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There is absolutely a shortage of doctors. AMA is unwilling to fix this and instead rely on a system that drives many to suicide. My wife is a doctor. I’m a so

• kevmo 3y ago
  America needs tuition-free state universities and trade schools. Full-stop. We're encountering endless problems, sending our entire economy (and living standards) out of whack, because we don't.
  • xyzelement 3y ago
    Who pays for tuition free universities and trade schools?
    • jLaForest 3y ago
      The same people that pay for tuition free primary education....
      • bequanna 3y ago
        Local taxpayers/property owners? That model doesn’t really work to fund higher education. The public won’t accept doubling or tripling their property tax.
        • WkndTriathlete 3y ago
          > That model doesn’t really work to fund higher education. The public won’t accept doubling or tripling their property tax. [citation needed] And I can give you a citation against. In my local municipality the tax base is roughly $1.5 billion. The annual expenditures for the local vo-tech school for that municipality is $30 million. If all of the state and tuition funding for the vo-tech school suddenly vanished the property owners would see a rise of ... wait for it ... a grand total of 2%. Certainly a far cry from the doubling or tripling you suggested. Amortizing the tuition across all public post-secondary institutions in the state via income and property tax bases of the entire state would likely be somewhere in the neighborhood of 1-2% total every year. Based on that analysis it seems monumentally stupid to NOT publicly fund post-secondary education. Ditch the NCAA sports programs and it probably gets cheaper. The whole sales pitch for sports is that scholarships provide a pathway for some students to go to college that otherwise could not afford it. Get rid of tuition and suddenly that reason goes away, too.
          • bequanna 3y ago
            Colleges/Universities absolutely do not need more money...they need more accountability. I'm not arguing with your numbers, I guess my point is that I don't think taxpayers will accept a huge "freebie" for one group which results in their taxes going up. The optics are terrible.
        • BeetleB 3y ago
          In reality (and historically), it's the state taxes and not property taxes. Still, if I had 2 kids, doubling my property tax would be cheaper for me than my paying for their tuition at current rates.
      • nordsieck 3y ago
        > The same people that pay for tuition free primary education.... Are you suggesting that people should be locked to the school in their district? Because that's the way primary education works.
        • antoniuschan99 3y ago
          Public community colleges primarily attract and accept students from the local community and are usually supported by local tax revenue - from Wikipedia.
        • sophacles 3y ago
          They aren't locked in. That's the one provided for free. It doesn't seem to stop private schools and homeschooling at all.
        • neaden 3y ago
          Public universities are generally run by the state, not a local government so sure, free in state tuition sounds reasonable.
    • hotnfresh 3y ago
      This question is important and needs to be asked because nobody's already solved this problem. We'd be moving into uncharted territory.
    • stronglikedan 3y ago
      If they were free, more people would take advantage of them, potentially earning more, bumping them into higher tax brackets, where their taxes would be used to fund tuition free education, and the cycle would continue.
      • bdzr 3y ago
        The money moves in a circle, thus creating the self-sustaining economy we’ve been looking for.
    • stonemetal12 3y ago
      Who pays for them in Germany? In Germany, universities are free for everyone even foreigners. Since GP says State Universities I would assume the State they were in would, through whatever tax policy they like.
      • rayiner 3y ago
        In Germany, taxes are 39.5% of GDP. In the US, they are 26.6% of GDP. There’s no realistic proposal that has ever been advanced, not even from the Bernie/AOC/Warren types, on how to raise the extra $2.8 trillion annually that would be required. Elizabeth Warren’s proposed wealth tax wouldn’t even raise that much money over a decade, much less annually.
        • ceejayoz 3y ago
          "extra $2.8 trillion" is incredibly dishonest. Nothing in any universal/single-payer healthcare proposal magically adds $2.8 trillion in actual medical expenses to the system. It's fundamentally an accounting change, akin to a married couple with a joint banking account deciding who'll pay the restaurant bill this time.
          • rayiner 3y ago
            To be like Germany, you would have to take $2.8 trillion from the private sector and put it into the public sector by taxing and spending an extra $2.8 trillion. That’s not an accounting change—the government doesn’t have a joint bank account with the private sector.
