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Yeah, this is the eternal threat, right? But ok, what are these people going to do? How many jobs in America are there that pay as much as medicine and aren’t ’top of the corporate pile after a 40 year career’ type jobs?
Very, very few.
A few jobs in big tech. A few jobs in front office high finance. A few jobs in big law. A relative handful in (other) professional services.
None of those professions have medicine-tier job security. All of them (save maybe big tech) have very long hours. All of them are ultra-competitive.
Doctors on the internet always seem to assume they could be investment bankers or deepmind engineers instead, but I don’t think they could. The truth is that medicine is a lot less competitive and more midwit than most of these jobs. Plus, most of these jobs have an extreme up-or-out career progression that medicine just doesn’t have. Of a thousand junior investment bankers at Goldman Sachs who already passed an application process with a 1% acceptance rate, how many become managing directors or seniors in PE? Maybe thirty or forty. Most end up failing out into comfortable PMC professions, often paid less than many medical specialties and again still with far, far less job security.
Plus, there’s status. Nobody in modern American society has higher status than doctors, not billionaires and certainly not bankers, lawyers or engineers. That also has value - socially and for one’s own ego - that can’t be measured solely in pecuniary terms.
Even if medicine paid half as much there would still be doctors. There are still huge numbers of bright eyed, intelligent college students with elite credentials who want to be journalists.
I know you hate that argument so I very specifically didn't make it this time.
Based off your historical unwillingness to update your understanding of anesthesia compensation and work duties I don't think we are going to have a fruitful discussion on the doctor skills/role and work alternatives side of things.
By the way, and I truly am sorry if you’ve gotten that impression, I have a great deal of respect for doctors. I think you do a great job, and I think you should be well-paid for it. And and, I think doctors’ pay is only one part of the issue with the US system’s immense inefficiencies, of which a great deal can be laid at the feet of Congress, insurance companies (not out of ‘evil’ or even the profit motive, but just because of the perverse regulatory and incentive environment they’ve been out in), the way big pharma is funded and to some extent the tragedy of the commons.
My only real ‘thought’ on doctor pay is that we should have more doctors. Let’s train them, let’s import them (from native english-speaking countries with decent standards, like our peers in the anglosphere), let’s do whatever it takes to increase residency spaces. And let’s make residency easier, let’s limit medical liability to bring down the ridiculous cost of malpractice insurance, let’s make medicine an undergraduate course like it is elsewhere so doctors don’t have to waste four years and more money going into debt.
But yes, ultimately, let’s work to bring down some salary costs. Is that so unreasonable?
Do these people want to come? I'm not sure they do.
Usually when this conversation comes up what happens is that I say something like "sure increase supply just don't compromise quality" and then someone says "being a doctor is easy, there aren't really quality differences or problems" I recall this argument from you in the past but if you don't endorse it now no problem, but ultimately most supply increasing options involve compromising quality in some way. Americans are mostly uninterested in decreasing quality, but if we decide that's on the table then we have a lot more tools available to solve some of these problems without touching supply at all.
Also, right now we seem to be in a situation where shortages are pronounced enough that the market can absorb a much higher number of physicians without bringing salaries down. In fact we likely need to increase salaries (specifically: one of the biggest problems right now is that people will refuse to work in red states or rural areas, these jobs already offer higher salaries, sometimes as much as twice as much, but in some cases that's not enough).
We already have some evidence that salaries are too low for some needs, taking salaries down further is liable to make those issues first (and again does little to decrease the overall healthcare costs).
Is this a ‘flyover’ issue that clears up for Miami, or is this progressive lying about Texas laws again?
A good half of it is medical people being hysterical idiots about "right wing legislation." Dumb shit for sure.
The other half is people refusing to work in rural Mississippi or whatever because they are educated, selected to be blue tribe, and want to actually have fun when they finally have the money and ability to actually choose where they live.
Stop being woke AF and this will self correct to some extent.
A lake house and a boat and a housekeeper(because getting paid $300k+ in Mississippi makes domestic labor cheap) isn't enough of a draw?
No, running theory is that the people in the pipeline currently are simply too culturally blue and want to avail themselves of big city resources when they finally have the ability to do so.
Given how many people leave residency single there is also the reality of finding a partner, and since most people want a class/wealth/intelligence equal and being a doctor isn't really a draw anymore, they go where the other young professionals are (and stay).
Totally get wanting a class-equal partner. But, uh, what are 'big city resources' in this context? You can travel(the usual blue tribe luxury AFAIK) from Atlanta or Houston or DFW about as easily as from NYC, and having to drive in or take a connecting flight doesn't seem like that big a deal? I can kind of grasp that the blue tribe doesn't want a lakehouse/cabin in the woods or a nice deer lease very much because they'd prefer to travel internationally, but everyone wants a nice big house with a housekeeper and a handyman, right? There's gyms and bars and decent restaurants and whatnot in flyover.
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