Everyone talks about the relationship between drug reps and doctors like it's the most

incestuous, evil, corrupt thing. How else are doctors, especially those who are 10, 20
years removed from their residency, supposed to learn about new treatments and
medicines? Alexa, what is best current treatment for a duodenal ulcer? You think a
doctor is going to spend his limited downtime perusing the PDR (which no longer exists,
and was always heavily influenced by the drug manufacturers anyway)?
Sure, there may be some excesses (although the truly major perks like entire vacations
dressed up as a "conference" no longer exist), but I would much rather have doctors be
aware of new drugs and yes, subject to marketing pitches, than have these drugs
languish (eventually leading to drugs not being created) because nobody knows about
them.

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austinjp 2 hours ago | root | parent | next [–]

Part of the job, as stipulated by medical regulators around the world, is keeping
up-to-date with evidence. This can be achieved by reading journals and attending
conferences, in theory.
But.... journal publishers exploit their monopolies, and conferences are funded by
corporate sponsors. So perhaps they're not so different.

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listenallyall 2 hours ago | root | parent | next [–]

Medical conferences basically would not exist if it wasn't for suppliers and drug
companies paying for sponsorships, trade show booths, opportunities to speak, etc. Not
really any different than any industry's trade conferences.
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throwawayboise 33 minutes ago | root | parent | next [–]

Sounds just like every technology conference I've ever been to. A bunch of software and
hardware vendor booths, and most of the speakers being authors hawking their latest
books.
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rafale 2 hours ago | root | parent | prev | next [–]

It's their responsibility to stay up-to-date. If a dev can keep up with front end tech stacks,
doctors, who are much more elite in their education, should keep track of latest
treatment breakthroughs in their domain of expertise.
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listenallyall 2 hours ago | root | parent | next [–]

First of all, the vast majority of devs do NOT stay "up to date." Most know one language
or even just one platform... i.e. "WordPress developer" or "Oracle admin". Secondly, how
do you think YOU hear about new technologies... usually due to marketing. Did React
just come out of nowhere? No, Facebook marketed it relentlessly. Did people discover
Kotlin on their own? No, JetBrains and Google hit people over the head with it. Etc, etc
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divbzero 1 hour ago | root | parent | prev | next [–]

Continuing medical education not only a responsibility but also a requirement to

maintain a medical license in many states (e.g. California [1]).
[1]: https://www.mbc.ca.gov/Licensing/Physicians-and-Surgeons/Ren...

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colinmhayes 2 hours ago | root | parent | prev | next [–]

In Illinois Doctors have to go to a one week conference every year that is supposed to
talk about this stuff. They also have to take board exams every few years that make
sure they're staying caught up on new advances.
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listenallyall 2 hours ago | root | parent | next [–]

It's 60 hours every 3 years, of which webinars are acceptable, and no records need to be
submitted with the renewal application. There are no tests or exams. The "new
advances" they must keep up on include Sexual Harassment Prevention and Implicit
Bias.
https://www.isms.org/CME/Medical-License/License-Requirement...

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afandian 2 hours ago | root | parent | prev | next [–]

Is there no continuing training throughout the career of a doctor? And if not, how are
they qualified to evaluate the claims of a sales rep?
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Jabbles 3 hours ago | root | parent | prev | next [–]

Scrubs covers this: https://www.youtube.com/watch?v=JVTWoPeMWSQ

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lotsofpulp 4 hours ago | parent | prev | next [–]

>that GPs in particular would be replaced by a lower-cost Watson descendant

It is happening. They are called physician assistants and nurse practitioners,
"supervised" by a doctor. I assume going forward, they will take more and more of the
usual pink eye/ear infection/flu and other common work that does not require 6 to 8
years of post bachelor education.

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goodells 4 hours ago | root | parent | next [–]

Yep. The midlevels are supported by automatic protocols in Epic (e.g. sepsis, DKA -> put
these dozens of orders in with 5 clicks) that physicians decide on and approve. They
also rely more heavily on imaging instead of a physical exam and history. When unsure,
they can consult a physician, even a specialist.
It’s a very polarizing topic in medicine that patients generally aren’t privy to. Especially
for resident physicians who often make half as much as these midlevels yet have more
education, there’s a lot of bitterness. The federal government is ultimately to blame…
having a fixed number of residency spots to artificially limit the supply of new
physicians is terrible, and this is the predictable result.

I think hospitals support inefficient midlevels because they can bill patients for the
increased resource usage, but it’s not good for the system overall when unnecessary
scans and consults are done, and more complex patients don’t get comprehensive care.
Many foresee a two-tiered system developing, where the rich see physicians, and the
poor see midlevels.

