Being a physician is a horrible career move right now. As a former Math/CS major turned eye surgeon, I can't help but think about how much easier my life would be had I stuck with tech. It's hard to understand exactly how hard the job is until you've lived it. I saw 40 patient's in clinic today in 8 hours without lunch or any kind of downtime and then spent 2 hours at the hospital because a patient needed an emergent procedure. They might go blind despite my efforts and I have to live with that. I also may get sued, if they're feeling spicy, despite going to heroic lengths to help this person. My son was asleep before I got home.
There's just no reason to do the job when you can get the same compensation working remotely in tech. Looking through the "Who's Hiring" thread is soul-crushing. Physician salaries are the only ones that do not grow relative to inflation and have decreased year-on-year relative to inflation for decades.
I do believe that the rigorous training model leads to a higher quality of care and much deeper understanding of the disease process. But, why would anyone want to do the job? It's just not worth the liability anymore. That said, is anyone hiring an ophthalmologist with CS and Math degrees?
I've no doubt the stress of your work is immense and the constant threat of litigation (and the expense of the insurance to fight it) can be overwhelming. As a recipient of multiple eye surgeries (I had strabismus as a kid), I am grateful for competent professionals like you. But I think you buried the lede.
In the 2010s I owned a high-end bicycle and sporting good store. It was 7 days of 10+ hours a day most weeks. And it was very nearly non-profit or barely-profit for most of its run. If you know anyone that owns a bike shop, you should give them a hug. They need it.
Nearly every Friday afternoon, just after lunch, a few of my customers who were physicians or surgeons would pull up in their Model X or Cayenne to get service for their 10k road bike they were taking to their vacation home for the weekend. On more than one occasion, one of them would exasperatedly tell me how much they envied me and how lucky I was to be doing what I "loved". As I confronted my busy, work-filled weekend cemented to the shop to deal with the fickle and spoiled public, I had to chuckle as they drove away in their luxury vehicles to their luxury vacation home with a nicer bike than my own.
In retrospect, I've concluded that the real problem they faced is they'd built a life dependent on a physician or surgeon's income. They were told they were building a castle, but instead they built a prison. The fact is, you just can't spend enough money to truly escape the stresses of your work, but you can certainly spend enough money to become shackled to it.
> There's just no reason to do the job when you can get the same compensation working remotely in tech. Looking through the "Who's Hiring" thread is soul-crushing. Physician salaries are the only ones that do not grow relative to inflation and have decreased year-on-year relative to inflation for decades.
What ? Most U.S physicians make 300K + after residency with job security set for life. The real bright ones, the "faang" doctors make close to a million. Show me anyone in tech who can have that guaranteed for him. You're basically guaranteed to join the millionaire club if you decide to work enough years even as a mediocre doctor.
Yes its an extremely difficult job I have no argument there, but there's no comparison to tech in terms of compensation or job security.
This viewpoint is just plain crazy. If you worked in tech you'd be totally disposable, just like all the rest of us programming drones. Hit 40-50 and boom, unless you've transitioned into management, suddenly no one wants to hire you, or if they do its half of what you were making before.
Your MD degree and the AMA literally writing laws on your behalf limits labor supply competition like nothing in tech. You may have noted 250K+ tech layoffs in last year or so. Many of those people could probably code circles around you. Where are the physician layoffs? There aren't any.
If you want fewer hours, work fewer hours. What are they going to do, fire you? They can't. There is a shortage as this notes.
> That said, is anyone hiring an ophthalmologist with CS and Math degrees?
As someone who recently transitioned to a tech role, I'd urge you to focus on applying to companies related to your existing fields (ophthalmology, medicine, surgery, and their derivatives) who happen to be seeking SWE's, rather than general tech companies. Especially Series A, B, C startups. Look up all the companies that make your equipment or the software that you use, and go to their jobs pages. See anything that is tech or tech adjacent: swe, swe test, qa engineer, automation engineer, data engineer, anything mentioning python or javascript. The job market is the worst in 20 years and so the only companies that gave me the light of day were the ones in my previous field (energy and mechanical engineering).
The biggest complaint I always hear from people in the medical field is the long hours. It sure sounds to me like that (and thus any knock-on problems) could be solved by more practitioners, spreading the work around. I can't speak for you, but personally, a proper work-life balance in comparison to these horror stories is surely worth a possible salary cut?
Your income is relatively insane (multiple 100k), you have ultimate job security even in old age, opening a private practice makes your income essentially open ended depending on how much hard work you put in, you can help your loved ones and yourself to better navigate health care, will always receive priority treatment and probably have the job with the highest social standing that exists.
