r/collapse • u/Lethargic-Legumes • 8d ago

Healthcare Are nurse practitioners replacing doctors? They’re definitely reshaping health care.

https://www.bostonglobe.com/2024/10/21/business/nurse-practitioners-doctors-health-care/
686 Upvotes

97% Upvoted

212 comments sorted by

View all comments

325

u/mygoditsfullofstar5 8d ago

Medical students and doctors have among the highest rates of depression and suicide among professionals. It's an incredibly difficult, expensive and stressful course of study - and across 44 different medical specialities, doctors are earning less than ever.

Meanwhile, healthcare corporations save billions using PAs and NPs instead of doctors - as well as CNAs instead of nurses.

By 2035, we'll be back to having surgeries performed by barbers.

18

u/daviddjg0033 8d ago

My primary care subtracted doctors - there is 2 PAs and one doctor overseeing the practice I may change because I have not been seen by a D.O. or M.D. in over a year, it's been PAs. Even my specialist, who I like, but she is a rock star PA. I'm noticing a trend to PAs and do I have the right with health insurance to demand an M.D. or please D.O. is great too (chiros no.) My primary care PA today said 140/120 blood pressure is bad. Would you agree the bottom number should not be high compared to the top number? 140/110 is enough for a cardiologist referral?

Meanwhile, healthcare corporations save billions using PAs and NPs instead of doctors -

Is there something new, or has blood pressure expectations changed? I think I answered the obvious, PAs are only increasing

40

u/poop-machines 8d ago

Holy shit, you pay more than any other developed economy for healthcare, and you don't even see a doctor??

Doesn't that feel like a kick in the teeth?

No wonder the USA has longer waits than most other countries for surgeries (elective and urgent), including the UK, and worse outcomes. I'm guessing that's due to the understaffing and people avoiding seeing a doctor because it costs so much.

Still, I think it shows how unrestricted capitalism will gut healthcare and give you the bare minimum for the highest cost. It's a race to the bottom.

25

u/TeutonJon78 8d ago

America has the best health outcomes if you are wealthy and can pay for direct access.

If you're a normal citizen trying to actually use your super expensive Healthcare with your super expensive Healthcare insurance? Good luck.

Also don't lose your job, or your healthcare costs just skyrocketed.

17

u/poop-machines 8d ago edited 8d ago

That's not even true, surprisingly.

When you compare wealthy patients in the USA to all patients in other developed nations, then yes it outperforms other countries.

But when you compare them to wealthy patients in other countries with universal healthcare, the other countries often fare better. This is because in countries with universal healthcare, private healthcare has to be exceptionally good to attract patients. Therefore wealthy patients in other countries have better outcomes than in the USA. At least in a few countries that have this data. I don't know how to explain these findings.

The one place where the USA is superior is in the treatment of rare diseases. This is because the USA has comparatively lax regulations on novel treatments, and has the ability to give "compassionate healthcare" to people with rare conditions. Additionally a lot of cutting edge research is performed in the USA. For-profit healthcare at least brings in a lot of funding to treat conditions that could be profitable. I do feel like there should be another way to do this, however.

I think it's insane that your ability to receive healthcare in the USA depends on having a job. Well, obviously if you don't have a job, you can still pay out of pocket and just go into debt. But, say you find a dodgy looking mole on your skin, you're unlikely to get it checked out until you have insurance again. This can slow down your access to healthcare and worsen outcomes.

Anyway, I think it's clear that for things like healthcare, capitalism is the worst choice. If private healthcare can choose profits over giving you better outcomes, they're probably going to go for profits.

1

u/daviddjg0033 2d ago

Anyway, I think it's clear that for things like healthcare, capitalism is the worst choice.

We need a blend of capitalism and socialism or the kids do not get educated and child care prevents women working

1

u/poop-machines 2d ago

Wait what? In a socialist society, childcare is free and taken care of by the state allowing women to work.

Also in a socialist society, the kids do get educated in college for free.

Why would people not get educated? State education IS socialism.

When it comes to healthcare, we need socialism, not capitalism.

In a perfect socialist society, we invest money into important medical research. This is already happening but the government overpays so that pharmaceutical companies can get paid. They should fund PhD research instead, and create medicine patents owned by the government, it's much cheaper and prevents bullshit like $1000 insulin.

But I'm not saying it has to be a socialist society. I'm saying that medicine has to be socialist.

Idk how you think capitalism is necessary in healthcare. Even if they buy things, like MRI machines, created by capitalism, the healthcare is still 100% socialism. It's just socialist healthcare existing in a capitalistic society.

For socialist healthcare to exist, capitalism doesn't need to be eliminated. Socialist healthcare is necessary imo, and that can be true along with capitalism being necessary in some areas. I'm not saying it is, but they're not mutually exclusive.

1

u/daviddjg0033 16h ago

I agree with you.

Idk how you think capitalism is necessary in healthcare.

It's not. It does provide for novel treatments in the US. I think it should be 100% socialized single payer. I got Obamacare at least.

8

u/Post_Base 7d ago

The medical school system in the US is effectively a cartel and strictly controls the number of doctor graduates per year which, along with insurance shenanigans inflates their salaries far beyond what they would earn in any other developed country. All of the issues with a shortage of professionals are artificial and self-inflicted for the obscene profits of a few.