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An associated problem is that bright people from rural or poor areas who are really passionate about being a doctor dont get the right grades to get in. Middle

by rr808 3y ago

An associated problem is that bright people from rural or poor areas who are really passionate about being a doctor dont get the right grades to get in. Middle class kids in cities get in because its a good career but dont really like it that much and definitely dont want to work outside their city. My brother worked as a doctor until his thirties then quit, such a waste of training.

space_oddity 3y ago
If I think about it.. it's unfortunate that access to medical education and careers can be limited by factors such as socioeconomic background or geographical location... If I understand correctly
jajko 3y ago
In Switzerland, at least for the french part, most of the doctors are not Swiss anymore. It literally became white collar immigrant job. Wife is one of those and sees the problem very clearly due to speaking about this with both (those few) swiss colleagues and the rest - its simply not attractive career path for locals, too much suffering and risk for relatively little reward. Those bright enough go to law, IT and similar. Speaking for my wife, she had to wade through absolutely brutal first 10 years for absolutely no good reason (she ain't no neurosurgeon, just internal medicine GP with FMH), no personal life at all at the prime of her life. 50 work week in contract (when average here is 42), reality with all required bureaucracy goes to 60-70, for everybody, consistently, unpaid (illegal here but who cares, state owns the hospital), often much more and catching up with tons of bureaucracy/billing at home. Add night shifts, which most of us elsewhere have no experience with, that mess you up for many further days. You are a fraction of yourself, mentally and physically, for easily a week, more if you had to go through say 4-5 in a row. These are the conditions that we put repeatedly people who have full control over life and death and health of their patients, often without further supervision, hoping they somehow magically never ever make a mistake, and when they do, folks immediately cry a murder and families sue to hell with massive dollar signs in their eyes. You complain about that, or that you spend whole weekend being on call 48h unable to do anything really for literally 20 USD altogether (price of a canteen lunch here), including when you have to come and work 10-hour shift? You are put under pressure, shushed for being a pussy if you complain, told to toughen up since previous generations had it even tougher, and they somehow got through. Nobody mentions how horrible parents those absent folks were, how burned out they often were, quietly weeping or drinking themselves into oblivion. Well yes, those that didn't just quit, didn't go insane, didn't commit suicide, sure they got through. And now enjoy seeing young going through a bit milder version of the same. Of course there are insane amounts of money involved, but its always between insurance and hospital, doctors get less than capable IT folks for much less work. I am IT guy and consider this utterly fucked up wrong. A good friend of ours sued the hospital (biggest public in Switzerland) for breaking basic Swiss law consistently like that, he was first but quickly gathered tons of other doctors. IIRC hospital finally caved in, a bit, but he is gone from it for good to private sector. Twice the pay, half the crap. I could go on and on like this, a lot of doctor friends in our circles. It ain't some dream job, (at least a bit well-placed) IT job is a blessing in comparison. /rant
- rr808 3y ago
  I think its similar worldwide. Like I said my brother quit. Its also true that IT people are ridiculously overpaid. Both problems will inevitably revert to the mean.
  - catlikesshrimp 3y ago
    Not everywhere though. The life of a doctor is much better in Costa Rica, even in public institutions. The extra time is paid. And the syndicates are strong (which has worked well) The doctors in Nicaragua, the neighboring country, is as described in your comment, except the economy of the whole country is in shambles, and they also have to "voluntarily" participate in "government" political activities. Oh, and since the country is poor there are no immigrants waiting in line to fulfill those positions.
    - mewpmewp2 3y ago
      But Costa Rica has one of the longest wait times for non emergency surgeries. https://www.oecd-ilibrary.org/sites/f8ac5867-en/index.html?itemId=/content/component/f8ac5867-en https://www.oecd-ilibrary.org/sites/f8ac5867-en/index.html?i... So high wait times there doesn't sound entirely perfect either.
      - _heimdall 3y ago
        Wouldn't this partly be a sign of markets deciding what wait time is worth it? For non-emergency surgery, like cataracts or knee replaces cited in the data, people can live with the conditions. It looks like wait times are consistent, meaning the backup isn't growing steadily over time. I'm pretty sure that would mean different populations just have a different threshold for how long they're willing to wait. If it was a consistent imbalance between the number of surgeries needed and the medical capacity I would expect to see wait times grow over time.
      - xiwenc 3y ago
        Perhaps this is related to the fact: Cost of medical treatment and holidays included still cheaper than America? Fits perfectly for non-emergencies.
lilsoso 3y ago
We should enforce rigorous qualifications for doctors. We've relaxed the standards far too much already.
- archagon 3y ago
  Qualifications should come at the end of your education, not at the start.
  - Wowfunhappy 3y ago
    Educating doctors is really expensive. It would really suck to invest all that money in someone (or in yourself) just for them to fail a final test or whatever. For what it's worth, I do agree we should train more doctors, but I think it's a complicated problem.
    - ejstronge 3y ago
      > Educating doctors is really expensive. It would really suck to invest all that money in someone (or in yourself) just for them to fail a final test or whatever. This happens already, today. There are dozens of reasonable questions you can raise based on this fact - but I don't think it's obvious that the failures at the end of training can majoritarily be identified by pre-training metrics. Some countries allow any student to take the first two years of medical courses, and then impose restrictions on the following years. This seems a relatively fair system; you can imagine someone persevering over many years to attain the requisite knowledge - but this person would not have had the opportunity if there were a pre-medical school filter
- casenmgreen 3y ago
  We do not need all doctors to be uber doctors. We need a range of doctors, who range in price according to quality. That way for simple stuff, which anyone can get right, we go to a cheap, reasonable doctor. A similar example would be if we only had uber software engineers. Each one had to have a PhD. There were no cheap and okay developers who could do say web-sites but not write a programming language from scratch.
throwaway2037 3y ago
Why did he quit? Burnout? And what career did he switch to?
peterfirefly 3y ago
> An associated problem is that bright people from rural or poor areas who are really passionate about being a doctor dont get the right grades to get in. This is unlikely to be true.