I don‘t know what it is with doctors world wide having zero awareness of their maximum privilege and zero perspective on how their average and median fellow citizens do.
Yes it‘s hard, but so are many, many other jobs you don‘t hear much about.
I dropped out of an MD/PhD program after I passed Step 1, it’s hard to articulate exactly how it felt staring down the barrel of a career in medicine but this is sort of what I feared.
Since I’ve been in tech I’ve been laid off several times, and it’s not clear that compensation or demand will always be as hot as it is right now. I’m not complaining but if you take any satisfaction in actually helping people, there’s a real possibility you won’t find that anymore.
That said, you have options. If you’re willing to work at a junior or mid-level role, companies probably won’t care much what you did before. Maybe wait til the next boom in hiring happens, jump on the hype train. With your technical skills there’s probably some very unique research roles you could fill if you’re interested in that lifestyle — although the compensation is not super appealing. If it doesn’t work out, I feel like you could go back to surgery right?
I understand your situation - it's all of our lives too. Nobody that works for a living has had a raise compared to inflation, all of us have less than we ought to.
Tech is a terrible place to be employed right now - at least you will still have a job for the foreseeable future.
Plus, if your income is around the average eye surgeon salaries in the US (250k-300k according to some random website) - your income places you in the 97th percentile.
I'm not saying you should suck it up and deal with it - not at all, this is wrong and you feel the way you do for a reason. It isn't your fault anymore than it's someone's fault for getting stuck at a dead end job.
We are all in the same boat... except for those in super yachts.
The truth is simply that most people are far worse off than you. Except for the billionaires, we are all poor.
Look at medical device and pharma companies with a strong optha pipeline.
I work with maybe 2 dozen retinal surgeons, and it seems like a pretty cushy gig. High 6 figure salary, mostly working from home, providing input for clinical trials and product development. Some do it part time and still maintain private practices.
No one really gets those (statistically). I never did, despite being great at what I do. Basically a lottery system where the one lucky person who did the same exact problem two days ago wins.
Tech is temporary, though. The reason salaries (and profits) are so high is because tech companies, when successful, displace whole industries and capture the revenue in a more labor-efficient way. But once the industry has been displaced, you don't need the software engineers anymore. Eventually the tech company becomes a dinosaur that the finance department milks for profits and share buybacks, and then gets replaced by a younger, hotter tech company.
If you ask 40+ year old software engineers, the biggest problem with the profession is the need to re-train every 5-10 years or face obsolescence. I'm in my early 40s, been doing this 20 years, and I've re-trained 4 times on new technology before finally switching into management. I just had an emergency medical procedure done. My surgeon graduated medical school in 1981, before I was born. He's able to learn one set of skills and then keep milking it for 40+ years.
I agree, I left a FAANG and startup to pursue medicine (not that finances were my motivation) and my co-founder who went back to a FAANG is earning more than most physicians now.
I’m far removed from this work environment now but at 10 years of SWE in a FAANG one seems to be making ~$350k-400k in total compensation? Not sure how many make it to L6 or higher, I defer to other commenters here.
If you consider the competitiveness of high earning jobs (especially in desirable markets, probably the top 20% of candidates), the opportunity cost during a decade of training I would imagine a similar %ile candidate in CS would be making more in major cities.
With that said physician income is relatively similar in metro vs cheaper COL areas so if you wanted to work in non-tech cities or smaller metros specialty physicians would probably make more.
With that said, with the hours and work intensity I put in now I could probably do 2 FTE SWE jobs (at least comparing to what it was like 10+ years ago).
"I saw 40 patient's in clinic today in 8 hours without lunch or any kind of downtime"
You want to give better care to patients, which means more time per visit and at least three breaks per day (morning, lunch and afternoon). You want to have more coworkers so that you can have consistent on-call work. Increasing the quality of your life-work balance will improve the quality of your work.
As a resident, you likely did 24 hour shifts -- or worse. That was just hazing: nobody does their best work while sleep-deprived, and training in it doesn't improve things. You need reform throughout the system.
You need a union. And one of the things that union needs to focus on is getting more people into this line of work.
>That said, is anyone hiring an ophthalmologist with CS and Math degrees?
I mean there's a bunch of AI stuff/hype now, you could probably find something if you want to leverage your MD? I imagine you'd have a lot of insight into what would actually work well in practice and improve outcomes.
And worldcoin probably needs an opthamologist who can help ensure the retina id scans are stable... there are also a lot of retina scan companies anyway for digital identification that probably need an opthamologist. It may be as simple as keeping a set of scans over time so you reauthenticate in person and get your token updated like when you get a passport renewed for example. But maybe there's other stuff like preventing adversarial attacks.
