Why does it take so long to schedule a doctor's appointment in the US?(nbcsandiego.com)
nbcsandiego.com
Why does it take so long to schedule a doctor's appointment in the US?
https://www.nbcsandiego.com/news/local/why-does-it-take-so-long-to-schedule-a-doctors-appointment-in-the-us/3222649/
175 comments
This type of service exists in the US, but it's VIP/concierge level. Insurance typically does not cover all or even most of it.
I looked into doing exactly what your wife (seems to) does at the Mayo clinic recently. It's not entirely out of the question, about double to triple my out of pocket for going local via the usual route.
What they offer is basically this: Describe your issue to a care team prior to your arrival, once you arrive you will meet with your primary specialist and get referred to any tests/etc. you may need doing. These will all be scheduled in advance and simply canceled if you end up not needing them. Even the most likely procedure(s) will be scheduled, so you end up getting done in 2-3 days what typically would take 3-6mo due to wait times via my local hospital system.
It's incredibly tempting, despite the cost. The primary reason I go without medical care is due to the constant starting/stopping of the system. I need to focus on a problem and get it done with, not let it drag on for months.
I looked into doing exactly what your wife (seems to) does at the Mayo clinic recently. It's not entirely out of the question, about double to triple my out of pocket for going local via the usual route.
What they offer is basically this: Describe your issue to a care team prior to your arrival, once you arrive you will meet with your primary specialist and get referred to any tests/etc. you may need doing. These will all be scheduled in advance and simply canceled if you end up not needing them. Even the most likely procedure(s) will be scheduled, so you end up getting done in 2-3 days what typically would take 3-6mo due to wait times via my local hospital system.
It's incredibly tempting, despite the cost. The primary reason I go without medical care is due to the constant starting/stopping of the system. I need to focus on a problem and get it done with, not let it drag on for months.
I don’t know about Korea, but I know I can save money and time by flying to Thailand and going to their top medical tourism hospital. Insurance pays for part of it, but even if not the out of pocket is less than my deductible if I just pay directly. Everything is done immediately on a walk in basis, start to finish. If I need to stay the night they even have a hotel in the hospital. If you need extended treatment they have agreements with luxury hotels to provide nursing etc and the cost is less than a normal hotel in a major American city or a nice hotel in a second/third tier city.
The medical system in America is broken. The best care is possible here, but it requires extraordinary measures to get it. For 99.9% of care it’s below third world.
The medical system in America is broken. The best care is possible here, but it requires extraordinary measures to get it. For 99.9% of care it’s below third world.
Vietnam also had some good hospitals. Their lasik treatments are top notch, latest equipment, and cheap. I've had great dental work done in Saigon.
Friend of mine just got dental done in Puerto Vallarta because their dentist in Berkeley kept screwing it up, wanting more and more money.
Friend of mine just got dental done in Puerto Vallarta because their dentist in Berkeley kept screwing it up, wanting more and more money.
There was a video about a dude getting a hair transplant (got bald at 25).
It was cheaper to take a week off work, fly to Turkey with the whole family, stay for a week in a five star hotel and get the treatments in a hospital than it was to do the same operation in the US.
The package covered even limo rides from the airport to the hotel and hospital =)
It was cheaper to take a week off work, fly to Turkey with the whole family, stay for a week in a five star hotel and get the treatments in a hospital than it was to do the same operation in the US.
The package covered even limo rides from the airport to the hotel and hospital =)
The exact same care is available in the U.S. for approximately the same price as Thailand, after adjusted for local cost of living.
Sorry, I've already survived once lying in a ditch getting IV fluid from a coconut while bleeding out and waiting for the morphine to cut in.
Does Thailand have real doctors now? I always put them up there with Cambodia, North Korea, Burma(Myanmar), and Hell, known for their abundance of primarily alcoholic or drug-addicted western doctors who fled their native countries to avoid criminal charges. But I ramble...
Does Thailand have real doctors now? I always put them up there with Cambodia, North Korea, Burma(Myanmar), and Hell, known for their abundance of primarily alcoholic or drug-addicted western doctors who fled their native countries to avoid criminal charges. But I ramble...
Thailand is extraordinarily developed, along the lines of South Korea. Your experience must be quite dated. The doctors in Thailand are often western trained, but are top of their fields globally. The education system in Thailand is excellent and universal, the economy is vibrant, and the infrastructure is well developed including high speed rail etc.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3883860/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3883860/
I've considered doing this, considering I can't get either PPO or HMO insurance to pay for an MRI here.
In India, I went got a physician appointment for next morning, diagnostics the same afternoon and results at night via a text message.
Follow up with the physician, next morning.
All out of pocket for $80. No BS bureaucracy.
American healthcare is utter garbage.
Follow up with the physician, next morning.
All out of pocket for $80. No BS bureaucracy.
American healthcare is utter garbage.
American healthcare has two problems: It's for profit, so they try to maximise the amount of money they get off patients.
And number two, the amount and cost of malpractice suits is staggering. This forces doctors to order ALL THE EXAMS for every single issue just to CYA for future malpractice cases.
And number two, the amount and cost of malpractice suits is staggering. This forces doctors to order ALL THE EXAMS for every single issue just to CYA for future malpractice cases.
Don't let hospitals lie to you. It's not malpractice and malpractice insurance.
https://carbonhealth.com/blog-post/why-is-u-s-healthcare-so-...
https://carbonhealth.com/blog-post/why-is-u-s-healthcare-so-...
Most third world healthcare is for-profit. All the countries mentioned above are for-profit.
The medical office building attached to my small town hospital has a lab and x-ray suite. Sometimes you have to walk over to the x-ray suite in the hospital if they are short staffed.
I've never had one done, but I guess the hospital has an MRI also.
I've never had one done, but I guess the hospital has an MRI also.
Every time I've interacted with one of these multi-discipline facilities (in the US), it didn't matter if you walked across the hall or across Antarctica, each office treated you uniquely and you had to fill out the same damn paperwork at each of them.
Because each medical practice within is its own business entity. Like the retail stores within a mall. Imagine the duplicated administrative effort.
It's ludicrous.
Also, care providers are treated like gig workers. For instance, my superior dermatologist has two practices AND a side hustle (reviewing medical images), just to stay afloat. (Two income household, raising two kids, house nearish to work, paying off student loans.)
They and their partner are debt slaves. For the foreseeable future.
It's insane.
It's ludicrous.
Also, care providers are treated like gig workers. For instance, my superior dermatologist has two practices AND a side hustle (reviewing medical images), just to stay afloat. (Two income household, raising two kids, house nearish to work, paying off student loans.)
They and their partner are debt slaves. For the foreseeable future.
It's insane.
Maybe it's because Kaiser is more integrated than most providers, but that wasn't the case for me. I might've had to check in with separate receptions, but no actual paperwork
Kaiser is the only place I’ve seen where these things are seamless (still didn’t feel enough to keep them). Even CareFirst HMO doesn’t have that level of integration.
How is Kaiser? As a Newyorker looking to move to California at some point, I’ve heard both good and bad. But the fact that it seems more integrated and seamless than almost anything else in the US (maybe except concierge care?) is highly appealing.
I left Kaiser 10+ years ago mainly because my pcp only accepted CareFirst and I liked her enough to switch from Kaiser after nearly 15 years.
No real complaints except the PCPs seemed Alright and I didn’t like having no choice.
No real complaints except the PCPs seemed Alright and I didn’t like having no choice.
I've heard anecdotes that their mental healthcare isn't great, and their PCPs tend to be a bit rushed (or maybe I just got unlucky when picking Dr's?). But overall I liked Kaiser. I liked how well integrated everything was, and it was easy to go to another office if my doctor was on vacation or didn't have any appt openings. I also really liked that I always knew what my appointments would cost in advance.
FWIW they kinda sucked for blood draws, when I had Kaiser I needed to make separate appointments at a lab, go in, and wait. The flip side is that when I went to urgent care with an issue they were able to say "go across the street and tell them you're here for imaging, they should be ready for you in 30 minutes or so" which was super convenient.
With my current PPO doctor, it's a bit more of a pain when I have to go to specialists and pricing sometimes feels like they call rand(600) every visit. But when the doctor wants a blood draw, a nurse comes and does it immediately, which I was was the way Kaiser did it.
FWIW they kinda sucked for blood draws, when I had Kaiser I needed to make separate appointments at a lab, go in, and wait. The flip side is that when I went to urgent care with an issue they were able to say "go across the street and tell them you're here for imaging, they should be ready for you in 30 minutes or so" which was super convenient.
With my current PPO doctor, it's a bit more of a pain when I have to go to specialists and pricing sometimes feels like they call rand(600) every visit. But when the doctor wants a blood draw, a nurse comes and does it immediately, which I was was the way Kaiser did it.
"Small town hopital"
You're lucky you still have one. That is the greatest percentage of closed facilities as the us health system continues to consolidate into regional/national monopolies...
You're lucky you still have one. That is the greatest percentage of closed facilities as the us health system continues to consolidate into regional/national monopolies...
