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Comment by eberkund | Hacker News Reader

I agree, why is it that doctors make such high salaries? Is it because of the long and relatively difficult education and training that they have to go through? That is definitely part of it but in my opinion those salaries (which in many countries are publicly funded) could be reduced drastically by training more doctors.

Professional societies have a strong interest in artificially keeping the supply of qualified doctors low in order to keep salaries high. University admissions for medical school continue to be extraordinarily low in proportion to the number of applicants yet there are still shortages in many parts of the country.

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If you paid doctors less, there's no reward for spending your entire 20's and early 30s in training, already earning almost nothing. Nobody, especially nobody talented, will do it.

It's already probably not worth it from a purely financial perspective, when you consider the options would-be doctors have (they are among the highest performing students already -- they could easily be lawyers, professors, engineers, etc).

The real growth in medical costs are from administrative overhead and the vast new amounts of paperwork that doctors have to spend their time shuffling.

If doctors spent 80% of their time in patient interaction or actual diagnosis, there would not be a perceived doctor shortage. Instead, it's 70% paperwork and filling out forms to check the right regulatory boxes. Increasing productivity by culling the paperwork and regulatory bloat will be vastly more productive than pumping out more low-quality doctors.

In plenty of other countries doctors are paid substantially less and the quality of healthcare is better. I don't think it's impossible for the U.S. to do what everyone else is already doing.

However, I doubt the quality of care is better BECAUSE they are paid less.

The statistics in similar free market countries (labor, not health care) are curious. Interested in any links you have, but this NYT blog post [1] seems to show that, GDP-per-capita normalized (which seems reasonable; second chart), there isn't that large of a divergence between what I would assume would be comparable nations.

Nurses make 0.9-1.4x, GPs 1.7-4.1x, and specialists 1.7-7.6x GDPpc.

Certainly a range, but nothing jumps out at me as "the US is an order of magnitude outlier."

I'd be fascinated to make a further breakdown of these numbers in terms of style of country's health care system, to see what correlations drop out though...

[1] https://economix.blogs.nytimes.com/2009/07/15/how-much-do-do...

It should be possible to train doctors faster tho. Asking them to go through four additional years of undergraduate program before they study medicine just adds years to it.

Sure. I'd also look at whether it's possible to train people to do specific procedures without needing to learn a lot of irrelevant stuff.

Coding bootcamp doctors?

I don't know biology but I took a 6 week class on plastic surgery.....

Something like that, as long as they know how to perform the specific procedure and how to deal with all the things that can go wrong.

The coding equivalent of doctors training would be a) taking a general bachelor's degree b) taking a 4 year computer science degree c) specific training in programming in 24 different languages and 400 frameworks d) get a job programming in Java and eventually forgetting most of the other stuff.

I think there would be a lot of merit to a workshop + 1 certified engineer method. Allow a medical facility to employ less-generally trained specialists (e.g. nurse practitioners) to perform procedures, as long as they have one generalist with deeper knowledge on site during procedures and who signs off on courses of treatment.

I realize this is somewhat the resident model, but it seems like there's room to expand that, decrease costs, and provide a job opportunity for people who are fine accepting a lower salary and stopping their medical training at that point.

Having had a few friends go through medical school, I absolutely have compassion for their side of the equation. They go into extensive debt (yes, usually with good loan terms) on the promise of "if you make it, then you'll be able to repay this / have the debt forgiven." But it doesn't seem like there's any "I don't want to go all the way" escape route.

>If you paid doctors less, there's no reward for spending your entire 20's and early 30s in training, already earning almost nothing. Nobody, especially nobody talented, will do it.

I don't think that's true. If you look at admissions to even second rate schools there are many times more students that there are spots. Students with grade point averages in the high nineties are being turned down and others are not even attempting it because the odds are so slim. Medicine as a profession is very prestigious because it carries a strong association with helping people and requiring high intelligence. Reducing wages might actually increase the quality of doctors because you might tempt some into other professions who are interested in it mostly for financial reasons and bring in some other people who are very passionate but might not have done it because of the very tough competition.

