4 ms·

The question is: where is the money going? The sums are so high we are in macroeconomic territory. There may be a few billionaires with private jets and yachts

by GuB-42 5y ago

The question is: where is the money going? The sums are so high we are in macroeconomic territory. There may be a few billionaires with private jets and yachts here and there but this is a detail, we are in the trillions here. It is money that moves around, making the livehood of millions of people, you may be one of them, and it it is not the case, probably one of your friends and relatives. So what? Are doctors too well paid? Are health institutions inefficient? Are there too many useless medical procedures? Where is the money going where it shouldn't go? Or maybe it is just the price of really good health care.

lotsofpulp 5y ago
The question is: where is the money going? https://www.healthsystemtracker.org/health-spending-explorer/?display=U.S.%2520%2524%2520Billions&service= https://www.healthsystemtracker.org/health-spending-explorer... >Are doctors too well paid? https://www.medscape.com/slideshow/2020-compensation-overview-6012684 https://www.medscape.com/slideshow/2020-compensation-overvie... https://www.kaptest.com/study/mcat/doctor-salaries-by-specialty/ https://www.kaptest.com/study/mcat/doctor-salaries-by-specia... Based on what US doctors have to go through to start earning that pay, I would not say they are paid too well given the alternatives available to a person smart and driven enough to become a doctor in the US. For example, I would advise my kids that finance/tech/law/engineering has better a better pay to lifestyle ratio than becoming a doctor. Giving up your 20s and early 30s is an enormous sacrifice. >Or maybe it is just the price of really good health care. I suspect this is the price of a small number of people getting really good care, while a somewhat larger number of people get decent care, and then a very large number of people get (or do not) get care, and when they do, it is with very high variance of quality.
- learc83 5y ago
  Doctor’s salary only accounts for a small fraction of healthcare spending, so it certainly isn’t the cause. However my wife is a doctor who is fellowship trained, so she didn’t start making real money until she was 32. But she made a good bit above the median salary for many years before that. She also doesn’t feel like she sacrificed her 20s. She had plenty of fun, although she says med school was much harder than her engineering degree. And now she makes much more than I do as a principal engineer, and she works less than 30 hours a week. She doesn’t have to worry about interview prep or job hopping. She has absolute job security in any economy. She gets paid for continuing education. She is highly respected (people are much more impressed that I married a doctor than that I’m a principal engineer lol). There is a legal framework protecting her autonomy and decision making at work. Not even the CEO of the hospital can overrule her. In short, she is almost completely above the rat race, and is a true professional in ways that we (software engineers ) are not. I would 100% recommend our children become doctors.
  - lotsofpulp 5y ago
    What year did your wife start working? I expect doctors to get squeezed much harder in the coming years. It is go big or go home everywhere, so from the doctors I know, in order to compete you have to join healthcare group, where you will eventually become a cog in the machine frequently owned by PE groups. They are in turn competing with bigger MCOs, hospital groups, etc. On the other side, politicians are doling out what responsibilities that were previously restricted to doctors to nurse practitioners and physician's assistance, effectively using 1 doctor's license (and liability) to increase the supply of healthcare (effectively lowering the quality of healthcare since you are no longer being seen by a doctor).
    - hellisothers 5y ago
      Seems like a problem across all sectors, as I get closer to staff at a FANNGy company I hear from others it’s getting harder or the bar is becoming higher as just more people technically qualified try for it. https://www.nationalreview.com/corner/the-overproduction-of-elites/ https://www.nationalreview.com/corner/the-overproduction-of-...
    - learc83 5y ago
      2018. Those concerns are mainly dependent on subspecialty. If you’re in family medicine or internal medicine, it is harder to run your own practice these days. You still have much more autonomy than nearly every other employee in other professions. But I wouldn’t recommend my kids go into family medicine. If you’re say a pediatric emergency medicine doctor, or a maternal fetal medicine doctor, there just aren’t enough of you to be just a cog. Increasing the number of mid level practitioners has been happening for a while, but it hasn’t had much impact on salaries [1]. My wife isn’t concerned. 1. https://www.hindawi.com/journals/nrp/2012/671974/ https://www.hindawi.com/journals/nrp/2012/671974/
  - mcguire 5y ago
