On the other hand, he seems to not have experienced the bullying described in the article, so maybe that part of it is the rent seeking you describe.
I do think that tech hiring is a little ridiculous at times, but if doctors mess up, people sometimes die. It would make much more sense for them to go through accreditation like engineers do, in my opinion of course.
> They put the students through hell because that's what they had to go through...
True. But the reason is that it toughens you up and winnows the wheat from the proverbial chaff. The forced marches through the wards at 2am in the morning prepare the budding doctor for the real world where he can be called upon as say, the sole doctor for miles in a rural area to attend to a mass casualty event.
>In most other countries, doctors don't have an accreditation board. ...
I do not know of any country that does not have an accreditation board. The difference between countries is the process of accreditation. Sometimes it is direct: the student takes centralized a board exam; sometimes indirect: the student takes a uni exam approved/supervised by the board.
> it doesn't require years of school to set a bone or put in some stitches
Maybe. But it requires erudition and experience to anticipate that a poorly set bone can heal with complications(malunion, non-union,infection etc.) Fun fact: when Admiral Nelson was wounded in the battle of Santa Cruz de Tenerife in 1797 field surgeons had his arm amputated but mistakenly trapped his nerve in a ligature that caused him great pain until the mistake was corrected )
> it doesn't require years of school ...(to) diagnose the flu or pneumonia
That pov is exactly how people get misdiagnosed and killed (by quacks).
There are many different diseases that present alike and even subgroups of the same diseases that have different management regimes. While it may seem obvious for instance, that a patient has pneumonia, one would also do well to ask what kind of pneumonia he has, why he has it (immunocompromise?, zoonosis?) and what the alternatives could be( the differential diagnosis). More than once has "ordinary pneumonia" been found to be lung cancer. It takes years of post graduate training and practice to become proficient enough to identify different disease conditions and manage them with confidence.
Medical school hazing is not done because the seniors are sadists. Some aspects of the process could be improved but the rigor works and makes for good doctors.
When has that happened to you, or anybody you've known?
> There are many different diseases that present alike and even subgroups of the same diseases that have different management regimes.
Sure, how frequent is that?
My point is that we're training doctors like they have to be Navy Seals, equipped and prepared for every situation, whereas in real life, a grunt with 3 months paramedic training would be up for the task.
Are you kidding me? I practiced medicine until 8 months ago when I burned out and had to take a break. One of the cases I recall having on an offshore medical center, involved 4 victims who had suffered burns(in one case over 80% of his body surface area), on a night when I had 2 other patients on admission. It easily took my team of four 5 hours to stabilize the patients and have them evacuated by helicopter.
In 2014, the oil company we subcontracted for had an incident where over 90 people suffered acute food poisoning from eating dinner at the staff canteen. This was a bacillus cereus infection with vomitting and stooling. Dont attempt to imagine that number of sick patients. There were only 2 doctors and five nurses initially to manage the incident. I could tell you war stories all day so could many other doctors.
How was any aspect of your job improved by your years of medical school, your years of residency?
Would you rather have more less trained doctors, or fewer elite doctors in those circumstances?
People fail out of the profession at various levels. A classmate of mine fled in the second year during her first dissection of a cadavar, never to return, some make it to residncy then quit. Certainly we should be vigilant and catch students before they become suicidal. But really, the practice of medicine requires a certain temperament. Some people are built for it and others are not.
> Would you rather have more less trained doctors, or fewer elite doctors in those circumstances?*
Unfortunately there is no middle ground. A doctor is either capable or he/she is not. We simply cant train them halfway. There are countries that have carried out the experiment you propose and attempt to train doctors to 'adequate' levels. The results are not good.
But how often does that occur? And is it worth the economic cost of not having doctors available, or doctors overworked? Individual human life is cheap.
>A doctor is either capable or he/she is not. We simply cant train them halfway. There are countries that have carried out the experiment you propose and attempt to train doctors to 'adequate' levels.
Do you have a source? I'd be quite interested in reading it. And the phrase "either <x> is capable or either he/she is not" can be applied to any other profession.
