regular doctor.

A friend's father stopped being a gynaecologist and returned to family-practise GP, because he felt like he could help people better that way, and keep himself more interested in medicine because it was more diverse an environment. In neither environment was he saving lives, but he was still helping people. The two are not synonymous.

Your comment comes off as personally bitter, and I think insulting to folks like GPs who do help people even if they aren't literally saving lives as part of daily practice. You also seem to have conflated 'finding new cures' with 'what a doctor does', the latter of which has a lot of 'applying found cures' to it, and certainly helps people.

prestadige2• 12 years ago

Going into a career because it's noble, rewarding or because it "helps people" seems like a mistake.

StavrosK2• 12 years ago

Going into a career because it's rewarding seems like a mistake?

adamnemecek• 12 years ago

I think he meant financially.

octix• 12 years ago

For some financial satisfaction comes 2nd.

ch4s33• 12 years ago

More work for less pay huh? Being squeezed by profit taking business people at the top... surely no one other than doctors can relate to such changes in the economy.

*Edit I am of course being a bit sarcastic. It's interesting to see how shifts in the general economy are changing the medical profession.

chubot• 12 years ago

That's not a helpful comment. It's already addressed in the article anyway:

Of course, doctors aren't the only professionals who are unhappy today. Many professions, including law and teaching, have become constrained by corporate structures, resulting in loss of autonomy, status, and respect.

Personally I think the history lesson in the article was great. It makes me wonder about programmers. We are riding high now. But if we keep producing software that neglects user intent, then perhaps we will also find ourselves regulated. I'm actually happy that the FTC has stepped in and constrained certain companies.

ch4s33• 12 years ago

You are of course correct, my comment was a bit too sarcastic. The history piece was really interesting.

I work around a lot of physicians, and I've become a bit tired of hearing them complain about their jobs and pay... so I think I zeroed in on that part of the article.

rayiner• 12 years ago

But if we keep producing software that neglects user intent, then perhaps we will also find ourselves regulated.

Regulation is why those professions had autonomy, status, and respect in the first place. Without legal protection, a "professional" is just a laborer, and capital always wins out over labor in the end. Temporarily the software industry is growing so quickly that programmers have a lot of leverage, but that will end. The "corporate structure" will absorb more and nore of the value created by the professional.

And that's a good thing, right? Protectionism is bad, leads to higher prices for everyone. Why should doctors or programmers be protected more than Wal-Mart shelf stockers?

jschwartzi• 12 years ago

Software Engineering is a regulated profession in some cases.

Here's one of numerous standards:

http://en.wikipedia.org/wiki/IEC_62304

Here's some FDA guidance covering Software Validation in Medical Devices:

http://www.fda.gov/medicaldevices/deviceregulationandguidanc...

It's absolutely essential that the FDA and international standards be applied when building a medical device, and that means that software must be developed according to the regulations.

Here's one reason why:

http://en.wikipedia.org/wiki/Therac-25

ams6110• 12 years ago

You seem quick to blame the "profit taking business" aspect of this but what about the government regulation and interference in medicine that caused "medicine as big business" to be the only way many doctors could operate. A sole practicioner these days would drown in paperwork and regulatory overhead. Many see their only option as becoming employees of large health care corporations.

ch4s33• 12 years ago

Yeah, the regulation can be a bit onerous, but most of its there for a reason. Especially the record keeping part, there is no reason your medical records should ever go on paper. The amount of waste due to unnecessary tests is just staggering, and most of it comes down to poor record keeping and transfer.

ArkyBeagle6• 12 years ago

Maybe this tool works, maybe it doesn't.

We sort of have to develop the habit of classifying producer-surplus-gain ( what people make above the cost of goods and services ) into rents and profits, where profits are proportional to "consumer surplus". "Consumer surplus" is the difference between what you pay for something and your reserve price for it. If you'd pay five bucks but get it for three, you have consumer surplus of two bucks.

Then and only then can we have even a hope of coherent discussion about "profit making enterprises". But one man's rent is another man's profit; it's all pretty nuanced.

marincounty• 12 years ago

1. I understand their frustration! 2. Yes--you are fighting with insurance companies; So are your patients. 3. No--you are not the "pillars of society" anymore. (That's change has been slowly taking place. Patients educated themselfs, I don't know, but patients wised up; they realize when when they are dragged in for unnecessary office visits--just to invoke another billing.) 4. O.K.--You are not making the money your father did--neither are most of your patients; the world changed. Hopefully, things will get better. You guys deserve Tort Reform--I think, but then again I sometimes feel the only reason you guys pick up the phone, or refill a prescription is because you you don't want a lawsuit. (It pathetic I'm even thinking like this?) 5. In the end, we are all in this mess together, and one day You will be a Patient. 6. I swore I would never comment on HN again. (The political Correctness is stifflling, but I needed to respond to this article.) 7. Goodbye again. That said, if you have realatively good genes, and you eat somewhat healthy; I would steer clear of most Doctors. I never thought I would say that about allopathic physicians.

exstudent3• 12 years ago

You can definitely feel this as a patient. If I could give my vitals to an app and have it diagnose and prescribe remedies, I would do it in a heart beat and never visit a doctor again (of course you would need robot surgeons too :).

I've never seen a doctor research anything either (although I'm sure they do behind the scenes). They seem to be pulling from whatever information cache they have in their head which I often suspect is horribly outdated.

I'd take a crowd sourced db of health info over a doctor's personal knowledge any day of the week.

secabeen3• 12 years ago

Every doctor is different. If you show a desire to engage with a doctor, and get the right one, you can have one that does research. When I started on cholesterol-managing medication, my physician emailed me three recent journal articles on the effectiveness of different options and the dosing considerations. It all depends on who you have, and how they run their practice.

exstudent3• 12 years ago

I agree that there are good doctors, but I'd rather not have it be such a crap shoot. The consistency and depth of knowledge provided by an expert system of some sort seems like the way to go.

khungus• 12 years ago

I've never seen a doctor research anything either

That's a little surprising to me. One of the coolest things about practicing medicine today is that I can pull out my phone in front of a patient and find guidelines that I'm not familiar with, medication side-effects, and other point-of-care resources that really do enhance my clinical ability in real-time.

Granted, I work in a hospital setting. Maybe it's different in the clinics.

BTW, though I feel I'm underpaid for what I do (which many outsiders would find ridiculous), I'm overall pretty happy with being a physician.

I'd take a crowd sourced db of health info over a doctor's personal knowledge any day of the week.

So would I. But what you'd learn in the first week of hanging out with a doctor in a typical clinical setting is that most patients are frankly too uneducated to be able to use that kind of tool. When I did residency, I suspect most of the patients I saw didn't have internet. Many were illiterate and a disturbing number simply didn't care about their own well-being.

