

“Ninety percent of doctors I know are fed up with medicine.” - czik
http://www.nytimes.com/2008/06/17/health/views/17essa.html?em&ex=1214020800&en=8c0530d81bc8f12f&ei=5070

======
jraines
Yeah, my dad, a family practice physician for 20 years, would confirm this.
His monthly overhead costs (in a tightly run physicians' group) are mind
blowing and he has working hours and a sleep schedule that would stupify this
25 year old. He could work a quarter of the hours and make more money just
doing ER work, but feels an obligation to his patient base. But there are many
other doctors making that choice or choosing lucrative niche specialties, and
who can blame them? There's almost no economic and lifestyle incentive to
become a general practitioner anymore.

Also, any time you have a complicated system that no one believes in, people
are going to try to game it. So you have some doctors billing Medicare these
huge sums for a patient coming in with a runny nose, and this further
discourages the honest doctors.

------
patrickg-zill
I know of no other field where you intensively train someone for years, then
make them do routine paperwork that takes up 25% or more of their time.

Do commercial jet pilots have to sign the purchase order for the jet fuel?
That is the equivalent kind of paperwork that doctors have to do.

~~~
ovi256
They have a problem, we have an opportunity guys. Help automatise their
paperwork and procedures! Nice big market, and clients with deep pockets. Do
it right, and it'll spread virally, as they'll recommend your product to their
collegues.

Now, I could not tell you in what form and how this automatisation would work.
Some standardizing (of data sharing etc) would help too.

And furthermore, you would help them HELP people.

~~~
nradov
There are dozens, maybe hundreds, of companies already doing this. If you have
a good idea then go ahead and try, but you'll find that the sales cycle is
slow, competition is fierce, and the pockets aren't all that deep.

There are a variety of existing standards for data sharing from organizations
like HL7, HITSP, IHE, ANSI, NCPDP, etc. The standards work but many vendors
don't fully support them yet. And sharing healthcare data means you also have
to enable your customers to comply with HIPAA privacy regulations as well as
(sometimes) more restrictive state rules.

------
iamelgringo
I've worked as an ER nurse for 15 years. I make it a habit to ask MD's that I
know whether they would become a doctor if they had to do it all over again,
and the vast majority tell me, "No". Adjusted for inflation, MD's salaries
haven't gone up for over 20 years, in fact, they've decreased over the past 10
years:
[http://www.hhnmag.com/hhnmag_app/jsp/articledisplay.jsp?dcrp...](http://www.hhnmag.com/hhnmag_app/jsp/articledisplay.jsp?dcrpath=HHNMAG/Article/data/12DEC2007/071211HHN_Online_Morrison&domain=HHNMAG)

And, if Bush's medicare cuts go through and aren't postponed, many of the good
doctors are going to be leaving 12-15 years of schooling behind and looking
for a different career.

~~~
hobbs
I've heard the same from the lawyers I know as well.

Suddenly, being an IT professional doesn't seem that bad...

------
dazzawazza
If they want they can come and work in the British NHS. A good GP here can get
£100,000 a year. Of course you'll have to put up with the MRI taking weeks
unless it's an emergency but it seems better then what that doctor suffered.

I think the biggest difference here is that although people in the UK moan a
lot about the National Health Service they do respect the doctors and staff
and value their input to society. Who doesn't benefit from feeling respected
and valued?

~~~
streety
Probably not such a good idea. We can barely find enough positions for the
doctors trained in this country.

~~~
dazzawazza
ahh, but there are a lot of openings for GP's. Our medical students all want
to be brain surgeons and don't seem to realise that without GP's most people
would be dead before needing a brain surgeon.

------
baha_man
"For me it's an endless amount of work that I can never get through to do it
properly".

Hands up anybody who's prepared to admit that this doesn't apply to their job,
and they have plenty of time to do everything expected of them to their
complete satisfaction.

------
hugh
Couldn't they find more than one guy to interview for this article? One guy
who happens to be a friend of the writer?

------
TheWama
There are some young approaches to solving this problem. One I just discovered
today is Qliance, a low-cost version of boutique care, dubbed "direct primary
care."

No insurance needed or accepted (thus no coding or paperwork), ~$50 a month,
same or next-day appointments, 24hr access to care, they take their own xrays
for free and dispense their own medicine at cost, &c.

Aside from making workloads managable (800 patients instead of 2-3000), the
really interesting part is how this does away with the perverse incentives of
insurance payments (which reward procedures rather than health, and which
turns primary care into 10 minute referral-fests, rather than actual care), as
well as sets up other good incentives, which reward the doctors for keeping
the patient healthy (healthy patients don't need to spend a bunch of time in
your office) and so on. His talk is really interesting:
[http://health.scribemedia.org/2008/01/21/garrison-bliss-
pion...](http://health.scribemedia.org/2008/01/21/garrison-bliss-pioneer-
medical-practice/)

------
dividendium
Maybe we need to redefine the problem. Some of the suggestions below were
about automating the paperwork. Why not automate the treatment? I mean
consider how unscalable it is to have a doctor, an actual person, see each
patient. At most they can get through one patient every 15 minutes.

A doctor normally looks at a patient, asks them a few questions to rule out
certain conditions and then prescribes a pill or requests a test for more
information.

Sounds like the perfect kind of job that software can do if it knew the
parameters.

The hard part is training the software, so you'd need doctors to perform
treatments in a way that a computer can understand it (codified in some way)
and then you need patients to report back on whether or not that treatment
worked.

There's your business opportunity and a real opportunity to help people, both
the doctors and the patients.

