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Another Job Americans Just Won't Do: Doctor
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From the New York Times:

Why America Needs Foreign Medical Graduates
Aaron E. Carroll
THE NEW HEALTH CARE OCT. 6, 2017

… The American system relies to a surprising extent on foreign medical graduates, most of whom are citizens of other countries when they arrive. By any objective standard, the United States trains far too few physicians to care for all the patients who need them. We rank toward the bottom of developed nations with respect to medical graduates per population.

… We don’t have enough graduates even to fill residency slots. This means that we are reliant on physicians trained outside the country to fill the gap. A 2015 study found that almost a quarter of residents across all fields, and more than a third of residents in subspecialist programs, were foreign medical graduates.

Clearly, doctor, like stoop farm laborer, is one of those jobs Americans just won’t do anymore. The shortage of American doctors couldn’t have anything to do with cartel behavior by powerful interest groups.

 
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  1. Sometimes I imagine a world where starting a medical school has no more government roadblocks than starting an online delivery service.

    Oh, very nice, very nice, very nice, very nice.

    But maybe in the next world.

    • Replies: @Forbes
    @njguy73

    From the end of World War I, until the 21st century, six new medical schools were opened in the US. Twenty have opened since the turn of the century, with three more starting anew in 2017--bringing the total to 141 med schools. (An increase of 20%.)

    Meanwhile the US population has tripled since 1920.

    https://en.wikipedia.org/wiki/List_of_medical_schools_in_the_United_States

    Replies: @Anonymous

    , @Anonymous
    @njguy73

    I know that reference too! Morrissey!

  2. Sounds like the easy way to to become an American doctor is to train somewhere else where it is faster and cheaper, and then come (back) to the US to “fill the gap”.

    • Replies: @nebulafox
    @Almost Missouri

    I've actually known American doctors who have done this already.

    , @Methodological Terrorist
    @Almost Missouri

    Wouldn't you lose out on important chances to make connections in the American medical labor market, though?

    Replies: @Anonymous

    , @Jim Bob Lassiter
    @Almost Missouri

    Bingo!! Imagine the student loan debt of a native US trained recent MD (four years undergrad, five years med school plus residency and internships) versus say that of a Costa Rican immigrant with a medical degree from Costa Rica. (five years of med school straight out of high school plus residency and then a US internship/equivalency accreditation paperwork package-- and they do have good doctors with functional high school educations to begin with) Sure, they can do alright living off Medicaid scams.

    , @Aristippus
    @Almost Missouri

    Scott Alexander at Slate Star Codex has mentioned this some and he did his medical training, as an American, in Ireland. As a guy in my late 20s, what I've noticed is that many of my classmates from college went alternative medical routes instead of becoming doctors. That's surprising because my undergrad uni is known for being a doctor training ground, but it seems like the only folks who went the medical school route were Asian. For whites (including Jews) it seems like being optometry, pharmacy, and dental school are the destinations now because the pay is almost as good as being an MD, but there is significantly less stress.

    Replies: @Maj. Kong

    , @Pat Boyle
    @Almost Missouri

    I use Kaiser Permanente and have for more than twenty years. I originally had a Jewish doctor and I was well satisfied with him. But about ten or fifteen years ago all the Jewish and other Caucasian physicians vanished. Now all the medical staff are Asian.

    My doctor is Korean. He is very competent. As all readers of this blog surely know South Korea has the highest IQ population of any nation on earth. My doctor is no exception.

    Because I have so many frailties I have been served by many Kaiser doctors. All are not Korean. Some are Japanese and many are Chinese. I spent a week in the hospital last month. I discovered that most of the nurses are Filipino (at least the good ones). This is remarkable because Kaiser purports to be a black run organization. There are certainly a lot of black patients but the only black staff you ever see are those with their pictures on the walls or in the corporate brochures.

    Kaiser is a medical service in blackface.

    Replies: @Karl, @anon, @Chrisnonymous

    , @Bill
    @Almost Missouri

    This is very common.

    Remember when we invaded Grenada to save the American medical students there from the commies?

  3. It’s also not like the restrictive licensing is translating into any degree of satisfactory medical safety, with something like 200,000 – 300,000 annual preventable medical deaths. We could drop the average IQ and training standards of doctors but regulate the industry properly by, for instance, giving them checklists to follow like pilots get and still save an almost mind boggling number of lives every year.

    • Replies: @Alden
    @Guy de Champlagne

    Those pocket notebooks already exist for about 30 medical jobs. They are check lists to do for any kind of patient presentation and what to do in each instance. Present presents A, do XYZ If result is B, do C

    They are the simplest manuals. They give standard practice. I got a sizeable malpractice settlement by simply going to a Borders book store and buying the orthopedic notebook for dummies. Around 9 Asian women drs didn't do what was required. That notebook of standard procedure proved they were idiots.

    Doctors and therapists often malpractice. I advise everyone to look on amazon or a barnes and noble and find the notebooks for what ever medical problem you have. There are many incompetent Drs, nurses, technicians and therapists around who don't do what they are supposed to do.

    So get those notebooks. There are many kinds. The best are called RN notebooks, LVN notebooks, Ortho notebooks, pediatrics notebooks etc.

    Point is, there are numerous manuals, but medics often don't follow standard procedure

    Replies: @Ivy

  4. The shortage of American doctors couldn’t have anything to do with cartel behavior by powerful interest groups.

    I opted out of becoming a doctor because of the rampant degeneracy fostered by Great Society social programs that I saw or heard about while volunteering and working in my city’s hospital and interacting with first responders in my area. Which underscores host’s point.

    No way I was going to go into debt for training–both time and money–then be required to waste it patching up a bunch of degenerates who not only wouldn’t behave long enough to heal but would be back demanding more free services/skills before the previous set of injuries had healed up. Which challenges host’s point.

    Then there were the kids. Most of whose suffering was caused by their own “families.”

    So maybe foreign medical graduates are more cold hearted. Like, if they are confronted with a black toddler who has been gang-raped at both ends, it won’t hurt or haunt them either in the moment or for years after.

    And think of how handy they will come in as Big Pharma starts the geronticide of whites born before 1965, with the accompanying Total Cashectomy and the promise of wealth transfer to a bunch of people who have to be taught, and reminded, how to use a toilet and wash their hands.

    A problem which, eventually, should be self-correcting thanks to the smallest forms of life on earth.

    • Replies: @Anonymous
    @Olorin


    Total Cashectomy
     
    I know that reference! Graham Chapman, RIP.
    , @AM
    @Olorin


    No way I was going to go into debt for training–both time and money
     
    It's hard not to question the sanity of those becoming MDs for the glamorous opportunity to be a primary care physician (or in your case an ER physician)

    If you want to be a primary care MD, get a PA with less time,debt, and stress and a nice niche career without the headaches.

    Yes, I want my specialists to be MDs, but there's no point to med school if the job is immunizations, sniffles, diabetes management, and referrals.

    Anyway, I think you made the right call. We wouldn't support my son in medical school unless he was planning to specialize from the beginning.

    Replies: @lavoisier

    , @Charles Erwin Wilson
    @Olorin

    Whoa Olorin. After reading your post I almost blacked out. But isn't your assessment too dark? In the end, reality will have the upper hand. And the stupidity of the current organization of the medical world will be swept away by lots and lots of people saying "WTF? This is not what we were promised."

    Replies: @bomag

  5. Funny, my son-in-law, who is a resident physician, was relieved to get a residency spot. Some in his graduating class could not find a match. He says the government under B.O. pushed for more spots in medical schools but failed to follow through with adequate residency spots.

    How would you like to pile up student loan dept to finish medical school, only to find no residency spot and then seeing foreign students getting some of the rare open spots instead of you? Without finishing your residency, your MD is pretty close to worthless. Less than an RN even.

    • Replies: @Triumph104
    @Hannah Katz


    We don’t have enough graduates even to fill residency slots.
     
    The article is wrong. The woman in the link was a registered nurse before she decided to go to medical school at Oregon Health and Sciences University. She goes into detail why she wasn't able to get a residency after graduating medical school. She is now $400,000 in debt with a baby plus she has a college-age child. She says that 1000 US medical school graduates and over 8000 International Medical Graduates fail to get residencies. In 2015 there were 41,000 applicants for 30,000 residency positions. (LINK)

    Missouri and several other states with physician shortages are in the process of passing laws that would allow physicians who have not done a residency to practice as "assistant physicians". (LINK)

    , @Chrisnonymous
    @Hannah Katz


    Funny, my son-in-law, who is a resident physician, was relieved to get a residency spot.
     
    The explanation seems to be that getting a desirable residency is very difficult.

    Like Steve's contention that being poor in America today means not being able to afford to move away from other poor people, being a bad doctor in America today means not being able to treat non-NAM patients.

    Old joke:

    Q: What do you call someone who graduates from medical school at the bottom of their class?
    A: Doctor!

    New joke:

    Q: What do you call someone who graduates from medical school at the bottom of their class?
    Possible answers: "a GP", "a VA doc", "a resident of Detroit", "Yo! Doctor!", etc

    No doubt, the competition for residencies in whitopias adds to the kind of phenomena studied by Charles Murray.

    Replies: @Bill

  6. My understanding is that the process is deliberately made excessively difficult and that a good number of US citizens schooled in foreign medical colleges never do get approved to practice here.

  7. I imagine it has more to do with a relative shortage of American medical schools. Basically, it’s very hard to get into any American medical school. By contrast, it’s not very hard to get into an American law school. I’m pretty sure you can get admitted to one, and probably graduate with a sub 100 IQ. There’s a reason why law schools are seen as a huge cash cow for universities without huge endowments.

    • Replies: @George
    @blah blah teleblah

    The issue with law school is why law schools are required. In the past smart teens worked for lawyers as clerks, eventually becoming lawyers. With all these fancy high schools for gifted students, a high school where the typical student would graduate with a law degree does not seem unreasonable. Maybe an apprenticeship as a paralegal with a lawyer would still be required. Exactly why there are no undergraduate law schools is also a mystery to me.

    President Martin Van Buren starts work as a legal clerk at age 15
    https://en.wikipedia.org/wiki/Martin_Van_Buren#Early_life_and_education

    Fun Fact: Van Buren married his first cousin's daughter.

    Replies: @bomag

    , @whoever
    @blah blah teleblah

    Yes, it's hard to get in, hard to stay in, and it costs a lot. UCSF Med School, eg., runs about $60,000 annually (something over half of that tuition) for in-state.
    I don't think a person should go to med school because it's a gateway to a comfortable living. If that is your goal, go into law or finance, real estate or politics. Go into medicine because you have a strong interest in, say, TBI and neurological surgery ... something that will motivate you and keep you going no matter what.

    Replies: @GU

    , @Meretricious
    @blah blah teleblah

    not if you're black or Hispanic

    Replies: @blah blah teleblah

  8. “The shortage of American doctors couldn’t have anything to do with cartel behavior by powerful interest groups.”

    AMA, and its successful racketeerization of American medicine to preserve fee-for-service and autonomy of practice. Another powerful lobby whose actual practices passeth all observation by the mainstream media.

    • Replies: @Karl
    @JackOH

    8 JackOH > successful racketeerization of American medicine to preserve fee-for-service


    iSteve, you on annual salary from RonUnz? Or do you get paid by the article....


    > and autonomy of practice

    and insist on writing about what YOU chose to write about?


    Yo iSteve, i'm a close friend of the ETHICAL Mr Avigdor Leiberman..... you want to be left un-molested when you open up your kiosk in a mall in suburban Israel, selling Mormon Salt Sea soap? It might could get arranged.

  9. Somewhat OT, but one of the big reasons that single payer is going to be tough to pull off in this country is because it’ll either screw over a lot of young doctors, or the debt collectors. You can’t go for single payer level salaries with the kind of debt they take on in school. Conversely, doctors in Germany might not go into debt, but they also do not make American level salaries.

    • Replies: @27 year old
    @nebulafox

    We're going to cancel White student loan debts anyway so, meh

    Replies: @Achmed E. Newman, @Alden, @Anonymous

    , @Dr. X
    @nebulafox


    Somewhat OT, but one of the big reasons that single payer is going to be tough to pull off in this country is because it’ll either screw over a lot of young doctors
     
    Quite the opposite. Any single-payer legislation would invariably include a de facto takeover of the medical schools. The government would avoid opposition from within the medical community by buying off the medical schools with grant money and the medical profession by paying off student debt.

    There would be plenty of mandatory affirmative action requirements, too.

  10. It’s great to be a foreign/immigrant medical doctor in the USA. Not only do you benefit from having passed relatively lax standards in your ‘old country’ to qualify, but administrators in the USA will bend over backward to protect you from censure, from criticism–from questions even–when you screw up.

    From the point of view of American patients, it behooves them to avoid physicians from third-world countries period. Otherwise you’re taking your life in your hands–or worse, theirs–and you will find you have no recourse when they put your life and health at risk. They are effectively untouchable, and they know it.

    • Replies: @bartok
    @Anonymous

    Looked up that Afghan psychiatrist working in the Cali. prison system, the highest-paid CA state employee at $800k a couple of years ago ... he has been suspended for allegedly falsifying time sheets ... https://www.yahoo.com/news/soledad-prison-psychiatrist-paid-800k-193142129.html

    The Chinese BART janitor who works 20 hour days? Still on the job and raking cash.

    , @dr kill
    @Anonymous

    This Daily Caller article nicely details my argument against admitting foreign med school grads and the associated riff-raff. This is the Bronx Hospital shooter.

    http://dailycaller.com/2017/07/05/coulter-immigrant-of-the-week-henry-bello-obotetukudo/

  11. @Almost Missouri
    Sounds like the easy way to to become an American doctor is to train somewhere else where it is faster and cheaper, and then come (back) to the US to "fill the gap".

    Replies: @nebulafox, @Methodological Terrorist, @Jim Bob Lassiter, @Aristippus, @Pat Boyle, @Bill

    I’ve actually known American doctors who have done this already.

  12. So, poor sick foreigners must remain untreated while their bright ones come to America to treat Americans?

    Sounds greedy.

    “Give us your doctors and let your people die of untreated diseases.”

    • Replies: @Elsewhere
    @Anon


    So, poor sick foreigners must remain untreated while their bright ones come to America to treat Americans?
     
    No, silly, the poor sick foreigners must be brought here because their country is (now) a medical desert.

    Replies: @Anonymous

  13. Unsaid in all of this is the fact that women, now 50% of medical school admittances, work less hours than male doctors, take time off to have kids, and do not go into those specialties requiring the delay of family formation as often as men. (Many male doctors have told me this – privately). I don’t blame these women, who go into family practice and work 3 days a week, but it means each female graduate offers less medical treatment over a career on average. So we need more doctors in practice, even though we may be theoretically graduating enough of them. So we hire foreign doctors. Most often, men. In other words, we are turning down American men for admittance to medical school (their places taken by women), so we can hire foreign men later.

    Of course no one can say this. No one can say we must increase admissions to make up for all the time off and specialties not pursued.

    • Agree: AM, Travis
    • Replies: @Anonymous
    @Cwhatfuture

    We see the same thing with law-school graduates. A couple years as a lowly, overworked associate in a big law firm and a certain number of recent grads decide they'd really rather take some time off to pursue motherhood, maybe occasional, high-end catering, or that scrapbooking website they've been contemplating.

    Then their salaries, such as they are, become aggregated with other women's and our society wrings its hands (and prepares its legislation) in the face of the 'wage gap' in relation to men, who will generally leave no stone unturned in the search for higher pay.

    Replies: @AM, @Ris_Eruwaedhiel

    , @SimpleSong
    @Cwhatfuture

    You also see this to some extent now with male grads. Lots of couples are med school classmates--after kids the woman won't want to completely give up her career so will go down to 20-40%; but that's still too much so to cover the difference the male will go down to 60-80%. It's actually completely rational behavior at the level of the couple--if the woman went down to 0% then she's out of medicine and if something happens to the man she can't ramp up to get them through the rough patch, and also all that time in med school etc. was totally wasted. But at the societal level it's totally bonkers--you just trained two docs and only got one.

    Replies: @Opinionator

    , @drt
    @Cwhatfuture

    As a surgeon in practice for 27 years, I can vouch for this comment. The rising number of female physicians coincides with the decline in prestige, power and income of American physicians, and has influenced the whole culture of medicine. Compared with earlier generations, young MDs are less hard working (but very good at taking written tests), relatively timid, and much more submissive. The majority want to be employed rather than have their own practices, and often are far less productive. At a recent dinner at a prestigious Boston hospital, I was amazed to hear a group of young doctors at my table trade tips on how to keep down the number of patients they had to see per day! When I was starting out, the conversation would have been trading tips on how to see more patients per day.

    BTW, my wife is a physician, and she agrees with the above.

    Replies: @Opinionator, @Brutusale

    , @Moses
    @Cwhatfuture

    Ditto for MBA graduates.

    Several of my female classmates found their high earning husband, then became full time mothers and PTA members.

    Nothing wrong with that, but wouldn't society be better off if their business school slots had gone to men who would work their whole careers creating value for society? Purely from a resource and return perspective, resources spent were resources wasted on those women's graduate education.

    Replies: @Karl, @RonaldB, @dwb

    , @Anon
    @Cwhatfuture

    I concur completly. It's not uncommon for female doctors to quite their practice to raise a family and never work again. Since quite a few are married to doctors themselves. It's really a waste of time and money for everyone.

    , @Escher
    @Cwhatfuture

    As long as they pay their way through med school (or pay off their medical loan) you really can't fault them.

  14. @Almost Missouri
    Sounds like the easy way to to become an American doctor is to train somewhere else where it is faster and cheaper, and then come (back) to the US to "fill the gap".

    Replies: @nebulafox, @Methodological Terrorist, @Jim Bob Lassiter, @Aristippus, @Pat Boyle, @Bill

    Wouldn’t you lose out on important chances to make connections in the American medical labor market, though?

    • Replies: @Anonymous
    @Methodological Terrorist

    You might think so, and it would seem to stand to reason--but I've known more than one personable, high-performing medical graduate thrown back upon his own devices in the search for a residency slot. Then again, this was in NYC where they considered Harvard, Yale, Columbia and Hopkins--or nothing. Cornell if they got desperate. Some ended up in Texas and Missouri.

  15. India provides the US with the largest percentage of doctors with foreign citizenship. According to the CIA Factbook, India has a 0.73 physicians per 1000 people. The US has 2.55 physicians per 1000 people. The US should only accept foreign doctors from countries that have a higher density of physicians than the US such as Belgium (2.97) or Finland (3.01).

    I don’t have a problem with the current system. If there is ever a glut of physicians, the US can just turn off the spigot of foreign doctors entering the country. Just stop accepting physicians from needy countries.

    • Replies: @Jonathan Mason
    @Triumph104


    Just stop accepting physicians from needy countries.
     
    It is the US that is needy.

    But then you run into the whole question of a great deal of medical practice being a private business in the US, and people in needy countries having freedom to travel and work wherever they want, so it is hard to see how such restrictions might be fairly enforced.

    If Donald Trump reads this thread, he might issue an Executive Tweet tomorrow to block the entry of foreign-born physicians on the grounds that they may endanger the health of Americans, and to block US-born and/or educated doctors from working overseas, but I daresay it would hit a legal snag or two along the way.

    Replies: @bomag

    , @Alden
    @Triumph104

    Why would a European immigrant want to move to America and send his kids to our public schools and spend a fortune on housing just to get away from the ghetto? Why would he want his kids to be discriminated against in college and job applications? Why would he want his kids to go into huge debt for college when he or she could stay home and get very low cost college? Why would he want to be sued because he didn't hire the required number of affirmative action slugs?

    In other words, there is no reason for any White person to immigrate to this White hating country.

    , @Hail
    @Triumph104

    Given the USA's much higher doctor-per-capita rate, it is clearly racist and harmful to people of color to drain away good Indian doctors from India.

    I wonder if we will see this editorialized any time or if the cognitive dissonance is too much for them to actually sit down and write it.

  16. Anonymous • Disclaimer says:

    Remember the Arab terrorism in Scotland some years ago?–turned out the terrorists were doctors. People wondered, why would a doctor in his right mind want to be a suicide murderer? It came out that under the UK medical system being a doctor was no longer the attractive career choice it had been. These guys were doctors imported from Baghdad medical school to remedy the shortage.

    • Replies: @AnotherGuessModel
    @Anonymous

    Nurse and doctor wages in Western Europe are not outstanding with consideration to the demands of obtaining the degree and the actual work. I can't comment on Iraqi doctors in Scotland, but nurses and doctors from poorer EU countries are causing employee shortages in their own countries by taking up the jobs that their Western European peers have abandoned for cushier jobs in the UAE.

    As for doctor shortages in the USA, surely the prohibitive cost of medical school is one factor? On this, you may have heard of Americans studying medicine in Eastern Europe because of the lower cost. You can find good medical programs in EE, but it's a red flag if you ever come across an EU citizen with a EE medical degree despite not being from that country. It likely wasn't about affordability, but not having the chops to pass their own country's medical school entrance exams.

    Replies: @jim jones

    , @Little Tripoli
    @Anonymous

    Nah. My understanding is that the BMA operates in a similar cartel fashion, refusing to allow an increase in medical student spots at top tier Brit universities, which are consequently massively over subscribed by adequately credentialed Britishers. This, combined with nationwide pay scales, is why London has a lot of foreign doctors. You can live pretty well in picturesque Cumbria on a junior doctor salary, the Great Wen not so much.

    , @Alden
    @Anonymous

    That was the attempted Glasgow airport bombing? Its not exactly that being a Dr in Britain is so unattractive. It is 2 things that discourage native British from being Drs.

    1 Severe affirmative action discrimination in med school admissions.

    2. Even more severe affirmative action discrimination in medical resident placement.

    That same year as the attempted Glasgow airport bombing, more that 300 White British native born medical school grads were denied residencies in Britain. The 300 resident placements were filled by turd world medical grads* recruited in their turd world homes.

    The native White British medical school grads were told to go off to Africa and other places and do volunteer work for 5 years. Unpaid of course and they would have to support themselves while working in some ghastly turd world clinic.

    Neither the NHS nor the government nor the powers that be want White native British Drs around.

    There is no Dr shortage in Britian. Its just discrimination againist the Native Whites so s to fill the medical professions with disfunctional turd worlders.

    * Many turd world medical schools give out diplomas to people who seldom attend classes, don't do lab work and fail the tests. Its the turd world way

  17. @Almost Missouri
    Sounds like the easy way to to become an American doctor is to train somewhere else where it is faster and cheaper, and then come (back) to the US to "fill the gap".

    Replies: @nebulafox, @Methodological Terrorist, @Jim Bob Lassiter, @Aristippus, @Pat Boyle, @Bill

    Bingo!! Imagine the student loan debt of a native US trained recent MD (four years undergrad, five years med school plus residency and internships) versus say that of a Costa Rican immigrant with a medical degree from Costa Rica. (five years of med school straight out of high school plus residency and then a US internship/equivalency accreditation paperwork package– and they do have good doctors with functional high school educations to begin with) Sure, they can do alright living off Medicaid scams.

  18. Anonymous • Disclaimer says:
    @Cwhatfuture
    Unsaid in all of this is the fact that women, now 50% of medical school admittances, work less hours than male doctors, take time off to have kids, and do not go into those specialties requiring the delay of family formation as often as men. (Many male doctors have told me this - privately). I don’t blame these women, who go into family practice and work 3 days a week, but it means each female graduate offers less medical treatment over a career on average. So we need more doctors in practice, even though we may be theoretically graduating enough of them. So we hire foreign doctors. Most often, men. In other words, we are turning down American men for admittance to medical school (their places taken by women), so we can hire foreign men later.

    Of course no one can say this. No one can say we must increase admissions to make up for all the time off and specialties not pursued.

    Replies: @Anonymous, @SimpleSong, @drt, @Moses, @Anon, @Escher

    We see the same thing with law-school graduates. A couple years as a lowly, overworked associate in a big law firm and a certain number of recent grads decide they’d really rather take some time off to pursue motherhood, maybe occasional, high-end catering, or that scrapbooking website they’ve been contemplating.

    Then their salaries, such as they are, become aggregated with other women’s and our society wrings its hands (and prepares its legislation) in the face of the ‘wage gap’ in relation to men, who will generally leave no stone unturned in the search for higher pay.

    • Replies: @AM
    @Anonymous


    A couple years as a lowly, overworked associate in a big law firm and a certain number of recent grads decide they’d really rather take some time off to pursue motherhood, maybe occasional, high-end catering, or that scrapbooking website they’ve been contemplating.
     
    Women, as a group, really should have never been pushed into careers as the "default"mode of their lives. It pains me to say it as a woman, but I am happier in low stress (low paid) careers. My nervous system is set a different level. Situations that cause my husband merely angst causes me almost total nervous breakdown.

    And it maybe a personality flaw (I certainly have enough of those),but I think I'm more typical than not.

    Replies: @Anonymous, @StillCARealist, @MadDog, @SimpleSong

    , @Ris_Eruwaedhiel
    @Anonymous

    I used to work in a big firm and many attorneys, especially women, became in-house attorneys for big companies. They wouldn't make as much money, but the others were more regular 9-5. True of paralegals, as well.

  19. @Anon
    So, poor sick foreigners must remain untreated while their bright ones come to America to treat Americans?

    Sounds greedy.

    "Give us your doctors and let your people die of untreated diseases."

    Replies: @Elsewhere

    So, poor sick foreigners must remain untreated while their bright ones come to America to treat Americans?