Or maybe robotic surgery? Or maybe start your own? You might be able to patent something even.
> I do believe that the rigorous training model leads to a higher quality of care and much deeper understanding of the disease process.
you somewhat answer your own question in the prior sentence. maybe not want, maybe called, or cared, maybe something else. not that it is binding or permanent, not that it should be.
but for all of the words spent about how it is a bad choice, how it has harmed you directly, how the money isn’t great, you’re bringing up positives, for patients.
you sound burned out. that’s not a criticism, nor should it be a badge of honor. maybe i have totally misjudged, but the career choice doesn’t sound like a purely financial decision for you.
even if not, even if i misjudge this, you, you did that ten hour plus death march. you gave your best efforts though that patient may go blind anyway, though they may feel punitive about it towards you.
you still did it. someone had to. by your own words, the patient NEEDED the procedure. you needed to go home, and be with family.
the patient got the procedure.
in case no one else has said it, or joining in with anyone that already has:
You’re on the wrong forum to complain about the medical field. These SWE think you’re a privileged complaining brat (ironic) who breezed through the 15 years of school and training and don’t deserve anything but disrespect. You’re part of the medical cartel and for the most part, they despise you. Your salary is deemed too high and you are expensive overhead that needs to be decreased - hence the outrage and popularity of these articles here.
You must know this? Have you not seen their comments on HN medical threads? So vocal and often horribly wrong it would be comical if it wasn’t so depressing.
I’m not going to one up you with my own sob story, but it’s like you say for all of us everywhere in the US - but you can really only complain to other MDs. Outsiders will demand you work more, get paid less, get sued more, and grovel. They hate us, so don’t complain to them. In the end they will get what they want - automated service by LLM combined with other diagnostic software and nursing. They will then complain for the return of the human physician. It’s so typical.
You are perfectly suited to giving them automated service. Just spitballing and probably wrong - have an optho specific app with an LLM and maybe a plug in smart phone device that has object detection/instance segmentation for diabetic retinopathy. Cataracts detection might be secondary? There’s plenty of products for retinopathy and looks like Inception networks do fine for cataracts. Other eye pathologies that are easily visually diagnosed are on the table too. Why see 40 patients when you could see 150 and the LLM/app have done the referral, initial screening questionnaire, and your nurses/MAs write your note/rx/orders etc. Ideally you should be like a dentist (they clearly figured this out already). You walk into the patient’s room do a quick eye exam, say what needs to happen, don’t answer any questions, and walk out. They hate you already anyways, might as well lean into it.
Would you be willing to share your story of how you made the switch? CS major here considering going into medicine (despite your best efforts to convince otherwise :) ) but the general coursework wasn't something I targeted in school all those many years ago.
Planning and predicting highly variable systems is hard. Long-range interventions are especially risky given the possibilities for unexpected consequences and also the long lead times in fixing the problems.
Central planning on resources has been especially rife with failed examples (the USSR being the all-in poster child.)
As the article points out, the concept of central planning is orthogonal to who is providing the service. With heath care there are a range of national strategies (from fully private to fully public), and the impact of central planning (or lack thereof) can be seen across the board.
So one should be careful of concluding that this is a party-political issue. It seems unrelated to left-right politics, and rather the result of central planning, predicting and modelling.
I feel like we are going too far. Central planning in presence of hostile adversaries unrestricted by any ethical systems failed. And by what measures has “free market” has proven itself as successful? You can come up with your measures of success and others will propose measures of shortcoming. Others will even dispute the claim the American-led west is anything different from a centrally planned set of cooperating economies.
During the pandemic, they were sending droves of doctors to Europe. They offered to assist in NYC but Trump turned them away as our population dwindled. Famously, when a British cruise ship with ill passengers aboard was denied by ports in Florida, Cuba took them in and saved many lives.
>Central planning on resources has been especially rife with failed examples (the USSR being the all-in poster child.)
This assertion is greatly exaggerated. It's certainly true that the centrally planned economy of the USSR didn't grow as quickly as peer countries with similar levels of economic development. The typical contrast is the much faster growth of Japan versus the Soviet Union in the late twentieth century. (Even the computer knows the story; my phone's predictive text got the countries right!)
But the Soviet Union nonetheless grew. Its growth rate was similar to that of the United States, but starting from a lower level (missing out on catch-up growth). It was the contradiction between the government's insistence that the planned economy would outperform the West versus the reality of the situation that led to a death spiral of political dysfunction and "alternative facts".
Even though the system was not efficient, it wasn't disastrous by itself, only suboptimal. It's a standard prediction of economic theory that lower risk tolerance comes at the cost of some expected return. But in the case of fields like education and medicine, we might have a lower risk tolerance and be willing to tolerate lower growth to achieve it.
