Hacker News Reader

Comment by highwaylights | Hacker News Reader

This is self-evidently true in all cases and I really don't get how some people can't get this.

Here in the UK we have a perpetual doctor shortage, except that we don't, because young doctors are worked to the bone in incredibly stressful environments in what seems to be a "paying your dues" model so that you can possibly, maybe earn the fat consultant money that older doctors get on their way to retirement. My understanding is that most leave for better money and living conditions in places like Australia. They exist, they just opt-out.

In the UK, independent software contractors are vilified pretty regularly, and there's often a lot of learn-to-code pushes because there's a perceived shortage. Maybe some of those people could just learn-to-medicine instead and solve both problems.

View on HN

The "paying your dues" model is also strong in the US, particularly in our manufacturing sector. I work ancillary to the machinst population (as the guy they call when their machines break, basically), and most of thee guys are so gaslit about "paying your dues" that they won't take all their vacation time because they don't want to be perceived as the lazy guy in the shop. In the sane line, senior workers will berate younger newcomers for not knowing anything, rationalizing it by proclaiming they are self-taught, and the suffering brings discipline. After all, the senior workers believe they had to suffer at that age, so everyone else should, right? The who manufacturing population in the US is low on critical thinking, and thus ripe for all kinds of abuse.

Factory owners understand and exploit this. In one such instance that I found frightening, a shop I was visiting in MI had plastered posters up with messages to the effect of "you have a right to work, don't let anyone take it!" as though their governer's repeal of the Right to Work was somehow an attack on workers themselves, and not a gut punch to factory owners who are anti-union. These same owners will spout "nobody wants to work anymore" while offering a pitiful wage for jobs that demand years of experience, or special skills.

I see the gaslighting in everything from tiny 10-man shops to factories the size of small towns, and it is frightening how much power the owners have over this population through insighting fear and anger.

You are seeing a symptom of even the small business owner seemingly struggling for income. People don’t realize the ultra wealthy hired the best and brightest for decades to capture all the excess wealth/productivity generated from technology capital gains.

If prosperity was shared as in 1965, the mode income would be 6 figures.

> Here in the UK we have a perpetual doctor shortage, except that we don't, because young doctors are worked to the bone in incredibly stressful environments in what seems to be a "paying your dues" model so that you can possibly, maybe earn the fat consultant money that older doctors get on their way to retirement.

I wonder what would it take to end feudal employment model that so, so many industries have and what software seems to mostly avoid.

I remember arguing with my doctor mother that had an intern. She practically claimed that the intern _should be_ paying her for learning experience and that's so burdensome for her to even share the knowledge she gathered during decades of experience. It's unthinkable for most software engineers, who often create free products, tutorials, articles with no expectations of pay.

the model for doctor work was designed by a guy who was a cocaine addict. he made it work... cuz he was stimmed to the gills most days. so start by tossing that approach out.

another specter hanging over the industry is that studies have shown that hand-offs to different nurses and doctors is what leads to errors, and in medicine that sometimes means people dying cuz of dumb mistakes. the solution was to keep someone on shift, like 12+ hours, or often more for sensitive cases.

i've done 60 hour weeks in IT, and even napped in a data center -- that hum is relaxing! -- but those were one-offs, while it's a lifestyle for the docs.

>people dying cuz of dumb mistakes. the solution was to keep someone on shift, like 12+ hours, or often more for sensitive cases.

Which was entirely the wrong "lesson" to learn! Once again doctors bristle at being told they should improve their processes instead of being arrogant hero complexes that can do no wrong.

They should have improved the handoff and paperwork processes. Airplane mechanics have been handing off extremely complex procedures and concerns for decades, with very few accidents. So maybe we should learn from them instead of letting tired doctors continue to mistreat people.

Doctors similarly were grumpy about bringing in checklists like pilots have, despite them having a demonstrated effect.

The UK government also artificially limits the number of doctors that can be trained each year. Doctors obviously support this to boost their wages.

https://www.bbc.com/news/health-62594141

The NHS is a monopsony employer and has hardly any competition, I don't think the limit on trainees has any effect on salary. Surely if what you're saying is true, junior doctors would not be paid less per hour than someone working in Aldi.

A friend of mine runs a successful business bringing over doctors from the Philippines, Pakistan, etc to work in the NHS, so the gap gets filled that way.

> I don't think the limit on trainees has any effect on salary

This is far from true. On the margin, doctors can work in the private sector or leave the country. Only a few choose to do so, but this is (among other reasons) because the NHS always has to respond to price pressure to keep that small number from growing to where it causes shortages.