            • ceejayoz 3y ago
              > To be like Germany, you would have to take $2.8 trillion from the private sector and put it into the public sector by taxing and spending an extra $2.8 trillion. And those taxes would replace the insurance premiums employers and individuals are currently paying out the ass for. It's a difference in who writes the checks, not how much actually goes out of individuals' pockets. Claiming "$2.8B in new taxes" is like claiming "I Venmo you $5, you Venmo me $10" costs me five bucks. > That’s not an accounting change—the government doesn’t have a joint bank account with the private sector. That "joint account" is the GDP you're on about.
    • deleted 3y ago
      [deleted]
    • MisterBastahrd 3y ago
      We literally had tuition free universities and trade schools for decades until desegregation. I'll let you figure out what happened after that.
  • bequanna 3y ago
    This sounds like less accountability when fixing the problem requires more. America needs to stop letting their University systems bloat everything unrelated to actual education and research.
    • ethbr1 3y ago
      Agreed. American universities need a two-pronged fix. - Implement ACA-style budget efficiency minimums This much of tuition must be spent on direct-teaching expenses. Only this much may be spent on everything else. Otherwise the university in ineligible for any federal educational assistance grant/loan. - Increase funding via increased state contributions to public universities (returning to historical averages), to lower tuition costs
  • readthenotes1 3y ago
    Full-stop? Hardly. Who would gatekeep so that universities and trade schools aren't just continuing the babysitting in high school?
• chmod775 3y ago
  Sounds like the system is basically set up to enrich loan companies, and to a lesser degree universities. Who is lobbying for this system to be improved? Because almost certainly loan companies and universities are lobbying against that.
  • deleted 3y ago
    [deleted]
  • HDThoreaun 3y ago
    Medical schools absolutely want to expand, they make tons of money and have many applicants who are qualified and willing to pay. The problem is there aren't enough residency seats. If there were more med school grads without expanding residences many competent graduates would go unmatched.
    • naveen99 3y ago
      In the us, there are almost 3 residency spots for every 2 us medical students.
      • endisneigh 3y ago
        Source?
        • naveen99 3y ago
          https://www.nrmp.org/about/news/2023/05/nrmp-releases-the-2023-main-residency-match-results-and-data-report-the-most-trusted-data-resource-for-the-main-residency-match/ https://www.nrmp.org/about/news/2023/05/nrmp-releases-the-20...
          • endisneigh 3y ago
            This is overall not per speciality and doesn’t include overall people who did not apply, the article even says itself it’s a all time match high. Look no further: https://www.nrmp.org/wp-content/uploads/2023/03/Match-Rates-by-State-Specialty-and-Applicant-Type-2023.pdf https://www.nrmp.org/wp-content/uploads/2023/03/Match-Rates-...
• nradov 3y ago
  Why are you expecting the AMA to fix this? The primary bottleneck on producing more physicians today is lack of residency program slots. Every year some doctors graduate from medical school but are unable to practice medicine because they can't get matched to a residency program. The AMA has been lobbying Congress to increase Medicare funding for those programs. https://savegme.org/ https://savegme.org/
  • eppp 3y ago
    Why on earth would medicare have anything to do with residency spots to start with? Why wouldn't the hospitals use this as an apprenticeship program and pay the residents and charge appropriately for their services?
    • ethbr1 3y ago
      Because hospitals generally don't have the funding (in the case of rural or urban trauma barely balancing the books) or inclination (in the case if wealthy suburb, managed facilities trying to maximize profit by running minimal staff) to do this. Ergo, like education in general, it's funded from the federal government.
      • s1artibartfast 3y ago
        If hospitals don't have the revenue, they should charge the cost of services to balance their books. I think government involvement in the residency program is problematic distortion, causing hospitals to chase a scarce resource instead of working to expand the supply pipeline.
        • ethbr1 3y ago
          Among other laws, there's the EMTALA that prevents charging the cost of services. https://en.m.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labor_Act https://en.m.wikipedia.org/wiki/Emergency_Medical_Treatment_...
