> I just read uber is rolling out driverless rides.
Ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha.
You made me laugh.
Each time a industry unionizes corporations try to downplay the need of labor. Executives think that employees are just a nuisance and that the working class is ungrateful for their salaries. The reality is that the only ones adding value are the working class.
Unionize, let them fear us instead of mocking us and steal from us.
Doctors pay has been increasing a lot and it has nothing to do with union. In fact they just do one thing, lobby to not allow a perfectly good set of students to go to college.
> CMS residency funding was capped beginning in 1997 at 1996 levels, and has only been raised once since then in Section 126 of the Consolidated Appropriations Act of 2021. From 1987 to 1997 the number of residents grew by 20.6%, while from 1997 to 2007 the growth in residencies was only 8%. The 2021 law attempts to address several issues by slowly increasing residencies in specific underserved situations such as rural areas. This officially just began with 200 new residencies nationwide this year, climbing to 1,000 additional residencies per year in five years. It is only a drop in the bucket compared to the 140,000 resident doctors in the US in 2020, the majority of whom were federally funded. Using a rough estimate from Census population data for 2000 and 2020, there are at least 50 million, or 18%, more people in the nation today than when the law was passed, making the current change a rather small effort.
> This growth in population without a corresponding growth in the doctors we train each year leads to higher salaries for doctors and higher costs for patients. More people are demanding the time of a similar number of doctors, driving up the price of doctor’s time, even before accounting for the US’ aging population.
Correct. "Collective bargaining" against society is called running a cartel. Having your cartel lobby the government to set the law to benefit it is called rent-seeking. They've caused massive damage to society, and limiting positions by quota is different from setting standards.
I can't even draw an "imagine if we limited... " comparison because limiting access to doctors is already close to the worst case, obviously destructive thing to do. Maybe food? If instead of subsidizing farming to ensure we always overgrow and don't have famines, we capped farming, ensuring famines?
In the US, patient time is eroded by system/admin friction, I'm hoping that has entered public consciousness by now.
from colleagues in the UK: their headline demand is “pay restoration,” but the underlying grievances are much broader: when understaffing becomes normal operating procedure, every absence is a freaking emergency. nights and on-call work are intense enough already; broken sleep and persistent overload should not be normal too.
The AMA has taken protectionist positions before, including opposing expansion—fair criticism. But opposing expansion can also mean opposing inadequately funded or structured training. And, as the other commenter said—thank you—don’t physicians deserve to pool bargaining power like other workers?
My point is: it has more and more directly to do with patients than it may seem - being able to do the work properly, with enough time and capacity for the clinical judgement we've been trained for to be fully deployed... leads to better patient outcomes and safety.
From the first week of school, you are all taught that the good doctor is the one that can stay awake and autopilot paperwork for 48+ hours.
That’s a nonstarter - it’s simply broken from the beginning.
> to be fully deployed... leads to better patient outcomes and safety.
Respectfully: no.
There is no other human resource-planning concept on the planet that says using 100% of resources all of the time, or running to failure, is the safest method for the customer (patient).
You guys messed up; your members are noticing, but instead of spending time cleaning up your own house, you want to educate the public?
No: get your stumbling behemoth of an “organization” under control, please.
apologies for the confusion, by "fully deployed" I meant fully able to exercise clinical judgement - which requires adequate rest. If understaffing forces back-to-back night shifts and that becomes standard, well you clearly recognize the risk to patient safety just as well. My point is - putting hard limits and minimums on rest, forces staffing choices and this is something physician collective bargaining/organising can help with and it concerns you as a patient.
Regarding "the good doctor" and accepting a near-constant state of fatigue... this is not a personal choice, and it shouldn't be treated as such (wrapped into the box of "the price of this qualification/profession" type of stories). From my experience and I don't claim to be the authority on understanding all aspects of this problem, it's 1. part structural - not enough people (AMA's anti-expansion positions really didn't help here, true) and high demand... and 2. part cultural: medicine has normalised "heroic" endurance which makes it convenient to focus on economics and not see fatigue for what it is - safety risk. The cultural narrative isn't exclusive to medicine.
anyway, I hope community appreciates a perspective from the other side of that organisation, I was hoping to illustrate we ultimately share the same goal - better patient outcomes and safety.
> and, well, they’re frankly not spending enough time with each patient per appointment.
Many doctors would agree with you. They're under enormous pressure to work faster from both non-medical administrators and non-medical reimbursement decision makers.
My company, my insurance company, my pharmacy insurance company, the required health startup I have to use, my doctor and I all get to decide whether I can take a commonly prescribed medicine that i need. Theres way way too many parties in that decision. The ama isn't the problem that's driving wedges between my doctor and me.
Also my insurance-mandated 20 minute time limit on appointments. Then I can only ask about one thing in that 20 minutes. If I have another thing, I have to make another appointment for it, because that's the only way insurance will cover my visit.
