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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.
Let me first reiterate that I don't think this is super rational.
Keep in mind that like 55-60 of percent of grads are women, and ultra woke ones at that. A good chunk of the guys are gay. 45% are non-white (mostly Asian and Indian).
The politics these days are super far left (downstream of admission requirements and other factors).
That alone makes these people disproportionately want to live in the biggest most blue areas or "one of the good ones" in a red state.
If my mom was here she would tell me to shut the fuck up about making this too much about politics so I'll point out other things like - you didn't do anything at all for fun (exaggeration but gets the point across) in your 20s or early 30s. You want to live in a place where you can go and make up for that, and not feel 30 years older than everyone else. That means SF, LA, NYC, Chicago, etc.
A college town has amenities but most of the people using them are younger and don't look soul crushed and it makes you feel worse.
This got rambley.
Atlanta/Houston/DFW are fine at attracting people but where the need is a two drive away from each of them. That's fine for a weekend trip but when you are trying to make up for lost time it isn't viable, you want to be able to catch a show after work, go to a hip new bar or restaurant.
An alternative way to think about this is that a lot of people graduate from college, spend a few years downtown somewhere partying and having fun, then calm down and move to a suburb or further out than that. Physicians are 10-15 years behind their peers on that process.
And then kids get involved and you want a good education because it is pretty much impossible to get through training without valuing education and unsurprisingly that extents to your kids. Not finding that in most rural areas or most places in general.
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