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

281–290 of 377 posts

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

#281

Post by VirusNewbie »

PheonixPharts wrote: post #236
VirusNewbie wrote: post #221

Earlier quoted context omitted.

Do you make 300k? You said it was “easy to get” so surely you’re above that?

Yes and so do all of my teammates and every senior engineer at a publicly traded company you've likely never heard of. Again it's pretty standard anywhere in tech right now, startup or otherwise, to get 200k base + equity. Technically most startups I've chatted with also offer 300k+ TC... but that assumes the equity component eventually becomes liquid. Around 200k base is very easy to get anywhere right now, and gett…

I make well above 300k. It wasn’t an “easy” interview by any means.

You can go look at levels.fyi and see that there are plenty of F500 companies that don’t pay 300k for L5. Just spot checked for Ford, Disney, AT&T, Verizon, Target, and more.

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

#282

Post by pknomad »

barry-cotter wrote: post #47
rayiner wrote: post #41

Earlier quoted context omitted.

What’s discriminatory about MCATs?

If there are differences in outcomes between demographic groups some groups, like the SCOTUS, assume malice unless proven otherwise. See disparate impact or Griggs vs. Duke Power . Obviously the writers of the MCAT worked very hard to ensure Asians would get higher scores than any other group on them. The US is a country built in Asian supremacy.

> Obviously the writers of the MCAT worked very hard to ensure Asians would get higher scores than any other group on them.

I am not sure how you are coming to that conclusion. Look at the latest metrics on scoring. Sure, Asians overall tend to score higher on average on standardized exams (which really ought to be split into different sub-ethnic groups because there is a disparity there too) and I'm not seeing the average MCAT score for Asians being disparately higher than the average score of Black Americans that would warrant such a statement.

https://www.aamc.org/media/6066/download

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

#283

Post by speakfreely »

mixmastamyk wrote: post #104
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…

> soul-crushing tech salaries No one really gets those (statistically). I never did, despite being great at what I do. Basically a lottery system where the one lucky person who did the same exact problem two days ago wins.

I've found it's really about your negotiation and your confidence to ask for it. I've hired software engineers and frequently talk with others who do hiring, and I can confirm there's plenty of people who are making $120-140k who could've come in at $160-180k+ just by asking for it.

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

#284

Post by pknomad »

lotsofpulp wrote: post #26
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…

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…

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.

This is my biggest concern about primary care. NP training significantly lacks rigor in clinical sciences and standardization. I would also say days of seeing competent primary care (even in urban settings) is behind for patients.

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

#285

Post by pknomad »

jimt1234 wrote: post #48
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…

I hate that this shift is being driven almost entirely by profit motives, but I also wonder if this is such a bad thing. I love my doctor; she's been my doctor for 25 years. However, I sometimes wonder what real value she provides. All she ever does is send me to a specialist. Couldn't a PA or NP do the same thing?

Yes. But PAs and NPs lack the training and will more likely give referral for the wrong things or provide worse clinical care.

Management did the same thing with offshoring engineering. It's akin to saying, "competent engineers who understand business requirements and good software engineering principles are expensive. Can't engineers from another country (who often cost less) do the same thing if all they do is write the same code?"

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

#286

Post by haldujai »

MichaelZuo wrote: post #266
VirusNewbie wrote: post #224

Earlier quoted context omitted.

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?

Hard to compare, the "high-income" specialties are either brutally intense (e.g. neurosurgery, cardiac surgery, vascular surgery), competitive (plastics, derm, radiology) or both (ortho).

The competitive ones are variable with ~50-80% match rates for US MD graduates. Generally hard to get employed in desirable markets (especially NYC, LA, SF, Boston) unless you trained around there so the "desirable" programs are harder to match to but numbers aren't released. Some residency programs are toxic dumpster fires.

Attrition is hard to gauge because once you're in you're kinda stuck due to loans, sunken cost etc. Completely made-up but I would consider any of the intense specialties to represent at least the top 10%ile of physicians for a combination of aptitude and work-ethic/masochism.

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

#287

Post by ryan93 »

TheCoelacanth wrote: post #186
looping__lui wrote: post #133

Earlier quoted context omitted.

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 i…

You'll have a similar wait in the US for most specialties.

Most specialists in the US can see you in well under two months.

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

#288

Post by sarchertech »

sokoloff wrote: post #140
sarchertech wrote: post #136

Earlier quoted context omitted.

> 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].

Sorry I invented the term fixed benefit to be in opposition to defined benefit. What I meant was defined contribution.

Which was my point physicians generally have access to the same plans as other industries.

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

#289

Post by lostlogin »

haldujai wrote: post #151
lostlogin wrote: post #100

Earlier quoted context omitted.

New Zealand. The issue is that the reimbursement is the same whenever the scan is done, but staffing costs more at night (so scans kind of need to cost more at night). Reading what an MRI costs in the US, I do wonder if a trip to NZ for the scan would actually be cheaper.

I only know 1-2 NZ radiologists but I understand the system there is egregiously underpaid. Medicare/insurance reimbursement rates for MRI (the professional fee component) are less than Canada (a system I know). We scan outpatients near 24/7 on some of our magnets in Canada, the ones we don’t are because we don’t have MRI technologists to staff the shifts (the more expensive part as they have unions with labour laws,…

I haven’t heard radiologists complain about their pay here, they seem pretty well paid. The techs are paid nicely too, though that will depend on the employer.

I’m surely misunderstanding you - you aren’t saying techs cost more than radiologists in Canada are you?

Doing those hours with outpatients is very impressive, though I hope to never be involved in such things. Weekends are bad enough!

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

#290

Post by sarchertech »

haldujai wrote: post #146
sarchertech wrote: post #136

Earlier quoted context omitted.

> 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.

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…

Sorry I invented the term fixed benefit to be in opposition to defined benefit. What I meant was defined contribution.

My wife is a physician, as are many of our close friends. They nearly all work for private groups, and they mostly have some kind of employer matched plan. My wife’s group just directly contributes up to 13% of her salary to her retirement plan through profit sharing.

I know a far higher percentage of non physicians without employee contributions to retirement.

My wife doesn’t get paid vacation, but she only needs to work 12 shifts per month to maintain full time status and she makes more than I do (working only 12 shifts) as a principal engineer.

Post reply on HN