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Unlike salary position that 300k, at least in my field, is all via private equity and we are all independent contractors--meaning does not include any vacation, any paid time off, any sick days, any retirement or medical care or insurance of any kind.
I have not seen a raise since I started which was prior to covid. I'm not saying I need a raise I am well paid but again to be 500k in debt with zero benefits and I see on Reddit buckees managers or UPS /fed ex drivers making 150 to 200k with benefits and the ability to call out sick and the ability to not lose everything because of a single case where you follow standard practices or guidelines followed around the country but something bad still happens.
I go to work everyday with the understanding that the majority of my colleagues have been sued and even if not career ending the stress is enormous. At work I wear a tracker so that every fart and cough and patent interaction can be tracked. A VIP club of patients that donates to the hospital can ruin me with some bad reviews. A stray comment about poor care by an ems crew can end my career (as they bring the hospitals patients).
I don't believe doctors are overpaid and we need more to bring their pay down. A patient will get billed 2000 dollars if they ask for a burrito out front in triage, walk in, are told by me that Taco Bell is across the street, and they promptly walk out without a single test done.
On the other hand I may see sixty people in a busy night which require procedures such as being intubated and put on a ventilator, fractures being reduced , etc.
A major problem is private equity in medicine. Everyone should be focused on removing these groups which skim money off everyone both doctors and patients included. Even if the argument that somehow their efficiency increases result in extra money to the system they can feed on there is no reason why hospitals can't group up and also be efficient and cut them out and pass down savings to the customer or not overwork us docs or treat us like expendable McDonald's employees. The lack of working directly for the hospital there is no metric for skill or seniority or anything like that you are an expendible piece of meat/fall guy that they load down with as many mid level providers as they can get away with
I know, never gonna happen.
In the US if a doctor is remotely competent with money then this is very achievable.
There's no solution other than training a lot, lot, lot, lot more doctors.
Their salaries need to be lower, training needs to be cheaper and faster, and we need a lot more of them.
Speaking from Romania: here medicine is prestigious. So many parents push their kids towards medicine. There's a glut of newly minted doctors every year, but rumour has it that the quality drops every year. Sure, they pass the exams and residency and what not, but... They're just not into medicine as much.
Do you want to get treated by such a person?
This year I had to go to a neurologist. I went to one locally, they dismissed me in 5 minutes, told me to take some vitamins basically. Went to another one in a much bigger city, they talked to me for an hour, ordered a ton of tests.
Would it help if we get a lot more of the first kind of doctors?
The prior post was specifically talking about the US. (I assure you, arrogant dismissive doctors are also a thing in the US)
In the US, there are a number of things that artificially increase the barriers to becoming a doctor.
1) You typically need a four year college degree to apply to medical school
2) Medical schools are accredited by the AMA, which is controlled by doctors. The AMA makes it very difficult to start a new MD-granting medical school.
3) Medical school in the US is very competitive to get in. They are likely turning away a lot of people who could complete the degree.
4) Since 1997, the federal government has a fixed number of Medicare (Medicare is a federal health insurance program for people over 65) supported residency positions. That number was basically flat for 25 years. We lost about 20% per capita of doctors being trained with support from this program. The caveat to this is that the total number of residents per capita has increased over time, particularly the past 15 years or so. My understanding is that they are less likely to be fully funded, so they spend more money getting trained, and then have higher students loans (on average graduating with debt above 200k going back to the late 2000s) that they need to pay off, so they charge more.
And you can add to this that it can be very difficult to be a doctor in another country and come to the US to practice here.
In my country, there's a big feud between cardiologists and radiologists right now, big enough to be a regular topic in national media. Inside sources tell me it has nothing to do with quality of care, and is entirely about the march of technology allowing radiologists to perform some diagnostics that previously required cardiological procedures, and those procedures happened to be the major funding source for the cardiology departments.
In the US, medical school is extremely expensive (like $400,000 expensive). There are many people who are excellent doctors who are just priced out of the profession. If we could make medical school less expensive (by subsidizing it and by reducing the amount of instruction), we would probably get many more excellent doctors.
I'll give you some N=1 sample on older doctors since I'm also from Romania: a lot of these older doctors haven't opened a book in a very long time and are still using older practices instead of providing their patients with the latest and most effective treatments available because they're too lazy and/or prestigious to go and learn new things. Would you say that they "into medicine"?
> Would it help if we get a lot more of the first kind of doctors?
It would certainly help hypochondriacs a lot. Ordering "a ton of tests" needs to have some basis behind it, and doing it just to make the patient "feel seen" is not a great way to do your profession. People being dismissed quickly also happens in the US quite a lot, sometimes with disastrous results though it's not incredibly common, it's typically labeled under "diagnostic error" https://qualitysafety.bmj.com/content/23/9/727.long
Hard to tell when you don't let us know which of those doctors ended up solving the issues that made you seek a doctor.
Dismissive doctors are bad but so are those that waste your time and risk complications from unnecessary invasive tests.
Earlier you just need to find a doctor and they were probably good. Now you have to take your luck with many till you find a good one (if you are still alive by then)..
I don't know why people think that they can mass produce competence..
Edit: I should have mentioned that pediatrics and family medicine represent a large proportion of available residency spots each year and are rarely full.
I hear people say "we need more doctors" all the time. It would seem to me, the people deciding how many new doctors we train per year, are doctors. Their pay is proportionate to their scarcity, if we had 5x as many doctors, existing doctors would make far less.
Imagine if existing software engineers got to decide how many juniors entered our profession each year. I think things would look very, very different.
The quality of the average physician is already so low I am not sure what you are hoping to accomplish with lower salaries and faster training.