        • nradov 3y ago
• onlyrealcuzzo 3y ago
  > Based on our math, we’ll be 25 to 30 years into our careers before her medical education with have a better ROI than my career choice. I didn’t even push for top-dollar jobs. I just want to point out that - you landed (probably more random than intentional) into arguably the best career in the history of labor. Compare a doctor to almost anything beside an engineer - and it won't seem so terrible. Most people that have been in engineering for >10 years got into it because it's what they liked doing - and then it just so happened to be ridiculously lucrative and not require you to go into hundreds of thousands of debt to get trained to do the job (medical, lawyer, etc). Even most trades (electrical, plumping, beauty, the taxi medallion system, etc) are designed similar to the medical industry - and require ever more schooling (debt, opportunity cost) to get the job - to artificially reduce the work force to benefit current workers at the cost of future workers and everybody who uses those services. I think the particular problem with the medical industry is... it's particular detrimental to society to be overworking doctors to the bone and it not really paying off for them until they're in their 50s. We're all gonna need medical help some day... Maybe we can do our own plumping and cut our own hair and be good law abiding citizens and not need a lawyer. But we're all going to have severe medical problems at some point.
  • Guvante 3y ago
    Your last point isn't correct. While that is the result I think emphasizing that it isn't made easier is important. Electricians need to install high voltage wires that are safe in the home for untrained individuals for potentially a century. Plumbers need to install water tight pipes that can withstand significant pressure without leaking (which can be difficult to detect and very quickly devastating damage wise) Doctors are expected to be able to catch nearly any disease in their specialty based on an honest consultation. Lawyers need to know a phenomenal amount of information to meaningfully know what o research when it comes to prepping for court cases. All of these jobs are hard to prepare for and their is value to everyone else that you can prove you actually prepared. The problem is the incentives for encouraging more people to prepare are backwards (those supporting the newbies benefit from fewer of them) which causes no real help to be given and the labor shortages. But it isn't made up boundaries just to benefit existing members.
• readthenotes1 3y ago
  Based on the workload of medical students and residents, I do not believe that even if the AMA relaxed the standards for entry that unless they relaxed the standards for exit we would have more doctors. And by workload, I don't mean just hours on the job, I mean amount of material to learn. It is overwhelming to most
  • HPsquared 3y ago
    Is it all really necessary? As an outsider it looks like letting the perfect be the enemy of the good. That, or it's just tradition / an elaborate hazing ritual. I don't see how the ability to work long hours is necessary to heal the sick. They don't train airline pilots like this, or nuclear plant operators. What's so special about doctors?
    • myheadasplode 3y ago
      Residency certainly seems like an elaborate hazing ritual. I believe there is something to be said for errors made when handing off patients between doctors at the end of a shift, which is why you would want to train physicians to maintain good performance even over long shifts. But in general, modern residency was invented by a morphine- and cocaine-addicted surgeon who decided, hey, I want you to undergo a grueling residency for an arbitrary number of years and you'll be a doctor when I say you are: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7828946/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7828946/
      • HPsquared 3y ago
        Sleep deprivation in the service of error prevention always seemed a bit illogical. Other professions have shift handovers
    • readthenotes1 3y ago
      Perfect? Hardly... The long hours are much less now, though nowhere close to pilot or trucker hours. they're trying to give the future the most experience they can while still under supervision. It'd be better to have a 5 year residency and go back to a 3 year med school, but that would reduce med school income so not likely.
• JoshTko 3y ago
  We don't have a shortage. We have too much regulation by AMA limiting number of doctors.
  • anonporridge 3y ago
    Just because the shortage is intentionally engineered doesn't make it not a shortage.
• nostromo 3y ago
  Similarly, my husband is a commercial pilot and is now starting to make more money than me in tech after his 10+ years of underpaid work and a high student loan debt load. But, here's the deal: he's basically going to make top dollar until he's 65. Meanwhile, I'll likely be seen as a dinosaur in tech by that age and will be lucky to find work at all. I imagine your wife will be seen the same way. She can comfortably work until retirement age, in an profession that sees experience as a positive thing, while you might be a pariah before you know it. Yes, we make good money when we're young in tech. But we age out much more quickly due to the bias common in our industry.
  • egl2021 3y ago
    "he's basically going to make top dollar until he's 65" ...unless he fails the flight physical.
  • mrits 3y ago
    If you were bringing in a competitive salary in tech for the last 20 years you don't even need to work anymore. So there is that..
    • hotnfresh 3y ago
      BLS says US median programmer salary in the US was just under $100,000 last year. 20 years of a normal US tech salary won't let you retire. A top-few-percent one, maybe.
      • mrits 3y ago
        That was a competitive salary when I started in 2005.
