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> If doctors don't have enough time, then there aren't enough doctors. It's not until around 1950 that medicine becomes a virtually guaranteed path to being in

> If doctors don't have enough time, then there aren't enough doctors. It's not until around 1950 that medicine becomes a virtually guaranteed path to being in the top 1-2%. It's not until the late 70s that it's viable for anyone almost anyone (people without already wealthy parents). It's not until the late 90s that the average person who cares about nothing but money has figured out that medicine is a virtually guaranteed ticket to being "rich". I think the problem stems from there being too many people in the profession that care about almost nothing but having a lot of money - which isn't any different from most professions where you can make a ton of money. I do believe that the vast majority of doctors, especially older ones, AT THE VERY LEAST have decent intentions. But even a very small percentage of wildly greedy people can damage a system severely. I'm not sure how you put Pandora back in the box here. At the end of the day, good doctors are providing a service of almost unlimited value. Modern medicine is basically a miracle if you're literally about to die.

fn-mote 1y ago
I disagree with most of the argument in the parent > I think the problem stems from there being too many people in the profession that care about almost nothing IMO you need to substantiate this claim. > even a very small percentage of wildly greedy people can damage a system severely This is medicine you're talking about. If the doctor doesn't have contact with patients, they aren't affecting them. I just cannot follow the claim that a greedy doctor can have an outsized effect. What is the mechanism? (Half a joke, to make my point:) Greedy doctors aren't like greedy venture capitalists... It seems like they can only suck $500k out of the system every year.
- ridgeguy 1y ago
  There are amplifiers that increase the suck. One is physician ownership of diagnostic clinic(s). A strong tendency to order tests can be remarkably enriching, way more than a paltry $500K.
  - epmaybe 1y ago
    Isn't that a Stark law violation?
    - GoodOldNe 1y ago
      It's complicated. Physicians can own imaging equipment, for example, but they can't require you to use it for the radiology tests that they order. There are weird carve-outs for in-office ancillary services (e.g. you're an orthopedic surgeon who uses x-rays in your office, which is common and arguably necessary). There's also rules regarding things like percentage ownership of physician owned facilities and the percentage of referrals to that equipment that come from the physician owners. Urine drug screens in an in-office "lab" are another big source of revenue for certain specialties that involve referring patients to your own tests, or doing your own pathology on biopsies as a dermatologist or whatever. My understanding is that most of those things, and many like them, are not Stark law violations.
  - MR_Bulldops 1y ago
    Can you provide any proof of this?
derektank 1y ago
It's no longer a guaranteed path to being rich, for the record. Since the 1990s, the average income of physicians has grown at less than the rate of inflation (Median physician compensation was ~$140k in 2000 and is ~$240k today). It's gone from being maybe a top 2% income to being a top 10% income. Not to say it's not still remunerative, or anyone is going to go poor choosing to become a doctor, but there are other paths to a good wage that don't require 8 years of schooling or nearly as much student debt.
- LPisGood 1y ago
  240k as an individual is a lot higher than top 10% of American incomes.
  - derektank 1y ago
    It's around the 5th percentile but obviously half of physicians make less than that
  - framerjohn 1y ago
    Inflation has jacked up salaries and rates. There’s a big disparity now depending on whether salaries have been adjusted.
- Auracle 1y ago
  Name another "standard" profession that makes a median of 240k per year.
  - derektank 1y ago
    Airline pilots make about $230K
MR_Bulldops 1y ago
Doctors, especially young doctors, are not the wildly greedy people you paint them to be. There are dozens of easier paths to riches these days than medicine and we all know it. My medical school is "cheap" and tuition + cost of living is ~$90k/year. Then, we have 3-7 years of residency before we start making the real money which is less than any generation of doctors in 100 years. I could become a senior software engineer at a Fortune 50 company in less time than it takes to graduate medical school and be better off financially than most doctors. Ask me how I know. "But even a very small percentage of wildly greedy people can damage a system severely." You are close to placing the blame in the correct place. My emergency department was just bought by a private equity group. There were 28 doctors. Most of whom worked there because they could spend adequate time with patients and work a reasonable schedule. After the PE company bought us, they mandated less of EVERY position from CNA to MD. The MD headcount is now 11, and the 17 physicians who are looking for jobs are having a tough time (relatively) because most other emergency departments in the area are also owned by PE firms who care about money over health outcomes. Those are the greedy people damaging the system you are looking for.
- bluefirebrand 1y ago
  Private Equity is probably responsible for a lot of the ills that are harming society in general, it goes way past their involvement in healthcare imo

