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> 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

> 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.
- s1artibartfast 3y ago
  >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. I would argue that it largely is just made up boundaries to benefit existing members. That is to say, regulatory capture has increased the barriers so far that any benefit from additional quality of service is far outweighed by the increased scarcity. It doesn't matter if you have the best doctors and electricians in the world, if they are so few and expensive that the public does not have access to them. The fundamental problem is that is both easy and popular to error on the side of "caution", creating increasingly stringent licensing requirements. These benefit established interests and sound attractive to the public.
  - Guvante 3y ago
    I don't disagree but I like to distinguish between "there shouldn't be barriers" and "there should be fewer barriers" and the verbiage I responded to felt like the former.
- cameronh90 3y ago
  I don’t think you can reasonably draw a comparison from medicine to home electrics and plumbing. My dad was a plumber and I’m preparing to pass the certification that permits me to work on home electrics. They are, to be blunt, easy. An average person can pick up most of it in a couple of months. Electrics and gas plumbing carry a certification requirement because an error can kill someone, but it’s easier than passing a driving test. Obviously, there are higher tiers of those trades that require a lot more training, but even those aren’t really comparable to the level of knowledge and study needed to become a qualified doctor, let alone a consultant. In the UK, shortages of tradespeople are less to do with the difficulty of training, or lack of course capacity, and more to do with people really just not wanting to do the job, for various reasons.
  - lesam 3y ago
    Medicine has more barriers to entry at least partly because we’ve decided to erect them. Doctors learn all kinds of things outside their direct specialty that they don’t really need to know, but nobody inside the system has an incentive to streamline medical education or to encourage more and earlier specialization. For example, we force most doctors to take a 4 year degree before medicine (sometimes pre-med, but often an arts or non-biological science degree). Wasting 4 years of a future doctor’s prime career on an expensive and often irrelevant screening program is extremely wasteful for society as a whole.
P_I_Staker 3y ago
Problems are doctors are unlikely to "help" with, and are highly likely to make matters much, much worse. Also, contrary to popular opinion, there's little stigma or awareness of "bad doctoring", for a number of systemic reasons. So you have someone who doesn't give a fuck about anything, certainly not your situation, not listening to you, and trying to prevent you from receiving medical treatment. This doesn't look so necessary to me. I know there will still be medical experts and surgeons and so forth, but much of this medical infrastructure doesn't benefit the average citizen (I know there's an argument that it does or for a change in perspective, but that's a whole different can of worms. Similar to policing, if you think of the typical way you interact with the medical system, you start to realize there's very little in there to help you. 99.99% of the infrastructure is built to benefit powerful people with tons of money; helping you is an after thought. What happens when you're a victim of crime? Turns out there's very little in place to help. Oh, someone is actively trying to murder you? well give us a call after it happens and maybe we'll investigate. How many of us have experienced something like this? I'm not saying there's no reason for the arrangement, but we should stop trying to pretend these people are looking out for the public. I know people may be tempted to chime in regarding some situation a police officer or doctor helped you. I'm not saying you're wrong, just explaining why some people are asking questions; if you honestly think about it, your naive assumptions about safety and health will be shattered. A doctor, in many ways, arguably has a patients WORST interests at heart, in a similar manor to a police officer, in it's interaction with the public. They have, as their most important responsibilities, to detect certain things, and take actions to hurt the person. This is priority #1, virtually everything else comes after. This is an important observation, is not obvious, and should cause us to reconsider these institutions.
- burnerburnito 3y ago
