20 ms·

Why doctors are sick of their profession

123 points by roye 12y ago

ihsanyounes90 12y ago
In my opinion(and general opinion), this is the most important job. Maybe we can find someone depressed(like in the article), but come on they save lives.
- jmspring 12y ago
  It is critical, but given sheer number of lives impacted daily, I rank teaching higher. Especially given the pay disparity.
- gulfie 12y ago
  Everyone dies, no one gets saved forever. Plumbers and garbage men saved more lives in the past century than doctors. (so I hear)
- nhstanley 12y ago
  > but come on they save lives. I'm going to say something controversial here, but please bear with me. Your statement sort of encompasses several parts of this problem. Some doctors are miracle workers (see [1] below), but most doctors are glorified auto mechanics. I don't say that to downplay the amount of intelligence/skill required for the job, but if you think of most doctors as "saving lives", then you obviously haven't spent a lot of time around doctors/clinics/hospitals. Most doctors rarely save lives, and often when they do it wasn't them that really did the critical life saving steps, they're just the interface the sick person is interacting with. Most doctors deal with a series of inputs (symptoms and circumstances) and output a solution (diagnosis and remedy), which requires very little critical thinking on their part. Sick kids with the flu. Idiots that took too many drugs that need fluids, benzos, cypro, or an ice bath. People at mid-life who made shitty decisions for most of their lives and now need Lipitor/Coumadin/a treadmill/a gravestone. The truth is most doctors get paid a lot because people erroneously assign to them the ethos of miracle workers, when most of them aren't. In fact, they often can't even do anything for their patients (see above, such kids with the flu, old people who've made shitty decisions their whole lives). The cures really come from researchers and pharma companies that come up with drugs and treatments for these incredibly difficult problems. If doctors deserve their paychecks, it's because they keep alive the illusion society wants. The illusion that when something is wrong, the doc will fix them up good. And indeed that's basically what the article is about. Doctors demand respect and to be paid to keep up the illusion and to deal with the bullshit. [1] Obvious and important exceptions to this are ER docs and trauma surgeons, who indeed save lives. There are also clinical doctors, who work tirelessly with armies of researchers to try to find new cures for cancers, autoimmune and genetic disorders (among many other things). There are surgeons who come up with new procedures to reduce the invasiveness and trauma of procedures. These are the people that deserve the lion's share of the praise that goes towards doctors, and they should get the lions share of the money as well (some certainly do). In this whole rant, I'm not trying to lay blame on doctors for the whole mess, because problems come from all sides, as I've hinted. Patients have unrealistic expectations of what doctors can do, the health industry is trying to low-ball doctors (not always without reason) to maximize profits, and many doctors who thought they would be genuinely helping people are realizing in reality that fate is largely decided before they even meet their patient (as a criminal lawyer friend put it, "90% of my client's case is decided before I ever meet him, but he wants me to work miracles!"). This is specifically why I didn't continue into medicine like so many of my friends. If you really want to help people, you don't become a regular doctor. You become a thoracic surgeon, or you do basic research, or you work in pharma, or you start a biotech. That's how you cure people. But no one will praise you for it.
  - jrapdx3 12y ago
    Practicing medicine for decades gives me some "perspective" on the subject. No one in medicine is a "miracle worker", though many of us work hard to the job responsibly. You are wrong. We do "save lives", and not just in the ED. Every day, if not as dramatically, immediately or even noticeably, our incremental toil helps patients progress bit-by-bit toward better health. Managing chronic, debilitating conditions really does enable patients to live longer and more fully. You are also wrong regarding income. Doctors in the US are getting paid less and less, while expenses of practice go ever higher. My own income is probably less than most of the people I know in other professions. The "mess" of the health care system (to the extent it is even systematic) is the result of the constant assault of corporations and governments at all cost to "reduce costs", but the result has been the degradation you and others notice. The most conspicuous evil has been perpetrated by the insurance industry. For example, amazingly short-sighted insistence on paying for a "generic" medication $3/mo cheaper than the drug already working is an every day challenge. If patients don't get what is really needed, they wind up getting sicker, need more care, the result is more money spent, not saved. The problem is that the industrialization of medicine makes it increasingly difficult to be helpful. People are not neat little uniform units produced in factories. People are enormously complex organisms that defy all rules we invent to "explain" illness and treatment. People are unique entities that require individual attention and customized approaches if true "health care" is going to be provided. If doctors are given the resources, time and respect to do their work, I believe almost all will strive to do it right.
    - pinkyand 12y ago
      > The problem is that the industrialization of medicine makes it increasingly difficult to be helpful. Atul gawande, which is a doctor and a healthcare journalist ,and knows the medical system from inside, thinks that industrialized medicine is exactly what's needed: http://www.newyorker.com/magazine/2012/08/13/big-med http://www.newyorker.com/magazine/2012/08/13/big-med And in general the positive results from decision support systems seem to agree with him.
      - jrapdx3 12y ago
prestadige 12y ago
Going into a career because it's noble, rewarding or because it "helps people" seems like a mistake.
- StavrosK 12y ago
  Going into a career because it's rewarding seems like a mistake?
  - adamnemecek 12y ago
    I think he meant financially.
    - prestadige 12y ago
      I think it's a mistake whether for financial reasons or in terms of personal satisfaction. You go into a field because you are interested in learning and engaging with the problems in that field. Not for status or rewards. You can't enter a profession on the basis that it will be personally rewarding. You can only leave because it turns out not to be.
    - StavrosK 12y ago
      Ah okay, I thought he meant personally.
- octix 12y ago
  For some financial satisfaction comes 2nd.
ch4s3 12y ago
More work for less pay huh? Being squeezed by profit taking business people at the top... surely no one other than doctors can relate to such changes in the economy. *Edit I am of course being a bit sarcastic. It's interesting to see how shifts in the general economy are changing the medical profession.
- chubot 12y ago
  That's not a helpful comment. It's already addressed in the article anyway: Of course, doctors aren't the only professionals who are unhappy today. Many professions, including law and teaching, have become constrained by corporate structures, resulting in loss of autonomy, status, and respect. Personally I think the history lesson in the article was great. It makes me wonder about programmers. We are riding high now. But if we keep producing software that neglects user intent, then perhaps we will also find ourselves regulated. I'm actually happy that the FTC has stepped in and constrained certain companies.
  - ch4s3 12y ago
    You are of course correct, my comment was a bit too sarcastic. The history piece was really interesting. I work around a lot of physicians, and I've become a bit tired of hearing them complain about their jobs and pay... so I think I zeroed in on that part of the article.
  - rayiner 12y ago
    > But if we keep producing software that neglects user intent, then perhaps we will also find ourselves regulated. Regulation is why those professions had autonomy, status, and respect in the first place. Without legal protection, a "professional" is just a laborer, and capital always wins out over labor in the end. Temporarily the software industry is growing so quickly that programmers have a lot of leverage, but that will end. The "corporate structure" will absorb more and nore of the value created by the professional. And that's a good thing, right? Protectionism is bad, leads to higher prices for everyone. Why should doctors or programmers be protected more than Wal-Mart shelf stockers?
  - jschwartzi 12y ago
marincounty 12y ago