    "Physician and Clinical Services" receive 20% of the total spending on healthcare. (https://www.cms.gov/files/document/highlights.pdf https://www.cms.gov/files/document/highlights.pdf and the CDC info I posted elsewhere).
- spaetzleesser 5y ago
  "Based on what US doctors have to go through to start earning that pay, I would not say they are paid too well given the alternatives available to a person smart and driven enough to become a doctor in the US. For example, I would advise my kids that finance/tech/law/engineering has better a better pay to lifestyle ratio than becoming a doctor. Giving up your 20s and early 30s is an enormous sacrifice." I deal with surgeons from time to time through work. Maybe their training is hard but being a surgeon is pretty much an almost guaranteed ticket to becoming a multi-multi-millionaire. These guys are extremely well paid.
  - lotsofpulp 5y ago
    And maybe it is worth it if you have a high likelihood of becoming a multi multi millionaire (a decamillionaire?). But for a person capable enough to become a surgeon, there very well may be decent odds of success via a different route that allows them to work a Mon to Fri 8 to 5 job, maybe even work from home, and live in a popular city as opposed to living in a less popular area (many doctor's get paid more for living in less popular areas, for obvious reasons).
    - learc83 5y ago
      >But for a person capable enough to become a surgeon, there very well may be decent odds of success via a different route There's a few issues here. First, surgery can have bad work life balance depending on the subspecialty. Some spend a lot of time on call, some basically work 9-5 or less. Second, unlike basically every other very high paying profession, surgery requires working with your hands, and physical and mental stamina to endure hours of operating. Just getting through med school requires above average intelligence and hard work, but you don't need to be a super genius. The abilities that make someone a good surgeon don't necessarily translate to any other profession that is that highly paid. Third, surgery is a very direct path to what most people would consider serious wealth for someone who is smart enough/hardworking enough to get into med school, but didn't necessarily get into one of the top tier schools that some of the other very high paying careers recruit from. All that aside, surgery isn't the only specialty that is very highly paid. > that allows them to work a Mon to Fri 8 to 5 job Many very highly paid subspecialties work Mon to Fri 9-5 and some even less. >maybe even work from home Radiologists routinely work from home, and there are remote opportunities for other doctors as well. >and live in a popular city as opposed to living in a less popular area (many doctor's get paid more for living in less popular areas, for obvious reasons). That is only true for certain specialties and subspecialties. My wife's sub speciality requires her to live in cities with a population of at least 500k or so. Many of the very highly paid subspecialties are similar. Even for family medicine the difference is only 5-10%.
pja 5y ago
US healthcare professionals at the top of the pile make 3-4x as much as equivalent posts in the EU IIRC. A huge amount is going in salary costs. Another huge chunk is spent on the bureaucracy of administrating the payments system, with patients, hosptials, insurers and general practicioner offices all fighting over payments. This is a deadweight cost that other systems don’t have to carry. Drug costs in the US are much higher than elsewhere, as (I understand it) medicare & medicaid are prevented from negotiating the prices they pay the in way national healthcare systems do in the EU & a myriad set of obfuscatory tactics are used by drug companies to maintain much higher prices that are achievable elsewhere. & probably lots of other little things too. But those are the big three I think.
- spaetzleesser 5y ago
  It's pretty futile to point out the one factor that makes US health care so expensive. The whole system is highly corrupt and obfuscated and allows doctors, administrators, investors, construction companies, insurances, pharma companies and multiple middlemen to make outrageous money. I am not sure how to fix this but an important first step would be to mandate full transparency of all pricing. In addition the same service should cost the same for uninsured and insured patients. Same for in- and out-of-network billing. Right now a patient basically has no way of navigating this. Even if you are insured there is a much greater than zero probability that you will get hit with some random charges you could not have anticipated. You just have to hope for the best when you go to a hospital.
amanaplanacanal 5y ago
The is almost no competition anywhere in Healthcare delivery. Drugs are under patent, doctors determine how many new doctors are allowed, you can't build a new hospital because there is already one serving that market. This all seems ripe for some sort of disruption.
deleted 5y ago
[deleted]

