WSJ: Apple Piloted Running Its Own Subscription Based Primary Healthcare Service With 'Apple Doctors'

[jlc1978]

WHAT? It's not 'doctors' limiting graduates from medical school, it's POLITICIANS, who are predominantly lawyers. Seriously...

Uh, who sets accreditation standards? Decides what should be required to allow foreign trained doctors to practice in the US? Politicians may write some laws governing them but the boards are run by MDs. And MDs donate to politicians, just like every other profession.

Sure licensing helps weed out bad MDs but licensing also is a very powerful way to limit competition and raise incomes. Protecting their turf (and income) is a powerful motivator for say, not wanting NPs to be able to practice independently within the bounds of their license. Doing so would mean less patient visits and lower prices.

Here is an interesting article:

Occupational licensing blunts competition and boosts inequality

How high earning professions lock their competitors out of the market

www.economist.com

It's why I wish engineers had done what lawyers did and require a PE to work as an engineer.

 

[PinkyMacGodess]

Uh, who sets accreditation standards? Decides what should be required to allow foreign trained doctors to practice in the US? Politicians may write some laws governing them but the boards are run by MDs. And MDs donate to politicians, just like every other profession.

Sure licensing helps weed out bad MDs but licensing also is a very powerful way to limit competition and raise incomes. Protecting their turf (and income) is a powerful motivator for say, not wanting NPs to be able to practice independently within the bounds of their license. Doing so would mean less patient visits and lower prices.

Here is an interesting article:

Occupational licensing blunts competition and boosts inequality

How high earning professions lock their competitors out of the market

www.economist.com

It's why I wish engineers had done what lawyers did and require a PE to work as an engineer.

To be clear, I am NOT TALKING ABOUT MEDICAL BOARDS, and LICENSES, I am talking about limits on the number of students trained and that go through the medical residency programs.

To be 'board certified' is to pass several tests, both written and oral/practical tests, and they do fail docs who then go work at HMO's. (Possibly, or other areas where being board certified isn't a necessity) Throughout a medical career, to maintain board certification, there are tests every so many years, and you obviously have to pass those too. Board certification is meant to be a 'standard of expectation' when treated by them. That all happens AFTER graduation from a residency. There are 'fellowships' as well in many specialties and they signify longer training and experience...

 

[DeepIn2U]

At the next Apple presentation: "And just for $299 per month, ApplePrimaryCare* is bundled with TV, Podcasts, Arcade, Music and Health. Magical!"

"You can buy ApplePrimaryCare+ addition - for just $599 extra which entitles you to 4 additional free appointments per year".

* maximum 1 appointment per two months

lol.

Apple really needs to tread super carefully not to implement such a service - not only the current wave have hate would have all kinds of backlash but the legal ramifications for treatment would be like winning the Power Ball lottery. Just not a good move. However working with existing doctors and NOT guiding their actions is something they should do - secure records viewing, sharing with family physicians, specialists and doctors.

This should be an OPEN system from software (ideally existing), to hardware used from all (personal and professional and clinical), to infrastructure under an open-shared-common protocol amongst all OS' current and potential future.

 

[futurist101]

I have always been a big opponent of large corporations like Amazon, Google, Apple and Samsung utilizing their dominance in one sector (& massive financial clout) to undercut competitors in other sectors and put them out of business. However, I do believe there are exceptions where it does provide a tangible benefit to society and should be allowed because that sector is already being monopolized by a few companies taking advantage of consumers. Examples I would cite are Google's foray into becoming an ISP and Amazon's online pharmacy store. Both sectors are already being monopolized by a few companies with consumers not having any comparable alternatives depending on where they live. I hope Apple does go into the health sector simply because it could result in some positive change. The ideal situation is that they team up with a reputable health provider and only handle the technology elements.

 

[DeepIn2U]

at least we know the iGlove will be thin!

NASTY ... for that skin-tight smooth contact for proper feeling of prostate. just yuck.

 

[jlc1978]

To be clear, I am NOT TALKING ABOUT MEDICAL BOARDS, and LICENSES, I am talking about limits on the number of students trained and that go through the medical residency programs.

Fair enough, but my point is they also play a role in limiting the number of physicians by establishing criteria needed to practice, unless one wants to face serious roadblocks, and are controlled mostly by MD/DOs; resulting in barriers to entry that can help maintain income.

