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PaperclipPerfector  8d ago (text post)   32620 thread views

Culture War Roundup for the week of March 31, 2025

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Rideshare apps completely slaughtered traditional cabs and cabbies, especially the racket of medallions. Sucks to be some poor cabbie who saved up for years to get his own medallion only to have his entire investment torpedoed.

It's worth noting that one of the main reasons for this transition is the sheer depth of poor quality service and outright fraud associated with the old yellow cab model. It truly was unbelievably brazen and hard to convey if you didn't live through it.

Now back to my regularly scheduled defense of doctorhood.

  1. We don't have a MD stranglehold in the US anymore.

There's a range, everything from pretty much parity (MD, DO, MBBS) to obviously inferior but often not in a way that patients notice (NP, PA, Psychology Prescribing), to actually quite dangerous (Chiropractors, Naturopaths, Alternative Medicine providers - some of these have full or mostly full rights in some settings/states).

You see all kinds of tensions associated with these options and I know plenty of doctors who have lost out on jobs to one of the others, but in terms of improving care well... we have evidence it makes it worse, and we have evidence that it saves no money or even costs money (example: unnecessary testing).

Many of physician job responsibilities extend outside of direct clinical work and you can't replace them adequately with the others (they make better administrators, managers, and executives). Others also can't fulfill the educator roles or research roles.

Most doctors do some form of teaching and research and essentially all of them have done both at some points in their career.

That kinda stuff doesn't track well on research into these matters but is important. Likewise physicians pick up the slack in the way the the others (especially nurses) do not.

We've been running a natural experiment for awhile now and having growing evidence of that gap.

  1. Again, physicians do more than you think. Carpal tunnel doctor actually needs to be able to know the physiology medications, and so on. Emergency overnight staff like a surgeon or surgical resident need to be able to cover part of the work of others otherwise you'll need full time overnight staff that you might not otherwise....a million things like this means the training is relevant and necessary.

You also have to consider that if you box someone into say total knees from the beginning then they have to do that 100% of the time they can't switch to another specialty to avoid burnout or other things like that. It's very common for surgeons to switch around and extend the longevity of their careers by doing that sort of stuff.

the sheer depth of poor quality service and outright fraud associated with the old yellow cab model

What'd they do, not tell you the price and then make up one that didn't make sense after services were rendered? Hard to believe that people wouldn't love that...

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