patrick.net

bap33 said Good doctors, much like good teachers, preachers, and coaches, are BORN and do not learn their craft from a book nor do it for a dollar. More “education” does not equate to being better doctors. Lots of highly eduated people are idots that can’t change a tire or solve a basic life problem. They are idiots with degrees Excellent point. The red tape in medical education and licencing does not make bad doctor a good doctor...it just increases the barrier to entry, cost of education ..etc. Actually we might be losing out on many good potential doctors because they could not afford to become doctors. just me says :Two things, Bad engineers just fail in the marketplace (well, most of the time :)), and their company fails selling products. But the good products will still get designed. And if we import a mix of good and bad engineers from India or elsewhere, the GOOD products will get designed, manufactured and sold around the world. Bad doctors fail curing patients, and leave dead, suffering or permanently injured patients in their wake. Each patient is unique, and medical service can not as easily be mass produced. There is quite a bit of difference here. We can afford failed products and companies. Most people would not like to be a failed patient. You are right when its a individual doctor but when medicine becomes market driven...doctors tend to gravitate towards working for hospitals. hospitals tend to start building brands ( to attract more patients) because patients don't want to take too many chances and value credibility of hospitals a lot.hospitals don't want to risk thier brand due to some bad doctor screwing up big time.its a self correcting system. Do you think good airlines will hire a pilot without proper training just because there is no restriction from govt...no ! They won't because thats bad for business.People in US have not seen true market driven Medicine so its hard for them to comprehend but i have seen this in other countries where there are bad hospitals and good hospitals and people know about it and avoid bad ones.

homeowner_for ever_san jose says

Excellent point. The red tape in medical education and licencing does not make bad doctor a good doctor…it just increases the barrier to entry, cost of education ..etc. Actually we might be losing out on many good potential doctors because they could not afford to become doctors.

This is mostly a load of bullshit. Education is certainly not everything -- but it's a form of experience, and you need to get experience before anybody will trust you. Everybody starts with 0 experience. How do you propose that medical professionals get experience? Do you want to let any random jackass start practicing medicine, and after he kills a few people when performing surgery you decide that he shouldn't do it anymore? That's what we had hundreds of years ago. People started demanding some way to know if someone was legitimate, so certification programs were created. Today we have universities and medical boards. Whether the government is involved or not is meaningless -- the end result will be the same. You can certainly argue for industry regulation instead of government regulation, but I would point out that the track record of industrial self-regulation is piss poor, regardless of what economic theorists who support a free market model might claim "should" happen. Now, medicine isn't my field, but I've seen first hand what a lack of education can do -- I'm a software engineer. In my experience, most "self taught" engineers know a little bit about applied engineering and jack shit about the fundamentals that back it up. Most don't know anything about physics and even less about math. They think that knowing how to write some Java code is what makes them 'good', even though they don't know the first thing about algorithms and data structures. As a result, they're crappy engineers who produce crap (and, worse, inefficient crap). For the most part, these are the people who claim that there are "plenty of good engineers" because they look at the people around them and determine that they are as good or better than themselves -- not realizing that they are in that group of "bad" engineers. This is also the same group that think that computing requirements haven't changed fundamentally since 1995. They don't have the slightest clue what it costs to decrypt a message using RSA, to implement a secure operating system kernel, or to detect that a program has been modified while it is running. I say this as a self-taught engineer who dropped out of school because I thought the teachers were full of shit, only to realize nearly a decade later what it was that I had missed. It's amazing how many people who lack an education claim that said education has little or no value. If the medical industry was as full of incompetent, unregulated "professionals" as the software industry, you would go in with a broken arm and come out with two broken legs and a nose job. Your arm is still broken, but the doctors insist that your arm was always broken and if it happened to work correctly before it was unintended behavior.

you make a valid case..but you missed my point.I am not saying the education is not needed. We need educated doctors but consumers need to decide if they need that educated doctor or somebody else..they need the freedom of choice. would you like , if government madated that companies can only hire Ph.d's for all software engineering jobs ? companies know whom to hire based on thier need and the job. Govt should only be in the business of creating certification programs and not force it on people.

