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PaperclipPerfector  1mo ago (text post)   27218 thread views

Culture War Roundup for the week of April 20, 2026

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There has, from time to time, been some discussion concerning doctor salaries. I don't personally care all that much about this. They're highly-trained professionals in an in-demand field, and doctor salaries probably aren't the main driver of overall healthcare costs.

Nevertheless, there's often some debate over what the numbers actually look like. I was just linked to this tweet in one of my econ link aggregators. (Yay, built-in browser translation!)

Their claim is that 84% of American physicians are in the top 10% of incomes, and 26% of American physicians are in the top 1%. Their paper makes comparisons to other countries. They also broke it down into primary care vs. specialists.

So, at least this is one snapshot view of the actual distribution of doctor salaries, which I hadn't really seen before in these discussions. Assuming, of course, that their methodology is sound, which I'm not qualified to assess.

That set of salary numbers seems pretty reasonable. Doctors are one of the few American professionals that actually need their long, expensive training regimes, and America has expensive labour regimes in general.

Yeah. Sure there's inefficiencies in the healthcare system but I'd rather the high-level medical professional got paid obscenely than the Facebook Button Color optimizer.

I think that this can not be reasonably discussed without mentioning student debt and artificial constraints on education supply.

In Germany, medicine are among the most favorite subjects to study. To be able to start to study directly after the 12th grade in school, you need to be in the top 10% of students or so, because there are not enough places in the university programs for everyone who is interested. Obviously there are people who will make fine physicians who were not in the top 10% of students (and indeed some of them are admitted after a waiting period). If instead you admitted anyone who you thought had a reasonable chance to pass the final exam, you would have tremendously increase the supply of physicians in half a decade, decreasing wages. I think this is exactly why this is not done.

In the US, I feel that it is linked to student debt. Doctors are expensive because studying medicine is expensive, because universities mostly do not compete on price but on amenities.

Top 10%?! In Sweden it's like top 2% and that is after and absolutely massive expansion of the number of spots.

After checking with AI it sounds like you're off by an order of magnitude. If you let the top 10% in then it would pretty much be open to everyone that could pass the final exam...

Yes, I was understating the situation. In my defense, while I could google the NC without trouble, I did not find grade distributions within two minutes. Anecdotally, I would say that there is more than one person per class with the required grade, though.

Unless your classes are absolutely massive that is almost certainly a bubble effect.

Doctors are one of the only high status, high income, high volume jobs.

This is actually a great way to think about this wider issue. There are high status (meaning respect as a profession) and high volume jobs - like nurses and architects, but the pay is usually decent or below. There are high pay and marginally higher volume jobs - like some computer programmers, oil rig workers, successful salespeople - but they tend to have medium or lower social status (both prestige and occupational respect). And there are high status, high(ish) pay jobs (senior judge, Hollywood A/B lister, senator), but they’re very low volume. How many astronauts are there? (Apparently the most ‘prestigious’ profession). 50?

There are a million doctors in America. Doctors have very high social status / occupational prestige. Doctors have excellent job security and high pay. This unique combination exists for no other profession.

Sure, there are people who make more than doctors, like investment bankers, quant traders, senior executives at major corporations, but they are arguably widely reviled and in any case there aren’t many of them. And sure, there are the astronauts and noble prize winning scientists, but they almost all get paid less than doctors (according to Reddit the recent lunar astronauts probably make $150k a year). There are more ‘fun’ jobs like artists and creatives, but again, the trade off is that you’ll be poor unless you’re 99.9th percentile. There are schoolteachers, who also have relatively high social respect and good job security, but they make far less than doctors unless they’re in a top-10 paying nationwide school district (in which case the local doctors make much more too) and they’re still lower status than being a doctor.

The question is ‘are all three levers necessary here’? STEM adjuncts (who are often very smart) work for shitty pay and there are still tens of thousands more PhDs produced every year. In countries where doctors are paid much less (including relative to average salaries), medical school is still very competitive - suggesting that status (or more charitably healing the sick) is enough of a motivation, you don’t need to add ‘getting (moderately) rich’. Lastly, there are so many doctors relative to other very high pay professions that they cannot all or mostly or even to a large extent find other jobs - and since nowhere pays doctors more than America, they can’t emigrate either.

This suggests doctor pay can be reduced in the United States without major risks.

The social status bit is undervalued I think. If you don't "deserve" your high pay, flaunting your wealth is hard to get away with. Doctors don't have to make excuses for having big houses and a couple of exotic cars, they earned it. But techbros have to be a bit sheepish about it.