    No, silly, the poor sick foreigners must be brought here because their country is (now) a medical desert.

    • Replies: @Anonymous
    @Elsewhere

    Most of the world would soon be depopulated by our betters' habit of trying to import all of them to the USA. However they continue to insist on having nine children per woman.

  20. @Olorin

    The shortage of American doctors couldn’t have anything to do with cartel behavior by powerful interest groups.
     
    I opted out of becoming a doctor because of the rampant degeneracy fostered by Great Society social programs that I saw or heard about while volunteering and working in my city's hospital and interacting with first responders in my area. Which underscores host's point.

    No way I was going to go into debt for training--both time and money--then be required to waste it patching up a bunch of degenerates who not only wouldn't behave long enough to heal but would be back demanding more free services/skills before the previous set of injuries had healed up. Which challenges host's point.

    Then there were the kids. Most of whose suffering was caused by their own "families."

    So maybe foreign medical graduates are more cold hearted. Like, if they are confronted with a black toddler who has been gang-raped at both ends, it won't hurt or haunt them either in the moment or for years after.

    And think of how handy they will come in as Big Pharma starts the geronticide of whites born before 1965, with the accompanying Total Cashectomy and the promise of wealth transfer to a bunch of people who have to be taught, and reminded, how to use a toilet and wash their hands.

    A problem which, eventually, should be self-correcting thanks to the smallest forms of life on earth.

    Replies: @Anonymous, @AM, @Charles Erwin Wilson

    Total Cashectomy

    I know that reference! Graham Chapman, RIP.

  21. I was told this years ago, maybe in college, that the medical establishment in America, be it the schools or the profession, deliberately limits the number of doctors, medical students, or whatever, to maintain artificial scarcity.

    Now, every time I turn around, I meet another doctor from someplace like India.

    Good thing I live where there are a lot of good, old fashioned, Jewish doctors. And believe me, they are good!

    • Replies: @Triumph104
    @Buzz Mohawk


    Good thing I live where there are a lot of good, old fashioned, Jewish doctors. And believe me, they are good!
     
    https://youtu.be/9mvvc7rPDq8?t=198
    , @Alden
    @Buzz Mohawk

    How old are they? I have the best of the best, gem of gems, the creme de la creme, a White American male Dr only 46 years old. There are almost no White American male Drs in the San Francisco Bay Area or the Central Valley. But there are some in Los Angeles. I just told the gal at the insurance company that I would only accept a White American man as my primary care. And I got one, only 8 blocks away.

    The easiest way to get an absolutely upstanding Dr is to insist on a White American man. Why?
    Because of affirmative action: Only a very small percentage of White American men are admitted into medical school any more. Soooooo only the highest MCAT scorers and the writers of the most nauseating suck up admission essays who are White men are accepted.

    Until affirmative action, most Drs were White American men. So the incompetent, competent excellent and outstanding Drs were all White American men. But wit discrimination against White American men, only the very best and brightest get accepted to medical school.

    Don't be shy about insisting on a White American male Dr. F**k liberals and affirmative action medics.

    Replies: @Achmed E. Newman

    , @Alden
    @Buzz Mohawk

    But they are liberals. Why give your insurance money to liberals? They are probably on the diversity, inclusion and affirmative action admissions committees of their med schools. Do they employ any White Americans in their offices? Or are all their employees turd world affirmative action types?

    Replies: @Buzz Mohawk

    , @Lagertha
    @Buzz Mohawk

    Well, I was told by so many people that limiting med students keeps the salaries of doctors artificially high (that's why doctors from Asia are dying :) to come here to work. With socialized medicine, like in Finland, my homeland, doctors make about 200K, tops. My dad's best friend, a well known pediatric surgeon in the European community, probably, after taxes (this was up until the early 90's), took home (net pay) 150K Euros...kid you not. About 65% of his income went to taxes. This is the major issue that Americans; politicians, lawyers, upper middle-class people don't understand about the Nordic countries: You are taxed according to your income; your properties, your stocks & savings, all your assets, like boats, 2nd homes, cars, even dogs/horses. And, you pay a "death tax." That's how you get your "universal coverage" in the Nordic countries. A cousin of mine said, "Everybody pays, everybody gets." This is also why European women don't have huge wardrobes or walk-in closets - this is a fact.

    Replies: @Joe Stalin

    , @Ris_Eruwaedhiel
    @Buzz Mohawk

    Well, at least they speak good English.

  22. @Methodological Terrorist
    @Almost Missouri

    Wouldn't you lose out on important chances to make connections in the American medical labor market, though?

    Replies: @Anonymous

    You might think so, and it would seem to stand to reason–but I’ve known more than one personable, high-performing medical graduate thrown back upon his own devices in the search for a residency slot. Then again, this was in NYC where they considered Harvard, Yale, Columbia and Hopkins–or nothing. Cornell if they got desperate. Some ended up in Texas and Missouri.

  23. @njguy73
    Sometimes I imagine a world where starting a medical school has no more government roadblocks than starting an online delivery service.

    Oh, very nice, very nice, very nice, very nice.

    But maybe in the next world.

    Replies: @Forbes, @Anonymous

    From the end of World War I, until the 21st century, six new medical schools were opened in the US. Twenty have opened since the turn of the century, with three more starting anew in 2017–bringing the total to 141 med schools. (An increase of 20%.)

    Meanwhile the US population has tripled since 1920.

    https://en.wikipedia.org/wiki/List_of_medical_schools_in_the_United_States

    • Replies: @Anonymous
    @Forbes


    Meanwhile the US population has tripled since 1920.
     
    Sigh. Can you imagine how wonderful this country would be if it held only 110 million people instead of 330 million?

    We could all live like Republicans.

    Replies: @Anonymous

  24. American medical school applicants are usually required to have done some oversees service work in addition to meeting the academic qualifications. Why? Their parents, or the students themselves, have to foot the bill for part of this travel, adding even more to the cost of becoming a doctor.

    I have read elsewhere that medical schools are leaning toward applicants with liberal arts degrees over science degrees. My eldest wanted to be a doctor. Her adviser told her to switch majors from a BS in biology to a BA in biology with a bunch of crap classes that didn’t help her prep for her MCATs.

    There were a lot of sane, apolitical, comments at the NYT on this article, but no consensus on what to do. Some comments even brought up the turpitude of harvesting the rest of the world’s doctors away from their home countries.

    • Replies: @Olorin
    @jJay


    I have read elsewhere that medical schools are leaning toward applicants with liberal arts degrees over science degrees. My eldest wanted to be a doctor. Her adviser told her to switch majors from a BS in biology to a BA in biology with a bunch of crap classes that didn’t help her prep for her MCATs.
     
    Back in the 1980s I think it was, Bryn Mawr was (one of?) the first to pioneer the idea of the "nontraditional pre-med student." It looked IIRC as you say--lib arts degrees taking the MCAT with tons of coaching from mommy's/daddy's paid test-taking coaches.

    A friend of mine was referred to an orthopedic clinic for assessment for a joint replacement after living too many years with the painful toll of physical labor on his hips. He sent me an e-mail with the name of the physician he was assigned to by the clinic. Asked me whether I knew him. I didn't but used Duck Fu to see what I could learn.

    The guy was a newish black hire with a bachelor's degree in economics, a master's in something something studies, and an MD from a second-tier medical school. Friend asked what I thought. My read was that this guy was taught just enough to qualify him to saw joints out of Medicare patients using high tech tools that complete most of the procedure for him and let the billing clear. Whether the procedure goes well for the patient isn't the point--cashectomy of elders and the fed programs that support them is. If something goes wrong? Why heck, just bring them in for a "revision."

    Friend said, "I wondered about that. I went over to the clinic just to look around, and this guy's photo was in the main lobby, the atrium, the lobby of the ortho unit, and the web site and on all the handouts on the tabletops. They're really pushing him."

    I recommended someone from my alma mater at that same clinic. Who confided to the friend that "we are hiring people who aren't really surgeons." That entire part of that (Pugetopolis) city, by the way, is being developed into elderghetto hives for retired California escapees. Kind of a mobile goldrush where the mother lode is in bodies.

    And FWIW, Jeff Bezos hopes to be the tip top controller of everybody's medical records in the future. Search on

    Amazon skunkworks 1492

    Replies: @Hibernian

  25. I have a solution: telemedicine.

    • Replies: @DCThrowback
    @songbird

    www.teladoc.com

    $40 for a consult, cheaper than the reg doc

  26. There are FMGs who are white Americans who would have otherwise gotten into med school if it weren’t for affirmative action cases taking their slots–often these are Caribbean grads and they tend to do fine in residency and practice. The FMGs who are actually from outside the US I find to be pretty terrible–they don’t really understand US culture or how to deal with Americans and tend to be soft on the science as well.

    Healthcare economics are extremely weird and the limitations on the number of doctors trained doesn’t necessarily drive up salaries, although it probably makes some marginal difference. This is because doctors make their own demand–for example if you’re a country doc and another primary care doctor moves into town, and suddenly your schedule isn’t full, then maybe you start bringing people back for blood pressure checks every six months instead of every year. Or if someone retires and you’re getting slammed, maybe blood pressure checks only happen once every two years.

    If tomorrow the American College of Orthopedic Surgeons decides it’s going to train twice as many residents, that’s not going to mean that they’re all going to work half as many hours and do half as many procedures and make half as much money, they’ll do about 1.7X as many procedures by doing a lot of marginal cases, they’ll make slightly less per capita, have slightly more time off, and healthcare costs will go up. Unclear if health will actually improve, however, there’s always a lot of fuzziness about where the line is drawn between a necessary and unnecessary procedure, and I think this is why you see that places that have a lot of healthcare providers tend to have very expensive healthcare, but not better outcomes.

    What really drives physician salaries is reimbursement levels; private insurance generally pays about 5 or 6X the reimbursement for a given procedure than Medicaid so assuming you fill your schedule your salary is determined by what mix of patients you have. Bigger picture, fundamentally your reimbursement as a physician has little to do with the difficulty of what you are doing or the quality of your care and everything to do with the average economic value of life in your patient population. That is, you can be the most skilled heart surgeon in the world, with great outcomes, but if you practice in Honduras, on patients who only have a few hundred dollars to their name, you’re going to make very little. At the other end of the spectrum you can sell homeopathic baloney that doesn’t work to rich white ladies with more money than brains and make a good living.

    Given this you would think physicians would be staunchly anti-immigration since it necessarily forces reimbursements down, but, to be blunt, most doctors are kinda dumb.

    • Agree: Triumph104
  27. @Anonymous
    Remember the Arab terrorism in Scotland some years ago?--turned out the terrorists were doctors. People wondered, why would a doctor in his right mind want to be a suicide murderer? It came out that under the UK medical system being a doctor was no longer the attractive career choice it had been. These guys were doctors imported from Baghdad medical school to remedy the shortage.

    Replies: @AnotherGuessModel, @Little Tripoli, @Alden

    Nurse and doctor wages in Western Europe are not outstanding with consideration to the demands of obtaining the degree and the actual work. I can’t comment on Iraqi doctors in Scotland, but nurses and doctors from poorer EU countries are causing employee shortages in their own countries by taking up the jobs that their Western European peers have abandoned for cushier jobs in the UAE.

    As for doctor shortages in the USA, surely the prohibitive cost of medical school is one factor? On this, you may have heard of Americans studying medicine in Eastern Europe because of the lower cost. You can find good medical programs in EE, but it’s a red flag if you ever come across an EU citizen with a EE medical degree despite not being from that country. It likely wasn’t about affordability, but not having the chops to pass their own country’s medical school entrance exams.

    • Replies: @jim jones
    @AnotherGuessModel

    My GP is required by law to post her salary on the practice website, it is $102,000

  28. @Anonymous
    It's great to be a foreign/immigrant medical doctor in the USA. Not only do you benefit from having passed relatively lax standards in your 'old country' to qualify, but administrators in the USA will bend over backward to protect you from censure, from criticism--from questions even--when you screw up.

    From the point of view of American patients, it behooves them to avoid physicians from third-world countries period. Otherwise you're taking your life in your hands--or worse, theirs--and you will find you have no recourse when they put your life and health at risk. They are effectively untouchable, and they know it.

    Replies: @bartok, @dr kill

    Looked up that Afghan psychiatrist working in the Cali. prison system, the highest-paid CA state employee at $800k a couple of years ago … he has been suspended for allegedly falsifying time sheets … https://www.yahoo.com/news/soledad-prison-psychiatrist-paid-800k-193142129.html

    The Chinese BART janitor who works 20 hour days? Still on the job and raking cash.

  29. @nebulafox
    Somewhat OT, but one of the big reasons that single payer is going to be tough to pull off in this country is because it'll either screw over a lot of young doctors, or the debt collectors. You can't go for single payer level salaries with the kind of debt they take on in school. Conversely, doctors in Germany might not go into debt, but they also do not make American level salaries.

    Replies: @27 year old, @Dr. X

    We’re going to cancel White student loan debts anyway so, meh

    • Replies: @Achmed E. Newman
    @27 year old

    Yeah, until you get a job. Then you'll be back making payments on the loans. You'll just be spreading your payments over some millions of students like yourself who got this great "benefit" from Uncle Sam. Oh, it won't be a separate entry on you electronic pay stub. Just look for it to be lumped under "Federal Taxes".

    Whaaaattt? Nobody told you how socialism worked?? I guess you missed a few days in kindergarten when you learn it from your fellow little ones. For me it was little Timaah, who wanted to play with my garbage truck, which I was taking damn good care of, after he broke his dump truck, that turned me into a foe of socialism. The teacher made me share my toy anyway, so I called her a useful idiot. Spent a lot of time in the other room on my little oval nap rug after that. Good times, good times.

    THERE! IS! NO! FREE! LUNCH!

    Replies: @Anonymous

    , @Alden
    @27 year old

    Why just White student debt? Or is your comment a joke?

    , @Anonymous
    @27 year old

    Trump should totally propose that,
    and then yell 'PSYCH!'

  30. @Hannah Katz
    Funny, my son-in-law, who is a resident physician, was relieved to get a residency spot. Some in his graduating class could not find a match. He says the government under B.O. pushed for more spots in medical schools but failed to follow through with adequate residency spots.

    How would you like to pile up student loan dept to finish medical school, only to find no residency spot and then seeing foreign students getting some of the rare open spots instead of you? Without finishing your residency, your MD is pretty close to worthless. Less than an RN even.

    Replies: @Triumph104, @Chrisnonymous

    We don’t have enough graduates even to fill residency slots.

    The article is wrong. The woman in the link was a registered nurse before she decided to go to medical school at Oregon Health and Sciences University. She goes into detail why she wasn’t able to get a residency after graduating medical school. She is now $400,000 in debt with a baby plus she has a college-age child. She says that 1000 US medical school graduates and over 8000 International Medical Graduates fail to get residencies. In 2015 there were 41,000 applicants for 30,000 residency positions. (LINK)

    Missouri and several other states with physician shortages are in the process of passing laws that would allow physicians who have not done a residency to practice as “assistant physicians”. (LINK)

  31. @Cwhatfuture
    Unsaid in all of this is the fact that women, now 50% of medical school admittances, work less hours than male doctors, take time off to have kids, and do not go into those specialties requiring the delay of family formation as often as men. (Many male doctors have told me this - privately). I don’t blame these women, who go into family practice and work 3 days a week, but it means each female graduate offers less medical treatment over a career on average. So we need more doctors in practice, even though we may be theoretically graduating enough of them. So we hire foreign doctors. Most often, men. In other words, we are turning down American men for admittance to medical school (their places taken by women), so we can hire foreign men later.

    Of course no one can say this. No one can say we must increase admissions to make up for all the time off and specialties not pursued.

    Replies: @Anonymous, @SimpleSong, @drt, @Moses, @Anon, @Escher

    You also see this to some extent now with male grads. Lots of couples are med school classmates–after kids the woman won’t want to completely give up her career so will go down to 20-40%; but that’s still too much so to cover the difference the male will go down to 60-80%. It’s actually completely rational behavior at the level of the couple–if the woman went down to 0% then she’s out of medicine and if something happens to the man she can’t ramp up to get them through the rough patch, and also all that time in med school etc. was totally wasted. But at the societal level it’s totally bonkers–you just trained two docs and only got one.

    • Replies: @Opinionator
    @SimpleSong

    After kids the woman won’t want to completely give up her career so will go down to 20-40%; but that’s still too much so to cover the difference the male will go down to 60-80%.

    How is it that a reduction in the male's schedule "covers" the difference caused by the female's reducing her hours?

    Replies: @SimpleSong

  32. Why go to medical school and sink into $350k+ in debt for a 200k per year job at 31 when you can make 250k by 27 on Wall Street? That was the calculus for some of my smart friends in college who looked at the pre-med track.

  33. Anon • Disclaimer says:

    Or… to put it in another way…

    Another Job that foreigners won’t do in their own nations and will do Only in America. These folks surely don’t want to serve and invest in their own countrymen who need the money and help more than rich Americans do.

    Foreigners: “Why don’t you want us to come to your country?”

    Patriots: “Why don’t you wanna live with others like yourself?”

  34. Anonymous [AKA "Assistant village idiot."] says:

    I have to slightly disagree Steve. You’re into affordable family formation. Health care costs are one of the tapeworms eating away at middle class take home wages. A decent private family health plan now often runs over $2000 a month in employer costs plus co pays. Alot of that is because of overpaid physicians.

    If the US had been importing doctors rather than stoop laborers and fast food workers for the last 30 years we’d be having an entirely different discussion about the effects of immigration on average living standards.

    • Replies: @Chrisnonymous
    @Anonymous


    Alot [sic] of that is because of overpaid physicians.
     
    I'm guessing you believe that because the chief village idiot told you it was so.
    , @dr kill
    @Anonymous

    Bless your heart.

  35. @blah blah teleblah
    I imagine it has more to do with a relative shortage of American medical schools. Basically, it’s very hard to get into any American medical school. By contrast, it’s not very hard to get into an American law school. I’m pretty sure you can get admitted to one, and probably graduate with a sub 100 IQ. There’s a reason why law schools are seen as a huge cash cow for universities without huge endowments.

    Replies: @George, @whoever, @Meretricious

    The issue with law school is why law schools are required. In the past smart teens worked for lawyers as clerks, eventually becoming lawyers. With all these fancy high schools for gifted students, a high school where the typical student would graduate with a law degree does not seem unreasonable. Maybe an apprenticeship as a paralegal with a lawyer would still be required. Exactly why there are no undergraduate law schools is also a mystery to me.

    President Martin Van Buren starts work as a legal clerk at age 15
    https://en.wikipedia.org/wiki/Martin_Van_Buren#Early_life_and_education

    Fun Fact: Van Buren married his first cousin’s daughter.

    • Replies: @bomag
    @George


    The issue with law school is why law schools are required.
     
    I recall several posts from lawyers musing that, at most, one year of their law schooling had any utility.

    In this day and age of Google and Wikipedia et al we can question more than ever the usefulness of formal schooling. It seems that school has become a secular church, and I expect a growth in the number of apostates and atheists from that institution.
  36. Thank you, Steve. As someone who visits some kind of specialist or another more than once a year, I am appalled that no one brings this up. There’s all this talk about who should pay for medical care, but almost everyone ignores the fact that there aren’t enough doctors.

    Also, if the government is going to determine who gets to be called a doctor, the least they could do is impose a little responsibility. For instance, since my convenient small town dermatologist (a dying breed) retired, I just can’t find anybody willing to give me an appointment sooner than six weeks out – and that’s if I’m really lucky. These same doctors make it clear on their websites that they spend a significant portion of their time doing cosmetic procedures like botox. This means that people who have skin cancer are made to wait to have their lesions biopsies because the dermatologists are too busy helping shallow middle aged women to maintain that youthful glow.

    It makes me ill, and yet, as you say, what goes unsaid goes unthought. By all means bring it up again. Maybe it will make an impression on some of those bigwigs who secretly read your material.

  37. There are probably more issues than just the medical cartel. For example k-12 is not producing feedstock for the medical school system. It is not just medical professions that are suffering. One reason for the Flint water crisis and the recent naval mishaps is a lack of people with the skills to operate the system.

    Lack of imagination too, for example:

    India experiments with mass-produced eye surgery

    Aravind Eye Care’s Vision for India
    https://www.forbes.com/global/2010/0315/companies-india-madurai-blindness-nam-familys-vision.html

  38. The medical industry is probably the biggest single racket, imo.

    Most doctors are incompetent boobs that use the internet right in front of you. Many primary care ones function almost entirely just as gatekeepers, referring you to specialists, unless you have a small cut or headache or need a vaccine. It seems you need a prescription even to get any sort of test. Few things have prices. Most doctors are hostile to the idea of paying in cash or giving something a price.

    I’ve seen pharmaceutical company reps actually buying the lunch for doctors’ offices.

    Anything non-addictive or not an antibiotic should be over the counter, at least in limited quantities. I personally would rather use a computer, or be diagnosed by any high school kid with an IQ of 115+, who through a short, interactive training program has competency in one narrow area, than waiting many weeks to see a specialist and paying through the nose.

    • Replies: @StillCARealist
    @songbird

    I'd love to give this comment several thumbs up. yes, I finally went to a doctor after several years (we lost our insurance thanks to Obama!) and she did indeed use the internet while we talked. I really just needed some basic screening based on my age and sex and having to pay through the nose for these procedures was ridiculous. All someone needs to do screening tests is basic competence. The nurse could have done everything. When it comes to more involved tests then what you need is lots of experience. After you've seen 1000 people you pretty much know what abnormalities look like and feel like.

    the rise of the PA is a good development and I'd like to see even more options for medical education that don't involve hundreds of thousands of $$. It's really experience that matters, not all that time you spent re-learning the Krebs cycle or naming the bones and muscles.

    Once I asked my Obstetrician about varicose veins and he shrugged. Then in another conversation I asked him how many vertebrae are in a spine. He didn't know that either. Then he laughed, "I catch babies!"

  39. @Hannah Katz
    Funny, my son-in-law, who is a resident physician, was relieved to get a residency spot. Some in his graduating class could not find a match. He says the government under B.O. pushed for more spots in medical schools but failed to follow through with adequate residency spots.

    How would you like to pile up student loan dept to finish medical school, only to find no residency spot and then seeing foreign students getting some of the rare open spots instead of you? Without finishing your residency, your MD is pretty close to worthless. Less than an RN even.

    Replies: @Triumph104, @Chrisnonymous

    Funny, my son-in-law, who is a resident physician, was relieved to get a residency spot.

    The explanation seems to be that getting a desirable residency is very difficult.

    Like Steve’s contention that being poor in America today means not being able to afford to move away from other poor people, being a bad doctor in America today means not being able to treat non-NAM patients.

    Old joke:

    Q: What do you call someone who graduates from medical school at the bottom of their class?
    A: Doctor!

    New joke:

    Q: What do you call someone who graduates from medical school at the bottom of their class?
    Possible answers: “a GP”, “a VA doc”, “a resident of Detroit”, “Yo! Doctor!”, etc

    No doubt, the competition for residencies in whitopias adds to the kind of phenomena studied by Charles Murray.

    • Replies: @Bill
    @Chrisnonymous

    The good residencies tend to be treating NAMs. Urban, teaching hospitals are where the best residencies are.

    Replies: @Opinionator, @Chrisnonymous

  40. @Buzz Mohawk
    I was told this years ago, maybe in college, that the medical establishment in America, be it the schools or the profession, deliberately limits the number of doctors, medical students, or whatever, to maintain artificial scarcity.

    Now, every time I turn around, I meet another doctor from someplace like India.

    Good thing I live where there are a lot of good, old fashioned, Jewish doctors. And believe me, they are good!

    Replies: @Triumph104, @Alden, @Alden, @Lagertha, @Ris_Eruwaedhiel

    Good thing I live where there are a lot of good, old fashioned, Jewish doctors. And believe me, they are good!

  41. “cartel behavior by powerful interest groups.”

    It’s a New York thing. – Lorne Michaels

    Lorne Michaels Defends SNL’s Silence On Harvey Weinstein: ‘It’s A New York Thing’
    https://www.huffingtonpost.com/entry/lorne-michaels-snl-harvey-weinstein_us_59db3c27e4b072637c452329

  42. anon • Disclaimer says:

    My 50 year old Filipino Dr was educated back there, moved to the US at about 26. She had no debt, which blew the minds of the other DRs, as they were in hock for a quarter million on average.

    I saw the admission requirements for US medical schools, where you needed a 3.7 to 3.8 GPA, Score at the 95th percentile on the med school admission test, plus have the ability to put your entire life on hold for the next 8+ years to get that diploma.

    The AMA has done a superior job of preventing any possibility of enough doctors….

    • Replies: @North Carolina Resident
    @anon

    My neighbor is a 65+yo MD and med school professor on the admissions committee. Grades and MCAT are important but not everything. They strongly prefer candidates with real world medical work experience such as nurses aid, EMT, military medic, etc.

  43. I don’t remember what came of it, but in 1993 the Clinton administration proposed limiting med school enrollments for specialties. The hope was to increase general practitioners and reduce specialist utilization and expense. We could be experiencing the result of that proposal.

  44. The sooner that doctors, journalists, humanities teachers, and especially lawyers have to compete with foreigners on the level that computer programmers and roofers do, the better.