I would argue that consumers are not in a position to judge whether or not a doctor is qualified to treat them in the first place, and even if licensure was completely private instead of the current hybrid public/private licensure that takes place, the result would be more or less the same. Insurers certainly wouldn't enter into any contract with unlicensed professionals, and as I've said before, there's no chance in hell of going to an insurance-free system (other than possibly single payer) anyway so it's a pointless conversation. That would leave us with exactly what we have today: A bunch of people who are medical professionals but are not licensed to "practice medicine". This includes everything from legitimate practitioners like nurses and midwives (who are still somewhat regulated, though nothing like what physicans have) to crackpots like homeopaths and aroma therapists. Do you know what the license to practice medicine actually does? For the most part, it allows you to write prescriptions. This is an important function because the vast majority of medications are controlled substances. If you want to eliminate licensure you're also going to have to eliminate all pharmaceutical regulations. Funnily enough, you can still perform many types of surgery without a license, you just can not claim to be licensed to practice medicine when you do so (this is why you can get horns implanted in your skull in a strip mall -- just don't expect any pain medication). For the most part, board certifications are what does the job here. So, yeah, eliminate the government licensure. The hospitals are still going to require that you have an equivalent certification, and that certification authority will still require that you have a Ph.D. I actually would be in favor of licensing requirements for software engineers, to be honest. For a long time I thought this was a bad idea, and then I observed how much better the quality of work from civil engineers (who require certification) is. Certification doesn't make someone "good", but it does ensure that you filter out most of the people who have no business in the profession at all, thus insuring that few practitioners are "bad". I like knowing that when I talk to a licensed physician, they actually tend to know what it is that they're talking about. It is rarely the case that this is true with software engineers -- it's just that so few non-engineers know what they're talking about to know the difference anyway.

I thought it was very interesting to get some healthcare insider perspective from DT, hanskung23 and pbenson, thanks guys. Hanskung23 said: >>a good 10-20% of the students that we graduate have no business being practicing physicians. That was a bit of an eye-opener, but presumably it would not apply uniformly across all universities. On second thought, perhaps I am not all that surprised. I think it is pretty common in many of the learned professions that about 10-20% practitioners are fairly clueless, and it would be surprising if medicine was fundamentally different.

actually would be in favor of licensing requirements for software engineers, to be honest. For a long time I thought this was a bad idea, and then I observed how much better the quality of work from civil engineers (who require certification) is The only issue is that you are giving somebody else the power to decide what the licensing requirements would be. When a third party gets the power ( without the right incentive) they abuse it. Actually it would be nice if govt can also decide and distribute everything we use so that we have better quality control in everything ( food production, clothes, toilet paper..) ...back to soviet style centralized govt ( sarcasm alert)

homeowner_for ever_san jose says

I personally know many good doctors from india ( some from top 1% in thier school ) who told me that there is too much red tape in US which prevents them from landing in US as a doctor. it was easy in 80’s and then AMA made it tough. BTW, these are same doctors who treat patients from US who go to india for best in the class treatment. I am pissed off that i can get a world class treatment in india for 1/10 th the cost of US but can’t use the same labor arbitrage (so called globalization) in US.

BS. If they can get a visa (which is a major problem post 9/11 and has nothing at all to do with the AMA), pass the same USMLE exams as American medical grads, and get hired by a residency program they can go through a residency program and practice here. If they are in the top 1% it should be a breeze. Or are you saying that having to actually pass the test is too much red tape? Or are you saying that the entire idea of testing is invalid? Your basic argument seems to be that testing people for competency is some kind of conspiracy to prevent competition. Eliminating it would certainly increase the supply of people like doctors and airline pilots. They could just self certify their skills and we would have some kind of web based satisfaction survey. That should work out nicely for the people that survive to be surveyed. Are you working in India? If not, how is it you are talking to so many Indian doctors who say they wouldn't come to America because there is so much red tape? How could they be from India but didn't come to America? Are they living in Poland? This statement doesn't add up. You sure have a lot of crtiticisms about the system, but don't seem to offer any alternatives except the vague idea of some type of H1B system that somehow attracts qualified docs without some onerous third party actually checking if they are qualified. I have no idea how that would actually work. Are you saying we don't want or need licensing here, but that we should accept licensing from other countries for qualifications? You don't see a little contradiction in this thought? Or should we just accept anyone who claims to be a doctor in another country, let them start operating on people and see how it works out? Hey Bap33, did a doctor rape your sister or something? If you really believe 80% of the people who become doctors are unqualified you are a seriously warped individual. That's one of the stupidest things I've ever seen posted. What exactly do you do for a living (or in life) that makes you so qualified to pass judgment on people who spend 11-15 years and hundreds of thousands of dollars to pursue their profession.

