The planning of U.S. physician shortages (2020)

https://www.niskanencenter.org/the-planning-of-u-s-physician-shortages/

by flummox • 3 years ago

216 349 3 years ago

nine_zeros• 3 years ago

Most problems in a rich country like America are entirely created due to backwards, uneducated policies.

discriminatory MCATs, brutal STEPS, insane Pre-Med curriculum, and more nonsense designed to cater to white elites who gamed the educational system and less to those who are genuinely trying to help the disenfranchised, unremembered, diverse and more.

Hopefully one day, we'll make it as easy to become a doctor as it is to -- say -- become an Engineer.

trustingtrust• 3 years ago

I hope it’s not as easy to make a doctor as it is to make an engineer.

I am an engineer dating a surgical resident who has to go through so much training that an engineer would never even come close to an engineer. The room for error is quite small. If it was as easy to make a doctor as an engineer I would lose faith in the medical system and would never want such a doctor opening me up.

carabiner2• 3 years ago

You're only referring to SWE, right? I've noticed that there are no bootcamps for becoming an aerospace engineer and getting a job at Boeing.

wwweston• 3 years ago

I agree we want medical personnel who are very well trained, certainly better than software engineers.

I'm less clear about which aspects of the current medical education system produce effective training and which are more of a hazing run selecting for the privilege and determination to survive it.

brutusborn2• 3 years ago

It’s not that medicine should be _easier_ or _as easy_ as engineering, it just needs to be easier than the status quo.

This is theoretically an easy change, since most complaints are about the unnecessary bureaucracy and not the pedagogy itself. Doesn’t matter how simple the solution is, it’s practically hard because the bureaucracy has so many incentives to make the process harder.

killjoywashere• 3 years ago

I'm a physician, pathologist specifically. But also did a surgical internship. My dad is an engineer, my undergrad is in Physics and I spent years on ships in engineering and weapons departments.

Yes, the room for error can be incredibly small. A surgeon might cut out a breast cancer that's 5 to 10 cm on a side. The margin, the distance between the cancer and the edge of the surgeon's incision, might be negative by 1 cell. The cancer might be 1 cell away from having been left in the patient's body. The room for error in medicine is in some ways disturbingly small, in others it is incredibly large. Factor of 10 errors are so common they are a standard outcome measure in trainee fatigue studies. Ask your SO about ACDF. Imagine driving screws essentially blindly, without tapped holes, a few millimeters away from a spinal nerve root, with an 8" torx driver. On 3 hours sleep, after standing on your feet for the last 7 hours. An engineer, hell, a carpenter, would have measured the system extensively, set up a jig, and spec'd the entire process, soup to nuts.

From that perspective the margins for error, in absolute terms can be, and often are, enormous. Which is what lets them run on 3 hours of sleep for months. In that setting, sleep-deprived, no exercise, terrible food, compounded by relentless moral injury, yes, it seems like the margins are miniscule. But a good cabinet maker, electrician, or pharmacist takes more care in many aspects of their work, in absolute terms.

HyperSane2• 3 years ago

If being a doctor is so incredibly hard then why are they allowed to practice after not sleeping for so long?

SkyPuncher• 3 years ago

I’m married to a doctor. My opinion is training level generally needs to correlate to the level of acuity.

Surgeons will always need to be extremely highly trained because they do not have the ability to hesitate. Most of healthcare simply isn’t anywhere near the acuity level of surgery.

By far, the biggest need is primary care. The exact opposite of acute. The rigor, effort, and expense of medical school simply doesn’t match modern primary care. Either the system needs to change to accommodate that or physicians are in for a reckoning.

Physician lobbies have a golden opportunity to ensure even higher pay and better product by building better care models. Instead they simple say “fuck your I got mine”

ytschfs• 3 years ago

Medical school and residency are incredibly hard things. So you could make getting admitted to them easier sure but you’d be setting people up to fail if they can’t pull 80 hour weeks and manage information overload when they get there.

0cf8612b2e1e• 3 years ago

I think what parent was referencing are the “tricks” required to get into med school. Applications are incredibly competitive, and students have every incentive to do anything they can to make the cut. Easier classes, begging for grades, leaning on connections, charity work (dependent on financial resources), etc. Leet code grinding, med school edition. Perfectly good potential doctors are passed over because they are missing X.

poly_morphis• 3 years ago

I wanted to become a doctor. But I also wanted to study engineering. I didn’t want to do some relatively useless degree path like biology simply to fill all the required prerequisites for med school. And then I learned about all of this other stuff, like the MCAT, and how you essentially get abused during residency. I don’t think I’d be able to function on the sleep you’d get anyways.

It shouldn’t be easy to become a doctor, but man the bar right now is so high.

hammock• 3 years ago

Too many white doctors? Have you been to a doctor in the last 15 years?

rayiner2• 3 years ago

What’s discriminatory about MCATs?

barry-cotter• 3 years ago

If there are differences in outcomes between demographic groups some groups, like the SCOTUS, assume malice unless proven otherwise. See disparate impact or Griggs vs. Duke Power. Obviously the writers of the MCAT worked very hard to ensure Asians would get higher scores than any other group on them. The US is a country built in Asian supremacy.

feraloink2• 3 years ago

... less to those who are genuinely trying to help the disenfranchised, unremembered, diverse and more.

There are many government and philanthropic institution-sponsored programs in the U.S. that repay 100% of medical school, dental school, or medical specialty tuition and expenses, in return for committing to five to 10 years of medical service, on site, to remote or under-served communities.

'Remote' can be rural communities in Appalachia. They can be 'under-served' and very remote, e.g. for American indigenous people who live on their sovereign nation's land.

Under-served communities can also be in economically devastated cities (usually due to offshoring of manufacturing) in the Midwest or East Coast where people of color and white people lack access to medical care that is within walking distance or public transport.

bruce5116• 3 years ago

Planning and predicting highly variable systems is hard. Long-range interventions are especially risky given the possibilities for unexpected consequences and also the long lead times in fixing the problems.

Central planning on resources has been especially rife with failed examples (the USSR being the all-in poster child.)

As the article points out, the concept of central planning is orthogonal to who is providing the service. With heath care there are a range of national strategies (from fully private to fully public), and the impact of central planning (or lack thereof) can be seen across the board.

So one should be careful of concluding that this is a party-political issue. It seems unrelated to left-right politics, and rather the result of central planning, predicting and modelling.

whitemary3• 3 years ago

"Communist" Cuba has 64 physicians per 10K population, which is 2nd in the entire world for physicians per capita.

https://en.m.wikipedia.org/wiki/List_of_countries_and_depend...

During the pandemic, they were sending droves of doctors to Europe. They offered to assist in NYC but Trump turned them away as our population dwindled. Famously, when a British cruise ship with ill passengers aboard was denied by ports in Florida, Cuba took them in and saved many lives.

alehlopeh• 3 years ago

What’s with the scare quotes around communist? Sure they have a lot of doctors. And how many of those doctors are allowed to do business as a private practice? Or how many would be allowed to change careers if they wanted to? How many are allowed to spend their income at fancy places, where the currency they get paid in isn’t even accepted? Hate to break it to you, but “your” worldview is incredibly, laughably, misinformed.

ch4s36• 3 years ago

I'm not sure how they could have assisted with anything, they basically have no medical supplies[1][2][3][4]. And before you bring it up, no medical supplies aren't covered by the embargo, they get a special exemption since the 90s.