That is similar to Taiwan and Spain (if you use private hospitals, but it is still comparably affordable). However, these systems are going to be under a lot of pressure with aging populations and potentially decreasing number of medical professionals. In many European countries, patients are already seeing large wait times in public health systems, and some politicians are trying to cut medical budgets and push for privatization.
> What takes weeks if not months to complete in the US
Counterpoint: in New York, I’ve never had to wait longer than a day or two for diagnostics. Most of the time it’s same day.
EDIT: to clarify, I'm not claiming it's hunky dory. Just that our system isn't an excuse for these delays.
Counterpoint: in New York, I’ve never had to wait longer than a day or two for diagnostics. Most of the time it’s same day.
EDIT: to clarify, I'm not claiming it's hunky dory. Just that our system isn't an excuse for these delays.
Counterpoint: I’m in New York too, and I’ve given up on a few minor annoying but not life threatening health issues because of the wait times and scheduling inflexibilities between each hop of the process. I’d love a reference to your doctors (or system) :)
The saving grace for me is that my employer provides a service similar to One Medical, which at least lets me visit a doctor or nurse practitioner to get an idea of how serious something is.
The saving grace for me is that my employer provides a service similar to One Medical, which at least lets me visit a doctor or nurse practitioner to get an idea of how serious something is.
The trick is to find an integrated system. NYU Langone, Mount Sinai and One Medical run decent shops. The friction in hand offs between providers, and then patient onboarding and insurance back-and-forth, contributes so heavily to these needless delays.
Counterpoint: in India, I've never had to wait longer than a few hours for diagnostics.
> I've never had to wait longer than a few hours for diagnostics
For an MRI? I have family in India. Bloodwork is fast. But imaging is slow.
For an MRI? I have family in India. Bloodwork is fast. But imaging is slow.
I imagine for a country India's size there must be a few top-tier facilities that keep their MRI machines half unused for the occasional last-minute request.
It feels like we could solve a lot of problems and reduce a lot of guesswork if every patient got an ultrasound, an xray, and/or an MRI as a part of intake. I know the MRI is asking a lot, but just having an objective record to look back on could help doctors immeasurably. Not to mention the people where they would immediately find the problem.
>You can visit one clinic and get a comprehensive full body diagnostic exam. Results come out within a week.
On the surface this may be appealing but on reality it can lead to a pretty big waste of resources, and quite unwarranted worry for the patient. You can allways find something wrong with people, but if its not something that they notice or are leading to anything, is it worth finding?
On the surface this may be appealing but on reality it can lead to a pretty big waste of resources, and quite unwarranted worry for the patient. You can allways find something wrong with people, but if its not something that they notice or are leading to anything, is it worth finding?
This is a wildly common trope that I've never heard a patient say. May I ask what nation you're in?
Especially never one that's had their expected quality of life greatly improved by treating a disease they'd adapted their mind to live with.
You'd be absolutely shocked what red-flag symptoms people will ignore out of ignorance, or just to consider (or label) themselves "perfectly healthy".
Especially never one that's had their expected quality of life greatly improved by treating a disease they'd adapted their mind to live with.
You'd be absolutely shocked what red-flag symptoms people will ignore out of ignorance, or just to consider (or label) themselves "perfectly healthy".
>> You'd be absolutely shocked what red-flag symptoms people will ignore out of ignorance, or just to consider (or label) themselves "perfectly healthy".
I would be very interested to know some of these 'red-flag' symptoms. Can you share a few?
I would be very interested to know some of these 'red-flag' symptoms. Can you share a few?
Chronic anything can apply, really. It's a trope in itself: "Oh, I've always had that, that's always been like that."
Here's a few from people close to me, from recent memory.
Chronic (before each): joint inflammation, skin rashes or flaking, cough and/or post-nasal drip, allergy-related symptoms (even things like daily congestion, head pain, multi-colored wet ear discharge).
Here's a few from people close to me, from recent memory.
Chronic (before each): joint inflammation, skin rashes or flaking, cough and/or post-nasal drip, allergy-related symptoms (even things like daily congestion, head pain, multi-colored wet ear discharge).
It’s strange that it takes such a ridiculous amount of time to see a doctor. Every time I need one this is the standard procedure:
Are you dying? - Yes: call 911 and go to the emergency room - No: wait weeks to see PCP or months for specialists - Don’t know: go to urgent care and they’ll decide between 911 and waiting few months
If you’re not dying, like say you’re in extreme pain but doctors determine you can wait a few weeks to see the right specialist, emergency room or urgent care will send you back with pain medications and say “only take them if you need it otherwise they can be habit forming”. Then you wait till you see the right doctor. This is not how medicine should work. You can’t say that the country has the best healthcare in the world if you have to wait months to receive it.
Are you dying? - Yes: call 911 and go to the emergency room - No: wait weeks to see PCP or months for specialists - Don’t know: go to urgent care and they’ll decide between 911 and waiting few months
If you’re not dying, like say you’re in extreme pain but doctors determine you can wait a few weeks to see the right specialist, emergency room or urgent care will send you back with pain medications and say “only take them if you need it otherwise they can be habit forming”. Then you wait till you see the right doctor. This is not how medicine should work. You can’t say that the country has the best healthcare in the world if you have to wait months to receive it.
Being in extreme pain sounds like something that should be dealt with promptly but a balance should be struck here given all societies face real resource limits.
There comes a point where spending more money on healthcare means there is less to spend on social support and that leads to worse health outcomes because poverty is a huge fe of ill health.
To take it to the extreme, nobody wants to live in a society made up only of doctors where there is no food to eat.
Living in the US I certainly feel I have been offered excess healthcare, tests given routinely that would JIT be ordered in other countries with better health outcomes. I suspect these are provided to reduce the amount spent lawyers so maybe it saves money in the end given the peculiarities of the US.
There comes a point where spending more money on healthcare means there is less to spend on social support and that leads to worse health outcomes because poverty is a huge fe of ill health.
To take it to the extreme, nobody wants to live in a society made up only of doctors where there is no food to eat.
Living in the US I certainly feel I have been offered excess healthcare, tests given routinely that would JIT be ordered in other countries with better health outcomes. I suspect these are provided to reduce the amount spent lawyers so maybe it saves money in the end given the peculiarities of the US.
Same in Israel
But this is how it works in many places in Europe, like Germany or Netherlands.
No, it isn't. I can see my Primary Care Physician (PCP) same- or next-day (or a rotating replacement on the weekend) and this is true for pretty much everybody in Germany. Appointments with specialists can take longer, and many do report waiting weeks or months, though this has not been my experience at all and I usually get an appointment within days or, rarely, a few weeks.
Ymmv, I think it mostly depends on where you live, how flexible you are, if you're willing to call another specialist practice when the first is booked and whether you're insistent. And on the specialty, obviously, I'm sure there are some that are perpetually overbooked, which I was fortunate to not need myself so far. There's an artificial limit on the number of medical practices in Germany, as well.
Incidentally, my relatives who live in more rural areas seem to think nothing of driving twenty minutes for every trivial thing sometimes multiple times day, but driving 90 minutes to see a specialist twice a year is totally out of the question.
Ymmv, I think it mostly depends on where you live, how flexible you are, if you're willing to call another specialist practice when the first is booked and whether you're insistent. And on the specialty, obviously, I'm sure there are some that are perpetually overbooked, which I was fortunate to not need myself so far. There's an artificial limit on the number of medical practices in Germany, as well.
Incidentally, my relatives who live in more rural areas seem to think nothing of driving twenty minutes for every trivial thing sometimes multiple times day, but driving 90 minutes to see a specialist twice a year is totally out of the question.
> But this is how it works in many places in Europe, like Germany or Netherlands.
Nope. I can see my Primary care physician today if I wanted to. It's currently 10:55 AM. If I had called before 9, I would have gotten a scheduled slot. If i wanted to see him now I'd have to go to the open office hour and wait 30-60 minutes.
For urgent (not emergency) stuff, the 4 hospitals in my city have daily open office hours with specialists. Without an appointment, you usually wait 1-2 hours (unless they prioritize you due to pain).
For non-urgent things like a diagnostic MRI "just to check", you'd wait 1-2 weeks for your appointment.
There are two exceptions to this: We got a lack of dermatologists and psychologists and you'd probably wait 2-3 months for an appointment.
Nope. I can see my Primary care physician today if I wanted to. It's currently 10:55 AM. If I had called before 9, I would have gotten a scheduled slot. If i wanted to see him now I'd have to go to the open office hour and wait 30-60 minutes.
For urgent (not emergency) stuff, the 4 hospitals in my city have daily open office hours with specialists. Without an appointment, you usually wait 1-2 hours (unless they prioritize you due to pain).
For non-urgent things like a diagnostic MRI "just to check", you'd wait 1-2 weeks for your appointment.
There are two exceptions to this: We got a lack of dermatologists and psychologists and you'd probably wait 2-3 months for an appointment.
I can't speak for Germany, but here in the Netherlands, I can get an appointment for same or next day if I call the doctor's office early enough.
Now, unless I really have something wrong with me, the treatment will probably be "take 2 paracetamol and come back in 2 weeks if you don't feel better", but that is a different problem from not getting an appointment at all.
