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

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

#361

Post by catchnear4321 »

singleshot_ wrote: post #359
catchnear4321 wrote: post #245

Earlier quoted context omitted.

> Why is an older doctor so much more valuable than an older developer? which would you take with you on a one way trip to a desert island? that’s a meaningless question, it assumes their jobs are their siloed experience, and that nothing outside of job is real. training. licensing. you can’t just go become a doctor. yes, there can be new doctors, cheaper, maybe better, maybe not. but the funnel is finite. got a comp…

> which would you take with you on a one way trip to a desert island? How long are we going to be there?

well, given that it is a one way trip, that’s largely up to you and your travel companion.

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

#362

Post by hn976827 »

FrustratedMonky wrote: post #345
hn976827 wrote: post #344

Earlier quoted context omitted.

A more nuanced discussion would perhaps help. You are just jumping between extremes. Obviously the average tech person can't retire with 50 while living in a golden castle. Nobody claimed that. If you retire that early then you lifestyle needs to match your wallet. I'm not even 50, I'm just below 40, but I could retire tomorrow despite not having worked at Google or similar. Obviously I couldn't own a 1500sqft condo…

That was the claim, I was replying to : "Difference is that in tech you can retire with 50. Few people who still work at 70 do so by choice.". Saying you can retire at 50 if you choose too, and working is a choice, is completely bogus. You are not being nuanced, you are being misleading. Nobody is retiring at 50 that isn't very well off. Even with a small house, remember, there is covering health insurance, taxes, fo…

> Saying you can retire at 50 if you choose too, and working is a choice, is completely bogus. You are not being nuanced, you are being misleading.

Perhaps read again what I wrote. I explicitly stated that those who still work at 70 rarely do this by choice. More concretely, the lady behind the counter at Walmart is 75, and she definitely does not do that job because she loves it so much.

This was to contrast with the comfortable situation that we in tech are in. We can choose to retire early, even if it comes with lifestyle impacts. Not everybody desires a penthouse in downtown. And not living there does not mean you are living on the street.

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

#363

Post by sarchertech »

haldujai wrote: post #327
sarchertech wrote: post #290

Earlier quoted context omitted.

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 o…

> 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. Knowing that your wife is in PEM now I expect she's not in the 500k-1M category (if she is kudos again but I definitely made a career mistake) and pr…

I’m not sure where we only started talking about physicians making >500k. Very very few software engineers are making that despite what you’d think from reading HN. The vast majority who are making anywhere near $1M are no longer really ICs, so they aren’t comparable to a physician who only does clinical work.

My wife doesn’t make $500k, but if she decided she wanted to work 40-50 hours a week instead of 25-30 she could get close.

Her group, and from what she says most hospitals in the country, are basically always struggling to find enough PEMs to maintain coverage.

The incentives to work more than 15 shifts and more than 4 overnights are very generous—the alternative is to bring people in from the next city over. And if she really wanted to she could pick up extra responsibilities and work towards becoming a partner.

But virtually no one is making $500k-1M in base compensation in any industry, so percentage based benefits are such a small part of it.

Look at Google for example, you’re at senior staff before your base reaches $250k, so percentage based contributions are based on a much smaller chunk of your total compensation.

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

#364

Post by chaostheory »

bruce511 wrote: post #328
chaostheory wrote: post #295

Earlier quoted context omitted.

Communism is just late stage socialism. Besides even if they were two separate things, by design in socialism nearly everything is centrally planned. Corruption just spreads much faster in systems where you centralize power from the start ie you want the groups running the media, producing goods, and managing the laws to be separate entities

I think we'll gave to agree to disagree there. In my understanding socialism and communism are two very different animals. Communism is about the absolute equality of all - no rich, no poor. Socialism is about caring for the poor, with no upper bound on the rich. In other words one squeezes from the top down. The other pushes from the bottom up.

What you’ve just described are socialized safety net programs inside mixed capitalist economies. That’s not socialism. There is no private ownership in socialism. Consequently, there are no rich in that system. The “community” owns and produces everything.

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

#365

Post by matheusmoreira »

mavelikara wrote: post #360
matheusmoreira wrote: post #341

Earlier quoted context omitted.

> Are the number of patients increasing The number of patients is literally never ending. It's a property of the decentralized public health system. If you have resources to spare, patients will be sent to you. No matter how much time and money you pour into healthcare, it's never enough. It's as if demand instantly scaled to exceed capacity. > or the time consumed by each increasing On the contrary, it's reducing. C…

Thank you for explaining. > Brazilian software developers working for american companies for a salary that would be inhumane to an american put doctors here to shame. I'm talking 2-4x, depending on the company and exchange rate. It wasn't like this before. It sounds to me that this is really the root cause of your unhappiness, rather than more doctors entering the market. We had a similar situation in India too, but…

> It sounds to me that this is really the root cause of your unhappiness

I know it sounds that way but the truth is I'm doing pretty good myself. I too make 2-4x more than those doctors. I just talked to one on Instagram about it. When I calculate the value per hour, I'm actually outcompeting those full time software developers. I make good money and have lots of free time.