  45. Cut the affirmative action med school admits and suddenly many white males wouldnt waste time in the Caribbean. These kebabs are mostly research slave monkeys

  46. @27 year old
    @nebulafox

    We're going to cancel White student loan debts anyway so, meh

    Replies: @Achmed E. Newman, @Alden, @Anonymous

    Yeah, until you get a job. Then you’ll be back making payments on the loans. You’ll just be spreading your payments over some millions of students like yourself who got this great “benefit” from Uncle Sam. Oh, it won’t be a separate entry on you electronic pay stub. Just look for it to be lumped under “Federal Taxes”.

    Whaaaattt? Nobody told you how socialism worked?? I guess you missed a few days in kindergarten when you learn it from your fellow little ones. For me it was little Timaah, who wanted to play with my garbage truck, which I was taking damn good care of, after he broke his dump truck, that turned me into a foe of socialism. The teacher made me share my toy anyway, so I called her a useful idiot. Spent a lot of time in the other room on my little oval nap rug after that. Good times, good times.

    THERE! IS! NO! FREE! LUNCH!

    • Replies: @Anonymous
    @Achmed E. Newman


    THERE! IS! NO! FREE! LUNCH!
     
    I dare you to look up how many tens of billions were thrown away on mortgage bailouts, write-downs, cramdowns, etc. Or just ask Puerto Ricans or Greeks if they plan on paying off their debts.

    Or just ask Hank Greenberg of AIG. (And before some idjit points out that he had to pay $9M in a settlement, please note that his net worth was over $3B with a B.)

    There are free lunches everywhere, if you're properly connected. While we're at it, what are Americans going to do with their $20T national debt? (With a T.)

    Replies: @Achmed E. Newman

  47. @Olorin

    The shortage of American doctors couldn’t have anything to do with cartel behavior by powerful interest groups.
     
    I opted out of becoming a doctor because of the rampant degeneracy fostered by Great Society social programs that I saw or heard about while volunteering and working in my city's hospital and interacting with first responders in my area. Which underscores host's point.

    No way I was going to go into debt for training--both time and money--then be required to waste it patching up a bunch of degenerates who not only wouldn't behave long enough to heal but would be back demanding more free services/skills before the previous set of injuries had healed up. Which challenges host's point.

    Then there were the kids. Most of whose suffering was caused by their own "families."

    So maybe foreign medical graduates are more cold hearted. Like, if they are confronted with a black toddler who has been gang-raped at both ends, it won't hurt or haunt them either in the moment or for years after.

    And think of how handy they will come in as Big Pharma starts the geronticide of whites born before 1965, with the accompanying Total Cashectomy and the promise of wealth transfer to a bunch of people who have to be taught, and reminded, how to use a toilet and wash their hands.

    A problem which, eventually, should be self-correcting thanks to the smallest forms of life on earth.

    Replies: @Anonymous, @AM, @Charles Erwin Wilson

    No way I was going to go into debt for training–both time and money

    It’s hard not to question the sanity of those becoming MDs for the glamorous opportunity to be a primary care physician (or in your case an ER physician)

    If you want to be a primary care MD, get a PA with less time,debt, and stress and a nice niche career without the headaches.

    Yes, I want my specialists to be MDs, but there’s no point to med school if the job is immunizations, sniffles, diabetes management, and referrals.

    Anyway, I think you made the right call. We wouldn’t support my son in medical school unless he was planning to specialize from the beginning.

    • Replies: @lavoisier
    @AM

    No point in specializing unless you go into a field where the government and insurance companies do not control how much you can charge.

    Plastic surgery is a good choice for example.

    But any field where your services are essential--oncology, surgery, cardiology, etc.--is totally controlled by government mandate. And you can lose everything you have worked hard for if you ever make a mistake--even if the mistake was well-intentioned.

    Many people who go into medicine go into it because they want to help people and want to be challenged in their professional careers. But there is far too much of a downside today to the practice of medicine. You literally have to give up too much to become a doctor now. Most people do not care about the plight of the doctor, and complain that they make too much money and play too much golf. But their healthcare will suffer as the best and the brightest realize that the practice of medicine today is a fool's errand.

    Hence the flight from medical school of many applicants to the top business and law schools. You finish your education in less than half the time in these fields, can have a work-life balance, and very quickly can make more money than you will ever make as a physician.

    The author of this article is right. America will need foreign doctors because very few self-respecting and bright American students will choose this field in the future.

  48. @Anonymous
    @Cwhatfuture

    We see the same thing with law-school graduates. A couple years as a lowly, overworked associate in a big law firm and a certain number of recent grads decide they'd really rather take some time off to pursue motherhood, maybe occasional, high-end catering, or that scrapbooking website they've been contemplating.

    Then their salaries, such as they are, become aggregated with other women's and our society wrings its hands (and prepares its legislation) in the face of the 'wage gap' in relation to men, who will generally leave no stone unturned in the search for higher pay.

    Replies: @AM, @Ris_Eruwaedhiel

    A couple years as a lowly, overworked associate in a big law firm and a certain number of recent grads decide they’d really rather take some time off to pursue motherhood, maybe occasional, high-end catering, or that scrapbooking website they’ve been contemplating.

    Women, as a group, really should have never been pushed into careers as the “default”mode of their lives. It pains me to say it as a woman, but I am happier in low stress (low paid) careers. My nervous system is set a different level. Situations that cause my husband merely angst causes me almost total nervous breakdown.

    And it maybe a personality flaw (I certainly have enough of those),but I think I’m more typical than not.

    • Replies: @Anonymous
    @AM

    It's hardly wrong (in any sense of the word) to simply acknowledge that on average women and men have a number of different tendencies. But admitting that can get you thrown out of polite conversation nowadays, not to mention schools, jobs, public conveyances, what have you.

    Of course there are exceptions! BFD.. The tendencies still remain. Women excel at things like emotional intelligence and empathy, and thank God for that. Who here would really prefer to be tended to by a male nurse? My own EQ is probably in the single digits, but I'm really good at mechanical stuff. Vive les differences.

    , @StillCARealist
    @AM

    women still make the best nurses and men the best doctors. Some crossover is good.

    As to your larger point about the default for women being a career, I couldn't agree more. The default should be wife and mother with the persistent and determined minority having careers. I know there's no perfect model for any woman's life, but telling every female HS graduate that she has to go to college and plan a fabulous career is no less harmful than telling everyone they should get married and have kids.

    , @MadDog
    @AM

    Couldn't agree more. I'm a female. Had high stress jobs. No longer. And I'm happy as a clam.

    Women in accounting professions tend to be stressed. The ones who stay tend to be overweight and unhappy.

    Unless they are married and work part time. Then their staff stressed because they pick up her workload.

    Replies: @Opinionator

    , @SimpleSong
    @AM

    Just different niches. My wife gets much more anxious about things than I do to the point that it hurts her professionally; I'm the better worker bee. On the other hand, good childrearing requires at least some baseline anxiety and I've realized I don't get anxious enough about things. If I were single my kids would have died of scurvy by now.

  49. anonymous • Disclaimer says:

    The American system relies to a surprising extent on foreign medical graduates, most of whom are citizens of other countries when they arrive. By any objective standard, the United States trains far too few physicians to care for all the patients who need them. We rank toward the bottom of developed nations with respect to medical graduates per population.

    So is this an issue of the USA not training enough of our own, or that we don’t have enough of our own to train?

    According to the World Health Organization, the USA has 2.55 physicians per 1000 people. That’s higher than Canada and is pretty high compared to the rest of the world. For example, India only has around 0.725.

    It seems almost criminal that the USA would encourage the importation of physicians from nations such as India when those nations have a dire need for physicians themselves.

    If you are going to import foreign doctors maybe you could import them from nations that seem to have a surplus. For example most of Europe has more physicians per capita than does the US. But my guess is we are not augmenting our ranks with European doctors.

  50. @nebulafox
    Somewhat OT, but one of the big reasons that single payer is going to be tough to pull off in this country is because it'll either screw over a lot of young doctors, or the debt collectors. You can't go for single payer level salaries with the kind of debt they take on in school. Conversely, doctors in Germany might not go into debt, but they also do not make American level salaries.

    Replies: @27 year old, @Dr. X

    Somewhat OT, but one of the big reasons that single payer is going to be tough to pull off in this country is because it’ll either screw over a lot of young doctors

    Quite the opposite. Any single-payer legislation would invariably include a de facto takeover of the medical schools. The government would avoid opposition from within the medical community by buying off the medical schools with grant money and the medical profession by paying off student debt.

    There would be plenty of mandatory affirmative action requirements, too.

  51. A lot of doctors do what nurses could and should do and get paid inflated prices for it due to the medicine industry’s cartel behavior.

  52. I think Dean Baker made a good point in “The Conservative Nanny State” that high-paying professions like doctors are precisely the ones we should be importing, rather than unskilled labor. There’s diminishing returns to lowering wages at the bottom.

    • Replies: @Alden
    @TGGP

    If you don't mind me asking, why should we import Drs? Why not train Americans to be Drs?

    Does Dean Baker want to have a Roman Empire style slave society in which almost all the work is done by slaves and 90 percent of the population lives on welfare because they are not slaves and cannot earn a living because all the work is done by slaves?

    I hope you don't run into the affirmative action immigrant asian women Drs who crippled me for life.
    I assume you already have a good source of income and don't have children who might want to be Drs or other professionals. I assume you will be totally healthy and will not need medical care until you suddenly die at age 85 or so.

    If you think turd world Drs are so great, check out what the turd world Drs have done to the British NHS.

  53. @njguy73
    Sometimes I imagine a world where starting a medical school has no more government roadblocks than starting an online delivery service.

    Oh, very nice, very nice, very nice, very nice.

    But maybe in the next world.

    Replies: @Forbes, @Anonymous

    I know that reference too! Morrissey!

  54. @Elsewhere
    @Anon


    So, poor sick foreigners must remain untreated while their bright ones come to America to treat Americans?
     
    No, silly, the poor sick foreigners must be brought here because their country is (now) a medical desert.

    Replies: @Anonymous

    Most of the world would soon be depopulated by our betters’ habit of trying to import all of them to the USA. However they continue to insist on having nine children per woman.

  55. @Forbes
    @njguy73

    From the end of World War I, until the 21st century, six new medical schools were opened in the US. Twenty have opened since the turn of the century, with three more starting anew in 2017--bringing the total to 141 med schools. (An increase of 20%.)

    Meanwhile the US population has tripled since 1920.

    https://en.wikipedia.org/wiki/List_of_medical_schools_in_the_United_States

    Replies: @Anonymous

    Meanwhile the US population has tripled since 1920.

    Sigh. Can you imagine how wonderful this country would be if it held only 110 million people instead of 330 million?

    We could all live like Republicans.

    • Replies: @Anonymous
    @Anonymous

    That's assuming that we would have the current level of wealth, just distributed among 110 million instead of 330 million. We don't know what economic growth would have looked like if the population stayed constant over a century.

    Replies: @Nico, @Anonymous, @Opinionator, @bomag

  56. Moshe says:

    I oppose any immigration to this country at all. I don’t care for “engineering qualifications” or any of that bullshit. Don’t allow them in. Even with a greencard.

    And the Dreamers have got to go, and the one million asians taking slots in our best universities that belong to US – Americans.

    I make only two exceptions.

    1) If there is a total slaughter sonewhere, like in Syria, we can take in refugees — TEMPORARILY.

    Before these people are saved they must make a video recording about why they choose to escape to America EVEN THOUGH THEY KNOW AND HAPPILY ACCEPT THE FACT THAT THEY WILL ONLY STAY IN CAMPS.

    Obviously these camps will be comfortable, large, and humane. ANS THEY ALSO SPEAK INTO THE VIDEO WHY THEY HAPPILY ACCEPT THE REQUIREMENT TO LEAVE WITHIN 4 YEARS, AND WHAT THEIR PLANS WILL BE THEN.

    They will also be part of the American economy of course. Of course they can not pay back all of the generosity that we graciously give them, but they will be taxed to the highest degree realistically possible.

    II)

    My other acception is DOCTORS!!

    Homecare Philippians are a problem because they will bring their families and be a burden to us. But Doctors make a lot of money. They will give our country more than they receive.

    And we need them and we want them.

    PhD’s doing medical research too.

    LONGER LIFE AND BETTER HEALTH is the one thing worthy of being important. And in vast numbers.

    The more of these people we have here the more competitive the field will be. Also we NEED them. Have you seen an emergency room lately?? Sometimes they stay there, packed one mattress against the other, for 2 whole days.

    Allow them in.

    • Replies: @Opinionator
    @Moshe

    Wouldn't it be better to produce homegrown doctors?

  57. Canada has a similar problem that is likely to get worse over the next few years (coming shortly thereafter to a USA near you).

    We have legalized euthanasia. Currently no doctor is required to participate, but so few are willing to participate that the “service” is hard to come by, so advocacy groups are pushing to make participation mandatory for all doctors. Similarly, they want to make it mandatory for all doctors to participate in abortion.

    Many doctors will not comply, which will mean they will be forced out of the business. Many potential physicians will simply apply their talents elsewhere. Either way, an existing doctor shortage will get worse (yay! more third world doctors!).

  58. @Cwhatfuture
    Unsaid in all of this is the fact that women, now 50% of medical school admittances, work less hours than male doctors, take time off to have kids, and do not go into those specialties requiring the delay of family formation as often as men. (Many male doctors have told me this - privately). I don’t blame these women, who go into family practice and work 3 days a week, but it means each female graduate offers less medical treatment over a career on average. So we need more doctors in practice, even though we may be theoretically graduating enough of them. So we hire foreign doctors. Most often, men. In other words, we are turning down American men for admittance to medical school (their places taken by women), so we can hire foreign men later.

    Of course no one can say this. No one can say we must increase admissions to make up for all the time off and specialties not pursued.

    Replies: @Anonymous, @SimpleSong, @drt, @Moses, @Anon, @Escher

    As a surgeon in practice for 27 years, I can vouch for this comment. The rising number of female physicians coincides with the decline in prestige, power and income of American physicians, and has influenced the whole culture of medicine. Compared with earlier generations, young MDs are less hard working (but very good at taking written tests), relatively timid, and much more submissive. The majority want to be employed rather than have their own practices, and often are far less productive. At a recent dinner at a prestigious Boston hospital, I was amazed to hear a group of young doctors at my table trade tips on how to keep down the number of patients they had to see per day! When I was starting out, the conversation would have been trading tips on how to see more patients per day.

    BTW, my wife is a physician, and she agrees with the above.

    • Replies: @Opinionator
    @drt

    The rising number of female physicians coincides with the decline in prestige, power and income of American physicians

    Could you explain the causal mechanism(s) at work there?

    Replies: @drt

    , @Brutusale
    @drt

    Bertrand, Goldin and Katz on the causes of the "income gap". I imagine it applies to MDs as much as MBAs; men are from neurosurgery, women are from pediatrics.

    https://scholar.harvard.edu/files/goldin/files/dynamics_of_the_gender_gap_for_young_professionals_in_the_financial_and_corporate_sectors.pdf


    Money shot: "Most interesting is why female MBAs have not done as well as their male peers.
    We identify three proximate reasons for the large and rising gender gap in earnings
    that emerges within a few years of MBA completion: differences in business school
    courses and grades; differences in career interruptions; and differences in weekly
    hours worked. These three determinants combined can explain 84 percent of the 31
    log point raw gender gap in earnings pooling across all the years following MBA
    completion. Because the relative importance of each factor changes with years since
    MBA completion, we explore the evolution in the earnings gap by sex by time since
    obtaining the MBA. We also compare women without any career interruptions and
    any children to all men."

    Of course, Mass General can afford to pay you pretty well because they save money, when compared to BMC and the Brigham, by paying their nurses less. They offered my girlfriend a job 3 years ago...for $35K less than she's making now at BMC.

  59. @Guy de Champlagne
    It's also not like the restrictive licensing is translating into any degree of satisfactory medical safety, with something like 200,000 - 300,000 annual preventable medical deaths. We could drop the average IQ and training standards of doctors but regulate the industry properly by, for instance, giving them checklists to follow like pilots get and still save an almost mind boggling number of lives every year.

    Replies: @Alden

    Those pocket notebooks already exist for about 30 medical jobs. They are check lists to do for any kind of patient presentation and what to do in each instance. Present presents A, do XYZ If result is B, do C

    They are the simplest manuals. They give standard practice. I got a sizeable malpractice settlement by simply going to a Borders book store and buying the orthopedic notebook for dummies. Around 9 Asian women drs didn’t do what was required. That notebook of standard procedure proved they were idiots.

    Doctors and therapists often malpractice. I advise everyone to look on amazon or a barnes and noble and find the notebooks for what ever medical problem you have. There are many incompetent Drs, nurses, technicians and therapists around who don’t do what they are supposed to do.

    So get those notebooks. There are many kinds. The best are called RN notebooks, LVN notebooks, Ortho notebooks, pediatrics notebooks etc.

    Point is, there are numerous manuals, but medics often don’t follow standard procedure

    • Replies: @Ivy
    @Alden

    Good advice, pursuing a variation now against an AA practitioner.

  60. Almost all of these foreign doctors are traitors to their third world countries which are all grossly under served by health care providers. Many came here to get educated and then stay. Others may be educated in their own country, but then come here to practice because its a better life style and they can get relatively wealthy. They are almost all from third world countries. You won’t see foreign doctors from first world countries. By most alleged left wing measures, they are disgusting selfish people. Another notch on the Democrat hypocrite stick.

    • Agree: Bliss
  61. @TGGP
    I think Dean Baker made a good point in "The Conservative Nanny State" that high-paying professions like doctors are precisely the ones we should be importing, rather than unskilled labor. There's diminishing returns to lowering wages at the bottom.

    Replies: @Alden

    If you don’t mind me asking, why should we import Drs? Why not train Americans to be Drs?

    Does Dean Baker want to have a Roman Empire style slave society in which almost all the work is done by slaves and 90 percent of the population lives on welfare because they are not slaves and cannot earn a living because all the work is done by slaves?

    I hope you don’t run into the affirmative action immigrant asian women Drs who crippled me for life.
    I assume you already have a good source of income and don’t have children who might want to be Drs or other professionals. I assume you will be totally healthy and will not need medical care until you suddenly die at age 85 or so.

    If you think turd world Drs are so great, check out what the turd world Drs have done to the British NHS.

  62. @27 year old
    @nebulafox

    We're going to cancel White student loan debts anyway so, meh

    Replies: @Achmed E. Newman, @Alden, @Anonymous

    Why just White student debt? Or is your comment a joke?

  63. @Anonymous
    Remember the Arab terrorism in Scotland some years ago?--turned out the terrorists were doctors. People wondered, why would a doctor in his right mind want to be a suicide murderer? It came out that under the UK medical system being a doctor was no longer the attractive career choice it had been. These guys were doctors imported from Baghdad medical school to remedy the shortage.

    Replies: @AnotherGuessModel, @Little Tripoli, @Alden

    Nah. My understanding is that the BMA operates in a similar cartel fashion, refusing to allow an increase in medical student spots at top tier Brit universities, which are consequently massively over subscribed by adequately credentialed Britishers. This, combined with nationwide pay scales, is why London has a lot of foreign doctors. You can live pretty well in picturesque Cumbria on a junior doctor salary, the Great Wen not so much.

  64. January 1, 2014 – UK Daily Mail – by Professor J Meirion Thomas
    Why having so many women doctors is hurting the NHS: A provocative but powerful argument from a leading surgeon

    http://www.dailymail.co.uk/debate/article-2532461/Why-having-women-doctors-hurting-NHS-A-provovcative-powerful-argument-leading-surgeon.html#ixzz4v40okFml

    Although I am a feminist — in the NHS hospital in which I work as a surgeon, some of the best doctors are women — this shift of the gender balance in medicine is a worrying trend.
    I believe it is creating serious workforce problems, and has profound implications for the way the NHS works.
    For many years — until the Sixties — fewer than 10 per cent of British doctors were female. Then things changed. For the past four decades about 60 per cent of students selected for training in UK medical schools have been female.

    This is understandable in academic terms because girls achieve slightly better A-level grades than boys. They also mature earlier and may present themselves more impressively to medical school selection committees at the age of 17.
    The effect is beginning to be seen. In 2012, a total of 252,553 doctors were registered with the General Medical Council. The male-to-female ratio was 57 to 43 per cent.
    However, in its annual report last year, the GMC documented the changes in the UK medical register between 2007 and 2012.
    The most significant change was that the number of female doctors under the age of 30 had increased by 18 per cent, while the number of males decreased by 1 per cent.
    Indeed, in this age group, 61 per cent of doctors are now women and 39 per cent men.
    In the age group 30 to 50 years, over the same period, the number of female doctors increased by 24 per cent compared with 2 per cent for males. In this age group, men still outnumber women by 54 per cent to 46 per cent — but that ratio will soon reverse.
    I fear this gender imbalance is already having a negative effect on the NHS.
    The reason is that most female doctors end up working part-time — usually in general practice — and then retire early.
    As a result, it is necessary to train two female doctors so they can cover the same amount of work as one full-time colleague.

    Given that the cost of training a doctor is at least £500,000, are taxpayers getting the best return on their investment?
    There is another important issue. Women in hospital medicine tend to avoid the more demanding specialities which require greater commitment, have more antisocial working hours and include responsibility for management.

    Instead of taking on a specialist career, many women prefer to look for a better work-life balance when they have young children of their own.
    A section in the GMC’s 2013 report is illuminating. It lists the number of female doctors by speciality for 2012, and shows how many are attracted to general practice rather than other areas of medicine: general practice 29,272; anaesthesia 3,118; paediatrics 2,477; psychiatry 1,778; general medicine 1,054; general surgery 467; trauma and orthopaedics 191.
    Compare this with the number of male doctors by speciality, and you can see the huge difference in general surgery as well as trauma and orthopaedics — both of which involve the complex, antisocial hours that deter so many women: general practice 31,711; anaesthesia 6,940; paediatrics 2,578; psychiatry 3,302; general medicine 3,737; general surgery 3,779; trauma and orthopaedics 3,629.
    Dame Carol Black, former president of the Royal College of Physicians, pointed out this growing discrepancy in 2004, when she controversially suggested that the feminisation of the medical profession would lead to its degradation.
    She said the issue was not whether women doctors could do their job properly, but whether they were willing to devote time and effort, beyond their clinical responsibilities, to activities such as committee work and research.
    Politicians are concerned, too. In a Commons debate in June, Anne McIntosh, a Tory MP, said that women doctors who had received expensive medical training but went part-time after starting a family were a huge burden on the NHS.

    In reply, Anna Soubry, then a health minister, agreed that they were a drain on resources.
    Within hours, after angry responses, some from the British Medical Association and the Royal College of GPs (two professional bodies opposed to any meaningful reform of general practice), Ms Soubry was forced to retract her comment and apologise.
    Of course, it is perfectly reasonable that women should have career breaks to have children. But is part-time working on such a large scale in the public interest, even if it is considered perfectly acceptable by our ultra-politically correct NHS management?
    GPs are very well paid. Their average salary is around £103,000 — quite sufficient for a woman doctor who is also a mother to be able to afford quality childcare at home.
    But the salary also means that part-time working still allows for a comfortable lifestyle.
    In addition, doctors tend to marry within their own socio-economic group and, in many cases, the wife is the secondary earner. This also encourages less demanding part-time work.
    Isolated

    A female junior surgical trainee told me recently that when she went to medical school, some female students announced from the start that they intended to be part-time GPs when they qualified.
    But in general practice, part-time working and job-sharing have an effect on patients.
    They can deprive them of continuity of care, which is the service they most value. That once key value of the NHS — the cradle-to-grave relationship with patients — has become a thing of the past.
    Indeed, I believe that current general practice fails to meet the needs of the modern health service and its patients.
    That such a great and growing number of GPs are part-time is a major problem, but it is not the only one.
    Because GPs tend to work in small group practices, there is a danger that these can become backwaters, isolated from the nourishing influences of mainstream hospital medicine.

    Failure to keep up with the latest developments is a real risk. The perfect solution, suggested by health minister Lord Darzi in 2007, was ‘polyclinics’ — super-surgeries in which GPs and hospital consultants would work together. Sadly the idea was not implemented.
    In truth, general practice is organised for the convenience of doctors — particularly, I suspect, for female GPs — and not their patients.
    No wonder many people, faced with a medical problem, ignore their local surgery and go straight to A&E — one reason why emergency medical services are at breaking point.
    The problems with A&E are very much in the public eye. Not so the issue of part-time working — but it certainly should be, as it is linked.
    In the UK we have a serious shortage of medical school places, with the result that more than half of male applicants with the required grades are rejected. As we have seen, many women who take up medical school places subsequently work part-time and, on the whole, tend to avoid A&E.
    We make up the shortfall in medical manpower by importing about 40 per cent of the doctors we need. Most now come from austerity-stricken EU countries.
    Does this make economic sense?
    We need accurate data on the extent of part-time working in order to allow public debate which could then inform medical school selection.

    For my part, I believe medical school places should be given to those most likely to repay their debt to society.
    Last year the U.S. businesswoman Sheryl Sandberg published a book called Lean In. It should be compulsory reading for female medical students.
    Her thesis is that too few women make it to the top of any profession. She acknowledges the conflict between professional success and domestic fulfilment, but says women should commit more professionally and not ‘lean out’.
    How do we persuade female doctors to ‘lean in’? It is a question we urgently need to address.

  65. @Buzz Mohawk
    I was told this years ago, maybe in college, that the medical establishment in America, be it the schools or the profession, deliberately limits the number of doctors, medical students, or whatever, to maintain artificial scarcity.

