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Primary care physicians and unions

One of the phenomena that have led to increased income inequality and the hollowing out of the middle class in America is the decline of unions. Recently, it appears that some workers are trying to claw back some of that lost economic ground. Now I don’t count PCPs as middle class or working class. Yes, they are among the most poorly compensated docs, but they still make well over the median income. But I’m happy to see this class of workers press for unionization. The alternative is a further decline in the number of PCPs, which has been declining for years. “Nearly 300 primary care physicians employed by Massachusetts General Brigham have notified federal authorities that they want to join a union, citing “burnout” and the “corporatization of medicine” at the state’s largest health system.   “The doctors comprise the “vast majority” of primary care physicians employed by Massachusetts General Hospital and Brigham and Women’s Hospital, according to Dr. Michael Barnett, a primary care
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RFK Jr and the food-as-medicine trope

Anti-vaxxer and brain-worm afflicted RFK Jr has announced, among his priorities, to use federal money to get people to eat better. From The Palm Beach Post: "The former independent presidential candidate is a big fan of Trump but not so much about the president-elect’s fast-food diet.   "During an interview on “The Joe Polish Show,” a marketing industry podcast that aired on Tuesday, Nov. 12, RFK Jr. criticized some of Trump’s food preferences. “The stuff that he eats is really, like, bad,” he stated, describing certain items on the former president’s menu as “poison” in some cases.   “Campaign food is always bad, but the food that goes onto that airplane is, like, just poison,” Kennedy said on the podcast, likely referring to Trump's private airplane. You have a choice between — you don’t have the choice, you’re either given KFC or Big Macs.” I’m not a fan of the food-as-medicine trope, or its inversion, the food-as-poison trope. It’s the dose that makes the poison. Nobo
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Diversity in healthcare delivery

Years ago, we had an MD/PhD student in our program who had Eilers-Danlos syndrome, a connective tissue disorder that causes joint laxity and frequent painful joint dislocations. After over a decade of being misdiagnosed, her correct diagnosis was made by a physical therapist, not a physician. I noted in a previous post that I’ve been seen by nurses and physician’s assistants in clinics and gotten good care. I’ve had robotically assisted surgery that worked out fine. Now that AI can read radiological images with greater accuracy than most radiologists, we can expect machines and paraprofessionals increasingly to take over jobs that used to be done by physicians. American healthcare is evolving. Diversity in healthcare delivery is a good thing and should help control costs. A PhD colleague who worked in a clinical department referred to physicians as “MDeities.” He was referring to their attitudes about their own status, but far too many patients treat their doctors as deities, too. Idea
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The Peter Principle and making lemonade from lemons

I remember reading the book "The Peter Principle" in high school. For those of you who didn't, or who forgot, the Peter Principle states that an employee continues to receive promotions to work in higher ranks up to that point where he reaches a level of incompetence. In simple terms, the higher the hierarchy ladder an individual goes, the more likely he is to fail in his new position. I'd forgotten about this until it came up in a comment thread over at jabberwocking.com: "One of the things that makes me more optimistic than some of my fellow liberals is based on the Peter Principle. Trump is applying the Peter Principle in an accelerated way, advancing people far past their levels of competence. While that might seem at first like a Bad Thing, it means that the Deep State Government Bureaucracy can do what it does best: Turf battles and red tape. "So while Elon Musk, et al can do a fair bit of damage, their lack of competence in government will limit what
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Access to medical care: right or privilege?

America is the only industrialized nation where you can go bankrupt because of medical care. The ACA helped mitigate that risk for tens of millions, but the Trump Administration is promising to abolish the ACA.  For those with some form of health insurance (private insurance, the ACA, Medicare), there’s still the challenge of (a) finding a physician and (b) keeping their attention for more than the few minutes they could afford to spend on each patient. Now, for the privileged, there’s “concierge medicine.” A few thousand dollars on top of your regular insurance gets you more time with your doctor and easier scheduling. Of course, if you can’t afford that extra payment, you get the physician cattle call with the rest of the hoi polloi. And increasingly, you’ll be seen by a nurse or physician’s assistant.* Doctors are embracing concierge medicine because it allows them to practice the sort of medicine they trained for, without the pressure to cut every encounter short. And they make mor
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Seafood says global warming is not a hoax

Trump and his minions may not believe in global warming, but people whose livelihoods depend on understanding climate change—bankers, insurance companies and the military—know it’s real. So do non-humans whose livelihoods are compromised by climate change: “Native fish populations will likely continue their decline off of Massachusetts’ coast, while species from further south will move in, scientists found. The bay will continue to get acidic and inhospitable for the many fish, plants, and shellfish that live there now.   “Oceans absorb about 30 percent of the carbon dioxide that’s released into the atmosphere. When absorbed, carbon dioxide makes sea water more acidic through chemical reactions, putting the entire food web in the marine ecosystem at risk, according to the National Oceanic and Atmospheric Administration.   “One example: Higher acidity causes shells to deteriorate, which kills shellfish. That will be an early marker of a shift in fishing ecology in Massachusetts Bay, the
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Tax cuts for the rich only increase wealth disparity

No, the 1% aren’t the job creators—that’s the middle class and working class. Tax cuts for the 1%, of course, don’t create jobs, they just create greater wealth disparity: “The authors set out to examine all instances of major tax reductions on the rich in 18 OECD countries between 1965 and 2015 and identify the results . . . There was no noticeable effect on growth. Or on unemployment. So what  did  the tax cuts accomplish? “We find that major tax cuts for the rich push up income inequality, as measured by the top 1% share of pre-tax national income. The size of the effect is substantial: on average,  each major tax cut results in a rise of over 0.7 percentage points in top 1% share of pre-tax national income.   “On the income inequality side, the results  do not closely align with the theory that the rich have greater incentives to work and invest when their taxes are cut,  given that we do not find any statistically significant effects on growth, unemployment or investment from cutt
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