Hacker News Reader

Comment by 0xB31B1B | Hacker News Reader

Black pill for me: the doctors that are paid extremely well (surgeons, complex specialties) are doing work that is extremely challenging and realistically only a tiny amount of people are able to do. Increasing med school and residency slots wouldn’t impact these specialties because the gating is due to innate qualities like IQ/drive/etc. The people who are currently excluded from these job roles are intentionally excluded due to a lack of these qualities and it is good.

View on HN

The US has fewer residency seats per capita than almost anyone else in the civilized world. Are American students less capable than everywhere else? Are Europeans dying in droves because getting into med school is marginally easier?

Looking at health outcomes in other countries, your argument just doesn't hold

It’s not residency slots that gate complex specialties it’s fellowship slots. At the end of residency, a “general surgeon” can do common and basic things like appendectomies. Those that go on to do organ transplants, complex cancer cases, etc do a fellowship that is another 1-3 years of training in a further sub field. We don’t need more internists or family med doctors, most of that caseload can be handled by NPs and PAs. Family med MDs make maybe 160k/year, they are not high earning.

> Family med MDs make maybe 160k/year, they are not high earning

The mean wage is 224k/year. https://www.bls.gov/oes/current/oes291215.htm Definitely high earning.

> We don’t need more internists or family med doctors, most of that caseload can be handled by NPs and PAs.

Ok. When someone in your family dies from horrible substandard care from an NP, we'll talk. I don't let anyone in my family deal be under the care of an NP, I've seen them make far too many serious mistakes.

> We don’t need more internists or family med doctors

Pretty sure the big shortage is precisely in FM, because it's low-status and not as stimulating intellectually/too routine

The obvious question I have then is why you think the current system is selecting exactly the right number of surgeons? How do you know the next 10% of potential surgeons who don't make it under the current system wouldn't have the IQ/drive/etc to be high quality, effective surgeons?

Fellowships are the last 1-3 year stint of training for specialist docs. There are unfilled training slots in competitive/complex fellowships in many disciplines. The fellowships are choosing not to train because they don’t have qualified applicants.

You are describing a bias in terms of expected traits of a doctor. You can imagine (and attempt to measure) that there are a good number of people who share these traits who are not doctors and a good number of doctors who do not share these traits.

Yes. The 3 dominant features are (1) income and (2) ability, (3) alternative opportunities. Highly specialized doctors in the US get paid a lot because they have great alternatives because they are some of the smartest and most driven people alive. If we increase the number of training slots, that doesn't increase then number of qualified applicants to train because we are already at an equilibrium where marginal slots are unfilled in competitive fields. If we want to increase the number of qualified doctors we need to increase training slots AND increase pay for these docs. This will move some of the top talent pool from drug discovery/finance/law/software back to medicine. Will a law partner become a top surgeon ever? No. Will a highly capable 18 year old who is choosing their path be more likely to take the "highly compensated surgeon" route over the "highly compensated finance worker" route? Yes. Some of the best folks I know in the field have previously worked in business services/legal routes before settling on medicine relatively late in their career.

Lots of things stated as fact that isn’t necessarily supported. How do you know they are the smartest and most driven people alive? How do you know we are at equilibrium? I open up 100 spots and pick a terrible qualifying criteria I can still have a shortage of “qualified candidates” but it doesn’t mean there aren’t qualified candidates, it just means I have a shitty filter.

> surgeons... are doing work that is extremely challenging and realistically only a tiny amount of people are able to do

As a medical student, I'd like to dispel this myth. The surgeons tell us all the time that they could teach a monkey to do surgery. What matters is putting in the 10,000 hours if takes to become proficient at surgery, and not everyone has the time/resources/opportunity to get that training. However, I believe that almosy anyone taken from the streets and given 10,000 hours of training could become a world-class surgeon

It's common for someone who finished his 10,000 hours to look back and say "I'm actually not that smart. It's simpler than it looks. It just takes time. Anyone can do it, really." Good luck finding those monkeys willing to put in the 10,000 grueling hours, endless practice questions always criticizing your performance, and a social environment that make you feel like you're the only one who is dumb, to get there in such a competitive field.

"Drive" in terms of motivation to do medicine specifically and nothing else, sure. But plenty of people who could succeed in medicine choose fields like tech instead due to work-life balance. Medicine could potentially attract this talent if it were willing to split its classic 24-hour shifts among two or three doctors instead of only one.

Your statement is not wrong, but most of the need is not in the advanced specialities.

There's a huge need for basic, primary care.

Reply on news.ycombinator.com