Those bright enough go to law, IT and similar.
Speaking for my wife, she had to wade through absolutely brutal first 10 years for absolutely no good reason (she ain't no neurosurgeon, just internal medicine GP with FMH), no personal life at all at the prime of her life. 50 work week in contract (when average here is 42), reality with all required bureaucracy goes to 60-70, for everybody, consistently, unpaid (illegal here but who cares, state owns the hospital), often much more and catching up with tons of bureaucracy/billing at home.
Add night shifts, which most of us elsewhere have no experience with, that mess you up for many further days. You are a fraction of yourself, mentally and physically, for easily a week, more if you had to go through say 4-5 in a row.
These are the conditions that we put repeatedly people who have full control over life and death and health of their patients, often without further supervision, hoping they somehow magically never ever make a mistake, and when they do, folks immediately cry a murder and families sue to hell with massive dollar signs in their eyes.
You complain about that, or that you spend whole weekend being on call 48h unable to do anything really for literally 20 USD altogether (price of a canteen lunch here), including when you have to come and work 10-hour shift? You are put under pressure, shushed for being a pussy if you complain, told to toughen up since previous generations had it even tougher, and they somehow got through. Nobody mentions how horrible parents those absent folks were, how burned out they often were, quietly weeping or drinking themselves into oblivion. Well yes, those that didn't just quit, didn't go insane, didn't commit suicide, sure they got through. And now enjoy seeing young going through a bit milder version of the same. Of course there are insane amounts of money involved, but its always between insurance and hospital, doctors get less than capable IT folks for much less work. I am IT guy and consider this utterly fucked up wrong.
A good friend of ours sued the hospital (biggest public in Switzerland) for breaking basic Swiss law consistently like that, he was first but quickly gathered tons of other doctors. IIRC hospital finally caved in, a bit, but he is gone from it for good to private sector. Twice the pay, half the crap.
I could go on and on like this, a lot of doctor friends in our circles. It ain't some dream job, (at least a bit well-placed) IT job is a blessing in comparison.
/rant
This is happening across society, and I consider it a tragedy the people focused on race and sex have taken all the oxygen out of the room for a much needed discussion on class.
I’d even go so far as to say it’s encouraged (eg, BlockRock ESG) as part of a “divide and conquer” strategy by the capital class.
If "anti-imperialist" Westerners truly care so much about brain drain negatively affecting other countries, they should go live in those countries themselves and provide their services there for the sake of greater good. But very few actually do so, and even fewer are willing to do it on any kind of non-temporary basis.
PS. I didn't say that people calling this imperialism are from west.
The doctors in Nicaragua, the neighboring country, is as described in your comment, except the economy of the whole country is in shambles, and they also have to "voluntarily" participate in "government" political activities. Oh, and since the country is poor there are no immigrants waiting in line to fulfill those positions.
https://www.oecd-ilibrary.org/sites/f8ac5867-en/index.html?i...
So high wait times there doesn't sound entirely perfect either.
Cost of medical treatment and holidays included still cheaper than America?
Fits perfectly for non-emergencies.
It is not that IT is overpaid, it is that doctors are underpaid - at least in France.
We are the world champions of strikes and yet, somehow, doctors rarely go on strike. I do not know why.
They also know where they are going, it is not like they discover the world of medicine after 8 or 10 years.
I am happy that they are people who want to help others, but they also need to eat, sleep and party. Nobody will give them that if they do not protest.
Regarding doctors strikes, I asked the question to multiple ones and the few explanations I got are : - they are deeply regulated and organized, they rely more on acting behind the scenes (lobbying) than going public in the streets - they still have a comfortable situation that they chose ; unlike blue-collar workers who can barely afford food/housing and have to take what job and salary is offered to them ; a GP can move to a private hospital if they want more money and less hours - even though they are organized, they have much more individualistic views of their job than labor workers ; after all they mostly are their own company
EDIT: I just looked up some numbers and you are right, MDs get about 5000€ net pour month in average, which is higher than IT
Poland chiming in. Nobody will give them that even when they go out and protest.
When talking about public healthcare, strikes mean little. State won't care unless the strike is massive enough to attract media attention. Hospitals can't close down, a "safe" minimum of workers must care for patients so not a big problem for the state generally.
Hard disagree here. I don't feel I need to state the reasons. If much of a business relies upon technology that the IT people ensure is up and running for the non-IT folk, I would say that is not overpaid.