        • hotnfresh 3y ago
          Well, it'd also represent a raise for about 50% of programmers in 2022. [EDIT] Further: "The lowest 10 percent earned less than $54,310, and the highest 10 percent earned more than $157,690." (in 2022, still). The ones who can retire in 20 years are making (ballpark) top-5%-of-field wages most or all of that time. [EDIT EDIT] I didn't pick the best category for this, but the numbers only skew up 25ish % for the most-relevant one. Not a single BLS computer job category has a median particularly close to "retire in 20 years at this income" money. FAANG, finance, and a small segment of the startup market that's in that same category—yeah. Almost all the rest? No.
• winrid 3y ago
  She has better job security than you, however.
  • tenpies 3y ago
    And career longevity. A 40 year old developer is "old". At 50 you're ancient. A 40 year old doctor is insanely young. A doctor in his late 60s can easily be in their prime, especially in some practice areas or research. Provided they are okay health-wise, even an 80 year old doctor can still be working, especially if they have a strong team. They'll probably be in a mentorship role or a more laid-back practice, but they'll still be earning a meaningful income and having a very real impact on their patients. And generally speaking, doctors in the West live longer than the general population, so that longevity is better as well.
  • SkyPuncher 3y ago
    You are absolutely correct. So far, that really hasn't been a factor for us. It is worth noting that job security becomes much less important as you build wealth. It's a lot easier to build wealth when you're not racking up debt and being underpaid in your 20's.
• strikelaserclaw 3y ago
  Who knows if software engineers will be paid the same in the future but doctors will most likely have a strong "moat" till the day they die. Software engineers lucked out in this era not because they are smarter / harder working than people like mechanical engineers but they just chose a profession that naturally scales, and scaling is really how you can make a lot money.
  • dylan604 3y ago
    eventually, the cost of a team of software engineers will be the monthly fee to chatGPT
    • mianos 3y ago
      Maybe, but how longs is eventually? I love GPT, use it every day but it is pretty flawed. 10 years?
      • dylan604 3y ago
        who knew what chatGPT was 2 years ago? things are moving fast, and gaining speed. will they plateau before getting to being ubiquitously useful?
        • rgifford 3y ago
          LLMs have been around since the 50s. Chomsky has plenty to say on them [1]. It's not half as rosy as the current hype cycle. 1. https://www.nytimes.com/2023/03/08/opinion/noam-chomsky-chatgpt-ai.html https://www.nytimes.com/2023/03/08/opinion/noam-chomsky-chat...
        • randomdata 3y ago
          Thing is, GPT is just another programming language. It no doubt brings a leap forward in approachability, like Javascript was a leap forward from assembly, but at the end of the day it still relies on programmers to use it. No matter how advanced it becomes, as long as it exists to serve the interests of humans, and not other machines, it is going to require programmers to describe what humans want to see carried out. It is possible that everyone will become a programmer, like everyone has become an elevator operator, but unlike an elevator button press that takes milliseconds and you're done, does it behoove "the boss" to spend their day describing their ideas to GPT? I suspect, like today, they will still want to hire other humans to bridge that gap so that they can spend time doing more important things.
• deleted 3y ago
  [deleted]
• anon115 3y ago
  i dont get ageism in tech at all if anything i would hire the most experienced programmers tf would i hire a less experienced person.
  • nytesky 3y ago
    Ageism in tech is based on the premise if you aren’t already a multimillionaire dabbling in angel investing by 30, you don’t have the “it” (ambition, skill, etc) to really contribute at a high level, and a young programmer can do similar work but be more familiar with latest tools and langs
    • mianos 3y ago
      While true, in my experience, many much more experienced developers can do a lot of things the less experienced ones think they can. What about the people who did make a lot of money but like to work and create things?
      • nytesky 3y ago
        The assumption would be if you are someone who likes to work and create you will be a founder or maybe work on some mission specific passion career.
  • khazhoux 3y ago
    People worry a lot about ageism here. I'm not seeing it be a problem in the real world. At every company I've been at, the most senior people are the ones with the most pull, with the strongest direction and advice. I've worked with a few people 60+ who suck. I bet they sucked at age 30, though.