[1] https://havanatimes.org/cuba/medicine-shortages-a-challenge-...

[2] https://www.reuters.com/world/americas/cuban-diaspora-sends-...

[3] https://www.sabcnews.com/sabcnews/south-african-medical-stud...

[4] https://cuba.miami.edu/business-economy/a-close-look-at-cuba...

codersfocus2• 3 years ago

The thing is, not all of those doctors work in Cuba. The government rents them to neighboring countries to make money.

badpun2• 3 years ago

Some of those physicians (mostly young and female) take second jobs as prostitutes, because their baseline pay makes it hard to survive.

DSingularity• 3 years ago

I feel like we are going too far. Central planning in presence of hostile adversaries unrestricted by any ethical systems failed. And by what measures has “free market” has proven itself as successful? You can come up with your measures of success and others will propose measures of shortcoming. Others will even dispute the claim the American-led west is anything different from a centrally planned set of cooperating economies.

cscurmudgeon2• 3 years ago

What are those adversaries and why were they unrestricted ethically?

bruce5116• 3 years ago

Central planning, in this context, is not the same as political philosophy. So be careful not to conflate the two.

Central planning does happen in free-market economies all the time, at various levels. An HOA for example is a hyper-local example of central planning. The larger the scale the stronger the lever, and hence the more variable the result.

The "free market" brings all kinds of its own oroblems of course - I'm not arguing for the elimination of planning - but long-range planning at national scales, is hard.

lokar• 3 years ago

Critics of mostly free market systems generally base their argument on a comparison of wealth levels in such systems. They implicitly assume (or don’t care) that in a planned system the total wealth would be the same, just distributed differently. There is little evidence to support this.

chaostheory3• 3 years ago

Central planning in presence of hostile adversaries unrestricted by any ethical systems failed.

This is what happens in any system that leans too much on central planning. What we’re witnessing is just entropy ie late stage capitalist society in decline due to too much power being centralized. It’s not exclusive to capitalist economies. Historically, it’s even worse in primarily socialist economies because there are much less divisions of power from the start, where as in capitalist systems this happens over time. For this reason, the same decline happens much faster in primarily socialist systems.

The main flaw in thinking that socialism is better than capitalism, despite the clear results in the 20th century, is missing the fact that corrupt sociopaths don’t just disappear just because you changed the economic and political system; they adapt.

scythe2• 3 years ago

Central planning on resources has been especially rife with failed examples (the USSR being the all-in poster child.)

This assertion is greatly exaggerated. It's certainly true that the centrally planned economy of the USSR didn't grow as quickly as peer countries with similar levels of economic development. The typical contrast is the much faster growth of Japan versus the Soviet Union in the late twentieth century. (Even the computer knows the story; my phone's predictive text got the countries right!)

But the Soviet Union nonetheless grew. Its growth rate was similar to that of the United States, but starting from a lower level (missing out on catch-up growth). It was the contradiction between the government's insistence that the planned economy would outperform the West versus the reality of the situation that led to a death spiral of political dysfunction and "alternative facts".

Even though the system was not efficient, it wasn't disastrous by itself, only suboptimal. It's a standard prediction of economic theory that lower risk tolerance comes at the cost of some expected return. But in the case of fields like education and medicine, we might have a lower risk tolerance and be willing to tolerate lower growth to achieve it.

In this case, the government stopped subsidizing medical schools. That would seem like what the libertarians want, but the outcomes were not good. Blaming central planning per se doesn't seem like the answer.

bruce5116• 3 years ago

Clearly there are multiple factors in play, and it is simplistic of me to pin all the failings of the USSR on central planning. (Which is the essence if my root post, planning is hard and only one small part of the political environment.)

Clearly geographical, climate, and population dynamics (Not to mention war damage) of the US , USSR and Japan post WW2 are enormously varied.

> the government stopped subsidizing medical schools

That's part of it, yes. The other part and perhaps more damaging part, is the moratorium on creation of new schools, and the measures to actively reduce the ability of hospitals to offer residency positions.

Given a finite money supply the feds have to pick winners and losers for receiving money. However introducing policy, beyond money, has more impact on outcomes.

The libertarians would argue that the policies caused the shortage, not the lack of money. (As evidenced by the US citizens training outside the country.)

lr19703• 3 years ago

But the Soviet Union nonetheless grew. Its growth rate was similar to that of the United States, but starting from a lower level (missing out on catch-up growth). ... Even though the system was not efficient, it wasn't disastrous by itself, only suboptimal.

I am sorry but it is total BS. I grew up in late USSR and can attest that its economy was in free fall. Central planning was one big demotivator and major contributor to the economic disastor. There were no incentives whatsoever to do your job well. Social mobility, career growth depended on factors outside of your direct control. Productivity was a fraction of what it was in the West. Bottom line -- any attempt on economic central planning first has to solve the problem of motivating productivity of human free agents. Otherwise it will fail in a similar way as Soviet Union did.

profsummergig• 3 years ago

It is troubling that people trained similarly (to the people who made the forecasting blunder in the article) and given similar powers, are involved in forecasting in other significant domains: climate, war, inflation, etc.

whitemary3• 3 years ago

Socialism or Barbarism.

ftxbro• 3 years ago

they better change how it works, or we're going to be out here doing minor surgeries on ourselves with scalpel in one hand and watching youtube tutorial on our phone in the other, with gpt on speaker

akiselev• 3 years ago

Multimodal ChatGPT is already capable of generating diagrams for a DIY appendectomy (in the style of LEGO instructions!).

Unfortunately, it completely hallucinates on the instructions on how to stitch oneself up afterwards, inevitably resulting in fatal internal bleeding. Thankfully it also forgot about anesthetic so I didn’t get that far.

paulddraper• 3 years ago

Doctor shortage, pilot shortage

Frustrating to see these problems of purely human design.

93po• 3 years ago

The doctor shortage is also specifically caused by doctors.

nemonemo2• 3 years ago

I doubt US would be able to see a level of medical accessibility on par with many European countries. The medical education system has a perverse incentive to reduce the yearly graduates -- the less graduates there are, the more profits and prestiges each of the current members can garner (with arguably better trained graduates) -- and as shown in the article, they seem to have monopolistic capability for the throttling. And the incentive is only larger when people spend more disposable income for their healthcare, which has been the case. Maybe political powers may shift the direction a bit, but I do not see any evidence of a major course correction.

lotsofpulp3• 3 years ago

There already has been. The solution was to pump out physician assistants (PAs) and nurse practitioners (NPs) that require a fraction of the training of a doctor to get licensed, and then have them practice medicine under the “supervision” of a doctor.

Some states even went as far as giving people with no medical training the right to prescribe, such as naturopaths, whatever that means.

So it is up to each person now to figure out how qualified the person giving them healthcare is.

Also, doctors now have to contend with a handful of large payers. Their customers are mostly the federal/state government, or a handful of managed care organizations like UHC/Elevance/CVS/Cigna/Humana/etc.