This is such a shallow opinion with no forethought into the domino effect. I won't try to make a commentary on doctors, because I am not a doctor and don't pretend to say that "doctors are ridiculously overpaid" because I know it would be a wasteful opinion that does nothing for the conversation.
A lot of what you say is true for doctors in their first 5-10 years into their career, when employed in a hospital.
This not true for doctors which reached a certain level like „oberarzt“ and above.
This is especially not true for doctors with their own „office“ (business).
Yeah people may cry, but normally it is very hard to bring a doctor to justice even when there are quite obvious mistakes or misconduct. They are very well protected, suing a doctor not seldom takes 10 years from start to verdict, with a lot of legal costs involved.
And last but not least, it is a very secure profession. You must be really really stupid to end up jobless. So you have 5-10 years with a „ok“ salary compared to the power you invest. And 20-30 Years with a very good to exceptional salary, especially when compared to the broader population.
Then it's just semi-official hazing. It's still something that should be fixed.
My sense is that the field developed in the era of independent/private practice, where the grueling hours worked was justified by high pay and minimal bureaucratic/administrative burden. Add decades of stagnant/falling pay plus death by a thousand administrative cuts and the profession no longer justifies the difficult working conditions as convincingly. Some practices are still good, others terrible. Look at the rate of physician turnover to see which is which.
Oh and the “provider” discussion is worth paying attention to. Your doctor has this calculus worked out - years & energy invested, work environment & income expected, then the only viable option in your city is to be employed by a large hospital system (because hospitals get paid at least double for the same work, outcome is as expected.) But wait there’s more: you are now called “provider” by your large hospital employer who hires 2x NP employees to do the “same” work as you and pay half. Guess what direction the pricing pressure is going. In the future expect few MDs to stay in primary care because the system does not support that path. Specialty training is the future for MDs who invest time, energy, & money to excel in their field.
Its trivial to sue a doctor, my wife, on her effin' first night shift in the country here got involved death of a patient and got into court case that took 6 months of court hearings to resolve. Not her fault, wasn't her patient even, but she still had to spent ridiculous amount of time for it outside work to get finally cleared.
Her colleague at this moment is getting sued, almost immediately after situation, for overlooking a cancer, when markers from test twice were non-conclusive (I don't/can't go into details, its a very complex case). Suing is very common here, its just that in case error can't be proved on their side, they have cca decent (and expensive) legal insurance. If they don't, license revocation, life-destroying fines, or even jail are on the table. Cases like this are common. This is very common for GPs with their own practice too, since they see more patients than some specialists.
Also not sure why you degrade other's people mental issues when under semi-constant decades of pressure from all sides. "Yeah people may cry" - this ain't how mental issues and burnout should be acknowledged. Please show some respect they properly deserve, you clearly are an outsider to profession and I sense some envy in between your lines. If its that bad with your life, go and start medicine studies, schools are open for anybody of any age and public schools here are free.
Last part - yes unemployment isn't generally high among doctors willing to work, but ie check canton Geneve now - no new GP licenses are granted (as = 0), and old folks are retiring fast. People are desperate to get a GP, I have colleagues begging me to find somebody via my wife for them, new doctors need to travel 2-3h every day to other cantons to find work, and some are properly desperate. As IT guy, I don't know a single capable colleague who has even similar employment issues, companies are always hiring good seniors, and there are tons of companies needing good IT folks left and right.
> too much suffering and risk for relatively little reward.
We need a range of doctors, who range in price according to quality.
That way for simple stuff, which anyone can get right, we go to a cheap, reasonable doctor.
A similar example would be if we only had uber software engineers. Each one had to have a PhD. There were no cheap and okay developers who could do say web-sites but not write a programming language from scratch.
If the demand is there, why is a cap imposed?
According to 'studentdoctor.net' from 2017 - there is a cap because there are not enough residencies for graduating med students. The government is the primary payer for residencies: "It was because of the cost of GME funding that this program came under the fire of budget-minded politicians in Congress. This resulted in curbing of funding for residencies under the Balanced Budget Act (BBA) of both 1997 and 1999:" [1]
> The limitation in funding has essentially put a cap on the number of residencies that can take place in the United States – and since a doctor cannot go into practice without a residency, this is essentially a cap on the number of new, American-trained physicians who are allowed to practice in this country. The American Medical Association, in its AMA wire, blames this cap for the record number of students in 2015 who were not matched with a residency program at the end of their four years in medical school: of the 18,025 allopathic seniors and 3,000 osteopathic seniors who participated in the Main Residency Match, the two groups matched at rates of 93.9% and 79.3% respectively, leaving the highest percentage ever unmatched – and also unable to practice on their own.