To your point about residency programs. IIRC, there are more med school grads than matches. While you can argue that is a political issues as the government pays for residency programs; nothing would stop hospitals from expanding self funding as well except they don't want to absorb the costs. Who generally runs hospitals? Doctors.

Like I said, it's a complex problem with no easy answers and will ultimately require rethink the way we deliver care across the board.

 

[PinkyMacGodess]

Fair enough, but my point is they also play a role in limiting the number of physicians by establishing criteria needed to practice, unless one wants to face serious roadblocks, and are controlled mostly by MD/DOs; resulting in barriers to entry that can help maintain income.

To your point about residency programs. IIRC, there are more med school grads than matches. While you can argue that is a political issues as the government pays for residency programs; nothing would stop hospitals from expanding self funding as well except they don't want to absorb the costs. Who generally runs hospitals? Doctors.

Like I said, it's a complex problem with no easy answers and will ultimately require rethink the way we deliver care across the board.

Well, you *can* find a job, as a physician, without board certification. Your choices for where you would can be somewhat limited, but there are hospitals and clinics that will hire non boarded physicians. The pay is likely less, but that's what happens with being able to prove your experience.

 

[jlc1978]

Well, you *can* find a job, as a physician, without board certification. Your choices for where you would can be somewhat limited, but there are hospitals and clinics that will hire non boarded physicians. The pay is likely less, but that's what happens with being able to prove your experience.

True, and it's often harder to get paid by insurance, get admitting privileges, etc. as well; licensing, in any profession where it is essentially required to work is a strong barrier to entry. Not that licensing is per se bad, I like to know my doctor is board certified. OTOH, I really don't care if my barber is since a bad haircut mistake isn't life threatening.

Personally, part of the solution, IMHO, is to rethink medical education. Is a 4 year undergrad really necessary? In Europe, a medical degree can be earned in anywhere from 4 -6+ years. Reducing the time in school would the lower debt load a doctor has even before starting practicing. Is suspect, like engineering, the real learning comes from the experience you gain practicing your craft under the guidance of experienced professionals. Of course, that would reduce the money schools get and thus no doubt is a non starter.

 

[PharmlyDoc]

I'm a licensed pharmacist (PharmD) who is not residency trained and therefore no one will hire me for clinical jobs, despite the fact that I worked in hospitals as a tech throughout pharmacy school. So instead I'm working in healthcare research which will hopefully contribute to improving patients lives.

I did four years of undergrad and four years of PharmD. Most pharmacy schools do not require a 4-year undergrad degree but I think they should. The maturity level between 8 years vs 6 years of schooling can be substantial. And as long as medical doctors are required to have a bachelor's degree I believe pharmacist should as well, especially if we want to call ourselves doctors of pharmacy.

I sincerely wish the Biden Administration's budget is passed, especially the sections for funding the NIH and health services research. Maybe Apple can start offering healthcare research grants.

 

[Expos of 1969]

I'm a licensed pharmacist (PharmD) who is not residency trained and therefore no one will hire me for clinical jobs, despite the fact that I worked in hospitals as a tech throughout pharmacy school. So instead I'm working in healthcare research which will hopefully contribute to improving patients lives.

I did four years of undergrad and four years of PharmD. Most pharmacy schools do not require a 4-year undergrad degree but I think they should. The maturity level between 8 years vs 6 years of schooling can be substantial. And as long as medical doctors are required to have a bachelor's degree I believe pharmacist should as well, especially if we want to call ourselves doctors of pharmacy.

I sincerely wish the Biden Administration's budget is passed, especially the sections for funding the NIH and health services research. Maybe Apple can start offering healthcare research grants.

I know nothing about Pharmacy training. From what you say, residency training is optional. What are the reasons one would choose or not choose to be residency trained?

 

[jlc1978]

I did four years of undergrad and four years of PharmD. Most pharmacy schools do not require a 4-year undergrad degree but I think they should. The maturity level between 8 years vs 6 years of schooling can be substantial. And as long as medical doctors are required to have a bachelor's degree I believe pharmacist should as well, especially if we want to call ourselves doctors of pharmacy.