~~~
nradov
Sounds good. This will be practical just as soon as you invent an AI smart
enough to make it through medical school and pass the boards.

~~~
yummyfajitas
All the AI needs to do to be medically useful is obey the samurai principle:
meet/exceed the effectiveness of a doctor on some subset of patients, and
`raise GoSeeARealDoctorException` on the rest.

I'm sure regulators/politicians/medical establishment won't like it. But the
technical problem isn't all that bad (and has actually been solved by machine
learning for a few use cases).

------
copenja
My uncle is a surgeon and he complains about the same things:

Overheads are getting huge, profits are shrinking, etc.

Meanwhile, however, he lives in a friggin mansion. Seriously,a mansion.

Not saying this is the common case, just one observation.

------
kingkongrevenge
Over half of doctors are glorified con-artists. The MO of modern American
medicine is to sucker in trusting patients and write prescriptions and perform
procedures at great cost that empirically do not work. The doctors are feeling
frustrated because the jig is up. There are too many of them and society can't
afford the con game anymore.

~~~
msg
I downvoted because there are a lot of assertions here without sources or
context.

My anecdotal experience, where my wife is in the doctor's office routinely due
to Hashimoto's disease, is that your mileage may vary. We went to an
immunologist who sat on his hands and waited for several months for her
thyroid to get enough out of whack before he ordered more testing. We've had
several incompetent doctors who failed to diagnose conditions that harmed her
health and the health of our son. On the other hand, since we've moved and had
to find new doctors, we've gotten some really helpful doctors who really know
their business and have been clearing up longstanding immune problems.

The right doctors have really been great for us, the wrong doctors have really
been bad.

The first close citation I found for your argument was here:

[http://www.washingtonpost.com/wp-
dyn/content/article/2007/12...](http://www.washingtonpost.com/wp-
dyn/content/article/2007/12/03/AR2007120301771.html)

There was a study that most doctors have high standards, but they would fail
to report colleagues who didn't meet those standards. However, they appear to
claim that reporting would not solve the problem, just lead to its own set of
headaches.

I would say that America needs to follow the money to get to the bottom of
this problem. The prices of medical care just aren't commensurate with the
costs anymore. Ease the financial pressure and the whole system will probably
improve.

~~~
kingkongrevenge
> there are a lot of assertions here without sources or context.

I don't have time to build the full case. The nutshell version is that modern
medicine is dominated by pharmaceuticals. Doctors are largely in the pill
dispensing business. Problem is, the pills don't work. Spend more than fifteen
minutes reading about the cholesterol and statin racket for just one example,
and this is a huge billion dollar thing. It's a big chunk of what doctors do
to earn a living. My familiarity with the business comes from the software
side of pharma sales. For another example read about long term efficacy of
many kinds of chemo and heart surgery. The stuff just doesn't really work, but
it sure costs a lot.

Doctors are something like the fifth leading cause of death. Malpractice is
rife.

Modern medicine is great for trauma, injuries, and various acute diseases. But
the financial reality of health care is that most of the spending and most of
what doctors do is about lifestyle diseases, and the treatments are useless.
They give pills and order tons of tests for people who should really just be
told that there's nothing to be done other than better diet and exercise, or
maybe bed rest. They also blow millions on people who are simply in the
process of dying, mostly of old age, and the treatments are empirically known
to do nothing.

~~~
arn
"Doctors are largely in the pill dispensing business."

You do realize that doctors don't make any more money based on medications
they prescribe.

"Problem is, the pills don't work. ..... and the treatments are empirically
known to do nothing."

I don't really want to get into a big discussion about it because I know I
won't be able to convince you. But this is just wrong. Many pills do work.
Modern medicine is based on the scientific method and millions on dollars are
spent on studies to prove that therapies work. Strnagely enough, insurance
companies are part of the gatekeepers for this, since they don't want to pay
out of their pockets to provide expensive care for things that don't work.

On the other hand, much of "natural" medicine and homeopathic medicine are
based in anectodal evidence and not on any large scale scientific evidence.

~~~
dividendium
"Strnagely enough, insurance companies are part of the gatekeepers for this,
since they don't want to pay out of their pockets to provide expensive care
for things that don't work."

Consider the economics here. If something is not expensive, you don't need
insurance. So it's in the insurance companies' interests to inflate the prices
so more people will need health insurance and can't pay for procedures out of
pocket. The insurance companies just have to raise their premiums to
compensate, and the larger the amounts of money passing through their hands,
the easier it is for them to keep some of it.

I'm not attacking insurance companies, just pointing out that it's not
entirely logical to assume that their interests are aligned with yours.

~~~
arn
I'm not saying they are the only gatekeeper. But point is, pharmaceudical
companies can't just create a medication and claim it "does xyz" and expect
that people will pay for it. These medications are reviewed before being
"covered" by insurance companies or medicare (goverenment), so it's not a free
for all, as implied in the original poster's comment.

------
jcdreads
This article, while greatly interesting, isn't really hacker news. Unless
we're talking about really, really sloppy doctors.

Perhaps this would fit better at reddit instead.

~~~
mechanical_fish
Spoken like a person who has never had to answer the question "why are you an
engineer when the big money, the prestige, and the long-term career prospects
are all in medicine or law"?

Sometimes it's useful to remember that other fields have Dilberts, too.

