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Comment by verteu | Hacker News Reader

Good point - I don't see why they're subsidized by the federal gvt at all, rather than the resident, the hospital, the AMA, etc.

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Med students don't have a lot of money, and hospitals are actually there (from their perspective, at least) to make money. The AMA doesn't have a lot of extra money either.

They don’t have a lot of money yet. They have a very high amount of lifetime earning potential compared to their peers in other countries (yes, even after debt service and malpractice insurance.)

Are you seriously asking residents to subsidize their own training working 60-80 hours a week [1] and being paid maybe $20-25/hr for 3-7 years while the hospitals make money from their services?

If that were the case, then the only ones who would put up with such a system would be those who have rich families to back them up.

I came from a blue collar background and my family could not help subsidize my training and I could not afford to live, make rent, or afford food if I had to pay for my training as well.

There are so many other things that you are completely glossing over including annual income between generalists vs specialists, pediatricians vs non-pediatricians, reimbursement inequality from Medicare (has not kept up with inflation and is ~40% below inflation), Medicaid pays at best 10-15% on the dollar, and so on.

American physicians also work almost teice as many hours as their European counterparts which would increase their incomes.

[1] it’s considerably more because if you report it then the program can be in danger and lose its credentialing

> subsidize their own training working 60-80 hours a week [1] and being paid maybe $20-25/hr for 3-7 years while the hospitals make money from their services

That sounds like an apprenticeship. Many other industries do exactly that. Why should doctors be different?

Because you don't work 60 to 80 hours a week during an apprenticeship.

But why must medical residency require 60 to 80 hours per week of work? AFAICT, it's because residencies are competitive, because there aren't enough of them, because nobody wants to pay for them. (But you can't make them unpaid, because, by circular logic, they require 60 to 80 hours per week.)

As an outsider, the whole system seems completely bizarre to me.

> [AMA president] Dr. Richard Corlin has called for re-evaluation of the training process, declaring "We need to take a look again at the issue of why the resident is there."

They don't but it's the current situation nonetheless because medical students are at the mercy of their resident doctors.

If you don't do it, they will sack you, fail you or you won't find a job there.

It’s at the intersection of the medical cartel and the credential cartel. A giant pile of suck.

> American physicians also work almost teice as many hours as their European counterparts which would increase their incomes.

I’d be curious as to where you got that. I was personally suprised to discover that in Germany, doctors in university hospitals can work up to 80 hours a week.

https://www.sciencedirect.com/science/article/pii/S016885102...

https://www.statista.com/statistics/1385440/physicians-work-...

https://medicalschoolexpert.co.uk/how-many-hours-do-doctors-...

https://www.theguardian.com/society/2019/jan/15/junior-docto...

https://www.france24.com/en/france/20240219-france-s-foreign...

https://www.irdes.fr/EspaceAnglais/Publications/IrdesPublica...

https://facharztjetzt.de/24-7-guardians-unveiling-the-workin...

US doctors are among the richest people in the entire world, have an involuntary unemployment rate that rounds to zero, can live wherever they like without serious impact on pay and yet somehow are also the most oppressed and put upon if you ask them. Go figure it out.

It’s inappropriate to link once dissatisfaction with one’s income.

There are multiple reasons why US doctors are unhappy about their profession. I’m not sure where you get being oppressed as being the titular complaint.

I was an engineer before going to medical school and have an outside perspective as well.

I have complaints with medicine as to how it has changed over the last 10 years and not for the best. I have the right to complain to make things better for my patients and my work-life balance. That doesn’t mean that I am oppressed.

You have the right to complain and I have the right to point out that your industry, along with the housing and education industries, has stolen the entire productivity gains of a generation of Americans. I’m not concerned with your work life balance.

Health care cost disease in the US has little to do with doctor salaries or demand for doctors. Unfortunately, as that would be a relatively easy problem to solve. The data I've seen indicates physician salaries adjusted for inflation are relatively flat or have even declined since the 1970s.

Your complaint should be directed towards the hospitals, for-profit insurance companies, and others who profit massively on the backs of patients.

My "industry" is only myself as I am beholden to my patients. I work and am paid by each patient who I treat and receive reimbursement by 50% of them at best.

If you don’t care about my work-life balance and lump me in with the rest of the healthcare system, then there’s nothing much to discuss.

Doctors also massively profit off the back of patients. They make far more and live a far more lavish lifestyle than doctors in other countries. I have multiple doctors in my family, they all work less than 30 hours a week and make more than 300k. And theyre not even in the lucrative specialties. Most are family physicians which Im sure you know is the worst paid doctor.

Doctors are paid by the patients that they treat. As an emergency physician, I treat 20-25 patients per shift on average and I am paid by approximately half of them due to not having insurance or money to pay for my services. I am paid roughly $120 per patient. Is that excessive in your opinion?

I would say that doctors in other countries are not paid accordingly and are UNDER-paid. See the UK NHS strikes as an example.

You should be complaining about is the excessive charges and reimbursement that hospitals receive for the care that they give. It gives me pause that despite having multiple physicians in your family that you do not understand the difficulty of their practice or work environment.

Most white collars jobs including doctors, engineers, and administrators make multiples of our European counterparts. I would say that Europe underpays its workers.

Again, I am a highly paid worker just like the rest of you. If I don’t work and treat patients then I am not paid anything whatsoever.

I would be further much ahead financially if I had stuck to being an engineer 18 years ago and not have put off earning an income for 7 years and going into massive debt. This was a risk because I come from a blue collar, lower middle class background without a safety net.

What is the point of your diatribe?

Yes $120 per patient is excessive. Yes the rest of the medical industry is even more of an excessive rip off. I dont think being a doctor is easy, I just think doctors are taking advantage of the government limited supply of their profession to negotiate salaries that are much higher than they would be if we had enough doctors. Doctor salaries are 9% of medical costs in the US, you cant just brush that off as insignificant.

You may be right about the work hours. I possibly mis-remembered an article from several years ago when they compared income and work hours.

I agree you should be paid properly. But I don't understand why, if the US has a privatised healthcare system, hospitals are not paying to train their own labour?

They do to a degree but most of the money comes from the government to subsidize costs. I’m not privy to the amount or percentage but they do cry about it when the residency union (CIR) asks for inflation adjusted salary increases.

US hospitals are almost all nominally non-profit. In practice, they are partnerships run for the economic benefit of controlling employees but the scam the tax code by pretending otherwise.

So hospitals won't pay to train their workforce because... they can save money by forcing Congress pay for it?

> hospitals are actually there (from their perspective, at least) to make money

Aren't most hospitals non-profit?

(Disclaimer: These are genuine questions; I have very little knowledge of the medical system.)

> So hospitals won't pay to train their workforce because... they can save money by forcing Congress pay for it?

They wont train their workforce because they would lose money doing it and can always hire people already trained. It's a tragedy of the commons which is why congress had to step in to subsidize.

> Aren't most hospitals non-profit?

Technically yes, but most are part of massive systems that are run by MBAs like traditional corporations.

>> hospitals are actually there (from their perspective, at least) to make money

> Aren't most hospitals non-profit?

"Non-profit" is not referring to how the company operates. "Non-profit" refers to the owners extracting profit. Of course there are extra pieces, such as regulated transparency, but "non-profit" as a category are not wholly the donation-supported organizations that first come to mind.

In other words, if you are the owner of a successful non-profit, you'll have to simply pay yourself a market rate (TM) salary for such a successful executive as yourself. Instead of buying lavish Christmas presents like all those executives at greedy "profit" companies, your family members will only be able to get lucrative positions at your non-profit.

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