i am just saying that you need "CERTIFICATION" and NOT LICENCING !!!!!! There is a difference. Also, if a requirement tests your patience ( length of training ) and desire for money ( expensive training needs bigger ROI) guess what you get : stupid , greedy and ambituous doctors ! In most countries, the requirement is such that , the person needs to be competent and smart. BTW, i go to india ofter and travel back and forth a lot.I have very good insurance in US but i prefer to get treated in india because i have found much "SMARTER" doctors who had the "NEEDED" training. I have GENERALLY found that doctors in US are more ambituous and money oriented but don't have the same IQ level ( for what they are paid). The barrier of entry in US to medicine due to the cost and length of education gives the avergage IQ guys (who have deep pockets , greed and focus on money ) advantage over the smart ones (but less fortunate). Thats one reason i mostly find that the smart people in US do Entrepreneurship and other fields than medicine. Nothing comes for free.. if you make the training excessively lengthy and cost prohibitive, you will ofcourse loose something ( smart people) and be left with dumb and greedy people. By the way my generalization does not apply to all doctors...i am just pointing to a trend in US versus other countries.I have found really good , passionate doctors here but the % does not match up to what it should be. I'll prefer to go to a less trained SMART guy who is passionate than a guy who is dumb , has trained for 15 years, and has spent thousands on education.

Some Guy : "Great. Why don’t you move to India and shut the fuck up, then?" BTW, Who the fuck are you to tell me that ? I will move as i wish ha..ha.. I enjoy best of both worlds ( which you can only dream of ) Has it become a norm to tell whoever complains about care in US to go to some other country.

I don’t want some hack with no medical training treating me. You are free to choose one with the training you want ...who is stopping you ?

i am anyway's getting my treatments in India..thanks for the tip though. i stay in US and have the flexibility to go anywhere i want depending on what i want. I like everything about US except healthcare so i don't want to move to any other country. Anyway, you didn't answer my question. I don’t want some hack with no medical training treating me. You are free to choose one with the training you want …who is stopping you ?

homeowner_for ever_san jose says

i am just saying that you need “CERTIFICATION” and NOT LICENCING !!!!!! There is a difference.

Uh, yeah, the difference is that practicing without a license gets you thrown in jail. Other than that they're the same thing. zetabeos1 says

Have you taken some time to mentor/train these ‘bad’ engineers? Your job, if you are a manager, is make your staff leaders for years to come.

I'm not currently in management (managers aren't engineers -- it's a completely different role for people with completely different skill sets, and good engineers rarely make good managers and vice versa), but your argument could still apply to a limited extent. The short answer is "yes", but that doesn't change the fact that 80% of people who are employed as software engineers aren't very good at it. We make do with what we have, but it would be a lot better if we just had better people, period. I'm all for more H1-Bs because it would mean a larger pool of good people to choose from. I don't have 10 years to spend training someone to make up for their own incompetence; technology can't wait that long. Bap33 says

There is no healthcare issue. None.

You don't consider the fact that we pay twice as much per capita for health care as any other country in the world to be an issue? You don't consider the fact that our medical costs account for 16% of GDP to be an issue? You don't see the fact that the only medical care program available for the elderly is going to be insolvent in 20 years as an issue? Are you on medication right now? Bap33 says

it would appear that free healthcare don’t work over yonder.