I think it is more than that. If you are a successful doctor, everybody wants to be your friend just in case they need you to get preferential treatment, and maybe even save their lives. You will be invited to parties and so forth. If you are a a techbro, then your status is related to your ability to fix their slow computer and maybe for an off-chance that they need you to vouche for their niece to get a job in your company - but knowing somebody from HR or at least somebody who can help with nepotism friendly bullshit job such as marketing manager would be better. Nobody will need you in case they need to setup their Vertical Pod Autoscalers or some such.

There are high pay and marginally higher volume jobs - like some computer programmers, oil rig workers, successful salespeople - but they tend to have medium or lower social status

Software development is higher status than nursing. Unless you're asking the bottom of society.

Unless you're asking the bottom of society? In other words, the people who become nurses?

Software development is higher status than nursing.

Was. The good times for status are over, I think.

Yeah, I'd agree. These days it looks like being a quant as well falls into the same category unless you're talking some very select elite groups. For the common person if a man says he's a nurse he'll get more respect than if he says he develops trading models for a living.

Sad times...

Where's it going, then?

Maybe in San Francisco. But here in my bubble in LA nursing is higher status. The only status conveyed by SWE is the status of money.

Even in San Francisco, I would bet that the average male nurse would get more opposite sex matches online than the average male SWE, which is as good a proxy for status as any. The only place that wouldn't hold is if you work for a number of prestige companies you could count on one hand (and, no, Meta and Google aren't there).

If we accept the premise that "the average male nurse would get more opposite sex matches online than the average male SWE," it'd only sound like Simpson's paradox.

I imagine the average male Californian nurse is whiter (less Asian), less foreign, and taller than the average male Californian SWE, correlated factors of which matter substantially in the domain of online dating where JBW ("Just Be White") and JBT ("Just Be Tall") reign supreme. An Asian American man may very well need a couple tens or thousands of $Ks (in 2004 or so Dollars) in annual income to be the equal of a white man in women's eyes. Furthermore, each inch of deficit in height adds another few $10Ks to make-up.

Suppose you ran an experiment with 100 trials each with 100 randomly selected young American women, where in each trial the woman is shown a randomly selected/generated white guy photo paired against a randomly selected/generated white guy photo where the only captions are "Profession: Nurse" for one and "Profession: Software Engineer" for the other and she has to choose one. I know which of the two professions I'd pick to crush the other like the Globetrotters crush the Generals. Even temporarily setting software engineer aside, the scent of "male nurse" smelling like "male bitch" for women is quite strong.

It's like "Hello, Human Resources?!" combined with the "when women say they do in fact like different kinds of guys" meme. A decently-shaped 6'0" white male software engineer might be smart and quirky. Until proven otherwise, a similarly-shaped 5'9" Asian male software engineer is geeky and weird.

Height doesn't predict sexual success.

This is a terrible lie. Height is probably a top screening factor for most women. There's also social pressure to avoid the appearance of couples where the man is noticably shorter.

In my experience, the compensating factor needed for short men is to be wealthier, more aggressive in proactively meeting women, and learning how to make others laugh. None of these came naturally to me.

The chart doesn't necessarily show that height doesn't predict sexual success.

It's totally possible that plenty of short men get married, just to less attractive women.

Likewise, plenty of ugly women have sex and marry. But we wouldn't say that 'female attractiveness doesn't predict sexual success' since they're not usually getting chad to commit, or getting sex on terms as favourable as their prettier peers.

Nursing seems really low status to me. It's a dirty job. Maybe status assessments vary so much, it's pointless to talk about The Status of X.

Nursing has the whole do gooder schtick attached to it; in the eyes of the normies that beats out the actual difficulty of breaking into the job (the job itself is not easy, I grant you, but then neither is being a janitor, and that's about as low status as you can get).

In San Francisco, people who aren't SWEs hate all the "techbros" and your average dead end L5 is hated, or at least considered uninteresting, by all the other average dead end L5s. You might get some respect if you work on something unusual (and you can feel smug around people who live on the peninsula), but converting your work to respect requires some cloutmaxxing (usually by poasting on Twitter, attending the right parties, and name-dropping). Even then, your status is limited to those who travel in the same cloutmaxxing circles. But if you do all this, carefully manage your bubble, and gas up your self conception, sometimes, just maybe, you can look in the mirror and convince yourself that you are high status.

Tough comment coming from someone who ostensibly thinks changing boomer diapers is high status. I've never considered before that nursing, of all things, could be high status. Sounds like self-serving nonsense from the median person, who could likely become a nurse. To me, investment banking, law, professors are all slightly higher status than doctors, who do a lot of filthy work.

