Why you should not go to medical school • Hacker News Board

Re: Why you should not go to medical school

#81

Post by roentgen » Sat, Sep 24, 2011, 3:26 PM UTC

andrewtbham wrote: post #78

roentgen wrote: post #66

Earlier quoted context omitted.

The Health Care Finance Administration ( Medicare / Medicaid ) sets reimbursements rates, and most private insurance companies follow suit. So, I don't get to charge whatever I want to read an MRI. And, I don't order the studies that I read, other doctors do that. The only thing I can control is the number of studies I read. If I work harder and read more, I make more. It just so happens that I am very fast, and I ha…

are you concerned that a computer program could eventually do your job?

I'm not sure if you're being serious or not, but I'll answer.

I happen to think real AI will not happen in my lifetime, if ever. This is not an uninformed opinion, I have MS in Neuroscience, and I'm a programmer. I'm sure others reading HN will disagree.

It will take nothing less than a full artificial intelligence to do what I do.

If you want to read more about early attempts, there is something called "Computer Aided Detection" that is used when reading mammograms. It is awful, and I'll let you in on a secret. Most places that CAD their mammograms do it so they can charge more, not because it helps.

Re: Why you should not go to medical school

#82

Post by pradocchia » Sat, Sep 24, 2011, 3:26 PM UTC

roentgen wrote: post #48

arn wrote: post #4

So, surprisingly, this rant is more or less accurate, imo. (I went to med school, residency, fellowship) I mean some things stronger than others, but it hits on the major negatives as you go through training. I know a lot of these rants tend to romanticize how hard people's own professions are in a "no one else has it this hard" type stance. We see similar "how hard it is to be a programmer" type rants as well. But,…

I had a different experience. Medical school was easy, I was single and went out drinking / partying two or three nights a week. Not to be crass, but I did well with the ladies. Luckily I can get by on four hours of sleep or less. So, I don't feel like I missed out on much of the early twenties experience. Most of my non-medical friends had jobs and I didn't, but that was the only real difference. Things got a little…

> I make over 800k a year, and take 14 weeks of vacation.

I, for one, am disheartened by this gross misallocation of resources, but good work on the vacation time.

Re: Why you should not go to medical school

#83

Post by sp332 » Sat, Sep 24, 2011, 3:47 PM UTC

Hyena wrote: post #80

sp332 wrote: post #68

Earlier quoted context omitted.

Generally, rare goods - and skills - are valuable. So going to school for a long time to learn an unusual skill well means that your services are more valuable. Also, providing a large amount of value in a small amount of time (like accurately interpreting the results of a scan) leads to providing huge amounts of value over the course of a year. Part of the explanation is the sheer volume of individuals he can give a…

This only applies if those rare skills aren't rare simply because the need for them is rare. Supply and demand determines prices.

Demand isn't just about how many people want it (although a little competition is good), it's also about how much each person wants it. It seems like medical diagnosis could command a high price, even if only one person needed it.

Re: Why you should not go to medical school

#84

Post by kenjackson » Sat, Sep 24, 2011, 3:55 PM UTC

sp332 wrote: post #68

patrickgzill wrote: post #57

Earlier quoted context omitted.

Thank you for your honesty. May I ask, what exactly do you do that you feel justifies your 800k per year? It seems to me that your career is ripe for disruption.

Generally, rare goods - and skills - are valuable. So going to school for a long time to learn an unusual skill well means that your services are more valuable. Also, providing a large amount of value in a small amount of time (like accurately interpreting the results of a scan) leads to providing huge amounts of value over the course of a year. Part of the explanation is the sheer volume of individuals he can give a…

So going to school for a long time to learn an unusual skill well means that your services are more valuable.

It's only a rare skill because of licensing/board requirements. I'm fairly certain if you told other people they could make $250k as a radiologist, they could self-teach.

The same thing could be said of programming if the only people that could practice had to be certified.

Re: Why you should not go to medical school

#85

Post by sp332 » Sat, Sep 24, 2011, 4:05 PM UTC

kenjackson wrote: post #84

sp332 wrote: post #68

Earlier quoted context omitted.

Generally, rare goods - and skills - are valuable. So going to school for a long time to learn an unusual skill well means that your services are more valuable. Also, providing a large amount of value in a small amount of time (like accurately interpreting the results of a scan) leads to providing huge amounts of value over the course of a year. Part of the explanation is the sheer volume of individuals he can give a…

So going to school for a long time to learn an unusual skill well means that your services are more valuable. It's only a rare skill because of licensing/board requirements. I'm fairly certain if you told other people they could make $250k as a radiologist, they could self-teach. The same thing could be said of programming if the only people that could practice had to be certified.

I really, really don't think that's true. Most people are not able to do this, and most of those few who could don't want to put themselves through it.

And then separately, how many people would trust a self-taught diagnostician?

Re: Why you should not go to medical school

#86

Post by Bloodwine » Sat, Sep 24, 2011, 4:06 PM UTC

roentgen wrote: post #79

billjings wrote: post #76

Earlier quoted context omitted.