1. I understand their frustration! 2. Yes--you are fighting with insurance companies; So are your patients. 3. No--you are not the "pillars of society" anymore. (That's change has been slowly taking place. Patients educated themselfs, I don't know, but patients wised up; they realize when when they are dragged in for unnecessary office visits--just to invoke another billing.) 4. O.K.--You are not making the money your father did--neither are most of your patients; the world changed. Hopefully, things will get better. You guys deserve Tort Reform--I think, but then again I sometimes feel the only reason you guys pick up the phone, or refill a prescription is because you you don't want a lawsuit. (It pathetic I'm even thinking like this?) 5. In the end, we are all in this mess together, and one day You will be a Patient. 6. I swore I would never comment on HN again. (The political Correctness is stifflling, but I needed to respond to this article.) 7. Goodbye again. That said, if you have realatively good genes, and you eat somewhat healthy; I would steer clear of most Doctors. I never thought I would say that about allopathic physicians.
exstudent 12y ago
You can definitely feel this as a patient. If I could give my vitals to an app and have it diagnose and prescribe remedies, I would do it in a heart beat and never visit a doctor again (of course you would need robot surgeons too :). I've never seen a doctor research anything either (although I'm sure they do behind the scenes). They seem to be pulling from whatever information cache they have in their head which I often suspect is horribly outdated. I'd take a crowd sourced db of health info over a doctor's personal knowledge any day of the week.
- secabeen 12y ago
  Every doctor is different. If you show a desire to engage with a doctor, and get the right one, you can have one that does research. When I started on cholesterol-managing medication, my physician emailed me three recent journal articles on the effectiveness of different options and the dosing considerations. It all depends on who you have, and how they run their practice.
  - exstudent 12y ago
    I agree that there are good doctors, but I'd rather not have it be such a crap shoot. The consistency and depth of knowledge provided by an expert system of some sort seems like the way to go.
    - jrapdx3 12y ago
      I'd imagine the proportion of "good" doctors might be about the same as good programmers, or good teachers, though probably exceeds the supply of "good" politicians. Point is medical care is only as good as the quality of the "team" consisting of the doctor and the patient. It's a partnership, an expression of the doctor-patient relationship. Not every two people will form a natural team, after all, many marriages fail. It's kind of a cliche, but still true, find a doctor you can work with, someone you can trust and relate to. More likely than not, that's the the definition of a "good" doctor.
- khungus 12y ago
727374 12y ago
I think it's funny that the first picture in the article is of a doctor taking a patient's blood pressure. It's a little ironic because I've never actually had a doctor take my blood pressure (in the US). I'm not even sure if I've had a nurse do it, but more likely a physician's assistant or phlebotomist. Just like other industries medicine has been turned into an assembly line where patients are herded through the system with professionals at each level of the training pyramid doing their part. We do this to be efficient and cost effective, but speaking from personal experience, the side effect is that information gets lost from transfer to transfer and a patient has less time to bond with a doctor. I'd like to believe that many doctors would be happier working with a patient from start to finish like in the old days.
- jessaustin 12y ago
  ...I've never actually had a doctor take my blood pressure... The one time I had a physician take my blood pressure, he was like a 150WPM typist compared to the hunt-and-peck crowd. He was pumping, releasing, pumping, releasing like a madman, with his eyes fixed on the second hand of a large wall clock. He must have gotten 6 or 7 readings in a minute. After all that, he just said, "hmmm, yeah, let's get you on a diuretic."
- wirrbel 12y ago
  What has always confused me is that the perceived gap between doctors and nurses is so big. I have the impression that nurses could benefit a lot from better training and there could be a good case for positions somewhere between a nurse and a doctor. Considering the effect that _care_ (time with patient) has on patients the current model with a demi-god in white just does not scale. My optometrist (the guy selling glasses) measured my eye sight and found that I needed a correction for some corneal irregularity (pardon me if I did not translate the terms right). I had never been given such a reading from my ophthalmologist (eye doctor) who just wrote down dioptry corrections. My optometrist then told me that the specific doctor never wrote down these numbers (i.e. ignoring a condition). This tought me a lot about medical professionals and highly educated doctors. My doctor probably is just a little bored to measure and monitor visual acuity changes in a person with small eyesight issues. That ophthalmologist also had very good reputation working with accident victims, etc.
ericHosick 12y ago
I think another frustration doctors are feeling today is due to a lack of patient-doctor relationships. Society views doctors as tools that society has a legal right to.
jseliger 12y ago
This resonates with what I've observed, and in 2012 I wrote an essay that fits this genre: "Why you should become a nurse or physicians assistant instead of a doctor: the underrated perils of medical school" (http://jseliger.wordpress.com/2012/10/20/why-you-should-become-a-nurse-or-physicians-assistant-instead-of-a-doctor-the-underrated-perils-of-medical-school/ http://jseliger.wordpress.com/2012/10/20/why-you-should-beco...), which explains everything my girlfriend wishes she'd known before she started.
- mikeleeorg 12y ago
  So true. Also, in San Francisco, many nurses in certain departments earn much more than doctors do.
- cloverich 12y ago
  I've read this before, and feel obligated to state I couldn't disagree more. And this is coming from someone who quit the profession (physician). Be a nurse or PA because you have shadowed one, and enjoy the work. Their job is different than a Physicians, and personality (etc.) plays a part in which you'll enjoy. Additionally, the available specializations in medicine are something thats simply not available outside the profession. Don't settle for one or the other, choose the one that suits you.
jprince 12y ago
I think we're the new independent professionals. Nobody has required a license to "practice technology" (yet, but I suspect California will find a way eventually...) and so we can do our job anywhere, for any hours, for any pay. Until bureaucracy swallows us up(as it does all professions ultimately) we'll have our golden age too.
- jjoonathan 12y ago
  It won't be bureaucracy that kills us but rather the inevitable grind of economics. Once our industry stops growing and the supply of programmers has a chance to catch up with demand, our bargaining position weakens and the impact will be felt across the board. Those in corporations will find higher expectations (even longer hours), less respect, lower pay, and fewer benefits. Those who are "independent" will find it more difficult to acquire funding, a higher probability of failure on launch, and lower returns even when they do manage to "crush it." This has already happened to older engineering professions and it has already happened to sectors of the software engineering world that have a different supply/demand balance than the mainstream (see: game developers). It will happen to us too. Hopefully not in the near future.
  - jprince 12y ago
    Damn, that was depressing, but after you say that I now agree with you. That's why we save aggressively...except for this year. This year, all my savings go to pay for a wedding I have very little choice about. This is the price of love. :(
  - lmm 12y ago
    The supply isn't growing that fast, given how the demographics are going and how poor most teaching is. And demand continues to grow very rapidly. If software really does eat the world, I can easily see a future where the number of available programming jobs exceeds the total population.
  - tomjen3 12y ago
    I work in game development and the issue isn't that there aren't enough work, the issue is that there are too few people willing to buy games. However I seriously doubt we will run out of work for programmers across all sectors - if we can code some business app to do something ten times as fast as a normal person takes to do it (likely a low bar) then there will always be businesses willing to pay for that.
kelukelugames 12y ago
Do you know what's incredible? Plenty of SDE 2s make more than 200k a year, and plenty of doctors don't. I'm not sure if we are overpaid or they are underpaid.