I'd love to build up a practice with patients like you, but people like you tend to be pretty healthy.

w1ntermute• 12 years ago

When I did residency, I suspect most of the patients I saw didn't have internet. Many were illiterate and a disturbing number simply didn't care about their own well-being.
I'd love to build up a practice with patients like you, but people like you tend to be pretty healthy.

There's also the factor that teaching hospitals tend to get a lot of poor and uneducated patients. Private clinics have a different clientèle, and there are definitely plenty of individuals out there who are not in perfect medical condition, yet are educated/informed enough for doctors to interact with on a higher level than they currently do.

toomuchtodo• 12 years ago

How would you feel about IBM's Watson providing a second opinion to help with your care delivery?

Watson thread from <1 week ago: https://news.ycombinator.com/item?id=8237618

exstudent3• 12 years ago

You sound like a really good doctor, but alas I'm pretty healthy (thankfully!).

wisty• 12 years ago

So would I. But what you'd learn in the first week of hanging out with a doctor in a typical clinical setting is that most patients are frankly too uneducated to be able to use that kind of tool.

Yep. There's apps to do your taxes. But the average person isn't able to understand double entry accounting without doing a year of study on it.

k-mcgrady• 12 years ago

> "I've never seen a doctor research anything either"

I have. It's terrifying. I recently went to the GP, told them my condition (which had been diagnosed by a different GP) and their first response was to look it up on Wikipedia. Seriously. I understand that a GP isn't going to know every condition you come in with but Wikipedia as the reference material?

DanBC2• 12 years ago

Being charitable the GP wanted to know what misinformation the patients come in with.

Being realistic: yes, it's terrifying. GPs are subject to the same biases and prejudices as everyone else.

ArkyBeagle6• 12 years ago

You can always tell the premeds as an undergrad - they are the ones who ask "will this be on the test?"

vacri5• 12 years ago

It shouldn't be terrifying at all. GPs are not specialists. And even specialists don't know everything. I used to work as a neuro tech and I remember a patient came in announcing that he had some particular syndrome (I can't recall the name). I stayed quiet about it, never having heard it, but needed to get a neurologist in for the test anyway. In comes the specialist, one whose skill I greatly respected, and the patient proudly announces the syndrome. The neurologist had no qualms about directly asking what that was. The thing is, if your syndrome only has five people in the country that are affected by it, it's not reasonable to expect every doctor (even specialist) to know what it is off the top of their head. There are hundreds of thousands of maladies that can affect the human body. Many of them go by multiple names.

To top this all off, a GP is a General Practitioner. Their main role is to filter out the sniffles and the rashes, and keep an eye out for the more serious stuff, which gets passed on to an appropriate specialist. In the GP's case, going to Wikipedia gives a good, quick baseline on what the disease is. A GP shouldn't be prescribing drugs from WP, but if you say you've got McGrady's Syndrome, the GP looks it up quickly on WP (which is a very quick, concise resource), and finds out it's a liver problem of a certain type, the GP now has a base to work with. Liver problems mean X, Y, or Z in general, start looking at those avenues of inquiry.

The other thing is that while it should not be a canonical reference, when it comes to scientific topics, WP is very well written, concise, and quick to access. If you've ever used medical software, you'd know the high variety of quality there is - some is just plain awful when it comes to looking things up. And textbooks by their very nature go out of date.

mikeleeorg5• 12 years ago

I've never seen a doctor research anything either (although I'm sure they do behind the scenes).

Yup, they do it behind the scenes. They worry that too many patients would complain and feel insecure about a doctor having to do research in front of them, since the majority of patients want to feel that their doctor is the expert on all matters of their health. If a patient feels the care he/she wasn't up to par, and there are any complications, there is generally a very high risk of a lawsuit. So to prevent that, most doctors will do research outside of the view of the patient.

To be fair, they aren't sitting at their desks pulling up Wikipedia. Their research often consists of consulting with a specialist (or multiple specialists), consulting with colleagues, and searching through the volumes of medical periodicals and databases.

Most do this not just to be thorough and careful, but also because they know they need to practice defensive medicine and, well, cover their butts in case anything goes wrong.

im3w1l• 12 years ago

I wonder if in the future, doctors will become more like bearucracts. You go to the internet, find out what you have. Then you fill out the appropriate form, go to a doctor who stamps the decision with a red mark of approval, granting you access to medication / surgery.

danieltillett• 12 years ago

This is exactly how I interact with the medical monopoly. I don't think I have been to the doctor for the last 10 years without knowing my diagnosis and treatment in advance. My job has then been to guide the doctor to the correct diagnosis in a way that keeps their ego intact.

esfandia2• 12 years ago

I'd take a crowd sourced db of health info over a doctor's personal knowledge any day of the week.

I think it's a great idea, and so I went looking for a StackExchange forum for it. It turns out there is one that is in the staging phase:

http://area51.stackexchange.com/proposals/66048/health

Obviously caveat emptor, YMMV etc. would apply to such a forum, and the other issue is that a patient posting there doesn't have access to all the diagnosis tools that doctors do.

727374• 12 years ago

I think it's funny that the first picture in the article is of a doctor taking a patient's blood pressure. It's a little ironic because I've never actually had a doctor take my blood pressure (in the US). I'm not even sure if I've had a nurse do it, but more likely a physician's assistant or phlebotomist. Just like other industries medicine has been turned into an assembly line where patients are herded through the system with professionals at each level of the training pyramid doing their part. We do this to be efficient and cost effective, but speaking from personal experience, the side effect is that information gets lost from transfer to transfer and a patient has less time to bond with a doctor. I'd like to believe that many doctors would be happier working with a patient from start to finish like in the old days.

jessaustin• 12 years ago

...I've never actually had a doctor take my blood pressure...

The one time I had a physician take my blood pressure, he was like a 150WPM typist compared to the hunt-and-peck crowd. He was pumping, releasing, pumping, releasing like a madman, with his eyes fixed on the second hand of a large wall clock. He must have gotten 6 or 7 readings in a minute. After all that, he just said, "hmmm, yeah, let's get you on a diuretic."

wirrbel• 12 years ago

What has always confused me is that the perceived gap between doctors and nurses is so big. I have the impression that nurses could benefit a lot from better training and there could be a good case for positions somewhere between a nurse and a doctor. Considering the effect that _care_ (time with patient) has on patients the current model with a demi-god in white just does not scale.