Nurses do not do diaper changes, CNA’s do, and CNA’s have a weeks long training program at company expense for a very modest pay increase. They are not socially respected.

That's being a care worker, not a proper hospital nurse, and is a very different job which yes I'd agree is low status. I'm thinking more like ICU or Operating theatre helper as "nurse".

Nursing assistants do the diaper changes.

I don't really understand what you are trying to say.

I really don’t care about “status” so long as the pay is good. Nobody is fooled when an unemployed person refers to himself as an “entrepreneur.”

Personally I'm a bit horrified at the thought of putting in all the time and effort to become a doctor and not being in the top 10% of incomes. What went wrong? Would anyone do that on purpose?

Well to start, your math is wrong. A quarter of all physicians in the US are in the 1% of the income bracket and almost half of all specialists in the US are in the 1% of the income bracket.

I strongly require a citation for this.

According to the Google the top 1% of of income earners in the U.S. make between 650-800 per year. According to the most recent salary data I've seen exactly zero specalities have an average salary in that range. Neurosurgery is not shown on this data and probably reaches 1% thresholds, however.

The bulk specialties (what most doctors are) all have average salaries which are less than half of the 1% threshold except for EM which is a tad over half of that threshold.

I also got it from Google. If it’s better sourced elsewhere, I’ll go with that instead but a glance at things seems to suggest otherwise.

According to the Google the top 1% of of income earners in the U.S. make between 650-800 per year.

That's household income. Top 1% individual income is something like 450k.

Does that imply as strong of a correlation between the two incomes of a two-income household as it seems at first glance? Something like "the average 1% individual earner is married to a top 5% individual earner or higher" seems like it would follow unless the distributions are particularly oddly shaped.

Selection effects are likely significant here. If high income people are disproportionately likely to get married, it could simply be a case of "the top 1% of the top 50% has a higher average than the top 1% of the whole."

Probably it's a combination of both.

Ah, correction noted!

I'm responding to the numbers, above, that 16% of American physicians are not in the top 10%. I didn't do any math. (Well I guess I subtracted 84 from 100 but I'm reasonably sure I got that part right.)

To get into the top 10% you only need to make like $220k/year. Is that level of income worth putting your whole life on hold until your early 30s, not to mention the debt from all the education?

I don't know how common that's in the US, but doctors at hospitals are probably the career professionals that can most easily reduce their working hours without significantly impacting the quality of their work. Want to only work 2 days a week? No problem, just take fewer shifts, and the hospital hires more doctors of your specialty.

In Europe, this leads to many doctors reducing working days while their children are small.

Yeah. Similar in Australia plus you get a lot of cases where people will soft-retire or soft-Stay at home parent by keeping whatever the minimum hours to maintain their accredited status. 1 day a fortnight telehealth or something.

Probably many of them are working for charities that pay well below market(and this is essentially a voluntary decision) or are perennial screwups stuck with lower paying jobs, or are at the very beginning of their career…

Pay is pretty flat - once you are an attending that's the salary, if anything it goes down with seniority because more senior people will take on less optional work/call and will take on non-clinical duties that pay less because clinical work is brutal.

Exception is if you go into private practice which is dying in the U.S.

Usually pay differences are more by specialty, some just don't pay well, but also you have working in academia (pay is ass) or working in a big city (pay is ass).

Opposite of most of life, in medicine more prestige and higher cost of living = lower salary.

How many of them are the female doctors that go part time once they have kids?

That is 100% a problem - female doctors are increasingly more common, work shorter careers, and work less hours during them. Many of them do switch to pure teaching or admin roles for lower hours, more consistency, and safety.

That said it is an oddity because a doctor with 20 years experience and one fresh out of residency make mostly the same in most situations.

With respect to specialty choice (which is responsible for most of the variation in pay) women are more likely to go into more mission focused fields that pay less (like pediatrics and infectious disease) and men are more likely to go into money machine go brrr fields like radiology and ortho.

Not everyone does things for money. Plenty of people get into medicine because they genuinely want to help others.

There are many, many ways to help others that don't require a tenth that much effort to get into. Not to mention the expense in terms of both time and money.

Someone who chooses to become a doctor does so only via willingness to expend blood, sweat, tears, and treasure, and lose a whole decade of their lives more or less before they can even begin. That takes some serious dedication to a very specific form of 'helping others'.

Someone with ten years of their lives and hundreds of thousands of dollars to volunteer could probably make a much larger difference than just being another doctor.