    Now, every time I turn around, I meet another doctor from someplace like India.

    Good thing I live where there are a lot of good, old fashioned, Jewish doctors. And believe me, they are good!

    Replies: @Triumph104, @Alden, @Alden, @Lagertha, @Ris_Eruwaedhiel

    How old are they? I have the best of the best, gem of gems, the creme de la creme, a White American male Dr only 46 years old. There are almost no White American male Drs in the San Francisco Bay Area or the Central Valley. But there are some in Los Angeles. I just told the gal at the insurance company that I would only accept a White American man as my primary care. And I got one, only 8 blocks away.

    The easiest way to get an absolutely upstanding Dr is to insist on a White American man. Why?
    Because of affirmative action: Only a very small percentage of White American men are admitted into medical school any more. Soooooo only the highest MCAT scorers and the writers of the most nauseating suck up admission essays who are White men are accepted.

    Until affirmative action, most Drs were White American men. So the incompetent, competent excellent and outstanding Drs were all White American men. But wit discrimination against White American men, only the very best and brightest get accepted to medical school.

    Don’t be shy about insisting on a White American male Dr. F**k liberals and affirmative action medics.

    • Replies: @Achmed E. Newman
    @Alden

    Alden, first of all, you are on a roll today! I like it (read your comment just below this one, so far).

    I have to tell this story after your one. This is not nearly as important a thing, but I needed a piece of general advice at the auto parts store. Yes, I can figure out and fix minor things, but this just needed a quick piece of general knowledge that someone very familiar with cars would know. There was a black guy and a white girl at the regular counter. I tried them first, but I know already that most of the people up front just know how to look up parts, and they are familiar with lots of parts, so they may at least know the timing belt is just outside the engine, etc ... That's all though.

    Now, quite often a white guy working there WILL be a car guy, with some good knowledge he brought with him to the job. In this case, no go, it was the other 2 at the retail counter. Everyone was all friendly as it was not busy, but I could tell nobody had answers. I finally just said "hey, isn't there a white guy here who I can talk to?" They both just pointed to the white COMMERCIAL sales guy and said "over there" Haha, some would have taken big offense, but I think most people where I live don't want to start arguments.

    Here's the thing. I did know that the COMMERCIAL guy, and the last guy before him, knew his stuff, but he's in the back. I was trying not to be rude, as he is not there for regular customers. He knew me though, and he was smiling as I went over there to talk for say 30 seconds. That's all it took to get the answer.

    Replies: @anon

  66. @Buzz Mohawk
    I was told this years ago, maybe in college, that the medical establishment in America, be it the schools or the profession, deliberately limits the number of doctors, medical students, or whatever, to maintain artificial scarcity.

    Now, every time I turn around, I meet another doctor from someplace like India.

    Good thing I live where there are a lot of good, old fashioned, Jewish doctors. And believe me, they are good!

    Replies: @Triumph104, @Alden, @Alden, @Lagertha, @Ris_Eruwaedhiel

    But they are liberals. Why give your insurance money to liberals? They are probably on the diversity, inclusion and affirmative action admissions committees of their med schools. Do they employ any White Americans in their offices? Or are all their employees turd world affirmative action types?

    • Replies: @Buzz Mohawk
    @Alden

    Well, my GP is actually a nice, White American man with a Polish name. In his 50s I guess. So I think I have a Polish Catholic M.D. That's good enough for me! His staff is all white.

    Two surgeons I used for minor things in recent years were both Jewish, and they did terrific work. Their staff were all white.

    I'm lucky where I live, where there are a lot of rich liberals, who you will notice have access to White / Jewish doctors and staff, as I do. My wife and I get most of the same stuff those assholes do.

    The Indian type doctors are in the walk-in clinics handling colds and pushing antibiotics. Oh, and about 15 years ago, I met a black doctor in one of those places who had to look up Motrin in his drug reference book. What a joke. Never again.

  67. @Anonymous
    Remember the Arab terrorism in Scotland some years ago?--turned out the terrorists were doctors. People wondered, why would a doctor in his right mind want to be a suicide murderer? It came out that under the UK medical system being a doctor was no longer the attractive career choice it had been. These guys were doctors imported from Baghdad medical school to remedy the shortage.

    Replies: @AnotherGuessModel, @Little Tripoli, @Alden

    That was the attempted Glasgow airport bombing? Its not exactly that being a Dr in Britain is so unattractive. It is 2 things that discourage native British from being Drs.

    1 Severe affirmative action discrimination in med school admissions.

    2. Even more severe affirmative action discrimination in medical resident placement.

    That same year as the attempted Glasgow airport bombing, more that 300 White British native born medical school grads were denied residencies in Britain. The 300 resident placements were filled by turd world medical grads* recruited in their turd world homes.

    The native White British medical school grads were told to go off to Africa and other places and do volunteer work for 5 years. Unpaid of course and they would have to support themselves while working in some ghastly turd world clinic.

    Neither the NHS nor the government nor the powers that be want White native British Drs around.

    There is no Dr shortage in Britian. Its just discrimination againist the Native Whites so s to fill the medical professions with disfunctional turd worlders.

    * Many turd world medical schools give out diplomas to people who seldom attend classes, don’t do lab work and fail the tests. Its the turd world way

  68. @Triumph104
    India provides the US with the largest percentage of doctors with foreign citizenship. According to the CIA Factbook, India has a 0.73 physicians per 1000 people. The US has 2.55 physicians per 1000 people. The US should only accept foreign doctors from countries that have a higher density of physicians than the US such as Belgium (2.97) or Finland (3.01).

    I don't have a problem with the current system. If there is ever a glut of physicians, the US can just turn off the spigot of foreign doctors entering the country. Just stop accepting physicians from needy countries.

    Replies: @Jonathan Mason, @Alden, @Hail

    Just stop accepting physicians from needy countries.

    It is the US that is needy.

    But then you run into the whole question of a great deal of medical practice being a private business in the US, and people in needy countries having freedom to travel and work wherever they want, so it is hard to see how such restrictions might be fairly enforced.

    If Donald Trump reads this thread, he might issue an Executive Tweet tomorrow to block the entry of foreign-born physicians on the grounds that they may endanger the health of Americans, and to block US-born and/or educated doctors from working overseas, but I daresay it would hit a legal snag or two along the way.

    • Replies: @bomag
    @Jonathan Mason


    people in needy countries having freedom to travel and work wherever they want
     
    It's not quite that simple. Pipelines get set up from certain countries and certain areas.

    We should have more pipelines from within our own country.
  69. @Triumph104
    India provides the US with the largest percentage of doctors with foreign citizenship. According to the CIA Factbook, India has a 0.73 physicians per 1000 people. The US has 2.55 physicians per 1000 people. The US should only accept foreign doctors from countries that have a higher density of physicians than the US such as Belgium (2.97) or Finland (3.01).

    I don't have a problem with the current system. If there is ever a glut of physicians, the US can just turn off the spigot of foreign doctors entering the country. Just stop accepting physicians from needy countries.

    Replies: @Jonathan Mason, @Alden, @Hail

    Why would a European immigrant want to move to America and send his kids to our public schools and spend a fortune on housing just to get away from the ghetto? Why would he want his kids to be discriminated against in college and job applications? Why would he want his kids to go into huge debt for college when he or she could stay home and get very low cost college? Why would he want to be sued because he didn’t hire the required number of affirmative action slugs?

    In other words, there is no reason for any White person to immigrate to this White hating country.

  70. @Almost Missouri
    Sounds like the easy way to to become an American doctor is to train somewhere else where it is faster and cheaper, and then come (back) to the US to "fill the gap".

    Replies: @nebulafox, @Methodological Terrorist, @Jim Bob Lassiter, @Aristippus, @Pat Boyle, @Bill

    Scott Alexander at Slate Star Codex has mentioned this some and he did his medical training, as an American, in Ireland. As a guy in my late 20s, what I’ve noticed is that many of my classmates from college went alternative medical routes instead of becoming doctors. That’s surprising because my undergrad uni is known for being a doctor training ground, but it seems like the only folks who went the medical school route were Asian. For whites (including Jews) it seems like being optometry, pharmacy, and dental school are the destinations now because the pay is almost as good as being an MD, but there is significantly less stress.

    • Replies: @Maj. Kong
    @Aristippus

    Pharmacy will face automation soon enough.

    Replies: @Aristippus, @Bill

  71. @Cwhatfuture
    Unsaid in all of this is the fact that women, now 50% of medical school admittances, work less hours than male doctors, take time off to have kids, and do not go into those specialties requiring the delay of family formation as often as men. (Many male doctors have told me this - privately). I don’t blame these women, who go into family practice and work 3 days a week, but it means each female graduate offers less medical treatment over a career on average. So we need more doctors in practice, even though we may be theoretically graduating enough of them. So we hire foreign doctors. Most often, men. In other words, we are turning down American men for admittance to medical school (their places taken by women), so we can hire foreign men later.

    Of course no one can say this. No one can say we must increase admissions to make up for all the time off and specialties not pursued.

    Replies: @Anonymous, @SimpleSong, @drt, @Moses, @Anon, @Escher

    Ditto for MBA graduates.

    Several of my female classmates found their high earning husband, then became full time mothers and PTA members.

    Nothing wrong with that, but wouldn’t society be better off if their business school slots had gone to men who would work their whole careers creating value for society? Purely from a resource and return perspective, resources spent were resources wasted on those women’s graduate education.

    • Replies: @Karl
    @Moses

    66 Moses > Purely from a resource and return perspective, resources spent were resources wasted on those women’s graduate education.


    yo Moshe, tell that to all the male MBA students who married a girl smart enough to get into a selective MBA program

    , @RonaldB
    @Moses

    Frankly, if you want smart women to focus on childbearing and family rearing, without the burden of getting a professional degree and maintaining certification for a rainy day, you have to re-institute alimony and get rid of no-fault divorce.

    This would make specialization within the family more equitable and, more importantly, more widespread.

    , @dwb
    @Moses

    This question presumes that there is actual value to most MBA degrees, rather than the exercise as just a couple of years to relax, hone your skills creating vacuous power point slides, improve your golf game, and network.

    Oh, and of course, learn how to use buzz-words like "paradigm," "align," and "leverage" in ever more creative ways.

  72. This is absolutely ridiculous. Not only are many of these foreign doctors poorly trained, are unethical(many are caught in insurance fraud, assault of female patients etc.), but when we take the good doctors from them we are also depriving poor 3rd world countries of doctors who are much needed there than here. Countries like India and in Africa already have a huge shortage of doctors, it’s simply unconscionable and unbelievably selfish for rich countries to poach their doctors. Here are the doctor to patient ratio in each of these countries:

    USA: 1 to 390
    China: 1 to 950
    India: 1 to 1,700
    Philippines: 1 to 1,800
    Egypt: 1 to 1,900
    Iran: 1 to 2,200
    Namibia: 1 to 3,300
    Bangladesh: 1 to 3,800
    Afghanistan: 1 to 5,300
    Kenya: 1 to 7,100
    Indonesia: 1 to 7,700
    Zambia: 1 to 8,300
    Angola: 1 to 12,000
    Rwanda: 1 to 20,000
    Ethiopia: 1 to 33,500
    Tanzania: 1 to 50,000
    http://bigthink.com/strange-maps/185-the-patients-per-doctor-map-of-the-world

    We have no business poaching doctors from all these already doctor deprived 3rd world countries. We have no shortage of doctors!

  73. • Replies: @eah
    @eah

    https://twitter.com/AJOccident/status/917616227517902848

  74. @Buzz Mohawk
    I was told this years ago, maybe in college, that the medical establishment in America, be it the schools or the profession, deliberately limits the number of doctors, medical students, or whatever, to maintain artificial scarcity.

    Now, every time I turn around, I meet another doctor from someplace like India.

    Good thing I live where there are a lot of good, old fashioned, Jewish doctors. And believe me, they are good!

    Replies: @Triumph104, @Alden, @Alden, @Lagertha, @Ris_Eruwaedhiel

    Well, I was told by so many people that limiting med students keeps the salaries of doctors artificially high (that’s why doctors from Asia are dying 🙂 to come here to work. With socialized medicine, like in Finland, my homeland, doctors make about 200K, tops. My dad’s best friend, a well known pediatric surgeon in the European community, probably, after taxes (this was up until the early 90’s), took home (net pay) 150K Euros…kid you not. About 65% of his income went to taxes. This is the major issue that Americans; politicians, lawyers, upper middle-class people don’t understand about the Nordic countries: You are taxed according to your income; your properties, your stocks & savings, all your assets, like boats, 2nd homes, cars, even dogs/horses. And, you pay a “death tax.” That’s how you get your “universal coverage” in the Nordic countries. A cousin of mine said, “Everybody pays, everybody gets.” This is also why European women don’t have huge wardrobes or walk-in closets – this is a fact.

    • Replies: @Joe Stalin
    @Lagertha

    The Democrat Dude Pritzker who is running for IL governor has a TV ad where he says our income tax is UNFAIR (5%) and that we NEED a PROGRESSIVE tax like all the stupid people in New York and California.

    This must be aimed at all the Blacks and big government Hispanics that are in need of ever more gibsmethat.

    Replies: @Anonymous

  75. Published a while ago but appropriate here:
    “I’M A DOCTOR — TOUCH MY ****!”
    http://www.theoccidentalobserver.net/2017/09/05/bad-medicine-the-sickening-truth-about-britains-foreign-doctorsbad-medicine-the-sickening-truth-about-britains-foreign-doctors/
    Key takeaway: you are allowed to actually ask for a white doctor, and to refuse any service unless you are unconscious. The phrase “domestically trained” (meaning, regardless of skin color, they studied here and not there) is popular and useful.
    OT
    You’ll never see this coming, but Jon Podhoretz is horrified. He is aghast at Tablet Magazine’s analysis of Harvey Weinstein. Comparison is made to Philip Roth’s Portnoy character.
    OT especially anti-Semitic bonus: Tablet charges you $2 to comment (no, seriously) and irate Jews are paying the money to be able to complain that this was published. Is it too much to suggest that whoever thought of this model is a genius right up to the point where his private plane crashes?
    http://archive.is/28ion
    https://mobile.twitter.com/jpodhoretz/status/917567756450623489

  76. @Olorin

    The shortage of American doctors couldn’t have anything to do with cartel behavior by powerful interest groups.
     
    I opted out of becoming a doctor because of the rampant degeneracy fostered by Great Society social programs that I saw or heard about while volunteering and working in my city's hospital and interacting with first responders in my area. Which underscores host's point.

    No way I was going to go into debt for training--both time and money--then be required to waste it patching up a bunch of degenerates who not only wouldn't behave long enough to heal but would be back demanding more free services/skills before the previous set of injuries had healed up. Which challenges host's point.

    Then there were the kids. Most of whose suffering was caused by their own "families."

    So maybe foreign medical graduates are more cold hearted. Like, if they are confronted with a black toddler who has been gang-raped at both ends, it won't hurt or haunt them either in the moment or for years after.

    And think of how handy they will come in as Big Pharma starts the geronticide of whites born before 1965, with the accompanying Total Cashectomy and the promise of wealth transfer to a bunch of people who have to be taught, and reminded, how to use a toilet and wash their hands.

    A problem which, eventually, should be self-correcting thanks to the smallest forms of life on earth.

    Replies: @Anonymous, @AM, @Charles Erwin Wilson

    Whoa Olorin. After reading your post I almost blacked out. But isn’t your assessment too dark? In the end, reality will have the upper hand. And the stupidity of the current organization of the medical world will be swept away by lots and lots of people saying “WTF? This is not what we were promised.”

    • Replies: @bomag
    @Charles Erwin Wilson


    In the end, reality will have the upper hand.
     
    I think this about a lot of things. But the para-adage from Keynes echoes through my head:

    "The world can remain irrational longer than you can stay solvent."
  77. @Anonymous
    @Cwhatfuture

    We see the same thing with law-school graduates. A couple years as a lowly, overworked associate in a big law firm and a certain number of recent grads decide they'd really rather take some time off to pursue motherhood, maybe occasional, high-end catering, or that scrapbooking website they've been contemplating.

    Then their salaries, such as they are, become aggregated with other women's and our society wrings its hands (and prepares its legislation) in the face of the 'wage gap' in relation to men, who will generally leave no stone unturned in the search for higher pay.

    Replies: @AM, @Ris_Eruwaedhiel

    I used to work in a big firm and many attorneys, especially women, became in-house attorneys for big companies. They wouldn’t make as much money, but the others were more regular 9-5. True of paralegals, as well.

  78. @Buzz Mohawk
    I was told this years ago, maybe in college, that the medical establishment in America, be it the schools or the profession, deliberately limits the number of doctors, medical students, or whatever, to maintain artificial scarcity.

    Now, every time I turn around, I meet another doctor from someplace like India.

    Good thing I live where there are a lot of good, old fashioned, Jewish doctors. And believe me, they are good!

    Replies: @Triumph104, @Alden, @Alden, @Lagertha, @Ris_Eruwaedhiel

    Well, at least they speak good English.

  79. Beyond the AMA cartel, I think part of the problem is the training path for doctors. Why should someone going into the medical field have to spend four years in undergrad? Then spend what, another 6-8 years in medical school? There’s no reason a family doctor can’t be turned out in five years. Take the final two years of high school to fulfill the well-rounded individual requirements, then four-five years of schooling and maybe a year or two apprenticeship type training.

  80. @blah blah teleblah
    I imagine it has more to do with a relative shortage of American medical schools. Basically, it’s very hard to get into any American medical school. By contrast, it’s not very hard to get into an American law school. I’m pretty sure you can get admitted to one, and probably graduate with a sub 100 IQ. There’s a reason why law schools are seen as a huge cash cow for universities without huge endowments.

    Replies: @George, @whoever, @Meretricious

    Yes, it’s hard to get in, hard to stay in, and it costs a lot. UCSF Med School, eg., runs about $60,000 annually (something over half of that tuition) for in-state.
    I don’t think a person should go to med school because it’s a gateway to a comfortable living. If that is your goal, go into law or finance, real estate or politics. Go into medicine because you have a strong interest in, say, TBI and neurological surgery … something that will motivate you and keep you going no matter what.

    • Replies: @GU
    @whoever

    Stay FAR AWAY from law if you want a "gateway to a comfortable living."

  81. @Triumph104
    India provides the US with the largest percentage of doctors with foreign citizenship. According to the CIA Factbook, India has a 0.73 physicians per 1000 people. The US has 2.55 physicians per 1000 people. The US should only accept foreign doctors from countries that have a higher density of physicians than the US such as Belgium (2.97) or Finland (3.01).

    I don't have a problem with the current system. If there is ever a glut of physicians, the US can just turn off the spigot of foreign doctors entering the country. Just stop accepting physicians from needy countries.

    Replies: @Jonathan Mason, @Alden, @Hail

    Given the USA’s much higher doctor-per-capita rate, it is clearly racist and harmful to people of color to drain away good Indian doctors from India.

    I wonder if we will see this editorialized any time or if the cognitive dissonance is too much for them to actually sit down and write it.

  82. the most dangerous “MD” is an affirmative action MD–for blacks, eg, a social worker’s IQ will get you into med school–never use an affirm act MD

  83. @27 year old
    @nebulafox

    We're going to cancel White student loan debts anyway so, meh

    Replies: @Achmed E. Newman, @Alden, @Anonymous

    Trump should totally propose that,
    and then yell ‘PSYCH!’

  84. @blah blah teleblah
    I imagine it has more to do with a relative shortage of American medical schools. Basically, it’s very hard to get into any American medical school. By contrast, it’s not very hard to get into an American law school. I’m pretty sure you can get admitted to one, and probably graduate with a sub 100 IQ. There’s a reason why law schools are seen as a huge cash cow for universities without huge endowments.

    Replies: @George, @whoever, @Meretricious

    not if you’re black or Hispanic

    • Replies: @blah blah teleblah
    @Meretricious

    I imagine that even the affirmative action types that get into an American medical school are pretty smart compared to the rest of the population, almost certainly IQ above 115. On the other hand, someone admitted to a fourth tier law school that didn't get a full scholarship is in all likelihood probably right smack dab in the middle of of the bell curve, and maybe a little bit on the left side. And there are accredited law schools that will admit anyone that has an undergraduate degree, no matter their GPA or LSAT score is. Once there, the school will do everything to make sure they graduate.

    As to why there are presumably a lot few American medical schools and many fewer spots, I would guess it has a lot to do with start up costs. Princeton could pretty much start its own law schools in a year or two if they wanted. I doubt it could do the same thing with a medical school.

    Replies: @Anonymous, @Hibernian

  85. @Aristippus
    @Almost Missouri

    Scott Alexander at Slate Star Codex has mentioned this some and he did his medical training, as an American, in Ireland. As a guy in my late 20s, what I've noticed is that many of my classmates from college went alternative medical routes instead of becoming doctors. That's surprising because my undergrad uni is known for being a doctor training ground, but it seems like the only folks who went the medical school route were Asian. For whites (including Jews) it seems like being optometry, pharmacy, and dental school are the destinations now because the pay is almost as good as being an MD, but there is significantly less stress.

    Replies: @Maj. Kong

    Pharmacy will face automation soon enough.

    • Replies: @Aristippus
    @Maj. Kong

    Sort of. Pharmacy technicians who fill the bottles are probably on the way out. My cousin just finished a Pharm D and he said that his school discouraged graduates from retail pharmacy. Instead they encouraged grads to look at hospitals and being part of a medical team with other specialists. The other trend is pharmacists working at nursing homes and retirement communities in more of public health role.

    Replies: @Jonathan Mason, @dwb

    , @Bill
    @Maj. Kong

    The issue isn't automation. There is no reason for, say, Walmart to have pharmacists --- one guy for every 20 stores available by phone would be fine. There is a legal requirement in (I think) every state for there to be a pharmacist physically present in a pharmacy. The pharmacists have a strong lobbying group, and they are allied with all the other medical professions' lobbying groups for "they came for the pharmacists and I said nothing . . ." reasons.

    Replies: @JackOH

  86. The UK seems to run a system where huge numbers of their homegrown medical graduates ( overwhelmingly Anglo-Celt ) depart the UK for greener pastures ( largely the Anglosphere ) and they are then replaced in the medical workforce by medical graduates from Asia and Africa .

    Even a few lefties seem to be troubled by this turn of events

  87. You guys have no idea what you’re talking about.

    For many specialties, particularly the lucrative surgical subspecialties like orthopedic surgery and otolaryngology, training slots are limited primarily by case volume and case variety. In other words, most of the hospitals that have the requisite patient throughput (and faculty) to create an orthopedic surgery residency already have an orthopedic surgery residency. You’re not going to be able to snap your fingers and start training surgeons at second tier suburban hospitals which don’t have the warm bodies for your trainees to operate on. This is a function of population distribution and not a matter of “cartels” protecting their turf by purposefully restricting supply (well, except for dermatology heh).

    Secondly, there is a huge oversupply of residencies as is. Roughly 22,000 students graduate from US medical schools each year. How many residency slots are there? Oh, about 34,000. The reason you see so many foreigners practicing medicine in this country is precisely because of the huge oversupply of residency positions relative to the number of American medical school graduates. There is absolutely no need to create even more residency positions since the existing number is already 36% greater than what is needed. You have to be a complete deadbeat to not match a residency as a graduate of US a medical school, so every new residency spot we add goes straight to a foreign medical graduate.

    Thirdly, there is no “doctor shortage” any more than there is a “STEM” shortage. If you want to ask yourself why the existence of a “doctor shortage” is constantly being pushed, well, just ask yourself why the existence of every other labor market “shortage” is always being pushed because the reasons are exactly the same.

    Finally, the fact that hundreds of thousands of people die as a result of “medical errors” is not evidence that stupid people can do the job just as well. It’s evidence of the exact opposite. If medical errors were a thing of rarity, one could make the argument that the job is so easy any moron could do it. If so many people die despite being in the care of highly intelligent doctors, imagine how many more would die in the care of stupid doctors.

    • Replies: @Opinionator
    @Felix....

    This is a function of population distribution and not a matter of “cartels” protecting their turf by purposefully restricting supply (well, except for dermatology heh).

    How does dematology restrict supply?

    Doesn't the surplus of residency spots indicate there is a shortage of American doctors?

    , @Chrisnonymous
    @Felix....

    My parents' family doctor recently retired. In a town with, maybe, hundreds (at least 3-figures) of doctors, there was only one accepting new patients. This is the "shortage"--it is a shortage in primary care that primarily affects certain demographics. The same applies to residencies. There are a surplus of slots at the same time doctors can't get into residencies because no one wants to be a family doc in a heavily black rural area.

    As other commenters have noted, the education in other countries is limited compared to the U.S. Our equivalent of a foreign doctor might be a PA or NP. American PA/NPs could fill primary care deficits in the U.S. by extending the work of American doctors.

    You're right about medical errors with the caveat that many intelligent people undermine their intelligence with preconceptions and prejudices combined with ego. Any hospital worker can probably tell you a story about a doctor ignoring best practice guidelines.

    , @eah
    @Felix....

    California's population has approximately doubled (!) since I went to HS in the SFBA in the mid-1970s -- yet the number of medical schools in the state has, AFAIK, remained constant during that time.

    http://www.samrafarms.com/uploads/1/2/8/8/12887491/4198758_orig.gif

    Replies: @eah

  88. Coming Soon: A Job Americans just won’t do anymore…………be an American.

  89. @Anonymous
    @Forbes


    Meanwhile the US population has tripled since 1920.
     