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lotsofpulp 4 hours ago | root | parent | next [–]

>Many foresee a two-tiered system developing, where the rich see physicians, and the
poor see midlevels.
There already was a tiered system, with rich people being able to buy concierge
medicine and getting preferred treatment based on who knows who on the hospital's
board or if their name is on a wing of the hospital.

The change now is a more visible and more granular price segmentation.

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jac241 3 hours ago | root | parent | next [–]

There’s no price segmentation. You pay the same for a visit with a PA or NP as for one
with a physician, so why see someone with less than a tenth the experience who may
have gone to an online only school with 100% acceptance rate and shadowed for
500hrs of “clinical experience“ right out of nursing school?
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lotsofpulp 3 hours ago | root | parent | next [–]

It will happen via in network and out of network agreements.

Healthcare providers with greater proportion of NP/PA will be selling for cheaper, so
MCO will sell access to only them in their lower price plans, and healthcare providers
where you get to see doctors will be in higher price plans.

This already happens, especially with many healthcare providers not accepting lower
reimbursed Medicaid patients.

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nradov 2 hours ago | root | parent | prev | next [–]

A two tiered system might actually be better for improving access to affordable health.
Mid-level providers seem to achieve equivalent outcomes for routine cases at lower
cost.
I agree that Congress should increase funding for residency programs.

https://www.ama-assn.org/education/gme-funding/ama-seeks-mor...

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goodells 1 hour ago | root | parent | next [–]

I generally dismiss these “equivalent outcome” studies. Any midlevel will (and should)
bounce the more complicated cases to their supervising physicians. Outcomes at that
point are meaningless.
There’s definitely a trade off between resources devoted to education vs. acceptable
risks from failed procedures, missed/delayed diagnoses, and increased utilization of
imaging and referrals (and the physician radiologists and others who participate in that -
it goes full circle). Physicians now are probably on one extreme end of that, and
midlevels on the other.

On the topic of servicing rural areas… the problem is that nobody with better options
(which includes midlevels) wants to live in these places. These educated, high-earning
people want to live in urban areas, and they can. CMS has tried to incentivize this with
billing by offering higher reimbursement rates to rural places that have a midlevel on
staff. That’s about it, though.

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mlyle 1 hour ago | root | parent | next [–]

> I generally dismiss these “equivalent outcome” studies. Any midlevel will (and should)
bounce the more complicated cases to their supervising physicians. Outcomes at that
point are meaningless.
If midlevels can successfully detect complicated cases to a supervising physician, and
handle a whole lot of other care independently... and the net result is equivalent
outcomes... this isn't a massive win? You've conserved the really expensive and
contended resource for where it's needed and not made anything worse...

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lotsofpulp 1 hour ago | root | parent | prev | next [–]

> the problem is that nobody with better options (which includes midlevels) wants to live
in these places.
Or the problem is that people are not offered enough money to make the sacrifices they
would make by living in rural places.

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itg 2 hours ago | root | parent | prev | next [–]

I'm having a hard time understanding why they would be bitter. Residency is temporary
and a part of the training process. Once completed, doctors will make 2x-3x+ compared
to midlevels for the rest of their careers.
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goodells 2 hours ago | root | parent | next [–]

Residency has a lot of problems. The match is stressful enough. Medical school
graduates carry a huge amount of debt, but must complete residency before earning
enough to meaningfully pay it off. Residencies pay 40-85k and most resident physicians
are expected to work 80+ hours per week. 80 is the theoretical maximum, but that
doesn’t count time arranging work, studying, taking board exams, etc.
All this, and if you don’t complete your residency, you have no prosperous future as a
doctor. You might re-match to another residency if you’re very lucky. The hospitals know
this and act accordingly. Residents and even medical students paying tuition (!) were
assigned to treat COVID patients and couldn’t really decline without risking the future
they’re heavily invested in.

Keep in mind, the federal government pays ~150k per year to the hospital for having the
resident. Yet the residents are often more indentured workhorses than trainees. It’s not
uncommon for entire departments to run overnight with only residents, but no attending
physicians.

Now imagine being in this situation, and not being allowed into the “providers lounge”
because you’re a resident. Or using a broad-spectrum antibiotic instead of something
more specific and being scolded for poor antibiotic stewardship, while the NP who has
“completed their training” can’t even properly decide antibiotics are indicated some of
the time. And if that NP were ever treated the way a resident is, they could go get a job
at the hospital on the other side of town and start in a week.

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lotsofpulp 2 hours ago | root | parent | prev | next [–]

Because the future is for doctors to not make 3x compared to them. The mid levels are
being used to increase supply of healthcare, using the doctor’s license for liability, in
order to reduce the price doctors collect (per unit of time and effort).
Basically, they are watching their expected wealth / purchasing power be reduced.

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