Now, unless I really have something wrong with me, the treatment will probably be "take 2 paracetamol and come back in 2 weeks if you don't feel better", but that is a different problem from not getting an appointment at all.
Deregulate medicine. The AMA restricts the supply of Doctors way too much to achieve $500,000 salaries . .
I am currently suffering from a torn Achilles tendon and the medical system in Palo Alto responded instantly (2hr walk-in care wait) on Saturday and with a 7am MRI and 10:45 a.m. follow-up appointment on Monday
I am currently suffering from a torn Achilles tendon and the medical system in Palo Alto responded instantly (2hr walk-in care wait) on Saturday and with a 7am MRI and 10:45 a.m. follow-up appointment on Monday
>Deregulate medicine. The AMA restricts the supply of Doctors way too much to achieve $500,000 salaries . .
This is a stupid conspiracy theory. A very brief check shows the average salary of a doctor in the US is less than $200k annually. The AMA does not have the authority over licensing of doctors to restrict anything.
Deregulating medicine can easily be shown to be a disaster in the making... since the Reagan years, regulations on health care have been relaxed like most other limits placed on corporations and it's led to poor quality care, the highest health care spending in the world, and rent seeking middlemen pocketing billions.
Health care in the US needs to be a government provided single payer system.
This is a stupid conspiracy theory. A very brief check shows the average salary of a doctor in the US is less than $200k annually. The AMA does not have the authority over licensing of doctors to restrict anything.
Deregulating medicine can easily be shown to be a disaster in the making... since the Reagan years, regulations on health care have been relaxed like most other limits placed on corporations and it's led to poor quality care, the highest health care spending in the world, and rent seeking middlemen pocketing billions.
Health care in the US needs to be a government provided single payer system.
Well, the conspiracy has an office on Michigan Avenue in Chicago, a couple of hundred employees and a nice website. It's the Accreditation Council for Graduate Medical Education. They control accreditation for medical residencies, including the number of doctors that are allowed to graduate from each accredited program each year, and in what specialties.
Until 2014 there was some competition in this with Doctors of Osteopathy, who had their own residency accreditation, but then they merged them, presumably so that they wouldn't start cranking out a bunch of DOs and devalue the profession.
This is not the AMA directly, but the AMA is one of the members of the ACGME.
Until 2014 there was some competition in this with Doctors of Osteopathy, who had their own residency accreditation, but then they merged them, presumably so that they wouldn't start cranking out a bunch of DOs and devalue the profession.
This is not the AMA directly, but the AMA is one of the members of the ACGME.
>This is not the AMA directly, but the AMA is one of the members of the ACGME.
As they should be. The largest association of doctors in the US SHOULD have a say in what constitutes a standard medical residency program in the US.
The idea that health care is expensive because hidden organizations are limiting the number of doctors in the US is a stupid conspiracy theory, period. Health care in the US is expensive because of out of control corporations that have been less and less regulated by anyone in the past 50 years.
As they should be. The largest association of doctors in the US SHOULD have a say in what constitutes a standard medical residency program in the US.
The idea that health care is expensive because hidden organizations are limiting the number of doctors in the US is a stupid conspiracy theory, period. Health care in the US is expensive because of out of control corporations that have been less and less regulated by anyone in the past 50 years.
They explicitly limit the number of residencies. You only get the number of slots they say in your residency program.
This is just like calling OPEC a stupid conspiracy theory.
This is just like calling OPEC a stupid conspiracy theory.
Residency slots are limited by federal government funding, not the AMA.
You went from "it's a conspiracy theory" to "it's true but this is the way it should be"
No, I did not. The mentioned organization establishes standards for residency programs. Just because the AMA participates does not mean they're "in control" of slots in residency programs, and in fact that organization itself does not control slots available.
You shop at a drugstore, does that mean you're part of the Big Pharma cabal?
You shop at a drugstore, does that mean you're part of the Big Pharma cabal?
That's the way with all conspiracy theories but it's usually longer than an hour for the about-face to happen.
The health care market needs functioning price signals regardless of who is paying. The fact that most providers cannot tell you up front how much something will cost should be plainly illegal. Providers charging different prices depending on who is paying should be plainly illegal. Fraudulent billing that displays a huge fake price and an "adjustment" should be plainly illegal. You can't point to regulations having been relaxed as an indication of much, because it's exactly the wrong regulations that have been removed, while the corrupt-entrenching ones have stayed - "insurance" companies forming cartels of "provider networks" should be blatantly illegal on anti-competitive grounds, but was seemingly viewed as a mechanism of competition back in the 80s or 90s and enshrined into law!
Furthermore speaking from personal experience it's not like Medicare is some panacea of needing care -> getting care. That system is full of its own rules limiting what it'll cover, reams of paperwork to justify things as medically necessary, etc. It only seems better because everyone is used to dealing with it and denials seem less opaque, but it's still ultimately rooted in top-down paternalism and controlling care, rather than patient-focused incentives.
Furthermore speaking from personal experience it's not like Medicare is some panacea of needing care -> getting care. That system is full of its own rules limiting what it'll cover, reams of paperwork to justify things as medically necessary, etc. It only seems better because everyone is used to dealing with it and denials seem less opaque, but it's still ultimately rooted in top-down paternalism and controlling care, rather than patient-focused incentives.
Agreed. The idea of "medicare for all" was a half step that was attempted because it was deemed to be more politically saleable than "socialist" health care to very partisan voters.
Expanding the present medicare system without massive changes not only be likely to decrease the quality of care but would be horrifically inefficient.
The US needs a rework of its health care system from the Federal level down, probably using something like the South Korean system as a model (which notably is NOT socialized medicine).
Expanding the present medicare system without massive changes not only be likely to decrease the quality of care but would be horrifically inefficient.
The US needs a rework of its health care system from the Federal level down, probably using something like the South Korean system as a model (which notably is NOT socialized medicine).
Let's hope the single payer isn't Medicare then, because you would have a lot fewer hospitals. Here's the money quote straight from the horse's mouth "In 2021, Medicare’s payments to hospitals continued to be below hospitals’ costs in aggregate" https://www.medpac.gov/document/march-2023-report-to-the-con...
Medicare and Medicaid are subsidized by a shadow tax on working people. Commercial insurance, like the majority of readers of this website get through their employers, pays roughly double the cost per procedure as Medicare and Medicaid. Your health premiums would be lower if we all paid the same price, but your taxes would be higher.
Medicare and Medicaid are subsidized by a shadow tax on working people. Commercial insurance, like the majority of readers of this website get through their employers, pays roughly double the cost per procedure as Medicare and Medicaid. Your health premiums would be lower if we all paid the same price, but your taxes would be higher.
Extending the current medicare system to simply cover everyone would be a stupid thing to do. Anyone involved with the problem knows that more changes are needed than to simply open the floodgates, and assumes that it will take a lot of work. I don't know why you don't understand that.
>Medicare and Medicaid are subsidized by a shadow tax on working people.
Straight out of the GOP list of talking points. Are you upset that your "hard earned dollars" are going to people who don't deserve them?
>Medicare and Medicaid are subsidized by a shadow tax on working people.
Straight out of the GOP list of talking points. Are you upset that your "hard earned dollars" are going to people who don't deserve them?
>Medicare and Medicaid are subsidized by a shadow tax on working people
It's right there on the damn W2, how is that a "shadow" tax?
>Commercial insurance, ..., pays roughly double the cost per procedure as Medicare and Medicaid.
And also every other developed country! Why is "the average american or their health plan pays double everyone else" a good thing?
>Your health premiums would be lower if we all paid the same price, but your taxes would be higher.
Also laughable. Somehow our citizens pay way more than anyone else in the world, and largely don't have better life expediencies (women giving birth in america die shockingly often!). We pay more into private healthcare systems than the rest of the world pays into public systems.
It's right there on the damn W2, how is that a "shadow" tax?
>Commercial insurance, ..., pays roughly double the cost per procedure as Medicare and Medicaid.
And also every other developed country! Why is "the average american or their health plan pays double everyone else" a good thing?
>Your health premiums would be lower if we all paid the same price, but your taxes would be higher.
Also laughable. Somehow our citizens pay way more than anyone else in the world, and largely don't have better life expediencies (women giving birth in america die shockingly often!). We pay more into private healthcare systems than the rest of the world pays into public systems.
If the costs are too high, you need a combination of cost controls and increased supply, not more funds to throw into the furnace. You also cut out as much of the admin as possible, as that is very low value spend vs delivering care.
I like taxes, with them I buy civilization. I want my taxes to go up, and my medical premiums to go away. Covering everyone is simply more economically efficient in aggregate vs the current Rube Goldberg system design, where the US spends more on healthcare than every other OECD country for worse outcomes.
I like taxes, with them I buy civilization. I want my taxes to go up, and my medical premiums to go away. Covering everyone is simply more economically efficient in aggregate vs the current Rube Goldberg system design, where the US spends more on healthcare than every other OECD country for worse outcomes.
