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I've run into that with doctors now and again. You'll meet a younger doctor who complains heavily about student debt and how impossible life in the US is. I'l

I've run into that with doctors now and again. You'll meet a younger doctor who complains heavily about student debt and how impossible life in the US is. I'll offer to write a check for the debt in return for a negotiated percentage of their income from now on. Silence ensues.

PragmaticPulp 6y ago
> I'll offer to write a check for the debt in return for a negotiated percentage of their income from now on. Silence ensues. Writing someone a check in exchange for their future earnings "from now on" is a terrible deal. You're essentially offering a loan that can never be paid back, yet requires payments forever. Loans are a good deal because the terms are known ahead of time, payments end when the principle is paid off, and the cost can be calculated. The idea behind ISAs is that they try to align the interests of the student and the educator, as the educator only gets paid proportionally to the students' future earnings. ISAs also have limits on how long they can collect from the student and thresholds that have to be met for collection criteria, as well as an upper limit on payments. What you're describing is just facetious and condescending to those with six-figure medical debt.
- bradleyjg 6y ago
  > What you're describing is just facetious and condescending to those with six-figure medical debt. The point is that medical debt is a very good deal for the reasons you point out and because the doctor cartel in the US has forced prices up to dizzying heights. Yet people bitching and moaning about having borrowed $300k at reasonable interest rates for the right to earn many millions with almost no risk (when was the last time you met an involuntarily unemployed doctor?) don’t acknowledge that.
  - hundreddaysoff 6y ago
    FWIW, garden-variety West Coast ER doc here. Right now, I'm an independent contractor who makes ~$200/h. In a few months when my small company gets acquired, I'll be a W-2 who for various reasons will make ~$160/h before CA taxes. So, clearly not starving, and maybe even undeserving to be in the top 10--15% after working just ~24--36h/wk in night shifts. But won't make $$MILLIONS$$ and won't get as much as your average Googler with equivalent career experience to mine, I reckon. And also never made more than ~$50k in my life until my mid-30s. Doctor pay is facing a whole lot of downward pressure from health insurers, private equity, and other FIRE people recently. Part of the C-suites' strategy has been to open self-funded residencies where they pay their residents much less than they would have to pay the equivalent lifelong salaried PA. This, then, creates an "oversupply" (from docs' perspective) of trained docs and forces pay down. Personally I have no sentiment for the profession and do see how this could ultimately be good for patients. Unfortunately, in reality the FIRE people seem to just take all that cash for themselves and the patient is left paying the same amount or more than they did 20 years ago (via insurance or whatever you want to call it).
    - bradleyjg 6y ago
      If I’m understanding the situation correctly you’ll be in the 97% percentile of individual income while working on average 30 hours a week. You also can pick up and move anywhere in the country and be pretty confident of finding a comparably paying job. As mentioned, involuntary unemployment is all but unheard of in your profession. Within the hospital you’re near the top of the pecking order. Outside work your profession is well respected and rarely is the subject of hit pieces in prestige media. I’m not saying it’s the best set up in the world, but it’s pretty good. Certainly a lot of people would consider it worth the financial costs of admission. (The hazing parts of medical training are unnecessary and unfortunate, different people are going to suffer more or less from that.) Edit: Everyone is entitled to blow off steam. Nothing is perfect and there’s always going to be downsides to every profession. It just seems like complaining doctors is something of a cliche but I’ve yet to have one convince me that’s it’s not a pretty sweet gig, loans and medmal notwithstanding.