I would say doctors’ golden years of having a favorable negotiating position are behind them.

rcme• 3 years ago

Hospitals have regional monopolies are are being consolidated by private equity companies. The doctors have way more leverage with the hospitals.

nemonemo2• 3 years ago

My experience with PAs and NPs have been mixed. I would still prefer MD doctors if I have a choice.

Now that there are many reasonably good medical education systems outside US, why doesn't US just open more to those international MDs? I would prefer those MDs to NPs or PAs. Maybe doctors' golden years have been passed, but I don't think that necessarily means more accessibility to quality cares.

jimt1234• 3 years ago

I hate that this shift is being driven almost entirely by profit motives, but I also wonder if this is such a bad thing. I love my doctor; she's been my doctor for 25 years. However, I sometimes wonder what real value she provides. All she ever does is send me to a specialist. Couldn't a PA or NP do the same thing?

MauroIksem2• 3 years ago

You're being disingenuous. PAs are required to have 2000 hours of clinical experience before they can sit for their licensing exam. NPs however only require 500 hours. MDs require 4000 hours.

pknomad3• 3 years ago

The solution was to pump out physician assistants (PAs) and nurse practitioners (NPs) that require a fraction of the training of a doctor to get licensed, and then have them practice medicine under the “supervision” of a doctor.

This is my biggest concern about primary care. NP training significantly lacks rigor in clinical sciences and standardization. I would also say days of seeing competent primary care (even in urban settings) is behind for patients.

looping__lui• 3 years ago

In Germany I can only see a specialist doctor if I 1) wait half a year, 2) am at the brink of dying or 3) give some cash. Most people have the illusion that the system works because 99% don’t have to deal with it and it’s a nice thing to believe if the yearly insurance fees are about $10k for public insurance (employee+employer). Whilst I agree that in Europe we do not have these outrageous costs for medication and intransparent and greedy billing - quality of healthcare is literally NIL. I have zero confidence this system would be able to help me beyond an ear infection or maybe removing an appendix.

TheCoelacanth2• 3 years ago

You'll have a similar wait in the US for most specialties.

trashface2• 3 years ago

The health care industry seems to be profiting off this by having more care provided by nurse practitioners and physician assistants but billing the insurers same as they would charge for M.D./D.Os.

w10-12• 3 years ago

Medicare and most insurance strictly control this.

But the industry benefits from a constrained supply of doctors because it means less competition; laws ultimately require doctors to be in charge of a practice. Some laws are now even restricting the number of PA/NP's that can be supervised, but it's not a strong effect.

Some states permit NP's to practice without a physician, but PA's all require a supervising physician.

in3d• 3 years ago

Not all. Iowa: https://www.desmoinesregister.com/story/news/politics/2023/0...

“With this move, Iowa joins five states that have removed the legally mandated relationship between physician assistants and doctors, according to the American Academy of Physician Associates.”

MauroIksem2• 3 years ago

PA's no longer require a supervising physician. Also why do people seem to think PAs and NPs are equivalent? PA's have 4x the clinical experience/ training that NPs have. 2000 hours vs 500 and MDs at 4000.

pessimizer3• 3 years ago

They carefully maintain the scarcity of doctors, but import as many nurses as they possibly can, work them hard, and pay them the least they can get away with. It's only logical.

w10-12• 3 years ago

This article is based on reading (some) government reports, not on actual experience reports from medical schools, funding (which has increase), etc. Still, it's an important issue and set of data.

It's not unreasonable given the training investment to err on the side of avoiding wasted education, and fill gaps with less-trained people.

The physician/patient ratio is not a good measure of service availability. Some would say US doctors are more productive.

The alternative is not more doctors, but more "advanced practice" providers - Nurse Practitioners and Physician Assistants (or Associates). Their numbers have increased dramatically, and they have taken over anything routine and many ancillary functions of complex cases. PA schools in particular have proliferated, and produced an over-supply of PA's, who depend entirely on having a supervising physician. NP's by contrast benefit from the long history of unionization in nursing, have taken over management in many cases, and restrict the supply at the school level. Overall they top out at what doctors start at, even with decades of experience. It's good for young professionals, but there's not a lot of headroom.

As for dependence on foreign schools, the US has more foreign graduates in every field, and most have been hired into hospital systems as a way of combating medical practice groups.

The independent medical practice groups almost completely died out, as hospital systems refused to contract out to practices, and instead hired doctors as employees so they could control costs. Recently with private equity targeting specific local monopolies, you're getting specialty practices in radiology, anesthesiology, cardiology (mostly stenting) and now even GI, where the same private equity firm coordinates everyone in a geographical area (and pursues a number of dark-billing practices). There may be small internal practice in the hospital for poor people to get middling care, but the good doctors go into the practice groups.

Access to care comes down to logistics (terrible IT) and PCP's being used to reduce care. They hate it, which is why those who can avoid primary care.

The other side of supply is loss. Doctors are leaving the profession at a high rate because they're not really doing medicine (and they can afford to leave). They need better systems and adjuncts and more sensitive administration.

the_d3f4ult3• 3 years ago

Being a physician is a horrible career move right now. As a former Math/CS major turned eye surgeon, I can't help but think about how much easier my life would be had I stuck with tech. It's hard to understand exactly how hard the job is until you've lived it. I saw 40 patient's in clinic today in 8 hours without lunch or any kind of downtime and then spent 2 hours at the hospital because a patient needed an emergent procedure. They might go blind despite my efforts and I have to live with that. I also may get sued, if they're feeling spicy, despite going to heroic lengths to help this person. My son was asleep before I got home.

There's just no reason to do the job when you can get the same compensation working remotely in tech. Looking through the "Who's Hiring" thread is soul-crushing. Physician salaries are the only ones that do not grow relative to inflation and have decreased year-on-year relative to inflation for decades.

I do believe that the rigorous training model leads to a higher quality of care and much deeper understanding of the disease process. But, why would anyone want to do the job? It's just not worth the liability anymore. That said, is anyone hiring an ophthalmologist with CS and Math degrees?

SamoyedFurFluff• 3 years ago

That said, is anyone hiring an ophthalmologist with CS and Math degrees?

I’m surprised you can’t leverage this into a product role or a consulting role for startups in the medical space. You know shit about med systems!!

SongofEarth• 3 years ago

It can be really hard to leverage this combination of skills, the demand for cross-discipline talents is usually much lower than for a single skill set, but also much deeper when the demand exists, it's going to take some serious searching to find a match but likely it's worth it. There was HN post about working with radiologists when building a AI diagnosis company:

https://news.ycombinator.com/item?id=36111596

May be try talk to some similar AI companies is a good idea, at this time the pay can be really good.

throwaway1737383• 3 years ago

In the US medical device companies usually have a board of practitioners to give advice about the state of the art and the challenges with existing practice in the field. You can also start building your own device or system and plan to sell it, but you should find someone to consult on how to lobby the FDA and CMS as early as possible, because some devices get stuck in De Novo or PMA for years, and that’s a big risk to take. You’ll also need to have a long term plan for how the company will grow as you get closer to regulatory approval. A “product role” in these companies is very heavy on managing regulatory approval and making sure the company doesn’t get sued.

mvanlonden• 3 years ago

We’re hiring founding engineers at Develop Health! https://jobs.lever.co/develophealth.io?utm_source=hackernews...

iancmceachern5• 3 years ago

Yes! The prior authorization process is so broken! I've been battling Blie Shield for months in a effort to fix theirs

xvedejas• 3 years ago

The biggest complaint I always hear from people in the medical field is the long hours. It sure sounds to me like that (and thus any knock-on problems) could be solved by more practitioners, spreading the work around. I can't speak for you, but personally, a proper work-life balance in comparison to these horror stories is surely worth a possible salary cut?

lostlogin8• 3 years ago

It sure sounds to me like that (and thus any knock-on problems) could be solved by more practitioners, spreading the work around.

