A comment here mentioned the absolute number of physicians in the United States, so I did some Googling and found a convenient website showing the number of physicians per 10,000 population in different countries. (The primary source for these data is studies by the World Health Organization, but the WHO website is not quite as user-friendly.) Note that in some countries the level of training and clinical experience to become a physician is much higher than in other countries.
How Being a Doctor Became the Most Miserable Profession
41–50 of 147 posts
Re: How Being a Doctor Became the Most Miserable Profession
#42Earlier quoted context omitted.
One solid reason is the same reason sleep deprivation is used in basic training. Most doctors, will, at some point in their life, have to make life and death decisions when they're operating far from 100% ... or at least that was true back in the days when they'd take calls at any hour of the day (as late as the '70s). Less dire, they have office hours they must keep unless they're really sick, and they certainly won…
I get that deprivation training can be helpful, but to be deprived nearly 100% of the time in a safety critical, fast paced environment? That's crazy. These guys aren't special forces (who I assume have in-field careers similar to pro-sports players), they're normal people trying to work at this for many decades. If your goal is to reduce medical errors, create systems that don't depend on a single person's fluctuati…
A nit, in the military this is not limited to "special forces", and I'm just talking about the stresses of peacetime. Look at e.g. https://en.wikipedia.org/wiki/Watch_system which doesn't list the 4 hours on, 4 hours off system the US Navy used, at least in the '50s when my father was First Lieutenant on a North Atlantic radar picket ship. He still remembers it being very hard.
Re: How Being a Doctor Became the Most Miserable Profession
#43> In fact, physicians are so bummed out that 9 out of 10 doctors would discourage anyone from entering the profession.
OP missed a perfect headline opportunity: "9 out of 10 doctors recommend not becoming a doctor."
But seriously, we wonder what's wrong with healthcare. I seriously believe it's because of the lawsuit-happy nature of patients nowadays. Yeah, something could go wrong during your surgery, or your diagnosis for that matter. But that's an inherent risk in having something wrong with you that you need checked out.
Re: How Being a Doctor Became the Most Miserable Profession
#44The biggest problem is just the AMA. They limit the number of doctors in America, so there are just too few. This drives up the salaries for the few doctors who live the tell the tale (but certainly don't want to go into primary care, when other more lucrative jobs are on offer), and drives up the hours for everyone. Making it easier to become a doctor would improve things immediately (especially given the recent res…
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> To pay this off in 10 years, the monthly payment would be on the order of $3400.
Once employed, hospitals agree on some arrangement in which they help pay sometimes up to as much as 50% of their loans (HRSA alone pays $170k in loan repayment to primary care docs for 5 years of service in a shortage area). And I don't know what kind of doctors you guys have been hanging out with, but most make way more than $300k after only a handful of years of experience.
> It's not unheard of for some medical students to have loan debt exceeding $300k.
True, but as it turns out, most doctors are sons and daughters of rich folks (at least that's what sister tells me, who's doing her residency now). So those loan debt episodes are being paid by mommies and daddies, and it's rather rare for these doctors to ever feel the pangs of financial pain in their time.
Re: How Being a Doctor Became the Most Miserable Profession
#45I don't get why overworked personnel aren't regarded as a dire safety issue. There's a reason the FAA restricted the number of hours commercial pilots are allowed to fly per week without rest. http://www.usatoday.com/story/todayinthesky/2014/01/03/pilot... I met a resident the other day, and they routinely get four hours of sleep or less and worked for shifts that are insanely long that are basically dictated by pati…
One solid reason is the same reason sleep deprivation is used in basic training. Most doctors, will, at some point in their life, have to make life and death decisions when they're operating far from 100% ... or at least that was true back in the days when they'd take calls at any hour of the day (as late as the '70s). Less dire, they have office hours they must keep unless they're really sick, and they certainly won…
Not sure why you were downvoted, but this is the exact reason that a couple of my relatives in medical profession gave when asked why their training involved 24-36 hour shifts routinely with very few sleep breaks.