  Perhaps a more diplomatic to phrase what I perceive as your thought there is that a good doctor or policeman is actually in some respects often acting that way regardless of the system -- they would've tried to help people as much as they could anyway. Meanwhile a bad or apathetic doctor, policeman, etc. will tend to receive little friction for it while you have to fight uphill to get basic care, all while being milked of as much of your money as possible and still having to wait unbearably long for useful treatment. Likewise, there's such a range of outcomes, and when it's involving chronic diseases combined with an apathetic or bad doctor, you can be stuck realizing you've wasted months with no resolution (not even getting into any potential costs) only to now have to start all over again potentially several more times just for a sliver of hope that you'll find a doctor who's caring and competent enough to finally help you out. So sitting on the receiving end feels like being bled dry by people who couldn't care less about your suffering or if you die, so long as you keep paying them, with little realistic recourse other than accepting that you got burned and moving on. In any case, just my two cents from what I think seems like a somewhat related view but with a different "spin".
dylan604 3y ago
>to artificially reduce the work force to benefit current workers at the cost of future workers is that really the purpose? or is it that an entire industry has been built on top of the trades, and that industry does whatever to continue to grow?
aborsy 3y ago
There can be more schooling and training in engineering. After undergrad, master’s, PhD, a postdoc or two, one would still make low income. After that, there is a never ending path where one has to constantly chase ever changing technologies. The older you get, the harder it will be to keep up and remain employed. In medical science, you finish the residency (roughly equivalent to 1-2 postdoc in engineering), and you start to practice. Already, income is OK in residency. The older you get, the better!
- classichasclass 3y ago
  The income is most assuredly not okay in residency, or for that matter, fellowship. Most U.S. residencies and fellowships range from $60-$70K a year, basically the U.S. median income, and on a per hour basis is terrible.
  - haldujai 3y ago
    To make it worse many of the big name institutions one would aspire to train in (e.g. 10 of the US News top 20 hospitals) are in expensive metros where you don't cross the "low-income line" until the third year of residency. All the while spending 60-80 hours a week on clinical service and 5-10 hours on research and education so you can maybe get a job somewhere not remote when you're done.
robocat 3y ago
> We're all gonna need medical help some day... 95% of health is being proactive about your health: food, fitness, sleep, dentist, etcetera. I wonder how much doctoring is due to negligence of a healthy lifestyle, or perhaps chronic choices (addictive substances like alcohol, shift-work). > But we're all going to have severe medical problems at some point. Which often are untreatable - and the doctoring is regularly prophylactic. Hip-replacements are an obvious outlier.
- Capricorn2481 3y ago
  > 95% of health is being proactive about your health: food, fitness, sleep, dentist, etcetera. Maybe 70%? Genetics play a huge role. You will likely need a doctor if your family has a long history of cancer.
- BeetleB 3y ago
  > 95% of health is being proactive about your health: food, fitness, sleep, dentist, etcetera. You're young, aren't you? The percentage is significant, but nowhere near 95%.
  - robocat 3y ago
    I'm middle-aged. I might be over-estimating the percentage. I might also be over-estimating how much we can affect diabetes, weight, fitness, addiction. I can say that the chronic health problems of my peer-group often appear to be self-inflicted. Of my dead acquantances there are maybe a few groups: (1) health problems caused by childhoods of poverty, (2) health problems that we haven't solved yet which the medical system helps little, (3) suicides, (4) crashes/accidents, and (5) health problems caused by smoking, drinking and drugs (e.g. HepC). Also acquaintances with chronic conditions often don't follow medical advice anyway e.g. diabetic friends that abuse their bodies. Or people told to quit drinking or smoking that do not stop. I'm not saying it is easy. I am saying I know plenty of acquantances that have made difficult choices to improve their lifestyle choices (presuming cause not correlation), and others that have not made positive changes. Context: I'm in New Zealand, so healthcare is mostly free and of reasonable quality. We have lots of immigrants so I have some exposure to people from other (often adjacent) cultures.
SkyPuncher 3y ago
> I just want to point out that - you landed (probably more random than intentional) into arguably the best career in the history of labor. I don't disagree. However, I certainly am not a top earner in the industry. Much of my career has been remote. My income is not out of line with most STEM fields. The main benefit for me was the ability to work remotely, moving with my wife to various small towns/cities. Keep in mind, my wife had almost 10 years of med school and residency to start her career. I was making income the whole time. That's essentially a $1M difference 10 years into careers. It takes a while to overcome that gap. ----- > 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. Yep. There's also a huge personal burden of carrying that non-dischargable debt. If residency doesn't work out for some reason, you're in a huge hole. We know many physicians who say they wouldn't do it again if they had know how shitty the journey would be.