- ntkachov 12y ago
  we've got the market playing for us. Once supply catches up, there won't be as high of a salary.
deleted 12y ago
[deleted]
praptak 12y ago
All this sounds quite a bit like Marx's theory of alienation: "The theoretic basis of alienation within the capitalist mode of production is that the worker invariably loses the ability to determine his or her life and destiny, when deprived of the right to think (conceive) of himself as the director of his actions; to determine the character of said actions; to define their relationship with other people; and to own the things and use the value of the goods and services, produced with their labour." http://en.wikipedia.org/wiki/Marx's_theory_of_alienation http://en.wikipedia.org/wiki/Marx's_theory_of_alienation
- ArkyBeagle 12y ago
  Just a quick thought but Henry Ford may have found a solution to this. It's also (possibly) been shown that Ford simply had data which showed that transaction costs from turnover made the $5 wage worth his while. Ford exhibited other bizarre managerial tics, but the world was new-and-all... Ford's hubris was total vertical integration, but that came later. Detroit is not exactly a worker's paradise today, and few people talk about it... Marx assumed Malthus, and Malthus could not have anticipated the more modern aspects of mass production and mass agriculture.
- grimtrigger 12y ago
  The article makes the opposite point - that government bureaucracy (and the mal-incentives it creates) is what is killing the relationships between doctors and patients.
  - esfandia 12y ago
    I didn't see any discrepancy: both the article and Marx are criticizing the alienating effect of the added bureaucracy and the lessening of the doctors' autonomy.
dobbsbob 12y ago
Surprised the average income for a GP is $161,000 in the US, thought they would be paid more than Canadian MDs who's average is $300k http://www.theglobeandmail.com/life/health-and-fitness/health/how-much-are-canadian-doctors-paid/article7750697/ http://www.theglobeandmail.com/life/health-and-fitness/healt... Canada also heavily relies on US medical labs in Houston. I had to have a blood analysis done as part of a health check for a work contract years ago and my provincial health authority shipped my samples there for testing. It's cheaper for Canada to outsource all this work to Americans wonder what they are paying lab technicians.
- djokkataja 12y ago
  A little strange to be comparing American GP average income to the average income of all Canadian MDs given that GPs are paid much less than average. "Geoff Ballinger, manager of Health Human Resources for CIHI, said the figures represent averages and vary significantly depending on a doctor’s specialty. For instance, the average family practitioner would earn less than a neurosurgeon or cardiologist." http://www.theglobeandmail.com/life/health-and-fitness/health/mds-gross-income-307000-report-finds/article7640498/ http://www.theglobeandmail.com/life/health-and-fitness/healt...
toasted 12y ago
Non-US anaesthesiologist here. I love my job and relish going to work each morning. I spend almost no time on non-clinical paperwork. I work reasonable hours, have some busy on-call shifts but am generally well supported by my department. I earn good money in the state system - enough to raise a family comfortably and have a nice house, but not silly money. I pay no malpractice insurance, but pay $400 annually to a non-profit society for medico-legal cover. If I want to I can do additional private sector work to earn more (but I don't). I live in a country where a high standard of medical care and longer life expectancy is provided for less than half the per capita health spend of USA, and the public health system is so good that the private health sector really does struggle to offer much additional benefit. There are many great examples of socialised health systems in the world, I'm not sure why the US ignores them? Some of the WSJ comments list all the problems inherent in the US system and then blame socialism for them when the problem is completely the opposite?
- tarr11 12y ago
  In which country do you work as an anaesthesiologist?
  - toasted 12y ago
    NZ
    - jasonisalive 12y ago
      Keep in mind that, well-paid and satisfied specialists aside, there is another side to this picture - important to remember with state-run healthcare systems such as NZ, so often a poster child for socialist policy. For example this IT department head of a major district health board who embezzled ~$17 million dollars over a period of 6 years, with which to buy, among other things, luxury vehicles. http://www.odt.co.nz/news/tags/michael-swann-0 http://www.odt.co.nz/news/tags/michael-swann-0 http://www.odt.co.nz/news/dunedin/32268/fake-invoices-made-pair-17m-crown http://www.odt.co.nz/news/dunedin/32268/fake-invoices-made-p... Can you imagine this sort of thing happening in a free market for healthcare? I can't.
ArkyBeagle 12y ago
The business model for doctors works out to is surviving a grueling educational process to gain a license against which they charge rents. The business model for professional athletes devolves to surviving a grueling selection process in the service of building their brand as a performer against which they can charge rents. The business model for performing musicians devolves to surviving a grueling selection process in the service of building their brand as a performer against which they can charge rents. This has a personal cost.
BenoitEssiambre 12y ago
Demographics is huge headwind for doctors. In the past 30 years, median age of the population in North America went from about 27 to almost 40 and is still rising. Doctors are usually on a fixed fee for service arrangement but every year as people get older, the length of time it takes to perform the average "service" goes up. The amount of time and ressources needed to treat older patients is almost exponential with age. Older patients' state of health is often very complex with all kinds of interactions between illnesses and medication side effects to manage. Sick people get more "services" but also each service takes significantly more time to perform. Yet doctors are expected to be able to perform as many of them each year. There is an oversized population of people in their fifties right now. This is the age where people start to get sick but are still young enough that they are often the main income earner for their family having one or more dependents. Doctors have to work more hours for less money trying to help families cope with increasingly common and tragic medical conditions. When a family is collapsing because of an illness and people pile up in the doctor's office (justifiably) in tears, there is no ethical way to "process" these patients in the time that is supposed to be allocated to them.
mikeleeorg 12y ago
Many friends of mine are doctors and they've expressed the same feelings. There are days when they absolutely love what they do, but as an outsider, I see them experiencing more low days than high days. Just as an anecdote, part of it is the expectations of the patient population in the Bay Area - and I'm only referring to the high income neighborhoods here; the situation differs significantly in low income neighborhoods. Patients from high income backgrounds tend to be much more demanding than patients from low income backgrounds. At Stanford, the doctors in the emergency department are (informally) expected to stop what they're doing and sing Happy Birthday to certain high income individuals. A lot of doctors translate this to a lack of respect, which echoes the quoted statement in the article. Here's another anecdote. While sites like WebMD are fantastic for educating the general public about health issues, it also makes some people falsely believe they know more than the doctors treating them. And I don't mean they simply question their doctors - that is a good practice and everyone should be as educated as they can about their own health. But apparently many people argue and flat out ignore their doctors, even when their own knowledge is tragically incorrect. As one doctor put it, "Why did they come and see me at all, if they are already convinced of what they have? Just to waste their own time and money, not to mention my time?" Again, there are times when one should definitely question their doctor and be as educated as they can. Second, third, and additional opinions can be very useful. But I'm sure many doctors would appreciate less arrogance and animosity in their attitudes. One more note. Apparently a very high number (between 75-99%) of all doctors will have faced a malpractice claim at least once in their career. Most of these claims are frivolous, but going through something like this is extremely demoralizing. A couple of doctors I know came close to leaving the profession because of it, even after they were cleared of all wrongdoing. I once described the job of a project manager to a doctor friend as a "thankless profession," and he immediately said, "that sounds like my job too!"