I'm not sure that salaries tell the whole story. A lot of doctors are also part-owners of the clinical businesses. The company that provides my care is doctor owned. I've read that the malpractice insurance business is also largely doctor owned.
You should read more and expand your sources of information.
Here's a place to start... a list of the top 10 hospital systems in the US:
https://www.definitivehc.com/blog/top-10-largest-health-syst...
Hospital systems are mostly following the same path as other corporations have, merging and acquiring until there are only a few dominant firms, at which point those firms will have the market in a death grip.
There are clinics and small partnerships where doctors are part owners, but they're a tiny minority in the US. For the most part, to be a doctor in the US you have to have admitting privileges at a hospital.
Here's a place to start... a list of the top 10 hospital systems in the US:
https://www.definitivehc.com/blog/top-10-largest-health-syst...
Hospital systems are mostly following the same path as other corporations have, merging and acquiring until there are only a few dominant firms, at which point those firms will have the market in a death grip.
There are clinics and small partnerships where doctors are part owners, but they're a tiny minority in the US. For the most part, to be a doctor in the US you have to have admitting privileges at a hospital.
> Deregulate medicine. The AMA restricts the supply of Doctors way too much to achieve $500,000 salaries
Are you implying that only software engineers should make $500k/yr?
By the time a medical doctor completes training, she's nearly 30 years old, having made slave wages thus far, and now stuck with a few $100k+ of student loan debt. Don't forget malpractice insurance, overhead costs, etc.
Compare that to your average CS tech graduate who's making $200k+ at age 21 which they then spend on Teslas and ticky-tacky apartments.
Are you implying that only software engineers should make $500k/yr?
By the time a medical doctor completes training, she's nearly 30 years old, having made slave wages thus far, and now stuck with a few $100k+ of student loan debt. Don't forget malpractice insurance, overhead costs, etc.
Compare that to your average CS tech graduate who's making $200k+ at age 21 which they then spend on Teslas and ticky-tacky apartments.
Let nature play it's course, We would want US medical system to be even more expensive to the point that travelling to another country like India or Korea becomes a cheaper alternative. Or even illegal treatment becomes a real option because you can't afford a registered doctor or get one on time.
If your doctor tells you to see another doctor, ask for a "stat referral". That seems to be the magic word to make the process go fast. I don't really know what this means, or if it's an official real thing, but a doctor used these magic words and I got an appointment with a rare specialist within a day.
I got in to see a retina specialist within three hours based on a stat referral from a general ophthalmologist. But I did have a retinal hemorrhage at the time.
Certain tests - e.g., echocardiography - are almost always ordered "stat" in the hospital. So it really means nothing unless the referring doctor calls the lab where they are performed and says "we are holding up an entire operating room and its personnel pending the results of this test". THAT gets results.
So, yes, "stat" referrals will get you in very quickly - but the referring doctor is placing their credibility on the line by doing so. They are asking the doctor being referred to to go out of their way and delay other patients in order to see you because what you have is something that needs to be seen right now. The referring doctor had better have a good reason to do so, or they will become the boy who cried wolf and get ignored.
Likewise, it's allowed for one surgeon to "bump" another one for an emergency case - but they have to call them personally and explain why this emergency can't even wait for a couple of hours (aside from massive trauma, almost all can).
Certain tests - e.g., echocardiography - are almost always ordered "stat" in the hospital. So it really means nothing unless the referring doctor calls the lab where they are performed and says "we are holding up an entire operating room and its personnel pending the results of this test". THAT gets results.
So, yes, "stat" referrals will get you in very quickly - but the referring doctor is placing their credibility on the line by doing so. They are asking the doctor being referred to to go out of their way and delay other patients in order to see you because what you have is something that needs to be seen right now. The referring doctor had better have a good reason to do so, or they will become the boy who cried wolf and get ignored.
Likewise, it's allowed for one surgeon to "bump" another one for an emergency case - but they have to call them personally and explain why this emergency can't even wait for a couple of hours (aside from massive trauma, almost all can).
This may get the asker closer to the front of the line, but it pushes everyone else back. If everyone asks for a stat referral, then stat referrals will take a long time. This is something that you should probably rely on your doctor to ask for and not to insist on.
It means immediately/as-quick-as-possible, but the referring physician needs to user their best judgement before placing such order. For example, if the doctor is suspecting you have renal colic (kidney stone), the lab orders can be marked as stat.
Stat, used as a directive to medical personnel during in an emergency situation, is from the Latin word statim, which means “instantly” or “immediately.”
struct stat {
dev_t st_dev; /\* ID of device containing file */
ino_t st_ino; /* inode number */
mode_t st_mode; /* protection */
nlink_t st_nlink; /* number of hard links */
uid_t st_uid; /* user ID of owner */
gid_t st_gid; /* group ID of owner */
dev_t st_rdev; /* device ID (if special file) */
off_t st_size; /* total size, in bytes */
blksize_t st_blksize; /* blocksize for file system I/O */
blkcnt_t st_blocks; /* number of 512B blocks allocated */
time_t st_atime; /* time of last access */
time_t st_mtime; /* time of last modification */
time_t st_ctime; /* time of last status change \*/I hope that its up to the doctor to descide who gets in front of the queue and who doesn't. To exaggerate a bit, isn't this like having a blinking siren on top of your car to skip ahead on your way to work.
[deleted]
Apparently this medical usage is the source of the wider adverbial use of 'stat' (as in "get it done stat!").
[deleted]
I have Kaiser for medical coverage, which is about the closest you'll get to socialized healthcare here in the US if you don't qualify for Medicare or the VA.
I live in a populated area so we have a full doctor's office and hospital nearby, which is where my primary care doctor is.
I never have trouble getting medical care. I don't always see the same specialist (in fact it's rare to see the same one for different cases) but I have no trouble seeing my primary doctor or getting his input.
I think they've done two things to make it a lot easier to get care -- email and video appointments. I can email my doctor whenever, including pictures, and oftentimes he's able to prescribe some tests or meds right over email, and if he's not there, one of his colleagues will answer the email instead. They have a really good shared mailbox system.
And if I need to talk to the doctor, I can get a video appointment. Those allow the doctor to see a lot more patients, because I just wait online until they're ready, we have our chat, and then they move on to the next person. They don't have to clean a room in between, they don't have to have a room for me to sit and wait in, they don't need a nurse to check me in, etc.
My annual checkups are the doctor sending me an email asking if I have any issues to talk about, and ordering a bunch of tests. I go in for the tests, which is super efficient because it's a huge lab for the entire office and hospital and I don't need an appointment. Then he emails me back when the results are in to let me know if he needs to see me.
Overall it's pretty efficient, in part because they've embraced technology, and in part because it's basically a team of doctors, with my primary care doc as the default but certainly not only person who can respond.
I live in a populated area so we have a full doctor's office and hospital nearby, which is where my primary care doctor is.
I never have trouble getting medical care. I don't always see the same specialist (in fact it's rare to see the same one for different cases) but I have no trouble seeing my primary doctor or getting his input.
I think they've done two things to make it a lot easier to get care -- email and video appointments. I can email my doctor whenever, including pictures, and oftentimes he's able to prescribe some tests or meds right over email, and if he's not there, one of his colleagues will answer the email instead. They have a really good shared mailbox system.
And if I need to talk to the doctor, I can get a video appointment. Those allow the doctor to see a lot more patients, because I just wait online until they're ready, we have our chat, and then they move on to the next person. They don't have to clean a room in between, they don't have to have a room for me to sit and wait in, they don't need a nurse to check me in, etc.
My annual checkups are the doctor sending me an email asking if I have any issues to talk about, and ordering a bunch of tests. I go in for the tests, which is super efficient because it's a huge lab for the entire office and hospital and I don't need an appointment. Then he emails me back when the results are in to let me know if he needs to see me.
Overall it's pretty efficient, in part because they've embraced technology, and in part because it's basically a team of doctors, with my primary care doc as the default but certainly not only person who can respond.
NYC is great. You can usually see a doc same-day or 1-2 weeks for a specialist.
With family back in the Midwest it takes 3 months to see a primary doc and six months to a year for some specialists.
August 3rd: "I have an ear infection."
Office: "Are you available November 4th at 4:30 PM?"
If it weren't for Teladoc and a whole host of at-home digital scopes they'd never get medical attention.
edit
Not sure how this comment lead to the train-wreck of a thread below.
With family back in the Midwest it takes 3 months to see a primary doc and six months to a year for some specialists.
August 3rd: "I have an ear infection."
Office: "Are you available November 4th at 4:30 PM?"
If it weren't for Teladoc and a whole host of at-home digital scopes they'd never get medical attention.
edit
Not sure how this comment lead to the train-wreck of a thread below.
>"I have an ear infection."
Maybe there has been a paradigm shift here? Analogous to house-calls no longer being a "thing", maybe minor things like ear infections, pink eye, strep throat, etc. are now relegated to urgent care physicians. And your GP is more for following up on non-urgent and chronic/recurrent conditions like diabetes, high blood pressure, etc..
Maybe there has been a paradigm shift here? Analogous to house-calls no longer being a "thing", maybe minor things like ear infections, pink eye, strep throat, etc. are now relegated to urgent care physicians. And your GP is more for following up on non-urgent and chronic/recurrent conditions like diabetes, high blood pressure, etc..