Uh, you do realize that the Japanese just elected a new liberal government that wants to expand their social safety nets (including health care), don't you? Why on earth would you point to this to support your argument? homeowner_for ever_san jose says

You are free to choose one with the training you want …who is stopping you ?

If I can't be reasonably confident that the practitioner is providing verifiable credentials, that's a pretty big barrier. How do I know that the less qualified guy is qualified enough to handle whatever my particular issue is? How do I know that he's going to be aware of the side effects and interactions when he tells me that I need some particular medication? Without some significant penalty for misrepresenting one's abilities and training, there's nothing to stop someone from outright lying about them -- which is exactly what we see in other industries. We have a bunch of shitty software engineers and shitty mechanics and shitty general contractors, but we put up with those because it's unlikely that anybody is going to die if they screw up. We don't take that same risk with physicians and civil engineers and similar professions because somebody will die if they screw up.

Patrick, I'm getting tired of your pro-healthcare views being posted on Patrick. I don't visit the website for political bias, I visit for Real Estate news. I'm sorry to say, that as a long time viewer, and fan of the site, I will have no choice but to quite, and boycott the site if I don't see a drastic reduction of political articles. You are RIGHT about real-estate, bu VERY VERY wrong about health care. You don't know what your talking about, and you are just regurgitating radical left talking points. Larry

You are one serious illness away from bankruptcy. Everything you ever earned will be taken from you in medical bills, even if you have insurance. Only America does that to its people. No other country.

How is that different from any of the other unfortunate and unforeseen consequences which is part of life? One layoff away from unemployment. One car accident away from being paralyzed... etc. Sure, there are solutions to mitigate these unfortunate occurrences but is larger government really the answer?

Bap33 "Your post is the stupest thing I’ve sen on the net ever in life — ever. You stupid motherfucker. Actually I am quite bright and used to be a conservative until the religious crazies co opted the term. Now I prefer to be independent with a fiscally conservative outlook. I think the thing you are truly searching for in life is called anger management counseling. You really need to get your meds readjusted. I noticed you never answered my questions by the way, just vilified my response. Typical of what passed for discourse in the far right wing. Why do you consider all American doctors scum and believe Indian doctors walk on water? Especially since lots of Indian doctors were trained in the American system that you so despise. What qualifies you to have this opinion? This should be interesting. FYI. Unlike America where the primary limit on medical students is the amount of funding provided by states and the federal government, in India the medical schools are strictly regulated by the government and there is a strict limit on of 18,000 on licensing (graduation). Since about 36,000 students graduate medical school in India half must go abroad to finish their training. Don't ever let facts interfere with you opinions.

to larrypatrickmaloney: Don't let the door hit your ass on the way out! Boycott the site?? Is that supposed to scare Patrick and everyone else here? Why don't you get a life? It's Patrick's site and he can post whatever he chooses!

Bap33 says

but Patrick, we are also able to move beyond our born-into-station of life here and that is not as easy to do elsewhere. I guess that exposes us to some risk not found elsewhere too?

What a heaping pile of bullshit! You have clearly never been outside of the United States if you believe such utter garbage.

bob2356 says :Unlike America where the primary limit on medical students is the amount of funding provided by states and the federal government, in India the medical schools are strictly regulated by the government and there is a strict limit on of 18,000 on licensing (graduation). Since about 36,000 students graduate medical school in India half must go abroad to finish their training. Don’t ever let facts interfere with you opinions. Utter bullshit...there is nothing like that in india. looks like bob is pulling facts out of his ass.

BTW, bap33 i don't think you need anger management. we don't need pussies here..we need people who get angry when people talk bullshit.

zetabeos1 says

A very interesting article…posted by Patrick Online database lists salaries of more than 134,000 workers across Bay Area and beyond Grown during better times, public paychecks stick out during lean years. Who are the FAT CATS now!