- a3n 12y ago
  > A lot of doctors translate this to a lack of respect, which echoes the quoted statement in the article. Does this mean a lack of general respect, the type that all people deserve? Or is this some kind of extra respect and dererence due to their education or profession, which no one deserves? Because I am constantly disrespected by the medical profession. I am sent email a day or two before each appointment, reminding me that late or canceled appointments are subject to cancellation fees, yet I have NEVER been seen on time by any doctor ever.
2mur 12y ago
I'm a physician. I love the value I bring to patients, and I enjoy what I do (most of the time). But the industry is disgusting. The people who are creating the real value for patients (nurses, technicians and doctors) have been saddled with increasing regulations and there are incredibly levels of administrators and belt-phone business guys riding them to extract every profit out of the environment. There is no chance I would do it again.
- the_duck 12y ago
  Huh. "Belt-phone business guy" is a new expression for me. What does this mean, exactly?
  - hkmurakami 12y ago
    I imagine it literally means "the kind of business guy who has his phone clipped to his belt" (implies a certain kind of caricature of the business/sales archetype).
- infogulch 12y ago
  Are you a cancer doctor by any chance?
- dmfdmf 12y ago
  The doctors lost the argument decades ago when they agreed that people had a right to medical services. It was self-imposed slavery (because they agreed) and now we are just discussing the details (e.g. Obamacare, medicare, etc.) and the govt programs that steal from people to pay for medical services are just windows dressing to make it look civilized and moral. The good news is that your rights are inalienable, you can reclaim them at any time. The doctors should go on strike and reject the assumption that anyone has the right to their work. As a patient I would support the doctors 100%. Let's see how long medical services last without doctors or how laughable it will be when the govt tries to force doctors back to work. LOL. Health Care is Not a Right. http://www.afcm.org/hcinar.html http://www.afcm.org/hcinar.html NB: I recently dropped all my medical customers at significant drop in revenue because of HIPPA. You think things are bad now wait until that monstrosity becomes strictly enforced.
analog31 12y ago
We've all read about how much health care costs in the US, but I'd like to know: Into whose pockets is that money actually flowing? My guess is that those people will be doctors, even if directly caring for patients isn't how they make their money. From what I've gathered by reading about this over the years: * More than half of doctors are self employed, meaning that their salaries don't tell the whole story about their incomes. * Doctors are heavily invested as stockholders in provider businesses (insurance, HMO's, etc.), and the malpractice insurance industry. Until recently, my employer-provided health care was delivered by a large organization that was entirely doctor-owned. Sorry, no links or evidence for either of these, and I think the gathering of that evidence may be difficult due to the complex financial relationships involved. But it makes me skeptical when I read about doctors struggling against "the system." Who owns the system? It may very well be that medical care costs less overseas simply due to a simpler system where costs can actually be tracked. Medicine might become a better profession in the US if med school were free, doctors worked for a salary, and everything else was owned by the government. To be fair, it may be doctors exploiting doctors, and your career prospects upon finishing medical school may have a lot to do with how much investment money (e.g., inheritance) you have at your disposal to buy into the portion of the business that ultimately profits.
joelberman 12y ago
I love my primary care doctor who is also my cardiologist. He is amazing. Explains everything, and is never rushed. The only negative is sometimes he is off schedule. I just had open heart surgery and that was also wonderful. The techs, nurses, PAs, and doctors were great. In simple terms, I am thrilled with the care I got and except for one nurse from hell, I have no complaints about care and I have the utmost respect for those who helped me. Now the dark side. I cannot imagine how many people are preparing bills, sending them to Medicare and then to my supplemental insurance. And how many questions I have about billing and how many phone calls I have to make. I am sure that the cost of administering payments is much higher than the cost of care. And yet none of that administrative work prevents disease or cures me. We need a single payer system and need to reduce the non-care-related paperwork. And let the healers heal.
joelberman 12y ago
I love my primary care doctor who is also my cardiologist. He is amazing. Explains everything, and is never rushed. The only negative is sometimes he is off schedule. I just had open heart surgery and that was also wonderful. The techs, nurses, PAs, and doctors were great. In simple terms, I am thrilled with the care I got and except for one nurse from hell, I have no complaints about care and I have the utmost respect for those who helped me. Now the dark side. I cannot imagine how many people are preparing bills, sending them to Medicare and then to my supplemental insurance. And how many questions I have about billing and how many phone calls I have to make. I am sure that the cost of administering payments is much higher than the cost of care. And yet none of that administrative work prevents disease or cures me. We need a single payer system and need to reduce the non-care-related paperwork. And let the healers heal.
healthisevil 12y ago
I am a physician in Australia. Being a doctor sucks here too. I encouraged my son to avoid medicine. He followed my advice and is enjoying himself in private equity. Anyone bright enough to do medicine would do far better in another profession.
- mariodiana 12y ago
  "Anyone bright enough to do medicine would do far better in another profession." Just as a point of reference, I'm in the U.S. and not a doctor. But I've always seen careers in medicine as a kind of social scam. Not necessarily a bad one, but there is or was something funny going on. A person smart enough to be a doctor could be many things and earn a lot more money doing one of those things. The only thing society can really offer doctors is independence and respect. That's why -- for the longest time in this country -- doctors often owned and ran their own practices. That's why we addressed doctors with the honorific "Doctor." But the first is all but dead in this country and the second, because of some kind of unwashed, egalitarian ethic that only gets worse and worse, is starting to die out too. We've really fucked up, as a society. No one in his or her right mind is going to want to spend life kow-towing to pervasive regulations and third-party bureaucrats second guessing them and tying their hands, while rushing to and fro like a retail clerk in an understaffed big box store, and all the while having to protect the egos of patients by introducing oneself as Bob or Sally. Doctors need prestige and independence. Without those, the lure of "doing good" just isn't enough to convince anyone to become one -- at least, not anyone I'd want to have to trust as a patient.
  - ForHackernews 12y ago
    > A person smart enough to be a doctor could be many things and earn a lot more money doing one of those things. Is that really true? Doctors are most of the best-paying jobs in the US [0] It seems to me that if you're bright, and care about making a lot of money, medicine is absolutely the way to go. Yes, there are some people who strike it rich with startups or high finance, but that's essentially buying a lotto ticket. [0]: http://www.bls.gov/oes/current/oes_nat.htm#00-0000 http://www.bls.gov/oes/current/oes_nat.htm#00-0000 (sort by annual mean wage, Anesthesiologists, Surgeons, Oral and Maxillofacial Surgeons, etc.)
cashoil 12y ago
Is Obamacare going to be the first step towards making the U.S. a socialist country ? Is the true goal to reditribute wealth ? It is meant here, http://www.mymustardseeds.com/ultimate-goals-of-obamacare.html http://www.mymustardseeds.com/ultimate-goals-of-obamacare.ht.... Or is it just verbiage to shine for the next election ? Will people suffer from Obamacare ? Are consequences to the whole system really under control (increase of the premiums, ...) ?
pessimizer 12y ago
Most important takeaway (other than a series of anecdotes, a general history lesson, and a few random undefended policy suggestions): "In 1940, in inflation-adjusted 2010 dollars, the mean income for U.S. physicians was about $50,000. By 1970, it was close to $250,000—nearly six times the median household income."