by rr808 3y ago

space_oddity 3y ago

If I think about it.. it's unfortunate that access to medical education and careers can be limited by factors such as socioeconomic background or geographical location... If I understand correctly

jajko 3y ago

In Switzerland, at least for the french part, most of the doctors are not Swiss anymore. It literally became white collar immigrant job. Wife is one of those and sees the problem very clearly due to speaking about this with both (those few) swiss colleagues and the rest - its simply not attractive career path for locals, too much suffering and risk for relatively little reward. Those bright enough go to law, IT and similar. Speaking for my wife, she had to wade through absolutely brutal first 10 years for absolutely no good reason (she ain't no neurosurgeon, just internal medicine GP with FMH), no personal life at all at the prime of her life. 50 work week in contract (when average here is 42), reality with all required bureaucracy goes to 60-70, for everybody, consistently, unpaid (illegal here but who cares, state owns the hospital), often much more and catching up with tons of bureaucracy/billing at home. Add night shifts, which most of us elsewhere have no experience with, that mess you up for many further days. You are a fraction of yourself, mentally and physically, for easily a week, more if you had to go through say 4-5 in a row. These are the conditions that we put repeatedly people who have full control over life and death and health of their patients, often without further supervision, hoping they somehow magically never ever make a mistake, and when they do, folks immediately cry a murder and families sue to hell with massive dollar signs in their eyes. You complain about that, or that you spend whole weekend being on call 48h unable to do anything really for literally 20 USD altogether (price of a canteen lunch here), including when you have to come and work 10-hour shift? You are put under pressure, shushed for being a pussy if you complain, told to toughen up since previous generations had it even tougher, and they somehow got through. Nobody mentions how horrible parents those absent folks were, how burned out they often were, quietly weeping or drinking themselves into oblivion. Well yes, those that didn't just quit, didn't go insane, didn't commit suicide, sure they got through. And now enjoy seeing young going through a bit milder version of the same. Of course there are insane amounts of money involved, but its always between insurance and hospital, doctors get less than capable IT folks for much less work. I am IT guy and consider this utterly fucked up wrong. A good friend of ours sued the hospital (biggest public in Switzerland) for breaking basic Swiss law consistently like that, he was first but quickly gathered tons of other doctors. IIRC hospital finally caved in, a bit, but he is gone from it for good to private sector. Twice the pay, half the crap. I could go on and on like this, a lot of doctor friends in our circles. It ain't some dream job, (at least a bit well-placed) IT job is a blessing in comparison. /rant