Sort of. The equipment is so expensive that the actual solution is usually to work the rooms and equipment harder. Night shifts, early starts and evening work are actually shit.

matheusmoreira6• 3 years ago

more practitioners

His other complaint was about the stagnant wages. More doctors will only compound that problem.

smarmgoblin• 3 years ago

I dropped out of an MD/PhD program after I passed Step 1, it’s hard to articulate exactly how it felt staring down the barrel of a career in medicine but this is sort of what I feared.

Since I’ve been in tech I’ve been laid off several times, and it’s not clear that compensation or demand will always be as hot as it is right now. I’m not complaining but if you take any satisfaction in actually helping people, there’s a real possibility you won’t find that anymore.

That said, you have options. If you’re willing to work at a junior or mid-level role, companies probably won’t care much what you did before. Maybe wait til the next boom in hiring happens, jump on the hype train. With your technical skills there’s probably some very unique research roles you could fill if you’re interested in that lifestyle — although the compensation is not super appealing. If it doesn’t work out, I feel like you could go back to surgery right?

matheusmoreira6• 3 years ago

it’s hard to articulate exactly how it felt staring down the barrel of a career in medicine

Yeah. I used to enjoy this blog, written by a person who hated US medical school:

https://web.archive.org/web/20101218031844/http://www.medsch...

lostlogin8• 3 years ago

I know an eye surgeon who wrote a piece of software that streamlined the referral process for cataract surgery.

It’s a seriously big deal in his world.

When domain experts write make their own tools, the results are so much better than when an outsider does it for them.

moneywoes7• 3 years ago

Curious if you have a link

merek• 3 years ago

Thanks for sharing. A couple of questions if I may:

For a typical surgeon in the US, how common are lawsuits from patients?

Do you have plans to run your own clinic (if not already doing so)? If so, would this address some of your current issues (work hours, compensation) at the risk of having to operate your own business?

the_d3f4ult3• 3 years ago

For a typical surgeon in the US, how common are lawsuits from patients?

Not very common. Pretty much everyone gets sued at some point in their career, but it's rare to break through the malpractice insurance ceiling. That said, it's always in the back of your mind and when it happens it messes with you psychologically.

Do you have plans to run your own clinic (if not already doing so)? If so, >would this address some of your current issues (work hours, compensation) at the >risk of having to operate your own business?

It's complicated. While being your own boss has a lot of perks, the path to ownership is not straightforward anymore in the current era of private equity. Some of the things that suck are not related to the financial aspects.

s1artibartfast• 3 years ago

Look at medical device and pharma companies with a strong optha pipeline.

I work with maybe 2 dozen retinal surgeons, and it seems like a pretty cushy gig. High 6 figure salary, mostly working from home, providing input for clinical trials and product development. Some do it part time and still maintain private practices.

fragmede• 3 years ago

https://www.gene.com/scientists/ophthalmology

matheusmoreira6• 3 years ago

Looking through the "Who's Hiring" thread is soul-crushing.

I know how you feel. I gave up on tech as a teenager and I still wonder what would've happened if I had stuck with it. Feels like it's impossible to switch careers now.

Where I live practicing medicine used to be a respectable profession but that's completely changed for the worse in the last 20 years. The communists currently running my country are literally quoted saying "we must create a new generation of leftist doctors who accept working for less". They flooded the job market with doctors.

mavelikara3• 3 years ago

They flooded the job market with doctors.

US doctors have to put in long hours because there aren't enough of them. Are things different in your country?

FredPret• 3 years ago

Just as an aside, I imagine there would be cool medical device startups working on smart glasses / artificial eyes.

They probably wouldn’t even advertise for an ophthalmologist/ CS / Math person, because I think there’s probably only the one of you!

rcarr• 3 years ago

With the rise of AR/VR this guy could probably make bank in the coming years.

epicureanideal3• 3 years ago

Physician salaries are the only ones that do not grow relative to inflation

Same has been happening to software engineers for the last 10 years at least. Salaries go up but not as fast as inflation.

I’ve gotten higher titles and more responsibility over the years but inflation is still winning compared to 5+ years ago.

That said, is anyone hiring an ophthalmologist with CS and Math degrees?

As soon as the job market recovers I think you’ll have no problem finding a job in software.

brutusborn2• 3 years ago

Same has been happening to all labour. At least in Aus I think labour’s share has been going down since the 80s

TheCoelacanth2• 3 years ago

Last 10 years? You must be joking. Software engineer salaries have done much better than inflation over the past ten years. If yours personally hasn't, you should have been asking for a raise or looking for a new job.

Over the past one year, they've probably done worse.

carabiner2• 3 years ago

That said, is anyone hiring an ophthalmologist with CS and Math degrees?

As someone who recently transitioned to a tech role, I'd urge you to focus on applying to companies related to your existing fields (ophthalmology, medicine, surgery, and their derivatives) who happen to be seeking SWE's, rather than general tech companies. Especially Series A, B, C startups. Look up all the companies that make your equipment or the software that you use, and go to their jobs pages. See anything that is tech or tech adjacent: swe, swe test, qa engineer, automation engineer, data engineer, anything mentioning python or javascript. The job market is the worst in 20 years and so the only companies that gave me the light of day were the ones in my previous field (energy and mechanical engineering).

FrustratedMonky8• 3 years ago

This. This is best advice. I can't imagine there isn't some software company that could use a doctor-SWE combo. Usually SWE struggle not knowing the subject matter they are coding about. It is the subject matter experts that they need.

nradov6• 3 years ago

Companies in the healthcare technology space typically prefer to hire physicians as product managers rather than engineers. There's a shortage of product managers who understand clinical workflows. Lots of job openings.

mixmastamyk2• 3 years ago

soul-crushing tech salaries

No one really gets those (statistically). I never did, despite being great at what I do. Basically a lottery system where the one lucky person who did the same exact problem two days ago wins.

speakfreely2• 3 years ago

I've found it's really about your negotiation and your confidence to ask for it. I've hired software engineers and frequently talk with others who do hiring, and I can confirm there's plenty of people who are making $120-140k who could've come in at $160-180k+ just by asking for it.

weatherlite7• 3 years ago

There's just no reason to do the job when you can get the same compensation working remotely in tech. Looking through the "Who's Hiring" thread is soul-crushing. Physician salaries are the only ones that do not grow relative to inflation and have decreased year-on-year relative to inflation for decades.

What ? Most U.S physicians make 300K + after residency with job security set for life. The real bright ones, the "faang" doctors make close to a million. Show me anyone in tech who can have that guaranteed for him. You're basically guaranteed to join the millionaire club if you decide to work enough years even as a mediocre doctor. Yes its an extremely difficult job I have no argument there, but there's no comparison to tech in terms of compensation or job security.

jimmydddd• 3 years ago

The job security issue is huge. Many of my tech and finance friends in their early 50's are getting pushed out of their jobs, while my physician friends in their 60's can keep their career as long as they want. A family member recently visited a dr. in his late 70's.