Re: How Being a Doctor Became the Most Miserable Profession
#46Also relevant: I wrote "Why you should become a nurse or physicians assistant instead of a doctor: the underrated perils of medical school" ( http://jseliger.wordpress.com/2012/10/20/why-you-should-beco... ) based on watching the experience of my fiancée and her friends and peers. EDIT: In the essay I describe why it can become so hard to leave medicine after one has invested more than a year or two in med school bec…
A similar phenomenon is at work with law students. Granted law school is shorter than an MD program at only 3 years -- but can still result in $150k of student loan debt.
Re: How Being a Doctor Became the Most Miserable Profession
#47The biggest problem is just the AMA. They limit the number of doctors in America, so there are just too few. This drives up the salaries for the few doctors who live the tell the tale (but certainly don't want to go into primary care, when other more lucrative jobs are on offer), and drives up the hours for everyone. Making it easier to become a doctor would improve things immediately (especially given the recent res…
The worst part about this set up is that increasing the number of doctors won't actually reduce healthcare costs, but paradoxically, increase them. This is because doctors in the USA make money through ordering tests and exams, rather than just spending face time with patients, as the article points out. There was an excellent Time [1] article on this phenomenon. To make matters worse, Canada is suffering the effects…
There's a million fixes for that. Ultimately it needs to be the patients that are in charge of the payment.
As it stands there are no published prices (or they're bogus, if your published prices are 3x what insurance companies pay it's not a real price) for anything so nobody can shop around. That means there is no competitive pressure on the non-critical, non-life-threatening things that are expensive-ish but possible to pay out of pocket. And that means that nobody can circumvent insurance. And that means that doctors have to keep spending $58 to process a form that will net them a $20 to $30 copay and maybe another $50 worth of reimbursement? So the doc nets between $30 and $40. Call it $35 and multiply by 5 (12 min per patient) and the doc is billing out at $175 per hour provided he teleports from one exam room to the next.
There are a great many people who could afford to pay $100 cash (or equivalent) for a doctors visit, for say 30 minutes with a doctor. So that's $200 per hour.
Major medical plans (for big stuff) coupled with health savings accounts will empower patients to ask "do I really need this" with a price sheet in hand and a real conversation about the benefits vs the costs. Right now that happens approximately zero.
Re: How Being a Doctor Became the Most Miserable Profession
#48In Canada our GPs are paid approximately $31 for a regular visit. They pay their overhead out of this $31 and still typically keep 65-70% of their billings. It's amazing that the billing costs in the US are a factor of magnitude higher.
I wonder how salaries for nurses and doctors compare in the US vs Canada. Do you happen to have any data on that (or know of a good government source for it in Canada)? I know that compared to much of first world Europe, our nurses and doctors often make two to four times as much as their counter parts there. Wonder if that's true compared to Canada as well.
In my province of BC, all payments from the Medical Service Plan (MSP is our public insurance system which costs Canadians a maximum of $65/mo or as little as $0 for low income individuals) publishes all annual payments to physicians:
http://www.health.gov.bc.ca/msp/legislation/pdf/bluebook2012...
The average for Family Doctors is around $240,000 CAD and for specialists is about $430,000.
Average registered nurse salary in BC is about $61,000 CAD.
Re: How Being a Doctor Became the Most Miserable Profession
#49The biggest problem is just the AMA. They limit the number of doctors in America, so there are just too few. This drives up the salaries for the few doctors who live the tell the tale (but certainly don't want to go into primary care, when other more lucrative jobs are on offer), and drives up the hours for everyone. Making it easier to become a doctor would improve things immediately (especially given the recent res…
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>Granted, the salary will probably hit $200k with some years of experience
More if they're specialty and/or surgical. One of the side effects of most hospitals being organized as non-profits is that they have to disclose the compensation level of their five highest-compensated, non-board/officer employees. I know at my hospital (mid-size, 250k metro area, ~$35k median income) that number ranges from $750k-1.2M.
Granted, most doctors aren't making anywhere near that, but it was pretty surprising to me when I looked up our 990 out of curiosity. I do think an MD, especially a specialist, stands a much better chance of making that sort of money than any given software engineer, though.
Re: How Being a Doctor Became the Most Miserable Profession
#50The biggest problem is just the AMA. They limit the number of doctors in America, so there are just too few. This drives up the salaries for the few doctors who live the tell the tale (but certainly don't want to go into primary care, when other more lucrative jobs are on offer), and drives up the hours for everyone. Making it easier to become a doctor would improve things immediately (especially given the recent res…
thanks obama