In this case, the government stopped subsidizing medical schools. That would seem like what the libertarians want, but the outcomes were not good. Blaming central planning per se doesn't seem like the answer.
It is troubling that people trained similarly (to the people who made the forecasting blunder in the article) and given similar powers, are involved in forecasting in other significant domains: climate, war, inflation, etc.
The health care industry seems to be profiting off this by having more care provided by nurse practitioners and physician assistants but billing the insurers same as they would charge for M.D./D.Os.
Medicare and most insurance strictly control this.
But the industry benefits from a constrained supply of doctors because it means less competition; laws ultimately require doctors to be in charge of a practice. Some laws are now even restricting the number of PA/NP's that can be supervised, but it's not a strong effect.
Some states permit NP's to practice without a physician, but PA's all require a supervising physician.
They carefully maintain the scarcity of doctors, but import as many nurses as they possibly can, work them hard, and pay them the least they can get away with. It's only logical.
A similar phenomenon occurred in the UK, where under fears of "medical unemployment", the British Medical Association argued against increasing medical school places [0].
The attitude persists even today, where the BMA advocates that medical school entries should be limited to the number of specialty training places that follow basic training, so as to avoid the risk of doctors becoming unemployed or under-employed.
As a consequence the UK has a dearth of doctors, and those who are trained are over-worked. The government tries to alleviate the situation somewhat by recruiting from overseas.
they better change how it works, or we're going to be out here doing minor surgeries on ourselves with scalpel in one hand and watching youtube tutorial on our phone in the other, with gpt on speaker
I doubt US would be able to see a level of medical accessibility on par with many European countries. The medical education system has a perverse incentive to reduce the yearly graduates -- the less graduates there are, the more profits and prestiges each of the current members can garner (with arguably better trained graduates) -- and as shown in the article, they seem to have monopolistic capability for the throttling. And the incentive is only larger when people spend more disposable income for their healthcare, which has been the case. Maybe political powers may shift the direction a bit, but I do not see any evidence of a major course correction.
> Physician salaries are the only ones that do not grow relative to inflation and have decreased year-on-year relative to inflation for decades.
Medical insurance has been increasing faster than inflation for a while now. Are only insurance companies getting this extra money? Are at least some medical professionals getting a cut?
What is a nutshell explanation of how healthcare got to the overall shortage state? (For the USA, but curious about other countries.) In the past 20 years, costs have shot up, doctors are seeing many more patients, and quality of care seems to have generally declined. Where have the resources gone? In the 1990s my GP had time to shoot the breeze for 20 minutes or more. Now I get a 5-minute diagnosis on the run, after scheduling months in advance.
I'm a physician as well (radiologist). I started practicing a few years ago, and I'm currently working part time and doing my masters in AI/data science. After a few years I hope to leave the field as well. It isn't because of lack of jobs (in fact, radiologist shortage is dire). It is because it is very stressful and demoralizing to be a physician in america, and the seemingly "high" pay does not make up for the downsides.
discriminatory MCATs, brutal STEPS, insane Pre-Med curriculum, and more nonsense designed to cater to white elites who gamed the educational system and less to those who are genuinely trying to help the disenfranchised, unremembered, diverse and more.
Hopefully one day, we'll make it as easy to become a doctor as it is to -- say -- become an Engineer.
A physician shortage is not a good thing, but I'm closer to the nurses shortage; my wife is a nurse. Nurses get it from all sides: The healthcare administrators never put enough on duty, similarly they don't have enough CNAs helping them, and the patients and families can be pretty abusive.
It's really a game of numbers: You should have 1 nurse for every X patients, and Y CNAs for every nurse. But the common story is that there are always games being played with increasing the number of patients and decreasing the number of CNAs, leaving nurses having to do more things for more patients. This directly, negatively impacts patient outcome.
This article is based on reading (some) government reports, not on actual experience reports from medical schools, funding (which has increase), etc. Still, it's an important issue and set of data.
It's not unreasonable given the training investment to err on the side of avoiding wasted education, and fill gaps with less-trained people.
The physician/patient ratio is not a good measure of service availability. Some would say US doctors are more productive.
The alternative is not more doctors, but more "advanced practice" providers - Nurse Practitioners and Physician Assistants (or Associates). Their numbers have increased dramatically, and they have taken over anything routine and many ancillary functions of complex cases. PA schools in particular have proliferated, and produced an over-supply of PA's, who depend entirely on having a supervising physician. NP's by contrast benefit from the long history of unionization in nursing, have taken over management in many cases, and restrict the supply at the school level. Overall they top out at what doctors start at, even with decades of experience. It's good for young professionals, but there's not a lot of headroom.