Doctoring isn't a matter of more warm bodies
Seems like having doctors emigrate from other countries would work as well.
It’s called physicians assistants and nurse practitioners. They are essentially exactly what’s you’re talking about. They make less and they have less training.
There's basically no need for GP to be a doctor.
Not true.. according to most around here, it will be AI and robots all the way.
So you’re doing a few things.
1. Moving more training from cheaper colleges to more expensive medical schools.
2. Moving the filter from undergrad to medical school
3. There is no national curriculum in US high schools, so essentially the first 2 years is getting everyone on the same footing. Removing this without changing high school, puts students at poor high schools at an even greater disadvantage.
You have to create a healthy system, that takes social engineering and government cooperating on a general plan. And in the US such a thing is basically not possible, even if they wanted to do it.
Ideally your transportation, agricultural, educational policies should all work together to produce healthy population. But this simply isn't the case.
But it will not 'reduce pressure' in a practical way, because such changes purely private or public take decades to work themselves threw the population.
I can’t even get basic foot stuff covered, they won’t care until my feet and knees land me under “disability,” so people like me - but unlike me they can’t afford to spend hundreds more a year on special inserts and shoes - just keep doing what they’re doing until they’re hurt.
People go to the grocery store and marketing teams are trying to sell them “vitamin water” which is neither of those things, so they have to do tons of research and pay constant attention to literally every food they buy. Then when they get hurt they can’t afford to go to a doctor and the insurance that is sucking up huge amount amounts of their annual pay doesn’t pay for it either.
Meanwhile we have a US administration that is telling everybody, a population that is incredibly predisposed to heart disease already, to go eat more red meat. Also, they have spent a decade telling people that vaccines are shady and maybe they shouldn’t get them. How much damage have we done to preventative care with that one?
I could go on and on, I’m barely covering the breadth and depth of this problem. We can’t just call it “personal responsibility” or whatever
I have no idea what this might be.
sucks but that's incentives for ya
No, the reality is we should be more healthy, so we need less doctors.
[0] https://www.calculatedriskblog.com/2013/08/us-population-dis...
You could argue specialists should make less but considering how long it takes to become a doctor, how much work it takes to get there, how long you’re putting off real earning potential, school debt, etc., I do not consider 150k overpaid.
From a more practical angle, I don’t know how you could possibly find more doctors by lowering their earning potential.
You certainly could if you were willing to accept people who are terrible at being a physician.
The notion that you can just throw more warm bodies at the problem is ludicrous
I think building a better prevention layer is more important.
Don't get me wrong, I agree that we need more doctors (and nurses, and physios, and dietetists, and ...), but it is much easier to scale a good prevention system than the number of workers in healthcare.
We need to reduce the requirements to be a doctor. I think general ability is way way way more important than the specialisation. I don't think the speciality that doctors spend money and time on add that much value..
And why do you think that? I'm a doctor and I disagree completely - the medicine nowadays is so advanced, that it's impossible to keep up with advances without specialising yourself in narrow area.
The answer: here's some key performance indicator we can improve.
Sigh.
Those nurses saved many people! It was worth it!
There are are arguments to be made about private or public but that logic makes no sense.
Some system that have many private aspects outperform other public systems and the other way around. And even in a public system many people will profit as many of the companies that are your suppliers are still for profit.
Sounds like good logic to me, at least for essentials!
This is Going to Hurt: Secret Diaries of a Junior Doctor by Adam Kay
https://en.wikipedia.org/wiki/This_Is_Going_to_Hurt_(TV_seri...
I'm in the process of leaving the profession.
I don't feel guilty for the patients who will be left behind, they voted for this.
> I had worked in a hospital network that covered 4 campuses and drove 500kms a week when covering these sites. I had worked in a hospital where I didn’t get home for days at a time, sleeping overnight in hospital quarters, outpatient clinic benches and in my car.
As a patient, I'd like the person performing surgery on me to be well-rested!
It gets worse:
> I used to be able to arrange the operating list because I know that some operations take longer than others. But now, the bookings office determine that that all my tonsillectomies take 14 minutes because that’s the average time recorded on the computer. The moment I scrub in, the timer starts. The moment I unscrub timer stops. Click. Click. Click. Because the theatre bookings does not take into account the interpreter time, pre-med period or transfer to ICU, the list is running late. The nurse in charge is breathing down my neck to finish on time.
And yet somehow that 14 minute tonsillectomy gets billed at ~$10,000.
This seems to me like a system that has been hyperoptimized in a way that grinds down the participants.
You don't perceive that system to be different from grocery stores, auto manufacturing, Nvidia, or lemonade stands? They're all very different in my mind, I'm surprised you see them as identical.
Although the whole website has 1 post and there’s a prominent advertising link to some doctor book that then links to herbal stuff, so not sure if the whole thing is fake to advertise books.
I'm sure burnouts happen but the fundamental problem is the pipeline.
Yes, you can allow patients to go uncovered. This hero mentality is what leads the bosses to not properly staff and the politicians to not properly fund in the first place.
It is not an individual’s responsibility to correct a societal failure by hurting themselves.
https://en.wikipedia.org/wiki/List_of_suicide_crisis_lines
Medicine is ran by a bunch of creepy boards. "ACGME Review Committee for Dermatology." For example gets together and votes on how many Dermatologist we get, fun fact it doesn't go up much.
$They were so kind to add 400 more Dermatologist$ in the past decade to the student pipeline.$ What could the rea$son be?
What I would do if you are a doctor and don't hate humans - ask these boards to let more people in (hopefully Americans, but Americans have an uphill climb getting accepted with the flood of fraud applications from around the world).
Why? Do you think Americans make better doctors?