123 points by roye 12y ago

In my opinion(and general opinion), this is the most important job. Maybe we can find someone depressed(like in the article), but come on they save lives.

jmspring 12y ago
It is critical, but given sheer number of lives impacted daily, I rank teaching higher. Especially given the pay disparity.
gulfie 12y ago
Everyone dies, no one gets saved forever. Plumbers and garbage men saved more lives in the past century than doctors. (so I hear)
nhstanley 12y ago
> but come on they save lives. I'm going to say something controversial here, but please bear with me. Your statement sort of encompasses several parts of this problem. Some doctors are miracle workers (see [1] below), but most doctors are glorified auto mechanics. I don't say that to downplay the amount of intelligence/skill required for the job, but if you think of most doctors as "saving lives", then you obviously haven't spent a lot of time around doctors/clinics/hospitals. Most doctors rarely save lives, and often when they do it wasn't them that really did the critical life saving steps, they're just the interface the sick person is interacting with. Most doctors deal with a series of inputs (symptoms and circumstances) and output a solution (diagnosis and remedy), which requires very little critical thinking on their part. Sick kids with the flu. Idiots that took too many drugs that need fluids, benzos, cypro, or an ice bath. People at mid-life who made shitty decisions for most of their lives and now need Lipitor/Coumadin/a treadmill/a gravestone. The truth is most doctors get paid a lot because people erroneously assign to them the ethos of miracle workers, when most of them aren't. In fact, they often can't even do anything for their patients (see above, such kids with the flu, old people who've made shitty decisions their whole lives). The cures really come from researchers and pharma companies that come up with drugs and treatments for these incredibly difficult problems. If doctors deserve their paychecks, it's because they keep alive the illusion society wants. The illusion that when something is wrong, the doc will fix them up good. And indeed that's basically what the article is about. Doctors demand respect and to be paid to keep up the illusion and to deal with the bullshit. [1] Obvious and important exceptions to this are ER docs and trauma surgeons, who indeed save lives. There are also clinical doctors, who work tirelessly with armies of researchers to try to find new cures for cancers, autoimmune and genetic disorders (among many other things). There are surgeons who come up with new procedures to reduce the invasiveness and trauma of procedures. These are the people that deserve the lion's share of the praise that goes towards doctors, and they should get the lions share of the money as well (some certainly do). In this whole rant, I'm not trying to lay blame on doctors for the whole mess, because problems come from all sides, as I've hinted. Patients have unrealistic expectations of what doctors can do, the health industry is trying to low-ball doctors (not always without reason) to maximize profits, and many doctors who thought they would be genuinely helping people are realizing in reality that fate is largely decided before they even meet their patient (as a criminal lawyer friend put it, "90% of my client's case is decided before I ever meet him, but he wants me to work miracles!"). This is specifically why I didn't continue into medicine like so many of my friends. If you really want to help people, you don't become a regular doctor. You become a thoracic surgeon, or you do basic research, or you work in pharma, or you start a biotech. That's how you cure people. But no one will praise you for it.
- jrapdx3 12y ago
  Practicing medicine for decades gives me some "perspective" on the subject. No one in medicine is a "miracle worker", though many of us work hard to the job responsibly. You are wrong. We do "save lives", and not just in the ED. Every day, if not as dramatically, immediately or even noticeably, our incremental toil helps patients progress bit-by-bit toward better health. Managing chronic, debilitating conditions really does enable patients to live longer and more fully. You are also wrong regarding income. Doctors in the US are getting paid less and less, while expenses of practice go ever higher. My own income is probably less than most of the people I know in other professions. The "mess" of the health care system (to the extent it is even systematic) is the result of the constant assault of corporations and governments at all cost to "reduce costs", but the result has been the degradation you and others notice. The most conspicuous evil has been perpetrated by the insurance industry. For example, amazingly short-sighted insistence on paying for a "generic" medication $3/mo cheaper than the drug already working is an every day challenge. If patients don't get what is really needed, they wind up getting sicker, need more care, the result is more money spent, not saved. The problem is that the industrialization of medicine makes it increasingly difficult to be helpful. People are not neat little uniform units produced in factories. People are enormously complex organisms that defy all rules we invent to "explain" illness and treatment. People are unique entities that require individual attention and customized approaches if true "health care" is going to be provided. If doctors are given the resources, time and respect to do their work, I believe almost all will strive to do it right.
  - pinkyand 12y ago
    > The problem is that the industrialization of medicine makes it increasingly difficult to be helpful. Atul gawande, which is a doctor and a healthcare journalist ,and knows the medical system from inside, thinks that industrialized medicine is exactly what's needed: http://www.newyorker.com/magazine/2012/08/13/big-med http://www.newyorker.com/magazine/2012/08/13/big-med And in general the positive results from decision support systems seem to agree with him.
    - jrapdx3 12y ago

prestadige 12y ago

Going into a career because it's noble, rewarding or because it "helps people" seems like a mistake.

StavrosK 12y ago
Going into a career because it's rewarding seems like a mistake?
- adamnemecek 12y ago
  I think he meant financially.
  - prestadige 12y ago
    I think it's a mistake whether for financial reasons or in terms of personal satisfaction. You go into a field because you are interested in learning and engaging with the problems in that field. Not for status or rewards. You can't enter a profession on the basis that it will be personally rewarding. You can only leave because it turns out not to be.
  - StavrosK 12y ago
    Ah okay, I thought he meant personally.
octix 12y ago
For some financial satisfaction comes 2nd.

ch4s3 12y ago

More work for less pay huh? Being squeezed by profit taking business people at the top... surely no one other than doctors can relate to such changes in the economy. *Edit I am of course being a bit sarcastic. It's interesting to see how shifts in the general economy are changing the medical profession.

