My husband, an interventional cardiologist, often talks about these issues. (He graduated med school in 1998.) Another challenge he sees, as he works with younger physicians, is that they have a totally different work ethic. More and more men and women physicians want to work at 0.8 FTE (or even 0.5) so they can have more family time or more work-life balance. This raises a host of new issues that the profession has never seen. Plus, there are nursing shortages, so temp staffing agencies can garner huge hourly rates for their nurses vs what the hospital will pay an employee. Turnover is high and the cost of care is high. And patient care suffers. It’s all very complex.
My husband’s dad and uncles were also physicians, but I have heard him say would discourage young people -- including our kids -- from going to medical school. Each year, around 560 cardiologists retire or leave practice who are not replaced by new, incoming cardiologists. The issues you discussed, and many more, are certainly contributing factors. It’s scary on several levels. Thanks for this interview. (“What the living fuck” left me in stitches. We are kindred spirits.)
Thank you for this podcast. I listened with interest because I'm an.Anerican expat permanent resident t living in Portugal with access to the government. Health care system. While living in the U.S., I could never afford health insurance. In Canada I was covered by my employers, after the first deductibles. I grew up in the 50s two blocks from the hospital which had an internship program . Several of my neighbors went through the program, while renting the houses next door,, so my family had good relationships with our family doctors whose families I had babysat , and from time to time they helped us when it was necessary, but we never abused their good will. The doctors in the Portuguese system are competent, but almost relegated to the roll of pill-pusher, handing out prescriptions and no follow up aside from regular annual visits from the patients. However if I need hospital care it is very good. The professionals work in teams.i don't know much about the admin side except that, as a foreigner i have the right to emergency care and the bill comes months later and is about 10% of the cost in the USA.
I'm too poor to live anywhere in the USA, but given the standard of living for most people there, I'm better off here in spite of the difficult language and social isolation.
Thanks for this great conversation. I was in the hospital for nearly a week after major surgery (I live in Switzerland); I'm immensely grateful to all the healthcare professionals - neurosurgeons, registered nurses, and nurse assistants - all of whom are overworked, yet visibly highly committed to their jobs. I talked to as many as I could, as the personnel shortage is a prominent media topic here. Nurses cited shift work and the lack of time to spend with patients as the main reasons colleagues were leaving the profession.
I'm no expert on comparative health insurance systems, but basic health insurance in Switzerland is mandatory, if relatively expensive, and supplemental (i.e. semi-private or private-ward hospital care) insurance plans even more so. Never heard of the concierge model, but I'm sure the wealthiest of the wealthy can find that here, too. I pay the equivalent of USD 500 a month, pay the first USD 750 in medical bills each year out of pocket, and 10% co-payment for meds.
Glad to hear Dr. Damania's take on annual flu jabs. I'm a staunch advocate. Have been getting the flu jab ever since my second bout of influenza some fifteen years ago and vowing to never repeat the experience if I could help it. The flu is definitely not just a "bad cold".
I am a registered nurse. When the doctor stated that Epic, and other electronic medical record systems, are essentially cash registers with the some patient stuff, he is right on. Healthcare is broken in this country. The cost to consumers, and the drive for profit is nothing short of disgusting. Big healthcare will work every angle to make money. They work the system to get every CMS dollar they can get their hands on and then some. If there were more of a collective effort to demand healthcare reform that would be a great use of our time as a populace instead of getting distracted by cultural politics.
My sister, who is not in healthcare, has a much better health plan than the one provided by my employer. Good health insurance is becoming increasingly rare. The large healthcare system I work for own a big portion of the health insurance they sell and provide to employees (at a high premium). High deductible plans with HSAs are the norm. Access is limited. It's almost easier not to seek care and they know this and even count on it from those who cannot pay.
A fascinating discussion, particularly from the other side of the border. It gives me more understanding of what my American friends have to deal with.
Of course Canada has its own problems with healthcare, but many people here also struggle to find a GP--my sister moved provinces and is finding it particularly difficult. Different reasons, for sure, but I wonder if Zubin’s talk of people going into specialties for a bigger paycheques is a factor.
I’ve stared to worry, myself, because I’m now in my 50s and my GP of 25 years has entered his 60s. I know he’ll eventually retire. Leaving me where? Even as a GP, it’s a bit of a specialty situation: I’m gay, as is he, so it’s easier to talk to him about health concerns specific to gay men, and so I trust him more.
With that in mind, I’m surprised when my female friends don’t have a female doctor. We live in a city of 3 million people, so there’s a better chance of finding a GP who understands one’s particular concerns. So beyond the discussion on this episode, I was wondering how important or even possible it would be for folks to access the the kind of shorthand I have with my own GP.
Interesting discussion. I pay $450 a month for a single adult nonsmoker and that's through an employer. And the copays suck. Unbelievable.
I laughed at the little aside about Elizabeth Holmes:
Being a young attractive woman in a male space garnered her a lot of positive attention in the good times.
Being a young attractive woman in a male space garnered her a lot of negative attention in the bad times.
I'm reminded of an apt saying in football (you don't need to be a sports geeks to understand it): The quarterback gets too much credit when the team wins.
The quarterback gets too much blame when the team loses.
