Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

Why you should not go to medical school

blogs.law.harvard.edu

Post reply on HN
Print view View original

161–170 of 186 posts

Re: Why you should not go to medical school

#161

Post by Gatsky »

pradocchia wrote: post #82
roentgen wrote: post #48

Earlier quoted context omitted.

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.

Ok, so everyone agrees that doctors are underpaid and overworked, and when someone isn't underpaid or overworked it's a misallocation?

Trust me, a good radiologist is easily worth that much and more. They make hundreds to thousands of decisions a day and produce data which is scrutinized carefully. Many radiology mistakes also eventually come to light through time or autopsy, so they are also accountable.

People in other jobs are paid more to do far less and be far less accountable, the finance industry being the number one example. (Thanks for your good work lately.)

One final point is that medical training in other countries isn't like this. In Australia, we don't work ridiculous hours most of the time and remuneration is reasonable. As well as making actual healthcare inefficient and needlessly expensive, the US has managed to do the same to medical training.

Re: Why you should not go to medical school

#162

Post by Gatsky »

mynameishere wrote: post #126
giardini wrote: post #107

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…

http://www1.salary.com/radiologist-Salary.html http://www1.salary.com/Physician-Cardiology-Non-Invasive-Sal... http://www1.salary.com/neurologist-Salary.html That radiologists make 100K more than cardiologists and 200k (!!!) more than neurologists absolutely screams market manipulation. Radiology seems literally one generation of Intel processors away from being automated into oblivion. God speed that it is.

I disagree with all your points. I think the main reason for differences in salary is that it is easy to measure what a radiologist does. It is also relatively easy to measure what a cardiologist does, particularly if they are doing procedures such as angiograms.

Mostly a neurologist diagnoses stuff and manages chronic disease, and how do you measure that? Arguably, the neurologist does the most difficult and complicated job. They get paid based on consultations per time, which is clearly a pretty hopeless measure.

Also, the notion that radiology is going to be automated by increased processor power is a bit ridiculous.

We are talking about a task where lives are at stake, communication and DISCUSSION with real people is required frequently, and there are large variations in the quality and modality of scanning.

Also, any data driven approach is very limited... what happens when a new MRI sequence is developed? We have to wait 15 years for real radiologists to do enough reporting so we can get a proper dataset?

Re: Why you should not go to medical school

#163

Post by arn »

adammichaelc wrote: post #160
roentgen wrote: post #141

Earlier quoted context omitted.

I'm not sure if you've ever seen a CT stroke study, which typically includes 4,000 images. If you think a computer can accurately interpret one of these any time soon, I would say you are poorly informed. See my response below, and look into "CAD" and mammography.

You might not see it because it's such an inconvenient thing to see; afterall your income is tied to it. The main factor keeping your income so high is the AMA and its regulatory allies. With rising costs and increasing pressure to save money in healthcare, you better believe that one day a computer will do your job. PS You might want to re-read The Innovator's Dilemma and The Innovator's Solution.

My income's not tied to it, so I'll say it.

Computers reliably interpreting films as the final word is not going to happen in the near future (within this guy's career). Reading films is as much an art as it is a science. I'm sure a lot of advances can be made on it, and we might see nice proofs of concept. But to the point that it actually replaces radiologists?

Even if you assume the technology can be perfected, there are too many non-technological hurdles for that to happen. Liability, trust, etc...

Machine EKG interpretation has been around for a while, but it's not even close to perfect and no one relies on it, and it's a much much much simpler problem.

Re: Why you should not go to medical school

#164

Post by kingkawn »

DTrejo wrote: post #149
kingkawn wrote: post #146

I started the med school track late in life (27 when I started taking premed classes), and while I haven't finished, I have to say that all of the complaining I hear from fellow students and doctors is ridiculous. All careers take up lots of your life. All careers end up dominating your social circles. All careers leave you feeling underpaid, including the people I know in finance who makes tons of money and work 12…

Did you read the article?

No of course not I'm studying to be a doctor.

Re: Why you should not go to medical school

#165

Post by thedufer »

arn wrote: post #163
adammichaelc wrote: post #160

Earlier quoted context omitted.

You might not see it because it's such an inconvenient thing to see; afterall your income is tied to it. The main factor keeping your income so high is the AMA and its regulatory allies. With rising costs and increasing pressure to save money in healthcare, you better believe that one day a computer will do your job. PS You might want to re-read The Innovator's Dilemma and The Innovator's Solution.

My income's not tied to it, so I'll say it. Computers reliably interpreting films as the final word is not going to happen in the near future (within this guy's career). Reading films is as much an art as it is a science. I'm sure a lot of advances can be made on it, and we might see nice proofs of concept. But to the point that it actually replaces radiologists? Even if you assume the technology can be perfected, th…

I don't know much about reading films, but I do know something about AI, and this kind of direct data->solution problem with an enormous existing data set is just about as easy as AI problems get. I wouldn't be surprised at all if we are already at the point where its a trust/liability issue rather than a technological one.