Urgent Care is an option out there but it's always a mad dash as soon as they're open to schedule an appointment. And there's only a two-hour window at the beginning of each day for walk-ins. You can lose the lottery and have to try again the next day.
I'm currently looking for a used EKG machine so family members can use it and send the results to a doctor without having to wait 12+ hours in the ER waiting room across the aisle from the COVID seating area.
I'm currently looking for a used EKG machine so family members can use it and send the results to a doctor without having to wait 12+ hours in the ER waiting room across the aisle from the COVID seating area.
Ear infections are not minor. If left untreated, they can lead to permanent hearing loss.
House calls are still a thing if your willing to pay a lot more.
It’s just luck. In NYC my relative (w/ terrible insurance) got a biopsy, saw a surgeon the following week, was offered a spot for surgery 3 days later. Pretty fast, but the system is confusing and opaque. I complained vociferously to the doctors in my family. Basically they have a sales quota to meet which requires them to work long billable hours. One told me the Cleveland Clinic has a very efficient system. Why don’t other hospitals copy it? The answer was a bunch of lame excuses. Basically, hospital management is usually excellent MDs but incompetent business people.
After hours of discussion, my conclusion is it’s easy to make incremental improvements to the current system because it so obviously sucks. But it needs a revolution to handle universal health care.
After hours of discussion, my conclusion is it’s easy to make incremental improvements to the current system because it so obviously sucks. But it needs a revolution to handle universal health care.
This is not my experience in NYC at all. For example, waiting to see a sleep specialist took me about six months. An endocrinologist took about the same. In both cases I spent hours calling different practices and trying to find shorter wait times. My doctor says it’s still because of COVID and the shock it had to the medical system.
> NYC is great. You can usually see a doc same-day or 1-2 weeks for a specialist.
I have family in NYC. For a non-emergency condition, the earliest appointment with a specialist was there months away. It was much easier to fly to India where one could get an appointment the same day.
I have family in NYC. For a non-emergency condition, the earliest appointment with a specialist was there months away. It was much easier to fly to India where one could get an appointment the same day.
I use horse medicine (burow's solution / used to be star-otic but now that stuff is reformulated to remove any active ingredients) for an ear infection.
The ear nose throat medical profession is so corrupt. They got the only medicine that works taken off the market so you have to see a doctor. By the time I see a doctor the infection is either gone or three times worse. So I buy the horse / dog / cat medicine instead. It's the same as a human medicine but the human medicine has been taken off the market! You can't talk me out of doing this because it's been working for me for 3 decades!
Lots of medicines have been castrated and/or taken off the market to drive more people to see doctors more -
1. Chlorasceptic 2. Burow's solution
The ear nose throat medical profession is so corrupt. They got the only medicine that works taken off the market so you have to see a doctor. By the time I see a doctor the infection is either gone or three times worse. So I buy the horse / dog / cat medicine instead. It's the same as a human medicine but the human medicine has been taken off the market! You can't talk me out of doing this because it's been working for me for 3 decades!
Lots of medicines have been castrated and/or taken off the market to drive more people to see doctors more -
1. Chlorasceptic 2. Burow's solution
The horse version of medicines is formulated differently and is in a different concentration than for humans. It's your life, though.
Burow's solution is available on Amazon: https://www.amazon.com/Domeboro-Medicated-Relief-Powder-Pack...
So is Chloraseptic: https://www.amazon.com/Chloraseptic-Throat-Spray-Menthol-Bot...
Burow's solution is available on Amazon: https://www.amazon.com/Domeboro-Medicated-Relief-Powder-Pack...
So is Chloraseptic: https://www.amazon.com/Chloraseptic-Throat-Spray-Menthol-Bot...
That is NOT chlorascepric. It's new "this doesn't work" -a-sceptic. AS I SAID, medical professional have been moving to castrate OTC medicines. I have a hoard of original chlorasceptic with actual working, antiseptic ingredients ...
You have too much of a reliance on fake info from stale web articles. The only active ingredients in current chloraseptic are benzocaine, menthol, and dextromethorpan hydrobromide. I have a box of the useless kind in front of me. No actual antiseptics any more, just cover up the problem; do nothing actually.
The benzocaine variants are just a different flavor. They're produced in parallel with the original formula.
You have no idea where I get my information, you just don't like anything to contradict your loony ideas. I'm done with this conversation.
You have no idea where I get my information, you just don't like anything to contradict your loony ideas. I'm done with this conversation.
You can buy Chloraseptic Sore Throat Spray with Phenol on Amazon, if that's the active ingredient you're looking for.
The same active ingredient, phenol, has been used in Chloraseptic since 1953.
For new med school grads it makes little sense to go into primary care. The pay is low, the hours are long, and job satisfaction is plummeting as check-the-box medicine takes over.
As giant corporations like CVS, Amazon, and Walmart acquire primary care practices we'll see primary care physicians turn into fast food workers, much like pharmacists did a couple decades ago.
As giant corporations like CVS, Amazon, and Walmart acquire primary care practices we'll see primary care physicians turn into fast food workers, much like pharmacists did a couple decades ago.
Main causes of physician shortage: (1) the AMA limits the number of doctors produced and (2) residency slots are limited by funding from CMS.
God didn't dictate that only CMS can fund residencies.
Congress could do something else if they wanted. Or like hospitals could act privately to fund them.
There's probably all sorts of reasons it would be bad, but I like the idea of a revenue tax on hospitals. Automatically scales to the price of the most intensive care.
Congress could do something else if they wanted. Or like hospitals could act privately to fund them.
There's probably all sorts of reasons it would be bad, but I like the idea of a revenue tax on hospitals. Automatically scales to the price of the most intensive care.
Do you think AMA would allow Congress to increase residencies? It's a union after all. The AMA might just stop performing deluxe congressional healthcare if the Congress crosses them! And those Congresspeople are a very unhealthy bunch!
I'm surprised this article doesn't mention "Urgent Care," which appears to serve the exact role implied by the title: seeing a doctor without waiting a long time.
Yeah it's to the point where in many cases you're better off not even bothering with a primary care doctor.
The quality of care is no worse at urgent care and you can typically make a same day appointment with the doctor if your choice. Yes they rush you through but so does primary care. Maybe in the past it was different.
Downside is that it may carry a higher deductible (for no good reason).
The quality of care is no worse at urgent care and you can typically make a same day appointment with the doctor if your choice. Yes they rush you through but so does primary care. Maybe in the past it was different.
Downside is that it may carry a higher deductible (for no good reason).
Weird. I have Kaiser. Routine things, like eye exams, can be months out, but a significant, non-emergency, health issue? I'd expect to be next day, usually.
Ex Kaiser user here. I was in a lot of pain at a point, after trying quite a few things, had to do CT scan. Couldn’t get an appointment sooner than 3 weeks out.
Kaiser user here: I have been able twice in the past three years to get a same day appointment for something which presented as emergent on the previous evening.
It's the same everywhere across the world. It seems that all hospitals and clinics everywhere are operating on a 2-3-months waiting list
Yes it is my experience in the US -- but not across the world.
Last year, I was in visiting in Korea and needed to see a doctor. I randomly picked a name out of the phone book and asked my Korean-speaking friend to call and make an appointment. They said no appointment needed, just walk in. So I did.
The doctor saw me within 5 minutes of arrival. He did a physical exam, listened to my lungs, did a simple blood test and gave me a prescription. He then asked if I had insurance, to which I said No.
So he said: "I'm sorry I wlll have to charge you." I went out to the front desk and got the bill. It was the equivalent of $12. In the US it would be $300 before insurance, and $50 after -- not counting the lab cost, which would be separately billed. And all this would take weeks or months to schedule.
I went to a Korean pharmacy with a prescription for 30 days supply of multiple medicines, which in the US costs me $200 with insurance. In Korea, the cost was $50 without any insurance. I had a similar experience in Portugal years back.
People in the US don't realize how screwed up the healthcare system is here. And seem powerless to change things.
Last year, I was in visiting in Korea and needed to see a doctor. I randomly picked a name out of the phone book and asked my Korean-speaking friend to call and make an appointment. They said no appointment needed, just walk in. So I did.
The doctor saw me within 5 minutes of arrival. He did a physical exam, listened to my lungs, did a simple blood test and gave me a prescription. He then asked if I had insurance, to which I said No.
So he said: "I'm sorry I wlll have to charge you." I went out to the front desk and got the bill. It was the equivalent of $12. In the US it would be $300 before insurance, and $50 after -- not counting the lab cost, which would be separately billed. And all this would take weeks or months to schedule.
I went to a Korean pharmacy with a prescription for 30 days supply of multiple medicines, which in the US costs me $200 with insurance. In Korea, the cost was $50 without any insurance. I had a similar experience in Portugal years back.
People in the US don't realize how screwed up the healthcare system is here. And seem powerless to change things.
[deleted]
I just scheduled my first appointment with a new primary care doctor. It's on January 7, 2025. NOT a typo.
