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Comment by PragmaticPulp | Hacker News Reader

> I'll offer to write a check for the debt in return for a negotiated percentage of their income from now on. Silence ensues.

Writing someone a check in exchange for their future earnings "from now on" is a terrible deal. You're essentially offering a loan that can never be paid back, yet requires payments forever.

Loans are a good deal because the terms are known ahead of time, payments end when the principle is paid off, and the cost can be calculated.

The idea behind ISAs is that they try to align the interests of the student and the educator, as the educator only gets paid proportionally to the students' future earnings. ISAs also have limits on how long they can collect from the student and thresholds that have to be met for collection criteria, as well as an upper limit on payments.

What you're describing is just facetious and condescending to those with six-figure medical debt.

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> What you're describing is just facetious and condescending to those with six-figure medical debt.

The point is that medical debt is a very good deal for the reasons you point out and because the doctor cartel in the US has forced prices up to dizzying heights.

Yet people bitching and moaning about having borrowed $300k at reasonable interest rates for the right to earn many millions with almost no risk (when was the last time you met an involuntarily unemployed doctor?) don’t acknowledge that.

FWIW, garden-variety West Coast ER doc here. Right now, I'm an independent contractor who makes ~$200/h. In a few months when my small company gets acquired, I'll be a W-2 who for various reasons will make ~$160/h before CA taxes.

So, clearly not starving, and maybe even undeserving to be in the top 10--15% after working just ~24--36h/wk in night shifts. But won't make $$MILLIONS$$ and won't get as much as your average Googler with equivalent career experience to mine, I reckon. And also never made more than ~$50k in my life until my mid-30s.

Doctor pay is facing a whole lot of downward pressure from health insurers, private equity, and other FIRE people recently. Part of the C-suites' strategy has been to open self-funded residencies where they pay their residents much less than they would have to pay the equivalent lifelong salaried PA. This, then, creates an "oversupply" (from docs' perspective) of trained docs and forces pay down.

Personally I have no sentiment for the profession and do see how this could ultimately be good for patients. Unfortunately, in reality the FIRE people seem to just take all that cash for themselves and the patient is left paying the same amount or more than they did 20 years ago (via insurance or whatever you want to call it).

If I’m understanding the situation correctly you’ll be in the 97% percentile of individual income while working on average 30 hours a week. You also can pick up and move anywhere in the country and be pretty confident of finding a comparably paying job. As mentioned, involuntary unemployment is all but unheard of in your profession. Within the hospital you’re near the top of the pecking order. Outside work your profession is well respected and rarely is the subject of hit pieces in prestige media.

I’m not saying it’s the best set up in the world, but it’s pretty good. Certainly a lot of people would consider it worth the financial costs of admission. (The hazing parts of medical training are unnecessary and unfortunate, different people are going to suffer more or less from that.)

Edit: Everyone is entitled to blow off steam. Nothing is perfect and there’s always going to be downsides to every profession. It just seems like complaining doctors is something of a cliche but I’ve yet to have one convince me that’s it’s not a pretty sweet gig, loans and medmal notwithstanding.

Not complaining, just giving y'all some interesting and updated information about my profession's economic situation and wondering why at least the patient end of the deal isn't getting any better. I'm pretty happy with my lot in life.

May be 97% by hourly pay but that implies I can work as many hours as I'd like. But I effectively already work all the hours I can work for various reasons, making my family 80--90th percentile.

Unfortunately, due to the physician oversupply and other forces I described, it's getting very hard to find random doctor jobs anywhere in the country. Just another interesting thing about medicine that is changing.

"You're essentially offering a loan that can never be paid back, yet requires payments forever."

A better analogy would be taking part ownership of a man's livelihood and expecting him to pay dividends like a stock.

If he tied his career to an LLC this would make sense oterwise he's literally selling himself.

There is such a thing as a perpetual (consol) bond although it's rare. What happens is that, over time, inflation erodes the real value of the payments. (And at that point, it looks a lot like equity with a contractually fixed dividend payout. Debt and equity can look a lot like each other.)

And, if this is a lifetime thing, this is just a form of annuity which are fairly common. (Give someone $X and they promise to pay you $Y annually for your lifetime (or other term)). There are also annuities that track the value of some investment pool like an endowment.

A doctor's salary is unlikely to be eroded by inflation.

Annuities often underperform inflation, and life annuities are typically offered by insurance companies with risk pooled assets, not by a single individual.

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