    Sigh. Can you imagine how wonderful this country would be if it held only 110 million people instead of 330 million?

    We could all live like Republicans.

    Replies: @Anonymous

    That’s assuming that we would have the current level of wealth, just distributed among 110 million instead of 330 million. We don’t know what economic growth would have looked like if the population stayed constant over a century.

    • Replies: @Nico
    @Anonymous

    I think that with 230 million and a different composition we would be quite comfortable. Meaning subtract enough of the current Asians and Hispanics to bring their total down to no more than 5% of the population.

    , @Anonymous
    @Anonymous

    Not at all--I wasn't referring to 'living large' I was referring to wastefulness wrt natural resources.

    , @Opinionator
    @Anonymous

    Land, food, and recreation would probably be a lot more affordable.

    , @bomag
    @Anonymous


    We don’t know what economic growth would have looked like if the population stayed constant over a century
     
    I'd classify the worship of economic growth as one of today's problems.

    I suspect we'd have the same hedonic advancements as today.

    I'd certainly trade some standard of living for more elbow room... for myself AND my kids... and their kids.
  90. @SimpleSong
    @Cwhatfuture

    You also see this to some extent now with male grads. Lots of couples are med school classmates--after kids the woman won't want to completely give up her career so will go down to 20-40%; but that's still too much so to cover the difference the male will go down to 60-80%. It's actually completely rational behavior at the level of the couple--if the woman went down to 0% then she's out of medicine and if something happens to the man she can't ramp up to get them through the rough patch, and also all that time in med school etc. was totally wasted. But at the societal level it's totally bonkers--you just trained two docs and only got one.

    Replies: @Opinionator

    After kids the woman won’t want to completely give up her career so will go down to 20-40%; but that’s still too much so to cover the difference the male will go down to 60-80%.

    How is it that a reduction in the male’s schedule “covers” the difference caused by the female’s reducing her hours?

    • Replies: @SimpleSong
    @Opinionator


    How is it that a reduction in the male’s schedule “covers” the difference caused by the female’s reducing her hours?
     
    Common arrangements I've seen are female has clinic Wednesday, male has clinic or OR time M T Th Fr. That way if the kids get sick or have a snow day or whatever there is always one person off and you never have to cancel clinic or OR, which is a huge huge deal. Sometimes they will have administrative or research days that overlap, but those it's fine to call in sick for. But the clinic or OR you pretty much have to keep running. The hospital I worked at for years had never canceled an OR due to surgeon or anesthesiologist illness in ten years, for example. Physicians can come to work sick, or if they are really really in bad shape, get a partner to cover, but if you do that too often (and you'll do it pretty often when you have little kids) you'll find yourself out of a job.

    Of course if you don't have kids or have helpful grandparents none of this is an issue, or if you have 2 nannies on call 24/7, but that brings its own issues.
  91. @drt
    @Cwhatfuture

    As a surgeon in practice for 27 years, I can vouch for this comment. The rising number of female physicians coincides with the decline in prestige, power and income of American physicians, and has influenced the whole culture of medicine. Compared with earlier generations, young MDs are less hard working (but very good at taking written tests), relatively timid, and much more submissive. The majority want to be employed rather than have their own practices, and often are far less productive. At a recent dinner at a prestigious Boston hospital, I was amazed to hear a group of young doctors at my table trade tips on how to keep down the number of patients they had to see per day! When I was starting out, the conversation would have been trading tips on how to see more patients per day.

    BTW, my wife is a physician, and she agrees with the above.

    Replies: @Opinionator, @Brutusale

    The rising number of female physicians coincides with the decline in prestige, power and income of American physicians

    Could you explain the causal mechanism(s) at work there?

    • Replies: @drt
    @Opinionator

    See comments #61 above.

    Historically American medicine generally attracted alpha males--who were aggressive, protective of their turf, i.e., professional and financial status, and willing to do what was required to maintain it, which translated into long hours, lots of work--and a wife at home who could make that all possible. They did not want a career of peonage, which is what employment by companies or hospitals leads to.

    My impression is that many of the men who in my generation would have gone into medicine are now becoming investment bankers, hedge fund/private equity types, or maybe trying to start a tech company.

    Replies: @Twinkie

  92. Anonymous • Disclaimer says:
    @AM
    @Anonymous


    A couple years as a lowly, overworked associate in a big law firm and a certain number of recent grads decide they’d really rather take some time off to pursue motherhood, maybe occasional, high-end catering, or that scrapbooking website they’ve been contemplating.
     
    Women, as a group, really should have never been pushed into careers as the "default"mode of their lives. It pains me to say it as a woman, but I am happier in low stress (low paid) careers. My nervous system is set a different level. Situations that cause my husband merely angst causes me almost total nervous breakdown.

    And it maybe a personality flaw (I certainly have enough of those),but I think I'm more typical than not.

    Replies: @Anonymous, @StillCARealist, @MadDog, @SimpleSong

    It’s hardly wrong (in any sense of the word) to simply acknowledge that on average women and men have a number of different tendencies. But admitting that can get you thrown out of polite conversation nowadays, not to mention schools, jobs, public conveyances, what have you.

    Of course there are exceptions! BFD.. The tendencies still remain. Women excel at things like emotional intelligence and empathy, and thank God for that. Who here would really prefer to be tended to by a male nurse? My own EQ is probably in the single digits, but I’m really good at mechanical stuff. Vive les differences.

  93. @Anonymous
    @Anonymous

    That's assuming that we would have the current level of wealth, just distributed among 110 million instead of 330 million. We don't know what economic growth would have looked like if the population stayed constant over a century.

    Replies: @Nico, @Anonymous, @Opinionator, @bomag

    I think that with 230 million and a different composition we would be quite comfortable. Meaning subtract enough of the current Asians and Hispanics to bring their total down to no more than 5% of the population.

  94. Anonymous • Disclaimer says:
    @Achmed E. Newman
    @27 year old

    Yeah, until you get a job. Then you'll be back making payments on the loans. You'll just be spreading your payments over some millions of students like yourself who got this great "benefit" from Uncle Sam. Oh, it won't be a separate entry on you electronic pay stub. Just look for it to be lumped under "Federal Taxes".

    Whaaaattt? Nobody told you how socialism worked?? I guess you missed a few days in kindergarten when you learn it from your fellow little ones. For me it was little Timaah, who wanted to play with my garbage truck, which I was taking damn good care of, after he broke his dump truck, that turned me into a foe of socialism. The teacher made me share my toy anyway, so I called her a useful idiot. Spent a lot of time in the other room on my little oval nap rug after that. Good times, good times.

    THERE! IS! NO! FREE! LUNCH!

    Replies: @Anonymous

    THERE! IS! NO! FREE! LUNCH!

    I dare you to look up how many tens of billions were thrown away on mortgage bailouts, write-downs, cramdowns, etc. Or just ask Puerto Ricans or Greeks if they plan on paying off their debts.

    Or just ask Hank Greenberg of AIG. (And before some idjit points out that he had to pay $9M in a settlement, please note that his net worth was over $3B with a B.)

    There are free lunches everywhere, if you’re properly connected. While we’re at it, what are Americans going to do with their $20T national debt? (With a T.)

    • Replies: @Achmed E. Newman
    @Anonymous

    Hey, as a Zerohedge reader (6 years on) I believe I DO know a whole lot about all that. I would be outraged, but I ran out of outrage long ago. I have no argument with you on the scams. Go here, for my take on a whole bunch of the stuff your wrote about.

    You do not get the expression THERE IS NO FREE LUNCH*, Anonymous, so let me explain it. It does not mean that nobody ever gets a free lunch, meaning something he has not earned via his labor. It means that there is no free lunch for society. (OK, maybe during wartime, when your army takes over an oil field or a whole country, there is a temporary big free lunch for THAT particular society, but not the whole of mankind. Adam Smith's expression wasn't about exceptions like wartime or the arrival of aliens.)

    If one person is "given" something by a government, that something must have been taken forcibly from the taxpayers. If Mr. 27 y/o and his cohorts have their loans forgiven, then that money will have to come from the taxpayers, and, per what you mentioned about debt, it'll be on these taxpayers kids and grandkids even (with the big assumption that there is no default of hyperinflation of the dollar - spoiler alert: there will be).

    BTW, about your $2,000,000,000,000 - that is only the current debt on paper. If one were to add up government and private "promises", meaning benefits that taxpayers and retired employees EXPECT they have coming, then this number goes up to almost 10X, 200 Trillion bucks, which is unfathomable, when you divide it over 100,000,000 or so ACTUAL tax-paying taxpayer families (as opposed to "taxpayers" that get money back from the rest of us but do fill out forms.)

    I hope that helps to explain Adam Smith's axiom.



    * I'm pretty sure it was Adam Smith who made this point first with the expression.

    Replies: @Anon

  95. @Anonymous
    @Anonymous

    That's assuming that we would have the current level of wealth, just distributed among 110 million instead of 330 million. We don't know what economic growth would have looked like if the population stayed constant over a century.

    Replies: @Nico, @Anonymous, @Opinionator, @bomag

    Not at all–I wasn’t referring to ‘living large’ I was referring to wastefulness wrt natural resources.

  96. @Cwhatfuture
    Unsaid in all of this is the fact that women, now 50% of medical school admittances, work less hours than male doctors, take time off to have kids, and do not go into those specialties requiring the delay of family formation as often as men. (Many male doctors have told me this - privately). I don’t blame these women, who go into family practice and work 3 days a week, but it means each female graduate offers less medical treatment over a career on average. So we need more doctors in practice, even though we may be theoretically graduating enough of them. So we hire foreign doctors. Most often, men. In other words, we are turning down American men for admittance to medical school (their places taken by women), so we can hire foreign men later.

    Of course no one can say this. No one can say we must increase admissions to make up for all the time off and specialties not pursued.

    Replies: @Anonymous, @SimpleSong, @drt, @Moses, @Anon, @Escher

    I concur completly. It’s not uncommon for female doctors to quite their practice to raise a family and never work again. Since quite a few are married to doctors themselves. It’s really a waste of time and money for everyone.

  97. @Felix....
    You guys have no idea what you're talking about.

    For many specialties, particularly the lucrative surgical subspecialties like orthopedic surgery and otolaryngology, training slots are limited primarily by case volume and case variety. In other words, most of the hospitals that have the requisite patient throughput (and faculty) to create an orthopedic surgery residency already have an orthopedic surgery residency. You're not going to be able to snap your fingers and start training surgeons at second tier suburban hospitals which don't have the warm bodies for your trainees to operate on. This is a function of population distribution and not a matter of "cartels" protecting their turf by purposefully restricting supply (well, except for dermatology heh).

    Secondly, there is a huge oversupply of residencies as is. Roughly 22,000 students graduate from US medical schools each year. How many residency slots are there? Oh, about 34,000. The reason you see so many foreigners practicing medicine in this country is precisely because of the huge oversupply of residency positions relative to the number of American medical school graduates. There is absolutely no need to create even more residency positions since the existing number is already 36% greater than what is needed. You have to be a complete deadbeat to not match a residency as a graduate of US a medical school, so every new residency spot we add goes straight to a foreign medical graduate.

    Thirdly, there is no "doctor shortage" any more than there is a "STEM" shortage. If you want to ask yourself why the existence of a "doctor shortage" is constantly being pushed, well, just ask yourself why the existence of every other labor market "shortage" is always being pushed because the reasons are exactly the same.

    Finally, the fact that hundreds of thousands of people die as a result of "medical errors" is not evidence that stupid people can do the job just as well. It's evidence of the exact opposite. If medical errors were a thing of rarity, one could make the argument that the job is so easy any moron could do it. If so many people die despite being in the care of highly intelligent doctors, imagine how many more would die in the care of stupid doctors.

    Replies: @Opinionator, @Chrisnonymous, @eah

    This is a function of population distribution and not a matter of “cartels” protecting their turf by purposefully restricting supply (well, except for dermatology heh).

    How does dematology restrict supply?

    Doesn’t the surplus of residency spots indicate there is a shortage of American doctors?

  98. @Anonymous
    @Anonymous

    That's assuming that we would have the current level of wealth, just distributed among 110 million instead of 330 million. We don't know what economic growth would have looked like if the population stayed constant over a century.

    Replies: @Nico, @Anonymous, @Opinionator, @bomag

    Land, food, and recreation would probably be a lot more affordable.

  99. @AnotherGuessModel
    @Anonymous

    Nurse and doctor wages in Western Europe are not outstanding with consideration to the demands of obtaining the degree and the actual work. I can't comment on Iraqi doctors in Scotland, but nurses and doctors from poorer EU countries are causing employee shortages in their own countries by taking up the jobs that their Western European peers have abandoned for cushier jobs in the UAE.

    As for doctor shortages in the USA, surely the prohibitive cost of medical school is one factor? On this, you may have heard of Americans studying medicine in Eastern Europe because of the lower cost. You can find good medical programs in EE, but it's a red flag if you ever come across an EU citizen with a EE medical degree despite not being from that country. It likely wasn't about affordability, but not having the chops to pass their own country's medical school entrance exams.

    Replies: @jim jones

    My GP is required by law to post her salary on the practice website, it is $102,000

  100. @Felix....
    You guys have no idea what you're talking about.

    For many specialties, particularly the lucrative surgical subspecialties like orthopedic surgery and otolaryngology, training slots are limited primarily by case volume and case variety. In other words, most of the hospitals that have the requisite patient throughput (and faculty) to create an orthopedic surgery residency already have an orthopedic surgery residency. You're not going to be able to snap your fingers and start training surgeons at second tier suburban hospitals which don't have the warm bodies for your trainees to operate on. This is a function of population distribution and not a matter of "cartels" protecting their turf by purposefully restricting supply (well, except for dermatology heh).

    Secondly, there is a huge oversupply of residencies as is. Roughly 22,000 students graduate from US medical schools each year. How many residency slots are there? Oh, about 34,000. The reason you see so many foreigners practicing medicine in this country is precisely because of the huge oversupply of residency positions relative to the number of American medical school graduates. There is absolutely no need to create even more residency positions since the existing number is already 36% greater than what is needed. You have to be a complete deadbeat to not match a residency as a graduate of US a medical school, so every new residency spot we add goes straight to a foreign medical graduate.

    Thirdly, there is no "doctor shortage" any more than there is a "STEM" shortage. If you want to ask yourself why the existence of a "doctor shortage" is constantly being pushed, well, just ask yourself why the existence of every other labor market "shortage" is always being pushed because the reasons are exactly the same.

    Finally, the fact that hundreds of thousands of people die as a result of "medical errors" is not evidence that stupid people can do the job just as well. It's evidence of the exact opposite. If medical errors were a thing of rarity, one could make the argument that the job is so easy any moron could do it. If so many people die despite being in the care of highly intelligent doctors, imagine how many more would die in the care of stupid doctors.

    Replies: @Opinionator, @Chrisnonymous, @eah

    My parents’ family doctor recently retired. In a town with, maybe, hundreds (at least 3-figures) of doctors, there was only one accepting new patients. This is the “shortage”–it is a shortage in primary care that primarily affects certain demographics. The same applies to residencies. There are a surplus of slots at the same time doctors can’t get into residencies because no one wants to be a family doc in a heavily black rural area.

    As other commenters have noted, the education in other countries is limited compared to the U.S. Our equivalent of a foreign doctor might be a PA or NP. American PA/NPs could fill primary care deficits in the U.S. by extending the work of American doctors.

    You’re right about medical errors with the caveat that many intelligent people undermine their intelligence with preconceptions and prejudices combined with ego. Any hospital worker can probably tell you a story about a doctor ignoring best practice guidelines.

  101. @Anonymous
    I have to slightly disagree Steve. You're into affordable family formation. Health care costs are one of the tapeworms eating away at middle class take home wages. A decent private family health plan now often runs over $2000 a month in employer costs plus co pays. Alot of that is because of overpaid physicians.

    If the US had been importing doctors rather than stoop laborers and fast food workers for the last 30 years we'd be having an entirely different discussion about the effects of immigration on average living standards.

    Replies: @Chrisnonymous, @dr kill

    Alot [sic] of that is because of overpaid physicians.

    I’m guessing you believe that because the chief village idiot told you it was so.

  102. @JackOH
    "The shortage of American doctors couldn’t have anything to do with cartel behavior by powerful interest groups."

    AMA, and its successful racketeerization of American medicine to preserve fee-for-service and autonomy of practice. Another powerful lobby whose actual practices passeth all observation by the mainstream media.

    Replies: @Karl

    8 JackOH > successful racketeerization of American medicine to preserve fee-for-service

    iSteve, you on annual salary from RonUnz? Or do you get paid by the article….

    > and autonomy of practice

    and insist on writing about what YOU chose to write about?

    Yo iSteve, i’m a close friend of the ETHICAL Mr Avigdor Leiberman….. you want to be left un-molested when you open up your kiosk in a mall in suburban Israel, selling Mormon Salt Sea soap? It might could get arranged.

  103. @Moses
    @Cwhatfuture

    Ditto for MBA graduates.

    Several of my female classmates found their high earning husband, then became full time mothers and PTA members.

    Nothing wrong with that, but wouldn't society be better off if their business school slots had gone to men who would work their whole careers creating value for society? Purely from a resource and return perspective, resources spent were resources wasted on those women's graduate education.

    Replies: @Karl, @RonaldB, @dwb

    66 Moses > Purely from a resource and return perspective, resources spent were resources wasted on those women’s graduate education.

    yo Moshe, tell that to all the male MBA students who married a girl smart enough to get into a selective MBA program

  104. @Cwhatfuture
    Unsaid in all of this is the fact that women, now 50% of medical school admittances, work less hours than male doctors, take time off to have kids, and do not go into those specialties requiring the delay of family formation as often as men. (Many male doctors have told me this - privately). I don’t blame these women, who go into family practice and work 3 days a week, but it means each female graduate offers less medical treatment over a career on average. So we need more doctors in practice, even though we may be theoretically graduating enough of them. So we hire foreign doctors. Most often, men. In other words, we are turning down American men for admittance to medical school (their places taken by women), so we can hire foreign men later.

    Of course no one can say this. No one can say we must increase admissions to make up for all the time off and specialties not pursued.

    Replies: @Anonymous, @SimpleSong, @drt, @Moses, @Anon, @Escher

    As long as they pay their way through med school (or pay off their medical loan) you really can’t fault them.

  105. @Felix....
    You guys have no idea what you're talking about.

    For many specialties, particularly the lucrative surgical subspecialties like orthopedic surgery and otolaryngology, training slots are limited primarily by case volume and case variety. In other words, most of the hospitals that have the requisite patient throughput (and faculty) to create an orthopedic surgery residency already have an orthopedic surgery residency. You're not going to be able to snap your fingers and start training surgeons at second tier suburban hospitals which don't have the warm bodies for your trainees to operate on. This is a function of population distribution and not a matter of "cartels" protecting their turf by purposefully restricting supply (well, except for dermatology heh).

    Secondly, there is a huge oversupply of residencies as is. Roughly 22,000 students graduate from US medical schools each year. How many residency slots are there? Oh, about 34,000. The reason you see so many foreigners practicing medicine in this country is precisely because of the huge oversupply of residency positions relative to the number of American medical school graduates. There is absolutely no need to create even more residency positions since the existing number is already 36% greater than what is needed. You have to be a complete deadbeat to not match a residency as a graduate of US a medical school, so every new residency spot we add goes straight to a foreign medical graduate.

    Thirdly, there is no "doctor shortage" any more than there is a "STEM" shortage. If you want to ask yourself why the existence of a "doctor shortage" is constantly being pushed, well, just ask yourself why the existence of every other labor market "shortage" is always being pushed because the reasons are exactly the same.

    Finally, the fact that hundreds of thousands of people die as a result of "medical errors" is not evidence that stupid people can do the job just as well. It's evidence of the exact opposite. If medical errors were a thing of rarity, one could make the argument that the job is so easy any moron could do it. If so many people die despite being in the care of highly intelligent doctors, imagine how many more would die in the care of stupid doctors.

    Replies: @Opinionator, @Chrisnonymous, @eah

    California’s population has approximately doubled (!) since I went to HS in the SFBA in the mid-1970s — yet the number of medical schools in the state has, AFAIK, remained constant during that time.

    • Replies: @eah
    @eah

    America: 'Ventura Highway' -- reminds me of CA in the 1970s -- but that place has disappeared forever -- good memories though.

    https://www.youtube.com/watch?v=fjgCqbPGq2A

  106. @Opinionator
    @drt

    The rising number of female physicians coincides with the decline in prestige, power and income of American physicians

    Could you explain the causal mechanism(s) at work there?

    Replies: @drt

    See comments #61 above.

    Historically American medicine generally attracted alpha males–who were aggressive, protective of their turf, i.e., professional and financial status, and willing to do what was required to maintain it, which translated into long hours, lots of work–and a wife at home who could make that all possible. They did not want a career of peonage, which is what employment by companies or hospitals leads to.

    My impression is that many of the men who in my generation would have gone into medicine are now becoming investment bankers, hedge fund/private equity types, or maybe trying to start a tech company.

    • Replies: @Twinkie
    @drt


    Historically American medicine generally attracted alpha males–who were aggressive
     
    Spoken like an old-time surgeon (ortho or urology?)... from the good ol' paternalistic days of medicine when married doctors slept with nurses, lorded over the OR like tyrants, didn't tell patients the bad news ("it's better for them not to know") and otherwise covered up mistakes.

    They did not want a career of peonage, which is what employment by companies or hospitals leads to.
     
    Guess what, old doc? Young doctors don't want peonage either. But they didn't work summer jobs to pay for medical school in the 1960's, face huge liabilities, and lucrative partnerships are fast disappearing, in large part due to the selfish greed of the older doctors (instead of passing on the partnerships to the younger generation, they are reaping a one-time windfall for themselves by selling the practices to large companies and hospitals). So what are they supposed to do, what with their huge debts and no prospect of partnerships? Not work?

    I have a profound sympathy for doctors - I happen to sit on the board of a large medical system and previously was a co-founder of a medical device company - but my sympathy is not for the older self-styled "alpha male" doctors, but to today's physicians who face challenges which the older generation couldn't even imagine.

    Replies: @Opinionator, @E. Rekshun

  107. @Charles Erwin Wilson
    @Olorin

    Whoa Olorin. After reading your post I almost blacked out. But isn't your assessment too dark? In the end, reality will have the upper hand. And the stupidity of the current organization of the medical world will be swept away by lots and lots of people saying "WTF? This is not what we were promised."

    Replies: @bomag

    In the end, reality will have the upper hand.

    I think this about a lot of things. But the para-adage from Keynes echoes through my head:

    “The world can remain irrational longer than you can stay solvent.”

  108. @Anonymous
    It's great to be a foreign/immigrant medical doctor in the USA. Not only do you benefit from having passed relatively lax standards in your 'old country' to qualify, but administrators in the USA will bend over backward to protect you from censure, from criticism--from questions even--when you screw up.

    From the point of view of American patients, it behooves them to avoid physicians from third-world countries period. Otherwise you're taking your life in your hands--or worse, theirs--and you will find you have no recourse when they put your life and health at risk. They are effectively untouchable, and they know it.

    Replies: @bartok, @dr kill

    This Daily Caller article nicely details my argument against admitting foreign med school grads and the associated riff-raff. This is the Bronx Hospital shooter.

    http://dailycaller.com/2017/07/05/coulter-immigrant-of-the-week-henry-bello-obotetukudo/

  109. @George
    @blah blah teleblah

    The issue with law school is why law schools are required. In the past smart teens worked for lawyers as clerks, eventually becoming lawyers. With all these fancy high schools for gifted students, a high school where the typical student would graduate with a law degree does not seem unreasonable. Maybe an apprenticeship as a paralegal with a lawyer would still be required. Exactly why there are no undergraduate law schools is also a mystery to me.

    President Martin Van Buren starts work as a legal clerk at age 15
    https://en.wikipedia.org/wiki/Martin_Van_Buren#Early_life_and_education

    Fun Fact: Van Buren married his first cousin's daughter.

    Replies: @bomag

    The issue with law school is why law schools are required.

    I recall several posts from lawyers musing that, at most, one year of their law schooling had any utility.

    In this day and age of Google and Wikipedia et al we can question more than ever the usefulness of formal schooling. It seems that school has become a secular church, and I expect a growth in the number of apostates and atheists from that institution.

  110. @AM
    @Olorin


    No way I was going to go into debt for training–both time and money
     
    It's hard not to question the sanity of those becoming MDs for the glamorous opportunity to be a primary care physician (or in your case an ER physician)

    If you want to be a primary care MD, get a PA with less time,debt, and stress and a nice niche career without the headaches.

    Yes, I want my specialists to be MDs, but there's no point to med school if the job is immunizations, sniffles, diabetes management, and referrals.

    Anyway, I think you made the right call. We wouldn't support my son in medical school unless he was planning to specialize from the beginning.

    Replies: @lavoisier

    No point in specializing unless you go into a field where the government and insurance companies do not control how much you can charge.

    Plastic surgery is a good choice for example.

    But any field where your services are essential–oncology, surgery, cardiology, etc.–is totally controlled by government mandate. And you can lose everything you have worked hard for if you ever make a mistake–even if the mistake was well-intentioned.