> There are proponents for keeping the current cap in place, however. This is mostly among budget-minded members of Congress who are wanting to cut spending, but even the Obama administration proposed reducing Medicare expenditure on GME, even halving support for children’s hospitals, which have their own separate sources of funding. People on this side of this issue tend to decry the seriousness of the physician shortage, pointing out that the increase of physician’s assistants and advanced nurse practitioners has helped to mitigate this problem, even with the cap still in place.
The resource [1] is a bit dated. "Congress recently took steps to support several programs supporting GME funding by fixing technical issues that left some rural programs with an inadvertently low cap, expanding eligibility for rural training track funding, and adding 1000 new Medicare-funded positions for the first time since 1997. " [2]
[1] https://www.studentdoctor.net/2017/01/24/medical-students-kn...
How is this synonymous with not specializing?
In the normal case, I would then think that cost in medicine and medical services would be related to outcome.
To the extent this generalization is true, then when cost is not related to outcome, this is not a normal situation, and then the question would be "why?" - what's going on to make a situation which on the face of it is not normal.
Your example doesn't even make sense. Having a PhD doesn't make software engineers more productive on average. PhD programs train researchers. Research skills have very little correlation with practical software engineering.
What could actually work is to train more physician assistants and nurse practitioners, then have them deliver the bulk of simple primary care services under the supervision of physicians. This is more cost effective and usually works well enough, although there may be some degradation in service quality for edge cases.
ACA (Obamacare)HMOs may have opened healthcare up to a lot of people who until then were going without. But its a faaaar cry from from Employer PPOs. And the ACA PPOs somewhere in between.
An don't forget the Trumpcare policies, with major policy exclusions.
If you really want "First Class" health care then you'll have to pay out of pocket for concierge medicine. That isn't directly covered by most insurance plans, although they will reimburse for certain services delivered through concierge medicine practices.
Having a doctor available to treat you at all is still much better than having your very high standards and then not having a doctor available period.
For what it's worth, I do agree we should train more doctors, but I think it's a complicated problem.
This happens already, today. There are dozens of reasonable questions you can raise based on this fact - but I don't think it's obvious that the failures at the end of training can majoritarily be identified by pre-training metrics.
Some countries allow any student to take the first two years of medical courses, and then impose restrictions on the following years. This seems a relatively fair system; you can imagine someone persevering over many years to attain the requisite knowledge - but this person would not have had the opportunity if there were a pre-medical school filter
We need doctors who are available to treat simple conditions and refer to a more qualified doctor for the complex ones. Such a job doesn't require being a genius, just people who are not complete idiots, and the qualifications required here are genius-level, not idiotproof-level.
It people can't see a doctor, or can't get decent care because doctors are overworked, they will go to the "pseudo doctors". "pseudo doctors" are usually much less regulated, because they don't really practice medicine, can't make prescriptions, are not covered by healthcare subsidies, etc... but they are available, and actually caring, because there is no shortage of them.
This is actually good for the patients, sometimes, all you need to get better is someone who listens to you and points you to a healthier lifestyle something, something that "pseudo doctors" can do well. The problem is when they bring their pseudoscience to "treat" actual medical problems that can't just be solved by eating vegetables and getting some rest.
Now imagine an actual doctor who is available and caring, giving you all the benefits of the "pseudo doctor", but in addition, can actually practice medicine. Maybe not to the highest level, but he would have attended an actual medical school and knows enough not to treat cancer with fruits.
The problem now in many places is that it is not just hard to become a doctor, it is hard to access medical studies.
> We need doctors who are available to treat simple conditions and refer to a more qualified doctor for the complex ones.
And does the (my impression) widespread support for oh-so-rigorous qualifications for doctors reflect any real-world data about actual resulting quality of patient care? Or is it a way for prospective patients to vocalize a bunch of anxieties and emotions about medical care, plus a way for the doctors who've had to endure such treatment to say "all the noobs should have to suffer as much as I did"?
This is unlikely to be true.