• ska 3y ago
  > salaries need to offset the insane burden of training A cycle here is that student loans rise with expected earnings and banks are fairly open ended about it, institutions happy to justify the use of the cash. Salaries wouldn't need to be nearly as high if you didn't walk out of residency with 200k+ [medical school ] debt at a point that is effectively mid-career. As a society we'd probably be better off if the both the median salary and median debt was much lower. I've also seen the "guarantee" of a high salary later lead many young doctors and med students to be foolish with money, as "eh, what's a little more debt" is easy to fall into. It's also part of the driver to overspecialization, more available GP's and fewer people reliant on emergency visits would obviously improve the system, but the economics and QOL for a general practice keep getting harder. Residency bottleneck and the high barrier for foreign trained mid-career people are the two other areas for potentially major impact.
  • HPsquared 3y ago
    The question is, does it really cost 200k to train each doctor? Surely the main input is the student's own time and effort, which isn't even included.
    • ska 3y ago
      I wasn't wording things clearly. The 200k is just the median residual debt from medical school alone. People don't tend to pay it off much during residency years though, since residency pay is relatively low (50-70k). Lots of them acquire extra personal debt during residency. Doctors aren't typically considered "trained" until after residency.
    • SkyPuncher 3y ago
      My wife had $210k in debt from medical school. It's basically impossible to pay it off durning residency, so it just balloons. All in, at the end of my wife's training, we would have been $1M ahead if she had simply worked a normal career. That's huge in your 20's and 30's when your trying to establish a house/family/etc.
    • jltsiren 3y ago
• benhurmarcel 3y ago
  You’re making the comparison with software engineering in the US which is one of the biggest outliers in terms of income.
• kulahan 3y ago
  I have no source for it, but I read once that (GP) doctors make less than software devs on average, simply because devs get that decade head-start with much less debt. It makes sense. This is such a hard problem to fix. I doubt anyone is interested in hearing any solutions that involve worse-trained doctors, or longer training schedules, or massive pay increases for what are viewed as some of the highest-paid people in the nation. There is a lot of talk about opening up medical care for more people - which, naturally, means there will be a surge in demand. I can only imagine this would exacerbate the problem. It feels like we're running out of time to fix this.
  • SkyPuncher 3y ago
    GP is a pretty shit field right now. Pay is stagnating and mid-levels are starting to take over an increasing number of general practice roles.
• raverbashing 3y ago
  Yeah, for real, the whole residency/shifts they are submitted into are borderline abusive, and I don't think any other profession accepts their professionals going though this It's basically a firm of hazing
• codegeek 3y ago
  And not to mention that doctors usually have no work life balance. I have many doctors in my family/friends here in the US and most of them have no time for anything including weeknights and weekends. It is crazy.
• atleastoptimal 3y ago
  Most of my friends who became doctors have rich parents. The ones without rich parents funnily enough dated software engineers who were the main breadwinners during their med school/residency.
• asdfman123 3y ago
  I know a guy who accrued $400k+ of med school debt and dropped out last quarter. Insane system. I didn't even consider medicine, despite being a top science student, because of the stress. And god forbid you think you can handle it at 18 years old and then being stuck on the medical track for... decades.
  • nextworddev 3y ago
    Why did he decide to do so, if I may ask?
    • asdfman123 3y ago
      I didn't know him well enough to ask
  • aborsy 3y ago
    That’s a year of their salary. The salary/debt ratio in engineering is lower.
    • asdfman123 3y ago
      But it's not a year of salary for a med school dropout.
• gist 3y ago
  > Based on our math, we’ll be 25 to 30 years into our careers before her medical education with have a better ROI than my career choice. I didn’t even push for top-dollar jobs. This has quite frankly zero relevance to anything. The analysis depends on what you her husband does (I mean seriously how does that prove a point at all) and your choice and abilities (totally arbitrary based on a host of factors especially given the tech scene over the last decade. I mean ROI? So someone makes a career decision by comparing to what their partner makes or what ROI is? > AMA is unwilling to fix this This has to do with residency slots and residency slots are determined by how many hospitals can accept residents. Now you can say AMA is a roadblock to that but there are a slew of other roadblocks in addition (if true not sure it is) to having more residency slots. You can think idealistically that you can re-imagine the whole system but massive change in something entrenched like that (where lives matter) most likely is not practical.