PheonixPharts4• 3 years ago

Even now 300k TC is pretty easy to get for any competent engineer wanting to work for a publicly traded company that can get comp in RSUs.

It's also very easy to get a 200k+ remote eng job, even now, that will allow you to spend as much time with your family as you like, rarely have you working past 5pm, and working in predictable, relatively low stress (potentially fun!) problems all day.

The job security is a good point, but job security isn't as meaningful for extremely high stress jobs since the risk of burnout is much higher. Doesn't matter if it's easy to get work if you find that work destroying your personal life.

chimeracoder2• 3 years ago

What ? Most U.S physicians make 300K + after residency

Most US physicians also pay for a lot of work-related expenses out-of-pocket (insurance, continuing ed, etc), and due to the nature of tax codes, most that often is not actually deductible in practice (particularly since they'll usually end up paying AMT).

There's a lot of variance depending on which specialty you choose and where you work, but as a point of reference: most new attending physicians in metro areas are actually netting less than an engineer in the same area who has been working since graduating college[0]. (And that's before you factor in any student debt, or the opportunity cost of forgoing ~10 years of gainful employment).

with job security set for life.

May have been true 40 years ago, but definitely not true today, especially for certain fields.

[0] If two people graduate college at the same time, and one goes into medicine and the other goes to work as an engineer, the engineer will easily reach career level (senior) by the time the other person is done with their residency.

foobiekr2• 3 years ago

Exactly. Longevity is much greater outside of tech.

TacticalCoder• 3 years ago

I've got friends and family that are physicians and they also work a lot. They're in the EU so at least the "getting sued" part is close to non-existent (there's still a risk but typically only if there's a real fuckup). At least one of them also complain that the job isn't paid well enough and that the job kinda lost some of its luster.

But...

There's just no reason to do the job when you can get the same compensation working remotely in tech.

Compared to serving ads and/or engaging in surveillance capitalism, at least there's a lot of comfort in that they're doing (and you 're doing) a useful job.

So I know it's not much but thanks a huge lot for what you're doing.

Traubenfuchs• 3 years ago

Your income is relatively insane (multiple 100k), you have ultimate job security even in old age, opening a private practice makes your income essentially open ended depending on how much hard work you put in, you can help your loved ones and yourself to better navigate health care, will always receive priority treatment and probably have the job with the highest social standing that exists.

I don‘t know what it is with doctors world wide having zero awareness of their maximum privilege and zero perspective on how their average and median fellow citizens do.

Yes it‘s hard, but so are many, many other jobs you don‘t hear much about.

iancmceachern5• 3 years ago

Like farmers

trashface2• 3 years ago

This viewpoint is just plain crazy. If you worked in tech you'd be totally disposable, just like all the rest of us programming drones. Hit 40-50 and boom, unless you've transitioned into management, suddenly no one wants to hire you, or if they do its half of what you were making before.

Your MD degree and the AMA literally writing laws on your behalf limits labor supply competition like nothing in tech. You may have noted 250K+ tech layoffs in last year or so. Many of those people could probably code circles around you. Where are the physician layoffs? There aren't any.

If you want fewer hours, work fewer hours. What are they going to do, fire you? They can't. There is a shortage as this notes.

wrp3• 3 years ago

This needs explanation. If there is such an extreme shortage of talent, why can't doctors demand better terms, e.g. shorter hours?

haldujai27• 3 years ago

Physicians are disposable too, look at what happened with primary care, nephrology, anesthesia and is starting in radiology where private equity firms move in and outsource physician care to allied health professions and create an “eat what you kill environment”.

In other countries like Canada it’s also near impossible to get a job in a surgical specialty (and until 2 years ago other ones like radiology), especially in a desirable city despite huge shortages and backlogs because our jobs use a lot of expensive resources.

If you want fewer hours, work fewer hours. What are they going to do, fire you? They can't.

They can, many jobs set a minimum FTE you can work.

They also reduce fee codes (with a system known as relative value units/RVUs) so you have to work harder to make the same money. We’re at the mercy of payers in US/Can.

My specialty (radiology) has had work-unit compensation periodically slashed over the last 10 years (20-30%) that’s been offset by reading more cases (and to a lesser extent technological advances making reading faster although studies have gotten far more complicated to read with modern treatments).

There’s also the increasing clinical demand and generally caring about the humans on the other end. I don’t want to read 50-90 CT scans on a ER shift but I have to because the studies are being ordered, the patients need their reports, and we don’t have enough radiologists.

moneywoes7• 3 years ago

Curious, are there any other fields with laws built to limit competition. Lawyers?

hn9768277• 3 years ago

Physician salaries are the only ones that do not grow relative to inflation

Spoken with the true conviction of a position of privilege, and blinded by the very same. (No pun intended.)

Hint: The majority of U.S. citizens have it worse than you.

throwaway1737383• 3 years ago

So what? Making a doctor’s life better doesn’t preclude making everyone else’s life better. I think we should buoy everyone who isn’t in the capital class. This crab bucket mentality has got to go.

dsr_• 3 years ago

"I saw 40 patient's in clinic today in 8 hours without lunch or any kind of downtime"

You want to give better care to patients, which means more time per visit and at least three breaks per day (morning, lunch and afternoon). You want to have more coworkers so that you can have consistent on-call work. Increasing the quality of your life-work balance will improve the quality of your work.

As a resident, you likely did 24 hour shifts -- or worse. That was just hazing: nobody does their best work while sleep-deprived, and training in it doesn't improve things. You need reform throughout the system.

You need a union. And one of the things that union needs to focus on is getting more people into this line of work.

GiorgioG• 3 years ago

I know this probably won’t make you feel better because you know this, but you’re actually making a huge impact on the quality of people’s lives. I work in tech (though not at a FAANG company) and my wife decided to go back to school (now that the kids are relatively self-sufficient) and she is hospice nurse. She gets home exhausted from 13-14 hour shifts. Having said that she feels so much more satisfaction than I ever have writing code to update a value in a database.

haldujai27• 3 years ago

I agree, I left a FAANG and startup to pursue medicine (not that finances were my motivation) and my co-founder who went back to a FAANG is earning more than most physicians now.

I’m far removed from this work environment now but at 10 years of SWE in a FAANG one seems to be making ~$350k-400k in total compensation? Not sure how many make it to L6 or higher, I defer to other commenters here.

If you consider the competitiveness of high earning jobs (especially in desirable markets, probably the top 20% of candidates), the opportunity cost during a decade of training I would imagine a similar %ile candidate in CS would be making more in major cities.

With that said physician income is relatively similar in metro vs cheaper COL areas so if you wanted to work in non-tech cities or smaller metros specialty physicians would probably make more.

With that said, with the hours and work intensity I put in now I could probably do 2 FTE SWE jobs (at least comparing to what it was like 10+ years ago).

djmips2• 3 years ago

But is that high paid era over?

VirusNewbie3• 3 years ago

Most people cannot last 10 years in FAANG. It’s up or out.