chubot 12y ago
That's not a helpful comment. It's already addressed in the article anyway: Of course, doctors aren't the only professionals who are unhappy today. Many professions, including law and teaching, have become constrained by corporate structures, resulting in loss of autonomy, status, and respect. Personally I think the history lesson in the article was great. It makes me wonder about programmers. We are riding high now. But if we keep producing software that neglects user intent, then perhaps we will also find ourselves regulated. I'm actually happy that the FTC has stepped in and constrained certain companies.
- ch4s3 12y ago
  You are of course correct, my comment was a bit too sarcastic. The history piece was really interesting. I work around a lot of physicians, and I've become a bit tired of hearing them complain about their jobs and pay... so I think I zeroed in on that part of the article.
- rayiner 12y ago
  > But if we keep producing software that neglects user intent, then perhaps we will also find ourselves regulated. Regulation is why those professions had autonomy, status, and respect in the first place. Without legal protection, a "professional" is just a laborer, and capital always wins out over labor in the end. Temporarily the software industry is growing so quickly that programmers have a lot of leverage, but that will end. The "corporate structure" will absorb more and nore of the value created by the professional. And that's a good thing, right? Protectionism is bad, leads to higher prices for everyone. Why should doctors or programmers be protected more than Wal-Mart shelf stockers?
- jschwartzi 12y ago

marincounty 12y ago

1. I understand their frustration! 2. Yes--you are fighting with insurance companies; So are your patients. 3. No--you are not the "pillars of society" anymore. (That's change has been slowly taking place. Patients educated themselfs, I don't know, but patients wised up; they realize when when they are dragged in for unnecessary office visits--just to invoke another billing.) 4. O.K.--You are not making the money your father did--neither are most of your patients; the world changed. Hopefully, things will get better. You guys deserve Tort Reform--I think, but then again I sometimes feel the only reason you guys pick up the phone, or refill a prescription is because you you don't want a lawsuit. (It pathetic I'm even thinking like this?) 5. In the end, we are all in this mess together, and one day You will be a Patient. 6. I swore I would never comment on HN again. (The political Correctness is stifflling, but I needed to respond to this article.) 7. Goodbye again. That said, if you have realatively good genes, and you eat somewhat healthy; I would steer clear of most Doctors. I never thought I would say that about allopathic physicians.

exstudent 12y ago

You can definitely feel this as a patient. If I could give my vitals to an app and have it diagnose and prescribe remedies, I would do it in a heart beat and never visit a doctor again (of course you would need robot surgeons too :). I've never seen a doctor research anything either (although I'm sure they do behind the scenes). They seem to be pulling from whatever information cache they have in their head which I often suspect is horribly outdated. I'd take a crowd sourced db of health info over a doctor's personal knowledge any day of the week.

secabeen 12y ago
Every doctor is different. If you show a desire to engage with a doctor, and get the right one, you can have one that does research. When I started on cholesterol-managing medication, my physician emailed me three recent journal articles on the effectiveness of different options and the dosing considerations. It all depends on who you have, and how they run their practice.
- exstudent 12y ago
  I agree that there are good doctors, but I'd rather not have it be such a crap shoot. The consistency and depth of knowledge provided by an expert system of some sort seems like the way to go.
  - jrapdx3 12y ago
    I'd imagine the proportion of "good" doctors might be about the same as good programmers, or good teachers, though probably exceeds the supply of "good" politicians. Point is medical care is only as good as the quality of the "team" consisting of the doctor and the patient. It's a partnership, an expression of the doctor-patient relationship. Not every two people will form a natural team, after all, many marriages fail. It's kind of a cliche, but still true, find a doctor you can work with, someone you can trust and relate to. More likely than not, that's the the definition of a "good" doctor.
khungus 12y ago

727374 12y ago

I think it's funny that the first picture in the article is of a doctor taking a patient's blood pressure. It's a little ironic because I've never actually had a doctor take my blood pressure (in the US). I'm not even sure if I've had a nurse do it, but more likely a physician's assistant or phlebotomist. Just like other industries medicine has been turned into an assembly line where patients are herded through the system with professionals at each level of the training pyramid doing their part. We do this to be efficient and cost effective, but speaking from personal experience, the side effect is that information gets lost from transfer to transfer and a patient has less time to bond with a doctor. I'd like to believe that many doctors would be happier working with a patient from start to finish like in the old days.

jessaustin 12y ago
...I've never actually had a doctor take my blood pressure... The one time I had a physician take my blood pressure, he was like a 150WPM typist compared to the hunt-and-peck crowd. He was pumping, releasing, pumping, releasing like a madman, with his eyes fixed on the second hand of a large wall clock. He must have gotten 6 or 7 readings in a minute. After all that, he just said, "hmmm, yeah, let's get you on a diuretic."
wirrbel 12y ago
What has always confused me is that the perceived gap between doctors and nurses is so big. I have the impression that nurses could benefit a lot from better training and there could be a good case for positions somewhere between a nurse and a doctor. Considering the effect that _care_ (time with patient) has on patients the current model with a demi-god in white just does not scale. My optometrist (the guy selling glasses) measured my eye sight and found that I needed a correction for some corneal irregularity (pardon me if I did not translate the terms right). I had never been given such a reading from my ophthalmologist (eye doctor) who just wrote down dioptry corrections. My optometrist then told me that the specific doctor never wrote down these numbers (i.e. ignoring a condition). This tought me a lot about medical professionals and highly educated doctors. My doctor probably is just a little bored to measure and monitor visual acuity changes in a person with small eyesight issues. That ophthalmologist also had very good reputation working with accident victims, etc.

ericHosick 12y ago

I think another frustration doctors are feeling today is due to a lack of patient-doctor relationships. Society views doctors as tools that society has a legal right to.

jseliger 12y ago

This resonates with what I've observed, and in 2012 I wrote an essay that fits this genre: "Why you should become a nurse or physicians assistant instead of a doctor: the underrated perils of medical school" (http://jseliger.wordpress.com/2012/10/20/why-you-should-become-a-nurse-or-physicians-assistant-instead-of-a-doctor-the-underrated-perils-of-medical-school/ http://jseliger.wordpress.com/2012/10/20/why-you-should-beco...), which explains everything my girlfriend wishes she'd known before she started.

mikeleeorg 12y ago
So true. Also, in San Francisco, many nurses in certain departments earn much more than doctors do.
cloverich 12y ago
I've read this before, and feel obligated to state I couldn't disagree more. And this is coming from someone who quit the profession (physician). Be a nurse or PA because you have shadowed one, and enjoy the work. Their job is different than a Physicians, and personality (etc.) plays a part in which you'll enjoy. Additionally, the available specializations in medicine are something thats simply not available outside the profession. Don't settle for one or the other, choose the one that suits you.

jprince 12y ago

I think we're the new independent professionals. Nobody has required a license to "practice technology" (yet, but I suspect California will find a way eventually...) and so we can do our job anywhere, for any hours, for any pay. Until bureaucracy swallows us up(as it does all professions ultimately) we'll have our golden age too.

jjoonathan 12y ago
It won't be bureaucracy that kills us but rather the inevitable grind of economics. Once our industry stops growing and the supply of programmers has a chance to catch up with demand, our bargaining position weakens and the impact will be felt across the board. Those in corporations will find higher expectations (even longer hours), less respect, lower pay, and fewer benefits. Those who are "independent" will find it more difficult to acquire funding, a higher probability of failure on launch, and lower returns even when they do manage to "crush it." This has already happened to older engineering professions and it has already happened to sectors of the software engineering world that have a different supply/demand balance than the mainstream (see: game developers). It will happen to us too. Hopefully not in the near future.
- jprince 12y ago
  Damn, that was depressing, but after you say that I now agree with you. That's why we save aggressively...except for this year. This year, all my savings go to pay for a wedding I have very little choice about. This is the price of love. :(
- lmm 12y ago
  The supply isn't growing that fast, given how the demographics are going and how poor most teaching is. And demand continues to grow very rapidly. If software really does eat the world, I can easily see a future where the number of available programming jobs exceeds the total population.
- tomjen3 12y ago
  I work in game development and the issue isn't that there aren't enough work, the issue is that there are too few people willing to buy games. However I seriously doubt we will run out of work for programmers across all sectors - if we can code some business app to do something ten times as fast as a normal person takes to do it (likely a low bar) then there will always be businesses willing to pay for that.

