My friends who are now doctors make much more money that I do, they are more respected, they don't have to deal with some annoying hierarchy, and their job is meaningful. As for working hours, it really depends on the speciality, and the hours they chose to work. I know some dermatologists who work 4 days a week for instance.
In the end, I don't regret that I chose a different path as I loved maths and programming and I did some interesting things as well. But nowadays I feel just like a worthless pawn, developing crappy programs, who is starting to suffer from age discrimination...
For your friends in derm, I would ask them how hard they had to work to earn their careers. Dermatology is consistently one of the few hardest subspecialties within medicine to get into. You may be able to work 4 days/week later on in your career, but you'll be working non-stop through medical school pumping out research papers and studying for top board scores just to get in to derm. These days, a huge percentage of medical students end up taking an extra year just to get more research out before applying to derm.
Even MD's still have to deal with some annoying hierarchy or another, unless they own their own practice.
Startups, and especially big tech, are relatively easy. More money etc., but no imminent risk of say death or infection.
You can join open source. For example, at dlang.org we don't care how old you are, and we won't pull crappy code.
It is, after all, open source and we make it all available for free.
However, having great contributions to D have landed several contributors very nice jobs. The sponsors of the annual D conference, past and present, did so to look for crackerjack D programmers. I expect it's the same for other open source conferences.
We have to switch to largely seeing mid-level providers like PAs or RNs and maybe push even lower. The doctors can be there for the tough cases and to consult and monitor. It is already starting to happen and is one way we can reduce the cost of health care.
EDIT: > It is already starting to happen and is one way we can reduce the cost of health care.
To the downvoters, I'm replying to this part of the comment, not the overall thread.
Another would be that you don't necessarily have the country's largest industry association behaving like a medieval guild and choking off access to the profession in order to deliberately drive up costs.
Both my wife and I were very much surprised at how much it costs and how many more hurdles one has to overcome to become a doctor in the US. Sure, we would like our brain surgeons and orthopedics to be trained extremely well. But we really don't need 8 years of schooling, 3-8 years of residency+fellowship training on top of many, many exams (Step 1, 2 CK, 2 CS, 3, state licenses) to become a competent doctor. After all, the doctors in the US have to follow the code/guidance set mostly by insurance companies to avoid being sued (meaning, they don't have a lot of leeway to use their intelligence in treating patients; they simply try to not get sued, so they would tell you to get tested on everything possible in order to avoid malpractice lawsuits later, which actually do happen much much higher than in other countries that I know of). The trust between doctors and patients is very, how do I say it, much impersonal and money based.
AMA, test prep companies (Kaplan, UWorld, AMBOSS), residency programs and everyone in the field are (either intentionally or unintentionally) making the bar to entry as high as possible (higher than necessary) to keep the number of doctors available low (my sister who lives in Rochester, NY cannot book a physician for annual check-up until May). India produces plenty of qualified doctors. So does my country (I'd say my country has produced so many doctors for Singapore, Australia and the US; they, like my wife, came to the US and AUS because they can make so much more money here). The field of medicine in the US is paved with money and has become very transactional (I pay you a lot, you'd better treat me and not mess up or else I'll sue you) and impersonal.
1: increase doctor salaries so there can be more doctors and
2: develop things around doctors so their efficiency improves. (Hire assistants, write software, design better hospitals).
>2: develop things around doctors so their efficiency improves. (Hire assistants, write software, design better hospitals).
As for this note, a doctors time is more valuable than basically all 3 of these. If you assume medical corporations desire making more money, then they would already be looking into this step. It's not something that would be improved by increasing the number of customers.
Preventative care is far easier than complex "shit, you've got stage four cancer because you didn't get that lump checked out". For uninsured folks, ERs wind up functioning as primary care, which is immensely wasteful use of resources.
> If you assume medical corporations desire making more money, then they would already be looking into this step.
They are. Some hospitals hire scribes for doctors, for example.
https://www.ama-assn.org/press-center/press-releases/ama-fun...
[1] - https://en.wikipedia.org/wiki/Medical_resident_work_hours
That plus the throughput of residents is going to be much lower than a trained physician.
As such, Medicare pays a "training institution" premium for all billing. It's a small bomb (5%?) but pays for the resident.
The ones that don't nickel and dime their patients, or even engage in outright billing fraud.
Do you really want to move more hospitals to the latter form of doing business? Because they would be a huge net loss for everyone except the hospital CEOs.
That's absolutely fascinating if so.