Pigalowda2• 3 years ago

You’re on the wrong forum to complain about the medical field. These SWE think you’re a privileged complaining brat (ironic) who breezed through the 15 years of school and training and don’t deserve anything but disrespect. You’re part of the medical cartel and for the most part, they despise you. Your salary is deemed too high and you are expensive overhead that needs to be decreased - hence the outrage and popularity of these articles here.

You must know this? Have you not seen their comments on HN medical threads? So vocal and often horribly wrong it would be comical if it wasn’t so depressing.

I’m not going to one up you with my own sob story, but it’s like you say for all of us everywhere in the US - but you can really only complain to other MDs. Outsiders will demand you work more, get paid less, get sued more, and grovel. They hate us, so don’t complain to them. In the end they will get what they want - automated service by LLM combined with other diagnostic software and nursing. They will then complain for the return of the human physician. It’s so typical.

You are perfectly suited to giving them automated service. Just spitballing and probably wrong - have an optho specific app with an LLM and maybe a plug in smart phone device that has object detection/instance segmentation for diabetic retinopathy. Cataracts detection might be secondary? There’s plenty of products for retinopathy and looks like Inception networks do fine for cataracts. Other eye pathologies that are easily visually diagnosed are on the table too. Why see 40 patients when you could see 150 and the LLM/app have done the referral, initial screening questionnaire, and your nurses/MAs write your note/rx/orders etc. Ideally you should be like a dentist (they clearly figured this out already). You walk into the patient’s room do a quick eye exam, say what needs to happen, don’t answer any questions, and walk out. They hate you already anyways, might as well lean into it.

- Currently an imaging fellow in the cartel.

haldujai27• 3 years ago

I remain optimistic that some people here are open to learning so I still try sometimes.

- Also a radiologist who gets told I’m egregiously overpaid when [insert immature AI tech] can definitely do my job better.

labcomputer• 3 years ago

Cry me a river. How horrible it must be to have perfect job security, as close as you can get to tenure, unless you massively fuck up. Oh, and an automatic 1% salary.

but you can really only complain to other MDs. Outsiders will demand you work more, get paid less, get sued more, and grovel.

Oh yes, this is exactly what I want. I don't care about anything my GP does, except whether they kiss my feet when I schedule an appointment. How do you know me so well?

belmarca• 3 years ago

Becoming a physician is a choice. Choosing your specialty is a choice as well (to an extent). Staying a physician is also a choice. And an immense privilege.

I have great respect for physicians I have worked with in IT for years. However I do not have patience for this sort of argument. You can always find another job if you'd like to, like everybody else. And unlike the majority of the population, you can set yourself up to have the financial freedom to do so.

No "sane" person "hates" doctors. They just don't pity them.

---

BTW, the tech FOMO is just FOMO. Grass is greener. Software engineering can be very exciting (just like medicine), but also very boring (just like medicine). Compensation is a really bad metric. If you value your time off, then don't become a physician. Sounds to me like some people just can't ever be fulfilled (usually the more privileged)!

MobiusHorizons• 3 years ago

In my experience, most of the outrage against the medical system is that it is so expensive, and has such variable outcomes. I don’t think overworking doctors (even more than they already are) is the solution, but I do feel something has to give. What do you think is the problem. What could be productively changed that would make access to healthcare more affordable?

jasmer• 3 years ago

Most devs are not earning anywhere near what a doctor is.

mensetmanusman• 3 years ago

Is working for half time for half the salary an option?

noleetcode• 3 years ago

Would you be willing to share your story of how you made the switch? CS major here considering going into medicine (despite your best efforts to convince otherwise :) ) but the general coursework wasn't something I targeted in school all those many years ago.

trentnix3• 3 years ago

I've no doubt the stress of your work is immense and the constant threat of litigation (and the expense of the insurance to fight it) can be overwhelming. As a recipient of multiple eye surgeries (I had strabismus as a kid), I am grateful for competent professionals like you. But I think you buried the lede.

In the 2010s I owned a high-end bicycle and sporting good store. It was 7 days of 10+ hours a day most weeks. And it was very nearly non-profit or barely-profit for most of its run. If you know anyone that owns a bike shop, you should give them a hug. They need it.

Nearly every Friday afternoon, just after lunch, a few of my customers who were physicians or surgeons would pull up in their Model X or Cayenne to get service for their 10k road bike they were taking to their vacation home for the weekend. On more than one occasion, one of them would exasperatedly tell me how much they envied me and how lucky I was to be doing what I "loved". As I confronted my busy, work-filled weekend cemented to the shop to deal with the fickle and spoiled public, I had to chuckle as they drove away in their luxury vehicles to their luxury vacation home with a nicer bike than my own.

In retrospect, I've concluded that the real problem they faced is they'd built a life dependent on a physician or surgeon's income. They were told they were building a castle, but instead they built a prison. The fact is, you just can't spend enough money to truly escape the stresses of your work, but you can certainly spend enough money to become shackled to it.

hotpotamus• 3 years ago

They were told they were building a castle, but instead they built a prison.

The industry term is "golden handcuffs".

BurningFrog• 3 years ago

The grass is always greener in another profession, and my problems are always uniquely bad :)

chimeracoder2• 3 years ago

But I think you buried the lede.
In retrospect, I've concluded that the real problem they faced is they'd built a life dependent on a physician or surgeon's income. They were told they were building a castle, but instead they built a prison. The fact is, you just can't spend enough money to truly escape the stresses of your work, but you can certainly spend enough money to become shackled to it.

I don't know why you're making the leap in assuming that, just because you knew some physicians and surgeons who seemed to be inflating their lifestyle to match a high income, that OP is necessarily doing the same. There's no indication in their post of any of that.

analog31• 3 years ago

I know doctors who live a modest lifestyle, so it can be done. The leader of a band that I play in was an ER doctor for a while, then got a job at a walk-in care clinic, and retired at a young enough age to enjoy his retirement. During this entire time, he lived in a modest house, and mostly rode his bike to work. He lived within his means like the rest of us.

There's no law that you have to live a rich lifestyle. Part of that may be feeling the need to maintain the class status that you were born into, and that you expect your kids to be born into. Case in point, my friend came from a working class background.

catchnear43217• 3 years ago

goodness gracious there is a lot to unpack here.

As I confronted my busy, work-filled weekend cemented to the shop to deal with the fickle and spoiled public
And it was very nearly non-profit or barely-profit for most of its run. If you know anyone that owns a bike shop, you should give them a hug. They need it.

some serious mental gymnastics to land this hypocrisy. someone else struggling differently? here’s an anecdote about how “their kind” are bad. incredible stuff.

read carefully, your comment suggests you don’t much like anyone other than bike shop owners.

maybe that’s why things felt so hard?

giovannibonetti• 3 years ago

In the 2010s...

I don't know how things are in the US, but here where I live in Brazil, my doctor friends always tell me how in medicine things aren't anymore as rosy as they were before. It seems like there has been a large increase in the supply of physicians by universities and the younger generations face way stiffer competition to move up the professional ladder than before.

haldujai27• 3 years ago

In retrospect, I've concluded that the real problem they faced is they'd built a life dependent on a physician or surgeon's income. They were told they were building a castle, but instead they built a prison. The fact is, you just can't spend enough money to truly escape the stresses of your work, but you can certainly spend enough money to become shackled to it.

