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PaperclipPerfector  1d ago (text post)   5844 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.

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.

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.

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).

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.

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.

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?

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. Business has been absurdly chaotic lately. As though there were writers scripting the whole thing out to generate an exasperating comedy at my expense.

It all seems directionally correct but the whiplash has been killer.

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.

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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