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

niskanencenter.org

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

#131

Post by dsr_ »

the_d3f4ult wrote: post #62

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…

"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.

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

#132

Post by GiorgioG »

the_d3f4ult wrote: post #62

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…

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.

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

#133

Post by looping__lui »

nemonemo wrote: post #23

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 throttl…

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.

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

#134

Post by haldujai »

Mordisquitos wrote: post #130
hn976827 wrote: post #129

Earlier quoted context omitted.

Difference is that in tech you can retire with 50. Few people who still work at 70 do so by choice.

So can many physicians. Furthermore, I'm willing to bet that most doctors in the 50–70 age group that continue to work do so not because they cannot retire, but rather because they do not want to retire because they find their practice fulfilling.

Not true, some do (stereotypically the surgeon with 4 ex wives and children that don’t know them) but it really depends on your country/practice pattern.

On one extreme Canadian physicians are (generally) ineligible for pension/retirement benefits. Many US private practice jobs are the same. Academic US jobs usually have some form of retirement support.

Add in the opportunity cost of not earning income until you’re 30+ as well as loans and I don’t think it’s a fair characterization to say “most physicians in the 50-70 age range want to work”, especially full time and considering burnout rates of ~50-60%.

Can’t speak about Europe which has very different compensation structure and debt burden.

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

#135

Post by wrp »

trashface wrote: post #123
the_d3f4ult wrote: post #62

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…

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 hav…

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

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

#136

Post by sarchertech »

haldujai wrote: post #134
Mordisquitos wrote: post #130

Earlier quoted context omitted.

So can many physicians. Furthermore, I'm willing to bet that most doctors in the 50–70 age group that continue to work do so not because they cannot retire, but rather because they do not want to retire because they find their practice fulfilling.

Not true, some do (stereotypically the surgeon with 4 ex wives and children that don’t know them) but it really depends on your country/practice pattern. On one extreme Canadian physicians are (generally) ineligible for pension/retirement benefits. Many US private practice jobs are the same. Academic US jobs usually have some form of retirement support. Add in the opportunity cost of not earning income until you’re 3…

> Many US private practice jobs are the same.

Where are you getting this from? The vast majority of doctors have access to the same kinds of fixed benefit retirement plans as people in other industries have.

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

#137

Post by haldujai »

the_d3f4ult wrote: post #62

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…

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).

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

#138

Post by haldujai »

trashface wrote: post #123
the_d3f4ult wrote: post #62

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…

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 hav…

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.

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

#139

Post by qwytw »

lr1970 wrote: post #78
scythe wrote: post #35

Earlier quoted context omitted.

>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…

> 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 contr…

> economy was in free fall

In the late 80s.. Before that there was some growth intertwined with stagnation.

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

#140

Post by sokoloff »

sarchertech wrote: post #136
haldujai wrote: post #134

Earlier quoted context omitted.

Not true, some do (stereotypically the surgeon with 4 ex wives and children that don’t know them) but it really depends on your country/practice pattern. On one extreme Canadian physicians are (generally) ineligible for pension/retirement benefits. Many US private practice jobs are the same. Academic US jobs usually have some form of retirement support. Add in the opportunity cost of not earning income until you’re 3…

> Many US private practice jobs are the same. Where are you getting this from? The vast majority of doctors have access to the same kinds of fixed benefit retirement plans as people in other industries have.

Very few people in private industry have access to fixed benefit plans (other than social security). Most everyone has fixed contribution plans: 401(k) [or 403(b) for education/non-profit].
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