As for dependence on foreign schools, the US has more foreign graduates in every field, and most have been hired into hospital systems as a way of combating medical practice groups.
The independent medical practice groups almost completely died out, as hospital systems refused to contract out to practices, and instead hired doctors as employees so they could control costs. Recently with private equity targeting specific local monopolies, you're getting specialty practices in radiology, anesthesiology, cardiology (mostly stenting) and now even GI, where the same private equity firm coordinates everyone in a geographical area (and pursues a number of dark-billing practices). There may be small internal practice in the hospital for poor people to get middling care, but the good doctors go into the practice groups.
Access to care comes down to logistics (terrible IT) and PCP's being used to reduce care. They hate it, which is why those who can avoid primary care.
The other side of supply is loss. Doctors are leaving the profession at a high rate because they're not really doing medicine (and they can afford to leave). They need better systems and adjuncts and more sensitive administration.
Are you by chance asking this so you have some places to escape to when the looming eternal September event ( triggered by the change in reddit's API policies July 1st) suddenly drives a bunch of, well, reddit-level traffic from there to here?
Imagine a world where computer use required a prescription from a limited number of licensed engineers. You have to pay to talk to them about your problem and they’ll set you up with an app to use for a week or two.
I'd take a giant stab in the dark suggesting there maybe a surplus of dermatologists but not enough oncologists, endocrinologists, or neurotolaryngological surgeons.
[+] [-] the_d3f4ult|2 years ago|reply
There's just no reason to do the job when you can get the same compensation working remotely in tech. Looking through the "Who's Hiring" thread is soul-crushing. Physician salaries are the only ones that do not grow relative to inflation and have decreased year-on-year relative to inflation for decades.
I do believe that the rigorous training model leads to a higher quality of care and much deeper understanding of the disease process. But, why would anyone want to do the job? It's just not worth the liability anymore. That said, is anyone hiring an ophthalmologist with CS and Math degrees?
[+] [-] trentnix|2 years ago|reply
In the 2010s I owned a high-end bicycle and sporting good store. It was 7 days of 10+ hours a day most weeks. And it was very nearly non-profit or barely-profit for most of its run. If you know anyone that owns a bike shop, you should give them a hug. They need it.
Nearly every Friday afternoon, just after lunch, a few of my customers who were physicians or surgeons would pull up in their Model X or Cayenne to get service for their 10k road bike they were taking to their vacation home for the weekend. On more than one occasion, one of them would exasperatedly tell me how much they envied me and how lucky I was to be doing what I "loved". As I confronted my busy, work-filled weekend cemented to the shop to deal with the fickle and spoiled public, I had to chuckle as they drove away in their luxury vehicles to their luxury vacation home with a nicer bike than my own.
In retrospect, I've concluded that the real problem they faced is they'd built a life dependent on a physician or surgeon's income. They were told they were building a castle, but instead they built a prison. The fact is, you just can't spend enough money to truly escape the stresses of your work, but you can certainly spend enough money to become shackled to it.
[+] [-] weatherlite|2 years ago|reply
What ? Most U.S physicians make 300K + after residency with job security set for life. The real bright ones, the "faang" doctors make close to a million. Show me anyone in tech who can have that guaranteed for him. You're basically guaranteed to join the millionaire club if you decide to work enough years even as a mediocre doctor. Yes its an extremely difficult job I have no argument there, but there's no comparison to tech in terms of compensation or job security.
[+] [-] trashface|2 years ago|reply
Your MD degree and the AMA literally writing laws on your behalf limits labor supply competition like nothing in tech. You may have noted 250K+ tech layoffs in last year or so. Many of those people could probably code circles around you. Where are the physician layoffs? There aren't any.
If you want fewer hours, work fewer hours. What are they going to do, fire you? They can't. There is a shortage as this notes.
[+] [-] carabiner|2 years ago|reply
As someone who recently transitioned to a tech role, I'd urge you to focus on applying to companies related to your existing fields (ophthalmology, medicine, surgery, and their derivatives) who happen to be seeking SWE's, rather than general tech companies. Especially Series A, B, C startups. Look up all the companies that make your equipment or the software that you use, and go to their jobs pages. See anything that is tech or tech adjacent: swe, swe test, qa engineer, automation engineer, data engineer, anything mentioning python or javascript. The job market is the worst in 20 years and so the only companies that gave me the light of day were the ones in my previous field (energy and mechanical engineering).
[+] [-] xvedejas|2 years ago|reply
[+] [-] Traubenfuchs|2 years ago|reply
I don‘t know what it is with doctors world wide having zero awareness of their maximum privilege and zero perspective on how their average and median fellow citizens do.