• matheusmoreira 3y ago
  On the other hand, you want doctors to be well rewarded because it's a high stress, high work hours, high responsibility, high liability, high effort and high opportunity cost profession. If it doesn't pay well, very few people are going to bust ass in medical school and residency for 10 years to do it. In my country the government flooded the market with doctors and the results weren't pretty to say the least.
  • seb1204 3y ago
    I would prefer to see a reasonable paid, not stressed and not overbooked and not over worked doctor.
    • matheusmoreira 3y ago
      Most doctors I know would rather be overworked than underpaid.
  • deleted 3y ago
    [deleted]
• demondemidi 3y ago
  Really helps to come from money so that you don't have that huge college debt to crawl out from under.
• atourgates 3y ago
  Just want to expand on that "tuition/debt/time" bit. TL;DR: Becoming a physician requires sacrificing an additional 6-10 years of your life to education and training beyond what you'd expect for most careers, and assuming something like $250K in additional debt. It'll take the average physician about 16-years out of college before they start to out-earn the average engineer. Details: Let's imagine that two smart people start college in the United States. One goes into engineering, the other into med school. The day they graduate, on average the engineer will get job that pays them $74k their first year. Year 4, the engineer is likely making $84k/yr, and they have earned a total of about $315k in their career. Meanwhile, our doctor friend has so far accrued about $250k in debt. A delta of about $560k in just 4 years, but it's gonna' get worse before it gets better. For the next ~3-5-years (for most specialties, there are outliers), our doctor friend is gonna make about $50k/yr . (Yay, positive cashflow!) We'll generously assume their debt doesn't accrue interest in this period. Assuming our engineer friend assumes an average career path, he's gonna be up to $92k/yr at the end of this period, with a lifetime total earnings of $669k, while our doctor friend has clawed their lifetime earnings all the way back up to -$52k. This is also the biggest delta between the two careers. At year 8, our engineer friend has out-earned our doctor friend by a delta of $720k. Now, on average, our doctor friend starts making $202k/yr. Good money, right! To make the math easy, we'll assume that their debt still doesn't accrue interest. With all that, it's not until 16-years out of college that the average American physician will start to out-earn the average American engineer. So if they both graduated at 23, our Engineer friend is gonna out-earn our doctor friend until they both hit just about 40. Of course, if our doctor friend has to pay some interest on their med school debt, and our engineer friend is able to invest a chunk of their salary in those early years, the magic of compound interest will be on their side as well. And that says nothing of the fact that our doctor friend probably had to sacrifice about 4-years of mandatory 80+ hour work weeks. It also assumes that our doctor friend doesn't drop out/fail out of med school and manages to match to and complete a residency. None of which are givens. Which is a very long way of saying: physician compensation is wonky because it's a career where you sacrifice a ton and take a ton of career risk very early on, for the promise of higher compensation and quite high job security later on in your career.
  • seb1204 3y ago
• hanniabu 3y ago
  > Residency was demanding and severely underpaid. Wait, you're getting paid?
• gnarbarian 3y ago
  chad?
• alberth 3y ago
  Will you mind breaking out the typical educational costs and earnings potential. I have a child I’m encouraging to become a doctor, and it’d be great to know some actual economics before I push too hard this profession.
  • AndrewKemendo 3y ago
    That would be helpful to me as well My teenager wants to be a radiologist but I have no idea if it’s even possible to do that in a way that isn’t a path to depression and burnout
  • oidar 3y ago
    It varies wildly depending on the medical school (state school in Texas is affordable for example), scholarships, program (MD/PhD programs, MD only, MD/JD programs), and terminal specialization.
  • oaktrout 3y ago
    On some quick googling the mean debt at graduation from medical school is about 250,000 (this includes undergrad). This number is trending upward. There is also the opportunity cost of 4 years additional school and 3-7 years of getting paid 60-70k. Most doctors end up making between 265k and 382k per year, this varies wildly (from pediatrician on the low end to brain surgeon on the high end). Here is a good article: https://www.whitecoatinvestor.com/how-much-do-doctors-make/ https://www.whitecoatinvestor.com/how-much-do-doctors-make/
• didgetmaster 3y ago
  Same here. I am a programmer with a wife who is a doctor. It took her about 12 years after she started her practice before her total earnings surpassed mine. One thing that rarely discussed in this kind of conversation is taxes. A doctor spends 12 years earning next to nothing and going into debt for training costs. Then the second they start making a real doctor salary, the IRS thinks they are 'rich'. They are taxed at the highest tax bracket even though it might take them another 10 years to surpass someone who was earning barely a six-figure salary the whole time. If you spend 9 years earning nothing and then make $1M in your tenth year, you will pay much more taxes than someone earning $100K for 10 years (even though both earned a total of $1M over those 10 years).