    Many people who go into medicine go into it because they want to help people and want to be challenged in their professional careers. But there is far too much of a downside today to the practice of medicine. You literally have to give up too much to become a doctor now. Most people do not care about the plight of the doctor, and complain that they make too much money and play too much golf. But their healthcare will suffer as the best and the brightest realize that the practice of medicine today is a fool’s errand.

    Hence the flight from medical school of many applicants to the top business and law schools. You finish your education in less than half the time in these fields, can have a work-life balance, and very quickly can make more money than you will ever make as a physician.

    The author of this article is right. America will need foreign doctors because very few self-respecting and bright American students will choose this field in the future.

  111. @Jonathan Mason
    @Triumph104


    Just stop accepting physicians from needy countries.
     
    It is the US that is needy.

    But then you run into the whole question of a great deal of medical practice being a private business in the US, and people in needy countries having freedom to travel and work wherever they want, so it is hard to see how such restrictions might be fairly enforced.

    If Donald Trump reads this thread, he might issue an Executive Tweet tomorrow to block the entry of foreign-born physicians on the grounds that they may endanger the health of Americans, and to block US-born and/or educated doctors from working overseas, but I daresay it would hit a legal snag or two along the way.

    Replies: @bomag

    people in needy countries having freedom to travel and work wherever they want

    It’s not quite that simple. Pipelines get set up from certain countries and certain areas.

    We should have more pipelines from within our own country.

  112. @Anonymous
    @Achmed E. Newman


    THERE! IS! NO! FREE! LUNCH!
     
    I dare you to look up how many tens of billions were thrown away on mortgage bailouts, write-downs, cramdowns, etc. Or just ask Puerto Ricans or Greeks if they plan on paying off their debts.

    Or just ask Hank Greenberg of AIG. (And before some idjit points out that he had to pay $9M in a settlement, please note that his net worth was over $3B with a B.)

    There are free lunches everywhere, if you're properly connected. While we're at it, what are Americans going to do with their $20T national debt? (With a T.)

    Replies: @Achmed E. Newman

    Hey, as a Zerohedge reader (6 years on) I believe I DO know a whole lot about all that. I would be outraged, but I ran out of outrage long ago. I have no argument with you on the scams. Go here, for my take on a whole bunch of the stuff your wrote about.

    You do not get the expression THERE IS NO FREE LUNCH*, Anonymous, so let me explain it. It does not mean that nobody ever gets a free lunch, meaning something he has not earned via his labor. It means that there is no free lunch for society. (OK, maybe during wartime, when your army takes over an oil field or a whole country, there is a temporary big free lunch for THAT particular society, but not the whole of mankind. Adam Smith’s expression wasn’t about exceptions like wartime or the arrival of aliens.)

    If one person is “given” something by a government, that something must have been taken forcibly from the taxpayers. If Mr. 27 y/o and his cohorts have their loans forgiven, then that money will have to come from the taxpayers, and, per what you mentioned about debt, it’ll be on these taxpayers kids and grandkids even (with the big assumption that there is no default of hyperinflation of the dollar – spoiler alert: there will be).

    BTW, about your $2,000,000,000,000 – that is only the current debt on paper. If one were to add up government and private “promises”, meaning benefits that taxpayers and retired employees EXPECT they have coming, then this number goes up to almost 10X, 200 Trillion bucks, which is unfathomable, when you divide it over 100,000,000 or so ACTUAL tax-paying taxpayer families (as opposed to “taxpayers” that get money back from the rest of us but do fill out forms.)

    I hope that helps to explain Adam Smith’s axiom.

    * I’m pretty sure it was Adam Smith who made this point first with the expression.

    • Replies: @Anon
    @Achmed E. Newman

    This shouldn't need explaining, but if you get a million dollars from the taxpayers, and your grandchildren have to pay a few thousand dollars back, you've come out way, way ahead. You appear to have missed the point of the OP entirely.

    The rest of your screed (aside from trouble understanding "T") is trivial stuff everyone knows. Now quit wasting everyone's time!

    Replies: @Achmed E. Newman

  113. “Another Jobs Americans Just Won’t Do”? In the plural? (With a neutral apostrophe?)

  114. Doctors unions (Often called ‘Associations’ to distance themselves from the riff-raff) are pretty successful. They keep the number of places at medical schools artificially low.

    Initially when the big influx began of foreign doctors they benefited the local doctors. They could be promoted faster and leave the foreign doctors with often inferior degrees below. But now it’s so intense and people so embarrassed to discriminate or say that Sub-Con doctors are horrifically incompetent and indifferent to patients that they are really suffering from lower and lower wages. Older doctors often have special deals with locked in wages but now native junior ones are doing very long hours for lower and lower pay.

    • Replies: @Opinionator
    @Altai

    Is a perception forming that subcon doctors are indifferent to patients? Why?

  115. @whoever
    @blah blah teleblah

    Yes, it's hard to get in, hard to stay in, and it costs a lot. UCSF Med School, eg., runs about $60,000 annually (something over half of that tuition) for in-state.
    I don't think a person should go to med school because it's a gateway to a comfortable living. If that is your goal, go into law or finance, real estate or politics. Go into medicine because you have a strong interest in, say, TBI and neurological surgery ... something that will motivate you and keep you going no matter what.

    Replies: @GU

    Stay FAR AWAY from law if you want a “gateway to a comfortable living.”

  116. As a physician, I do seem to recall in my training scores of patients rotting in the fields….

    • Replies: @Achmed E. Newman
    @Hawk


    As a physician, I do seem to recall in my training scores of patients rotting in the fields….
     
    Haha! That's why they call your business a practice, Doc Hawk. Just keep at it, and maybe not so many will make it out to the fields to rot, at least until you get your billing dept. to process their insurance.

    My friend back in Med School had a patient non-rotting down in the lab, due to formaldehyde, of course. She was fairly young and had died early. My friend seemed to have somewhat of an ... uhh... interest in her... Is that wrong?

    OK, to be serious, as a Doc, I'd like to know what you think about the (economic aspect) healthcare in China, if you know anything. I had one doctor agree with my assessment.

    Replies: @Hawk

    , @Chrisnonymous
    @Hawk

    No, that's just how geriatric patients usually smell.

  117. @songbird
    The medical industry is probably the biggest single racket, imo.

    Most doctors are incompetent boobs that use the internet right in front of you. Many primary care ones function almost entirely just as gatekeepers, referring you to specialists, unless you have a small cut or headache or need a vaccine. It seems you need a prescription even to get any sort of test. Few things have prices. Most doctors are hostile to the idea of paying in cash or giving something a price.

    I've seen pharmaceutical company reps actually buying the lunch for doctors' offices.

    Anything non-addictive or not an antibiotic should be over the counter, at least in limited quantities. I personally would rather use a computer, or be diagnosed by any high school kid with an IQ of 115+, who through a short, interactive training program has competency in one narrow area, than waiting many weeks to see a specialist and paying through the nose.

    Replies: @StillCARealist

    I’d love to give this comment several thumbs up. yes, I finally went to a doctor after several years (we lost our insurance thanks to Obama!) and she did indeed use the internet while we talked. I really just needed some basic screening based on my age and sex and having to pay through the nose for these procedures was ridiculous. All someone needs to do screening tests is basic competence. The nurse could have done everything. When it comes to more involved tests then what you need is lots of experience. After you’ve seen 1000 people you pretty much know what abnormalities look like and feel like.

    the rise of the PA is a good development and I’d like to see even more options for medical education that don’t involve hundreds of thousands of $$. It’s really experience that matters, not all that time you spent re-learning the Krebs cycle or naming the bones and muscles.

    Once I asked my Obstetrician about varicose veins and he shrugged. Then in another conversation I asked him how many vertebrae are in a spine. He didn’t know that either. Then he laughed, “I catch babies!”

  118. @AM
    @Anonymous


    A couple years as a lowly, overworked associate in a big law firm and a certain number of recent grads decide they’d really rather take some time off to pursue motherhood, maybe occasional, high-end catering, or that scrapbooking website they’ve been contemplating.
     
    Women, as a group, really should have never been pushed into careers as the "default"mode of their lives. It pains me to say it as a woman, but I am happier in low stress (low paid) careers. My nervous system is set a different level. Situations that cause my husband merely angst causes me almost total nervous breakdown.

    And it maybe a personality flaw (I certainly have enough of those),but I think I'm more typical than not.

    Replies: @Anonymous, @StillCARealist, @MadDog, @SimpleSong

    women still make the best nurses and men the best doctors. Some crossover is good.

    As to your larger point about the default for women being a career, I couldn’t agree more. The default should be wife and mother with the persistent and determined minority having careers. I know there’s no perfect model for any woman’s life, but telling every female HS graduate that she has to go to college and plan a fabulous career is no less harmful than telling everyone they should get married and have kids.

  119. anon • Disclaimer says:

    There is a lot of commenters spouting off about a subject about which they know virtually nothing. Let me try to set the record straight with some gross generalizations.

    Yes, there is a shortage of physicians, particularly in primary care, particularly in flyover country or other less desirable states (e.g. Alaska), because most U.S.-trained doctors want to work in prestigious hospitals that have the best residents (=labor to be trained) and live in desirable coastal areas- even at less favorable salary-to living costs ratios than you’d get, say, in rural Alabama.

    Obviously, the number of U.S. medical school spots is deliberately limited to enforce high quality and pay of its eventual graduates. Laws of supply and demand strike again. However, the competition and the prestige of the profession make it more likely that you get some of the highest quality of care. I’ve been a patient in a country where medicine is not an overly prestigious or well paid profession – you don’t want to go that route.

    Yes, female MDs of child-bearing age tend to work less, as do ones in their 50s (e.g., you don’t have to take overnight call after a certain age). That leaves a few years before they want to have kids, or a few years after the kids have flown the coop to work typical 70-80-hour weeks.

    Foreign medical grads have a much tougher time gaining the plummest residency spots that determine where you get to choose to be an attending physician. But if they can get them, then yes, no debt and all the benefits that being an attending at a good hospital entail. Even at the best hospitals the physician staffs can be quite foreign-born, depending on the specialty.

    And yes, lots of the non-European ones, particularly Indians, loudly jangle their Pokemon diversity chips in the pockets of their white coats (“they’re not giving me enough [lucrative] surgeries/too much call to do because I’m brown”), sometimes while performing surgery.

    U.S. citizens who graduate from a foreign medical school (typical Caribbean) are second-rate (didn’t get into a US one) and viewed as such. They can hope to get those undesirable spots in flyover country that U.S. medical school grads won’t take.

    • Replies: @Reg Cæsar
    @anon


    I’ve been a patient in a country where medicine is not an overly prestigious or well paid profession – you don’t want to go that route.
     
    Sounds like the old USSR, where the majority of doctors were women, signalling low prestige and/or compensation. (Cue Steven Goldberg...)

    Also sounds like the teaching profession here.


    And yes, lots of the non-European ones, particularly Indians, loudly jangle their Pokemon diversity chips in the pockets of their white coats (“they’re not giving me enough [lucrative] surgeries/too much call to do because I’m brown”), sometimes while performing surgery.
     
    I've met a few Indian-born priests serving in small-town parishes, and got to know one of them fairly well. They were all wonderful guys.

    I wonder what the difference is between this profession, and the engineers and physicians you hear so many complaints about. Perhaps taking a vow of poverty (not to mention chastity as well!) weeds out the bad apples.

    , @Karl
    @anon

    116 Anon > U.S. citizens who graduate from a foreign medical school (typical Caribbean) are second-rate


    The lucky vehicle owners are the ones who never experience problems which require a first-rate mechanic

  120. Kind of apropos this thread…

    Everyone else laughed at something (?). I laughed at the non-native use of the article, which puts a different spin on it…

  121. @Hawk
    As a physician, I do seem to recall in my training scores of patients rotting in the fields....

    Replies: @Achmed E. Newman, @Chrisnonymous

    As a physician, I do seem to recall in my training scores of patients rotting in the fields….

    Haha! That’s why they call your business a practice, Doc Hawk. Just keep at it, and maybe not so many will make it out to the fields to rot, at least until you get your billing dept. to process their insurance.

    My friend back in Med School had a patient non-rotting down in the lab, due to formaldehyde, of course. She was fairly young and had died early. My friend seemed to have somewhat of an … uhh… interest in her… Is that wrong?

    OK, to be serious, as a Doc, I’d like to know what you think about the (economic aspect) healthcare in China, if you know anything. I had one doctor agree with my assessment.

    • Replies: @Hawk
    @Achmed E. Newman

    Actually been to China, as in your article and did see physicians both in the big cities as well as in the smaller ones. Chinese treat medical personnel as either tradesmen or as professionals depending on the environment (poor town/doctor plumber VS big city/professor doctor). And yes they do not queue up like the Englishmen.

    American medicine would improve if Trump did as follows:
    1. Let health insurance be sold across state lines.
    2. The only regulations that the insurer must comply with are those of its own home state (i.e. they all will move HQ to S. Dakota with low regulations).
    3. Tort reform (caps on pain and suffering etc.).
    4. Revoke Obama's health care law entirely (insurers get to be insurance companies with risk tables and pre-existing conditions etc. You can't buy flood insurance after the house gets flooded for example.
    5. Make all fees for any service providers offer be published online, like a restaurant menu.
    6. Revoke the Match, a socialist process which forces students to take training positions in hospitals at below minimum wage i.e. you are working a hundred hours but aren't getting paid for it. Let the free market work like with Law Schools. If you want the best Harvard grad at your firm, you have to pay for it.
    7. Make medicine (and law) impossible for foreigners to practice here in the USA. There are social aspects to the professions. Does the burkha wearing dermatologist understand why the girl with pimples is worried about prom night?
    8. Cancel/revise EMTALA, that forces hospitals to provide care to illegals. Help someone in an emergency sure, then if they're illegal, arrest and deport plus charge the country of origin for the care provided plus a penalty.
    9. Make student debt a yuuuge tax exemption. Being $300K plus in debt when starting residency precludes having a family. Residents used to get free room and board from the hospital and thus started families.
    10. Build. The. Wall.

    Replies: @Karl, @Twinkie

  122. @Hawk
    As a physician, I do seem to recall in my training scores of patients rotting in the fields....

    Replies: @Achmed E. Newman, @Chrisnonymous

    No, that’s just how geriatric patients usually smell.

  123. @eah
    @Felix....

    California's population has approximately doubled (!) since I went to HS in the SFBA in the mid-1970s -- yet the number of medical schools in the state has, AFAIK, remained constant during that time.

    http://www.samrafarms.com/uploads/1/2/8/8/12887491/4198758_orig.gif

    Replies: @eah

    America: ‘Ventura Highway’ — reminds me of CA in the 1970s — but that place has disappeared forever — good memories though.

  124. Clearly, opening up more medical schools/expanding the ones we have is not an option, since it’s well known that the problem with medical schools is a lack of qualified applicants. Why, all my friends with premed degrees just waltzed into med school with no problems. Well, no actually one was waitlisted and the other got rejected from all his picks and went into a suicidal depression, because his 3.8 GPA and 511 MCAT weren’t good enough. The only solution is to import doctors with dicey credentials from abroad. Imagine my shock.

  125. @Almost Missouri
    Sounds like the easy way to to become an American doctor is to train somewhere else where it is faster and cheaper, and then come (back) to the US to "fill the gap".

    Replies: @nebulafox, @Methodological Terrorist, @Jim Bob Lassiter, @Aristippus, @Pat Boyle, @Bill

    I use Kaiser Permanente and have for more than twenty years. I originally had a Jewish doctor and I was well satisfied with him. But about ten or fifteen years ago all the Jewish and other Caucasian physicians vanished. Now all the medical staff are Asian.

    My doctor is Korean. He is very competent. As all readers of this blog surely know South Korea has the highest IQ population of any nation on earth. My doctor is no exception.

    Because I have so many frailties I have been served by many Kaiser doctors. All are not Korean. Some are Japanese and many are Chinese. I spent a week in the hospital last month. I discovered that most of the nurses are Filipino (at least the good ones). This is remarkable because Kaiser purports to be a black run organization. There are certainly a lot of black patients but the only black staff you ever see are those with their pictures on the walls or in the corporate brochures.

    Kaiser is a medical service in blackface.

    • Replies: @Karl
    @Pat Boyle

    122 Pat Boyle > most of the nurses are Filipino



    the large operations do their own, direct recruiting, to include showing up in distant province capitols. I have seen it with my own eyes.

    A (e.g.) Kaiser VP and an older veteran Filipino nurse-supervisor will fly to Philippines (AFTER having put ads in local newspapers weeks in advance, advising the girls as to EXACTLY which documents they need to have in hand to show at the interviews. A Manila manpower-agency is hired to do all the appointment-interview booking-scheduling. the duo flies from city to city, checkds in at the local 4-star hotel for three days, does the interviews, sniffs around the girls, goes home to the US, and makes hiring decisions

    The best-situated girls are the ones who have previously worked abroad in (eg) the MidEast.

    The USA-nursing-license exams USED TO require that the girls get flown to Guam for a weekend for the test. The NCLEX organization dropped that American-soil requirement and now offers the test in about 5 major cities all over the Philippines.

    Maybe the American HMOs bitched about the cost of flying the girls to Guam?

    , @anon
    @Pat Boyle


    Kaiser purports to be a black run organization
     
    Now I understand why they caved to the nurses union and are paying close to $200k for an RN. The one that has me stand on the scale, stick the thermometer in my mouth, and checks my BP. The could/should get a robot to do that....and save the money.

    But they get their paws on billions in member dues and want to spread it to the minorities.
    , @Chrisnonymous
    @Pat Boyle


    I discovered that most of the nurses are Filipino (at least the good ones).
     
    No offense, but you might not know which nurses are the good ones. The difference between good and bad nurses is in things that patients and family don't usually see.

    Replies: @Opinionator, @Pat Boyle

  126. @Maj. Kong
    @Aristippus

    Pharmacy will face automation soon enough.

    Replies: @Aristippus, @Bill

    Sort of. Pharmacy technicians who fill the bottles are probably on the way out. My cousin just finished a Pharm D and he said that his school discouraged graduates from retail pharmacy. Instead they encouraged grads to look at hospitals and being part of a medical team with other specialists. The other trend is pharmacists working at nursing homes and retirement communities in more of public health role.

    • Replies: @Jonathan Mason
    @Aristippus

    Could be, the tendency in many countries is to have the standard amount of a medication, say a 30-day supply in cards in a box (the cards can have reminders like the days of the week, time of day to take the medication, like birth control pills have always had) and just pick the box or boxes off the shelf and sling them at the patient.

    In the traditional method the pharmacist reads the prescription, enters the(correct) information in the computer, prints out the labels, then gives them to the pharmacy tech to fill. What could possibly go wrong?

    The pharmacist may have to call back the prescribing doctor if the prescription is wrong on frequency or dose, or the computer shows the patient to be allergic to this drug or a chemically similar one. This is not exactly uncommon.

    There is no particular reason to have non-liquid medications in bottles.

    Pharmacy in hospitals is rather more complex as intravenous medications have to be prepared and premixed, doses are different for babies and children, correct diluents must be selected, and you definitely don't want to get the dosage wrong by a decimal point. Hospital pharmacists may have to cover shifts for 24 hours and 7 days a week including holidays. In retail the hours are rather more accommodating.

    , @dwb
    @Aristippus

    There is a high number of Pharm D graduates who work in big pharma companies as "medical science liaisons."

    If I had a kid going to get a Pharm D, I would suggest this as a good way to get paid well, eat in expensive restaurants on the company dime, and rack up free frequent flyer and hotel points.

    Replies: @Karl

  127. @Moses
    @Cwhatfuture

    Ditto for MBA graduates.

    Several of my female classmates found their high earning husband, then became full time mothers and PTA members.

    Nothing wrong with that, but wouldn't society be better off if their business school slots had gone to men who would work their whole careers creating value for society? Purely from a resource and return perspective, resources spent were resources wasted on those women's graduate education.

    Replies: @Karl, @RonaldB, @dwb

    Frankly, if you want smart women to focus on childbearing and family rearing, without the burden of getting a professional degree and maintaining certification for a rainy day, you have to re-institute alimony and get rid of no-fault divorce.

    This would make specialization within the family more equitable and, more importantly, more widespread.

  128. @Alden
    @Buzz Mohawk

    How old are they? I have the best of the best, gem of gems, the creme de la creme, a White American male Dr only 46 years old. There are almost no White American male Drs in the San Francisco Bay Area or the Central Valley. But there are some in Los Angeles. I just told the gal at the insurance company that I would only accept a White American man as my primary care. And I got one, only 8 blocks away.

    The easiest way to get an absolutely upstanding Dr is to insist on a White American man. Why?
    Because of affirmative action: Only a very small percentage of White American men are admitted into medical school any more. Soooooo only the highest MCAT scorers and the writers of the most nauseating suck up admission essays who are White men are accepted.

    Until affirmative action, most Drs were White American men. So the incompetent, competent excellent and outstanding Drs were all White American men. But wit discrimination against White American men, only the very best and brightest get accepted to medical school.

    Don't be shy about insisting on a White American male Dr. F**k liberals and affirmative action medics.

    Replies: @Achmed E. Newman

    Alden, first of all, you are on a roll today! I like it (read your comment just below this one, so far).

    I have to tell this story after your one. This is not nearly as important a thing, but I needed a piece of general advice at the auto parts store. Yes, I can figure out and fix minor things, but this just needed a quick piece of general knowledge that someone very familiar with cars would know. There was a black guy and a white girl at the regular counter. I tried them first, but I know already that most of the people up front just know how to look up parts, and they are familiar with lots of parts, so they may at least know the timing belt is just outside the engine, etc … That’s all though.

    Now, quite often a white guy working there WILL be a car guy, with some good knowledge he brought with him to the job. In this case, no go, it was the other 2 at the retail counter. Everyone was all friendly as it was not busy, but I could tell nobody had answers. I finally just said “hey, isn’t there a white guy here who I can talk to?” They both just pointed to the white COMMERCIAL sales guy and said “over there” Haha, some would have taken big offense, but I think most people where I live don’t want to start arguments.

    Here’s the thing. I did know that the COMMERCIAL guy, and the last guy before him, knew his stuff, but he’s in the back. I was trying not to be rude, as he is not there for regular customers. He knew me though, and he was smiling as I went over there to talk for say 30 seconds. That’s all it took to get the answer.

    • Replies: @anon
    @Achmed E. Newman

    While on vacation in a very white Northern state, I went to a national auto parts chain store to get a part I wasn't too sure would be right for the job. Within seconds of entering, an older white guy salesman had greeted me and asked me what I needed. Before I could explain fully, he already knew exactly what I needed, went and got it, ripped it open to make sure it was functional before he sold it to me, rang it up, and I was out the door in a couple of minutes.
    Was looking for another part in my home state, at another store of the same auto parts chain. I was wandering around the store for a good 15 minutes while the female sales associate was having a loud, LOUD conversation in her native Spanish with her colleague, interrupted by thunderous cackling, and not paying any attention to the customers. When I finally ran out of hope of finding it myself, I went up to the counter to ask for the part. She basically couldn't speak English at all. Luckily I knew the make and model # of the part, and started spelling it out for her. She wasn't able to enter the spelled letters and numbers into the computer correctly, just didn't know what 'J' was, kept entering G, A, K, whatever. Finally, I reached across the counter and typed it in myself. ¡Jeb!

  129. @Achmed E. Newman
    @Hawk


    As a physician, I do seem to recall in my training scores of patients rotting in the fields….
     
    Haha! That's why they call your business a practice, Doc Hawk. Just keep at it, and maybe not so many will make it out to the fields to rot, at least until you get your billing dept. to process their insurance.

    My friend back in Med School had a patient non-rotting down in the lab, due to formaldehyde, of course. She was fairly young and had died early. My friend seemed to have somewhat of an ... uhh... interest in her... Is that wrong?

    OK, to be serious, as a Doc, I'd like to know what you think about the (economic aspect) healthcare in China, if you know anything. I had one doctor agree with my assessment.

    Replies: @Hawk

    Actually been to China, as in your article and did see physicians both in the big cities as well as in the smaller ones. Chinese treat medical personnel as either tradesmen or as professionals depending on the environment (poor town/doctor plumber VS big city/professor doctor). And yes they do not queue up like the Englishmen.

    American medicine would improve if Trump did as follows:
    1. Let health insurance be sold across state lines.
    2. The only regulations that the insurer must comply with are those of its own home state (i.e. they all will move HQ to S. Dakota with low regulations).
    3. Tort reform (caps on pain and suffering etc.).
    4. Revoke Obama’s health care law entirely (insurers get to be insurance companies with risk tables and pre-existing conditions etc. You can’t buy flood insurance after the house gets flooded for example.
    5. Make all fees for any service providers offer be published online, like a restaurant menu.
    6. Revoke the Match, a socialist process which forces students to take training positions in hospitals at below minimum wage i.e. you are working a hundred hours but aren’t getting paid for it. Let the free market work like with Law Schools. If you want the best Harvard grad at your firm, you have to pay for it.
    7. Make medicine (and law) impossible for foreigners to practice here in the USA. There are social aspects to the professions. Does the burkha wearing dermatologist understand why the girl with pimples is worried about prom night?
    8. Cancel/revise EMTALA, that forces hospitals to provide care to illegals. Help someone in an emergency sure, then if they’re illegal, arrest and deport plus charge the country of origin for the care provided plus a penalty.
    9. Make student debt a yuuuge tax exemption. Being $300K plus in debt when starting residency precludes having a family. Residents used to get free room and board from the hospital and thus started families.
    10. Build. The. Wall.

