4 ms·

>this assumes the main motivation is money People evaluate pay to quality of life at work ratio, not just pay (although it is most commonly referred to as pay

>this assumes the main motivation is money People evaluate pay to quality of life at work ratio, not just pay (although it is most commonly referred to as pay to avoid writing or saying all of that out). You cannot expect a person to come out of school at 30 to 35 years old with $300k+ of debt after working 80 hour weeks during their 20s and slaving away in residency and not expect a decent pay to quality of life at work ratio. If you do not increase quality of life to make up for lower pay, you will end up with less driven or less capable people. Note that quality of life also includes security of income, which can reduce that type of stress.

bumby 2y ago
I agree and I think that supports the idea that salary alone is a bad metric for skills. Many people will take a lower pay to support a mission they are passionate about. To claim that makes them lower skilled or that they couldn’t get a higher paying job elsewhere is an overly simplified mental model. Sometimes the job itself is what leads to the higher quality of life.
- lotsofpulp 2y ago
  No one is passionate about taking care of too many patients and making sure they document everything to the T to prioritize not being sued for millions of dollars.
  - bumby 2y ago
    This is a different argument. And there are plenty of people who put up with the bad parts of a job because the good parts are rewarding. Nobody should be so naive to think every job is all rainbows and puppy breath. If your stance is that the healthcare system needs improvement, I’d agree. If your point is that the best doctors are the people who have money as their top priority, I’d disagree. I’d extend the latter to say, we may not get a better healthcare system by just paying people more. Throwing more money at a bad system tends to make a worse system. Do you think we’d get better doctors if we could create a new system that lets them focus the majority of their effort on patient care, or if we kept the current system and just gave all physicians pay raises?
    - lotsofpulp 2y ago
      >Throwing more money at a bad system tends to make a worse system. There are most likely decreasing returns on both ends of the scale. >Do you think we’d get better doctors if we could create a new system that lets them focus the majority of their effort on patient care, or if we kept the current system and just gave all physicians pay raises? "A new system" is too nebulous, but step by step reform is the obvious way forward. From decreasing unnecessary requirements for new doctors (there must be a way to not have to completely sacrifice one's 20s and early 30s and still become a doctor), to tort reform that allows for sensible judgments, to increasing funding for residency and medical schools to allow for higher supply of doctors, etc. Also, doctor pay (per hour or per patient) has been declining in real terms for many, many years now. Which is not bad in and of itself, but when you are simultaneously decreasing remuneration and quality of life at work, intelligent people will pick up on that signal to look elsewhere to sell their services. A lot of US healthcare is performed by smart people from poorer countries who just want a chance for their kids to grow up in the USA. That the country relies on that arbitrage has always been ridiculous to me.
      - bumby 2y ago
        I agree with basically all of this. The one distinction I would make is that the pay reduction is real terms is across all kinds of domains so I don’t think it’s particularly unique of physicians, but part of a larger issue. Same with the cost of education/training etc. In other words, I think the healthcare issues you highlight may be emblematic of bigger systemic problems. With all that said, it’s still a different argument than “pay = ability”. Put differently: the $ amount in TFA could be used to increase Congress member pay from $174k to $10MM each. Do you think that would result in better politicians?
        wat10000 2y ago
        I do think substantially increasing Congress’s pay would result in better politicians. Dishonest people who are only in it for the money can find plenty of ways to profit from the office. As it stands, $174k is not a whole lot of money for a job that requires a ton of travel to the extent of basically requiring you to own two houses. This low pay means that non-wealthy members of Congress have a hard time of it. Non-wealthy people who would be good in Congress but don’t want to have that much hardship will bow out, or work around it with corruption. Low pay selects for rich and corrupt politicians. Someone who just wants to be in Congress to make a sweet $10 million in honest pay would be infinitely better than most of the people there right now.
Gud 2y ago
Why should they come out of university with $300k+ in debt and do 80 hour weeks?! Sounds insane to me!

bumby 2y ago

I agree and I think that supports the idea that salary alone is a bad metric for skills. Many people will take a lower pay to support a mission they are passionate about. To claim that makes them lower skilled or that they couldn’t get a higher paying job elsewhere is an overly simplified mental model. Sometimes the job itself is what leads to the higher quality of life.

lotsofpulp 2y ago
No one is passionate about taking care of too many patients and making sure they document everything to the T to prioritize not being sued for millions of dollars.
- bumby 2y ago
  This is a different argument. And there are plenty of people who put up with the bad parts of a job because the good parts are rewarding. Nobody should be so naive to think every job is all rainbows and puppy breath. If your stance is that the healthcare system needs improvement, I’d agree. If your point is that the best doctors are the people who have money as their top priority, I’d disagree. I’d extend the latter to say, we may not get a better healthcare system by just paying people more. Throwing more money at a bad system tends to make a worse system. Do you think we’d get better doctors if we could create a new system that lets them focus the majority of their effort on patient care, or if we kept the current system and just gave all physicians pay raises?
  - lotsofpulp 2y ago
    >Throwing more money at a bad system tends to make a worse system. There are most likely decreasing returns on both ends of the scale. >Do you think we’d get better doctors if we could create a new system that lets them focus the majority of their effort on patient care, or if we kept the current system and just gave all physicians pay raises? "A new system" is too nebulous, but step by step reform is the obvious way forward. From decreasing unnecessary requirements for new doctors (there must be a way to not have to completely sacrifice one's 20s and early 30s and still become a doctor), to tort reform that allows for sensible judgments, to increasing funding for residency and medical schools to allow for higher supply of doctors, etc. Also, doctor pay (per hour or per patient) has been declining in real terms for many, many years now. Which is not bad in and of itself, but when you are simultaneously decreasing remuneration and quality of life at work, intelligent people will pick up on that signal to look elsewhere to sell their services. A lot of US healthcare is performed by smart people from poorer countries who just want a chance for their kids to grow up in the USA. That the country relies on that arbitrage has always been ridiculous to me.
    - bumby 2y ago
      I agree with basically all of this. The one distinction I would make is that the pay reduction is real terms is across all kinds of domains so I don’t think it’s particularly unique of physicians, but part of a larger issue. Same with the cost of education/training etc. In other words, I think the healthcare issues you highlight may be emblematic of bigger systemic problems. With all that said, it’s still a different argument than “pay = ability”. Put differently: the $ amount in TFA could be used to increase Congress member pay from $174k to $10MM each. Do you think that would result in better politicians?
      - wat10000 2y ago
        I do think substantially increasing Congress’s pay would result in better politicians. Dishonest people who are only in it for the money can find plenty of ways to profit from the office. As it stands, $174k is not a whole lot of money for a job that requires a ton of travel to the extent of basically requiring you to own two houses. This low pay means that non-wealthy members of Congress have a hard time of it. Non-wealthy people who would be good in Congress but don’t want to have that much hardship will bow out, or work around it with corruption. Low pay selects for rich and corrupt politicians. Someone who just wants to be in Congress to make a sweet $10 million in honest pay would be infinitely better than most of the people there right now.

Gud 2y ago

Why should they come out of university with $300k+ in debt and do 80 hour weeks?! Sounds insane to me!