Comments URL: https://news.ycombinator.com/item?id=49768738

Points: 2

# Comments: 1

To give a concrete example: I am a physician and have a site for my private clinic. I am not only unopposed to being scraped by bots/LLMs, I prefer it. The only value I gain from users being on my site is referral to my practice, and that same information being surfaced by search engines and LLMs just means I'm getting in front of more potential patients.

Comments URL: https://news.ycombinator.com/item?id=40330912

Points: 8

# Comments: 2

Russian Folk Belief by Ivanits is a good one.

If he was alive today, he (still) wouldn't be a PhD, but he'd have a YT channel, a vigorously active twitter page, and maybe have penned a couple of D&D modules.

1. A good subset of patients have wildly unrealistic ideas about pregnancy and delivery, and when their ideas meet reality it's not always reality that wins.

1.B. You will be the target of their ire whenever their desires are not fulfilled, because patients seem to think docs are actually in charge of something at the hospital. We usually are not.

2. It's wildly litigious. Their child was perfect (in their imagination) before being born; then you got involved, and now their child is not perfect. You must have fucked something up in the delivery and ruined the perfection of their child.

3. Way too much family involvement. When you're doing surgery, you're usually dealing with a patient's attempts to understand what's going on. When you're doing OB, you're dealing with the patient, the husband, the mother, mother-in-law, etc. Each person will come up with their own distorted vision of how things should be, and when it doesn't align with reality, the doctor is an idiot who doesn't know what they're doing. (Doctors are not perfect - just people - but it seems like every single person without medical training seems better equipped to identify the proper medical course of action than a physician is.)

4. Lots and lots of on-call time. Lots of unexpected interruptions and lots of drop-everything-and-drive-to-the-hospital.

5. There used to be good money in it. There isn't now, which makes all of the above grate on one's nerves.

The results of the above really add up to demolishing the spirit of OB/GYNs. Points 1-3 really make you feel like you're persistently at war with patients, which is the worst feeling ever. I've never been on anyone's side but the patient's, and having them treat me like an enemy ruins my job, and ruins my ability to do my job.

I ultimately chose to pursue a niche thing that shares a name with an existing medical specialty, but is a distinct niche. I can't really identify it without doxing myself, so forgive me for not.

Which is another way of saying "even where it looks like the numbers matter unto themselves without context, nope, you still can't meaningfully interpret them without context."

Responding to what you have written, however:

1. I provided a direct explanatory mechanism for how physician reimbursement caps lead to low-quality auxiliary services - by pointing out that investing in an activity or service that provides no marginal revenue is a strictly money-losing proposition. You assert, without mechanism or evidence, that this is strictly due to "for profit insurance." You need to clarify how the insurer, and their profit motive, creates this result - as the mechanism I put forward simply requires that the physician is has a fixed fee schedule and is at capacity volume. I won't go so far as to assert you should take my word on it, but you could do worse than listening to a doctor say "this is exactly what's going on in my and my friends' practices."

2. The majority of healthcare dollars in the United States flow through Medicare and Medicaid. Given that these services reimburse quite a bit lower in dollars/service than for-profit insurers, they actually make up a larger volume of total services rendered. I can't argue with a statement as vague as "usually a for-profit entity," but I can state more precisely that it "will be a non-profit entity for more than 50% of services and more than 50% of reimbursed dollars."

3. Minimizing loss ratio has nothing to do with what I said at all. If you can put forward a mechanism that translates my front desk expenses into reduced MLR for the payor, I'm listening with open ears. Look at this thought experiment: let's say my insurer's MLR stays flat, and I can accept a 100$/yr subscription fee from all of my patients to improve front-desk service, with the caveat that I'm taking a profit off the top. Would the insurer care? No? Is there anything the insurer's payment processes would do to affect this? No? Then the issue is my profit motive, not the insurer.

4. The convoluted payment processes are there to aid the insurer in sorting through their giant piles of paperwork (you didn't think that administering a health insurance network was low in bureaucracy, did you?) and, more cynically, to create pitholes for us to step into so patient care is denied reimbursement. You're going to have actually, again, provide a mechanism by which that translates into "Doctor doesn't improve services offered." Because I can tell you that if the bureaucratic hurdle that is insurance billing doesn't step me from billing in the current environment, then it's not going to stop me from billing for higher amounts if I could get them.