Recently a change in how pension contributions are taxed was pushed through almost entirely because it affected senior doctors. If the NHS had pricing power as you suggest, why wouldn't they just tell doctors to pay up?

If that's true why aren't they going to work at Aldi?

Salary progression is the most obvious reason but don't discount the effect of morality and ethics.

I know two junior doctors, one is working in Australia and the other is still in the NHS and would never countenance leaving no matter how rational a decision it may appear.

I don't think its lack of suitably qualified people leaving school - I know someone whose parter was responsible for selection of students for entry to one of the UK's top medical schools and they said they really struggled to find fair ways of selecting people given the oversupply of "perfect" candidates for a relatively small number of places.

Agreed but there is a time component here as well. There may in fact be a doctor's shortage because getting a supply of new doctors takes X number of years but the demand is now.

In the UK with NHS shortages it's all about wages though. The time component just means that whenever they finally get the wages figured out it will still take years to improve.

That's always an excuse to not pay market rates.

If you really need doctors NOW, bump up the rates as high as they will go. At some point you will either run out of money, or you'll find a doctor somewhere in the world willing to take the 12 hour plane to move to the UK for the 1 million pound an hour wage you're offering them.

Or you don't literally run out of money...but it still doesn't work out so well - https://en.wikipedia.org/wiki/Hyperinflation_in_the_Weimar_R...

Also worth keeping in mind - there's a big difference in "market rate" between "well-treated doctor in a well-functioning health system" and "relentlessly over-worked doctor in a wretchedly crumbling health system". And even if paid well above "market rate", the latter position will attract far fewer applicants who really care about patient welfare and outcomes. And suffer considerably higher turn-over.

I do see your point, but the fall of the Weimar Republic isn’t a great comparison.

Ultimately, it still boils down to “I think you should be limited to making X for doing job Y, because I don’t believe it should be worth as much as job Z, which is clearly prestigious enough to be worth 2X.”

Market forces are a surprisingly efficient means of separating perceived and actual value for pretty much anything, even with some fairly sizeable warts.

> of the Weimar Republic isn't a great...

Yes and no. A nation like the UK can afford to pay any one doctor millions of pounds. But that solution scales poorly to a national level. And worse if you try to scale it to all the other sorts of essential workers. And when an extremely large, complex system is wretchedly mismanaged - paying the guys in the trenches 10X does not fix that. For example, many of the UK's public buildings were built with "RAAC", and are at risk of collapse: https://www.theguardian.com/uk-news/2023/sep/04/raac-crisis-...

Meanwhile - a rather large number of HNer's seem to disagree with you about the virtues of those "efficient market forces" when it comes to health care. Perhaps discuss it with them here? - https://news.ycombinator.com/item?id=37398504

No. Doctors who qualified in a different country cannot simply start working. They have to do expensive and time consuming training to convert their credentials. This is partly because it's very important your doctor has appropriate language skills and understands the local system - and partly because local trade associations of doctors insist on it to protect their own jobs.

We have a peculiar situation where NHS can't raise wages, but they certainly can hire staff from agencies at much higher rates (and agency mark up). Imagine if NHS could hire staff directly at those rates...

I’m not familiar with UK politics. Why can’t they raise wages?

Leaving aside the political aims of the governing party, the NHS employs a lot of people, it's the biggest employer in Europe and one of the biggest in the world, so even a 1% raise costs a large sum of money.

Large nominal sums of money are really easy to turn into a negative headline, rather than the cost of using staffing agencies which requires a bit of analysis.

See Brexit for an example. "We're spending £350m per week on this, isn't that mad?!" versus "various analyses and projections show that raising trade barriers and reducing staff mobility will likely have a negative effect on domestic businesses"

>"We're spending £350m per week on this, isn't that mad?!"

Aren't you sorta forgetting the more salient point of this headline? That it was an outright fabrication with no justification or basis in reality?

I know, but it doesn't necessarily matter in this context, my point is that big simple numbers make good headlines, and complicated analyses do not.

The Conservative party wishes to destroy (by privatization) the National Health System. It will be replaced with a "health" system substantially identical to the American system.

Bureaucracy, corruption...

NHS management is notoriously corrupt and a bureaucratic nightmare, which is why the national health service failed in the UK.

If you live elsewhere and are surprised to have never heard about this, it’s because it hasn’t been acknowledged yet by the government to save face, but anyone with relatives stuck on a NHS waiting list or who have sadly passed away waiting for an ambulance that doesn’t come already knows this.

Reply on news.ycombinator.com