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

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

niskanencenter.org

Post reply on HN
Print view View original

201–210 of 377 posts

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

#201

Post by kevinventullo »

haldujai wrote: post #158
vibrio wrote: post #154

Earlier quoted context omitted.

“ The super high income (radiology) jobs people are alluding to here (500k-1m) are structured as partnerships that don’t offer employer contributions” Am I reading correctly that having no 401k match would be a concern for someone making $500k-$1m annually?

You’re reading incorrectly and I also wasn’t very clear. It’s not a concern and I’m not saying we’re not well-compensated but 7% is something to consider when comparing total compensation across industries (and is one of the easiest line-items to objectively discuss). A larger part of that physician’s income has to go towards planning retirement and inflation (and self managing that) than is being posited here. In ad…

The defined-contribution matching is not actually that significant. Google and Facebook e.g. match half of what one contributes up to 7%, so they’re paying at most 3.5%. More importantly, employees can only contribute up to the annual 401(k) max; that’s $22,500 in 2023. Thus, the matching is worth at most $11,250, even for execs with a seven-figure base salary.

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

#202

Post by hansthehorse »

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.

Many of the doctors at the VA I go to are retired then took the VA job. They see 8 to 10 patients a day and spend between 20 to 30 minutes with each. They work 8am to 4pm and go home. On the other hand surgeons and their support staff have crazy schedules.

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

#203

Post by hedora »

naveen99 wrote: post #198

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.

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.

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

#204

Post by MobiusHorizons »

Pigalowda wrote: post #148
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…

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 populari…

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?

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

#205

Post by jandrewrogers »

soared wrote: post #179
PheonixPharts wrote: post #178

Earlier quoted context omitted.

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…

Your circle of 2/300k engineers does not represent average people. 99% of Americans should not be able to get a faang job even if the exact park was laid in front of them before college.

FWIW, 200-300k is not that uncommon far outside of FAANG or the usual tech cities for experienced senior engineers with current skills. We are not even talking startups necessarily but boring industrials and other companies no one thinks of as tech companies. Every large business is being forced to be much tech savvier and this reality has diffused high-paying tech jobs among a much wider range of companies and locales.

You are correct on one point: most Americans don't have the skills for these jobs. That is why these jobs pay so well, almost definitionally.

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

#206

Post by lotsofpulp »

rcme wrote: post #36
lotsofpulp wrote: post #26

Earlier quoted context omitted.

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…

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

That is not what I have read. Doctors are having to join as employees of larger doctor groups, that are owned and operated by older doctors or private equity. Or they can join the local hospital system as a W-2 employee. Either way, they are up against big payers, so they have to also join big employer groups themselves.

Or work in undesirable locations.

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

#207

Post by rs999gti »

candiddevmike wrote: post #191
jimmydddd wrote: post #120

Earlier quoted context omitted.

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.

It's interesting that places value seniority and experience so much more in medicine vs tech. Things change daily in both fields--new procedures, new findings--yet tech seems to have far more ageism. Why is an older doctor so much more valuable than an older developer?

> Why is an older doctor so much more valuable than an older developer?

The lower barrier to entry that the developer has?

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

#208

Post by rs999gti »

vibrio wrote: post #154
haldujai wrote: post #146

Earlier quoted context omitted.

From my job search as a physician. Literally no private practice job I’ve interviewed at or heard of provides defined-benefit retirement, if you know one let me know. Similarly I don’t know of many non-medicine jobs that still offer this either, but they do offer defined-contribution plans and GlassDoor suggests Google matches 7%. The super high income (radiology) jobs people are alluding to here (500k-1m) are struct…

“ The super high income (radiology) jobs people are alluding to here (500k-1m) are structured as partnerships that don’t offer employer contributions” Am I reading correctly that having no 401k match would be a concern for someone making $500k-$1m annually?

> super high income (radiology) jobs

Weren't these replaced by outsourcing imaging reading to third world doctors?

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

#209

Post by cronix »

candiddevmike wrote: post #191
jimmydddd wrote: post #120

Earlier quoted context omitted.

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.

It's interesting that places value seniority and experience so much more in medicine vs tech. Things change daily in both fields--new procedures, new findings--yet tech seems to have far more ageism. Why is an older doctor so much more valuable than an older developer?

I've heard of the "tech bro" stereotype (and seen it many times first hand), but struggle to recall a "doc bro" or equivalent one. I've also never heard of the term "culture fit" when discussing a potential hire in the medical industry like I do tech, software specifically. I wonder if the majority of the types of people who go into tech are different than the majority that go into medicine.

> It's interesting that places value seniority and experience so much more in medicine vs tech

I don't think the tech world devalues seniority as much as they despise people older than them and not of the same generation(ish).

All big generalities and of course don't fit every situation/company/person.

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

#210

Post by shadowofneptune »

throwaway173738 wrote: post #199
shadowofneptune wrote: post #85

Earlier quoted context omitted.

The question is what you are angling for . If your goal is, sincerely, to provide better service, then you won't get it. Keep in mind that with so many patients nowadays being eligible for Medicare, the money will come in anyway. Nursing homes got the brunt of the attention for their quality of care, but with hospitals facing the same population the same management techniques come too. I work as a nurse on nights and…

> EDIT: Also these companies now often run pharmacies, investment systems, healthcare programs... patient care is by no means the biggest earner. Are you referring to companies like Optum in the US? They own entire medical systems(Everett Clinic in Washington), an insurance company(United Healthcare), and a pharmacy(Optum Rx) as subsidiaries so if there’s a problem everyone can point fingers and nothing gets done. Th…

Optum is an extreme example, but it's all of them. The non-profits run the same as the for-profits, and have converged more and more since 2000 or so.
Post reply on HN