      - hundreddaysoff 6y ago
        Not complaining, just giving y'all some interesting and updated information about my profession's economic situation and wondering why at least the patient end of the deal isn't getting any better. I'm pretty happy with my lot in life. May be 97% by hourly pay but that implies I can work as many hours as I'd like. But I effectively already work all the hours I can work for various reasons, making my family 80--90th percentile. Unfortunately, due to the physician oversupply and other forces I described, it's getting very hard to find random doctor jobs anywhere in the country. Just another interesting thing about medicine that is changing.
- ghaff 6y ago
  There is such a thing as a perpetual (consol) bond although it's rare. What happens is that, over time, inflation erodes the real value of the payments. (And at that point, it looks a lot like equity with a contractually fixed dividend payout. Debt and equity can look a lot like each other.) And, if this is a lifetime thing, this is just a form of annuity which are fairly common. (Give someone $X and they promise to pay you $Y annually for your lifetime (or other term)). There are also annuities that track the value of some investment pool like an endowment.
  - Klinky 6y ago
    A doctor's salary is unlikely to be eroded by inflation. Annuities often underperform inflation, and life annuities are typically offered by insurance companies with risk pooled assets, not by a single individual.
- 0x4d464d48 6y ago
  "You're essentially offering a loan that can never be paid back, yet requires payments forever." A better analogy would be taking part ownership of a man's livelihood and expecting him to pay dividends like a stock. If he tied his career to an LLC this would make sense oterwise he's literally selling himself.
llaolleh 6y ago
Haha I love this. If we think about it in terms of pure game play, medicine is a part of the game where the strategy is to take on a massive amount of debt, high risk and uncertainty for incredible returns.
- PragmaticPulp 6y ago
  > medicine is a part of the game where the strategy is to take on a massive amount of debt, high risk and uncertainty for incredible returns. Not really. It's exceedingly rare for someone to complete medical school and then not be able to find a relatively high-paying job if they want one. The risk would be something like later deciding not to pursue a career in medicine, but that's a personal decision rather than an external risk.
  - robotresearcher 6y ago
    Illness and accident can end anyone's career any time.
    - kingsuper20 6y ago
      That's why you need to purchase a half dozen doctors.
- dasil003 6y ago
  I'm not sure I like the investment analogy for ones career since you have to actually put the work in to get the pay. Your time, effort and talent are at least as much of a contributor as the medical school tuition. Perhaps a name brand school gives you a significant bump in earning potential on the margins but "incredible returns" still feels reductive of what is essentially a very hard and traditional career path.
- bidirectional 6y ago
  I heard a (probably invented) story that one year the Harvard Business School commencement speech basically boiled down to "you can earn an upper-middle class income for the rest of your life without ever working as hard as you did to get in to this programme".
Klinky 6y ago
Please provide the full terms before you imply the young doctor was being unreasonable. The silence was probably because you were offering an awful predatory loan, not that you were delivering the ultimate gotcha zinger.
pavel_lishin 6y ago
That's probably because the deal you're offering them is objectively worse than their current deal.