My husband, an interventional cardiologist, often talks about these issues. (He graduated med school in 1998.) Another challenge he sees, as he works with younger physicians, is that they have a totally different work ethic. More and more men and women physicians want to work at 0.8 FTE (or even 0.5) so they can have more family time or more work-life balance. This raises a host of new issues that the profession has never seen. Plus, there are nursing shortages, so temp staffing agencies can garner huge hourly rates for their nurses vs what the hospital will pay an employee. Turnover is high and the cost of care is high. And patient care suffers. It’s all very complex.
My husband’s dad and uncles were also physicians, but I have heard him say would discourage young people -- including our kids -- from going to medical school. Each year, around 560 cardiologists retire or leave practice who are not replaced by new, incoming cardiologists. The issues you discussed, and many more, are certainly contributing factors. It’s scary on several levels. Thanks for this interview. (“What the living fuck” left me in stitches. We are kindred spirits.)
Thank you for this podcast. I listened with interest because I'm an.Anerican expat permanent resident t living in Portugal with access to the government. Health care system. While living in the U.S., I could never afford health insurance. In Canada I was covered by my employers, after the first deductibles. I grew up in the 50s two blocks from the hospital which had an internship program . Several of my neighbors went through the program, while renting the houses next door,, so my family had good relationships with our family doctors whose families I had babysat , and from time to time they helped us when it was necessary, but we never abused their good will. The doctors in the Portuguese system are competent, but almost relegated to the roll of pill-pusher, handing out prescriptions and no follow up aside from regular annual visits from the patients. However if I need hospital care it is very good. The professionals work in teams.i don't know much about the admin side except that, as a foreigner i have the right to emergency care and the bill comes months later and is about 10% of the cost in the USA.
I'm too poor to live anywhere in the USA, but given the standard of living for most people there, I'm better off here in spite of the difficult language and social isolation.
Thanks for this great conversation. I was in the hospital for nearly a week after major surgery (I live in Switzerland); I'm immensely grateful to all the healthcare professionals - neurosurgeons, registered nurses, and nurse assistants - all of whom are overworked, yet visibly highly committed to their jobs. I talked to as many as I could, as the personnel shortage is a prominent media topic here. Nurses cited shift work and the lack of time to spend with patients as the main reasons colleagues were leaving the profession.
I'm no expert on comparative health insurance systems, but basic health insurance in Switzerland is mandatory, if relatively expensive, and supplemental (i.e. semi-private or private-ward hospital care) insurance plans even more so. Never heard of the concierge model, but I'm sure the wealthiest of the wealthy can find that here, too. I pay the equivalent of USD 500 a month, pay the first USD 750 in medical bills each year out of pocket, and 10% co-payment for meds.
Glad to hear Dr. Damania's take on annual flu jabs. I'm a staunch advocate. Have been getting the flu jab ever since my second bout of influenza some fifteen years ago and vowing to never repeat the experience if I could help it. The flu is definitely not just a "bad cold".
I am a registered nurse. When the doctor stated that Epic, and other electronic medical record systems, are essentially cash registers with the some patient stuff, he is right on. Healthcare is broken in this country. The cost to consumers, and the drive for profit is nothing short of disgusting. Big healthcare will work every angle to make money. They work the system to get every CMS dollar they can get their hands on and then some. If there were more of a collective effort to demand healthcare reform that would be a great use of our time as a populace instead of getting distracted by cultural politics.
My sister, who is not in healthcare, has a much better health plan than the one provided by my employer. Good health insurance is becoming increasingly rare. The large healthcare system I work for own a big portion of the health insurance they sell and provide to employees (at a high premium). High deductible plans with HSAs are the norm. Access is limited. It's almost easier not to seek care and they know this and even count on it from those who cannot pay.
Wow, this was terrific. I've heard interviews with him before, but this is the best.
You and the doctor really had sizzle. I think he is totally into you.
A fascinating discussion, particularly from the other side of the border. It gives me more understanding of what my American friends have to deal with.
Of course Canada has its own problems with healthcare, but many people here also struggle to find a GP--my sister moved provinces and is finding it particularly difficult. Different reasons, for sure, but I wonder if Zubin’s talk of people going into specialties for a bigger paycheques is a factor.
I’ve stared to worry, myself, because I’m now in my 50s and my GP of 25 years has entered his 60s. I know he’ll eventually retire. Leaving me where? Even as a GP, it’s a bit of a specialty situation: I’m gay, as is he, so it’s easier to talk to him about health concerns specific to gay men, and so I trust him more.
With that in mind, I’m surprised when my female friends don’t have a female doctor. We live in a city of 3 million people, so there’s a better chance of finding a GP who understands one’s particular concerns. So beyond the discussion on this episode, I was wondering how important or even possible it would be for folks to access the the kind of shorthand I have with my own GP.
Amazing conversation. Amazing.
Interesting discussion. I pay $450 a month for a single adult nonsmoker and that's through an employer. And the copays suck. Unbelievable.
I laughed at the little aside about Elizabeth Holmes:
Being a young attractive woman in a male space garnered her a lot of positive attention in the good times.
Being a young attractive woman in a male space garnered her a lot of negative attention in the bad times.
I'm reminded of an apt saying in football (you don't need to be a sports geeks to understand it): The quarterback gets too much credit when the team wins.
The quarterback gets too much blame when the team loses.
Being the center of attention cuts both ways.
An excellent and informative interview that left me totally confused about the health insurance industry — and why it even still exists.
Ooohh looking forward to listening to this one