Comment by TimorousBestie

Comment by TimorousBestie 3 days ago

> Doctor competence is highly variable, as there are few incentives for improvement.

> But all hospitalists are paid under the same schedule (based on years of experience), meaning that the high-agency hospitalist is getting paid the same as their counterparts. Greater intrinsic motivation and competence are not explicitly rewarded.

I find it very hard to believe that it’s possible to measure “greater intrinsic motivation and competence” objectively here (and for GPs as well, basically any profession with high variety in the Stafford Beer sense), so explicitly rewarding that seems fraught with Goodhart-style problems.

faidit 2 days ago

Yeah. Minimizing patient days spent in hospital was also mentioned as a metric. Sure that may be good for some reasons (eg avoiding iatrogenesis) but incentivizing it could lead to patients being sent home too early instead of receiving proper care.

They also mentioned surgeons being "top of their list" - what list? Surgery success rates? That's widely understood to be a problematic measure. Surgeons can boost their success rate by only doing easy operations. Conversely, a surgeon who operates on the most at-risk patients will get a lower success rate because the patients' chances of a good outcome were bad no matter what. Regardless of how good the surgeon actually is, which might be impossible to measure objectively.

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toast0 2 days ago

> Minimizing patient days spent in hospital was also mentioned as a metric. Sure that may be good for some reasons (eg avoiding iatrogenesis) but incentivizing it could lead to patients being sent home too early instead of receiving proper care.
You usually combine a minimize days in hospital goal with a minimize readmittance goal. And combine with supervision to ensure low readmittance isn't due to patients being admitted to the morgue instead. Ideally, some longer term measure of patient outcomes. But as you mentioned, you also need to account for the mix of patients.

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- TimorousBestie 2 days ago
  
  You’re describing the vicious cycle of Goodhart’s law. The one measuring the metric adds epicycle after epicycle while the one gaming the metric develops ever more subtle strategies for subverting it.
  
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