  • Hextinium 3y ago
    Not to mention that most retirement accounts have yearly maximums, if you where making 401k for 10 years at 100k you will have significantly lower effective taxes than a person who made nothing and then sees high earnings trying to put into retirement.
• onos 3y ago
  Yeah but doctors also get social cachet, and get to feel like they’re doing something positive.
• magic_man 3y ago
  There is a reason why most med schools have like a 5% acceptance rate. They have a much bigger moat than most software engineers. They are guaranteed a lot of money even if they aren't that good. They don't have to worry about leet code grinding and learning the newest random framework either.
  • HEmanZ 3y ago
    Here’s a secret: if you’re a good software engineer, you don’t have to worry about those things either.
  • Pigalowda 3y ago
    Leet code grinding is maybe like USMLE and board grinding? Life will always get you. There’s no way around work if you are a well paid professional. Maybe nepotism or fraud can get you there. I’m not sure what leet code entails but these tests required a lot of preparation: MCAT (hundreds of hours, thousands of questions, 10 practice exams) USMLE Step 1 (hundreds of hours, 5,000 questions, 1 practice test) USMLE Step 2 (maybe 40-60 hours, probably less than 2,000 questions) USMLE Step 2 CS (4 hours a few dozen practice clinical scenarios. this thing doesn’t exist anymore) USMLE Step 3 (30 hours, less than a 1,000 questions Radiology CORE 1st board licensing exam (hundreds of hours, 5,000+questions) Radiology Certifying 2nd board licensing exam (8 hours, 2,500 questions) My next one is the CAQ and I haven’t started grinding for that yet. I do wake up every morning and do practice q’s though. I still have a deeply negative networth and hate my job. Maybe others don’t, good for them.
    • haldujai 3y ago
      The amount of studying described here may be what you did but is not a minimum requirement by any means. I'm not even sure where you're getting 5000+ questions for the ABR Core. -Another radiologist.
      • Pigalowda 3y ago
        I actually did 3 months for Core, i think that’s pretty average. Kevlar Radprimer Board vitals Radprimer has probably more than 5,000 basic and intermediate questions by itself. Are you saying I lowballed it? I was pulling numbers out of my ass
• raincole 3y ago
  Programmers face much more ageism than doctors. Actually they face the reverse ageism (against younger ones).
• _v7gu 3y ago
  I'd say that the law of one price applies here. Doctors need to be making this much to compensate for living in debt their whole youth and early adulthood. Also having money is probably more enjoyable when you're younger.
  • hnfong 3y ago
    Not necessarily. The demand for doctors is generally greater than the supply. Because the profession gatekeeps. The law of one price requires free market competition.
• cyanydeez 3y ago
  socialism needs to offset the cost. it's that simple.
• qudat 3y ago
  Hmm, are you turning both your wages into hourly rates and then comparing? My wife is a physician (me a SWE) and at face value she makes more but after considering hours worked it’s not even close. She is regularly pulling 65-90 hrs/wk with little flexibility in her schedule.
  • alberth 3y ago
    Is your spouse still in residency? I ask because I didn’t know 65-90 hrs/week (13 hr days / 7 days per week) was typical for non-residents.
• darksim905 3y ago
  >Based on our math, we’ll be 25 to 30 years into our careers before her medical education with have a better ROI than my career choice. I didn’t even push for top-dollar jobs. Depending on if you're married or brought a home, her education and status already paid off with special rates for doctors/lawyers/high earners/professional mortgages: https://www.studentloanplanner.com/professional-mortgage-loans-lawyers-doctors/ https://www.studentloanplanner.com/professional-mortgage-loa...
• 1letterunixname 3y ago
  The difference being a doctor is a lifestyle business requiring performance of service while a software developer can potentially make passive income. There is, however, a lack of essentialism to being a software developer that AI can replace, whereas caregivers will be the last to be automated away. It is likely software development incomes have peaked and will decline long term.