by GuB-42 5y ago

lotsofpulp 5y ago

The question is: where is the money going? https://www.healthsystemtracker.org/health-spending-explorer/?display=U.S.%2520%2524%2520Billions&service= https://www.healthsystemtracker.org/health-spending-explorer... >Are doctors too well paid? https://www.medscape.com/slideshow/2020-compensation-overview-6012684 https://www.medscape.com/slideshow/2020-compensation-overvie... https://www.kaptest.com/study/mcat/doctor-salaries-by-specialty/ https://www.kaptest.com/study/mcat/doctor-salaries-by-specia... Based on what US doctors have to go through to start earning that pay, I would not say they are paid too well given the alternatives available to a person smart and driven enough to become a doctor in the US. For example, I would advise my kids that finance/tech/law/engineering has better a better pay to lifestyle ratio than becoming a doctor. Giving up your 20s and early 30s is an enormous sacrifice. >Or maybe it is just the price of really good health care. I suspect this is the price of a small number of people getting really good care, while a somewhat larger number of people get decent care, and then a very large number of people get (or do not) get care, and when they do, it is with very high variance of quality.

learc83 5y ago
Doctor’s salary only accounts for a small fraction of healthcare spending, so it certainly isn’t the cause. However my wife is a doctor who is fellowship trained, so she didn’t start making real money until she was 32. But she made a good bit above the median salary for many years before that. She also doesn’t feel like she sacrificed her 20s. She had plenty of fun, although she says med school was much harder than her engineering degree. And now she makes much more than I do as a principal engineer, and she works less than 30 hours a week. She doesn’t have to worry about interview prep or job hopping. She has absolute job security in any economy. She gets paid for continuing education. She is highly respected (people are much more impressed that I married a doctor than that I’m a principal engineer lol). There is a legal framework protecting her autonomy and decision making at work. Not even the CEO of the hospital can overrule her. In short, she is almost completely above the rat race, and is a true professional in ways that we (software engineers ) are not. I would 100% recommend our children become doctors.
- lotsofpulp 5y ago
  What year did your wife start working? I expect doctors to get squeezed much harder in the coming years. It is go big or go home everywhere, so from the doctors I know, in order to compete you have to join healthcare group, where you will eventually become a cog in the machine frequently owned by PE groups. They are in turn competing with bigger MCOs, hospital groups, etc. On the other side, politicians are doling out what responsibilities that were previously restricted to doctors to nurse practitioners and physician's assistance, effectively using 1 doctor's license (and liability) to increase the supply of healthcare (effectively lowering the quality of healthcare since you are no longer being seen by a doctor).
  - hellisothers 5y ago
    Seems like a problem across all sectors, as I get closer to staff at a FANNGy company I hear from others it’s getting harder or the bar is becoming higher as just more people technically qualified try for it. https://www.nationalreview.com/corner/the-overproduction-of-elites/ https://www.nationalreview.com/corner/the-overproduction-of-...
  - learc83 5y ago
    2018. Those concerns are mainly dependent on subspecialty. If you’re in family medicine or internal medicine, it is harder to run your own practice these days. You still have much more autonomy than nearly every other employee in other professions. But I wouldn’t recommend my kids go into family medicine. If you’re say a pediatric emergency medicine doctor, or a maternal fetal medicine doctor, there just aren’t enough of you to be just a cog. Increasing the number of mid level practitioners has been happening for a while, but it hasn’t had much impact on salaries [1]. My wife isn’t concerned. 1. https://www.hindawi.com/journals/nrp/2012/671974/ https://www.hindawi.com/journals/nrp/2012/671974/
- mcguire 5y ago
  "Physician and Clinical Services" receive 20% of the total spending on healthcare. (https://www.cms.gov/files/document/highlights.pdf https://www.cms.gov/files/document/highlights.pdf and the CDC info I posted elsewhere).
spaetzleesser 5y ago
"Based on what US doctors have to go through to start earning that pay, I would not say they are paid too well given the alternatives available to a person smart and driven enough to become a doctor in the US. For example, I would advise my kids that finance/tech/law/engineering has better a better pay to lifestyle ratio than becoming a doctor. Giving up your 20s and early 30s is an enormous sacrifice." I deal with surgeons from time to time through work. Maybe their training is hard but being a surgeon is pretty much an almost guaranteed ticket to becoming a multi-multi-millionaire. These guys are extremely well paid.
- lotsofpulp 5y ago
  And maybe it is worth it if you have a high likelihood of becoming a multi multi millionaire (a decamillionaire?). But for a person capable enough to become a surgeon, there very well may be decent odds of success via a different route that allows them to work a Mon to Fri 8 to 5 job, maybe even work from home, and live in a popular city as opposed to living in a less popular area (many doctor's get paid more for living in less popular areas, for obvious reasons).
  - learc83 5y ago
    >But for a person capable enough to become a surgeon, there very well may be decent odds of success via a different route There's a few issues here. First, surgery can have bad work life balance depending on the subspecialty. Some spend a lot of time on call, some basically work 9-5 or less. Second, unlike basically every other very high paying profession, surgery requires working with your hands, and physical and mental stamina to endure hours of operating. Just getting through med school requires above average intelligence and hard work, but you don't need to be a super genius. The abilities that make someone a good surgeon don't necessarily translate to any other profession that is that highly paid. Third, surgery is a very direct path to what most people would consider serious wealth for someone who is smart enough/hardworking enough to get into med school, but didn't necessarily get into one of the top tier schools that some of the other very high paying careers recruit from. All that aside, surgery isn't the only specialty that is very highly paid. > that allows them to work a Mon to Fri 8 to 5 job Many very highly paid subspecialties work Mon to Fri 9-5 and some even less. >maybe even work from home Radiologists routinely work from home, and there are remote opportunities for other doctors as well. >and live in a popular city as opposed to living in a less popular area (many doctor's get paid more for living in less popular areas, for obvious reasons). That is only true for certain specialties and subspecialties. My wife's sub speciality requires her to live in cities with a population of at least 500k or so. Many of the very highly paid subspecialties are similar. Even for family medicine the difference is only 5-10%.