As someone currently in medical school, I'm going to have to agree w/ the previous comment that often "simple" cases are not so simple. For dealing with something as simple as diarrhea, you have to understand the anatomy of the GI tract, the physiology of nutrient absorption, pathophysiology of different diseases, important details about infectious causes (i.e. toxins, mech of transmission, etc.), labs, clinical presentation, associated phys/pathophys like neurological, immunological, and hematological features, associated symptoms, common patient histories, drugs and their mechanisms of actions, etc. etc. etc. The sheer volume of knowledge that you need to know and how everything fits together is something I hadn't realized before coming to med school. Plus, you have to learn clinical skills like how to take a patient history, do a physical exam, etc. all of which is only for treatment of diarrhea. Now imagine learning all of this for topics as wide ranging as all the different cancers, heart failure, emphysema, diabetes, all the different congenital defects, etc. You also have to know how to read radiology, how to intubate, draw blood, perform disease-specific tests, maybe learn how to do surgery, etc. Anyway, the point is it takes a lot of skills and concepts for a fully trained doctor to work up simple things.
You don't have to understand it. You can say "Hey, usually when you take this pill things get better" or "Just keep him hydrated with a water/salt/sugar mixture, and these things generally take care of themselves."
Human life is cheap. There are 7 billion of us. Why are we optimizing for the very few to reduce medical care for the masses?
I think this is the main point I and the other commenters are trying to explain. You do have to understand it. Imagine someone coming and telling you your software job is better done by overseas contractors - they're less efficient and cheaper so you naturally must be overpaid.
Except that ignores the many ways in which your training might make your higher cost worthwhile.
> Why are we optimizing for the very few to reduce medical care for the masses?
Are you implying there's a concerted effort to deny care? With the proliferation of nurse practitioners and physicians assistants, we're broadening the range of people who can take care of our population. Overseas, groups like Partners in Health are training community members to offer care in order to fill in gaps in health care availability.
Sorry to take this to its extreme, but I think you're proposing the idea of the marketplace finding the optimum amount of training for caregivers. As a point of opinion, this kind of system would be far more disadvantageous for society's less powerful than what we have now.
Go to your local urgent care or CVS doc in a box and you'll get a nurse practitioner who can help you out with routine stuff for low cost.
The scope of what a paramedic does and what a doctor does are totally different. The way medical care is organized capitalizes on each person's training: paramedics stabilize and transport patients; nurses carry out treatment plans; and doctors create treatment plans.
It sounds like you're saying, just because we don't always need to use an efficient algorithm all the time, we should never be trained to use efficient algorithms. This could make sense in the context of the next Rails app, but, when your life is at stake, the extra training matters.
> When has that happened to you, or anybody you've known?
In the state I grew up in, there were only three pediatric psychiatrists for multiple millions of citizens. If a doctor's training confers the ability to affect hundreds of children's lives, I definitely want them to be as knowledgeable of their area of practice as possible.
Seems like the issue is not a lot of doctors in the area. While we can't test this easily, wouldn't reducing the forced marches give more people incentive to join the profession? Then you have more doctors, better coverage and people scheduled to be on call for this.
Essentially, where's the balance between few superheroes who survived and a large number of doctors who are just pretty good.
> but the rigor works and makes for good doctors.
You're commenting on an article which talks about medical students being suicidal. And I know of 2 local doctors actually going through with that. That's not my definition of "good".
The thing is...when that fracture extends into the joint capsule, or is in multiple pieces and needs a surgical repair, you'll want the doctor around to manage that.
When that flu weakens your immune system and causes you to get a superimposed bacterial pneumonia, you'll want the doctor around to manage that.
The days when a doctor could make a living managing only simple problems are long gone, if they ever existed. These days, PAs and NPs handle the majority of healthcare's equivalent to CRUD applications, and physicians handle the complicated cases.
I have noticed that it's become popular on HN to refer to parts of the healthcare industry as "rent seeking," and while I agree to some extent, I haven't seen much evidence that doctors or medical schools themselves are rent seeking.
If we get a cold and need time off we need to visit a GP, this is rent seeking that could easily be handled by a non doctor for half the price.
As for the other points, that's just a matter of having escalation procedures. The current system has highly paid specialists doing front line technical support.
I'm not sure where you work, but I have never needed a doctor's note to get off work for a simple cold. That's a company policy issue, not the fault of the medical industry.
As I said, a lot of the front-line work is now handled by NPs and PAs. There are still physicians in primary care, but they spend much of their time handling the more complicated patients.
Every single prescription or referral to a specialist is a doctor's note.
In most of Latin America (the countries I've been to), the pharmacists were the first source of triage.
