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

niskanencenter.org

141–150 of 377 posts

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

#141

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.

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.

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

#142
post #135

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?

Sometimes they do, look at the UK strike for an example although the environment here is no where near as toxic.

One of the shortage issues is that it takes 9-12 years to train a specialty physician. For example we need more radiologists today but we can’t fix that until we increase residency spots which won’t impact the job market for 6 years so until then I’m reading more than I want to, even though I’d gladly work less for less total compensation.

Someone has to do the work though and I can’t just say “not me” and leave the studies unreported. There is a human on the other end who needs care.

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

#143

Earlier quoted context omitted.

> It sure sounds to me like that (and thus any knock-on problems) could be solved by more practitioners, spreading the work around. Sort of. The equipment is so expensive that the actual solution is usually to work the rooms and equipment harder. Night shifts, early starts and evening work are actually shit.

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

Think that is the point. If their is expense equipment, high capital. Then companies will try to maximize the current labor first, grind them down, before taking the leap to hire more labor. Like running 2, 10 hour shifts, with few hours downtime, will be better than running 3, 8 hour shifts, at 24 hour uptime. The incentive is to stretch labor head count out, before adding more.

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

#144

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…

> That said, is anyone hiring an ophthalmologist with CS and Math degrees? As someone who recently transitioned to a tech role, I'd urge you to focus on applying to companies related to your existing fields (ophthalmology, medicine, surgery, and their derivatives) who happen to be seeking SWE's, rather than general tech companies. Especially Series A, B, C startups. Look up all the companies that make your equipment…

This. This is best advice. I can't imagine there isn't some software company that could use a doctor-SWE combo. Usually SWE struggle not knowing the subject matter they are coding about. It is the subject matter experts that they need.

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

#145
post #139
post #78

Earlier quoted context omitted.

> 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.

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

In both 70th and 80th there was no growth. Maybe in 60th there was some but it was before my time. Anyway, it was depressing place. There were some great people there but it was despite the system not because of it.

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

#146

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.

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 structured as partnerships that don’t offer employer contributions (depending if you own your own facilities you can potentially exit for a lump-sum at retirement, if you are just part of a hospital based group you don’t have any assets other than the contract so it’s like a 1-200k exit similar to the buy-in).

My surgeon friends in that income bracket are also all fee-for-service/eat what you kill rats that also don’t get employer retirement contributions/benefits or equity. A lot of us don’t even get paid sick days.

The jobs that offer you defined-benefit or employer contributions for retirement are academia or HMOs which is like 250-350k in radiology.

In Canada we’re technically corporations (for tax deferral) and consequently don’t even have RRSP (401k/IRA equivalent) contribution room (unless you pay yourself in salary). But there’s no employer matching/contribution in either case.

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

#147
This is depressing. After recent medical scare that let me see the current level of medical treatment up close. I had though of leaving SWE to go into a medical field in order to help people. I'm in the US, and man, being in a hospital is really depressing, people are literally just dying for lack of help, being left behind. Or, maybe it's just more late stage capitalism, and I just happened to get a glimpse at how our society is choosing solve the problem of poor people, just put them down.

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

#148

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 popularity of these articles here.

You must know this? Have you not seen their comments on HN medical threads? So vocal and often horribly wrong it would be comical if it wasn’t so depressing.

I’m not going to one up you with my own sob story, but it’s like you say for all of us everywhere in the US - but you can really only complain to other MDs. Outsiders will demand you work more, get paid less, get sued more, and grovel. They hate us, so don’t complain to them. In the end they will get what they want - automated service by LLM combined with other diagnostic software and nursing. They will then complain for the return of the human physician. It’s so typical.

You are perfectly suited to giving them automated service. Just spitballing and probably wrong - have an optho specific app with an LLM and maybe a plug in smart phone device that has object detection/instance segmentation for diabetic retinopathy. Cataracts detection might be secondary? There’s plenty of products for retinopathy and looks like Inception networks do fine for cataracts. Other eye pathologies that are easily visually diagnosed are on the table too. Why see 40 patients when you could see 150 and the LLM/app have done the referral, initial screening questionnaire, and your nurses/MAs write your note/rx/orders etc. Ideally you should be like a dentist (they clearly figured this out already). You walk into the patient’s room do a quick eye exam, say what needs to happen, don’t answer any questions, and walk out. They hate you already anyways, might as well lean into it.

- Currently an imaging fellow in the cartel.

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

#149

Earlier quoted context omitted.

> It sure sounds to me like that (and thus any knock-on problems) could be solved by more practitioners, spreading the work around. Sort of. The equipment is so expensive that the actual solution is usually to work the rooms and equipment harder. Night shifts, early starts and evening work are actually shit.

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 but no nursing money for the OR, recovery room, or patient wards.

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

#150

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…

I remain optimistic that some people here are open to learning so I still try sometimes.

- Also a radiologist who gets told I’m egregiously overpaid when [insert immature AI tech] can definitely do my job better.

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