This. All of a sudden you go from 70k/year as a senior resident to 400k/year+ as a specialist with no financial education. Add on a decade worth of burnout (especially in training but ~60% in attending physicians) and living in relative poverty (70k/year - interest on $200k in debt doesn't leave much) and you end up with a group of mostly financially illiterate people making up for lost time and depression by overspending on luxuries with their new found income.

If you can believe it I worked with people who made > 1m and started having anxiety that they couldn't cover their mortgages when covid slow-downs resulted in a 25% pay cut.

Physicians are well paid, and I don't mean to suggest otherwise, but it's a really shitty path to earn that paycheck if money is all you want out of the career considering what you give up to get there (e.g. all of your 20s and spending 5 years working 24 hour shifts every 3-4 days and 2/4 weekends) and how stressful the job can be.

Obviously this is a generalization, and no one is forcing them to overspend, but I strongly suspect an element of this spending pattern is driven by unhappiness/regrets based on interactions with colleagues. Medical training is a lot of (very) delayed gratification until you get to the end and realize it is no where near as fulfilling/satisfying as promised.

nostrademons• 3 years ago

Tech is temporary, though. The reason salaries (and profits) are so high is because tech companies, when successful, displace whole industries and capture the revenue in a more labor-efficient way. But once the industry has been displaced, you don't need the software engineers anymore. Eventually the tech company becomes a dinosaur that the finance department milks for profits and share buybacks, and then gets replaced by a younger, hotter tech company.

If you ask 40+ year old software engineers, the biggest problem with the profession is the need to re-train every 5-10 years or face obsolescence. I'm in my early 40s, been doing this 20 years, and I've re-trained 4 times on new technology before finally switching into management. I just had an emergency medical procedure done. My surgeon graduated medical school in 1981, before I was born. He's able to learn one set of skills and then keep milking it for 40+ years.

akkartik• 3 years ago

This whole comment needs a big "citation required". It's all anecdotes and speculation.

Tech displaces industries, yes, but in the history of tech there has never been a company that stopped needing software engineers.

If you ask your surgeon he'll tell you how many times he feels he's retrained in his 40 year career. It's not going to be 0.

And don't your two paragraphs contradict each other? Isn't the need to retrain every 5-10 years a big sign that software engineers are not going anywhere?

I would agree with everything you wrote if it was prescriptive rather than normative. I would like software engineers to work themselves out of a job. And I'd like technology to be stable so we can focus on something besides the tech aspect of a company. But that seems poles apart from the world we live in.

NemoNobody7• 3 years ago

I understand your situation - it's all of our lives too. Nobody that works for a living has had a raise compared to inflation, all of us have less than we ought to.

Tech is a terrible place to be employed right now - at least you will still have a job for the foreseeable future.

Plus, if your income is around the average eye surgeon salaries in the US (250k-300k according to some random website) - your income places you in the 97th percentile.

I'm not saying you should suck it up and deal with it - not at all, this is wrong and you feel the way you do for a reason. It isn't your fault anymore than it's someone's fault for getting stuck at a dead end job.

We are all in the same boat... except for those in super yachts.

The truth is simply that most people are far worse off than you. Except for the billionaires, we are all poor.

catchnear43217• 3 years ago

But, why would anyone want to do the job?
I do believe that the rigorous training model leads to a higher quality of care and much deeper understanding of the disease process.

you somewhat answer your own question in the prior sentence. maybe not want, maybe called, or cared, maybe something else. not that it is binding or permanent, not that it should be.

but for all of the words spent about how it is a bad choice, how it has harmed you directly, how the money isn’t great, you’re bringing up positives, for patients.

you sound burned out. that’s not a criticism, nor should it be a badge of honor. maybe i have totally misjudged, but the career choice doesn’t sound like a purely financial decision for you.

even if not, even if i misjudge this, you, you did that ten hour plus death march. you gave your best efforts though that patient may go blind anyway, though they may feel punitive about it towards you.

you still did it. someone had to. by your own words, the patient NEEDED the procedure. you needed to go home, and be with family.

the patient got the procedure.

in case no one else has said it, or joining in with anyone that already has:

thank you, stranger.

theGnuMe• 3 years ago

That said, is anyone hiring an ophthalmologist with CS and Math degrees?

I mean there's a bunch of AI stuff/hype now, you could probably find something if you want to leverage your MD? I imagine you'd have a lot of insight into what would actually work well in practice and improve outcomes.

I just skimmed your comment history, so you already know about AI diagnostics e.g. https://health.google/caregivers/arda/

And worldcoin probably needs an opthamologist who can help ensure the retina id scans are stable... there are also a lot of retina scan companies anyway for digital identification that probably need an opthamologist. It may be as simple as keeping a set of scans over time so you reauthenticate in person and get your token updated like when you get a passport renewed for example. But maybe there's other stuff like preventing adversarial attacks.

Or maybe robotic surgery? Or maybe start your own? You might be able to patent something even.

This being HN, the world is your oyster and all.

aiphex• 3 years ago

This might sound crude, but a man who becomes a physician (and especially a surgeon) gets his pick of the most attractive mates as well as a high social status for life. That's pretty strong motivation for many.

iancmceachern5• 3 years ago

These people might:

https://www.arcscan.com/

I can make an intro if you're serious

singleshot_6• 3 years ago

Respectfully, the "reason to do the job" is that you help people see. That's pretty cool. I understand the rest of the experience is pretty poor, but you do have a pretty fair amount of "helping people" potential at work.

If you worked in tech, you could help people see... advertisements. That's potentially more lucrative but it's gotta be depressing after a life of that to reflect on one's life work.

pcrh2• 3 years ago

A similar phenomenon occurred in the UK, where under fears of "medical unemployment", the British Medical Association argued against increasing medical school places [0].

The attitude persists even today, where the BMA advocates that medical school entries should be limited to the number of specialty training places that follow basic training, so as to avoid the risk of doctors becoming unemployed or under-employed.

As a consequence the UK has a dearth of doctors, and those who are trained are over-worked. The government tries to alleviate the situation somewhat by recruiting from overseas.

[0] https://www.bmj.com/content/348/bmj.g2398

was_a_dev• 3 years ago

While this is a problem. The single largest issue that isn't properly being disscussed (especially during the strikes) is retention.

The NHS is a leaking bucket of highly skilled doctors and nurses.

Anecdotally, my wife is a doctor at a large tertiary hospital. Asking all the completing Foundation junior doctors what their career plans are, 80% of them have obtained either an Australian or New Zealand Visa and were securing jobs abroad.

No one skilled and smart enough wants to stay in the UK.

poirot22• 3 years ago

Completely true. Killer stats on this: 1 in 7 U.K. trained doctors work abroad The number of GP training places are up 2000 and number of qualified GPs hasn’t changed due to poor retention. I could go on and on. U.K. medicine is a shitshow of poor pay and poor retention. Even the cheap imported doctors are only staying a short time due to the chaos of the system and better ops back home once NHS training is on your CV

supahfly_remix• 3 years ago

Physician salaries are the only ones that do not grow relative to inflation and have decreased year-on-year relative to inflation for decades.

Medical insurance has been increasing faster than inflation for a while now. Are only insurance companies getting this extra money? Are at least some medical professionals getting a cut?

