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.
I'm not sure where you got this information, but it does not apply to Physician services who have gotten 5% year over year increases in medicare reimbursements.
Physical Therapists? Sure. But the American Medical Association is a fierce lobbyist.
The AMA is indeed a fierce lobby - just not for physicians. They are widely regarded as a shill for hospital interests rather than doctors or medical professionals.
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.
There's an incredible blind spot which makes humans think of intelligence and sentience as individual.
It isn't. It isn't even individual among humans.
We're colony organisms individually, and we're a colony organism collectively. We're physically embedded in a complex ecosystem, and we can't survive without it.
We're emotionally and intellectually embedded in analogous ecosystems to the point where depriving a human of external contact with the natural world and other humans is considered a form of torture, and typically causes a mental breakdown.
Colony organisms are the norm, not the exception. But we're trapped inside our own skulls and either experience the systems around us very indirectly, or not at all.
Personally, I actually count all of those examples into abstract lifeforms which you described :D
There's also things like "symbolic" lifeforms like viruses, yeah, they don't live per-se, but they do replicate and go through "choices", but in a more symbolic sense as they are just machines that read out/ execute code.
The way I distinct symbolic lifeforms and abstract lifeforms is that mainly symbolic lifeforms are "machines" that are kind of "inert" in a temporal sense.
Abstract lifeforms are just things that are in a way or other, "living" and can exist on any level of abstraction. Like cells are things that can be replaced, so can be CEO's, or etc.
Symbolic lifeforms can just be forever inert and hope that entropy knocks them to something to activate them, without getting into some hostile enough space that kills them.
Abstract lifeforms on the other hand just eventually run out of juice.
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?
The iris thing is only used to open an account to stop you getting multiple accounts. After that access is private key. Maybe I'll try going back for a second account!? My irises may be different enough 2 years on?
Thanks for this interesting point of view. However, it may makes sense to consider whether the gap you point to can be reduced significantly with AI, by training it separately with aging eye data using existing medical data independent from the general iris pool. I have no idea how realistic that would be personally.
Why would you assume I'm in any way partial to this technology? If AI is being used to tackle medical domains, it stands to reason they would try to use it to overcome what the GP considers to be important constraints, especially since the guy in question also runs an AI company.
And what part of "I have no idea how realistic that would be personally" implies that I think it can be done without the danger of hallucinations.
I wondered this with things like FaceID. In my head, every time it unlocks it’s tweaking and tuning the what it knows to be the user, so it can adapt as a person ages, goes through weight changes, etc. However, in practice this may not be the case, since there is an easy backup and a person can re-register pretty easily.
On the topic of eyes, my dad recently had surgery on his eyes and they did one at a time, for obvious reasons. That could be a way to transition. Register both, have surgery on one, let it heal, register the healed eye, have surgery on the other, then register that. Always using the good and registered eye to authenticate. But this isn’t realistic. It requires way too much forethought and planning, when people’s minds are elsewhere.
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.
> 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.
It's mixed, though. We don't know how much "squeezing as much training" helps or hinders future performance. We do know that sleep debt hurts retention of new knowledge and skills.
So I'm not positive whether "50% more training, but with not enough sleep during most of the interval" will result in better outcomes.
> I'd be more open to this line of reasoning if physician's salaries had kept pace with inflation over the last 30 years
Doctors in the US are artificially scarce and artificially expensive compared to the rest of the world. The artificial scarcity of residencies also contributes to the unusually harsh residency work conditions.
Doctors in the United States are paid more than doctors in Norway and Switzerland even though those countries are richer and our doctors aren't better.
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.
I replied to your other comment but wanted to reply here to say that this is also probably a fair point. I guess I dont really see doctors as employees taking orders (dont doctors mostly own their own practice?) since theyre so highly paid, but probably thats how being a software dev looks to others aswell.
Im curious if you think malpractice insurance is also a significant, unnecessary cost? What if we made it harder to sue doctors? On the flip side, malpractice is still a real problem - probably not one that will be fixed by removing medical licences :D just hoping you see this comment since I am genuinely interested in your answer
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.
Thank you for the reply. As in all things, I'm prepared to be wrong, if that 7% is indeed even ballpark accurate.
btw I appreciate being called uninformed (which I dont dispute and find no offence in) rather than stupid or pigheaded or whatever. The point of talking about things is to share and increase our understanding.
For what its worth I did check this today and it seems to be more like 20% of healthcare is going to providers, not 7%.
However in the grand scheme of things this still isnt that bad, and I do think doctors/nurses deserve a good compensation, so given the problems associated, maybe we dont go with removing medical licences as a solution to healthcare costs
Hey, good attitude to have. I've been seeing this type of exchange less and less on HN, but agree completely that it's (reassessing their positions) something more people should be doing / willing to do.