My optometrist (the guy selling glasses) measured my eye sight and found that I needed a correction for some corneal irregularity (pardon me if I did not translate the terms right). I had never been given such a reading from my ophthalmologist (eye doctor) who just wrote down dioptry corrections. My optometrist then told me that the specific doctor never wrote down these numbers (i.e. ignoring a condition). This tought me a lot about medical professionals and highly educated doctors. My doctor probably is just a little bored to measure and monitor visual acuity changes in a person with small eyesight issues. That ophthalmologist also had very good reputation working with accident victims, etc.

bps4484• 12 years ago

"positions somewhere between a nurse and a doctor"

I think this is what a physicians assistant and nurse practitioners are. At least that's my understanding. They don't have an MD but are able to do a number of diagnostics and can prescribe medicine.

jkestner• 12 years ago

positions somewhere between a nurse and a doctor

They call that a physician's assistant or nurse practitioner. The latter has the nurse's more user-centric approach but can do pretty much everything a general practitioner does, including writing prescriptions (though not in Texas, yeehaw).

jdietrich• 12 years ago

Here in the UK, in addition to Nurse Practitioners we also have Surgical Care Practitioners - non-doctors who are trained to perform a specific subset of routine surgeries, or to assist in more complex surgery. It really doesn't make much sense to have a highly trained cardiac surgeon spend half an hour stitching up a patient after a surgery.

Our National Health Service benefits from substantial levels of integration, allowing for Fordist division of labour. The per-capita budget is much lower than in the US, but we can use that budget very efficiently.

Another example is the National Institute for Clinical Excellence, which develops evidence-based care pathways and makes key decisions on drug prescribing and purchasing. Because our drug buying is done centrally (giving the NHS considerable negotiating power), and because NICE are prepared to reject a drug on the basis of an inadequate cost-benefit ratio, we pay far less than most industrialised nations for medicines. It is my understanding that competition legislation would prevent insurers and HMOs from implementing such a system in the US.

GreenPlastic• 12 years ago

In order to understand the US, you have to go back to the formation of the country. The US was started because of distrust in the British government. The constitution was setup on a system of distrust, not trust.

As such, mistrust of social systems and government is deeply ingrained in US culture. Contrast this to Scandinavian countries or European countries who fundamentally trust the government.

georgemcbay• 12 years ago

I'm a leftie socialist tree-hugger American who thinks taxes (on the wealthy and corporations) need to go up quite a bit... but I still think a system of distrust is the way to go, because humans, while generally more good than evil, are inherently selfish and flawed and can too easily rationalize injustice in the face of personal gain and that makes them worthy of distrust, especially when organized.

The problem, IMO, isn't that we set up a system of distrust, but rather that we allowed the checks and balances (originally placed in the system to keep balance) to erode over time so now we have a negative feedback loop where our distrust of our own government is growing ever stronger, but for pretty good reasons (regardless of which "side of the aisle" you are on) -- unrestricted lobbying, mostly unrestricted campaign finance and lack of meaningful term limits on too much of our government increases power imbalance and thus distrust with no counterbalances to allow people to take back any power from the system that is now spinning out of control.

At this point the game is basically lost, I think, and we're just stuck sitting back and watching what happens as the system collapses over the next couple of decades. Hopefully it'll go a bit better than that "Collapse Gap" analysis suggested it will.

imroot• 12 years ago

I go to a doctor who always takes his own blood pressure readings. He also goes over every word that the nurse has charted, to make sure that he's not missing anything.

I have moved a few times, and I now happily make the two+ hour journey to see this doctor every time I need anything routine or that my major-city's doctor has a 2+ week waiting list.

This is in sharp contrast to last night, where my significant other visited the emergency room and the doctor came in and asked us why she weren't taking the medicine that our a doctor wrote for her on Wednesday. The kicker: she hadn't been to the doctor on Wednesday -- he completely screwed up everything, and then refused to see her again for the rest of the night, basically, making the OB/GYN nurse come down after surgery to talk to her and then the nurses.

My Small town doctor that I drive two+ hours for is much more amazing, happier, and gives me better care than my Cincinnati doctor. I can say the same about the dentists, and opticians that I've visited in Cincinnati as well.

chrisbennet• 12 years ago

At my doctor, the nurse takes my blood pressure and then then my doctor takes it again when he first sees me.

hkmurakami2• 12 years ago

My primary care physician and my neurologist both would personally take my readings and do even the most basic of exams themselves. They were extremely thorough, and had the utmost respect for their patients. Maybe this was the case because they were both 60+ years of age and had their own practices -- maybe this allowed them to buck the trend by having established their business before things got really bad.

They both retired earlier this year, and I am like a lost child again, having had so much trust in these two doctors :(

ericHosick• 12 years ago

I think another frustration doctors are feeling today is due to a lack of patient-doctor relationships.

Society views doctors as tools that society has a legal right to.

jseliger• 12 years ago

This resonates with what I've observed, and in 2012 I wrote an essay that fits this genre: "Why you should become a nurse or physicians assistant instead of a doctor: the underrated perils of medical school" (http://jseliger.wordpress.com/2012/10/20/why-you-should-beco...), which explains everything my girlfriend wishes she'd known before she started.

mikeleeorg5• 12 years ago

So true. Also, in San Francisco, many nurses in certain departments earn much more than doctors do.

cloverich• 12 years ago

I've read this before, and feel obligated to state I couldn't disagree more. And this is coming from someone who quit the profession (physician).

Be a nurse or PA because you have shadowed one, and enjoy the work. Their job is different than a Physicians, and personality (etc.) plays a part in which you'll enjoy. Additionally, the available specializations in medicine are something thats simply not available outside the profession. Don't settle for one or the other, choose the one that suits you.

jprince2• 12 years ago

I think we're the new independent professionals. Nobody has required a license to "practice technology" (yet, but I suspect California will find a way eventually...) and so we can do our job anywhere, for any hours, for any pay. Until bureaucracy swallows us up(as it does all professions ultimately) we'll have our golden age too.

jjoonathan2• 12 years ago

It won't be bureaucracy that kills us but rather the inevitable grind of economics. Once our industry stops growing and the supply of programmers has a chance to catch up with demand, our bargaining position weakens and the impact will be felt across the board. Those in corporations will find higher expectations (even longer hours), less respect, lower pay, and fewer benefits. Those who are "independent" will find it more difficult to acquire funding, a higher probability of failure on launch, and lower returns even when they do manage to "crush it."

This has already happened to older engineering professions and it has already happened to sectors of the software engineering world that have a different supply/demand balance than the mainstream (see: game developers). It will happen to us too. Hopefully not in the near future.

jprince2• 12 years ago

Damn, that was depressing, but after you say that I now agree with you. That's why we save aggressively...except for this year. This year, all my savings go to pay for a wedding I have very little choice about. This is the price of love. :(

lmm• 12 years ago

The supply isn't growing that fast, given how the demographics are going and how poor most teaching is. And demand continues to grow very rapidly. If software really does eat the world, I can easily see a future where the number of available programming jobs exceeds the total population.

tomjen3• 12 years ago

I work in game development and the issue isn't that there aren't enough work, the issue is that there are too few people willing to buy games.

