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Piecework: Medicine’s money problem (newyorker.com)
56 points by jimsojim on Jan 13, 2016 | hide | past | favorite | 8 comments



This could use a 2005 flag on it.

Not that much has changed - I got rather far before the size of the premium increases raised a red flag to me.


Thanks for the heads up; I totally missed the date. Geeze.

He also didn't mention the ACA, which should have been a yellow flag.

I have a relative in the pain management business -- and I do mean business. He's an internal medicine doc, making over a million a year, probably substantially more in fact, by focusing on a lucrative niche of people with whiplash, back aches, etc. The trick is to process them through as quickly as possible. He gets 40-60 patients a day, and each billing between $60 and $800 depending on the condition. If you puncture someone, e.g. shot for sciatic pain, the billable is $800 to $1200. Pain pills might be worth $100. With enough numbers, and keep the personnel costs down by using medical assistants, and you've got a really lucrative practice.


Paying doctors by procedure is like paying programers by line of code.

If this were the case, there'd be tons of Java programers and few enlightened souls would bother with Perl.


It's far worse than that. It is more like paying programmers for every bug they write a line of code to address. You can bet that every fix for an existing bug would create at least two new bugs. They would call such bugs "side effects" and give you six page handouts and convince everyone that "side effects" are just a necessary evil and less worse than just living with the bugs being fixed by the buggy lines of code introducing the "side effects."


Heh. If that were the case, we'd still program in assembly, and RISC architectures would have taken over CPUs.


RISC architectures have taken over CPUs


Only internally. The public ISA is usually CISC. But the internal RISC-ness is why most RISC architectures died out. Once it happened, you got many of the benefits of both RISC and CISC.


This entire thing just could be the most crazy @#$%^&* thing I've ever heard.




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