    • Replies: @Karl
    @Hawk

    126 Hawk > Does the burkha wearing dermatologist understand why the girl with pimples is worried about prom night?


    The more sack-like the burka, the more the culture focuses on youth and beauty for getting a girl married off.

    I read somewhere that Iran is second only to South Korea in prevalance of cosmetic plastic surgery. I imagine that the second-place thing is because of disparate ability to pay.

    Replies: @Twinkie

    , @Twinkie
    @Hawk

    Your list is excellent, but it doesn't address one of the fundamental problems with medical insurance - that is, it does not work like any other insurance program (auto, flood, etc.) in that it is EXPECTED to be used and used frequently. That is not a sustainable model for any form of insurance. If an insurance payout is expected and expected frequently, the premium, by economic logic, cannot be low-cost.

    What we ought to do is to untie medical insurance from employment and switch people back to an older model in which they pay for a very low cost (and tax-deductible) catastrophic insurance for unforeseen events and pay cash for "routine" services. And, as heartless as it sounds, even the catastrophic insurance should cost more - a lot more - for those with very unhealthy habits, e.g. alcohol/drug abuse, cigarette smoking, gluttony (morbidly overweight), STD's, etc. We should not subsidize life choices and behaviors that are all but guaranteed to worsen health outcomes and dramatically increase the chance of incurring medical costs.

    Medicare/Medicaid should be abolished and the truly needy people (e.g. children in poverty) should receive subsidies for purchasing the catastrophic insurance.

    Replies: @Opinionator, @E. Rekshun

  130. @Aristippus
    @Maj. Kong

    Sort of. Pharmacy technicians who fill the bottles are probably on the way out. My cousin just finished a Pharm D and he said that his school discouraged graduates from retail pharmacy. Instead they encouraged grads to look at hospitals and being part of a medical team with other specialists. The other trend is pharmacists working at nursing homes and retirement communities in more of public health role.

    Replies: @Jonathan Mason, @dwb

    Could be, the tendency in many countries is to have the standard amount of a medication, say a 30-day supply in cards in a box (the cards can have reminders like the days of the week, time of day to take the medication, like birth control pills have always had) and just pick the box or boxes off the shelf and sling them at the patient.

    In the traditional method the pharmacist reads the prescription, enters the(correct) information in the computer, prints out the labels, then gives them to the pharmacy tech to fill. What could possibly go wrong?

    The pharmacist may have to call back the prescribing doctor if the prescription is wrong on frequency or dose, or the computer shows the patient to be allergic to this drug or a chemically similar one. This is not exactly uncommon.

    There is no particular reason to have non-liquid medications in bottles.

    Pharmacy in hospitals is rather more complex as intravenous medications have to be prepared and premixed, doses are different for babies and children, correct diluents must be selected, and you definitely don’t want to get the dosage wrong by a decimal point. Hospital pharmacists may have to cover shifts for 24 hours and 7 days a week including holidays. In retail the hours are rather more accommodating.

  131. @Moses
    @Cwhatfuture

    Ditto for MBA graduates.

    Several of my female classmates found their high earning husband, then became full time mothers and PTA members.

    Nothing wrong with that, but wouldn't society be better off if their business school slots had gone to men who would work their whole careers creating value for society? Purely from a resource and return perspective, resources spent were resources wasted on those women's graduate education.

    Replies: @Karl, @RonaldB, @dwb

    This question presumes that there is actual value to most MBA degrees, rather than the exercise as just a couple of years to relax, hone your skills creating vacuous power point slides, improve your golf game, and network.

    Oh, and of course, learn how to use buzz-words like “paradigm,” “align,” and “leverage” in ever more creative ways.

    • Agree: bomag
  132. @Aristippus
    @Maj. Kong

    Sort of. Pharmacy technicians who fill the bottles are probably on the way out. My cousin just finished a Pharm D and he said that his school discouraged graduates from retail pharmacy. Instead they encouraged grads to look at hospitals and being part of a medical team with other specialists. The other trend is pharmacists working at nursing homes and retirement communities in more of public health role.

    Replies: @Jonathan Mason, @dwb

    There is a high number of Pharm D graduates who work in big pharma companies as “medical science liaisons.”

    If I had a kid going to get a Pharm D, I would suggest this as a good way to get paid well, eat in expensive restaurants on the company dime, and rack up free frequent flyer and hotel points.

    • Replies: @Karl
    @dwb

    129 dwb > a good way to get paid well, eat in expensive restaurants on the company dime, and rack up free frequent flyer and hotel points


    ....“medical science liaisons"... until the day that your sales quota is un-met, 3 months in a role.

    Pharmacy companies have fancy names for salesmen, not for party MC's.....

  133. @Altai
    Doctors unions (Often called 'Associations' to distance themselves from the riff-raff) are pretty successful. They keep the number of places at medical schools artificially low.

    Initially when the big influx began of foreign doctors they benefited the local doctors. They could be promoted faster and leave the foreign doctors with often inferior degrees below. But now it's so intense and people so embarrassed to discriminate or say that Sub-Con doctors are horrifically incompetent and indifferent to patients that they are really suffering from lower and lower wages. Older doctors often have special deals with locked in wages but now native junior ones are doing very long hours for lower and lower pay.

    Replies: @Opinionator

    Is a perception forming that subcon doctors are indifferent to patients? Why?

  134. @Anonymous
    I have to slightly disagree Steve. You're into affordable family formation. Health care costs are one of the tapeworms eating away at middle class take home wages. A decent private family health plan now often runs over $2000 a month in employer costs plus co pays. Alot of that is because of overpaid physicians.

    If the US had been importing doctors rather than stoop laborers and fast food workers for the last 30 years we'd be having an entirely different discussion about the effects of immigration on average living standards.

    Replies: @Chrisnonymous, @dr kill

    Bless your heart.

  135. @anon
    My 50 year old Filipino Dr was educated back there, moved to the US at about 26. She had no debt, which blew the minds of the other DRs, as they were in hock for a quarter million on average.

    I saw the admission requirements for US medical schools, where you needed a 3.7 to 3.8 GPA, Score at the 95th percentile on the med school admission test, plus have the ability to put your entire life on hold for the next 8+ years to get that diploma.

    The AMA has done a superior job of preventing any possibility of enough doctors....

    Replies: @North Carolina Resident

    My neighbor is a 65+yo MD and med school professor on the admissions committee. Grades and MCAT are important but not everything. They strongly prefer candidates with real world medical work experience such as nurses aid, EMT, military medic, etc.

  136. @anon
    There is a lot of commenters spouting off about a subject about which they know virtually nothing. Let me try to set the record straight with some gross generalizations.

    Yes, there is a shortage of physicians, particularly in primary care, particularly in flyover country or other less desirable states (e.g. Alaska), because most U.S.-trained doctors want to work in prestigious hospitals that have the best residents (=labor to be trained) and live in desirable coastal areas- even at less favorable salary-to living costs ratios than you'd get, say, in rural Alabama.

    Obviously, the number of U.S. medical school spots is deliberately limited to enforce high quality and pay of its eventual graduates. Laws of supply and demand strike again. However, the competition and the prestige of the profession make it more likely that you get some of the highest quality of care. I've been a patient in a country where medicine is not an overly prestigious or well paid profession - you don't want to go that route.

    Yes, female MDs of child-bearing age tend to work less, as do ones in their 50s (e.g., you don't have to take overnight call after a certain age). That leaves a few years before they want to have kids, or a few years after the kids have flown the coop to work typical 70-80-hour weeks.

    Foreign medical grads have a much tougher time gaining the plummest residency spots that determine where you get to choose to be an attending physician. But if they can get them, then yes, no debt and all the benefits that being an attending at a good hospital entail. Even at the best hospitals the physician staffs can be quite foreign-born, depending on the specialty.

    And yes, lots of the non-European ones, particularly Indians, loudly jangle their Pokemon diversity chips in the pockets of their white coats ("they're not giving me enough [lucrative] surgeries/too much call to do because I'm brown"), sometimes while performing surgery.

    U.S. citizens who graduate from a foreign medical school (typical Caribbean) are second-rate (didn't get into a US one) and viewed as such. They can hope to get those undesirable spots in flyover country that U.S. medical school grads won't take.

    Replies: @Reg Cæsar, @Karl

    I’ve been a patient in a country where medicine is not an overly prestigious or well paid profession – you don’t want to go that route.

    Sounds like the old USSR, where the majority of doctors were women, signalling low prestige and/or compensation. (Cue Steven Goldberg…)

    Also sounds like the teaching profession here.

    And yes, lots of the non-European ones, particularly Indians, loudly jangle their Pokemon diversity chips in the pockets of their white coats (“they’re not giving me enough [lucrative] surgeries/too much call to do because I’m brown”), sometimes while performing surgery.

    I’ve met a few Indian-born priests serving in small-town parishes, and got to know one of them fairly well. They were all wonderful guys.

    I wonder what the difference is between this profession, and the engineers and physicians you hear so many complaints about. Perhaps taking a vow of poverty (not to mention chastity as well!) weeds out the bad apples.

  137. @anon
    There is a lot of commenters spouting off about a subject about which they know virtually nothing. Let me try to set the record straight with some gross generalizations.

    Yes, there is a shortage of physicians, particularly in primary care, particularly in flyover country or other less desirable states (e.g. Alaska), because most U.S.-trained doctors want to work in prestigious hospitals that have the best residents (=labor to be trained) and live in desirable coastal areas- even at less favorable salary-to living costs ratios than you'd get, say, in rural Alabama.

    Obviously, the number of U.S. medical school spots is deliberately limited to enforce high quality and pay of its eventual graduates. Laws of supply and demand strike again. However, the competition and the prestige of the profession make it more likely that you get some of the highest quality of care. I've been a patient in a country where medicine is not an overly prestigious or well paid profession - you don't want to go that route.

    Yes, female MDs of child-bearing age tend to work less, as do ones in their 50s (e.g., you don't have to take overnight call after a certain age). That leaves a few years before they want to have kids, or a few years after the kids have flown the coop to work typical 70-80-hour weeks.

    Foreign medical grads have a much tougher time gaining the plummest residency spots that determine where you get to choose to be an attending physician. But if they can get them, then yes, no debt and all the benefits that being an attending at a good hospital entail. Even at the best hospitals the physician staffs can be quite foreign-born, depending on the specialty.

    And yes, lots of the non-European ones, particularly Indians, loudly jangle their Pokemon diversity chips in the pockets of their white coats ("they're not giving me enough [lucrative] surgeries/too much call to do because I'm brown"), sometimes while performing surgery.

    U.S. citizens who graduate from a foreign medical school (typical Caribbean) are second-rate (didn't get into a US one) and viewed as such. They can hope to get those undesirable spots in flyover country that U.S. medical school grads won't take.

    Replies: @Reg Cæsar, @Karl

    116 Anon > U.S. citizens who graduate from a foreign medical school (typical Caribbean) are second-rate

    The lucky vehicle owners are the ones who never experience problems which require a first-rate mechanic

  138. @dwb
    @Aristippus

    There is a high number of Pharm D graduates who work in big pharma companies as "medical science liaisons."

    If I had a kid going to get a Pharm D, I would suggest this as a good way to get paid well, eat in expensive restaurants on the company dime, and rack up free frequent flyer and hotel points.

    Replies: @Karl

    129 dwb > a good way to get paid well, eat in expensive restaurants on the company dime, and rack up free frequent flyer and hotel points

    ….“medical science liaisons”… until the day that your sales quota is un-met, 3 months in a role.

    Pharmacy companies have fancy names for salesmen, not for party MC’s…..

  139. @Pat Boyle
    @Almost Missouri

    I use Kaiser Permanente and have for more than twenty years. I originally had a Jewish doctor and I was well satisfied with him. But about ten or fifteen years ago all the Jewish and other Caucasian physicians vanished. Now all the medical staff are Asian.

    My doctor is Korean. He is very competent. As all readers of this blog surely know South Korea has the highest IQ population of any nation on earth. My doctor is no exception.

    Because I have so many frailties I have been served by many Kaiser doctors. All are not Korean. Some are Japanese and many are Chinese. I spent a week in the hospital last month. I discovered that most of the nurses are Filipino (at least the good ones). This is remarkable because Kaiser purports to be a black run organization. There are certainly a lot of black patients but the only black staff you ever see are those with their pictures on the walls or in the corporate brochures.

    Kaiser is a medical service in blackface.

    Replies: @Karl, @anon, @Chrisnonymous

    122 Pat Boyle > most of the nurses are Filipino

    the large operations do their own, direct recruiting, to include showing up in distant province capitols. I have seen it with my own eyes.

    A (e.g.) Kaiser VP and an older veteran Filipino nurse-supervisor will fly to Philippines (AFTER having put ads in local newspapers weeks in advance, advising the girls as to EXACTLY which documents they need to have in hand to show at the interviews. A Manila manpower-agency is hired to do all the appointment-interview booking-scheduling. the duo flies from city to city, checkds in at the local 4-star hotel for three days, does the interviews, sniffs around the girls, goes home to the US, and makes hiring decisions

    The best-situated girls are the ones who have previously worked abroad in (eg) the MidEast.

    The USA-nursing-license exams USED TO require that the girls get flown to Guam for a weekend for the test. The NCLEX organization dropped that American-soil requirement and now offers the test in about 5 major cities all over the Philippines.

    Maybe the American HMOs bitched about the cost of flying the girls to Guam?

  140. One widely touted solution is to lower medical labor requirements for common procedures. Commenters in this thread mention that demand for dermatology services exceeds supply of medical staff. Many common dermatology diagnostics and procedures that currently legally require a full MD doctor with dermatology speciality training can be done with nurses or techs that have more limited but specific training.

    This could reduce demand for highly trained medical graduates, provide giant cost reductions, more availability and convenience to consumers, and provide more job opportunities to people that want them.

    Also, the pipelines producing medical graduates are strictly government controlled and the government can raise outputs of these pipelines at will. I’d prefer the industry adapt to requiring lower numbers of medical graduates.

  141. @Hawk
    @Achmed E. Newman

    Actually been to China, as in your article and did see physicians both in the big cities as well as in the smaller ones. Chinese treat medical personnel as either tradesmen or as professionals depending on the environment (poor town/doctor plumber VS big city/professor doctor). And yes they do not queue up like the Englishmen.

    American medicine would improve if Trump did as follows:
    1. Let health insurance be sold across state lines.
    2. The only regulations that the insurer must comply with are those of its own home state (i.e. they all will move HQ to S. Dakota with low regulations).
    3. Tort reform (caps on pain and suffering etc.).
    4. Revoke Obama's health care law entirely (insurers get to be insurance companies with risk tables and pre-existing conditions etc. You can't buy flood insurance after the house gets flooded for example.
    5. Make all fees for any service providers offer be published online, like a restaurant menu.
    6. Revoke the Match, a socialist process which forces students to take training positions in hospitals at below minimum wage i.e. you are working a hundred hours but aren't getting paid for it. Let the free market work like with Law Schools. If you want the best Harvard grad at your firm, you have to pay for it.
    7. Make medicine (and law) impossible for foreigners to practice here in the USA. There are social aspects to the professions. Does the burkha wearing dermatologist understand why the girl with pimples is worried about prom night?
    8. Cancel/revise EMTALA, that forces hospitals to provide care to illegals. Help someone in an emergency sure, then if they're illegal, arrest and deport plus charge the country of origin for the care provided plus a penalty.
    9. Make student debt a yuuuge tax exemption. Being $300K plus in debt when starting residency precludes having a family. Residents used to get free room and board from the hospital and thus started families.
    10. Build. The. Wall.

    Replies: @Karl, @Twinkie

    126 Hawk > Does the burkha wearing dermatologist understand why the girl with pimples is worried about prom night?

    The more sack-like the burka, the more the culture focuses on youth and beauty for getting a girl married off.

    I read somewhere that Iran is second only to South Korea in prevalance of cosmetic plastic surgery. I imagine that the second-place thing is because of disparate ability to pay.

    • Replies: @Twinkie
    @Karl


    I read somewhere that Iran is second only to South Korea in prevalance of cosmetic plastic surgery.
     
    Most cases in Iran are rhinoplasty - Persians have hooked noses, and apparently that is not in vogue among the Persian women. It is also the number one cosmetic procedure among the Iranian diaspora in the West. With South Koreans the procedures are far more varied.
  142. @Almost Missouri
    Sounds like the easy way to to become an American doctor is to train somewhere else where it is faster and cheaper, and then come (back) to the US to "fill the gap".

    Replies: @nebulafox, @Methodological Terrorist, @Jim Bob Lassiter, @Aristippus, @Pat Boyle, @Bill

    This is very common.

    Remember when we invaded Grenada to save the American medical students there from the commies?

  143. @Chrisnonymous
    @Hannah Katz


    Funny, my son-in-law, who is a resident physician, was relieved to get a residency spot.
     
    The explanation seems to be that getting a desirable residency is very difficult.

    Like Steve's contention that being poor in America today means not being able to afford to move away from other poor people, being a bad doctor in America today means not being able to treat non-NAM patients.

    Old joke:

    Q: What do you call someone who graduates from medical school at the bottom of their class?
    A: Doctor!

    New joke:

    Q: What do you call someone who graduates from medical school at the bottom of their class?
    Possible answers: "a GP", "a VA doc", "a resident of Detroit", "Yo! Doctor!", etc

    No doubt, the competition for residencies in whitopias adds to the kind of phenomena studied by Charles Murray.

    Replies: @Bill

    The good residencies tend to be treating NAMs. Urban, teaching hospitals are where the best residencies are.

    • Replies: @Opinionator
    @Bill

    What makes a residency a "good residency"?

    Replies: @Bill

    , @Chrisnonymous
    @Bill

    A lot of docs headed to Detroit and Atlanta then?

    Replies: @Bill

  144. @Maj. Kong
    @Aristippus

    Pharmacy will face automation soon enough.

    Replies: @Aristippus, @Bill

    The issue isn’t automation. There is no reason for, say, Walmart to have pharmacists — one guy for every 20 stores available by phone would be fine. There is a legal requirement in (I think) every state for there to be a pharmacist physically present in a pharmacy. The pharmacists have a strong lobbying group, and they are allied with all the other medical professions’ lobbying groups for “they came for the pharmacists and I said nothing . . .” reasons.

    • LOL: Triumph104
    • Replies: @JackOH
    @Bill

    The full complement of Big Medicine's Iron Pyramid includes the AMA, Big Pharma, the AHA, AHIP (group health insurance), and medical equipment makers, and other organizations, such as pharmacists. They are pretty much okay with seeing health care debate occupied by fringe issues and dubious, marginal solutions. They are fully in accord on the overall legitimacy of the existing health care system, and maintenance of the status quo. They are, I'm very confident, frightened by any close examination of what America's group health insurance actually is, as but one example.

  145. @Meretricious
    @blah blah teleblah

    not if you're black or Hispanic

    Replies: @blah blah teleblah

    I imagine that even the affirmative action types that get into an American medical school are pretty smart compared to the rest of the population, almost certainly IQ above 115. On the other hand, someone admitted to a fourth tier law school that didn’t get a full scholarship is in all likelihood probably right smack dab in the middle of of the bell curve, and maybe a little bit on the left side. And there are accredited law schools that will admit anyone that has an undergraduate degree, no matter their GPA or LSAT score is. Once there, the school will do everything to make sure they graduate.

    As to why there are presumably a lot few American medical schools and many fewer spots, I would guess it has a lot to do with start up costs. Princeton could pretty much start its own law schools in a year or two if they wanted. I doubt it could do the same thing with a medical school.

    • Replies: @Anonymous
    @blah blah teleblah

    Interesting testimony. Princeton has always been a notable case among the Ivy League, having as it does no medical, law, or business schools. (Even tiny Dartmouth has a business school, and a good one!)

    Not least because graduates of those three types of professional schools are generally well-situated when it comes time for alumni contributions. Yet Princeton has never hurt for funds.

    As you say, starting a new medical school from scratch would be difficult, but if any school could pull it off, I daresay it would be Princeton.

    , @Hibernian
    @blah blah teleblah

    "Once there, the school will do everything to make sure they graduate."

    I think you're confusing the bad law schools with the good ones. The bad ones have historically had high attrition.

  146. @Alden
    @Buzz Mohawk

    But they are liberals. Why give your insurance money to liberals? They are probably on the diversity, inclusion and affirmative action admissions committees of their med schools. Do they employ any White Americans in their offices? Or are all their employees turd world affirmative action types?

    Replies: @Buzz Mohawk

    Well, my GP is actually a nice, White American man with a Polish name. In his 50s I guess. So I think I have a Polish Catholic M.D. That’s good enough for me! His staff is all white.

    Two surgeons I used for minor things in recent years were both Jewish, and they did terrific work. Their staff were all white.

    I’m lucky where I live, where there are a lot of rich liberals, who you will notice have access to White / Jewish doctors and staff, as I do. My wife and I get most of the same stuff those assholes do.

    The Indian type doctors are in the walk-in clinics handling colds and pushing antibiotics. Oh, and about 15 years ago, I met a black doctor in one of those places who had to look up Motrin in his drug reference book. What a joke. Never again.

  147. @AM
    @Anonymous


    A couple years as a lowly, overworked associate in a big law firm and a certain number of recent grads decide they’d really rather take some time off to pursue motherhood, maybe occasional, high-end catering, or that scrapbooking website they’ve been contemplating.
     
    Women, as a group, really should have never been pushed into careers as the "default"mode of their lives. It pains me to say it as a woman, but I am happier in low stress (low paid) careers. My nervous system is set a different level. Situations that cause my husband merely angst causes me almost total nervous breakdown.

    And it maybe a personality flaw (I certainly have enough of those),but I think I'm more typical than not.

    Replies: @Anonymous, @StillCARealist, @MadDog, @SimpleSong

    Couldn’t agree more. I’m a female. Had high stress jobs. No longer. And I’m happy as a clam.

    Women in accounting professions tend to be stressed. The ones who stay tend to be overweight and unhappy.

    Unless they are married and work part time. Then their staff stressed because they pick up her workload.

    • Replies: @Opinionator
    @MadDog

    I would think that accounting would be a relatively less stressful occupation than law, medicine, or finance. Why do people find it stressful?

    Replies: @Hibernian, @E. Rekshun

  148. @Lagertha
    @Buzz Mohawk

    Well, I was told by so many people that limiting med students keeps the salaries of doctors artificially high (that's why doctors from Asia are dying :) to come here to work. With socialized medicine, like in Finland, my homeland, doctors make about 200K, tops. My dad's best friend, a well known pediatric surgeon in the European community, probably, after taxes (this was up until the early 90's), took home (net pay) 150K Euros...kid you not. About 65% of his income went to taxes. This is the major issue that Americans; politicians, lawyers, upper middle-class people don't understand about the Nordic countries: You are taxed according to your income; your properties, your stocks & savings, all your assets, like boats, 2nd homes, cars, even dogs/horses. And, you pay a "death tax." That's how you get your "universal coverage" in the Nordic countries. A cousin of mine said, "Everybody pays, everybody gets." This is also why European women don't have huge wardrobes or walk-in closets - this is a fact.

    Replies: @Joe Stalin

    The Democrat Dude Pritzker who is running for IL governor has a TV ad where he says our income tax is UNFAIR (5%) and that we NEED a PROGRESSIVE tax like all the stupid people in New York and California.

    This must be aimed at all the Blacks and big government Hispanics that are in need of ever more gibsmethat.

    • Replies: @Anonymous
    @Joe Stalin

    Or perhaps he's hinting that Illinois might one day decide to step up and start paying its bills...

  149. Anonymous • Disclaimer says:

    Too many spots in US medical schools are set aside for black and hispanic doctors who often come in with much lower credentials. The justification for affirmative action is that black and hispanic patients would rather see doctors of the same race, even if they are less qualified. Yet many of these doctors end up working in areas that are majority not black or hispanic, while the clinics in those ethnic enclaves are often populated by liberal white doctors wanting to help blacks or foreign doctors who just want a green card.

    I can understand wanting more women in medicine, I’m a woman and I am much more comfortable seeing female doctors, especially for obgyn. I highly suspect males who want to be obgyn. But I don’t get the wanting to see a doctor of the same race thing. I’m Asian and I avoid Asian female doctors, I don’t feel comfortable talking to them, it’s like talking to my mom.

    Affirmative action is wrong and dangerous and should not be allowed in medicine. The most qualified people should be doctors, not the ones with the right skin color. How many more medical hacks like Michael Jackson’s doctor do we need? I would like to see some stats on suspension of medical licenses by race, ethnicity and where they were trained. I suspect a large number are minority doctors and doctors who were trained abroad.

  150. anon • Disclaimer says:
    @Achmed E. Newman
    @Alden

    Alden, first of all, you are on a roll today! I like it (read your comment just below this one, so far).

    I have to tell this story after your one. This is not nearly as important a thing, but I needed a piece of general advice at the auto parts store. Yes, I can figure out and fix minor things, but this just needed a quick piece of general knowledge that someone very familiar with cars would know. There was a black guy and a white girl at the regular counter. I tried them first, but I know already that most of the people up front just know how to look up parts, and they are familiar with lots of parts, so they may at least know the timing belt is just outside the engine, etc ... That's all though.

    Now, quite often a white guy working there WILL be a car guy, with some good knowledge he brought with him to the job. In this case, no go, it was the other 2 at the retail counter. Everyone was all friendly as it was not busy, but I could tell nobody had answers. I finally just said "hey, isn't there a white guy here who I can talk to?" They both just pointed to the white COMMERCIAL sales guy and said "over there" Haha, some would have taken big offense, but I think most people where I live don't want to start arguments.