However I seriously doubt we will run out of work for programmers across all sectors - if we can code some business app to do something ten times as fast as a normal person takes to do it (likely a low bar) then there will always be businesses willing to pay for that.

kelukelugames• 12 years ago

Do you know what's incredible?

Plenty of SDE 2s make more than 200k a year, and plenty of doctors don't.

I'm not sure if we are overpaid or they are underpaid.

ntkachov• 12 years ago

we've got the market playing for us. Once supply catches up, there won't be as high of a salary.

praptak• 12 years ago

All this sounds quite a bit like Marx's theory of alienation:

"The theoretic basis of alienation within the capitalist mode of production is that the worker invariably loses the ability to determine his or her life and destiny, when deprived of the right to think (conceive) of himself as the director of his actions; to determine the character of said actions; to define their relationship with other people; and to own the things and use the value of the goods and services, produced with their labour."

http://en.wikipedia.org/wiki/Marx's_theory_of_alienation

ArkyBeagle6• 12 years ago

Just a quick thought but Henry Ford may have found a solution to this. It's also (possibly) been shown that Ford simply had data which showed that transaction costs from turnover made the $5 wage worth his while.

Ford exhibited other bizarre managerial tics, but the world was new-and-all...

Ford's hubris was total vertical integration, but that came later. Detroit is not exactly a worker's paradise today, and few people talk about it...

Marx assumed Malthus, and Malthus could not have anticipated the more modern aspects of mass production and mass agriculture.

grimtrigger• 12 years ago

The article makes the opposite point - that government bureaucracy (and the mal-incentives it creates) is what is killing the relationships between doctors and patients.

esfandia2• 12 years ago

I didn't see any discrepancy: both the article and Marx are criticizing the alienating effect of the added bureaucracy and the lessening of the doctors' autonomy.

dobbsbob2• 12 years ago

Surprised the average income for a GP is $161,000 in the US, thought they would be paid more than Canadian MDs who's average is $300k http://www.theglobeandmail.com/life/health-and-fitness/healt...

Canada also heavily relies on US medical labs in Houston. I had to have a blood analysis done as part of a health check for a work contract years ago and my provincial health authority shipped my samples there for testing. It's cheaper for Canada to outsource all this work to Americans wonder what they are paying lab technicians.

djokkataja• 12 years ago

A little strange to be comparing American GP average income to the average income of all Canadian MDs given that GPs are paid much less than average.

"Geoff Ballinger, manager of Health Human Resources for CIHI, said the figures represent averages and vary significantly depending on a doctor’s specialty. For instance, the average family practitioner would earn less than a neurosurgeon or cardiologist."

http://www.theglobeandmail.com/life/health-and-fitness/healt...

toasted2• 12 years ago

Non-US anaesthesiologist here. I love my job and relish going to work each morning. I spend almost no time on non-clinical paperwork. I work reasonable hours, have some busy on-call shifts but am generally well supported by my department. I earn good money in the state system - enough to raise a family comfortably and have a nice house, but not silly money. I pay no malpractice insurance, but pay $400 annually to a non-profit society for medico-legal cover. If I want to I can do additional private sector work to earn more (but I don't). I live in a country where a high standard of medical care and longer life expectancy is provided for less than half the per capita health spend of USA, and the public health system is so good that the private health sector really does struggle to offer much additional benefit.

There are many great examples of socialised health systems in the world, I'm not sure why the US ignores them? Some of the WSJ comments list all the problems inherent in the US system and then blame socialism for them when the problem is completely the opposite?

tarr11• 12 years ago

In which country do you work as an anaesthesiologist?

toasted2• 12 years ago

javert• 12 years ago

The actual experience in the US has been that healthcare functioned best when it was closest to a free market, and the more we socialize it, the worse it gets. (We have been slowly socializing it for many decades through regulation.)

You can argue that we haven't been socializing it "properly," but the way we are doing it is just the way government works in the US, and that's not going to change.

In general, we don't have an efficient, honest, effective government, so it can't do anything right on a large scale. Though there are some exceptions, those are exceptions. Look at the Obamacare website scandal. That is the rule.

eli_gottlieb• 12 years ago

The actual experience in the US has been that healthcare functioned best when it was closest to a free market,

When was this?

the way we are doing it is just the way government works in the US, and that's not going to change.

That's some nice fatalism you've got there.

In general, we don't have an efficient, honest, effective government, so it can't do anything right on a large scale.

Except for all the things you forget to mention, or even to think of as government programs, because they tick quietly away, working perfectly, in the background.

venomsnake• 12 years ago

In US you have socialized the costs. Not the healthcare system. I think the only social type of medicine in US is the VA (they have the purse, their own hospitals and staff IIRC) and last time I read their costs of delivered product were much lower that the US average.

forkandwait2• 12 years ago

Downvoted, here is why:

I find your statements to be over general to an almost crazy degree -- "the actual experience"? Everywhere? "In general we don't have an honest effective government" -- really? Got data? Etc, etc.

Also, I would be interested in specific metrics of worse and better -- you make the claim it is worse because of regulation, which you imply is basically the same as socialized funding (which it isn't). So where is the data?

No offense, but this sounds like canned right wing bullshit rhetoric straight off Fox News. Granted, there is plenty of canned rhetoric on all "sides" to go around, but that doesn't make this any better.

ArkyBeagle6• 12 years ago

So we can't but Canada can?

As straining-of-credulity as such a bumper-sticker is, isn't that the logical conclusion?

Very Serious People ( with whom I happen to agree) actually say such things in "Fragile By Design". Calomiris/Haber are good writers and good thinkers. They do not call out medical nor political leadership there, but it's not exactly a stretch.

It's a short drop from this to the view of America from "V for Vendetta".

johan_larson• 12 years ago

There is very little about the health care industry, at any level, that is "free market". The government funds much of the basic research that generates new medicines and medical devices and then regulates which ones can be sold. It works hand in hand with medical professional associations to determine who can practice medicine and in what capacity; it also funds residencies, the crucial gateway to becoming a physician. It pays for a hefty portion of medical care (for the young, the old, the very poor, and veterans) directly and regulates how the rest is paid for (out of pocket, through employer-provided insurance, or privately purchased insurance).

There are a few islands of private industry in healthcare, but between the regulation and the direct payments, it's a government sea.

Barring the most radical dissolution of the current system, the question isn't whether the government should be involved, but how.