"Pooping too much? Here, take this pill. Oh wait, there's blood in there? You should probably go see somebody more informed."
Incidentally, the free availability of drugs in the way you described is being curtailed in Latin American countries.
that's what i think too, especially when students go through rounds in the hospital they get "pimped"[1] it's like hazing on top of rent seeking
[1] https://drottematic.wordpress.com/2009/11/30/pimping-in-medi...
Medicine is really hard. I have a condition that affects my lifestyle, I have to learn about it, the more I learn the better my outcome. I'm not studying medicine and only "have to" learn one little part. All the same it is not easy. It would be as though all someone had to do in their entire life was (something specific) but computer science is so hard that this is not easy.
I would say medicine is harder than computer science. DNA is 650 megabytes, not every underlying process is understood, drugs and their interractions have to be learned with tons of difficulty, even after you specialize you have to understand the entire system.
But then I read the rest of your comment, and I must say - perhaps it is true that there is room for someone to "diagnose pneumonia" or something. Doctors are expert systems: but perhaps there is room for lesser expertise.
(A small aside - it is certainly true that the long required training artificially reduces supply of doctors in the united states - however I think you are using an imprecise term "rent-seeking" and should pick a more specific term from economics since I think you are technically misusing it.)
I guess I should have mentioned my point first, which is that just like you don't need a star computer scientist to write an app for a restaurant, you don't need a doctor with all that training and theoretical knowledge to diagnose a sprained ankle.
I'm sorry about your condition, but that condition probably is fairly rare. How many of your other health issues couldn't be diagnosed by somebody with less training?
> however I think you are using an imprecise term "rent-seeking"
I don't see how I am. Can you please elucidate? You have to pass boards to practice medicine in the US, which requires a huge investment of time and money, and after you do that, you want to restrict supply so that you're in high demand. That way for the rest of your career you can coast on your laurels and keep collecting a paycheck.
You say that a "sprained ankle" is easy to diagnose -- but is it really? On the differential, how many other conditions manifest similarly? What complications can a trained doctor see, what questions do they know to ask?
In my interaction with the medical industry, in no case would I have been as well-served by a "lesser expert."
Regarding the term rent-seeking. This is quite a specific term, that means causing payment to be made for something that would be free. For example, if I opened an institute to monitor air quality and make recommendations, and managed to get the government to force everyone to pay an "air tax" for my endeavors -- this is "rent-seeking", since, of course, air can be enjoyed without paying for it.
From how I read your comment, you did not intend this usage. Rather, you meant to speak about the supply of trained doctors (not to speak about something that might be free otherwise), so it is more cartel-like behavior, at least as far as I read your argument.
I assume you still want the lesser experts we're discussing to be regulated legally, etc, and weren't comparing with "free" opinions such as if I ask an aunt about herbal medicines that have worked for her. If the latter, then, sure, I would say it is rent-seeking to start charging people to discuss herbal medicines for which discussion is otherwise free.
We're talking probabilities here. Most likely your illness is due to the most probable cause. And if it isn't, well, stuff happens.
From wikipedia: In economics and in public-choice theory, rent-seeking involves seeking to increase one's share of existing wealth without creating new wealth.
I believe that's what a lot of doctors do these days. After a weekend of tromping through the woods, I got a case of poison oak. I had to see a doctor and get a prescription for a steroid, because apparently it's a scheduled medication.
There is a lot of overlap between a cartel and rent-seeking though.
> In my interaction with the medical industry, in no case would I have been as well-served by a "lesser expert."
Is that only from your diabetic condition, or other issues? I think the question I'm raising is that maybe sometimes "it'll do" is just as good "he's elite, I'm lucky to have him".
> I assume you still want the lesser experts we're discussing to be regulated legally, etc
No. I think you should be able to hang out your shingle without government regulation.
A few things I've personally witnessed: going to the doctor for a sick note, going to the doctor for routine travel immunizations, going to the doctor for a birth control prescription, going to an optometrist for routine eye correction prescriptions.
They put the students through hell because that's what they had to go through, and they're rent seeking.
In most other countries, doctors don't have an accreditation board. Most things are simple, and it doesn't require years of school to set a bone or put in some stitches, or even diagnose the flu or pneumonia.
Similarly, you don't need a rockstar or ninja to write your CRUD app. Anybody who knows what he's doing will be able to do that, he doesn't need to be the best of the best, he just needs to be competent.