PragmaticPulp 6y ago

> I'll offer to write a check for the debt in return for a negotiated percentage of their income from now on. Silence ensues. Writing someone a check in exchange for their future earnings "from now on" is a terrible deal. You're essentially offering a loan that can never be paid back, yet requires payments forever. Loans are a good deal because the terms are known ahead of time, payments end when the principle is paid off, and the cost can be calculated. The idea behind ISAs is that they try to align the interests of the student and the educator, as the educator only gets paid proportionally to the students' future earnings. ISAs also have limits on how long they can collect from the student and thresholds that have to be met for collection criteria, as well as an upper limit on payments. What you're describing is just facetious and condescending to those with six-figure medical debt.

bradleyjg 6y ago
> What you're describing is just facetious and condescending to those with six-figure medical debt. The point is that medical debt is a very good deal for the reasons you point out and because the doctor cartel in the US has forced prices up to dizzying heights. Yet people bitching and moaning about having borrowed $300k at reasonable interest rates for the right to earn many millions with almost no risk (when was the last time you met an involuntarily unemployed doctor?) don’t acknowledge that.
- hundreddaysoff 6y ago
  FWIW, garden-variety West Coast ER doc here. Right now, I'm an independent contractor who makes ~$200/h. In a few months when my small company gets acquired, I'll be a W-2 who for various reasons will make ~$160/h before CA taxes. So, clearly not starving, and maybe even undeserving to be in the top 10--15% after working just ~24--36h/wk in night shifts. But won't make $$MILLIONS$$ and won't get as much as your average Googler with equivalent career experience to mine, I reckon. And also never made more than ~$50k in my life until my mid-30s. Doctor pay is facing a whole lot of downward pressure from health insurers, private equity, and other FIRE people recently. Part of the C-suites' strategy has been to open self-funded residencies where they pay their residents much less than they would have to pay the equivalent lifelong salaried PA. This, then, creates an "oversupply" (from docs' perspective) of trained docs and forces pay down. Personally I have no sentiment for the profession and do see how this could ultimately be good for patients. Unfortunately, in reality the FIRE people seem to just take all that cash for themselves and the patient is left paying the same amount or more than they did 20 years ago (via insurance or whatever you want to call it).
  - bradleyjg 6y ago
    If I’m understanding the situation correctly you’ll be in the 97% percentile of individual income while working on average 30 hours a week. You also can pick up and move anywhere in the country and be pretty confident of finding a comparably paying job. As mentioned, involuntary unemployment is all but unheard of in your profession. Within the hospital you’re near the top of the pecking order. Outside work your profession is well respected and rarely is the subject of hit pieces in prestige media. I’m not saying it’s the best set up in the world, but it’s pretty good. Certainly a lot of people would consider it worth the financial costs of admission. (The hazing parts of medical training are unnecessary and unfortunate, different people are going to suffer more or less from that.) Edit: Everyone is entitled to blow off steam. Nothing is perfect and there’s always going to be downsides to every profession. It just seems like complaining doctors is something of a cliche but I’ve yet to have one convince me that’s it’s not a pretty sweet gig, loans and medmal notwithstanding.
    - hundreddaysoff 6y ago
      Not complaining, just giving y'all some interesting and updated information about my profession's economic situation and wondering why at least the patient end of the deal isn't getting any better. I'm pretty happy with my lot in life. May be 97% by hourly pay but that implies I can work as many hours as I'd like. But I effectively already work all the hours I can work for various reasons, making my family 80--90th percentile. Unfortunately, due to the physician oversupply and other forces I described, it's getting very hard to find random doctor jobs anywhere in the country. Just another interesting thing about medicine that is changing.
ghaff 6y ago
There is such a thing as a perpetual (consol) bond although it's rare. What happens is that, over time, inflation erodes the real value of the payments. (And at that point, it looks a lot like equity with a contractually fixed dividend payout. Debt and equity can look a lot like each other.) And, if this is a lifetime thing, this is just a form of annuity which are fairly common. (Give someone $X and they promise to pay you $Y annually for your lifetime (or other term)). There are also annuities that track the value of some investment pool like an endowment.
- Klinky 6y ago
  A doctor's salary is unlikely to be eroded by inflation. Annuities often underperform inflation, and life annuities are typically offered by insurance companies with risk pooled assets, not by a single individual.
0x4d464d48 6y ago
"You're essentially offering a loan that can never be paid back, yet requires payments forever." A better analogy would be taking part ownership of a man's livelihood and expecting him to pay dividends like a stock. If he tied his career to an LLC this would make sense oterwise he's literally selling himself.

llaolleh 6y ago

Haha I love this. If we think about it in terms of pure game play, medicine is a part of the game where the strategy is to take on a massive amount of debt, high risk and uncertainty for incredible returns.

PragmaticPulp 6y ago
> medicine is a part of the game where the strategy is to take on a massive amount of debt, high risk and uncertainty for incredible returns. Not really. It's exceedingly rare for someone to complete medical school and then not be able to find a relatively high-paying job if they want one. The risk would be something like later deciding not to pursue a career in medicine, but that's a personal decision rather than an external risk.
- robotresearcher 6y ago
  Illness and accident can end anyone's career any time.
  - kingsuper20 6y ago
    That's why you need to purchase a half dozen doctors.
dasil003 6y ago
I'm not sure I like the investment analogy for ones career since you have to actually put the work in to get the pay. Your time, effort and talent are at least as much of a contributor as the medical school tuition. Perhaps a name brand school gives you a significant bump in earning potential on the margins but "incredible returns" still feels reductive of what is essentially a very hard and traditional career path.
bidirectional 6y ago
I heard a (probably invented) story that one year the Harvard Business School commencement speech basically boiled down to "you can earn an upper-middle class income for the rest of your life without ever working as hard as you did to get in to this programme".

Klinky 6y ago

Please provide the full terms before you imply the young doctor was being unreasonable. The silence was probably because you were offering an awful predatory loan, not that you were delivering the ultimate gotcha zinger.

pavel_lishin 6y ago

That's probably because the deal you're offering them is objectively worse than their current deal.