Yes it‘s hard, but so are many, many other jobs you don‘t hear much about.
[+] [-] smarmgoblin|2 years ago|reply
Since I’ve been in tech I’ve been laid off several times, and it’s not clear that compensation or demand will always be as hot as it is right now. I’m not complaining but if you take any satisfaction in actually helping people, there’s a real possibility you won’t find that anymore.
That said, you have options. If you’re willing to work at a junior or mid-level role, companies probably won’t care much what you did before. Maybe wait til the next boom in hiring happens, jump on the hype train. With your technical skills there’s probably some very unique research roles you could fill if you’re interested in that lifestyle — although the compensation is not super appealing. If it doesn’t work out, I feel like you could go back to surgery right?
[+] [-] SamoyedFurFluff|2 years ago|reply
I’m surprised you can’t leverage this into a product role or a consulting role for startups in the medical space. You know shit about med systems!!
[+] [-] lostlogin|2 years ago|reply
It’s a seriously big deal in his world.
When domain experts write make their own tools, the results are so much better than when an outsider does it for them.
[+] [-] NemoNobody|2 years ago|reply
Tech is a terrible place to be employed right now - at least you will still have a job for the foreseeable future.
Plus, if your income is around the average eye surgeon salaries in the US (250k-300k according to some random website) - your income places you in the 97th percentile.
I'm not saying you should suck it up and deal with it - not at all, this is wrong and you feel the way you do for a reason. It isn't your fault anymore than it's someone's fault for getting stuck at a dead end job.
We are all in the same boat... except for those in super yachts.
The truth is simply that most people are far worse off than you. Except for the billionaires, we are all poor.
[+] [-] epicureanideal|2 years ago|reply
Same has been happening to software engineers for the last 10 years at least. Salaries go up but not as fast as inflation.
I’ve gotten higher titles and more responsibility over the years but inflation is still winning compared to 5+ years ago.
> That said, is anyone hiring an ophthalmologist with CS and Math degrees?
As soon as the job market recovers I think you’ll have no problem finding a job in software.
[+] [-] s1artibartfast|2 years ago|reply
I work with maybe 2 dozen retinal surgeons, and it seems like a pretty cushy gig. High 6 figure salary, mostly working from home, providing input for clinical trials and product development. Some do it part time and still maintain private practices.
[+] [-] hn976827|2 years ago|reply
Spoken with the true conviction of a position of privilege, and blinded by the very same. (No pun intended.)
Hint: The majority of U.S. citizens have it worse than you.
[+] [-] mixmastamyk|2 years ago|reply
No one really gets those (statistically). I never did, despite being great at what I do. Basically a lottery system where the one lucky person who did the same exact problem two days ago wins.
[+] [-] nostrademons|2 years ago|reply
If you ask 40+ year old software engineers, the biggest problem with the profession is the need to re-train every 5-10 years or face obsolescence. I'm in my early 40s, been doing this 20 years, and I've re-trained 4 times on new technology before finally switching into management. I just had an emergency medical procedure done. My surgeon graduated medical school in 1981, before I was born. He's able to learn one set of skills and then keep milking it for 40+ years.
[+] [-] haldujai|2 years ago|reply
I’m far removed from this work environment now but at 10 years of SWE in a FAANG one seems to be making ~$350k-400k in total compensation? Not sure how many make it to L6 or higher, I defer to other commenters here.
If you consider the competitiveness of high earning jobs (especially in desirable markets, probably the top 20% of candidates), the opportunity cost during a decade of training I would imagine a similar %ile candidate in CS would be making more in major cities.
With that said physician income is relatively similar in metro vs cheaper COL areas so if you wanted to work in non-tech cities or smaller metros specialty physicians would probably make more.
With that said, with the hours and work intensity I put in now I could probably do 2 FTE SWE jobs (at least comparing to what it was like 10+ years ago).
[+] [-] dsr_|2 years ago|reply
You want to give better care to patients, which means more time per visit and at least three breaks per day (morning, lunch and afternoon). You want to have more coworkers so that you can have consistent on-call work. Increasing the quality of your life-work balance will improve the quality of your work.
As a resident, you likely did 24 hour shifts -- or worse. That was just hazing: nobody does their best work while sleep-deprived, and training in it doesn't improve things. You need reform throughout the system.
You need a union. And one of the things that union needs to focus on is getting more people into this line of work.
[+] [-] FredPret|2 years ago|reply
They probably wouldn’t even advertise for an ophthalmologist/ CS / Math person, because I think there’s probably only the one of you!
