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They work very hard to provide a valuable service to people in need.

Contrast that with what exactly is provided by healthcare insurance executives, bankers, lawyers, lobbyists, and certain departments in government.

To be blunt: once you note the fact that other countries in the world can provide healthcare at fractions of the cost, it's obvious those insurance execs, politicians, and lobbyists are eating value, not creating it. The contrast is that Doctors actually produce something of value.

I'd like to see you maintain your "cry me a river" perspective when the doctor tasked with saving your kids life is burnt out and going through a divorce because of his chosen career.

And even if I were to agree with your premises, do we really want a system that selects for the kind of doctors who are willing to put themselves and their loved ones through years of hell in exchange for an eventual high and stable paycheck? What kind of people are these? Are they the kind of people you'll trust to treat your scared child gently and empathetically?

You act as if the alternative is free. Will you maintain the same "life at any cost" mentality when your insurance premiums or taxes increase to the point that you can no longer afford them? If you lower the cost of healthcare you increase access, you can raise the costs involved and provide better care but less people will be able to use it. It isn't as simple as you postulated.

200k is also on the low end. A friend of mine just finished her residency and is making almost twice that now. I did some on-site PC service for a few doctors in a job about a decade ago. They literally all had 911s and mansions. Anecdotal sure, but from what I've seen, doctors here are loaded. Anesthesiologist always seemed like the best gig....you work a few days a week, set up your schedule months ahead of time, bring in your kit and pump the person full of drugs, sit there and watch the screen for however long the surgery takes, bring them back to life, then go home with a few grand. The anesthesiologist is typically an independent contractor.

It's great until a patient dies and you have to inform their families. You are keeping a living being in a state between life and death chemically while they are undergoing massive trauma. Do you know how much their malpractice insurance is?

It's not just hard work to become a doctor. It's hard work and sustained excellence. You don't just put in the hours, you have consume an enormous amount of information and are tested on it constantly through the education process. You have to take on enormous personal risk financially in loans. You very frequently have to make large personal sacrifice in your life to get to the point of board certification.

Some get paid great, most get paid well, but if you know more than a few doctors you would probably be less glib. /me not a doctor.

You are keeping a living being in a state between life and death chemically while they are undergoing massive trauma.

Why can't this be automated?

Its almost exactly analogous to being an airline pilot, everything easy enough to automate was automated multiple human generations ago, now the primary purpose of the human is judgment calls, emergencies, monitoring, what boils down to non-computer systems administration using hopefully sterile biochemical machinery rather than CPUs and disks, equipment failures ...

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3971909/

You possess an uninformed opinion of what it takes to practice medicine at an acceptable level.

So it's okay that doctor's commit suicide because at least they're paid well?

It pays well because supply is constrained and demand is inelastic.

It isn't clear how much the grueling training actually factors in to limiting the supply.

There are plenty of dropouts at every step. Probably the biggest drop-off is the PGY-1 year (internship). That's when you really find out if you can cope with clinical medicine. Staff physicians only want interns and residents to do the scut work they don't want to do: in house call, dis-impacting old ladies in the ER, etc. If it wasn't for the parts that suck, they would assure you they can handle the hospital without residents just fine. I suppose that's why teaching hospitals consistently deliver better care: because the staff can do everything just fine. If it wasn't for parts that suck.

I think the attitude you have is really common among doctors, too.

I will say thought, that this is a really typical path in the US, at least:

* 4 years undergraduate ($200K debt, high competition/workload)

* 4 years medical school ($250K debt, high stress/workload, 50% odds of not being accepted)

* ~3 years residency (pay only $50K/yr, famously high stress/workload, possibility of being separated from loved ones or making hard choices in residency match)

So assuming starting undergrad at age 17, you have had a tough 11 years and are at least $300K in debt by the time you are 28 and getting your certification. This is ignoring specialties with fellowships. I don't have the time, but I'm sure it's possible to estimate the quality of the time sacrificed to education and lost compensation during that time and then amortize that over a typical career.

And the field is different... after all of that training they get to spend an inordinate amount of time doing paperwork/fighting with insurers, which (seems to be) leading to more group practices with workloads like those described in the article.

Bingo. Also, there is a nontrivial chance of going to med school but not getting into a residency program. And, residency is typically 4 years, not 3. In the case of my partner, she did undergrad (4) + post-bacc (2) + med school (4) + residency (4) + optional fellowship (3). So call it 12-17 years of training. Then, and only then, do you make a "starting doctor salary". But now you have hundreds of thousands in debt, interest payments, malpractice insurance, and, in some specialties, still insane hours.

If you're a doctor who is "doing it for the money", you have simply not understood the concept of opportunity cost. :)

I tried to err on the side of understating things (I found higher figures for cost estimates as well knowing residencies/fellowships could go a lot longer... and that was ignoring continuting education/certification/training and costs of running a practice). I think that people see the dollar figures for some specialist and make two errors: extrapolate it to all doctors and ignore the huge investment/risk to get there.

Congratulations to your partner (and you)! I for one still think its a noble and altruistic calling.

People have to get out of the mindset that all doctors get paid well. Please. This is so incredibly inaccurate and makes it hard for conditions to improve for doctors that do not do well.

The hourly rate for some doctors (mostly non-procedural) are much much lower than people realise and is only made up for my doing ridiculous hours. This is just not right.

This delusion that all doctors do well financially draws more poor students into the long training commitment only to find out at the end that with all the debt and sacrificed family hours and stress (having been through this) they are going nowhere financially.

Looking after patients can be a great and fulfilling career but this depends so much on the particular speciality you choose and the work life balance that it provides.

Next time you see your ED physician or family practitioner feel sorry for them. The shit and conditions they deal with and poor renumeration is something you simply don't understand.

> However it also pays incredibly well. Even moreso for specialities and surgeons, who can make over 200k a year even in low cost of living areas. Despite the difficulties of being a doctor it's harder to get into medical school than ever. The difficulties are not deterring med students.

I wonder how many doctors would be up for "sharing work (and compensation)" - in other words, would a doctor be OK with dropping his comp to $150K (from $200K) so the savings can be used to add a third more doctors to the staff? The "relief" in working conditions may well be worth it, for the doctor's sanity of course, but also for the patients (and all of the benefits down the line from having fewer mistakes, etc).

It's obviously not the only dimension that can be played with to help, but it's one that could be fairly straightforward to implement, as long as there is enough supply of applicants to increase the workforce.

It depends on the speciality. Internal medicine and almost anything related to pediatrics tends to pay less than other fields. Surgical fields tend to pay much more.

My wife is a pediatric emergency medicine physician and I get paid more than her because I'm in tech. Also, I started my career and began earning an income right after college, whereas she went to medical school and a fellowship before she could begin earning income.

I always joke with her that, in terms of income efficiency, my field is way more profitable than hers. And a lot less stressful too.

None of what you say negates the need to make improvements. Doctor workload impacts the quality of care, therefore we should investigate solutions and mitigate the problem where possible.

Definitely does not pay well in UK