Re: Why you should not go to medical school

#166

Post by Robin_Message »

arn wrote: post #163
adammichaelc wrote: post #160

Earlier quoted context omitted.

You might not see it because it's such an inconvenient thing to see; afterall your income is tied to it. The main factor keeping your income so high is the AMA and its regulatory allies. With rising costs and increasing pressure to save money in healthcare, you better believe that one day a computer will do your job. PS You might want to re-read The Innovator's Dilemma and The Innovator's Solution.

My income's not tied to it, so I'll say it. Computers reliably interpreting films as the final word is not going to happen in the near future (within this guy's career). Reading films is as much an art as it is a science. I'm sure a lot of advances can be made on it, and we might see nice proofs of concept. But to the point that it actually replaces radiologists? Even if you assume the technology can be perfected, th…

It's naturally for humans, especially ones who've invested years of effort into something and get paid a lot for it to continue, to claim that something is "more of an art than a science." They are wrong. Do they collect data on how they make decisions and what the outcomes are, and then check that they are improving?

For contrast, look at http://www.lifeclinic.com/fullpage.aspx?prid=508121&type... There they decided to stop gathering lots of information and making a judgement and instead use a few simple rules to make a decision on whether someone was having a heart attack and how bad. It was more accurate.

Re: Why you should not go to medical school

#167

Post by roentgen »

shabble wrote: post #157
roentgen wrote: post #81

Earlier quoted context omitted.

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 Aid…

You mentioned in an earlier comment about a CT scan being 6k+ images. I'm assuming these are cross-sectional slices or something similar? I know a guy who's working for one of the big CT manufacturers (Toshiba, I think) working on 3D image-registration and partial analysis. In essence, lining up the features from different slides and sewing them into a 3D model. One of the big features being looked at was automatic l…

I use this software when we perform a CT scan looking at the coronary arteries. Under perfect conditions it can correctly idenitfy the coronary arteries, and subtract away the rib cage, heart, and lungs.

It sounds like you already understand what it does. It helps me read a study quicker by automatically processing the data, a step I used to do by hand. Many times the processing fails due to an artifact while scanning ( patient moves, ectopic heart beat, poor contrast injection timing, variation in anatomy), and I need to process it manually.

When it works well it is very helpful, but to be clear, it does not interpret the studies. I think many people replying in this thread don't understand the enormous complexity to accurate radiology reporting.

Re: Why you should not go to medical school

#168

Post by roentgen »

arn wrote: post #163
adammichaelc wrote: post #160

Earlier quoted context omitted.

You might not see it because it's such an inconvenient thing to see; afterall your income is tied to it. The main factor keeping your income so high is the AMA and its regulatory allies. With rising costs and increasing pressure to save money in healthcare, you better believe that one day a computer will do your job. PS You might want to re-read The Innovator's Dilemma and The Innovator's Solution.

My income's not tied to it, so I'll say it. Computers reliably interpreting films as the final word is not going to happen in the near future (within this guy's career). Reading films is as much an art as it is a science. I'm sure a lot of advances can be made on it, and we might see nice proofs of concept. But to the point that it actually replaces radiologists? Even if you assume the technology can be perfected, th…

This guy gets it. Many replies in this thread are asking about computers interpreting scans, assuming I know nothing about the underlying technology, or am blinded by some form of bias.

I have been programming computers since I was 5 years old. I have a MS in neuroscience, and I am a board certified radiologist, so I think I'm qualified to understand the problem.

Believe it or not, nothing would make me happier than a magical black box that could spit out accurate radiology reports. Someday I'm going to get sick, and I would benefit from the technology.

If my job was replaced tomorrow I would be OK. I'm smart and hard working, and I'm good at almost everything I try, eventually. Also, I'm saving every last penny I earn, so I can keep things up for a few more years I should be financially secure.

Having said all that, I still think the problem is not solvable. On any given day I read xrays, CT scans, MRIs, ultrasounds, PET scans, mammograms, nuclear medicine studies, or live flouroscopic studies, and using CT or ultrasound guidance I can get a needle into just about any part of your body to take a biopsy. Doctors talk to me and our discussion influences the differential diagnosis, and the interventions planned. I am not just matching patterns, I am thinking and using my hard worn judgement.

Wishful thinking aside, computers cannot do this now, if ever. And if / when we reach the point that computers can do this, my guess is every other job will have fallen, with the exception of plumbing.

Re: Why you should not go to medical school

#169

Post by roentgen »

msellout wrote: post #101
roentgen wrote: post #88

Earlier quoted context omitted.

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 Me…

Do you think this Medicare law is useful for protecting consumers?

Not really, no.

Re: Why you should not go to medical school

#170

Post by roentgen »

zmanian wrote: post #153
roentgen wrote: post #48

Earlier quoted context omitted.

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'd describe you as a possessing several traits that make you well suited for a career in medicine. Hypomanic personality. Characterized by low need for sleep, excessive energy. High IQ/ general intelligence. Low tolerance for risk. You are probably making less money than you could as entrepreneur or in finance but that's consistent with your risk tolerance. The professional medical career path is almost ideal for yo…

You have accurately described me.
Post reply on HN