CamperBob24• 12 years ago

It's not a free market if you're forced to participate in it. Which we all are, by virtue of being alive.

ArkyBeagle6• 12 years ago

I think it's all about 1945-1950. That's when Truman (accidentally?) ensconced employer-based healthcare into law in the US and the NHS began in Britain. Of course France's solution is quite compelling, as is Germany's, Canada's, Japan's...

The "socialism" thing is just spall from decades of identity politics. Pick apart the propaganda aspects of John Wayne's movies, especially "The Alamo". I'm not snarkin' on Wayne, I love his stuff, partly because it's propaganda.

Our cognitive dissonance is best cognitive dissonance :)

I also have to wonder - if the US actually embraces a public health service would that take the pressure off the public health services of the world to keep cost down?

As economics, it's actually pretty difficult to analyze this issue. The assumptions are formidable.

alexqgb6• 12 years ago

It's not true to say that the US, in general, ignores these systems when in fact, a significant portion of the US population pays very close attention to them and would like nothing more than to seem them implemented here.

There is, however, a significant minority of really horrible, angry, violent, and generally racist people who feel deeply and ideologically threatened by the social contract on which these systems rest. And because of some unfortunate quirks in the American electoral system, they wield a level of political power that vastly exceeds their numbers. In a properly representational system, they'd be just as aggressive, ignorant, and self-defeating as they are right now. However, the body politic would be largely insulated from their rage, allowing us to safely get on with the design and development of a decent, cost-effective system.

In other words, we're being plagued by a really nasty infestation of trolls, and it's making progress in general pretty damn difficult. The good news is that this, too, shall pass. In demographic terms, this problematic political outlook is the rooted in the reactionary portion of the generation that came of age during the Civil Rights era. Their bigotry translated into a life-long political identity that has done everything it can to resist, if not reverse the "loss" they suffered in the wake of Jim Crow ending.

The Drug War is probably the best example of their continued effort to put a boot on the necks of black people. It's worth noting that the militarization of US police forces, combined with an exploding private prison industry, took root in the former Confederate states before spreading outwards to damage the rest of the nation. And of course, opposition to any kind of drug legalization remains strongest in places with the deepest histories of institutionalized racism.

The same perspective that says the state should be used as a weapon to harm black people also says the state should not be used to protect or help them in any way. Thus, the vitriolic opposition to any kind of welfare program than benefits black people. Keeping them out of the health care system was part and parcel of this larger push for institutionalized white supremacy.

But again, all this is a generational reaction to the 1960s, a particularly divisive and transformative time in American politics. When the generation that dedicated itself to obstructing the movement for greater equality finally passes from the stage, there won't be another one with either the size or the depth of hatred to maintain the current levels of opposition. So even in an electoral system as warped as ours, the certifiably batshit-insane won't be able to maintain their dominance. That's bad news for everyone with a stake in Fox News, great news for everyone else on planet Earth.

At that stage, with the right wing of the baby boom dead and buried, America will be able get on with the long-delayed work of creating a more-perfect union. Given how much pent-up demand there is for policies that reflect intelligence, fairness, humanity, and decency, I suspect demand for change - and the consensus to support it - will appear quite swiftly. So it's nice to know that there are already well-developed models we can refer to when the time comes.

mynameishere• 12 years ago

Dude, chill. Not to intrude on your fantasy world too much, but a few things:

1. The left wing of the baby boom is going to die with the right.

2. The baby boomers were famously a bunch of hippies and radicals. More seriously, they were easily the most liberal-minded generation in America at the time--and they may still be.

3. This country's ongoing demographic transformation into Brazil is not going to help the health care system, or move us toward a "more perfect union", or do anything at all positive in general. It baffles me that people think things like that.

moo• 12 years ago

Your comment reminds me of a book, "Welfare, Ethnicity and Altruism: New Data and Evolutionary Theory". The book looks for empirical evidence for the theory of ethnic nepotism and kin altruism. I don't think I agree with all conclusions but interesting in that the book argues ethnic groupings resist collective programs because they don't want to share with or support other ethnic groups.

ianstallings2• 12 years ago

Such a bunch of bullshit hand wavy name calling tripe. I'd respond with eloquence but it's completely undeserved in this case. And to think you call others trolls. That in itself is humorous.

mariodiana5• 12 years ago

"really horrible, angry, violent, and generally racist people"

Seek help.

chelch• 12 years ago

It's not as simple as the right-wing boomers dying. There are a few things we need to keep in mind: - People become more conservative as they age. - The political right receives more support from crony capitalists. - Crony capitalism is what's causing problems for these doctors in the first place.

It's happening all over the world. There's a general trend where the right-wing trolls are aligning themselves with the cronies. While the next generation wants to fight the nastiness in racial/sexist/homophobic discrimination, they're not too enthusiastic about doing anything besides paying lip service to structural problems in the way the world works economically.

ConceptJunkie3• 12 years ago

really horrible, angry, violent, and generally racist people

Bigoted commenter is really a bigot.

Thanks, you saved me from reading your post. If you had something worth saying, you blew your chance by starting out insulting me.

e403• 12 years ago

There are many great examples of socialised health systems in the world, I'm not sure why the US ignores them?

Because debate in this country has been taken over by assholes and idiots. They lie at every turn to justify their position and they don't care about facts or figures, unless they agree with their ideology.

In my dreams I fantasize about what happened in Portugal regarding decriminalization of drugs. In the current US climate, that could never happen. It bums me out, too.

dobbsbob2• 12 years ago

Problem with social health care is of course each successive government tries to purposely run it into the ground in my country so they can point to it's failures and claim we must adopt a US style private insurance method.

Another problem is creeping fees. Most clinics, hospitals ect all nickle and dime you for fees here which add up even though they aren't supposed to. Some regional health authorities here charge a flat monthly tax, which if you can't pay or are in arrears you're screwed and have to pay cash to these clinics. Because there is a standardized rate you're going to pay $135 just to talk to a doctor for 5 minutes because there's no low income clinics, all rates are the same.

Source: my young, foolish self who had to pay this out numerous times to clinics for being behind on taxes.

It's good that this works where you live but you need to be hyper vigilant on who is elected to govern your health authority, which is a huge downside of any kind of socialization of medicine. Governments are fleeting, the next one could purposely sabotage it to satisfy insurance lobbyists or be so incompetent they accidentally let it all go to hell.

jval4• 12 years ago

The problem is that the United States isn't a 'country' in the way the UK, or Denmark, or Australia is. The entire population of Denmark is 5.59 million, the size of a single second or third tier city in the US. Australia is 22 million, the size of the NYC metro area. You can socialise and centralise healthcare in countries on such a small scale, but it becomes exponentially more difficult to do in a country like the US (pop: 313 M).