I’m so excited for driverless cars, and I wonder how this will affect the shift towards services like Waymo. If the choice of whether to take Waymo vs Uber comes down to cost, unions seem like they would shift the usage towards Waymo. (or Waymo simply increases prices to match)
The economics of self driving taxis is still to be determined. Waymo right now costs significantly more than Uber and Lyft and service is extremely limited. And Google is still pouring billions into the division with no expectation of profit in the short term. A lot has to change before self driving taxis will seriously start to displace regular ones.
My experience is that while they are all priced based on demand, Waymo is often much cheaper during periods of low demand. I have benefitted from a few 50% off rides in the past month, so I was able to pay $5.50-$6.00 for rides that would be $20-30 across all the providers during high demand and for which Uber was quoting $13-18 at the time of those rides.
Presuming that paying fair wages drives up service price. Uber and Lyft may increase prices a bit, but there are other factors that affect customers willingness to pay which don’t change with increases in driver compensation. The companies can always choose to take slightly less profit to pay a fair wage, and they might make that choice if it’s less painful than the loss in paid rides due to a price increase.
Great news, although I just read uber is rolling out driverless rides.
Just as I support the AMA for doctors I support collective bargaining rights even for gig drivers.
Let's hope it makes a difference.
> I just read uber is rolling out driverless rides.
Ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha. You made me laugh.
Each time a industry unionizes corporations try to downplay the need of labor. Executives think that employees are just a nuisance and that the working class is ungrateful for their salaries. The reality is that the only ones adding value are the working class.
Unionize, let them fear us instead of mocking us and steal from us.
> Just as I support the AMA for doctors
Doctors pay has been increasing a lot and it has nothing to do with union. In fact they just do one thing, lobby to not allow a perfectly good set of students to go to college.
That hasn't been true for years.
> Just as I support the AMA for doctors
Strong disagree: they’re the main entity responsible for limiting the available quantity of doctors/medical practitioners available,
and, well, they’re frankly not spending enough time with each patient per appointment.
Not something to glance over - it’s a complete mishandling of the only formula that matters to the patient.
100%. A few relevant articles: https://www.openhealthpolicy.com/p/medical-residency-slots-c... and https://www.openhealthpolicy.com/p/best-of-open-health-congr...
A snippet:
> CMS residency funding was capped beginning in 1997 at 1996 levels, and has only been raised once since then in Section 126 of the Consolidated Appropriations Act of 2021. From 1987 to 1997 the number of residents grew by 20.6%, while from 1997 to 2007 the growth in residencies was only 8%. The 2021 law attempts to address several issues by slowly increasing residencies in specific underserved situations such as rural areas. This officially just began with 200 new residencies nationwide this year, climbing to 1,000 additional residencies per year in five years. It is only a drop in the bucket compared to the 140,000 resident doctors in the US in 2020, the majority of whom were federally funded. Using a rough estimate from Census population data for 2000 and 2020, there are at least 50 million, or 18%, more people in the nation today than when the law was passed, making the current change a rather small effort.
> This growth in population without a corresponding growth in the doctors we train each year leads to higher salaries for doctors and higher costs for patients. More people are demanding the time of a similar number of doctors, driving up the price of doctor’s time, even before accounting for the US’ aging population.
OK, doctors don't deserve collective bargaining rights?
I'm not defending their profession.
I'm drawing a parallel in rights.
And limiting entry is great for wages.
Flooding your profession with people lowers wages.
A drivers union would do the same if they could: create and raise standards.
Correct. "Collective bargaining" against society is called running a cartel. Having your cartel lobby the government to set the law to benefit it is called rent-seeking. They've caused massive damage to society, and limiting positions by quota is different from setting standards.
I can't even draw an "imagine if we limited... " comparison because limiting access to doctors is already close to the worst case, obviously destructive thing to do. Maybe food? If instead of subsidizing farming to ensure we always overgrow and don't have famines, we capped farming, ensuring famines?
Yes there need to be solidarity between members of unions otherwise it is just some feudal guild society.
What is it called when they move past collective bargaining into being entrenched in law?
What’s the opposite of flooding?
…because that’s what their mandate has been since the 90s.
In the US, patient time is eroded by system/admin friction, I'm hoping that has entered public consciousness by now.
from colleagues in the UK: their headline demand is “pay restoration,” but the underlying grievances are much broader: when understaffing becomes normal operating procedure, every absence is a freaking emergency. nights and on-call work are intense enough already; broken sleep and persistent overload should not be normal too.
The AMA has taken protectionist positions before, including opposing expansion—fair criticism. But opposing expansion can also mean opposing inadequately funded or structured training. And, as the other commenter said—thank you—don’t physicians deserve to pool bargaining power like other workers?
My point is: it has more and more directly to do with patients than it may seem - being able to do the work properly, with enough time and capacity for the clinical judgement we've been trained for to be fully deployed... leads to better patient outcomes and safety.