To me, the question is: "Is the quality of care impacted negatively if a 4 year undergrad is not required?" If the answer is no, then the lower cost of education seems to be a good idea.

 

[PinkyMacGodess]

I really don't care if my barber is since a bad haircut mistake isn't life threatening.

In the beginning a 'barber' was the towns dentist, and often the surgeon too. Some say licensing for 'barbers' is a throwback to those times. And you don't have to go to a licensed 'barber', you can go to a 'cosmetologist', who in many state is ALSO licensed.

I think the idea comes to working with people's skin/scalp. There are a lot of things that can go wrong dealing in direct contact with human beings. From scabies to lice to, heck, all kinds of nasty infections, and also causing razor burns, and not cutting the jugular when straight razor shaving. It's not just hang out a sign and start working on people. (Personally I think the occupations of barber, physician, dental hygienist and cosmetologist, and related similar fields, are so beyond me. I can't stand touching other people, YUCK!!! OMG! HARD PASS!)

It is *anticipated* that by the time a 'physician in training' has done their time in school, exterships, internships, residency, and passed the boards, they are a mature and competent physician, and yet, ask *ANY* doctor if there are people they wouldn't want treating their dead grandparent. The list is sometimes rather long, and with good reason. There are still some doctors that either never matured, regressed, burned out, or somehow faked the whole thing and are just incompetent. But the numbers could be worse.

The only other career that I can think of that comes close to a physician is possibly an airline pilot. It is *anticipated* that by the time a pilot gets to the 'big metal', they are a mature and competent pilot, and yet, how many accidents are caused by incompetence. Flying into mountains, running out of gas, becoming spatially disorientated, being a general jerk... The history of air travel is filled with examples of incompetent pilots that died, and all it took was being paired with the wrong co-pilot, or be too stressed/tired. After 9/11, the Colgan crash in New York is an example of two incompetent pilots being placed in the cockpit together. Reading the transcript is just horrifying. But bad operations,a nd bad outcomes happen.

The thing that irks me about *ANY* specialty is that those boards will often spend significant sums of money DEFENDING bad doctors, lawyers, dentists, Wall Street types... One 'doctor' in the town I went to college had an abysmal record for women surviving his 'surgeries'. It took a near act of congress to get him out of practice. The damn board he was in DEFENDED HIM TO THE END. So there goes any legitimacy for the idea that boards work to insure their members are competent I guess...

But anyway, I think the medical education is pretty good in America. The limits need to be lifted a little higher because if you look in many specialties, there are more foreign physicians than 'natives'. Some of that has to do with the insurance industry too. They pay family practice, and GP's peanuts, yet expect those physicians to act as gatekeepers to more expensive treatments and procedures.

I thought that GM's idea was interesting. Seeing a 'company doc'. Hmm... Could it have worked? Many think not. I don't think it ever got off the ground.

Apple Medicine would be interesting. Possibly like the 'clinic' in Ideocracy?

 

[jlc1978]

I snipped some for brevity. Lots of good points.

And you don't have to go to a licensed 'barber', you can go to a 'cosmetologist', who in many state is ALSO licensed.

The difference between my barber and a friends hair stylist is about $100...

It's not just hang out a sign and start working on people.

You could still go to a beauty school/barber college etc. to learn and then work. I get your point but think licesning is a bit much.

The only other career that I can think of that comes close to a physician is possibly an airline pilot.

I can think of a few others: nuclear plant operators, LNG tankers captains, generally any job where experience is needed to be able to size up a situation and use experience to maintain safety.

It is *anticipated* that by the time a pilot gets to the 'big metal', they are a mature and competent pilot, and yet, how many accidents are caused by incompetence.

The 3 most dangerous things to hear in a cockpit:

1. A Second Officer who says "In my years of experience..."
2. A First Officer who says "You know, I've been thinking..."
3. A Captain that says "Watch what happens when I do this..."

Flying into mountains, running out of gas, becoming spatially disorientated, being a general jerk... The history of air travel is filled with examples of incompetent pilots that died, and all it took was being paired with the wrong co-pilot, or be too stressed/tired. After 9/11, the Colgan crash in New York is an example of two incompetent pilots being placed in the cockpit together. Reading the transcript is just horrifying. But bad operations,a nd bad outcomes happen.

