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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)

#151

Post by haldujai »

lostlogin wrote: post #100
greiskul wrote: post #91

Earlier quoted context omitted.

> It is also hard to get patients to agree to having tests done at 5am or 9pm, so it's a case of diminishing returns. In the US? With health care prices as they are? There are people that travel to entirely other countries for access to health. I'm plenty sure lots wouldn't mind at all to have an exam at 9pm if it meant it was way cheaper.

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, radiologists can be worked like dogs with no benefits/protections as contractors).

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

#152

Post by LadyCailin »

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?

They can, just not alone. If they were to unionize in sufficient numbers, there would be nothing to do but meet the demands. But “unions are bad” is the prevailing belief in the US, not to mention the huge amount of efforts that companies and the government go through to suppress them.

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

#153

Post by 8b16380d »

hn976827 wrote: post #129
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.

Difference is that in tech you can retire with 50. Few people who still work at 70 do so by choice.

That’s not true at all.

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

#154

Post by vibrio »

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…

“ 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?

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

#155

Post by haldujai »

FrustratedMonky wrote: post #144
carabiner wrote: post #102

Earlier quoted context omitted.

> 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.

Even large corporations, Matt Lungren is a notable radiologist with a tech background and was hired at AWS and is now CMIO at Microsoft + Nuance.

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

#156

Post by jasmer »

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…

Most devs are not earning anywhere near what a doctor is.

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

#157

Post by savrajsingh »

wrp wrote: post #110

What is a nutshell explanation of how healthcare got to the overall shortage state? (For the USA, but curious about other countries.) In the past 20 years, costs have shot up, doctors are seeing many more patients, and quality of care seems to have generally declined. Where have the resources gone? In the 1990s my GP had time to shoot the breeze for 20 minutes or more. Now I get a 5-minute diagnosis on the run, after…

It seems doctors want to intentionally keep their supply low so their pay remains high.

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

#158

Post by haldujai »

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?

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 addition to health benefits, sick leave and vacation. Someone making 400k at a place matching 7% with a good benefits package isn’t making less than a radiologist at 500k in private practice.

As an example a colleague of mine recently changed jobs and went to ~350k in an academic environment from ~520k PP and after calculating all of the benefits and reduced hours (less evenings/weekends, so assumed he would sign up for extra shifts) came out financially ahead. I haven’t worked an engineering job in over a decade but my gut/recollection is that similar base comp numbers would probably pan out the same especially as there is a significant opportunity cost.

It’s the difference between any independent contractor vs employee, regardless of if that’s medicine, construction or freelance SWE so when comparing the “high income physician” job it should be compared like you would a freelancer to FAANG employee @ 10 years of experience.

FWIW the median in private practice radiology is ~500k. As our compensation is literally per work-unit the only way to go higher is to work more hours, so the equivalent of FAANG engineer doing freelance work on the side.

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

#159

Post by mistrial9 »

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…

private office physicians, and General Practitioner physicians, effectively were eliminated in rounds of consolidation and changes in insurance practices, by the early 2000s here in California. Second, large areas of low population density have zero local MDs.

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

#160

Post by poirot2 »

MauroIksem wrote: post #56
w10-1 wrote: post #46

Earlier quoted context omitted.

Medicare and most insurance strictly control this. But the industry benefits from a constrained supply of doctors because it means less competition; laws ultimately require doctors to be in charge of a practice. Some laws are now even restricting the number of PA/NP's that can be supervised, but it's not a strong effect. Some states permit NP's to practice without a physician, but PA's all require a supervising physi…

PA's no longer require a supervising physician. Also why do people seem to think PAs and NPs are equivalent? PA's have 4x the clinical experience/ training that NPs have. 2000 hours vs 500 and MDs at 4000.

This implies PAs are at half the level of an MD but the difference is astronomical. Those 4000 MD hours are training to be a physician, the 2000 are training to be a PA which is a much simpler role. If PA school went to 8000h doing what they do currently to train wouldn’t get you near an MD (not to mention the talent of the intake, rigour of exams and depth/ breadth of knowledge required).
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