kelukelugames 12y ago

Do you know what's incredible? Plenty of SDE 2s make more than 200k a year, and plenty of doctors don't. I'm not sure if we are overpaid or they are underpaid.

ntkachov 12y ago
we've got the market playing for us. Once supply catches up, there won't be as high of a salary.

deleted 12y ago

[deleted]

praptak 12y ago

All this sounds quite a bit like Marx's theory of alienation: "The theoretic basis of alienation within the capitalist mode of production is that the worker invariably loses the ability to determine his or her life and destiny, when deprived of the right to think (conceive) of himself as the director of his actions; to determine the character of said actions; to define their relationship with other people; and to own the things and use the value of the goods and services, produced with their labour." http://en.wikipedia.org/wiki/Marx's_theory_of_alienation http://en.wikipedia.org/wiki/Marx's_theory_of_alienation

ArkyBeagle 12y ago
Just a quick thought but Henry Ford may have found a solution to this. It's also (possibly) been shown that Ford simply had data which showed that transaction costs from turnover made the $5 wage worth his while. Ford exhibited other bizarre managerial tics, but the world was new-and-all... Ford's hubris was total vertical integration, but that came later. Detroit is not exactly a worker's paradise today, and few people talk about it... Marx assumed Malthus, and Malthus could not have anticipated the more modern aspects of mass production and mass agriculture.
grimtrigger 12y ago
The article makes the opposite point - that government bureaucracy (and the mal-incentives it creates) is what is killing the relationships between doctors and patients.
- esfandia 12y ago
  I didn't see any discrepancy: both the article and Marx are criticizing the alienating effect of the added bureaucracy and the lessening of the doctors' autonomy.

dobbsbob 12y ago

Surprised the average income for a GP is $161,000 in the US, thought they would be paid more than Canadian MDs who's average is $300k http://www.theglobeandmail.com/life/health-and-fitness/health/how-much-are-canadian-doctors-paid/article7750697/ http://www.theglobeandmail.com/life/health-and-fitness/healt... Canada also heavily relies on US medical labs in Houston. I had to have a blood analysis done as part of a health check for a work contract years ago and my provincial health authority shipped my samples there for testing. It's cheaper for Canada to outsource all this work to Americans wonder what they are paying lab technicians.

djokkataja 12y ago
A little strange to be comparing American GP average income to the average income of all Canadian MDs given that GPs are paid much less than average. "Geoff Ballinger, manager of Health Human Resources for CIHI, said the figures represent averages and vary significantly depending on a doctor’s specialty. For instance, the average family practitioner would earn less than a neurosurgeon or cardiologist." http://www.theglobeandmail.com/life/health-and-fitness/health/mds-gross-income-307000-report-finds/article7640498/ http://www.theglobeandmail.com/life/health-and-fitness/healt...

toasted 12y ago

Non-US anaesthesiologist here. I love my job and relish going to work each morning. I spend almost no time on non-clinical paperwork. I work reasonable hours, have some busy on-call shifts but am generally well supported by my department. I earn good money in the state system - enough to raise a family comfortably and have a nice house, but not silly money. I pay no malpractice insurance, but pay $400 annually to a non-profit society for medico-legal cover. If I want to I can do additional private sector work to earn more (but I don't). I live in a country where a high standard of medical care and longer life expectancy is provided for less than half the per capita health spend of USA, and the public health system is so good that the private health sector really does struggle to offer much additional benefit. There are many great examples of socialised health systems in the world, I'm not sure why the US ignores them? Some of the WSJ comments list all the problems inherent in the US system and then blame socialism for them when the problem is completely the opposite?

tarr11 12y ago
In which country do you work as an anaesthesiologist?
- toasted 12y ago
  NZ
  - jasonisalive 12y ago
    Keep in mind that, well-paid and satisfied specialists aside, there is another side to this picture - important to remember with state-run healthcare systems such as NZ, so often a poster child for socialist policy. For example this IT department head of a major district health board who embezzled ~$17 million dollars over a period of 6 years, with which to buy, among other things, luxury vehicles. http://www.odt.co.nz/news/tags/michael-swann-0 http://www.odt.co.nz/news/tags/michael-swann-0 http://www.odt.co.nz/news/dunedin/32268/fake-invoices-made-pair-17m-crown http://www.odt.co.nz/news/dunedin/32268/fake-invoices-made-p... Can you imagine this sort of thing happening in a free market for healthcare? I can't.

ArkyBeagle 12y ago

The business model for doctors works out to is surviving a grueling educational process to gain a license against which they charge rents. The business model for professional athletes devolves to surviving a grueling selection process in the service of building their brand as a performer against which they can charge rents. The business model for performing musicians devolves to surviving a grueling selection process in the service of building their brand as a performer against which they can charge rents. This has a personal cost.

BenoitEssiambre 12y ago

Demographics is huge headwind for doctors. In the past 30 years, median age of the population in North America went from about 27 to almost 40 and is still rising. Doctors are usually on a fixed fee for service arrangement but every year as people get older, the length of time it takes to perform the average "service" goes up. The amount of time and ressources needed to treat older patients is almost exponential with age. Older patients' state of health is often very complex with all kinds of interactions between illnesses and medication side effects to manage. Sick people get more "services" but also each service takes significantly more time to perform. Yet doctors are expected to be able to perform as many of them each year. There is an oversized population of people in their fifties right now. This is the age where people start to get sick but are still young enough that they are often the main income earner for their family having one or more dependents. Doctors have to work more hours for less money trying to help families cope with increasingly common and tragic medical conditions. When a family is collapsing because of an illness and people pile up in the doctor's office (justifiably) in tears, there is no ethical way to "process" these patients in the time that is supposed to be allocated to them.

mikeleeorg 12y ago

Many friends of mine are doctors and they've expressed the same feelings. There are days when they absolutely love what they do, but as an outsider, I see them experiencing more low days than high days. Just as an anecdote, part of it is the expectations of the patient population in the Bay Area - and I'm only referring to the high income neighborhoods here; the situation differs significantly in low income neighborhoods. Patients from high income backgrounds tend to be much more demanding than patients from low income backgrounds. At Stanford, the doctors in the emergency department are (informally) expected to stop what they're doing and sing Happy Birthday to certain high income individuals. A lot of doctors translate this to a lack of respect, which echoes the quoted statement in the article. Here's another anecdote. While sites like WebMD are fantastic for educating the general public about health issues, it also makes some people falsely believe they know more than the doctors treating them. And I don't mean they simply question their doctors - that is a good practice and everyone should be as educated as they can about their own health. But apparently many people argue and flat out ignore their doctors, even when their own knowledge is tragically incorrect. As one doctor put it, "Why did they come and see me at all, if they are already convinced of what they have? Just to waste their own time and money, not to mention my time?" Again, there are times when one should definitely question their doctor and be as educated as they can. Second, third, and additional opinions can be very useful. But I'm sure many doctors would appreciate less arrogance and animosity in their attitudes. One more note. Apparently a very high number (between 75-99%) of all doctors will have faced a malpractice claim at least once in their career. Most of these claims are frivolous, but going through something like this is extremely demoralizing. A couple of doctors I know came close to leaving the profession because of it, even after they were cleared of all wrongdoing. I once described the job of a project manager to a doctor friend as a "thankless profession," and he immediately said, "that sounds like my job too!"

a3n 12y ago
> A lot of doctors translate this to a lack of respect, which echoes the quoted statement in the article. Does this mean a lack of general respect, the type that all people deserve? Or is this some kind of extra respect and dererence due to their education or profession, which no one deserves? Because I am constantly disrespected by the medical profession. I am sent email a day or two before each appointment, reminding me that late or canceled appointments are subject to cancellation fees, yet I have NEVER been seen on time by any doctor ever.