One theory I've heard that sounds plausible is that
a) insurers do not pay anywhere near what hospitals bill to uncovered patients
b) hospitals do not even expect patients to pay the whole bill, but more like 20% of it, so it is always good to contest the bill
So the problem is that hospitals are cash-strapped for systemic reasons, but can't get it from insurers or the state because those have contracts in place. So hospitals try to squeeze uninsured patients as much as they can with inflated bills, with predictably horrifying consequences. Insurers don't mind because that makes the case for buying insurance even stronger.
So one solution might be to pay for poor/homeless care via state/federal budgets. This could cover poor people up to an income level that can afford insurance.
Fun fact, if you're unable to pay the full amount most hospitals will do almost ANYTHING to stop from having to send your bill to collection. Even if you say 'I'll pay $50/month forever' thats way better than they'll get from the debt agency that buys your debt.
I honestly can't name more than a handful of large or small startups that do anything remotely valuable. And the ones that do provide actual value don't operate at a loss...
https://hbr.org/2017/10/how-u-s-hospitals-and-health-systems...
Residency is a job and should be interviewed for and selected like any other job.
In a similar way, there are students who spend $200k to go to college, then go to law school, wanting to practice in a certain area of law, and find out at the end that the only job they can get is poorly paying or in an area they don't want to live.
At the same time, it does seem like medical internship conditions and pay are ridiculously terrible, underpaid, way overworked.
On second thought maybe it would make sense to only subsidize the residency programs that are financially unsustainable but necessary, like family medicine or non-subspecialty internal medicine. Downside to this could be that hospitals could choose to not have residents and exacerbate the physician shortage.
looks at the two grant proposals I'm on right now arguing for exactly that
If Hospitals and practices paid for their own residencies, they could lower overall costs, and perhaps work on deals with people to encourage them to stay, etc.
This is simply false. Paying for their own residencies would increase hospital costs since they don't currently pay for residency positions, and they're already free to work on deals to encourage residents to stay post-residency, including, for example, supplementing residents' pay.
Because an Association of Doctors with no Doctors to represent seems like a rather sad sight doesn't it?
Also, considering it is the main force behind setting the barrier to entry, it seems like a bad idea to cut them off from the consequences of the policies they push for by letting them off the hook in terms of not having a fundamental part to play in the training up of new medical talent.
It isn’t a solved problem because not all above is the case. The catch is that Boards will not train more than a few people in order to limit supply and keep wages up
Excuses like “oh the government won’t pay the resident” are shallow excuses — these are highly profitable (for the hospital) positions, not volunteer positions. They are self financing assuming the barriers to spots are removed.
Non-matching graduates constitute a miniscule percentage, and almost none are from US medical schools. And something like 96% of them (cannot find the journal study at the moment) find physician work within 3 years of graduating.
Revenue or profit, who cares, but tax them and then spend the money on residencies.
Or just stop funding any residencies through Medicare and VA. Of course, that relies on the industry deciding to avoid the doctor shortage getting worse.
[1] https://www.livemint.com/news/india/15-700-more-mbbs-seats-s...
I think we need a solution to two problems: First, figure out how to pay people (the hospital, the students/residents themselves, and the hospital attending physicians who spend their time teaching) to train physicians. Second, figure out how many clinical/surgical encounters a physician in training needs to truly be competent when they complete their training. This is more of a problem for surgeons, as they need x number of cases before they feel comfortable doing that procedure on their own.
For the first problem, there are smarter people than myself who pose solutions. CMS (and DHHS) pay for most of this in the US, and is a fixed amount each year with few changes since 1995. So an obvious solution without trashing our current system would be to just have Congress authorize more funding, about $100k/yr/new resident they are willing to pay for. Hospitals should also consider adding their own funding to pay for more residency spots, which is already happening. Note that hospitals bid on the hahnemann hospital (drexel) residents for about the $100k asking price ($55m for ~550 residents).
For the second, you have to decide how many years you want doctors to be training for, at their reduced salary. If you increase training time, you can achieve the clinical/surgical volume needed to become proficient, at the risk of keeping residents at the hospital for longer than they really want. You could seek out more volume at satellite clinics, but then you force the trainees to have to travel, which makes that specific training program less desirable (at least, it does for me)
Grossly over-simplified, I know.
This seems like the sort of thing that should be widely studied, but I can't find the terms to get nice Google Scholar results. In my field we do this sort of assessment for the users of (fairly low-risk) medical devices. It requires a team and is quite work-intensive to assess, but the stakes for insurance providers are high enough that this must already be known....
What a useless step. Why not just have these wait times (and other info) publicly available so people can look them up?