Aviation accidents, and industrial ones in general, are fascinating to investigate for root causes. In my experience, operator error is often the result of several casual factors, including inadequate training, poor human factors engineering and human error. There is always the just plain stupid move, but often the situation leads the operator to the fatal error.

The thing that irks me about *ANY* specialty is that those boards will often spend significant sums of money DEFENDING bad doctors, lawyers, dentists, Wall Street types...

As with the old guilds, they defend their own.

But anyway, I think the medical education is pretty good in America. The limits need to be lifted a little higher because if you look in many specialties, there are more foreign physicians than 'natives'. Some of that has to do with the insurance industry too. They pay family practice, and GP's peanuts, yet expect those physicians to act as gatekeepers to more expensive treatments and procedures.

I agree, though we need to rethink, IMHO, how and who delivers what the GP does today. It's not surprising most docs don't want, or at least can't afford, to be a GP.

I thought that GM's idea was interesting. Seeing a 'company doc'. Hmm... Could it have worked? Many think not. I don't think it ever got off the ground.

I did some work awhile ago with some folks on preventative medicine practices and, IIRC, several companies ran on site clinics for their employees. Dow, USAA come to mind but that was a while ago so I could be wrong.

The whole preventative medicine concept is interesting. While the savings estimates vary, it appears with good preventative measures you can limit the rise in health care costs to inflation, even if you just prevent people from getting sicker. Some estimates were as high a 2 -3$ saved for every 1$ spent if you include productivity gains, less absenteeism or presenteeism. One of the only better ways to limit health care costs was to encourage smoking since smokers tend to die younger. The challenge was it costs money today and you don't see any returns for a number of years, so with CEOs focused on stock prices there is no incentive for them to invest the money, IIRC the reason the companies did it was simply they felt it was the right thing to do.

 

[PinkyMacGodess]

1) The difference between my barber and a friends hair stylist is about $100...

2) You could still go to a beauty school/barber college etc. to learn and then work. I get your point but think licesning is a bit much.

3) I can think of a few others: nuclear plant operators, LNG tankers captains, generally any job where experience is needed to be able to size up a situation and use experience to maintain safety.

4) The 3 most dangerous things to hear in a cockpit:
1. A Second Officer who says "In my years of experience..."
2. A First Officer who says "You know, I've been thinking..."
3. A Captain that says "Watch what happens when I do this..."

5) Aviation accidents, and industrial ones in general, are fascinating to investigate for root causes. In my experience, operator error is often the result of several casual factors, including inadequate training, poor human factors engineering and human error. There is always the just plain stupid move, but often the situation leads the operator to the fatal error.

6) As with the old guilds, they defend their own.

7) I agree, though we need to rethink, IMHO, how and who delivers what the GP does today. It's not surprising most docs don't want, or at least can't afford, to be a GP.

8) I did some work awhile ago with some folks on preventative medicine practices and, IIRC, several companies ran on site clinics for their employees. Dow, USAA come to mind but that was a while ago so I could be wrong.

The whole preventative medicine concept is interesting. While the savings estimates vary, it appears with good preventative measures you can limit the rise in health care costs to inflation, even if you just prevent people from getting sicker. Some estimates were as high a 2 -3$ saved for every 1$ spent if you include productivity gains, less absenteeism or presenteeism. One of the only better ways to limit health care costs was to encourage smoking since smokers tend to die younger. The challenge was it costs money today and you don't see any returns for a number of years, so with CEOs focused on stock prices there is no incentive for them to invest the money, IIRC the reason the companies did it was simply they felt it was the right thing to do.

1) I haven't seen a barber in decades. I don't know where there are any here. I assumed they were kinda gone. Hair stylists, and cosmetologists by the container loads are far more numerous...

2) Licensing is rather pointless at some point. The young girl that cut my hair a decade ago was a 'cosmetologist', and licensed, but what does it get me. She knows about contagious stuff. Well, okay. I guess that means something? I paid $25.00. *shrug*

3) Nuclear plant operators? They sure don't have a stellar history...

4) I'd add 'Oops!', and 'What was that?'. 'There are old pilots, and bold pilots, but there are no old bold pilots'.

