Live data from Hacker News

Why you should not go to medical school

blogs.law.harvard.edu

131–140 of 186 posts

Re: Why you should not go to medical school

#131

Earlier quoted context omitted.

So, effectively pilots are only working 1/4th of the time that I work? Or is there non-flight-time work that eats up 120 more hours a month?

There's a fair amount of non-flight work. It'd say that it averages 120 hours of work time total per month. Less than we work, but with worse hours. If you fly international with the majors, you're in good shape. Those guys make $200k easily, but those jobs are essentially inaccessible because the people who get them never retire. The rest make very little, and work a lot harder.

What sort of non-flight work do they do? I'm honestly curious, and I don't know any professional pilots. I imagine there's paperwork to fill out before and after every flight, and maybe mandatory training...

Re: Why you should not go to medical school

#132

Earlier quoted context omitted.

The median salary for experienced radiologists is $300k-400k. And increasingly radiology has been outsourced overseas with mostly technicians required stateside (scan during the day, radiologist in India examines at night, results available the next morning). But roentgen claims to be a businessman as well as a radiologist. If so, most of his income would be from several radiology businesses. In that case the 800k/ye…

If you read my other comments, I state that I make twice the average salary, because I read twice as many films. > increasingly radiology has been outsourced overseas with mostly technicians required stateside (scan during the day, radiologist in India examines at night, results available the next morning). This is not true. Some "preliminary reads" are read overseas at night, but the doctors reading the studies are…

> "Final reads", the CT scan report that counts, cannot be read elsewhere.

Why not?

Re: Why you should not go to medical school

#133

Earlier quoted context omitted.

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 sp…

>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. Thanks for the comments in this thread, they've been very informative. I'm happy there are certifications, and I believe you that the bar should be raised, but given the huge demand for doctors, why aren't we increasing t…

Just wanted to point out that while it may seem intuitive that increased supply = cheaper prices, thats not how it works with doctors

Doctors have the ability and incentive to increase demand, and I remember seeing data that this is what actually happens historically when you increase doctor supply.

Re: Why you should not go to medical school

#134
post #2

One could say the same for any given field from sports to programming to business to pet-sitting. It's a hard knock life for us all. None of these reasons should have stopped any decent doctor from taking the path. The single reason would be: Don't go into medical school if you care more about money and an easy-going life than the actual field and people involved. And the same applies to every single field.

> One could say the same goes for any given field Please name a sport, business, or other profession that involves staying up 40 hours straight unshowered, unfed, on a routine basis, for years, trying to not die or get anyone killed. I can think of only two: medicine and the military. I do both. They're roughly equal. Given the choice between residency and deployment, I would need more information. edit: Actually, I'…

Deep sea fishing? It certainly gets the very little sleep, unwashed and very dangerous aspects.

Re: Why you should not go to medical school

#135
I personally have been very happy with my decision to go into medicine (specifically, interventional radiology). I have a few comments about this discussion:

1. The average radiologist gets paid about $40 (after expenses) to read a CT scan. So you have to read a LOT of scans to make as much as roentgen. Many scans contain hundreds of images, and the diagnosis can depend on just a few pixels. Partly based on the radiologist's diagnosis, the patient may need to go to surgery (at least $25,000) or need another round of chemotherapy ($50,000), etc. When viewed in this context, I think $40 is a great value for getting an expert opinion. (As a side note, there is a lot of regional variation in salaries. They are probably lowest in New York City. Contrast that to law or finance, where the highest salaries are probably in New York City. I think the difference is due to the fact that medicine (even radiology) is practiced locally, and thus depends on local supply and demand, and does not have the kind of network effects that you see in law or finance.)

2. In terms of disruptive technologies in radiology, I don't think that computers will be able to replace radiologists any time soon, but there are lots of ways that computers could help radiologists be more productive or accurate. Much of the advances in consumer technology from the past decade are not yet available in radiology. Images are usually transferred to another hospital by mailing a CD. Reports are transferred using a fax machine. We're lucky if we can get 10 frames per second when scrolling through a large study. Computer systems are not linked -- ie, we have to type the patient's name into both the radiology system and the medical records system. For various reasons, many of these problems will have to be solved by big companies and not startups. But there are other opportunities for startups. If you're interested, check out my startup http://www.revisionrads.com.