[+] [-] theGnuMe|2 years ago|reply
I mean there's a bunch of AI stuff/hype now, you could probably find something if you want to leverage your MD? I imagine you'd have a lot of insight into what would actually work well in practice and improve outcomes.
I just skimmed your comment history, so you already know about AI diagnostics e.g. https://health.google/caregivers/arda/
And worldcoin probably needs an opthamologist who can help ensure the retina id scans are stable... there are also a lot of retina scan companies anyway for digital identification that probably need an opthamologist. It may be as simple as keeping a set of scans over time so you reauthenticate in person and get your token updated like when you get a passport renewed for example. But maybe there's other stuff like preventing adversarial attacks.
Or maybe robotic surgery? Or maybe start your own? You might be able to patent something even.
This being HN, the world is your oyster and all.
[+] [-] catchnear4321|2 years ago|reply
> I do believe that the rigorous training model leads to a higher quality of care and much deeper understanding of the disease process.
you somewhat answer your own question in the prior sentence. maybe not want, maybe called, or cared, maybe something else. not that it is binding or permanent, not that it should be.
but for all of the words spent about how it is a bad choice, how it has harmed you directly, how the money isn’t great, you’re bringing up positives, for patients.
you sound burned out. that’s not a criticism, nor should it be a badge of honor. maybe i have totally misjudged, but the career choice doesn’t sound like a purely financial decision for you.
even if not, even if i misjudge this, you, you did that ten hour plus death march. you gave your best efforts though that patient may go blind anyway, though they may feel punitive about it towards you.
you still did it. someone had to. by your own words, the patient NEEDED the procedure. you needed to go home, and be with family.
the patient got the procedure.
in case no one else has said it, or joining in with anyone that already has:
thank you, stranger.
[+] [-] Pigalowda|2 years ago|reply
You must know this? Have you not seen their comments on HN medical threads? So vocal and often horribly wrong it would be comical if it wasn’t so depressing.
I’m not going to one up you with my own sob story, but it’s like you say for all of us everywhere in the US - but you can really only complain to other MDs. Outsiders will demand you work more, get paid less, get sued more, and grovel. They hate us, so don’t complain to them. In the end they will get what they want - automated service by LLM combined with other diagnostic software and nursing. They will then complain for the return of the human physician. It’s so typical.
You are perfectly suited to giving them automated service. Just spitballing and probably wrong - have an optho specific app with an LLM and maybe a plug in smart phone device that has object detection/instance segmentation for diabetic retinopathy. Cataracts detection might be secondary? There’s plenty of products for retinopathy and looks like Inception networks do fine for cataracts. Other eye pathologies that are easily visually diagnosed are on the table too. Why see 40 patients when you could see 150 and the LLM/app have done the referral, initial screening questionnaire, and your nurses/MAs write your note/rx/orders etc. Ideally you should be like a dentist (they clearly figured this out already). You walk into the patient’s room do a quick eye exam, say what needs to happen, don’t answer any questions, and walk out. They hate you already anyways, might as well lean into it.
- Currently an imaging fellow in the cartel.
[+] [-] noleetcode|2 years ago|reply
[+] [-] mvanlonden|2 years ago|reply
[+] [-] unknown|2 years ago|reply
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[+] [-] bruce511|2 years ago|reply
Central planning on resources has been especially rife with failed examples (the USSR being the all-in poster child.)
As the article points out, the concept of central planning is orthogonal to who is providing the service. With heath care there are a range of national strategies (from fully private to fully public), and the impact of central planning (or lack thereof) can be seen across the board.
So one should be careful of concluding that this is a party-political issue. It seems unrelated to left-right politics, and rather the result of central planning, predicting and modelling.
[+] [-] DSingularity|2 years ago|reply
[+] [-] whitemary|2 years ago|reply
https://en.m.wikipedia.org/wiki/List_of_countries_and_depend...
During the pandemic, they were sending droves of doctors to Europe. They offered to assist in NYC but Trump turned them away as our population dwindled. Famously, when a British cruise ship with ill passengers aboard was denied by ports in Florida, Cuba took them in and saved many lives.
[+] [-] scythe|2 years ago|reply
This assertion is greatly exaggerated. It's certainly true that the centrally planned economy of the USSR didn't grow as quickly as peer countries with similar levels of economic development. The typical contrast is the much faster growth of Japan versus the Soviet Union in the late twentieth century. (Even the computer knows the story; my phone's predictive text got the countries right!)
But the Soviet Union nonetheless grew. Its growth rate was similar to that of the United States, but starting from a lower level (missing out on catch-up growth). It was the contradiction between the government's insistence that the planned economy would outperform the West versus the reality of the situation that led to a death spiral of political dysfunction and "alternative facts".