5) So much of aviation accidents are a crescendo of seeming unrelated things that end up gelling and an accident happens. The $0.50 light bulb that killed a plane full of passengers in the Everglades, for an example. And on and on... The pilot that broke the tail off the plane in New York after 9/11/2001. Experiences that thoroughly mess with the mind, and under-experienced pilots interpret their sense rather than the instruments. That Colgen crash, the last thing, last meaningful thing heard was something like 'I'm retracting the flaps!'. It was the final nail in the future of that plane. Oops...

6) Don't know... I thing Guilds did expel members. The example I cited in my post was of a physician that spent a LOT of money on the state board. They were going to miss his money. I'm not the only one to say that.

7) It's not just GP's, TEACHERS are paid an insane low wage. INSANE LOW WAGE! What they are paid is an insult for what they do to society. Family practice, general practice see most, of the patients that filter to the upper echelons of specialties. And those physicians get abused. Hell, some of the ER docs I know were hit with pay cuts. They are vilified by the specialties and the fight to get them to come in (it's called 'call') is insane for some docs and specialties. They are crapped on from 'up high' almost constantly at some hospitals. ER docs see everything that comes into the hospital through those doors. I would think that the hospitals would want EDUCATED and COMPETENT physicians to triage those potential patients to avoid sending people that don't need specialized attention into the rest of the hospital, but PA's are cheaper, and the management groups can still charge more for them, and make more money. Some of those groups clear billions a year! But this extends to CEO salaries. Is one person, (more like 10's to 100's) worth thousands of times more than a worker at the same company? I feel that the inequity feeds the idea that workers are liabilities, and can be 'disposed of'. I remember being at an 'all inclusive' in Jamaica, and overheard a conversation int he business office. Apparently an employee had asked a few questions that put the management on their toes. The response was 'Fire him! There are hundreds of people we can get here TODAY that be grateful to have his job, and not give us any crap!' I paraphrase, but it was 'throw him away, he's replaceable, disposable'. No attempt to see if he had a point. No attempt to 'fix' what he might have thought was wrong, or needed attention. Yikes.

8) Look at the mess from that woman's breast cancer charity. They REFUSED to fund research that interfered with their donors. So what causes breast cancer? In general, what causes cancer in general? There are persistent chemicals that have not been tested for their effects on multiple generations of living subjects. Not tested BY DESIGN! Could it be phalites? Could it be nitrates? Could it be lead exposure? Roundup? Chlorine? Cigarettes? Well, if you don't fund research looking at *ALL* potential causes, HOW ARE YOU GOING TO FIND THE CAUSE? If you only look in a lighted room for something you lost in the dark basement, you aren't going to find it.

Thanks for responding. I hope I'm not overly critical of your comments. You hit things that I so agree with.

 

[jlc1978]

A lot of good points snipped for brevity.

7) It's not just GP's, TEACHERS are paid an insane low wage. INSANE LOW WAGE! What they are paid is an insult for what they do to society.

Tell me about. My wife is a special ed teacher; and I could not put up with what she has to from parents, the school administration, etc. She loves her kids and will do anything to help them, but she is burnt out; as are a lot of teachers.

Family practice, general practice see most, of the patients that filter to the upper echelons of specialties. And those physicians get abused.

Yea, I can't understand why any doc would not want to be a specialist.

8) Look at the mess from that woman's breast cancer charity. They REFUSED to fund research that interfered with their donors. So what causes breast cancer? In general, what causes cancer in general?

As always, it's about money and long term preservation of the organization. There are lot of groups out there trying to do good, but there are a lot that spend more on fundraising and staff than research.

Thanks for responding. I hope I'm not overly critical of your comments. You hit things that I so agree with.

Same here. It's refreshing to have a reasoned, respectful discussion with an intelligent person instead of the usual name calling. Take care...

 

[PinkyMacGodess]

A lot of good points snipped for brevity.



Tell me about. My wife is a special ed teacher; and I could not put up with what she has to from parents, the school administration, etc. She loves her kids and will do anything to help them, but she is burnt out; as are a lot of teachers.



Yea, I can't understand why any doc would not want to be a specialist.



As always, it's about money and long term preservation of the organization. There are lot of groups out there trying to do good, but there are a lot that spend more on fundraising and staff than research.



Same here. It's refreshing to have a reasoned, respectful discussion with an intelligent person instead of the usual name calling. Take care...

You called me intelligent. Wow... Thanks. 😂