Doctors can decide to set up practices in the area in their own.
Patients can see and ask who’s the hold up is. Is the pay too low? Some crazy liability laws? Whatever.
With this publicly available, it’s much easier to compare service across the state/nation/world without having to be on the inside.
If the NEA restricted the number of teachers the same way the medical industry limits the number of doctors I'd say yes, this is a perfect analogy. Since they don't, then it's a bad analogy.
> Doctors can decide to set up practices in the area in their own.
Not sure about private practices, but hospitals can't just open up without the current hospitals in an area agreeing that it's under served.
> Patients can see and ask who’s the hold up is. Is the pay too low? Some crazy liability laws? Whatever.
> With this publicly available, it’s much easier to compare service across the state/nation/world without having to be on the inside.
If your city limited the number of auto mechanics and granted the guild of car repair persons control over who was allowed to become a mechanic and they only allowed one garage to open up in your town, you would correctly identify this as rent seeking behavior and not a market failure. The choices at that point would be to dissolve their monopoly on auto repair or to create conditions that would encourage their normal human behavior to attenuate the rent seeking. Do you really want to dissolve the AMA? Or would you rather encourage the AMA membership to change their behavior to not artificially limit the supply of doctors?
My solution doesn't give central orders about how to fix the problem, it simply creates a penalty when there is a problem. If the various practitioners realized they could be 20% more efficient while still maintaining quality that would be fine. Or they could create more practitioners. That would also be fine. The problem was created by the industry, the industry can fix the problem.
Really?
If you can't differentiate between hospitals and the healthcare system, you should probably spend more time reading comments in this thread than writing them.
I know a number of doctors who love working for Kaiser after having worked in private practice or at other hospital chains.
Average income is more like $32K.
Also, while I don't know about the competitiveness of jobs in certain locations, rural states can have some of the higher mean wages for fam and gen practioners (https://www.bls.gov/oes/current/oes291062.htm).
Its not that great of a profession.
33% to hospitals
20% to physicians and clinical services
9% to retail prescription drugs
5% for other health, residential and personal care services
5% for nursing care facilities and continuing care retirement communities
4% for dental services
I can't find any clear answer to what proportion doctors earn themselves:
https://www.medicalbag.com/home/finance/health-care-costs-in...
Median salary for physicians is almost certainly significantly higher than for software engineers, but it is less obvious what happens when you factor in length of career, debt load etc.
Neither group tend to work nominal (40h) weeks either...
Nah. The average salary of a software engineer is about $104k per year (remember, <10% of IT people work at FAANGs).
The average earnings of doctors according to Medscape is around $290k, and even primary care doctors earn $237k per year on average. [1]
> Only [1/10th of docs] will have a chance at out earning someone at FAANG.
And FAANG is a similarly small highly-paid fraction of the software workforce as well, so it is comparing like-for-like again. And average pay for those medical specialties according to [1] is $350k to $500k per year, which I bet beats the average pay of even FAANG individual contributors pretty handsomely...
[1]https://www.medscape.com/slideshow/2019-compensation-overvie...
It struck me as very sad, as I've heard similar things from other physicians.
Ideally we would increase the amount of Medicare residencies too. Then everyone could get a residencie and we would also be able to import MD from around the world.
The more layers get forced in between the people providing a service and the people receiving the service, the worse things seem to get.
Maybe things will get better down the road, 20-30 years from now; But as it is now, a lot of the good paying companies will be very hesitant in hiring you once you're old enough.
I'd say 35 - 45 is the period when age starts to become a question. With some young startups on the lower and, and more regular (but relatively young) companies on the upper end.
By the time you're 50, it becomes even more apparent. Hell, by then you're not even safe outside the tech-world - I've worked with good people (in their 50's) who were some of the first to get cut when recession / busts hit, and have struggled to find anything comparable ever since.
If so, I wonder what is the ROI of expertly done plastic surgery.
There is a significant difference between the skillset that produces a medical student (work ethic and drive) and a SWE (analytical reasoning).
There's a difference in skill set that is developed over time, but doctors have to be able to have mental models of how bodies work, how things work in the body, "just like us".
Jr year I interned at Amazon after that experience I knew I made the right decision. It is a really, really hard sell for this current generation to do another 5 years of school with residency and then specialization when you can quickly make 100k+ at a tech company. All of my friends who went into medical school are working hours like 6am-6pm or 8pm-8am. They get like two days off every two weeks. I think there are a bunch of possible solutions but the easiest one is making 5 year medical programs (2 years undergrad, 3 graduate) more common in the US.