> as the other commenter said—thank you—don’t physicians deserve to pool bargaining power like other workers?
For the same reason Americans don’t care much about the (often very valid) complaints of Congresspeople,
you’ll want to start ensuring better service before you start asking for us to care and make noise for you.
You’ve underlined the problem.
From the first week of school, you are all taught that the good doctor is the one that can stay awake and autopilot paperwork for 48+ hours.
That’s a nonstarter - it’s simply broken from the beginning.
> to be fully deployed... leads to better patient outcomes and safety.
Respectfully: no.
There is no other human resource-planning concept on the planet that says using 100% of resources all of the time, or running to failure, is the safest method for the customer (patient).
You guys messed up; your members are noticing, but instead of spending time cleaning up your own house, you want to educate the public?
No: get your stumbling behemoth of an “organization” under control, please.
apologies for the confusion, by "fully deployed" I meant fully able to exercise clinical judgement - which requires adequate rest. If understaffing forces back-to-back night shifts and that becomes standard, well you clearly recognize the risk to patient safety just as well. My point is - putting hard limits and minimums on rest, forces staffing choices and this is something physician collective bargaining/organising can help with and it concerns you as a patient.
Regarding "the good doctor" and accepting a near-constant state of fatigue... this is not a personal choice, and it shouldn't be treated as such (wrapped into the box of "the price of this qualification/profession" type of stories). From my experience and I don't claim to be the authority on understanding all aspects of this problem, it's 1. part structural - not enough people (AMA's anti-expansion positions really didn't help here, true) and high demand... and 2. part cultural: medicine has normalised "heroic" endurance which makes it convenient to focus on economics and not see fatigue for what it is - safety risk. The cultural narrative isn't exclusive to medicine.
anyway, I hope community appreciates a perspective from the other side of that organisation, I was hoping to illustrate we ultimately share the same goal - better patient outcomes and safety.
Do you share the same goal enough to walk until it’s more people are being cared for properly?
Not trying to personally attack - it’s a question I’d like to gently ask anyone who empathizes from within.
Unfortunately there’s only so much individuals can do - we must lean on each other to really review.
> and, well, they’re frankly not spending enough time with each patient per appointment.
Many doctors would agree with you. They're under enormous pressure to work faster from both non-medical administrators and non-medical reimbursement decision makers.
Neither of those groups seem to be in a rush to buck the AMA workflows that lead to this.
My company, my insurance company, my pharmacy insurance company, the required health startup I have to use, my doctor and I all get to decide whether I can take a commonly prescribed medicine that i need. Theres way way too many parties in that decision. The ama isn't the problem that's driving wedges between my doctor and me.
Also my insurance-mandated 20 minute time limit on appointments. Then I can only ask about one thing in that 20 minutes. If I have another thing, I have to make another appointment for it, because that's the only way insurance will cover my visit.
Doctors have an ethical and professional responsibility to demand the appropriate amount of time to see patients - or walk.
You have a personal responsibility to demand the appropriate amount of time to be seen by your provider - or walk.
> Strong disagree: they’re the main entity responsible for limiting the available quantity of doctors/medical practitioners available,
People (especially conservatives) repeat this, but AMA was lobbying for more residencies for years and conservative party was always against.
You seem to have this backwards.
The AMA’s public-facing stance seems to be shifting since the 90s and 00s where they obviously wanted limits.
They’re on paper as supporting expansions on 2021 and 2023.
Decades are long.
I’m so excited for driverless cars, and I wonder how this will affect the shift towards services like Waymo. If the choice of whether to take Waymo vs Uber comes down to cost, unions seem like they would shift the usage towards Waymo. (or Waymo simply increases prices to match)
The economics of self driving taxis is still to be determined. Waymo right now costs significantly more than Uber and Lyft and service is extremely limited. And Google is still pouring billions into the division with no expectation of profit in the short term. A lot has to change before self driving taxis will seriously start to displace regular ones.
Waymo has taken significant market share from Lyft and Uber in San Francisco already:
https://underscoresf.com/in-san-francisco-waymo-has-now-best...
My experience is that while they are all priced based on demand, Waymo is often much cheaper during periods of low demand. I have benefitted from a few 50% off rides in the past month, so I was able to pay $5.50-$6.00 for rides that would be $20-30 across all the providers during high demand and for which Uber was quoting $13-18 at the time of those rides.
Presuming that paying fair wages drives up service price. Uber and Lyft may increase prices a bit, but there are other factors that affect customers willingness to pay which don’t change with increases in driver compensation. The companies can always choose to take slightly less profit to pay a fair wage, and they might make that choice if it’s less painful than the loss in paid rides due to a price increase.
Or they might signal supporting a fellow human. I preferentially but union made things because in general the workers are getting a bigger cut.
[dead]
I'd love to have been a fly on the wall of the Waymo offices when this news broke