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.

s1artibartfast 3y ago
>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. I would argue that it largely is just made up boundaries to benefit existing members. That is to say, regulatory capture has increased the barriers so far that any benefit from additional quality of service is far outweighed by the increased scarcity. It doesn't matter if you have the best doctors and electricians in the world, if they are so few and expensive that the public does not have access to them. The fundamental problem is that is both easy and popular to error on the side of "caution", creating increasingly stringent licensing requirements. These benefit established interests and sound attractive to the public.
- Guvante 3y ago
  I don't disagree but I like to distinguish between "there shouldn't be barriers" and "there should be fewer barriers" and the verbiage I responded to felt like the former.
cameronh90 3y ago
I don’t think you can reasonably draw a comparison from medicine to home electrics and plumbing. My dad was a plumber and I’m preparing to pass the certification that permits me to work on home electrics. They are, to be blunt, easy. An average person can pick up most of it in a couple of months. Electrics and gas plumbing carry a certification requirement because an error can kill someone, but it’s easier than passing a driving test. Obviously, there are higher tiers of those trades that require a lot more training, but even those aren’t really comparable to the level of knowledge and study needed to become a qualified doctor, let alone a consultant. In the UK, shortages of tradespeople are less to do with the difficulty of training, or lack of course capacity, and more to do with people really just not wanting to do the job, for various reasons.
- lesam 3y ago
  Medicine has more barriers to entry at least partly because we’ve decided to erect them. Doctors learn all kinds of things outside their direct specialty that they don’t really need to know, but nobody inside the system has an incentive to streamline medical education or to encourage more and earlier specialization. For example, we force most doctors to take a 4 year degree before medicine (sometimes pre-med, but often an arts or non-biological science degree). Wasting 4 years of a future doctor’s prime career on an expensive and often irrelevant screening program is extremely wasteful for society as a whole.

P_I_Staker 3y ago

Problems are doctors are unlikely to "help" with, and are highly likely to make matters much, much worse. Also, contrary to popular opinion, there's little stigma or awareness of "bad doctoring", for a number of systemic reasons. So you have someone who doesn't give a fuck about anything, certainly not your situation, not listening to you, and trying to prevent you from receiving medical treatment. This doesn't look so necessary to me. I know there will still be medical experts and surgeons and so forth, but much of this medical infrastructure doesn't benefit the average citizen (I know there's an argument that it does or for a change in perspective, but that's a whole different can of worms. Similar to policing, if you think of the typical way you interact with the medical system, you start to realize there's very little in there to help you. 99.99% of the infrastructure is built to benefit powerful people with tons of money; helping you is an after thought. What happens when you're a victim of crime? Turns out there's very little in place to help. Oh, someone is actively trying to murder you? well give us a call after it happens and maybe we'll investigate. How many of us have experienced something like this? I'm not saying there's no reason for the arrangement, but we should stop trying to pretend these people are looking out for the public. I know people may be tempted to chime in regarding some situation a police officer or doctor helped you. I'm not saying you're wrong, just explaining why some people are asking questions; if you honestly think about it, your naive assumptions about safety and health will be shattered. A doctor, in many ways, arguably has a patients WORST interests at heart, in a similar manor to a police officer, in it's interaction with the public. They have, as their most important responsibilities, to detect certain things, and take actions to hurt the person. This is priority #1, virtually everything else comes after. This is an important observation, is not obvious, and should cause us to reconsider these institutions.

burnerburnito 3y ago
Perhaps a more diplomatic to phrase what I perceive as your thought there is that a good doctor or policeman is actually in some respects often acting that way regardless of the system -- they would've tried to help people as much as they could anyway. Meanwhile a bad or apathetic doctor, policeman, etc. will tend to receive little friction for it while you have to fight uphill to get basic care, all while being milked of as much of your money as possible and still having to wait unbearably long for useful treatment. Likewise, there's such a range of outcomes, and when it's involving chronic diseases combined with an apathetic or bad doctor, you can be stuck realizing you've wasted months with no resolution (not even getting into any potential costs) only to now have to start all over again potentially several more times just for a sliver of hope that you'll find a doctor who's caring and competent enough to finally help you out. So sitting on the receiving end feels like being bled dry by people who couldn't care less about your suffering or if you die, so long as you keep paying them, with little realistic recourse other than accepting that you got burned and moving on. In any case, just my two cents from what I think seems like a somewhat related view but with a different "spin".

