We only don’t have enough doctors and nurses because many have simply left healthcare entirely due to the low pay, impossible conditions and how the administrative tasks of the hospital were being placed on doctors and nurses in addition to their existing jobs with no additional pay. This is all while hospital systems were doing large dividends and share buybacks to extract capital and return it to shareholders.
That’s a perfectly fine business model for a manufacturing plant, but we have to ask if that for-profit model makes sense for health care. With a public system, you can just decide to pay doctors and nurses more until you actually have enough of them to run the system. You can make cost / service level trade-offs intentionally rather than “how much capital can we extract before the whole thing collapses”?
Not to mention the almost impossible system of schooling, training, credentials, and general hoop-jumping to become a practicing doctor (and to reach that very desired $200k+ salary) means the supply of new doctors is incredibly constrained.
The amount of friends and peers of mine who gave up a career medicine because the ridiculousness of this whole system turned them off completely is really saddening.
I understand that we should be diligent about making sure the people we entrust our lives to are trained and trustworthy, but do we really need:
- 4 years of undergraduate studies that have ZERO medical treatment curricula
- 2-3 years of work experience if you don't get into medical school right away
- Studying for the MCAT concurrently and trying to get a high score
- 4 years of medical school
- A high stakes test that determines if you will receive the residency you want
- A lottery system that "matches" you with hospitals for residency
- 3-5 years of this residency in hopefully the specialization of your choice (depending on if you passed that test), hopefully in a location you desired. You will be paid very little and work 80+ hour weeks
If you track this entire system perfectly, you will become a full fledged doctor that makes the 6-figure salary at around 32 - 35 years old. And every step of the way is a huge filter that break and washout many promising potential doctors.
And then there is the medical school debt that you will be saddled with even if you washout.
This system is madness and we need something more efficient to both incentivize more people becoming doctors and less people washing out.
> And every step of the way is a huge filter that break and washout many promising potential doctors.
> And then there is the medical school debt that you will be saddled with even if you washout.
> This system is madness and we need something more efficient to both incentivize more people becoming doctors and less people washing out.
Who has the control over this? A legalized monopoly here in America (the AMA) that also famously restrict the number of available residency spots. This creates an artificial scarcity and props up the price of care for the public. Same organization that lobbied and got the government to create laws mandating “certificates of need” [0] to make sure they wouldn’t have to compete in a fair market.
This can end at any time. But it won’t because this would go against their interests.
I’ve dated a lot of doctors actually. The only one who made more than me was a plastic surgeon. Even the guy who was a cardiothoracic surgeon was barely matching my middle-management salary.
Side note, a lot of doctors in their late 30s are single for a reason. They literally do not know how to turn work off. Not a bad quality to have in a doctor, but also not a good one to have in a prospective partner.
I don’t know. Doctors work 80+ hour weeks, calls and holidays making $50,000 a year in their twenties and early 30s after paying for the privilege of grueling med school. Then they come out, maybe work 60-hours but still have the call, weekends and holidays. Then people kind of smugly think salaries like$300,000 a year is a lot. Well yeah; it’s-a lot but it took aheluva time getting to that point making about minimum wage and once they’re finished with training is not like they’re working 40 hour weeks with weekends and holidays off like most of us.
Residency programs are straight up exploitive and the crazy hours they work young doctors is dangerous.
Pilots have mandatory crew rest. Truck drivers have mandatory rest. Doctors need mandatory rest too. Any job that involves real risk to life should have rest procedures.
* Each duty period must begin with at least 10 hours off-duty.
* Drivers may work no more than 60 hours on-duty over seven consecutive days or 70 hours over eight days....
* Drivers may be on duty for up to 14 hours following 10 hours off duty, but they are limited to 11 hours of driving time.
I mostly agree, but I'll point out that the $300,000 / year part isn't the problem.
If we just raise the doctor's salaries to $500,000/year, it won't really solve those other, more important issues.
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Similarly, if we lower the cost of creating Doctors, I don't think we'll necessarily see a drop in their salary. We're in too much of a doctor shortage for that to happen, at least immediately. (Of course, the market / supply+demand will shift things in the long run, but that's over a 20+ year cycle and not over a short one)
I have no doubt this is hard work, but is it smart work?
From having been around residents, I can tell there's a lot of work getting done 2-3 times because of poor communication or sleep deprived professionals making mistakes. And there’s absolutely no automation in the field!
Do I understand what you’re saying… doctors are working hard because they’re not working smart? Maybe the answer is they just need a sufficiently smart person to tell them how to work?
> doctors are working hard because they’re not working smart? Maybe the answer is they just need a sufficiently smart person to tell them how to work?
Correct. Duplicated work, endless shifts because it's believed that switching doctors is more dangerous than having one work for 24 hours at a time are all accepted practices in modern medicine.
NASA (and the military) figured out how to solve both issues back in the 60’s as it was impossible for manned flight to work (or nuclear subs). The medical field still has not, and there’s no incentives to (it’s not result-based, unlike NASA).
That’s a perfectly fine business model for a manufacturing plant, but we have to ask if that for-profit model makes sense for health care. With a public system, you can just decide to pay doctors and nurses more until you actually have enough of them to run the system. You can make cost / service level trade-offs intentionally rather than “how much capital can we extract before the whole thing collapses”?