The United States is an enormous country comprised of 50 separate state governments, where the powers of the federal government are extremely limited (both by the constitution itself, and by the fact that it is practically impossible to do anything at that kind of scale).

As a result, it is extremely hard to pass any sort of massive reforms. Can you imagine how difficult it would be to pass one single, uniform system of health care for all Europeans?

Talking about solutions that work well in smaller countries is all well and good, but the reality is you need different solutions if you want them to work at scale. It's the same reason why most of Facebook's backend is now written in C++ instead of PHP. It is much more painstaking to work with and harder to pick up but when you're building a huge system of interconnected parts you want something that isn't going to fall over and die suddenly.

The supposed chaos and gridlock of the US political system is a feature, not a bug. It's the reason why if you look at a list of the world's oldest nations the United States is right at the top, and is one of the largest.

EDIT: Sorry - not saying the US's healthcare system is the best it can be and didn't make that clear enough. Just saying that comparing it to other countries won't help as the US has a unique political reality.

hvidgaard2• 12 years ago

I can understand the political barriers to socialized healthcare in the US, for starters it would require a federal tax.

However, I am not buying the scale argument. What exactly makes it hard to scale? The only argument I've heard is that managing all doctors and hospitals, but that is trying to control everything, something that never works when you try to scale out, and isn't necessary either.

If anything the scale enables you to build large and very specialized hospitals that only deal with one particular aspect, e.g. cancer, and do some serious research as well.

ThomPete5• 12 years ago

I agree that Denmark don't scale. But that doesn't mean that the current system we have in the US is good or that the insurance based version is by any metrics the best possible solution for the US. You could also think in states instead.

If you look at it from a purely financial point of view the problem of the US system is that when given the choice, younger people don't insure themselves because they are healthy and so don't participate in financing those who are sick by costing the system less.

As they grow older and get sicker they end up paying insane prices unless they are paid by employees and even there the quality of the insurance varies and you still have some really absurd pre-existing conditions rules etc. If you don't have an employer to back you up you are basically screwed.

Obama Care is an attempt at solving this issue. It's not single payer but it's closer and hopefully it will help improving the healthcare system for millions of those without either healthcare or proper healthcare.

Now in my mind there is a middle ground where you pay most of your healthcare yourself (the checkups, the sinus infection etc) but you don't end up in endless debt because you become sick, your kid gets born to early and have to stay at a neonathal facility, for a longer period of time and don't have the right insurance.

And having been through the system I must say that if people think it's less beucratic than say they Danish system (which is much more social in its approach) then they would be mistaken. The sheer number of interests involved in any single episode creates complexity way beyond what seems reasonable.

So agree it's not possible to take a small nation and apply what they do, but it is possible to look at the current system and realize that the healthcare system in the US is def not a feature but rather a system with plenty of room for improvement.

Mvandenbergh2• 12 years ago

Healthcare is administered regionally, by the NHS trusts, in the UK.

Also, Germany is a federal country of 80+ million people, that's surely a better comparison than Denmark.

VLM• 12 years ago

"50 separate state governments"

I'm not understanding the problem here. Run "git clone" on the Canadian model fifty times. All done.

Furthermore we seem to have "no problem" scaling up central federal control of seemingly everything other than health care, so a comparative explanation would seem necessary, as to why federal social security is possible or federal OSHA or federal EPA or federal militarized police or the federal military itself, but for no provided reason federal health care would be impossible to scale.

mehwoot• 12 years ago

Hold on, if the U.S. is 50 separate governments, each of which have great power (since "the powers of the federal government are extremely limited"), then shouldn't each state be able to pass effective healthcare by itself? Only 2 U.S. states have populations larger than Australia, and none would make it into the top 5 E.U. countries by population.

Talking about solutions that work well in smaller countries is all well and good, but the reality is you need different solutions if you want them to work at scale.

But you just said each state is separate and the federal government has limited power, so why do they need to work at scale larger than anywhere else?

ceejayoz4• 12 years ago

You can socialise and centralise healthcare in countries on such a small scale, but it becomes exponentially more difficult to do in a country like the US (pop: 313 M).

First, as with the EU, the US is divided into fairly independent states who already manage most parts of their own healthcare/insurance systems.

Second, the idea that 30 million versus 300 million makes a huge difference in scaling healthcare is pretty silly. Sure, a healthcare system for 1,000 people would have different challenges than one for 1,000,000 people, but on nation-sized scales? You have regional divisions to keep it manageable.

What exactly makes Australia or the UK's system unscalable to the size of a US state?

It's the reason why if you look at a list of the world's oldest nations the United States is right at the top, and is one of the largest.

Massive amounts of minimally populated land to expand into likely played a more significant role, as well as a lack of aristocracy - if you look at European upheaval it's usually an issue of one of the two.

amirmc• 12 years ago

"It's the reason why if you look at a list of the world's oldest nations the United States is right at the top, and is one of the largest."

Really? Please can you elaborate on this as it makes no sense to me.

Spooky232• 12 years ago

The Feds pretty much mastered the "how do I make 50 states do stuff" problem -- they give the states money and threaten to take it away.

We've had Medicare and Medicaid for almost 50 years now, and it works reasonably well, despite significant differences in administrative practices between states. So it absolutely can be done.

We've figured out how to build a national road system, healthcare for old people, healthcare for destitute people, a national tax collection system, and 1,000 other examples. It's a solvable problem.

kghose• 12 years ago

Radiology, Ophthalmology, Anesthesiology, and Dermatology ROAD to success.

Symmetry2• 12 years ago

The issue is more complicated than just socialized vs. non-socialized. There are many countries with privately run healthcare system that are perfectly good, such as France or Switzerland. And there are countries that combine both public and private provision of healthcare and have it work perfectly well, such as Sweden or Singapore[1]. The US actually does run some hospitals directly, the VA, and I doubt this made the news outside of the US but there was a huge scandal a while ago concerning them.

The current US health situation is the end result of a long process of complicated schemes to provide more healthcare to Americans without any clearly visible costs in ways complicated enough that there are no obvious deficiencies. For instance Nixon's scheme[2] to lower costs by preventing competitions between hospitals[3] is still on the books all these years later. Given all the government interventions in the healthcare market combined with an unwillingness to bite the bullet pay for or subsidize most people's insurance directly has left the US with a healthcare system that is neither government run nor free market, but something far inferior to both.

[1] Singapore has a really weird combination of forced savings, mostly private payment, and mostly public provision which is really weird compared to everyone else but somehow gives them really good health outcomes really cheaply. I don't think the US could make that system work, though.

[2] Is there something Nixon didn't screw up? Well, besides repairing our relationship with China.