Apparently, Patrick is one of them ;p

REGISTRATION OF DOCTORS 2004 21,003 2005 16,634 2006 17,064 2007 15,517 This is information is from the Indian Medical Register at the Medical Council of India website http://www.mciindia.org/ as pulled out of my ass. Registration is what we would call licensing. The Indian Medical Council is the governing body for Indian medical schools. As in (major dirty word) licensing, although they call it recognition. Interesting reading for the intellectually curious. The demagogues can just look at the pretty pictures I guess.

" there is a strict limit on of 18,000 on licensing (graduation) " I didn't find this anywhere ...where did you get this if not from your ass. BTW, it takes just 5 years after high school in india to become a doctor (primary care) and i have found one of the best pimary care physicians in india.

I misspoke, the limits change year to year. You don't become a doctor in India in 5 years. You become a MBBS roughly equivalent to a masters degree. You also have to take 2 years of medical school courses in high school leading into medical school. After your MBBS you go on to post graduate courses. It's an additional 3 year course to an MD degree. If you want to specialize, such as surgery, there is an additional 3 years after that.

Just wait until NUMMI closes in March 2010. 4,600 direct jobs + 95,000 indirect but related jobs - GONE! Fremont and East Bay prices will see some more serious downward pressure coming soon. Any valuation today will be even lower next spring.

You don’t become a doctor in India in 5 years. You become a MBBS roughly equivalent to a masters degree. You also have to take 2 years of medical school courses in high school leading into medical school. After your MBBS you go on to post graduate courses. It’s an additional 3 year course to an MD degree. If you want to specialize, such as surgery, there is an additional 3 years after that. Dude i studied high school in india...To be qualified to prescribe medicines ( general physician -> MBBS), you need 12 years (elementary to high school) + 5.5 years (medical school) in INDIA ..period ! MD is for specialization. 2 years of medical school courses in high school is just biology, zoology and botany and is part of 10+2 curriculam. kids who want to do engineering take math, physics and chemistry during those years. The reason costs are high in US are due to pseudo- free market in health care. its worst of socialism + worst of capitalism. Supply side is screwed : doctors ( limited supply), equipment ( monopolies , long patents), drug monopolies.. demand side is screwed : patients are price insensitive ( due to third party payment) . If patients are price sensitive they will go to better HOSPITALS which have good credibility and give good care for less money. I thought price sensitivity of consumer is the backbone of a free market. when free market does not work..then obviously you have wastage and in-efficiency ( remember soviet union) The real fix is : 1. ease licencing and make it industry regulated. training should be based on market demand.kick out AMA lobby 2. ban all insurance except catastrophic medical insurance ( that too with 10% deductible which caps at 3X annual salary).This will get free market working for everything except catastrophies.It will also reduce admistrative costs.For people who are intellectually challenged, catastrophic medical insurance means insurance which also covers big ticket emergencies ( including accidents ...duh) 3. ban liability insurance and limit financial damages awarded to patients to 3X ( some number) the doctors annual salary.liability insurance defeats the purpose of creating fear in doctors against malpractice. 4. Reduce patent time period from 20 years to 10 ( like japan)..i am throwing a number but the time period should be just enough to motivate people to innovate and not long enough to be rent seeking. 5) Use the global supply of cheap skilled labor ( doctors)..create H1B's for doctors... we are using cheap labor everyplace. goods ( remote labor in china), engineering ( H1B's from india, china..etc), labor jobs ( cleaning, farming, construction) done mostly by illegals...etc, medicine has not opened up to cheap global supply of skilled labor which makes the service expensive RELATIVE to other services. If all the services were protected and were expensive : house cleaners getting 50k/year, engineering jobs $300k/year , auto jobs 100K/year, doctors salaries would look normal.

I like Some Guy's response. Short, and totally to the point.

Kudlow is a perma-bullsh*t artist who's always filly his oats and he's hot to trot to stirrup hopeful information but he's gone totally hay-wire. There's too much manure spreading when he piles it on. His sanity has left the barn, it behooves me to say. He should be given the boot since he's a heel who's hell bent for leather and never wants to pony up. That's my mane complaint. Give him no quarter because he tells too many tails and has lost track. He actually spooks me. Is he a friend or foal? Whoa, please spur me the drama.

heah, I believe this guy

In 1987 Kudlow was rehired by Bear, Stearns & Company as their chief economist and senior managing director. He was fired in 1994 after his drug use resulted in him missing an important client presentation.