dylan604 3y ago

>to artificially reduce the work force to benefit current workers at the cost of future workers is that really the purpose? or is it that an entire industry has been built on top of the trades, and that industry does whatever to continue to grow?

aborsy 3y ago

There can be more schooling and training in engineering. After undergrad, master’s, PhD, a postdoc or two, one would still make low income. After that, there is a never ending path where one has to constantly chase ever changing technologies. The older you get, the harder it will be to keep up and remain employed. In medical science, you finish the residency (roughly equivalent to 1-2 postdoc in engineering), and you start to practice. Already, income is OK in residency. The older you get, the better!

classichasclass 3y ago
The income is most assuredly not okay in residency, or for that matter, fellowship. Most U.S. residencies and fellowships range from $60-$70K a year, basically the U.S. median income, and on a per hour basis is terrible.
- haldujai 3y ago
  To make it worse many of the big name institutions one would aspire to train in (e.g. 10 of the US News top 20 hospitals) are in expensive metros where you don't cross the "low-income line" until the third year of residency. All the while spending 60-80 hours a week on clinical service and 5-10 hours on research and education so you can maybe get a job somewhere not remote when you're done.

robocat 3y ago

> We're all gonna need medical help some day... 95% of health is being proactive about your health: food, fitness, sleep, dentist, etcetera. I wonder how much doctoring is due to negligence of a healthy lifestyle, or perhaps chronic choices (addictive substances like alcohol, shift-work). > But we're all going to have severe medical problems at some point. Which often are untreatable - and the doctoring is regularly prophylactic. Hip-replacements are an obvious outlier.

Capricorn2481 3y ago
> 95% of health is being proactive about your health: food, fitness, sleep, dentist, etcetera. Maybe 70%? Genetics play a huge role. You will likely need a doctor if your family has a long history of cancer.
BeetleB 3y ago
> 95% of health is being proactive about your health: food, fitness, sleep, dentist, etcetera. You're young, aren't you? The percentage is significant, but nowhere near 95%.
- robocat 3y ago
  I'm middle-aged. I might be over-estimating the percentage. I might also be over-estimating how much we can affect diabetes, weight, fitness, addiction. I can say that the chronic health problems of my peer-group often appear to be self-inflicted. Of my dead acquantances there are maybe a few groups: (1) health problems caused by childhoods of poverty, (2) health problems that we haven't solved yet which the medical system helps little, (3) suicides, (4) crashes/accidents, and (5) health problems caused by smoking, drinking and drugs (e.g. HepC). Also acquaintances with chronic conditions often don't follow medical advice anyway e.g. diabetic friends that abuse their bodies. Or people told to quit drinking or smoking that do not stop. I'm not saying it is easy. I am saying I know plenty of acquantances that have made difficult choices to improve their lifestyle choices (presuming cause not correlation), and others that have not made positive changes. Context: I'm in New Zealand, so healthcare is mostly free and of reasonable quality. We have lots of immigrants so I have some exposure to people from other (often adjacent) cultures.

SkyPuncher 3y ago

> I just want to point out that - you landed (probably more random than intentional) into arguably the best career in the history of labor. I don't disagree. However, I certainly am not a top earner in the industry. Much of my career has been remote. My income is not out of line with most STEM fields. The main benefit for me was the ability to work remotely, moving with my wife to various small towns/cities. Keep in mind, my wife had almost 10 years of med school and residency to start her career. I was making income the whole time. That's essentially a $1M difference 10 years into careers. It takes a while to overcome that gap. ----- > 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. Yep. There's also a huge personal burden of carrying that non-dischargable debt. If residency doesn't work out for some reason, you're in a huge hole. We know many physicians who say they wouldn't do it again if they had know how shitty the journey would be.