The planning of U.S. physician shortages (2020) • Hacker News Board

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

#261

Post by MichaelZuo » Sat, Jun 03, 2023, 5:22 PM UTC

FrustratedMonky wrote: post #141

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.

That is BS, a big load of BS. There are a ton of people in tech that struggle, and reach 50 just to be nearly living on the street. This thread must have a lot of top FAANG's managers posting this morning.

An above average eye surgeon in the US with a few years of experience is the rough equivalent of a middle manager in terms of age and could be in terms of rarity.

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

#262

Post by ch4s3 » Sat, Jun 03, 2023, 5:24 PM UTC

Tanjreeve wrote: post #226

ch4s3 wrote: post #73

Earlier quoted context omitted.

Really because the Cuban state bio pharmaceutical industry items at least a 40% shortage in medical supplies[1](I hope you read Spanish). Here’s another from Univision[2]. I could dig through the state news and find where they say the same thing but I have limited patience for stalinist ramblings. As for the training, I did only cite one study. But I know doctors who have worked along side Cuban doctors in Africa thr…

The shortage of medical supplies is a problem created by the US which is then recycled into evidence of medical failure which is quite a nice little Gordian knot. >As for the training, I did only cite one study. But I know doctors who have worked along side Cuban doctors in Africa through MSF, and they’re according to multiple people I’ve spoken with very poorly trained. The medical missions are also as I pointed out…

It is categorically not a problem created by the US. Cuba was a satrap of the USSR that never developed any local economic or agricultural capacity. This is despite receiving free oil, machinery, training and fertilizer from the USSR and later free oil from Venezuela. Cuba still has the lowest agricultural output in the Caribbean by miles, clearly this is a result of communist economic policies. One only needs to look to Deng’s agricultural reforms in 1980s China to see this.

The embargo is no excuse. Cuba’s largest trading partner is Spain and they could get any European good or equipment they wanted if they had anything worth exporting for foreign currency. Cuba receives nearly a billion dollars a year in remittances from Cubans in the US alone, yet they are unable to do anything to unlock the potential of that inflow because they’re hung up on broken stalinist policies.

I sent you several Spanish language articles on the topic published outside of the US, this isn’t a “corporate media” narrative. The Cuban government is just terrible. If you can’t read Spanish that isn’t my fault. I know tons of Cubans, including Cuban leftists, and I read Spanish. I’m pretty well informed here and not just buying a narrative.

Human Rights Watch calls the medical mission slavery. They don’t allow the doctors to communicate with family, take their passports, take their wages, often send them into conflict zones, threaten their families, and on and on.

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

#263

Post by MichaelZuo » Sat, Jun 03, 2023, 5:25 PM UTC

wrp wrote: post #135

trashface wrote: post #123

Earlier quoted context omitted.

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?

This is what I don't get, if there was such an extreme shortage then the average visit to a family doctor should cost hundreds of dollars.

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

#264

Post by lucaspm98 » Sat, Jun 03, 2023, 5:25 PM UTC

kevinventullo wrote: post #201

haldujai wrote: post #158

Earlier quoted context omitted.

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.

Do Google and Facebook really only match half of 401(k) contributions up to 7%?

I thought employers competing on benefits were moving towards dollar for dollar or better matching. This is especially important for high income earners who'd be maxing out, because the 401(k) contribution limit for 2023 is $22,500 for employee contributions but $66,000 for combined employee and employer contributions.

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

#265

Post by akkartik » Sat, Jun 03, 2023, 5:26 PM UTC

nostrademons wrote: post #213

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…

Tech is temporary, though. The reason salaries (and profits) are so high is because tech companies, when successful, displace whole industries and capture the revenue in a more labor-efficient way. But once the industry has been displaced, you don't need the software engineers anymore. Eventually the tech company becomes a dinosaur that the finance department milks for profits and share buybacks, and then gets replac…

This whole comment needs a big "citation required". It's all anecdotes and speculation.

Tech displaces industries, yes, but in the history of tech there has never been a company that stopped needing software engineers.

If you ask your surgeon he'll tell you how many times he feels he's retrained in his 40 year career. It's not going to be 0.

And don't your two paragraphs contradict each other? Isn't the need to retrain every 5-10 years a big sign that software engineers are not going anywhere?

I would agree with everything you wrote if it was prescriptive rather than normative. I would like software engineers to work themselves out of a job. And I'd like technology to be stable so we can focus on something besides the tech aspect of a company. But that seems poles apart from the world we live in.

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

#266

Post by MichaelZuo » Sat, Jun 03, 2023, 5:28 PM UTC

VirusNewbie wrote: post #224

haldujai wrote: post #137

Earlier quoted context omitted.

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 compe…

Most people cannot last 10 years in FAANG. It’s up or out.

It's a pretty reasonable expectation for the 95th percentile. IDK how that translates to surgeons, maybe 70th-80th percentile?

