Potentially controversial opinion, but perhaps it is exactly the immigrants who are enabling the dysfunction to continue? I imagine tougher decisions would have been made to balance doctor quality of life with patient outcomes without immigrants taking whatever abuse the current system throws at them.

If you allow the capital class to import new workers when the current batch get too “uppity”, why would you expect conditions to improve?

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.

Ah, yes. Literal victim blaming.

They voluntarily immigrated to the country to take highly skilled jobs and are free to leave at any time. They are not victims; they are willing participants in an exploitative system.

People with limited choices can still be victims even if they volunteer.

You're kinda ignoring the part where the exploitative system is global, and those people are coming from places that are on the more exploited end of it. The reason why they come to take those jobs is because of the quality of life that comes with that, that is impossible to achieve in their home country. And the reason for the latter is largely because their countries have historically been exploited by the one they're now coming to, and in many cases, are still being economically exploited in various ways (including directly sponsoring local political corruption by foreign businesses). If you don't want them to come to your country to chase a better life, raise the living standard in their country.

The governments set the immigration policies. They probably think it’s easier to import doctors than fix the problems with medical schools, hospitals, doctors guilds, payment systems, ect… It is very uncharitable to view this as an attack on immigrants.

This is getting downvoted like it is some horrible bigoted remark, and I don’t think it is. It seems reasonable to me to say that immigration can paper over problems.

Are you suggesting that the solution is that immigrants just make better decisions?

If you're on a work visa and need a employer to sponsor you to stay in the country, it's pretty hard to quit if you're being taken advantage of. Being ineligible for unemployment payments or other support doesn't exactly help. Immigrants are often making the best decisions they can given the constraints of the situation, but it's not good for them or for local workers if immigrant workers are an exploitable underclass.

While somewhat rudely expressed, but in principle I'd agree. There are people who call it modern day imperialism – it's the draining high performant brains from other countries what allows western societies to keep doing a lot of things.

As an immigrant myself, I've heard this take a lot. I despise it because it treats us as a resource that you can allocate here or there as needed to solve problems, ignoring the person themselves and their needs and wants. What if the "high performant brain" does not want to sacrifice their own well-being for the sake of "improving their country"?

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.

Don't be offended. I completely understand that in personal level the view is very different. It's normal that in personal level you make your own choices and choose whatever is better for you personally. But it doesn't mean that a lot of people choosing whatever it's best for them are creating outcome that's better for the world.

PS. I didn't say that people calling this imperialism are from west.

I think its similar worldwide. Like I said my brother quit. Its also true that IT people are ridiculously overpaid. Both problems will inevitably revert to the mean.

Not everywhere though. The life of a doctor is much better in Costa Rica, even in public institutions. The extra time is paid. And the syndicates are strong (which has worked well)

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.

But Costa Rica has one of the longest wait times for non emergency surgeries.

https://www.oecd-ilibrary.org/sites/f8ac5867-en/index.html?i...

So high wait times there doesn't sound entirely perfect either.

Wouldn't this partly be a sign of markets deciding what wait time is worth it? For non-emergency surgery, like cataracts or knee replaces cited in the data, people can live with the conditions. It looks like wait times are consistent, meaning the backup isn't growing steadily over time. I'm pretty sure that would mean different populations just have a different threshold for how long they're willing to wait. If it was a consistent imbalance between the number of surgeries needed and the medical capacity I would expect to see wait times grow over time.

Perhaps this is related to the fact:

Cost of medical treatment and holidays included still cheaper than America?

Fits perfectly for non-emergencies.

Hey, there is a reason you can use Internet and this is us :)

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.

If you're talking about the situation here in France, it's a bit different regarding money. Doctors are still paid more than most people in IT. Given the IT money in the US, I'm not sure they have the same situation if we look at the hourly rate.

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

I will have to look up actual numbers, but with 30 patients a day this is 25€x30x5x4=15000 a month pre everything. You take out taxes, costs, everything they need to pay in full and I guess the salary will not be very different from IT.

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

> Nobody will give them that if they do not protest.

Poland chiming in. Nobody will give them that even when they go out and protest.

> We are the world champions of strikes and yet, somehow, doctors rarely go on strike. I do not know why.

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.

Except if that safe minimum is on strike as well. It takes a coordinated effort, sure, but we have role models such as the train conductors or other champions of strikes

Absolutely not. Not all IT jobs & Doctor jobs are created equal. Entry-level roles might not warrant super high salaries in either case. Both IT and Doctor fields have a spectrum of jobs with varying pay scales depending on complexity and criticality.

> Its also true that IT people are ridiculously overpaid

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.

The picture you are painting is way too dark. And does not give a realistic picture.

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.

> A lot of what you say is true for doctors in their first 5-10 years into their career, when employed in a hospital.

Then it's just semi-official hazing. It's still something that should be fixed.

Surgeon here, in private practice. Agree with the article - all the stressors he mentions are typical of both residents and staff physicians. The hour crunch for me is better post residency but overall the stress is unchanged. Probably higher after training with the added responsibilities & risks.

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.

I’m so glad I’m not alone in noticing this “provider” bs. Peel back the creepy Orwellian doublespeak and all you find is cynical ploy to save money by creating a false equivalence of doctors’ work with non-doctors. The health care industry is just the latest home of the money-grubbing vampire squid of finance. Sickens me.

Not sure how much you are actually in the business here, but almost everything you write is incorrect for literally every single doctor we know (cca 50, variously close, everything from GP to heart/neurosurgeons). You are clearly talking about German part, I talk about French, but still same general rules do apply.

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.

Same in Sweden, it is rare to meet a Swedish doctor at the 'vårdcentral' (group practice). In my infrequent visits with one of my children I've met doctors from Iran, from Iraq, from Germany and from the Netherlands but not from Sweden. Nurses tend to come from Sweden. What seems to happen is that Swedish doctors find work in e.g. Norway where the pay is a lot higher while the working environment is less stressful. That in itself is also a bit of an oddity since Swedish doctors don't see as many patients per day as those in e.g. the Netherlands do.

    > too much suffering and risk for relatively little reward.

Is the pay as high as the US? Specialist doctors have crazy high salaries in the US.