None of what you said is incorrect. And yet, it is a fact that people do indeed go into medicine for the idealized reason to wish to help others. You say you can't imagine it, so presumably you would never do that, but that doesn't change that there exist people who don't see it the way you do and would choose medicine no matter how much or little it paid.

They may not purely do it for the money but it is a big factor after graduating with a quarter million dollars in debt. That’s a contributing factor for why so many of them pursue a specialty at some point in their career.

Somebody's gotta hang out in East Kentucky and treat the Black Lung.

A lot of very intelligent people work very hard for jobs that pay much less than the 90th percentile income.

It did not improve my day to be reminded I'm in this situation.

I swing back and forth between top 1% and right around that (top 10%) every few weeks lately it seems.

You forgot to attach the "wiping up tears with handfuls of money" gif.

George Halvorson is the best person I know to consult on the state of the healthcare industry today. One of the major cost drivers for things is simply ordinary price inflation, believe it or not.

Whenever I think of the associated costs in healthcare, the complexities surrounding it are so daunting that it always brings me back to 2016 when Hillary and Bernie were running for the democratic ticket and why there’s so much bad data on this.

Back when Bernie Sanders was running for president, I don’t know how many people remember this but there was an infamous “Yale” study that come out during that period, which was a paper that supposedly showed how his plan could effectively nationalize large portions of healthcare as a whole, making things cheaper and more efficient for everybody.

Then I did a little bit of digging, and it became very clear to me that nobody read beyond the headline. Go into any hospital and walk into the insurance department and ask the person there, “What would happen to your hospital if you were reimbursed only at the Medicare rates?” The answer is always “Oh that’s simple. We would have to shutdown the hospital.

The author of that study simply took the Medicare reimbursement rates and applied them across the entire healthcare industry as a whole, which is grossly inaccurate because private insurance cross subsidizes Medicare to the tune of hundreds of billions of dollars each year. This goes away under Medicare for all and the Yale study simply ignored that fact.

"The program in this country with the lowest health care prices happens to be one where there's a very high percentage of government involvement. That's Medicaid. So, we do know where we have low prices in our health care system. And that would argue that we need more government involvement. "

-A comment from a presumably intelligent healthcare professor on a recent healthcare podcast

Everyone always talks about "Medicare for all", but "Medicaid for all" is probably more achievable: people with existing insurance options probably aren't going to drop it en masse because it's definitely a downgrade in provider selection (read: quality) and availability. Heck, more than half of Medicare beneficiaries now opt to use those dastardly insurance companies as intermediaries rather than traditional Medicare.

But I haven't tried to figure out the costs of doing this, this post is mostly an observation that the two nominally-similar services have different valences with the nation and politicians.

The problem though is that doesn’t really speak to the OP’s point about doctor salaries. If you look at what doctors employed by the NHS get paid by, it’s paltry by comparison. I don’t think most doctors get into the profession because they’re more obsessed with money than the average person is, but the level of skill and education and time and investment it takes into being one, should require compensation at the end of that journey in some form.

Remember we had initiatives like Medicare for all on the ballot already in individual states. That’s what Colorado Care was. It was rejected the moment people saw the costs associated with it via the increase in payroll tax and elsewhere. Democrats, labor unions and insurance companies all voted it down for that reason.

You have to compare it to what the option is, pretty much all salaries in the UK are much lower than their equivalent in the US.

Being a doctor is the safe option to join the UMC in the country you're in (salary wise anyway). You basically can't fail once you're in. It has by far the lowest drop out rate in their educational cohort, there are plenty of jobs, guaranteed salary progression and ironclad employment security for life.

Other paths are much more precarious, even if you go to a top program somewhere.

So if you're motivated by money and are risk averse then medicine is almost certainly your best bet. The downside is that the salary ceiling is far lower, but those who make more are a small group.

Furthermore, if you don't want to live in a HCOL then being a doctor is an amazing deal.

Furthermore, if you don't want to live in a HCOL then being a doctor is an amazing deal.

In the US this is not true, doctors get paid less in HCOL areas (not universally because California is a bit different). Want to live in NY? Boston? Chicago? Take a 25-35% pay cut.

If you don’t want to live in an HCOL.

Well shit. My B.

I need a vacation.

Oh, I was just adding on to your point about the study. The healthcare system would implode if we tried to impose Medicare or Medicaid prices on providers.

Yeah medicare and medicaid can often pay below cost, sometimes to a ridiculous extent. I think I saw someone saying California Medicaid was paying under 40 an hour at one point on Meddit - with costs like front desk staff and MAs that is just grossly unsustainable.

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