[3] Back in the day everybody knew that the USSR had a far more efficient economy than the US did (the Soviet statistics said so!), and one way people explained this was that the Soviets weren't wasting resources on competition but instead just figured out the best way to do something and put all their effort behind that.

refurb• 12 years ago

This is the best explanation of the healthcare problems the US has that I've seen in a while. It's not a "public vs. private" thing in the US that is the problem. It's a byzantine system of patchwork laws that have tried to make the system better, but only made it worse. It's so complicated now that it'll take a hell of a lot of work to fix it.

ArkyBeagle6• 12 years ago

The business model for doctors works out to is surviving a grueling educational process to gain a license against which they charge rents.

The business model for professional athletes devolves to surviving a grueling selection process in the service of building their brand as a performer against which they can charge rents.

The business model for performing musicians devolves to surviving a grueling selection process in the service of building their brand as a performer against which they can charge rents.

This has a personal cost.

BenoitEssiambre• 12 years ago

Demographics is huge headwind for doctors. In the past 30 years, median age of the population in North America went from about 27 to almost 40 and is still rising.

Doctors are usually on a fixed fee for service arrangement but every year as people get older, the length of time it takes to perform the average "service" goes up. The amount of time and ressources needed to treat older patients is almost exponential with age. Older patients' state of health is often very complex with all kinds of interactions between illnesses and medication side effects to manage. Sick people get more "services" but also each service takes significantly more time to perform. Yet doctors are expected to be able to perform as many of them each year.

There is an oversized population of people in their fifties right now. This is the age where people start to get sick but are still young enough that they are often the main income earner for their family having one or more dependents.

Doctors have to work more hours for less money trying to help families cope with increasingly common and tragic medical conditions. When a family is collapsing because of an illness and people pile up in the doctor's office (justifiably) in tears, there is no ethical way to "process" these patients in the time that is supposed to be allocated to them.

mikeleeorg5• 12 years ago

Many friends of mine are doctors and they've expressed the same feelings. There are days when they absolutely love what they do, but as an outsider, I see them experiencing more low days than high days.

Just as an anecdote, part of it is the expectations of the patient population in the Bay Area - and I'm only referring to the high income neighborhoods here; the situation differs significantly in low income neighborhoods.

Patients from high income backgrounds tend to be much more demanding than patients from low income backgrounds. At Stanford, the doctors in the emergency department are (informally) expected to stop what they're doing and sing Happy Birthday to certain high income individuals.

A lot of doctors translate this to a lack of respect, which echoes the quoted statement in the article.

Here's another anecdote. While sites like WebMD are fantastic for educating the general public about health issues, it also makes some people falsely believe they know more than the doctors treating them. And I don't mean they simply question their doctors - that is a good practice and everyone should be as educated as they can about their own health. But apparently many people argue and flat out ignore their doctors, even when their own knowledge is tragically incorrect. As one doctor put it, "Why did they come and see me at all, if they are already convinced of what they have? Just to waste their own time and money, not to mention my time?"

Again, there are times when one should definitely question their doctor and be as educated as they can. Second, third, and additional opinions can be very useful. But I'm sure many doctors would appreciate less arrogance and animosity in their attitudes.

One more note. Apparently a very high number (between 75-99%) of all doctors will have faced a malpractice claim at least once in their career. Most of these claims are frivolous, but going through something like this is extremely demoralizing. A couple of doctors I know came close to leaving the profession because of it, even after they were cleared of all wrongdoing.

I once described the job of a project manager to a doctor friend as a "thankless profession," and he immediately said, "that sounds like my job too!"

a3n• 12 years ago

A lot of doctors translate this to a lack of respect, which echoes the quoted statement in the article.

Does this mean a lack of general respect, the type that all people deserve? Or is this some kind of extra respect and dererence due to their education or profession, which no one deserves?

Because I am constantly disrespected by the medical profession. I am sent email a day or two before each appointment, reminding me that late or canceled appointments are subject to cancellation fees, yet I have NEVER been seen on time by any doctor ever.

mikeleeorg5• 12 years ago

Just a general level of respect, from what I can gather. This is all second-hand info of course. But the stories they've told me seem to indicate this.

I should have added that my friends are specialists, not general practitioners. I've heard lots of complaints about general practitioners too, in terms of late and canceled appointments, little to no interaction, being rushed out the door, etc.

aianus2• 12 years ago

As one doctor put it, "Why did they come and see me at all, if they are already convinced of what they have? Just to waste their own time and money, not to mention my time?"

Because I can't write my own prescriptions. Doctors like to abuse this privilege to charge ridiculous 'consultation fees' for giving me what I already know I need. One recent example I had to deal with: travel vaccines. $50 + $10/shot in addition to the cost of the vaccines so the guy could go "uh-huh you do need those vaccines; here you are".

mikeleeorg5• 12 years ago

That's a legitimate reason. I believe people that come in simply seeking drugs make it tough on you. Enough people abuse this privilege that many (but certainly not all) doctors have become vary of writing prescriptions. I honestly don't know if this translates into high consultation fees though.

kamaal• 12 years ago

>As one doctor put it, "Why did they come and see me at all, if they are already convinced of what they have? Just to waste their own time and money, not to mention my time?"

A lot of people are anxious that they are going to lose their jobs to automation. The profession of medicine should be no different. Whatever is happening to them is happening to nearly every single individual on earth.

>I once described the job of a project manager to a doctor friend as a "thankless profession," and he immediately said, "that sounds like my job too!"

The job of a project manager is probably the job with the highest ROI on earth. Where else do you get paid big money, to do meta supervisory work, forward emails and approve leaves. While not moving a finger towards doing any actual work yourself.

2mur• 12 years ago

I'm a physician. I love the value I bring to patients, and I enjoy what I do (most of the time). But the industry is disgusting. The people who are creating the real value for patients (nurses, technicians and doctors) have been saddled with increasing regulations and there are incredibly levels of administrators and belt-phone business guys riding them to extract every profit out of the environment.

There is no chance I would do it again.

infogulch• 12 years ago

Are you a cancer doctor by any chance?

the_duck• 12 years ago

Huh. "Belt-phone business guy" is a new expression for me. What does this mean, exactly?

hkmurakami2• 12 years ago

I imagine it literally means "the kind of business guy who has his phone clipped to his belt" (implies a certain kind of caricature of the business/sales archetype).

dmfdmf14• 12 years ago

The doctors lost the argument decades ago when they agreed that people had a right to medical services. It was self-imposed slavery (because they agreed) and now we are just discussing the details (e.g. Obamacare, medicare, etc.) and the govt programs that steal from people to pay for medical services are just windows dressing to make it look civilized and moral.