Some problems solve themselves. If you're already deceased by the time the service date comes up, the provider doesn't have to do anything.
That's fucked up.
That's fucked up.
My dad used to say he had three piles of papers on his desk: "urgent", "very urgent" and "no longer urgent".
While it's mostly not quite as bad here in Norway, it's getting there.
Lots of GP's here are quitting because they've been overloaded by paperwork. Government wants more documentation on everything. Can't just trust "some random doctor" who's known the patient for decades to sign a few days of sick leave, nope, we need paper trail!
My SO's GP almost started crying during one of her checkups since he was so overworked. He'd have a normal day seeing people during normal working hours, then there would be at least 5-6 hours of paperwork to do. He quit half a year later.
The newly trained doctors have caught on and don't apply for open GP positions. The result is that we have a massive deficit of GPs which keeps getting worse day by day.
While it's mostly not quite as bad here in Norway, it's getting there.
Lots of GP's here are quitting because they've been overloaded by paperwork. Government wants more documentation on everything. Can't just trust "some random doctor" who's known the patient for decades to sign a few days of sick leave, nope, we need paper trail!
My SO's GP almost started crying during one of her checkups since he was so overworked. He'd have a normal day seeing people during normal working hours, then there would be at least 5-6 hours of paperwork to do. He quit half a year later.
The newly trained doctors have caught on and don't apply for open GP positions. The result is that we have a massive deficit of GPs which keeps getting worse day by day.
Death by paperwork is the symptoms of late-stage bureaucracy. In the early days of something, it's all fly-by-pants and everything is so good compared to the previous alternative that nobody cares, but as it gets more and more "finalized" the paperwork mounts more and more to "prevent" issues, because the issues the overload of paperwork causes aren't accounted for.
Ten patients die because there was no doctor to see them? Nothing important.
One patient sued because a doctor made a mistake that didn't even kill them? Hugely important, ten more pages of paperwork will have to be added; the paperwork won't prevent it happening again, but now it'll clearly be the doctor that is liable, not the practice/hospital/insurance company.
Ten patients die because there was no doctor to see them? Nothing important.
One patient sued because a doctor made a mistake that didn't even kill them? Hugely important, ten more pages of paperwork will have to be added; the paperwork won't prevent it happening again, but now it'll clearly be the doctor that is liable, not the practice/hospital/insurance company.
You must be psychic. I'll be 75 on June 8 of this year, and it occurred to me that scheduling old people for appointments a year and a half way is a frictionless way of keeping a full schedule that will only get lighter as geezers like me drop dead before we can be seen. Oh well...
Reminds me of this little-known Seuss book: https://www.youtube.com/watch?v=WHyrVyCqKwo
If it's not a scheduled appointment, but a "next available time" one, ask to be put on a cancellation notification if you're near the doctor's office; they get a cancellation, call you, you're there in 10 minutes kind of thing.
If it's not a scheduled appointment, but a "next available time" one, ask to be put on a cancellation notification if you're near the doctor's office; they get a cancellation, call you, you're there in 10 minutes kind of thing.
You must also be psychic! The day after I got my "see you in the future" 2025 appointment, I woke up and saw there was a text from the doctor's office offering an earlier appointment: it said to go to the scheduling portal and follow the instructions.
I thought, "huh." That was around 6 am. I mulled it over: did I even want an earlier appointment? I'm not a big fan of doctors (full disclosure: I am one). So I went about my day and finally around 1 p.m. decided it wouldn't hurt to have a look; after all, I could ignore or decline the offered new slot.
No worries: when I logged on around 1 p.m., the portal said the new slot was no longer available.
I wasn't sad.
I thought, "huh." That was around 6 am. I mulled it over: did I even want an earlier appointment? I'm not a big fan of doctors (full disclosure: I am one). So I went about my day and finally around 1 p.m. decided it wouldn't hurt to have a look; after all, I could ignore or decline the offered new slot.
No worries: when I logged on around 1 p.m., the portal said the new slot was no longer available.
I wasn't sad.
Not psychic at all, unfortunately! I just upvote you a lot and keep and eye out for your (nearly always thought provoking) posts. IIRC, you said in the past you're a retired M.D., is that right?
If you live around the bay area, I'd love to buy you lunch sometime. You are indisputably a super interesting person, @bookofjoe! Email in profile, promise I'm pretty cool as far as humans go :p
If you're not in the bay stea, would still likely to connect with you if you're open to it. Cheers good sir.
If you live around the bay area, I'd love to buy you lunch sometime. You are indisputably a super interesting person, @bookofjoe! Email in profile, promise I'm pretty cool as far as humans go :p
If you're not in the bay stea, would still likely to connect with you if you're open to it. Cheers good sir.
Thanks for your kind words. Yes, I'm a retired neurosurgical anesthesiologist (38 years: 1977-2015).
I lived in LA from 1966-1983, when I moved to Charlottesville, Virginia, where I've remained.
I'm easy to connect with: [email protected]
When I'm not acting out on HN, I do so in these arenas:
https://www.bookofjoe.com/ (since August 2004) https://www.youtube.com/user/bookofjoe (since March 2006) https://twitter.com/bookofjoe (since November 2006)
I lived in LA from 1966-1983, when I moved to Charlottesville, Virginia, where I've remained.
I'm easy to connect with: [email protected]
When I'm not acting out on HN, I do so in these arenas:
https://www.bookofjoe.com/ (since August 2004) https://www.youtube.com/user/bookofjoe (since March 2006) https://twitter.com/bookofjoe (since November 2006)
Modern problems require modern solutions
General practitioners (who you need for primary care doctors) are unfortunately in extreme undersupply in the US.
This is a combination of things:
1) Being a specialist is much more lucrative
2) The AMA has been resisting calls to increase the pipeline of doctors
3) The absolutely shitty treatment of medical interns.
4) Many of them left due to Covid (the primary care physician is on the front line dealing with the Covidiots)
This is a combination of things:
1) Being a specialist is much more lucrative
2) The AMA has been resisting calls to increase the pipeline of doctors
3) The absolutely shitty treatment of medical interns.
4) Many of them left due to Covid (the primary care physician is on the front line dealing with the Covidiots)
Is a doctor really necessary for GP type stuff though? I've found physicians assistants to be just as effective and more readily available.
Yes and no. The buck needs to stop with somebody and that responsibility is on the GP. So, you need at least ONE visit to the main GP before you can access their assistants.
I agree that most of what GPs do is be a "router" than sends your packet to various specialists. But somebody actually has to do it.
I agree that most of what GPs do is be a "router" than sends your packet to various specialists. But somebody actually has to do it.
NPs can practice independently in ~1/2 of states, they aren't relegated to being 'assistants':
https://www.aanp.org/advocacy/state/state-practice-environme...
Of course they will escalate some care to other providers.
https://www.aanp.org/advocacy/state/state-practice-environme...
Of course they will escalate some care to other providers.
That's ... insane. We can get an appointment same-day sometimes, and never more than a week out.
Maybe it's a very popular doctor?
Maybe it's a very popular doctor?
Is this doctor special or in high demand or something? this sounds like a machine err.
Kaiser's web portal showed no PCP doctors available, but when I called I was able to get assigned.
Kaiser's web portal showed no PCP doctors available, but when I called I was able to get assigned.
No, just an ordinary family doctor. Coincidentally, my neighbor across the street, a 70-year-old woman, had her longtime family doctor retire. She was given a list of names recommended by her doctor. She called the first one to make an appointment and — believe it or not — received one for January 2025 (not the same doctor as me). I told her we should go as a couple to both appointments for moral support.
Woah. Where in the United States is this? Have you tried looking around at different providers or is there a extreme shortage?
Might as well drive or fly to another area for healthcare.
Might as well drive or fly to another area for healthcare.
Charlottesville, Virginia
Wow, I'm in the Nova/DC area. Thats really somewhat surprising to hear.
Does Charlottesville have a medical network like One Medical that exist there?
Whenever that happens I just to the ER and greatly exaggerate my symptoms.
anecdata - E/Rs in my locale are 6 to 8 hour waits with total time spent with triage/nurse/physician totalling maybe 15 minutes (20 if they decide you need an x-ray). Since the queue seems to vary very little it just seems weird.
Due to this wait, I've been conditioned to treat it as a last resort. Perhaps that is the desired effect.
Due to this wait, I've been conditioned to treat it as a last resort. Perhaps that is the desired effect.
You wanna be careful with that...
Was that due to a lack of supply or too much demand?
Which city/system?
Is it really?
I come from a country with universal healthcare, and while public healthcare suffers from the same wait times we see in the US, private healthcare is on an entirely different league. For instance, with a good private health insurance plan, on a whim, without a referral, one could get an appointment at a decent specialist, and possibly the specialist of their choice within the week. My experience in the US is that you wait 3 months to see any specialist at all.
I come from a country with universal healthcare, and while public healthcare suffers from the same wait times we see in the US, private healthcare is on an entirely different league. For instance, with a good private health insurance plan, on a whim, without a referral, one could get an appointment at a decent specialist, and possibly the specialist of their choice within the week. My experience in the US is that you wait 3 months to see any specialist at all.