rr808 3y ago
I think its similar worldwide. Like I said my brother quit. Its also true that IT people are ridiculously overpaid. Both problems will inevitably revert to the mean.
- catlikesshrimp 3y ago
  Not everywhere though. The life of a doctor is much better in Costa Rica, even in public institutions. The extra time is paid. And the syndicates are strong (which has worked well) The doctors in Nicaragua, the neighboring country, is as described in your comment, except the economy of the whole country is in shambles, and they also have to "voluntarily" participate in "government" political activities. Oh, and since the country is poor there are no immigrants waiting in line to fulfill those positions.
  - mewpmewp2 3y ago
    But Costa Rica has one of the longest wait times for non emergency surgeries. https://www.oecd-ilibrary.org/sites/f8ac5867-en/index.html?itemId=/content/component/f8ac5867-en https://www.oecd-ilibrary.org/sites/f8ac5867-en/index.html?i... So high wait times there doesn't sound entirely perfect either.
    - _heimdall 3y ago
      Wouldn't this partly be a sign of markets deciding what wait time is worth it? For non-emergency surgery, like cataracts or knee replaces cited in the data, people can live with the conditions. It looks like wait times are consistent, meaning the backup isn't growing steadily over time. I'm pretty sure that would mean different populations just have a different threshold for how long they're willing to wait. If it was a consistent imbalance between the number of surgeries needed and the medical capacity I would expect to see wait times grow over time.
    - xiwenc 3y ago
      Perhaps this is related to the fact: Cost of medical treatment and holidays included still cheaper than America? Fits perfectly for non-emergencies.

lilsoso 3y ago

We should enforce rigorous qualifications for doctors. We've relaxed the standards far too much already.

archagon 3y ago
Qualifications should come at the end of your education, not at the start.
- Wowfunhappy 3y ago
  Educating doctors is really expensive. It would really suck to invest all that money in someone (or in yourself) just for them to fail a final test or whatever. For what it's worth, I do agree we should train more doctors, but I think it's a complicated problem.
  - ejstronge 3y ago
    > Educating doctors is really expensive. It would really suck to invest all that money in someone (or in yourself) just for them to fail a final test or whatever. This happens already, today. There are dozens of reasonable questions you can raise based on this fact - but I don't think it's obvious that the failures at the end of training can majoritarily be identified by pre-training metrics. Some countries allow any student to take the first two years of medical courses, and then impose restrictions on the following years. This seems a relatively fair system; you can imagine someone persevering over many years to attain the requisite knowledge - but this person would not have had the opportunity if there were a pre-medical school filter
casenmgreen 3y ago
We do not need all doctors to be uber doctors. We need a range of doctors, who range in price according to quality. That way for simple stuff, which anyone can get right, we go to a cheap, reasonable doctor. A similar example would be if we only had uber software engineers. Each one had to have a PhD. There were no cheap and okay developers who could do say web-sites but not write a programming language from scratch.

throwaway2037 3y ago

Why did he quit? Burnout? And what career did he switch to?

peterfirefly 3y ago

> An associated problem is that bright people from rural or poor areas who are really passionate about being a doctor dont get the right grades to get in. This is unlikely to be true.