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[m0dus]

I don't mind doctors being paid more. I work in the healthcare industry and enemy #1 has to be hospitals. The amount that they (over)charge for various services and fees should be criminal. The reason healthcare costs are as high as they are isn't because a doctor makes almost $200k a year. It's because the shitty hospital he works at does whatever it can to charge patients as much as possible and insurances companies end up raising their rates as a result. Unless we have a law that mandates standard fees for all services in every hospital, costs will keep going up for everyone (except for the hospital).

The problem with this line of thinking, though, is that it's an oversimplification. Many hospitals have seen their margins become razor thin over the years, in part due to greater and greater quality expectations put into place by Medicare and the insurance industry. The problem is, they pass this along to physicians and nurses they employ.

Sometimes these metrics are attainable, and the quality improvements they realize promote better patient care. Sometimes, however, they are not or do not.

 

[CraigerGamer]

Pretty typical. Cut healthcare costs on the backs of the labor providing the service instead of the insurance companies, drug companies, and corporate CEOs fleecing the american people on a daily basis.

 

[Nivash]

It seems a bit high, yeah. I think you could pay the chief doctor salary at a Swedish hospital with just the average US salary and still have money left for breakfast.

Then again, the Swedish doctor didn't pay for his education, so... still, i figure the US doctors are a bit overpaid. But that seems to be a general trend with US salaries - the high end jobs have too high salaries while the low end jobs have much too low salaries.

Swede here and yeah, our median physician wage is significantly lower, 90K for the entire profession with limited variability between specialties. Interestingly enough, primary care is one of our highest paid specialties which is a bit unusual. It's an odd case of supply and demand in a state-run monopoly caused by a specialist shortage forcing rural hospitals to pay more to even be able to get any GPs. We have a much more compressed national wage structure though and physicians are still ranked as the job with the 4th highest median wage (the top spots are in finance, the third place curiously goes to air traffic controllers).

You're obviously correct about the much smaller impact from student debt. I will be graduating in 2 months with 37K debt, the people who maxed their loans in my class ended up with 47K. Those numbers are not strictly comparable to US debt though. The national student loans have almost no interest and never force you to pay more than you can afford - if you end up unemployed, you pay nothing. I will service my debt with montly payments of $125 for a few decades, but that's basically it. It's a non-issue.

I have a position lined up after graduation that pays 45K which is the same as internship pay (have to wait for the internship, Sweden currently has too few spots for new graduates so less than a half of my class grabbed one, long story). That's more than enough to live comfortably. Internship pay will rise to about 55-60K after about two years. Residency will pay a bit better and specialist positions after that are usually close to that 90K median wage. The actual earnings are higher than this though since this doesn't include overtime pay, positions with lots of overtime, nights or weekends can boost their stated wage by about 33-50 %.

I mean dollar for dollar that's obivously still much less than US wages, but you need to account for externalities and societal differences.

 

[darkistheway]

Does every elevated troponin mean the person needs to go to the catch lab? The answer is not necessarily. Risk stratification based on the TIMI score or the HEART score is only one small component. An elevated BNP doesn't mean the patient is having an acute exacerbation of their heart failure.

Hyperkalemia is also not the only indication for emergent dialysis in a ESRD patient. The other indications are based on clinical diagnosis.

You are also only seeing a subset of all presentations that physicians see and are extrapolating your limited and flawed view to everything a physician does.

[EDIT]

damn, already covered by m0dus!

Haha, you have every physician on this board replying to you :/

I am well aware that a single lab value is not adequate to make treatment decisions. At no point did I say anything close to that. In fact, I pretty much said the opposite.

What are the factors involved in deciding on sending a patient to the Cath lab? In my experience, the patient is in the Cath lab well before the troponin result is even available.

There is obviously a process which enables the attending physician to gather enough information to justify the necessity/risks/cost of the procedure. That process is likely more fact-based than most would credit.

What about dialysis? I am under the impression that GFR and/or creatinine clearance is the more valuable lab result. What other data is needed? Is that data readily available or does it require specialized knowledge to acquire?

 

[Particle Physicist]

I am well aware that a single lab value is not adequate to make treatment decisions. At no point did I say anything close to that. In fact, I pretty much said the opposite.

What are the factors involved in deciding on sending a patient to the Cath lab? In my experience, the patient is in the Cath lab well before the troponin result is even available.

There is obviously a process which enables the attending physician to gather enough information to justify the necessity/risks/cost of the procedure. That process is likely more fact-based than most would credit.

What about dialysis? I am under the impression that GFR and/or creatinine clearance is the more valuable lab result. What other data is needed? Is that data readily available or does it require specialized knowledge to acquire?

Only if it's a STEMI or STEMI equivalent.

As far as dialysis. There is a difference between the need for scheduled dialysis, urgent dialysis and emergent dialysis.

Clearly, you only seem versed in very finite presentations of specific disease processes.

At this point I am not going to get into medical school related discussions here.

When patients come in they don't fit into prepackaged boxes. I think it's obvious to anyone in the field, following your posts that you really do not understand what it is like to take care of patients.

 

[SuperBowser]

I am well aware that a single lab value is not adequate to make treatment decisions. At no point did I say anything close to that. In fact, I pretty much said the opposite.

What are the factors involved in deciding on sending a patient to the Cath lab? In my experience, the patient is in the Cath lab well before the troponin result is even available.

There is obviously a process which enables the attending physician to gather enough information to justify the necessity/risks/cost of the procedure. That process is likely more fact-based than most would credit.

What about dialysis? I am under the impression that GFR and/or creatinine clearance is the more valuable lab result. What other data is needed? Is that data readily available or does it require specialized knowledge to acquire?

We aren't close to a technological level where we could even consider such algorithms. It doesn't feel like you understand the procedures you are talking about. Otherwise you'd realise how many factors affect decisions about something like PCI or dialysis. What you suggest is either:
a) applicable to a tiny subset of specific patients (which raises the question, how on earth do you decide which patients are suitable for this algorithm - Oh right, a doctor)
or
b) dangerous

On the bright side, I'm a psychiatrist. I've probably got several extra decades before someone tries computerising my field.