1letterunixname• 3 years ago

I'd take a giant stab in the dark suggesting there maybe a surplus of dermatologists but not enough oncologists, endocrinologists, or neurotolaryngological surgeons.

wrp3• 3 years ago

What is a nutshell explanation of how healthcare got to the overall shortage state? (For the USA, but curious about other countries.) In the past 20 years, costs have shot up, doctors are seeing many more patients, and quality of care seems to have generally declined. Where have the resources gone? In the 1990s my GP had time to shoot the breeze for 20 minutes or more. Now I get a 5-minute diagnosis on the run, after scheduling months in advance.

Dalewyn• 3 years ago

Grossly insufficient pay for the work concerned. This applies to everywhere, US and otherwise.

Unless you are a saint given existence upon this mortal plane instead of the high heavens, there are simply no objectively good reasons for ordinary men to pursue a career in medical.

wrp3• 3 years ago

I get how low wages could cause personnel shortages, but how does the tremendously rising cost of medical come out of this? I would expect the causation to be rising costs => stalled wages => personnel shortages.

wnolens• 3 years ago

Nursing, I agree. But as a doc in the USA? It's THE highest status you can achieve on title alone, and comes with a paycheck in the top 1-5% guaranteed for almost 100% of entrants.

lotsofpulp3• 3 years ago

Where have the resources gone? In the 1990s my GP had time to shoot the breeze for 20 minutes or more. Now I get a 5-minute diagnosis on the run, after scheduling months in advance.

See the population pyramid getting older and the general decline of healthiness / increase in proportion of people with health problems.

savrajsingh• 3 years ago

It seems doctors want to intentionally keep their supply low so their pay remains high.

truthseeker13• 3 years ago

Physicians don’t control the supply of physicians. The federal govt funds residency slots so they indirectly controls the supply.

JustSomeNobody• 3 years ago

Shareholders.

schoolornot• 3 years ago

Very easy solution, allow every 4-year state college to have MD programs. Flood the market.

electriclove• 3 years ago

Yup, increasing the supply is the obvious solution but one that the medical cartel has actively lobbied against.

newZWhoDis• 3 years ago

I’m glad to see others calling it what it is, “medical cartel” is the most accurate description I’ve seen for our system

FrustratedMonky8• 3 years ago

This is depressing. After recent medical scare that let me see the current level of medical treatment up close. I had though of leaving SWE to go into a medical field in order to help people. I'm in the US, and man, being in a hospital is really depressing, people are literally just dying for lack of help, being left behind. Or, maybe it's just more late stage capitalism, and I just happened to get a glimpse at how our society is choosing solve the problem of poor people, just put them down.

shadowofneptune3• 3 years ago

If it's any help...

It has been a lot of shit, a lot of brutality, but it is changing. It is difficult to sustain such an environment forever. Most of the mega-laws that got passed in the last few decades, if they ever were, have become unenforceable with how overloaded public services are in the... are we still calling them red states, cultural South, etc?.

You have people in Indonesia, Argentina, US, etc. all talking to each other. Where there isn't formal education, informal education can actually take a decent place. The young across the world are more like each other than anyone would really admit. People who come to the US aren't really forced to learn the language to an unrealistic degree anymore, and that's good, really. The standards have been too high for a century.

Things are so overloaded because turns out people do still need a law system, a health system. It shows a self-respect people didn't have 10 years ago. I could go on but, there is still hope.

RNCTX• 3 years ago

Perhaps designing a society around profit motives was a poor decision.

naveen99• 3 years ago

There is also planning of hospital bed shortages through certificates of need. https://en.wikipedia.org/wiki/Certificate_of_need

anti kickback laws are also a double edged sword. https://en.wikipedia.org/wiki/Stark_Law

But in the end, the usa has the healthcare system where doctors want to work and rich patients want to be treated given an option of any country.

hedora• 3 years ago

The rich people I know in the US do have an option of getting their healthcare from any other country, and that is what they often do.

NemoNobody7• 3 years ago

Yeah, rich people are "Global citizens" and utilize the entire work as we do the county we live in.

haldujai27• 3 years ago

They have it backwards, rich people come to the US for their treatment. It's not a coincidence that places like Mayo/Hopkins/MD Anderson all have buildings named after a gulf country sheikh.

Top US institutions are definitely the best/most advanced in the world right now for cancer care and arguably overall, especially for weird and wonderful stuff.

Affordability and accessibility is a different question.

linsomniac• 3 years ago

A physician shortage is not a good thing, but I'm closer to the nurses shortage; my wife is a nurse. Nurses get it from all sides: The healthcare administrators never put enough on duty, similarly they don't have enough CNAs helping them, and the patients and families can be pretty abusive.

It's really a game of numbers: You should have 1 nurse for every X patients, and Y CNAs for every nurse. But the common story is that there are always games being played with increasing the number of patients and decreasing the number of CNAs, leaving nurses having to do more things for more patients. This directly, negatively impacts patient outcome.

algkkb2• 3 years ago

I would've been a CNA out of high school instead of working retail if it would have paid me more than retail. Fact is, you're wiping ass for minimum wage and obviously not a lot of people are going to want do that. I'd say start with wages if I was addressing the issue.

truthseeker13• 3 years ago

I'm a physician as well (radiologist). I started practicing a few years ago, and I'm currently working part time and doing my masters in AI/data science. After a few years I hope to leave the field as well. It isn't because of lack of jobs (in fact, radiologist shortage is dire). It is because it is very stressful and demoralizing to be a physician in america, and the seemingly "high" pay does not make up for the downsides.

arbuge• 3 years ago

Can you explain how being a radiologist is stressful and demoralizing? Genuinely curious.

I do know some radiologists and they certainly don't appear stressed to me. At least one of them works from home pretty much full time; not sure about the others.

truthseeker13• 3 years ago

Medicine is a pretty high stakes career. You mess up and people can die. In radiology, we are expected to be near perfect (not miss important findings however subtle they might be) and make the right calls. This is difficult to do even with the training we have had. Part of it is just dealing with uncertainties. Did I make the right calls? Did I miss something subtle but important that might harm the patient - such as a subtle small nodule that 2 years later can become metastatic cancer? If so, am I going to get sued? You do that with every case, none which pay well at all. Medicare is the largest insurer in America and they pay around 4-5$ for a chest x ray or a wrist x ray or whatever joint x ray. A CT be it a cancer staging ct or trauma ct is valued at 40$. It can take a while to read if you really do your due diligence…meaning you compare to the past CTs to see how things have progressed, read history, take your time looking at the images. So it should take half an hour to read. Often times the prior imaging and clinical history isn’t even available. And if you work at big academic centers you are forced to read quickly.

No physicians want to do a bad job but we are just cogs in wheels in the medical industry complex.

jl2718• 3 years ago

Imagine a world where computer use required a prescription from a limited number of licensed engineers. You have to pay to talk to them about your problem and they’ll set you up with an app to use for a week or two.

ChainOfFools2• 3 years ago

Are you by chance asking this so you have some places to escape to when the looming eternal September event ( triggered by the change in reddit's API policies July 1st) suddenly drives a bunch of, well, reddit-level traffic from there to here?

The planning of U.S. physician shortages (2020)

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