2mur 12y ago

I'm a physician. I love the value I bring to patients, and I enjoy what I do (most of the time). But the industry is disgusting. The people who are creating the real value for patients (nurses, technicians and doctors) have been saddled with increasing regulations and there are incredibly levels of administrators and belt-phone business guys riding them to extract every profit out of the environment. There is no chance I would do it again.

the_duck 12y ago
Huh. "Belt-phone business guy" is a new expression for me. What does this mean, exactly?
- hkmurakami 12y ago
  I imagine it literally means "the kind of business guy who has his phone clipped to his belt" (implies a certain kind of caricature of the business/sales archetype).
infogulch 12y ago
Are you a cancer doctor by any chance?
dmfdmf 12y ago
The doctors lost the argument decades ago when they agreed that people had a right to medical services. It was self-imposed slavery (because they agreed) and now we are just discussing the details (e.g. Obamacare, medicare, etc.) and the govt programs that steal from people to pay for medical services are just windows dressing to make it look civilized and moral. The good news is that your rights are inalienable, you can reclaim them at any time. The doctors should go on strike and reject the assumption that anyone has the right to their work. As a patient I would support the doctors 100%. Let's see how long medical services last without doctors or how laughable it will be when the govt tries to force doctors back to work. LOL. Health Care is Not a Right. http://www.afcm.org/hcinar.html http://www.afcm.org/hcinar.html NB: I recently dropped all my medical customers at significant drop in revenue because of HIPPA. You think things are bad now wait until that monstrosity becomes strictly enforced.

analog31 12y ago

We've all read about how much health care costs in the US, but I'd like to know: Into whose pockets is that money actually flowing? My guess is that those people will be doctors, even if directly caring for patients isn't how they make their money. From what I've gathered by reading about this over the years: * More than half of doctors are self employed, meaning that their salaries don't tell the whole story about their incomes. * Doctors are heavily invested as stockholders in provider businesses (insurance, HMO's, etc.), and the malpractice insurance industry. Until recently, my employer-provided health care was delivered by a large organization that was entirely doctor-owned. Sorry, no links or evidence for either of these, and I think the gathering of that evidence may be difficult due to the complex financial relationships involved. But it makes me skeptical when I read about doctors struggling against "the system." Who owns the system? It may very well be that medical care costs less overseas simply due to a simpler system where costs can actually be tracked. Medicine might become a better profession in the US if med school were free, doctors worked for a salary, and everything else was owned by the government. To be fair, it may be doctors exploiting doctors, and your career prospects upon finishing medical school may have a lot to do with how much investment money (e.g., inheritance) you have at your disposal to buy into the portion of the business that ultimately profits.

joelberman 12y ago

I love my primary care doctor who is also my cardiologist. He is amazing. Explains everything, and is never rushed. The only negative is sometimes he is off schedule. I just had open heart surgery and that was also wonderful. The techs, nurses, PAs, and doctors were great. In simple terms, I am thrilled with the care I got and except for one nurse from hell, I have no complaints about care and I have the utmost respect for those who helped me. Now the dark side. I cannot imagine how many people are preparing bills, sending them to Medicare and then to my supplemental insurance. And how many questions I have about billing and how many phone calls I have to make. I am sure that the cost of administering payments is much higher than the cost of care. And yet none of that administrative work prevents disease or cures me. We need a single payer system and need to reduce the non-care-related paperwork. And let the healers heal.

joelberman 12y ago

healthisevil 12y ago

I am a physician in Australia. Being a doctor sucks here too. I encouraged my son to avoid medicine. He followed my advice and is enjoying himself in private equity. Anyone bright enough to do medicine would do far better in another profession.

mariodiana 12y ago
"Anyone bright enough to do medicine would do far better in another profession." Just as a point of reference, I'm in the U.S. and not a doctor. But I've always seen careers in medicine as a kind of social scam. Not necessarily a bad one, but there is or was something funny going on. A person smart enough to be a doctor could be many things and earn a lot more money doing one of those things. The only thing society can really offer doctors is independence and respect. That's why -- for the longest time in this country -- doctors often owned and ran their own practices. That's why we addressed doctors with the honorific "Doctor." But the first is all but dead in this country and the second, because of some kind of unwashed, egalitarian ethic that only gets worse and worse, is starting to die out too. We've really fucked up, as a society. No one in his or her right mind is going to want to spend life kow-towing to pervasive regulations and third-party bureaucrats second guessing them and tying their hands, while rushing to and fro like a retail clerk in an understaffed big box store, and all the while having to protect the egos of patients by introducing oneself as Bob or Sally. Doctors need prestige and independence. Without those, the lure of "doing good" just isn't enough to convince anyone to become one -- at least, not anyone I'd want to have to trust as a patient.
- ForHackernews 12y ago
  > A person smart enough to be a doctor could be many things and earn a lot more money doing one of those things. Is that really true? Doctors are most of the best-paying jobs in the US [0] It seems to me that if you're bright, and care about making a lot of money, medicine is absolutely the way to go. Yes, there are some people who strike it rich with startups or high finance, but that's essentially buying a lotto ticket. [0]: http://www.bls.gov/oes/current/oes_nat.htm#00-0000 http://www.bls.gov/oes/current/oes_nat.htm#00-0000 (sort by annual mean wage, Anesthesiologists, Surgeons, Oral and Maxillofacial Surgeons, etc.)

cashoil 12y ago

Is Obamacare going to be the first step towards making the U.S. a socialist country ? Is the true goal to reditribute wealth ? It is meant here, http://www.mymustardseeds.com/ultimate-goals-of-obamacare.html http://www.mymustardseeds.com/ultimate-goals-of-obamacare.ht.... Or is it just verbiage to shine for the next election ? Will people suffer from Obamacare ? Are consequences to the whole system really under control (increase of the premiums, ...) ?

pessimizer 12y ago

Most important takeaway (other than a series of anecdotes, a general history lesson, and a few random undefended policy suggestions): "In 1940, in inflation-adjusted 2010 dollars, the mean income for U.S. physicians was about $50,000. By 1970, it was close to $250,000—nearly six times the median household income."