Still, it's a bleak picture. In a few decades, medicine went from an elite profession, essentially guaranteed prosperity, to basically a normal job. Soon it looks like the liabilities will exceed the returns. Too much responsibility for too little pay. People here love suing doctors just like in the US. Why would anyone want to put up with that if they're not making a fortune?

The best option right now is to use medicine to raise some quick capital, start a business then quit medicine.

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

#366

Post by weatherlite »

singleshot_ wrote: post #357
weatherlite wrote: post #184

Earlier quoted context omitted.

I don't agree about lawyers actually. If you haven't made it into something close to partner level or have extremely valuable knowledge and skillset you'll be seen as a liability. There's plenty of people in their late 20s to early 40s who will be preferred over you. Same goes for most jobs actually, doctors are the outliers. For now...wait till A.I makes progress in medical circles.

One fact I can add to your knowledge is that at my firm, the lawyers who have been practicing longest have the highest billable rate. One more is that I very, very rarely ask any 29 year old lawyers at my firm any questions, although I love them dearly. When I need someone to review my work or answer a ticklish question, I seek out 72 year olds and ask them. I'm not sure who clients prefer but when it comes to legal…

Yes they are partner level. How many 50 year old lawyers has your firm hired recently? Ones who haven't advanced to partner?

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

#367

Post by weatherlite »

weatherlite wrote: post #366
singleshot_ wrote: post #357

Earlier quoted context omitted.

One fact I can add to your knowledge is that at my firm, the lawyers who have been practicing longest have the highest billable rate. One more is that I very, very rarely ask any 29 year old lawyers at my firm any questions, although I love them dearly. When I need someone to review my work or answer a ticklish question, I seek out 72 year olds and ask them. I'm not sure who clients prefer but when it comes to legal…

Yes they are partner level. How many 50 year old lawyers has your firm hired recently? Ones who haven't advanced to partner?

To be clear I'm not saying this never happens (hiring of mid level 50 year olds), I'm just saying it's just as rare as in tech. I don't think I'm imagining this, it's a pretty well established statistic that after 50 job participation rates begin to fall.

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

#368

Post by FrustratedMonky »

hn976827 wrote: post #362
FrustratedMonky wrote: post #345

Earlier quoted context omitted.

That was the claim, I was replying to : "Difference is that in tech you can retire with 50. Few people who still work at 70 do so by choice.". Saying you can retire at 50 if you choose too, and working is a choice, is completely bogus. You are not being nuanced, you are being misleading. Nobody is retiring at 50 that isn't very well off. Even with a small house, remember, there is covering health insurance, taxes, fo…

> Saying you can retire at 50 if you choose too, and working is a choice, is completely bogus. You are not being nuanced, you are being misleading. Perhaps read again what I wrote. I explicitly stated that those who still work at 70 rarely do this by choice. More concretely, the lady behind the counter at Walmart is 75, and she definitely does not do that job because she loves it so much. This was to contrast with th…

OK. Guess I read it opposite. Your wording of choice, seemed to imply there was a choice. I missed a negative, so you are saying, a lot of people do NOT have a choice.

I guess then, I agree. A lot of people have very limited choices, and in tech we have slightly more choices. I'd just disagree with the degree of choice. In Tech we have more choice, I'd say that isn't much more. If there is some arbitrary scale of choice, from 0-100, and most people have 10% of choice, and in tech we have 20%, that is still at the bottom. When you get outside of SF, there is a vast world of tech, where tech people are not rich, and they are slugging away making ends meat like everyone else. Generally better off, but I'd say a really long way from being able to make a choice to retire early.

It's kind of like the scene in Game of Thrones where they are arguing about slaves having a choice, and Tyrion is saying slaves have a choice, meaning that they can commit suicide. So yes, we all have a choice.

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

#369

Post by hn976827 »

FrustratedMonky wrote: post #368
hn976827 wrote: post #362

Earlier quoted context omitted.

> Saying you can retire at 50 if you choose too, and working is a choice, is completely bogus. You are not being nuanced, you are being misleading. Perhaps read again what I wrote. I explicitly stated that those who still work at 70 rarely do this by choice. More concretely, the lady behind the counter at Walmart is 75, and she definitely does not do that job because she loves it so much. This was to contrast with th…

OK. Guess I read it opposite. Your wording of choice, seemed to imply there was a choice. I missed a negative, so you are saying, a lot of people do NOT have a choice. I guess then, I agree. A lot of people have very limited choices, and in tech we have slightly more choices. I'd just disagree with the degree of choice. In Tech we have more choice, I'd say that isn't much more. If there is some arbitrary scale of cho…

> In Tech we have more choice, I'd say that isn't much more.

Ok. Then our main disagreement is whether a household income of $400k grants significantly more freedom than a household income of $150k. I'd argue that it indeed does.

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

#370

Post by scythe »

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…

>I grew up in late USSR

Data is better than anecdotes:

https://commons.wikimedia.org/wiki/File:GDP_per_capita_devel...

These are data reconstructed by Western economists, not Soviet partisans. Only when the political system was in a meltdown by the end of the '80s did the USSR experience a sustained economic decline.

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