The good news is that your rights are inalienable, you can reclaim them at any time. The doctors should go on strike and reject the assumption that anyone has the right to their work. As a patient I would support the doctors 100%. Let's see how long medical services last without doctors or how laughable it will be when the govt tries to force doctors back to work. LOL.

Health Care is Not a Right. http://www.afcm.org/hcinar.html

NB: I recently dropped all my medical customers at significant drop in revenue because of HIPPA. You think things are bad now wait until that monstrosity becomes strictly enforced.

bagels• 12 years ago

"they agreed that people had a right to medical services"

What does this refer to?

e403• 12 years ago

The doctors lost the argument decades ago when they agreed that people had a right to medical services.

A bold claim without any backup.

cmdrfred• 12 years ago

I manage IT for ten dental offices, Hippa isn't that hard (full disk encryption isn't even mandatory). You must not be very good at what you do, and its probably why you are so angry.

tim333• 12 years ago

when they agreed that people had a right to medical services ... It was self-imposed slavery...

We've had rights to medical services in most of the developed world outside the US for decades. Doctors have high salaries and reasonable conditions for the most part. Funny version of slavery.

phren0logy2• 12 years ago

I am also an MD, and I find you embarrassing. The core of medicine is service to others. Granted, we could do a better job of advocating for ourselves, but you are doing it wrong.

angersock• 12 years ago

I'm rather sure that the turning point in medicine would've been the introduction of health insurance at scale and the consolidation of healthcare institutions over the past twenty years.

In a modern civilization, in a first-world nation, healthcare is a right--if it isn't, then I would like to have back the rights to monopoly of force I've granted to the government.

Also, HIPAA is not that hard.

rpgmaker• 12 years ago

Heh, one of those funny and stupid (fringe) libertarian ideas one comes across from time to time. HIPAA is actually relatively old so I think you're probably recycling an old comment you made on some web "portal" a while back.

DrFunke• 12 years ago

Put the book down, John Galt.

FLUX-YOU• 12 years ago

I am so sorry for the quality of Electronic Medical Records software you have to deal with. I realize that software quality probably takes a backseat to the matters in the article, but it certainly can't help when things don't often work and you don't know why and support can't fix it and this affects your care delivery process.

analog31• 12 years ago

We've all read about how much health care costs in the US, but I'd like to know: Into whose pockets is that money actually flowing? My guess is that those people will be doctors, even if directly caring for patients isn't how they make their money. From what I've gathered by reading about this over the years:

* More than half of doctors are self employed, meaning that their salaries don't tell the whole story about their incomes.

* Doctors are heavily invested as stockholders in provider businesses (insurance, HMO's, etc.), and the malpractice insurance industry. Until recently, my employer-provided health care was delivered by a large organization that was entirely doctor-owned.

Sorry, no links or evidence for either of these, and I think the gathering of that evidence may be difficult due to the complex financial relationships involved. But it makes me skeptical when I read about doctors struggling against "the system." Who owns the system? It may very well be that medical care costs less overseas simply due to a simpler system where costs can actually be tracked. Medicine might become a better profession in the US if med school were free, doctors worked for a salary, and everything else was owned by the government.

To be fair, it may be doctors exploiting doctors, and your career prospects upon finishing medical school may have a lot to do with how much investment money (e.g., inheritance) you have at your disposal to buy into the portion of the business that ultimately profits.

joelberman• 12 years ago

I love my primary care doctor who is also my cardiologist. He is amazing. Explains everything, and is never rushed. The only negative is sometimes he is off schedule. I just had open heart surgery and that was also wonderful. The techs, nurses, PAs, and doctors were great. In simple terms, I am thrilled with the care I got and except for one nurse from hell, I have no complaints about care and I have the utmost respect for those who helped me.

Now the dark side. I cannot imagine how many people are preparing bills, sending them to Medicare and then to my supplemental insurance. And how many questions I have about billing and how many phone calls I have to make. I am sure that the cost of administering payments is much higher than the cost of care. And yet none of that administrative work prevents disease or cures me. We need a single payer system and need to reduce the non-care-related paperwork. And let the healers heal.

healthisevil2• 12 years ago

I am a physician in Australia. Being a doctor sucks here too.

I encouraged my son to avoid medicine. He followed my advice and is enjoying himself in private equity.

Anyone bright enough to do medicine would do far better in another profession.

mariodiana5• 12 years ago

"Anyone bright enough to do medicine would do far better in another profession."

Just as a point of reference, I'm in the U.S. and not a doctor. But I've always seen careers in medicine as a kind of social scam. Not necessarily a bad one, but there is or was something funny going on.

A person smart enough to be a doctor could be many things and earn a lot more money doing one of those things. The only thing society can really offer doctors is independence and respect. That's why -- for the longest time in this country -- doctors often owned and ran their own practices. That's why we addressed doctors with the honorific "Doctor." But the first is all but dead in this country and the second, because of some kind of unwashed, egalitarian ethic that only gets worse and worse, is starting to die out too.

We've really fucked up, as a society. No one in his or her right mind is going to want to spend life kow-towing to pervasive regulations and third-party bureaucrats second guessing them and tying their hands, while rushing to and fro like a retail clerk in an understaffed big box store, and all the while having to protect the egos of patients by introducing oneself as Bob or Sally.

Doctors need prestige and independence. Without those, the lure of "doing good" just isn't enough to convince anyone to become one -- at least, not anyone I'd want to have to trust as a patient.

ForHackernews2• 12 years ago

A person smart enough to be a doctor could be many things and earn a lot more money doing one of those things.

Is that really true? Doctors are most of the best-paying jobs in the US [0] It seems to me that if you're bright, and care about making a lot of money, medicine is absolutely the way to go. Yes, there are some people who strike it rich with startups or high finance, but that's essentially buying a lotto ticket.

[0] http://www.bls.gov/oes/current/oes_nat.htm#00-0000 (sort by annual mean wage, Anesthesiologists, Surgeons, Oral and Maxillofacial Surgeons, etc.)

cashoil• 12 years ago

Is Obamacare going to be the first step towards making the U.S. a socialist country ? Is the true goal to reditribute wealth ? It is meant here, http://www.mymustardseeds.com/ultimate-goals-of-obamacare.ht....

Or is it just verbiage to shine for the next election ?

Will people suffer from Obamacare ? Are consequences to the whole system really under control (increase of the premiums, ...) ?

pessimizer• 12 years ago

Most important takeaway (other than a series of anecdotes, a general history lesson, and a few random undefended policy suggestions):

"In 1940, in inflation-adjusted 2010 dollars, the mean income for U.S. physicians was about $50,000. By 1970, it was close to $250,000—nearly six times the median household income."

Why doctors are sick of their profession

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