Even though the system was not efficient, it wasn't disastrous by itself, only suboptimal. It's a standard prediction of economic theory that lower risk tolerance comes at the cost of some expected return. But in the case of fields like education and medicine, we might have a lower risk tolerance and be willing to tolerate lower growth to achieve it.
In this case, the government stopped subsidizing medical schools. That would seem like what the libertarians want, but the outcomes were not good. Blaming central planning per se doesn't seem like the answer.
[+] [-] profsummergig|2 years ago|reply
[+] [-] trashface|2 years ago|reply
[+] [-] w10-1|2 years ago|reply
But the industry benefits from a constrained supply of doctors because it means less competition; laws ultimately require doctors to be in charge of a practice. Some laws are now even restricting the number of PA/NP's that can be supervised, but it's not a strong effect.
Some states permit NP's to practice without a physician, but PA's all require a supervising physician.
[+] [-] pessimizer|2 years ago|reply
[+] [-] naveen99|2 years ago|reply
anti kickback laws are also a double edged sword. https://en.wikipedia.org/wiki/Stark_Law
But in the end, the usa has the healthcare system where doctors want to work and rich patients want to be treated given an option of any country.
[+] [-] pcrh|2 years ago|reply
The attitude persists even today, where the BMA advocates that medical school entries should be limited to the number of specialty training places that follow basic training, so as to avoid the risk of doctors becoming unemployed or under-employed.
As a consequence the UK has a dearth of doctors, and those who are trained are over-worked. The government tries to alleviate the situation somewhat by recruiting from overseas.
[0] https://www.bmj.com/content/348/bmj.g2398
[+] [-] ftxbro|2 years ago|reply
[+] [-] nemonemo|2 years ago|reply
[+] [-] supahfly_remix|2 years ago|reply
Medical insurance has been increasing faster than inflation for a while now. Are only insurance companies getting this extra money? Are at least some medical professionals getting a cut?
[+] [-] paulddraper|2 years ago|reply
Frustrating to see these problems of purely human design.
[+] [-] wrp|2 years ago|reply
[+] [-] truthseeker1|2 years ago|reply
[+] [-] schoolornot|2 years ago|reply
[+] [-] RNCTX|2 years ago|reply
[+] [-] DieBruderBauer|2 years ago|reply
Hopefully one day, we'll make it as easy to become a doctor as it is to -- say -- become an Engineer.
[+] [-] linsomniac|2 years ago|reply
It's really a game of numbers: You should have 1 nurse for every X patients, and Y CNAs for every nurse. But the common story is that there are always games being played with increasing the number of patients and decreasing the number of CNAs, leaving nurses having to do more things for more patients. This directly, negatively impacts patient outcome.
[+] [-] w10-1|2 years ago|reply
It's not unreasonable given the training investment to err on the side of avoiding wasted education, and fill gaps with less-trained people.
The physician/patient ratio is not a good measure of service availability. Some would say US doctors are more productive.
The alternative is not more doctors, but more "advanced practice" providers - Nurse Practitioners and Physician Assistants (or Associates). Their numbers have increased dramatically, and they have taken over anything routine and many ancillary functions of complex cases. PA schools in particular have proliferated, and produced an over-supply of PA's, who depend entirely on having a supervising physician. NP's by contrast benefit from the long history of unionization in nursing, have taken over management in many cases, and restrict the supply at the school level. Overall they top out at what doctors start at, even with decades of experience. It's good for young professionals, but there's not a lot of headroom.
As for dependence on foreign schools, the US has more foreign graduates in every field, and most have been hired into hospital systems as a way of combating medical practice groups.
The independent medical practice groups almost completely died out, as hospital systems refused to contract out to practices, and instead hired doctors as employees so they could control costs. Recently with private equity targeting specific local monopolies, you're getting specialty practices in radiology, anesthesiology, cardiology (mostly stenting) and now even GI, where the same private equity firm coordinates everyone in a geographical area (and pursues a number of dark-billing practices). There may be small internal practice in the hospital for poor people to get middling care, but the good doctors go into the practice groups.
Access to care comes down to logistics (terrible IT) and PCP's being used to reduce care. They hate it, which is why those who can avoid primary care.
The other side of supply is loss. Doctors are leaving the profession at a high rate because they're not really doing medicine (and they can afford to leave). They need better systems and adjuncts and more sensitive administration.
[+] [-] nine_zeros|2 years ago|reply
[+] [-] ChainOfFools|2 years ago|reply
[+] [-] jl2718|2 years ago|reply
[+] [-] 1letterunixname|2 years ago|reply