Not really been my experience in a midsized US town. Don’t think I’ve ever waited more than a month or so… and generally same week if it’s something urgent. I do have Blue Cross though, which is I guess pretty good as us insurance goes.
What was the last time that you tried to get an appointment at a decent specialist at your home country?
To give you some context, my home country is Brazil. Last time I used my private health insurance was in July 2021 and the wait time to see a top specialist was one week. However, I have been there again (without health insurance) and was able to get a same week appointment at the end of March this year, which cost $200.
With a good private insurance (a PPO plan), I had a similar experience in the US. Well, in NYC which is not representative of the US, of course. Many things in the US basically repeat the population density map.
The US equivalent would be concierge medicine, which performs as well as you're saying private medicine does in your country.
Not true at all, in countries with dual systems(public healthcare and private one) the private care usually acts as a shortcut to get things done quickly.
Often it's useful to get things going in private care and if you are not rich you can continue on the public system. The idea is that once you know which specialist you need to see, the waiting lists are shorter and you will be triaged depending on you situation. If that specialist happens to have long waitlist, you can choose to get private care and maybe get the actually expensive surgery in a public hospital. Also, the governments can run special programs where they purchase services from the private sector and offer those as public services where capacity is needed.
Most often patients don't need that advanced care or diagnostics and in some cultures people are just doctor-happy, so different lines with a premium tier can work to do good triage and optimize the workforce.
Often it's useful to get things going in private care and if you are not rich you can continue on the public system. The idea is that once you know which specialist you need to see, the waiting lists are shorter and you will be triaged depending on you situation. If that specialist happens to have long waitlist, you can choose to get private care and maybe get the actually expensive surgery in a public hospital. Also, the governments can run special programs where they purchase services from the private sector and offer those as public services where capacity is needed.
Most often patients don't need that advanced care or diagnostics and in some cultures people are just doctor-happy, so different lines with a premium tier can work to do good triage and optimize the workforce.
But I was always assured the US has the greatest healthcare system in the universe because it's privately profited from!
The US is the greatest healthcare system, because it's the most profitable (for insurance companies).
Patient outcomes and public health are irrelevant and unimportant; only profit matters.
Patient outcomes and public health are irrelevant and unimportant; only profit matters.
Any system predicated on the assumption that all humans are good-willed and eager to sacrifice for others is doomed.
ie. there must be some other incentive for a system, operated by humans, to succeed.
ie. there must be some other incentive for a system, operated by humans, to succeed.
Only 2-3 months would be heaven sent. And don't forget we're paying twice as much for the care that we do receive.
If you understand queuing theory, making your queue longer does NOT increase throughput. If you can handle 50 visits per week a longer queue will not change that. If there are more requests for visits than you can handle the queue will eventually become infinitely long. The only reason for longer queues is to ration care by only allowing so many visits per year. I see the reason for this happening as due to something that started a couple decades ago. People started saying "I paid for medical care, so I'm going to use it as much as I want" and they started going in to see a doctor for every minor thing. The medical systems responded by requiring appointments months in advance. If you have to wait three months for an appointment you can only get in four times a year. Thus the people who were coming in every week were blocked. Essentially the people started abusing the system and the system used its scheduling power to counter that abuse. Over time it became standard practice, the clinicians like it because it makes their jobs easier. I would have thought the insurance companies would have hated it, because less care means less volume overall which means their prices would have to go down (paying more is used to justify higher prices so for a fixed profit percentage more volume means more profit). Maybe this is an area where the clinicians got their way, or maybe the insurance companies just couldn't find a way to claim they had control over scheduling.
Usually doctors keep some appointment slots open to handle patients that need quicker care and their assistants will use those slots if they think you need it. Otherwise long queues are a way to ration non-urgent care.
Usually doctors keep some appointment slots open to handle patients that need quicker care and their assistants will use those slots if they think you need it. Otherwise long queues are a way to ration non-urgent care.
Businesses prioritize cutting costs and boosting profits. The more pressing a problem, the more cash it brings in. So if you wait 6 months and your minor issue becomes urgent, its seen as more profitable and a good thing.
This narrative is echoed throughout our economy, with total disregard for the social damage caused by chasing profits. Take housing, for example: Real estate investors benefit from scarcity. The lack of new construction to meet population growth has always been intentional.
This narrative is echoed throughout our economy, with total disregard for the social damage caused by chasing profits. Take housing, for example: Real estate investors benefit from scarcity. The lack of new construction to meet population growth has always been intentional.
Not just in the US. I live in Netherland, and if I had to go to the doctor, I used to be able to get an appointment in a few days. Now it's two weeks.
I don't live in the US so take this with a grain of salt but I get the impression recently that with the insurance regime they have in place, for most people the US effectively has socialized healthcare, with all of the downside. The advantage I think, is that if you have enough money you can get better care and not have to wait. But if you've got some run of the mill insurance you're relying on, you might as well be in Canada (our healthcare sucks) with massive wait times and very limited access to any kind of specialist.
Personally I'm growing to favor a mixed model, where people pay for primary care and government insures treatment for really expensive, catastrophic stuff. That's much more in line with the normal way we insure things (insuring against regular, knows costs is stupid) and also makes sure people don't become bankrupt when they get a serious illness.
Lastly, I was in a European country recently and got doctors appointments (without national insurance) for myself and my son basically on demand, for so little money it was not an issue. That's possible in the US too, I think the current "socialized" insurance system is the biggest impediment.
Personally I'm growing to favor a mixed model, where people pay for primary care and government insures treatment for really expensive, catastrophic stuff. That's much more in line with the normal way we insure things (insuring against regular, knows costs is stupid) and also makes sure people don't become bankrupt when they get a serious illness.
Lastly, I was in a European country recently and got doctors appointments (without national insurance) for myself and my son basically on demand, for so little money it was not an issue. That's possible in the US too, I think the current "socialized" insurance system is the biggest impediment.
> That's possible in the US too
Absolutely, as long as you don’t rely on hospitals for your care exclusively. We have many alternative care facilities in place, most of which are at cheaper prices and lesser wait times. Clinics (which can specialize in everything from mental health, dentistry, rehabilitation, general care), colleges/universities (for both students and non-students, universities with medical courses can provide free/discounted medical care), even some smaller hospitals will have days where they waive fees for general checkups/smaller tests.
The staff may be “less experienced”, but I don’t need to waste my time and money on a doctor for an infection when they’ll prescribe me the same things a nurse practitioner would. And if I lack dental/eye insurance, then any care is better than none at all.
Though it should also be noted that the US doesn’t have many easily available forms of socialized medicine. We have four forms, two of which are highly state-dependent (which means its a PITA to get). First, veterans get free healthcare for life, paid entirely by the taxpayer via the federal government. Similar to colleges, where prices are insane because its basically the government signs blank checks, but that price thankfully never comes to the vet directly, unlike colleges.
Then we have Medicare and Medicaid, for those 65 or older and low income individuals respectively. You can get both, in fact the way coverages are split its almost assumed you will, but while Medicare is paid for by your own taxes, and thus almost immediately available to you once you hit 65, Medicaid is paid by everyones state taxes, and is notoriously hard to get. Additionally, since its a state-funded program, its offerings depend on each state. Finally we have “charity care”, also known as “financial assistance”, which federally is defined as “ free or discounted health services provided to persons who meet the organization’s eligibility criteria for financial assistance and are unable to pay for all or a portion of the services.”[0] This leaves the actual services available and eligibility at the discretion of state law, local law, and the hospital themselves.
So our long wait times aren’t exclusively due to any socialized programs. Instead, it’s almost exclusively due to a doctor shortage. For one, costs and time are a natural gate that’s basically ever present outside of extreme situations. One of the major blockades is in residency positions, a requirement for doctors that’s held with a firm grip by Congress via Medicare. And that’s not even getting into the limitations for importing doctors permanently via green cards.
[0] - IRC Section 501(r)(4) - https://www.irs.gov/charities-non-profits/financial-assistan...
The staff may be “less experienced”, but I don’t need to waste my time and money on a doctor for an infection when they’ll prescribe me the same things a nurse practitioner would. And if I lack dental/eye insurance, then any care is better than none at all.
Though it should also be noted that the US doesn’t have many easily available forms of socialized medicine. We have four forms, two of which are highly state-dependent (which means its a PITA to get). First, veterans get free healthcare for life, paid entirely by the taxpayer via the federal government. Similar to colleges, where prices are insane because its basically the government signs blank checks, but that price thankfully never comes to the vet directly, unlike colleges.
Then we have Medicare and Medicaid, for those 65 or older and low income individuals respectively. You can get both, in fact the way coverages are split its almost assumed you will, but while Medicare is paid for by your own taxes, and thus almost immediately available to you once you hit 65, Medicaid is paid by everyones state taxes, and is notoriously hard to get. Additionally, since its a state-funded program, its offerings depend on each state. Finally we have “charity care”, also known as “financial assistance”, which federally is defined as “ free or discounted health services provided to persons who meet the organization’s eligibility criteria for financial assistance and are unable to pay for all or a portion of the services.”[0] This leaves the actual services available and eligibility at the discretion of state law, local law, and the hospital themselves.