It's also worth noting that radiology has been undergoing some significant transformations. Formerly, a practice would contract with one nearby hospital to read their cases. With the advent of teleradiology, though, it is no longer necessary for the practice to be all that close to the hospital. As a result, radiological practices are contracting with more hospitals. They are growing and sometimes putting smaller pra…

My group does this, but not because we're evil. Larger groups often have fellowship trained radiologists who are experts in a certain sub-specialty, for example Neuroradiology. Smaller groups are usually all 'general' radiologists. If we can read pediatric brain MRIs more accurately from across the country than the local small group, why shouldn't we? One additional note. My 'customers' are not really the patients, m…

What protects you from outsourcing the reading of scans to foreign countries, such as India? Obviously some medical institutions will want to keep it all local, but won't this open up a market for cheaper, foreign competition resulting in a downward pressure on compensation?

Re: Why you should not go to medical school

#87

Post by 2mur » Sat, Sep 24, 2011, 4:28 PM UTC

Bloodwine wrote: post #86

roentgen wrote: post #79

Earlier quoted context omitted.

My group does this, but not because we're evil. Larger groups often have fellowship trained radiologists who are experts in a certain sub-specialty, for example Neuroradiology. Smaller groups are usually all 'general' radiologists. If we can read pediatric brain MRIs more accurately from across the country than the local small group, why shouldn't we? One additional note. My 'customers' are not really the patients, m…

What protects you from outsourcing the reading of scans to foreign countries, such as India? Obviously some medical institutions will want to keep it all local, but won't this open up a market for cheaper, foreign competition resulting in a downward pressure on compensation?

Trust. FMG (foreign medical graduates) have an extremely low reputation in the US. It's a component of defensive medicine.

Re: Why you should not go to medical school

#88

Post by roentgen » Sat, Sep 24, 2011, 4:29 PM UTC

Bloodwine wrote: post #86

roentgen wrote: post #79

Earlier quoted context omitted.

My group does this, but not because we're evil. Larger groups often have fellowship trained radiologists who are experts in a certain sub-specialty, for example Neuroradiology. Smaller groups are usually all 'general' radiologists. If we can read pediatric brain MRIs more accurately from across the country than the local small group, why shouldn't we? One additional note. My 'customers' are not really the patients, m…

What protects you from outsourcing the reading of scans to foreign countries, such as India? Obviously some medical institutions will want to keep it all local, but won't this open up a market for cheaper, foreign competition resulting in a downward pressure on compensation?

See my other answers. "Final reads" must be performed my a physician who did a radiology residency in the USA, and credentialed in the USA. Note, you don't need to be located in the USA, but it doesn't matter, there is no competing on price.

See my other answers. For each scan or xray performed, two fees are billed. The reimbursements are generally set in stone, and non-negotiable. Additionally, "fee-splitting" is Medicaire fraud. Meaning, if you as an independent businessperson own an imaging center and I read cases for you, you cannot keep any of my "professional fee" for reading the case. So there is no way for another radiologist to compete on price with me, it is simply illegal to offer to read the cases for less.

Re: Why you should not go to medical school

#89

Post by [deleted] » Sat, Sep 24, 2011, 4:30 PM UTC

Bloodwine wrote: post #86

roentgen wrote: post #79

Earlier quoted context omitted.

My group does this, but not because we're evil. Larger groups often have fellowship trained radiologists who are experts in a certain sub-specialty, for example Neuroradiology. Smaller groups are usually all 'general' radiologists. If we can read pediatric brain MRIs more accurately from across the country than the local small group, why shouldn't we? One additional note. My 'customers' are not really the patients, m…

What protects you from outsourcing the reading of scans to foreign countries, such as India? Obviously some medical institutions will want to keep it all local, but won't this open up a market for cheaper, foreign competition resulting in a downward pressure on compensation?

[deleted]

Re: Why you should not go to medical school

#90

Post by roentgen » Sat, Sep 24, 2011, 4:38 PM UTC

kenjackson wrote: post #84

sp332 wrote: post #68

Earlier quoted context omitted.

Generally, rare goods - and skills - are valuable. So going to school for a long time to learn an unusual skill well means that your services are more valuable. Also, providing a large amount of value in a small amount of time (like accurately interpreting the results of a scan) leads to providing huge amounts of value over the course of a year. Part of the explanation is the sheer volume of individuals he can give a…

So going to school for a long time to learn an unusual skill well means that your services are more valuable. It's only a rare skill because of licensing/board requirements. I'm fairly certain if you told other people they could make $250k as a radiologist, they could self-teach. The same thing could be said of programming if the only people that could practice had to be certified.

I'm going to respectfully disagree.

This may be possible in some medical fields (I doubt it), but not radiology. There is simply too much to learn. I completed 4 years of medical school followed by a 5 year residency. Some radiologists go through additional sub-specialty training. I've been practicing for 5+ years, and I'm still learning everyday.

I am a doctor's doctor, meaning my customers are doctors from every specialty, who order studies and read my reports looking for answers they can't answer clinically. I can talk to Orthopedic surgeons in their language, Neurologists in theirs, and Gastroenterologists in theirs. I'm familiar with the radiological manifestation of most pathological processes a human can experience.

The notion that someone could self-teach what I know seems impossible.

There are licensing and board requirements, but conspiracy theories aside they are not designed to create artificial scarcity, they're supposed to keep dangerously ignorant doctors from practicing.