> why is it that doctors make such high salaries?

It could be relevant that, "The AMA has one of the largest political lobbying budgets of any organization in the United States."

https://en.wikipedia.org/wiki/American_Medical_Association#P...

Dean Baker makes the important point that while our politicians are happy to support the outsourcing of manufacturing, they're in favor of protectionism when it comes to doctors and medicine[1]. This is part of what drives up costs for the average American.

[1] http://www.huffingtonpost.com/dean-baker/the-tpp-and-free-tr...

In the US a lot of non-specialty doctors make around $150-$200k, meaning they're in line with some snot-nosed kid with a bachelor's in CS and an offer from Google. Becoming a doctor isn't the end-all it used to be unless you really love it and/or are really good.

Plus, you know the whole 4 years of graduate work, 3 tiers of USMLE testing, 3 years of residency at what works out to be less than what you can make at Starbucks, a few more as a fellow before you can even start practicing. Even at the top end (cardiologists, anesthesiologists, neurologists), you're going to pretty much salary cap at around $750k pre-tax. There is a lot of waste in medicine, but the salary of doctors is pretty fairly priced.

Imagine if cardiologists all of a sudden went 'value-based free market' in their pricing. With all the retiring boomers in their waning years, I could very easily see 6 hours of labor for a staff of ~6-8 in the OR performing a bypass being billed at $100k.

Most countries have doctors skip undergrad which makes a huge difference. The US problem is people become doctors late in life and retire relatively soon after that. In UK Medical school might be 4-6 years, but saving 4+ up front and possibly a 'gap' year is huge. No only do people work longer, but they also have fewer years of compounding interest effing them over. Net result is you simply need around 20% fewer people to go though medical school.

Absolutely. It's crazy to me that "pre-med" is a psuedo degree. 4 years of your life to take a handful of relevant classes.

How much physics should a doctor know? Do you not agree that there is value in a well-rounded liberal education before specialization?

isn't that what highschool is meant to be?

> How much physics should a doctor know?

Most (all?) countries outside the US seem to agree that roughly one year of undergrad maths/physics/chemistry blended into their med school program is enough.

None? I really, really don't care if the guy operating on my appendix can calculate torque. I care that he knows a lot about appendixes and has a steady hand.

Is it worth ~50 billion per year for doctors to be well rounded? I am gong to say No.

Society doesn't seem to take issue with screwing over kids who go to law-school (outside the top 3) with asinine levels of debt and low salaries. All salaries should be subject to market forces.

Bad lawyers also don't kill people as frequently as bad doctors.

> Bad lawyers also don't kill people as frequently as bad doctors.

You mean other than death row cases and suits to pay for life-saving treatments and suits that affect product safety and prosecutors who fail to convict violent recidivists and ... ?

About three quarters of a million people die each year just from HAI's... never mind all of the other problems, pain, expense, and poor outcomes. Lawyers do a lot of harm, but doctors are have unique access, and it would seem, shitty hygiene.

> About three quarters of a million people die each year just from HAI's

Less than three quarters of a million people get HAIs each year. About 75,000 of them die.

https://www.cdc.gov/hai/surveillance/

Meanwhile lawyers operate at scale. How many people do you estimate would have died if tobacco companies had won their challenge to laws prohibiting them from advertising to children? And that's the damage from one lawyer losing one case.

I wonder if this a a compromise for tuition free education? Start with medicine.

Yeah, sign me up to go see that $15.00 per hour doctor. /s

If salaries weren't in line with the amount of time and dedication it takes to be a dr, we would all be worse off.

Not to pick on you, but your statement reflects a prejudice that many professions -- including doctors, but also lawyers, professional athletes, even hitmen -- are far too happy to exploit.

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