Yea, the biggest problem for realwhores is that appraisers are using comps of actual sales, including short sales. Realwhores say that those aren't true comps, that they drive down the values.

This is a loaded topic. Shoot, I really don't care for a woman of this caliber. She needs to get the lead out. She's all pistol and vinegar and her aim is off. She should down a few Colt 45's, get hammered and take a powder. That would be a blast.

I'm considering a bid on a short sale in my area and would appreciate any advice and/or suggested strategies to expedite the process.

Will the RE listing agent, the mortgage servicing bank or the investor announce the appraisal value?

Will the RE listing price typically be at, above or below the appraisal value?

Should I bid at the asking price? Higher or lower?

Regards

Ray

Ray, your best bet is to research all of the comps, that is comparable sales, in your area. Size of home, year built, size of yard if applicable, amenities. These should all be looked at. You can find this info using zillow.com or redfin.com and their maps that can show you houses sold. This info will give you the basis of where your offer should be.

In the very small neighborhood I have my eye on, asking prices are all over the place. Some much higher than what they should be, some much lower (Usefull to create a bidding war), and some actually spot on.

As to the appraisal, the appraiser may not be familiar with the area due to new rules about appraisals. As such, the appraisal may come in higher, lower, or at the asking price.

I don't know if the appraisal will be shown to you as I haven't made it that far in the process yet. Be ready for a very long wait, lots of discouragment, and most likely your offer getting refused or not hearing from the selling agent at all. Things are terrible out here for anyone who isn't buying cash.

I have been a prospective buyer ever since I started reading the forums. This site has provided alot of information that helped me understand where the market should be for me to buy and how I can know when that time is. Its not there yet. Maybe next year.

I know, that's why I am still out. Prices are still too high, sellers and buyers still too crazy.

Prices are still too high, and the market is being blatantly manipulated. Artificial scarcity and a rush of demand due to temporarily low rates and an insulting $8000 buyers bribe. Let the fools pay $30k extra for their $8k bribes. I will have no part in it. I'll buy when it resembles a free market with reasonable prices.

As far as waiting, and being perfectly positioned for your dream home is just Patrick.net fantasy mantra…..always has been…always will be ----Well if you think Patrick.net is "fantasy mantra," why are you on his site?

Bap, I hope you don't mean I should move along. I am with Patrick's thinking. Oh yeah and my realtor told me that bank owned homes/property is taking longer to come on the market and the banks "are so backed up" and that it is taking longer to list them.

Ditto, to what Tude said. I am waiting for the economic collapse to happen when China will stop giving the US money. We will really hit a high unemployment rate then. At that point, houses will sell for next to nothing, only a matter of time. On top of that, I heard that China is buying 93 billion worth of gold. Most Americans turn a blind eye to what China is thinking and doing but the shit will hit the fan in a few years, maybe even sooner. I can't believe China hasn't pulled the plug yet because the US is a deadbeat nation that doesn't pay its bills.

nowhere but up from here says

Yahhhhhoooooooo…..thats what we did and “PAYDAY” baby…..house was gone in less than 2 weeks + 50K over asking price…..”can you smell what the Rock is cooking”…..and more NEW YORK (TheStreet) — Stocks moved slightly to the upside early Wednesday after a sharp increase in mortgage activity, ahead of another checkup on the U.S. economy, this one region by region. Meanwhile, the Mortgage Bankers Association said early Wednesday that its seasonally adjusted index of mortgage applications, including both purchase and refinance loans, increased 17% to 648.3 for the week ended Sept 4. That’s its highest level since May. I know things are bad but damn…..between the market, the house sold, all rentals full…all distressed homes for sale sold in my area and appreciating….it’s better now than in ‘07

Why did you sell your house if homes are appreciating?