pja 5y ago

US healthcare professionals at the top of the pile make 3-4x as much as equivalent posts in the EU IIRC. A huge amount is going in salary costs. Another huge chunk is spent on the bureaucracy of administrating the payments system, with patients, hosptials, insurers and general practicioner offices all fighting over payments. This is a deadweight cost that other systems don’t have to carry. Drug costs in the US are much higher than elsewhere, as (I understand it) medicare & medicaid are prevented from negotiating the prices they pay the in way national healthcare systems do in the EU & a myriad set of obfuscatory tactics are used by drug companies to maintain much higher prices that are achievable elsewhere. & probably lots of other little things too. But those are the big three I think.

spaetzleesser 5y ago
It's pretty futile to point out the one factor that makes US health care so expensive. The whole system is highly corrupt and obfuscated and allows doctors, administrators, investors, construction companies, insurances, pharma companies and multiple middlemen to make outrageous money. I am not sure how to fix this but an important first step would be to mandate full transparency of all pricing. In addition the same service should cost the same for uninsured and insured patients. Same for in- and out-of-network billing. Right now a patient basically has no way of navigating this. Even if you are insured there is a much greater than zero probability that you will get hit with some random charges you could not have anticipated. You just have to hope for the best when you go to a hospital.

amanaplanacanal 5y ago

The is almost no competition anywhere in Healthcare delivery. Drugs are under patent, doctors determine how many new doctors are allowed, you can't build a new hospital because there is already one serving that market. This all seems ripe for some sort of disruption.

deleted 5y ago

[deleted]