Comment by lotsofpulp | Hacker News Reader

Comment by lotsofpulp | Hacker News Reader

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The question is: where is the money going?

https://www.healthsystemtracker.org/health-spending-explorer...

>Are doctors too well paid?

https://www.medscape.com/slideshow/2020-compensation-overvie...

https://www.kaptest.com/study/mcat/doctor-salaries-by-specia...

Based on what US doctors have to go through to start earning that pay, I would not say they are paid too well given the alternatives available to a person smart and driven enough to become a doctor in the US. For example, I would advise my kids that finance/tech/law/engineering has better a better pay to lifestyle ratio than becoming a doctor. Giving up your 20s and early 30s is an enormous sacrifice.

>Or maybe it is just the price of really good health care.

I suspect this is the price of a small number of people getting really good care, while a somewhat larger number of people get decent care, and then a very large number of people get (or do not) get care, and when they do, it is with very high variance of quality.

Doctor’s salary only accounts for a small fraction of healthcare spending, so it certainly isn’t the cause.

However my wife is a doctor who is fellowship trained, so she didn’t start making real money until she was 32. But she made a good bit above the median salary for many years before that. She also doesn’t feel like she sacrificed her 20s. She had plenty of fun, although she says med school was much harder than her engineering degree.

And now she makes much more than I do as a principal engineer, and she works less than 30 hours a week.

She doesn’t have to worry about interview prep or job hopping. She has absolute job security in any economy. She gets paid for continuing education. She is highly respected (people are much more impressed that I married a doctor than that I’m a principal engineer lol).

There is a legal framework protecting her autonomy and decision making at work. Not even the CEO of the hospital can overrule her.

In short, she is almost completely above the rat race, and is a true professional in ways that we (software engineers ) are not.

I would 100% recommend our children become doctors.

What year did your wife start working? I expect doctors to get squeezed much harder in the coming years. It is go big or go home everywhere, so from the doctors I know, in order to compete you have to join healthcare group, where you will eventually become a cog in the machine frequently owned by PE groups. They are in turn competing with bigger MCOs, hospital groups, etc.

On the other side, politicians are doling out what responsibilities that were previously restricted to doctors to nurse practitioners and physician's assistance, effectively using 1 doctor's license (and liability) to increase the supply of healthcare (effectively lowering the quality of healthcare since you are no longer being seen by a doctor).

Seems like a problem across all sectors, as I get closer to staff at a FANNGy company I hear from others it’s getting harder or the bar is becoming higher as just more people technically qualified try for it.

https://www.nationalreview.com/corner/the-overproduction-of-...

2018. Those concerns are mainly dependent on subspecialty. If you’re in family medicine or internal medicine, it is harder to run your own practice these days. You still have much more autonomy than nearly every other employee in other professions.

But I wouldn’t recommend my kids go into family medicine. If you’re say a pediatric emergency medicine doctor, or a maternal fetal medicine doctor, there just aren’t enough of you to be just a cog.

Increasing the number of mid level practitioners has been happening for a while, but it hasn’t had much impact on salaries [1]. My wife isn’t concerned.

1. https://www.hindawi.com/journals/nrp/2012/671974/

"Physician and Clinical Services" receive 20% of the total spending on healthcare. (https://www.cms.gov/files/document/highlights.pdf and the CDC info I posted elsewhere).

It’s important to note that that is physician and clinical services. That’s very different from doctor’s salaries are 20% of healthcare spending.

Edit: I noticed that you already mentioned this in your other thread.

Also in the US physicians salaries are also directly paying for physician training thanks to large student loans unlike in many other countries.

"Based on what US doctors have to go through to start earning that pay, I would not say they are paid too well given the alternatives available to a person smart and driven enough to become a doctor in the US. For example, I would advise my kids that finance/tech/law/engineering has better a better pay to lifestyle ratio than becoming a doctor. Giving up your 20s and early 30s is an enormous sacrifice."

I deal with surgeons from time to time through work. Maybe their training is hard but being a surgeon is pretty much an almost guaranteed ticket to becoming a multi-multi-millionaire. These guys are extremely well paid.

And maybe it is worth it if you have a high likelihood of becoming a multi multi millionaire (a decamillionaire?). But for a person capable enough to become a surgeon, there very well may be decent odds of success via a different route that allows them to work a Mon to Fri 8 to 5 job, maybe even work from home, and live in a popular city as opposed to living in a less popular area (many doctor's get paid more for living in less popular areas, for obvious reasons).

>But for a person capable enough to become a surgeon, there very well may be decent odds of success via a different route

There's a few issues here. First, surgery can have bad work life balance depending on the subspecialty. Some spend a lot of time on call, some basically work 9-5 or less.

Second, unlike basically every other very high paying profession, surgery requires working with your hands, and physical and mental stamina to endure hours of operating. Just getting through med school requires above average intelligence and hard work, but you don't need to be a super genius. The abilities that make someone a good surgeon don't necessarily translate to any other profession that is that highly paid.

Third, surgery is a very direct path to what most people would consider serious wealth for someone who is smart enough/hardworking enough to get into med school, but didn't necessarily get into one of the top tier schools that some of the other very high paying careers recruit from.

All that aside, surgery isn't the only specialty that is very highly paid.

> that allows them to work a Mon to Fri 8 to 5 job

Many very highly paid subspecialties work Mon to Fri 9-5 and some even less.

>maybe even work from home

Radiologists routinely work from home, and there are remote opportunities for other doctors as well.

>and live in a popular city as opposed to living in a less popular area (many doctor's get paid more for living in less popular areas, for obvious reasons).

That is only true for certain specialties and subspecialties. My wife's sub speciality requires her to live in cities with a population of at least 500k or so. Many of the very highly paid subspecialties are similar.

Even for family medicine the difference is only 5-10%.

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