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

#267

Post by whimsicalism » Sat, Jun 03, 2023, 5:28 PM UTC

haldujai wrote: post #149

whimsicalism wrote: post #80

Earlier quoted context omitted.

That makes no sense, if the capital is expensive then you should hire more labor.

The expensive labor isn’t physicians and infrastructure/capital expenditures aren’t the barrier either. It’s nursing costs and bed counts. Look at Canada for an example, we have unemployed surgeons and interventional radiologists/cardiologists with surgical backlogs > 1 year. We have the rooms, the hospital I trained at had 90 operating rooms but only 4 are funded for after-hours and on weekends, the rest run 8am-4am…

Research indicates the "unemployed surgeon" problem in Canada is more folklore than reality. [0] AFAICT, Canada has a shortage of physicians. [1] That unemployed people exist at all is not evidence that there is no labor crunch.

[0]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5866140/ [1]: https://www.cbc.ca/news/politics/canada-turning-away-home-gr...

That you are not running these rooms as much as possible indicates some failure in pricing/profit seeking, but I have no idea how the Canadian medical system works.

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

#268

Post by NemoNobody » Sat, Jun 03, 2023, 5:32 PM UTC

whitemary wrote: post #34

alehlopeh wrote: post #22

Earlier quoted context omitted.

What’s with the scare quotes around communist? Sure they have a lot of doctors. And how many of those doctors are allowed to do business as a private practice? Or how many would be allowed to change careers if they wanted to? How many are allowed to spend their income at fancy places, where the currency they get paid in isn’t even accepted? Hate to break it to you, but “your” worldview is incredibly, laughably, misin…

According to a Marxist definition of communism (classless society) neither Cuba or the Soviet Union are or were communist.

Well, you're right but it's think that despite the definition Marx coined, or the government he imagined, Communism has evolved and so has the definition.

The countries that tried Communism did so differently but with many similarities and all still had/have social classes.

A classless society only works theoretically - those that have tried to implement such societal changes have been unable to realize that goal practically.

Practical application matters most.

It may not be so much that modern Communists have failed to implement Marxist government but rather that Marx failed by focusing so solely on social class.

Inequality is the problem - it eats away at a society and its people. True equality is impossible and honestly not even desirable. Absolute equality doesn't mesh well with individuality.

I don't need to own the same things that everyone else does, live in the same size house or drive comparable cars - it's OK that people have nicer things than I do. It's not OK that everyone I know works hard their entire lives and others don't have too.

It's not OK that I know several people that have died bc they were avoiding medical care they knew they needed due to the expense.

It's not OK that everyone I talk to under 25 all seem to want to skip college and go work wherever - they are not lazy, they are certain that our future is uncertain. Why have goals that can't be reached?

I'm fine with classes as long as all classes have the same MINIMUM quality of life. Society should never limit the individual but should rather empower them to live well, as such, the only limits on maximum wealth I would impose would come after several billions have been added to an account - it does the society that generated that wealth no good if it simply sits an account and gets bigger.

Gates, Zuck, Mush, Bezos and other super rich are examples of our societal failure to regulate OUR economy well enough to prevent the greediest of us all from taking all of OUR collective wealth.

This is what Marx missed. This is why his definition/ideology didn't work out - also why so many have failed.

There will always be owners and workers, rich and poor, good and bad people - this is why government exists. How can a government eliminate the reason it exists?

To be frank, it was kinda stupid to think that paying everyone the same, trying to treat everyone the same, taking away ownership and attempting to equalize access to possessions would transform society into a paradise.

tl;dr: The definition of Communism has changed since Marx because everyone that tried Marx failed miserably and had to make due - today Communism is what they are doing now and isn't at all like Marx proposed.

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

#269

Post by haldujai » Sat, Jun 03, 2023, 5:40 PM UTC

kevinventullo wrote: post #201

haldujai wrote: post #158

Earlier quoted context omitted.

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.

Thanks for sharing, I'm still learning how retirement works in the US and was unaware of that detail.

I also wasn't sure how to value benefits (at least health/dental + disability if that's included) and PTO (including sick days and mat/pat leave which are unpaid for this subset of physicians), do you have a ballpark on what that is worth for accounting purposes?

Overall I think the biggest hidden line item in any physician's income is still opportunity cost of 10 years +/- loans but my main point is there are hidden costs behind that 500k which are fairly significant.

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

#270

Post by mrep » Sat, Jun 03, 2023, 5:48 PM UTC

lucaspm98 wrote: post #264

kevinventullo wrote: post #201

Earlier quoted context omitted.

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.

Do Google and Facebook really only match half of 401(k) contributions up to 7%? I thought employers competing on benefits were moving towards dollar for dollar or better matching. This is especially important for high income earners who'd be maxing out, because the 401(k) contribution limit for 2023 is $22,500 for employee contributions but $66,000 for combined employee and employer contributions.

Each is slightly different but it amounts to $10,250 worth of match if you max it out and then you can hit the $66,000 limit through the mega backdoor roth.