fn-mote 1y ago

I disagree with most of the argument in the parent > I think the problem stems from there being too many people in the profession that care about almost nothing IMO you need to substantiate this claim. > even a very small percentage of wildly greedy people can damage a system severely This is medicine you're talking about. If the doctor doesn't have contact with patients, they aren't affecting them. I just cannot follow the claim that a greedy doctor can have an outsized effect. What is the mechanism? (Half a joke, to make my point:) Greedy doctors aren't like greedy venture capitalists... It seems like they can only suck $500k out of the system every year.

ridgeguy 1y ago
There are amplifiers that increase the suck. One is physician ownership of diagnostic clinic(s). A strong tendency to order tests can be remarkably enriching, way more than a paltry $500K.
- epmaybe 1y ago
  Isn't that a Stark law violation?
  - GoodOldNe 1y ago
    It's complicated. Physicians can own imaging equipment, for example, but they can't require you to use it for the radiology tests that they order. There are weird carve-outs for in-office ancillary services (e.g. you're an orthopedic surgeon who uses x-rays in your office, which is common and arguably necessary). There's also rules regarding things like percentage ownership of physician owned facilities and the percentage of referrals to that equipment that come from the physician owners. Urine drug screens in an in-office "lab" are another big source of revenue for certain specialties that involve referring patients to your own tests, or doing your own pathology on biopsies as a dermatologist or whatever. My understanding is that most of those things, and many like them, are not Stark law violations.
- MR_Bulldops 1y ago
  Can you provide any proof of this?

derektank 1y ago

It's no longer a guaranteed path to being rich, for the record. Since the 1990s, the average income of physicians has grown at less than the rate of inflation (Median physician compensation was ~$140k in 2000 and is ~$240k today). It's gone from being maybe a top 2% income to being a top 10% income. Not to say it's not still remunerative, or anyone is going to go poor choosing to become a doctor, but there are other paths to a good wage that don't require 8 years of schooling or nearly as much student debt.

LPisGood 1y ago
240k as an individual is a lot higher than top 10% of American incomes.
- derektank 1y ago
  It's around the 5th percentile but obviously half of physicians make less than that
- framerjohn 1y ago
  Inflation has jacked up salaries and rates. There’s a big disparity now depending on whether salaries have been adjusted.
Auracle 1y ago
Name another "standard" profession that makes a median of 240k per year.
- derektank 1y ago
  Airline pilots make about $230K

MR_Bulldops 1y ago

Doctors, especially young doctors, are not the wildly greedy people you paint them to be. There are dozens of easier paths to riches these days than medicine and we all know it. My medical school is "cheap" and tuition + cost of living is ~$90k/year. Then, we have 3-7 years of residency before we start making the real money which is less than any generation of doctors in 100 years. I could become a senior software engineer at a Fortune 50 company in less time than it takes to graduate medical school and be better off financially than most doctors. Ask me how I know. "But even a very small percentage of wildly greedy people can damage a system severely." You are close to placing the blame in the correct place. My emergency department was just bought by a private equity group. There were 28 doctors. Most of whom worked there because they could spend adequate time with patients and work a reasonable schedule. After the PE company bought us, they mandated less of EVERY position from CNA to MD. The MD headcount is now 11, and the 17 physicians who are looking for jobs are having a tough time (relatively) because most other emergency departments in the area are also owned by PE firms who care about money over health outcomes. Those are the greedy people damaging the system you are looking for.

bluefirebrand 1y ago
Private Equity is probably responsible for a lot of the ills that are harming society in general, it goes way past their involvement in healthcare imo