Re: Why you should not go to medical school

#136
post #132

Earlier quoted context omitted.

If you read my other comments, I state that I make twice the average salary, because I read twice as many films. > increasingly radiology has been outsourced overseas with mostly technicians required stateside (scan during the day, radiologist in India examines at night, results available the next morning). This is not true. Some "preliminary reads" are read overseas at night, but the doctors reading the studies are…

> "Final reads", the CT scan report that counts, cannot be read elsewhere. Why not?

I have sort of answered this question below.

Final interpretations must be performed by a radiologist residency trained in the USA, licensed in the state there are reading from, and credentialed for the facility and the insurance company.

Why? Well, I guess it's supposed to be to ensure quality. In general, it is probably good that every hospital in the USA has an independent credentialing process. You could debate the fact that doctors in the USA are better trained, but in fact that has overwhelmingly been my experience.

Cynically, I believe that the lawyers need someone to sue. Like I said, most doctors complain about malpractice, but not me. The trial lawyers can't sue doctors overseas, but they can sue me. So, in a sense they are my ally, they ensure that no one else ( except people they can sue ) can read the studies.

That being said, there are companies that take USA trained radiologists and station them overseas. Australia and Geneva are both popular. They take advantage of the time difference to read hospital cases that occur overnight, when I am home in bed. They usually provide a preliminary read, something like "no appendicitis." The next day I do a final read, look for mistakes in the preliminary read, and in general do a more thorough job. Sure, there's no appendicitis, but the preliminary read didn't mention the small tumor in your left kidney that kind of looks like a cyst, but isn't.

FYI - overseas reads by USA trained radiologists tend to be more expensive, not less.

Anyway, thanks for jquery.

Re: Why you should not go to medical school

#137
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…

Wouldn't radiological and physician services, in general, be less "rare" if medical schools started to train more physicians (admit more students)? I have read studies that suggest that in certain markets and certain practice specialties we are and will face shortages of physicians in part because medical schools are training too few physicians. When I ask academic physicians they seem to think admitting more student…

The Planet Money podcast covered this topic once. In proper markets, increasing the supply of a good or service decreases its cost. However, in the US, the more doctors we train, the more we spend on healthcare.

A reason this is the case is because the average healthcare consumer is totally removed from the cost of healthcare and the doctor has a perverse incentive to make work for him or herself and other specialists.

Re: Why you should not go to medical school

#138
post #119

Earlier quoted context omitted.

Meta-comment: how is it possible that 2 reasonable, informative comments from roentgen are being downvoted?

I didn't down vote it but I suspect that it's "Medical school was easy" "went out drinking" "partying two or three nights a week" "did well with the ladies" "get by on four hours of sleep" "nurses were much more responsive to my advances" "busy but always had time for each other" "make over 800k a year". "ultimate job security" "tremendous resource for my family" "easy to get screwed by the medical system...won't hap…

Sorry, but I wanted to be completely honest. There were a few guys like me in my medical school. There needs to be a counterpoint to the doom and gloom reports of "no life" and "living hell".

Re: Why you should not go to medical school

#139

Earlier quoted context omitted.

>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. Thanks for the comments in this thread, they've been very informative. I'm happy there are certifications, and I believe you that the bar should be raised, but given the huge demand for doctors, why aren't we increasing t…

Just wanted to point out that while it may seem intuitive that increased supply = cheaper prices, thats not how it works with doctors Doctors have the ability and incentive to increase demand, and I remember seeing data that this is what actually happens historically when you increase doctor supply.

BINGO. You win the thread. The Clintons learned this the hard way, but most people don't understand how this could be true.

Re: Why you should not go to medical school

#140

Earlier quoted context omitted.

In fact, the medical licensing exams and board exams are too lenient. The general quality of people going to medical school in the US has been dropping for a generation. The standards are sliding, to our detriment.

I'd be quite interested to see evidence to support this assertion. Or is it just generally the case that everyone sees Osler's days as medicine's primetime, with a long slide since then?

I don't have any hard evidence, but I insist that it is true.

Bright and determined baby-boomers became doctors and lawyers and accountants. Today smart and determined people aren't even going to college. The HN demographic is a perfect example of this.

Post reply on HN