So our long wait times aren’t exclusively due to any socialized programs. Instead, it’s almost exclusively due to a doctor shortage. For one, costs and time are a natural gate that’s basically ever present outside of extreme situations. One of the major blockades is in residency positions, a requirement for doctors that’s held with a firm grip by Congress via Medicare. And that’s not even getting into the limitations for importing doctors permanently via green cards.
[0] - IRC Section 501(r)(4) - https://www.irs.gov/charities-non-profits/financial-assistan...
It seriously sucks in France too. I didn't realize it was so bad until I started to have health issues. I suppose that when things are/become serious, doctors find a slot for you. That is if you're fortunate enough to at least have access to a MD.
When it gets really bad you can always go to the ER, but I hope I can be treated before reaching that stage.
At least, things are cheap compared to the US.
When it gets really bad you can always go to the ER, but I hope I can be treated before reaching that stage.
At least, things are cheap compared to the US.
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For an annual checkup, I see the same waits. But if I actually need to talk to a doctor now, I can get access to a MD within a day or two by calling the office.
The dentist wait list is the worst though. During Covid, it was like 6 month wait time when everybody suddenly remembered to take care of their teeth
The dentist wait list is the worst though. During Covid, it was like 6 month wait time when everybody suddenly remembered to take care of their teeth
I’m going deaf in one ear for an unknown reason which is causing major tinnitus, I have been waiting a year already to actually see an ENT. I managed to get a hearing test so they can tell me what I already knew but that took 6 months to schedule, and the follow up with an actual doctor is still pending.
The more tricks you learn over time, the more effective the US health care system can be. It shouldn't have to be that way.
For example, if I want to see my doctor it would normally take about a month. But a few key words to the receptionist will lead to "the doctor will see you in a couple hours".
My provider also has an urgent care clinic with drop-in. Early on in COVID (so early there were signs saying "No COVID tests unless you flew from Wuhan in past 48h") I presented at the clinic barely able to breath. 10 minutes later they had me hooked up to albuterol and I was out the door shortly after.
For example, if I want to see my doctor it would normally take about a month. But a few key words to the receptionist will lead to "the doctor will see you in a couple hours".
My provider also has an urgent care clinic with drop-in. Early on in COVID (so early there were signs saying "No COVID tests unless you flew from Wuhan in past 48h") I presented at the clinic barely able to breath. 10 minutes later they had me hooked up to albuterol and I was out the door shortly after.
In India the healthcare system is far more efficient. Most of the specialists, one can just walk in the clinic and see same day. For diagnostic tests, you can book any tests (without doctor prescription) online and a qualified person comes home to collect your blood etc sample and sends it off to the lab and you get the report in your email within 24-48 hours. The cost of all of this is quarter or less of what it costs in the USA.
I think it's this way for a lot of countries. Americans who move or Ecuador say the experience is way better than in the US.
You can just what's app your doctor whenever and they respond personally. It's affordable and when you see them they spent 45 minutes with you
You can just what's app your doctor whenever and they respond personally. It's affordable and when you see them they spent 45 minutes with you
One medical is decent, but a lot of times it won't actually be a doctor but some other medical certification (not sure how that affects quality of treatment)
I’ve got a good GP now, but honestly if I’m going to an urgent care with a sinus infection or an asthma flairup, I’d actually rather see a nurse practitioner than an MD. The NP deals with the common stuff all day long, and often the actual doctors at those sorts of places are often not great in terms of communication skills, bedside manner, that sort of thing.
Paying MDs to do physicals is as wasteful as paying engineers to install software updates.
One medical charged me 560 for a general check up. Absolutely disgusting, and zero help from their support team. And this was after insurance.
American healthcare is a laughing stock
American healthcare is a laughing stock
You're referring to a nurse practitioner (NP), and the key thing is they can prescribe medication, so, if you need prescription strength cough medicine or something like that, they're great! However, if you have something strange that you'd need a medical savant like Dr House to diagnose, they're no good, so they'll confer with MD colleagues and follow up. But also, Dr House is a fictional doctor and no doctor is that good. (If you know of a specialist that is, I've got a friend with a chronic pain disorder that needs help.)
Having a medical professional on tap - I've never had to wait more than 15 mins to see someone virtually - is great and well worth the price of admission of you can afford it (couple hundred a year). Virtually is great because if you're sick, the last thing you want to do is leave the house, but they also do in person visits as well.
They also have the facilities to do blood draws and give vaccines.
Hope their new owner (Amazon) doesn't mess things up.
Having a medical professional on tap - I've never had to wait more than 15 mins to see someone virtually - is great and well worth the price of admission of you can afford it (couple hundred a year). Virtually is great because if you're sick, the last thing you want to do is leave the house, but they also do in person visits as well.
They also have the facilities to do blood draws and give vaccines.
Hope their new owner (Amazon) doesn't mess things up.
Nurse practitioner prescriptions have to be reviewed by a superior doctor that's how the AMA keeps its Union controlling everything!
My former employer Qualcomm hired about three people to have an employee-only GP medical department. It was a great deal because the very simple treatments could be done very economically and when your company has more than about 500 people it pays actual medical costs directly and the insurance company just runs the books they don't actually do insurance.
My former employer Qualcomm hired about three people to have an employee-only GP medical department. It was a great deal because the very simple treatments could be done very economically and when your company has more than about 500 people it pays actual medical costs directly and the insurance company just runs the books they don't actually do insurance.
The AMA isn't a union.
Most doctors in the US aren't union anyway - only about 7%.
Seriously, you need to look for better sources of data than wherever you're getting it.
Most doctors in the US aren't union anyway - only about 7%.
Seriously, you need to look for better sources of data than wherever you're getting it.
If you can even locate a doctor who accepts new patients these days. And even if they do, they will not accept your insurance.
It's not really whether the doctor will "accept your insurance". Doctors will "accept", i.e. bill, any insurance, but if your insurance company doesn't consider that doctor in-network, it will just not pay and you're stuck with a nice medical bankruptcy.
In my area (suburban CA, not particularly in the middle of nowhere), nearly all the doctors that are in-network are not accepting new patients. The one I found that had that magical overlap of "accepting new patients" and "in-network" has a 6-12 month waiting period for new patients. Hope I don't get sick!
In my area (suburban CA, not particularly in the middle of nowhere), nearly all the doctors that are in-network are not accepting new patients. The one I found that had that magical overlap of "accepting new patients" and "in-network" has a 6-12 month waiting period for new patients. Hope I don't get sick!
2-4 months waiting times for specialists appointments is nothing compared to Germany. Earliest 6 months, usually one year, with a referral from your general doctor. Even when he explicitly states it's an acute problem
We live in a medical tyranny in which doctors are treated as demigods by government and every BigCo. In that environment it should come as no surprise that our medical overlords treat us with open contempt.
I don’t think you read the article, or at least you’re not addressing its claim that doctors are burned out and leaving the profession while new doctors are unable to secure enough residency spots to enter the workforce. Those two issues probably go hand in hand — there just aren’t enough doctors and the existing ones are overworked as a result.
> Those two issues probably go hand in hand — there just aren’t enough doctors and the existing ones are overworked as a result.
That makes the grandparent comment relevant, no?
Medicine seems oriented around scarcity of physicians, coupled with paying physicians by the appointment or patient interaction. So the apparatus around healthcare is set up to fully utilize the doctor, as in having a deep queue of work so they never wait and moving them from task to task. Which is a really shitty way to work and leads to burnout.
Some alternate reality that had more doctors getting paid reasonably to work an a normal human pace might be better for everyone, even if the average salary went down a bit.
That makes the grandparent comment relevant, no?
Medicine seems oriented around scarcity of physicians, coupled with paying physicians by the appointment or patient interaction. So the apparatus around healthcare is set up to fully utilize the doctor, as in having a deep queue of work so they never wait and moving them from task to task. Which is a really shitty way to work and leads to burnout.
Some alternate reality that had more doctors getting paid reasonably to work an a normal human pace might be better for everyone, even if the average salary went down a bit.
>its claim that doctors are burned out and leaving the profession
Americans totally mistreated and abused its healthcare practitioners during 2 nightmarish years of Covid, and now the chickens are coming home to roost.
Americans totally mistreated and abused its healthcare practitioners during 2 nightmarish years of Covid, and now the chickens are coming home to roost.
You think one month is too long? Try Germany, where 3 months is common.
One thing the article didn't mention is the aging boomer generation. I suspect that's significant. They're roughly 60-80 and huge.
As a Korean American who’s been in the US for nearly all my life, I didn’t understand it at first. Then I went with her and saw the Korean medical system in action and I’m now a believer.
You can visit one clinic and get a comprehensive full body diagnostic exam. Results come out within a week.
You can make an appointment with a doctor and get all associated procedures done (blood work, X-ray, MRI) often on the same day, same building, same staff.
What takes weeks if not months to complete in the US takes days or a week or two there.
It’s like a less personal, but sometimes faster and more efficient, version of the “concierge medicine” services popping up in the US.