    Here's the thing. I did know that the COMMERCIAL guy, and the last guy before him, knew his stuff, but he's in the back. I was trying not to be rude, as he is not there for regular customers. He knew me though, and he was smiling as I went over there to talk for say 30 seconds. That's all it took to get the answer.

    Replies: @anon

    While on vacation in a very white Northern state, I went to a national auto parts chain store to get a part I wasn’t too sure would be right for the job. Within seconds of entering, an older white guy salesman had greeted me and asked me what I needed. Before I could explain fully, he already knew exactly what I needed, went and got it, ripped it open to make sure it was functional before he sold it to me, rang it up, and I was out the door in a couple of minutes.
    Was looking for another part in my home state, at another store of the same auto parts chain. I was wandering around the store for a good 15 minutes while the female sales associate was having a loud, LOUD conversation in her native Spanish with her colleague, interrupted by thunderous cackling, and not paying any attention to the customers. When I finally ran out of hope of finding it myself, I went up to the counter to ask for the part. She basically couldn’t speak English at all. Luckily I knew the make and model # of the part, and started spelling it out for her. She wasn’t able to enter the spelled letters and numbers into the computer correctly, just didn’t know what ‘J’ was, kept entering G, A, K, whatever. Finally, I reached across the counter and typed it in myself. ¡Jeb!

  151. @Hawk
    @Achmed E. Newman

    Actually been to China, as in your article and did see physicians both in the big cities as well as in the smaller ones. Chinese treat medical personnel as either tradesmen or as professionals depending on the environment (poor town/doctor plumber VS big city/professor doctor). And yes they do not queue up like the Englishmen.

    American medicine would improve if Trump did as follows:
    1. Let health insurance be sold across state lines.
    2. The only regulations that the insurer must comply with are those of its own home state (i.e. they all will move HQ to S. Dakota with low regulations).
    3. Tort reform (caps on pain and suffering etc.).
    4. Revoke Obama's health care law entirely (insurers get to be insurance companies with risk tables and pre-existing conditions etc. You can't buy flood insurance after the house gets flooded for example.
    5. Make all fees for any service providers offer be published online, like a restaurant menu.
    6. Revoke the Match, a socialist process which forces students to take training positions in hospitals at below minimum wage i.e. you are working a hundred hours but aren't getting paid for it. Let the free market work like with Law Schools. If you want the best Harvard grad at your firm, you have to pay for it.
    7. Make medicine (and law) impossible for foreigners to practice here in the USA. There are social aspects to the professions. Does the burkha wearing dermatologist understand why the girl with pimples is worried about prom night?
    8. Cancel/revise EMTALA, that forces hospitals to provide care to illegals. Help someone in an emergency sure, then if they're illegal, arrest and deport plus charge the country of origin for the care provided plus a penalty.
    9. Make student debt a yuuuge tax exemption. Being $300K plus in debt when starting residency precludes having a family. Residents used to get free room and board from the hospital and thus started families.
    10. Build. The. Wall.

    Replies: @Karl, @Twinkie

    Your list is excellent, but it doesn’t address one of the fundamental problems with medical insurance – that is, it does not work like any other insurance program (auto, flood, etc.) in that it is EXPECTED to be used and used frequently. That is not a sustainable model for any form of insurance. If an insurance payout is expected and expected frequently, the premium, by economic logic, cannot be low-cost.

    What we ought to do is to untie medical insurance from employment and switch people back to an older model in which they pay for a very low cost (and tax-deductible) catastrophic insurance for unforeseen events and pay cash for “routine” services. And, as heartless as it sounds, even the catastrophic insurance should cost more – a lot more – for those with very unhealthy habits, e.g. alcohol/drug abuse, cigarette smoking, gluttony (morbidly overweight), STD’s, etc. We should not subsidize life choices and behaviors that are all but guaranteed to worsen health outcomes and dramatically increase the chance of incurring medical costs.

    Medicare/Medicaid should be abolished and the truly needy people (e.g. children in poverty) should receive subsidies for purchasing the catastrophic insurance.

    • Replies: @Opinionator
    @Twinkie

    In which direction (if any) would this change push medical costs and physician incomes?

    Replies: @Twinkie

    , @E. Rekshun
    @Twinkie

    Good points!

    medical insurance – that is, it does not work like any other insurance program (auto, flood, etc.) in that it is EXPECTED to be used and used frequently.

    I'm not so sure about this. I would guess that males, say, aged 18 - 65, avoid preventive care and seldom go to the doctor. Men just die. I haven't been for a check-up in five years, though I have a full employer-funded plan. On the other hand, females of all ages have many ailments (imaginary and otherwise) and need lots of attention (medical and otherwise).

    catastrophic insurance

    Obamacare outlawed catastrophic medical insurance plans.

    Medicare/Medicaid should be abolished and the truly needy people (e.g. children in poverty) should receive subsidies for purchasing the catastrophic insurance.

    Good idea. Sounds very reasonable and probably much more effective and much less costly. Medicaid fully covers pre-natal care and pregnancy for eligible women. So, I guess a catastrophic plan should include this coverage as well.

  152. Anon • Disclaimer says:
    @Achmed E. Newman
    @Anonymous

    Hey, as a Zerohedge reader (6 years on) I believe I DO know a whole lot about all that. I would be outraged, but I ran out of outrage long ago. I have no argument with you on the scams. Go here, for my take on a whole bunch of the stuff your wrote about.

    You do not get the expression THERE IS NO FREE LUNCH*, Anonymous, so let me explain it. It does not mean that nobody ever gets a free lunch, meaning something he has not earned via his labor. It means that there is no free lunch for society. (OK, maybe during wartime, when your army takes over an oil field or a whole country, there is a temporary big free lunch for THAT particular society, but not the whole of mankind. Adam Smith's expression wasn't about exceptions like wartime or the arrival of aliens.)

    If one person is "given" something by a government, that something must have been taken forcibly from the taxpayers. If Mr. 27 y/o and his cohorts have their loans forgiven, then that money will have to come from the taxpayers, and, per what you mentioned about debt, it'll be on these taxpayers kids and grandkids even (with the big assumption that there is no default of hyperinflation of the dollar - spoiler alert: there will be).

    BTW, about your $2,000,000,000,000 - that is only the current debt on paper. If one were to add up government and private "promises", meaning benefits that taxpayers and retired employees EXPECT they have coming, then this number goes up to almost 10X, 200 Trillion bucks, which is unfathomable, when you divide it over 100,000,000 or so ACTUAL tax-paying taxpayer families (as opposed to "taxpayers" that get money back from the rest of us but do fill out forms.)

    I hope that helps to explain Adam Smith's axiom.



    * I'm pretty sure it was Adam Smith who made this point first with the expression.

    Replies: @Anon

    This shouldn’t need explaining, but if you get a million dollars from the taxpayers, and your grandchildren have to pay a few thousand dollars back, you’ve come out way, way ahead. You appear to have missed the point of the OP entirely.

    The rest of your screed (aside from trouble understanding “T”) is trivial stuff everyone knows. Now quit wasting everyone’s time!

    • Replies: @Achmed E. Newman
    @Anon

    Nope, you missed it now, too, but the other anonymous had probably never heard the saying from Adam Smith, but he seemed on the ball. You are just dense.

    Of course you can come out ahead by taking other people's money via welfare or whatever. Adam Smith meant there is no free lunch for society. There are lots of people that really don't get that. "This money is from the government" "It's FREE money!"

    I did put 2 Trillion instead of 20 Trillion bucks, and I recognized that mistake only just now. I write it out longhand, as some don't really get the magnitude of these dollar figures without seeing 20,000,000,000,000 - like that.

    duckduckgo's got this one: "THERE! IS! NO! FREE! LUNCH!" from Adam Smith, economist.

  153. @jJay
    American medical school applicants are usually required to have done some oversees service work in addition to meeting the academic qualifications. Why? Their parents, or the students themselves, have to foot the bill for part of this travel, adding even more to the cost of becoming a doctor.

    I have read elsewhere that medical schools are leaning toward applicants with liberal arts degrees over science degrees. My eldest wanted to be a doctor. Her adviser told her to switch majors from a BS in biology to a BA in biology with a bunch of crap classes that didn't help her prep for her MCATs.

    There were a lot of sane, apolitical, comments at the NYT on this article, but no consensus on what to do. Some comments even brought up the turpitude of harvesting the rest of the world's doctors away from their home countries.

    Replies: @Olorin

    I have read elsewhere that medical schools are leaning toward applicants with liberal arts degrees over science degrees. My eldest wanted to be a doctor. Her adviser told her to switch majors from a BS in biology to a BA in biology with a bunch of crap classes that didn’t help her prep for her MCATs.

    Back in the 1980s I think it was, Bryn Mawr was (one of?) the first to pioneer the idea of the “nontraditional pre-med student.” It looked IIRC as you say–lib arts degrees taking the MCAT with tons of coaching from mommy’s/daddy’s paid test-taking coaches.

    A friend of mine was referred to an orthopedic clinic for assessment for a joint replacement after living too many years with the painful toll of physical labor on his hips. He sent me an e-mail with the name of the physician he was assigned to by the clinic. Asked me whether I knew him. I didn’t but used Duck Fu to see what I could learn.

    The guy was a newish black hire with a bachelor’s degree in economics, a master’s in something something studies, and an MD from a second-tier medical school. Friend asked what I thought. My read was that this guy was taught just enough to qualify him to saw joints out of Medicare patients using high tech tools that complete most of the procedure for him and let the billing clear. Whether the procedure goes well for the patient isn’t the point–cashectomy of elders and the fed programs that support them is. If something goes wrong? Why heck, just bring them in for a “revision.”

    Friend said, “I wondered about that. I went over to the clinic just to look around, and this guy’s photo was in the main lobby, the atrium, the lobby of the ortho unit, and the web site and on all the handouts on the tabletops. They’re really pushing him.”

    I recommended someone from my alma mater at that same clinic. Who confided to the friend that “we are hiring people who aren’t really surgeons.” That entire part of that (Pugetopolis) city, by the way, is being developed into elderghetto hives for retired California escapees. Kind of a mobile goldrush where the mother lode is in bodies.

    And FWIW, Jeff Bezos hopes to be the tip top controller of everybody’s medical records in the future. Search on

    Amazon skunkworks 1492

    • Replies: @Hibernian
    @Olorin

    I think medical schools require only basic physics, chemistry, biology, and possibly math courses. They have to be the "real" STEM courses that I took as an engineering undergrad, but they don't need many of them.

    Replies: @Achmed E. Newman

  154. @drt
    @Opinionator

    See comments #61 above.

    Historically American medicine generally attracted alpha males--who were aggressive, protective of their turf, i.e., professional and financial status, and willing to do what was required to maintain it, which translated into long hours, lots of work--and a wife at home who could make that all possible. They did not want a career of peonage, which is what employment by companies or hospitals leads to.

    My impression is that many of the men who in my generation would have gone into medicine are now becoming investment bankers, hedge fund/private equity types, or maybe trying to start a tech company.

    Replies: @Twinkie

    Historically American medicine generally attracted alpha males–who were aggressive

    Spoken like an old-time surgeon (ortho or urology?)… from the good ol’ paternalistic days of medicine when married doctors slept with nurses, lorded over the OR like tyrants, didn’t tell patients the bad news (“it’s better for them not to know”) and otherwise covered up mistakes.

    They did not want a career of peonage, which is what employment by companies or hospitals leads to.

    Guess what, old doc? Young doctors don’t want peonage either. But they didn’t work summer jobs to pay for medical school in the 1960’s, face huge liabilities, and lucrative partnerships are fast disappearing, in large part due to the selfish greed of the older doctors (instead of passing on the partnerships to the younger generation, they are reaping a one-time windfall for themselves by selling the practices to large companies and hospitals). So what are they supposed to do, what with their huge debts and no prospect of partnerships? Not work?

    I have a profound sympathy for doctors – I happen to sit on the board of a large medical system and previously was a co-founder of a medical device company – but my sympathy is not for the older self-styled “alpha male” doctors, but to today’s physicians who face challenges which the older generation couldn’t even imagine.

    • Replies: @Opinionator
    @Twinkie

    Was it common for married doctors to sleep with nurses?

    , @E. Rekshun
    @Twinkie

    Spoken like an old-time surgeon (ortho or urology?)… from the good ol’ paternalistic days of medicine when married doctors slept with nurses, lorded over the OR like tyrants, didn’t tell patients the bad news (“it’s better for them not to know”) and otherwise covered up mistakes.

    ...and smoked!

  155. @Bill
    @Chrisnonymous

    The good residencies tend to be treating NAMs. Urban, teaching hospitals are where the best residencies are.

    Replies: @Opinionator, @Chrisnonymous

    What makes a residency a “good residency”?

    • Replies: @Bill
    @Opinionator

    At an abstract level, the same sorts of things which make a university a good university. In principle, a good residency is a residency at which you learn a great deal about treating patients in a short time. In practice, the places where this happens become renown, and so good can also mean renown. Also in practice, a good residency is a residency which is disproportionately likely to lead to a good job (e.g. being hired by a good medical school, being hired by the Mayo Clinic, etc).

    There are two (or three) levels to the learning. First, you learn all the routine stuff. Common diseases and what to do about them. Common personality types of patients and how to deal with them. How to work in the institutional structures of modern medicine. This stuff you can learn pretty much anywhere. This sort of routine medicine can be practiced by anyone with an above average intelligence and some training. We use doctors to do it largely because the law mandates that.

    Second, you learn all the exceptional stuff. Uncommon diseases or uncommonly hard cases of common diseases. Difficult patient types. Difficult institutional environments. Third, if you want to think of it as distinct, you learn how to tell the first from the second. This sort of medicine requires that you actually know human physiology and can apply what you know. This second/third level you learn best when surrounded by difficulties and under the direction of good attending physicians (where good means good at applying their experience and knowledge of physiology to particular difficult cases).

    The hospitals full of difficult/interesting cases are, for both historical and current reasons, urban tertiary referral centers---places where difficult cases get sent. As an example, if you want to learn how to sew up gunshot wound victims before they bleed to death, you want to learn in the hospital closest to a black ghetto. Want to know how to recognize and treat chronic alcoholism combined with exposure and malnutrition? There is no substitute for the hospital near the local homeless hangout. The hospital all the other hospitals send their most difficult cases to is usually the one affiliated with the biggest nearby university. The doctors the other doctors send their most difficult cases to practice at the university hospital. For historical reasons, these tend to be in urban centers.

    I'm simplifying above, but it's the general idea.

    Replies: @Opinionator

  156. @Twinkie
    @drt


    Historically American medicine generally attracted alpha males–who were aggressive
     
    Spoken like an old-time surgeon (ortho or urology?)... from the good ol' paternalistic days of medicine when married doctors slept with nurses, lorded over the OR like tyrants, didn't tell patients the bad news ("it's better for them not to know") and otherwise covered up mistakes.

    They did not want a career of peonage, which is what employment by companies or hospitals leads to.
     
    Guess what, old doc? Young doctors don't want peonage either. But they didn't work summer jobs to pay for medical school in the 1960's, face huge liabilities, and lucrative partnerships are fast disappearing, in large part due to the selfish greed of the older doctors (instead of passing on the partnerships to the younger generation, they are reaping a one-time windfall for themselves by selling the practices to large companies and hospitals). So what are they supposed to do, what with their huge debts and no prospect of partnerships? Not work?

    I have a profound sympathy for doctors - I happen to sit on the board of a large medical system and previously was a co-founder of a medical device company - but my sympathy is not for the older self-styled "alpha male" doctors, but to today's physicians who face challenges which the older generation couldn't even imagine.

    Replies: @Opinionator, @E. Rekshun

    Was it common for married doctors to sleep with nurses?

  157. @Twinkie
    @Hawk

    Your list is excellent, but it doesn't address one of the fundamental problems with medical insurance - that is, it does not work like any other insurance program (auto, flood, etc.) in that it is EXPECTED to be used and used frequently. That is not a sustainable model for any form of insurance. If an insurance payout is expected and expected frequently, the premium, by economic logic, cannot be low-cost.

    What we ought to do is to untie medical insurance from employment and switch people back to an older model in which they pay for a very low cost (and tax-deductible) catastrophic insurance for unforeseen events and pay cash for "routine" services. And, as heartless as it sounds, even the catastrophic insurance should cost more - a lot more - for those with very unhealthy habits, e.g. alcohol/drug abuse, cigarette smoking, gluttony (morbidly overweight), STD's, etc. We should not subsidize life choices and behaviors that are all but guaranteed to worsen health outcomes and dramatically increase the chance of incurring medical costs.

    Medicare/Medicaid should be abolished and the truly needy people (e.g. children in poverty) should receive subsidies for purchasing the catastrophic insurance.

    Replies: @Opinionator, @E. Rekshun

    In which direction (if any) would this change push medical costs and physician incomes?

    • Replies: @Twinkie
    @Opinionator


    In which direction (if any) would this change push medical costs and physician incomes?
     
    The name of the game today is consolidation. This will undoubtedly lower physician compensation, as doctors become corporate employees. As for medical costs, you would think that consolidation ought to lower costs, but there are negative externalities that will increase overall costs. What is really being hurt by consolidation is geographic coverage - small towns can kiss those beautiful, friendly mid-sized hospitals goodbye. Those are bleeding money and doctors (as older ones retires and new ones do not move to the towns) and will be closed down and merged with others that are more solvent.

    By the way, this is all occurring along with several other trends such as increase in foreign medical doctors, nurse militancy (with those with doctorates in nursing demanding to be called "doctors" in a clinical setting), and a whole host of less-than positive practice conditions. Is it any wonder that smart, ambitious young Americans are increasingly avoiding medical schools?

    Replies: @candid_observer, @Johann Ricke

  158. @MadDog
    @AM

    Couldn't agree more. I'm a female. Had high stress jobs. No longer. And I'm happy as a clam.

    Women in accounting professions tend to be stressed. The ones who stay tend to be overweight and unhappy.

    Unless they are married and work part time. Then their staff stressed because they pick up her workload.

    Replies: @Opinionator

    I would think that accounting would be a relatively less stressful occupation than law, medicine, or finance. Why do people find it stressful?

    • Replies: @Hibernian
    @Opinionator

    Tax season.

    , @E. Rekshun
    @Opinionator

    I would think that accounting would be a relatively less stressful occupation than law, medicine, or finance. Why do people find it stressful?

    Hibernian is correct - tax season - if you're preparing tax returns for an accounting firm. And tax season if four months of six or seven ten-hour days. Moreover, what I've found is that the accounting firms, from low-end to the Big 4, hire loads of new accounting grads and work them to death year-round, while at the same time the new grads also prepare to take the CPA.

    Similar to law, most accountants working for an accounting firm will never make partner and will leave after a few years to take a Chief Accountant, Controller, or CFO job with one of the firm's clients.

    Nonetheless, accounting is the language of business and makes a great foundation for a career in any industry in corporate America or the government, education, or non-profit sectors. I'd recommend accounting to any young person trying to figure out what they want to do. And the CPA exam acts somewhat as a barrier to entry to the immigrants.

    Replies: @Opinionator

  159. anon • Disclaimer says:
    @Pat Boyle
    @Almost Missouri

    I use Kaiser Permanente and have for more than twenty years. I originally had a Jewish doctor and I was well satisfied with him. But about ten or fifteen years ago all the Jewish and other Caucasian physicians vanished. Now all the medical staff are Asian.

    My doctor is Korean. He is very competent. As all readers of this blog surely know South Korea has the highest IQ population of any nation on earth. My doctor is no exception.

    Because I have so many frailties I have been served by many Kaiser doctors. All are not Korean. Some are Japanese and many are Chinese. I spent a week in the hospital last month. I discovered that most of the nurses are Filipino (at least the good ones). This is remarkable because Kaiser purports to be a black run organization. There are certainly a lot of black patients but the only black staff you ever see are those with their pictures on the walls or in the corporate brochures.

    Kaiser is a medical service in blackface.

    Replies: @Karl, @anon, @Chrisnonymous

    Kaiser purports to be a black run organization

    Now I understand why they caved to the nurses union and are paying close to $200k for an RN. The one that has me stand on the scale, stick the thermometer in my mouth, and checks my BP. The could/should get a robot to do that….and save the money.

    But they get their paws on billions in member dues and want to spread it to the minorities.

  160. @Opinionator
    @SimpleSong

    After kids the woman won’t want to completely give up her career so will go down to 20-40%; but that’s still too much so to cover the difference the male will go down to 60-80%.

    How is it that a reduction in the male's schedule "covers" the difference caused by the female's reducing her hours?

    Replies: @SimpleSong

    How is it that a reduction in the male’s schedule “covers” the difference caused by the female’s reducing her hours?

    Common arrangements I’ve seen are female has clinic Wednesday, male has clinic or OR time M T Th Fr. That way if the kids get sick or have a snow day or whatever there is always one person off and you never have to cancel clinic or OR, which is a huge huge deal. Sometimes they will have administrative or research days that overlap, but those it’s fine to call in sick for. But the clinic or OR you pretty much have to keep running. The hospital I worked at for years had never canceled an OR due to surgeon or anesthesiologist illness in ten years, for example. Physicians can come to work sick, or if they are really really in bad shape, get a partner to cover, but if you do that too often (and you’ll do it pretty often when you have little kids) you’ll find yourself out of a job.

    Of course if you don’t have kids or have helpful grandparents none of this is an issue, or if you have 2 nannies on call 24/7, but that brings its own issues.

  161. @Karl
    @Hawk

    126 Hawk > Does the burkha wearing dermatologist understand why the girl with pimples is worried about prom night?


    The more sack-like the burka, the more the culture focuses on youth and beauty for getting a girl married off.

    I read somewhere that Iran is second only to South Korea in prevalance of cosmetic plastic surgery. I imagine that the second-place thing is because of disparate ability to pay.

    Replies: @Twinkie

    I read somewhere that Iran is second only to South Korea in prevalance of cosmetic plastic surgery.

    Most cases in Iran are rhinoplasty – Persians have hooked noses, and apparently that is not in vogue among the Persian women. It is also the number one cosmetic procedure among the Iranian diaspora in the West. With South Koreans the procedures are far more varied.

  162. @AM
    @Anonymous


    A couple years as a lowly, overworked associate in a big law firm and a certain number of recent grads decide they’d really rather take some time off to pursue motherhood, maybe occasional, high-end catering, or that scrapbooking website they’ve been contemplating.
     
    Women, as a group, really should have never been pushed into careers as the "default"mode of their lives. It pains me to say it as a woman, but I am happier in low stress (low paid) careers. My nervous system is set a different level. Situations that cause my husband merely angst causes me almost total nervous breakdown.

    And it maybe a personality flaw (I certainly have enough of those),but I think I'm more typical than not.

    Replies: @Anonymous, @StillCARealist, @MadDog, @SimpleSong

    Just different niches. My wife gets much more anxious about things than I do to the point that it hurts her professionally; I’m the better worker bee. On the other hand, good childrearing requires at least some baseline anxiety and I’ve realized I don’t get anxious enough about things. If I were single my kids would have died of scurvy by now.

  163. @Opinionator
    @Twinkie

    In which direction (if any) would this change push medical costs and physician incomes?

    Replies: @Twinkie

    In which direction (if any) would this change push medical costs and physician incomes?

    The name of the game today is consolidation. This will undoubtedly lower physician compensation, as doctors become corporate employees. As for medical costs, you would think that consolidation ought to lower costs, but there are negative externalities that will increase overall costs. What is really being hurt by consolidation is geographic coverage – small towns can kiss those beautiful, friendly mid-sized hospitals goodbye. Those are bleeding money and doctors (as older ones retires and new ones do not move to the towns) and will be closed down and merged with others that are more solvent.

    By the way, this is all occurring along with several other trends such as increase in foreign medical doctors, nurse militancy (with those with doctorates in nursing demanding to be called “doctors” in a clinical setting), and a whole host of less-than positive practice conditions. Is it any wonder that smart, ambitious young Americans are increasingly avoiding medical schools?

    • Replies: @candid_observer
    @Twinkie


    Is it any wonder that smart, ambitious young Americans are increasingly avoiding medical schools?
     
    And yet MCAT scores -- and I believe GPAs as well -- are gradually creeping further and further up. Likewise, the USMLE scores are creeping up.

    All the evidence is that medicine is attracting more, not less, of the best and brightest.

    Replies: @Twinkie

    , @Johann Ricke
    @Twinkie


    Your list is excellent, but it doesn’t address one of the fundamental problems with medical insurance – that is, it does not work like any other insurance program (auto, flood, etc.) in that it is EXPECTED to be used and used frequently.
     
    Based on what I've seen about the difference between published prices and what insurance companies pay (i.e. much less), insurance also distorts pricing for individuals without insurance. Insurance companies use monopsony power to compress prices to a fraction of what uninsured individuals pay. That is why self-insuring (i.e. saving up the premiums for future medical expenses instead of buying insurance) is so risky, and possibly non-viable - it exposes the uninsured individual to paying many multiples of what an insurance company would pay for the same procedure and the same drugs.

    Replies: @Twinkie

  164. Anonymous • Disclaimer says:
    @blah blah teleblah
    @Meretricious

    I imagine that even the affirmative action types that get into an American medical school are pretty smart compared to the rest of the population, almost certainly IQ above 115. On the other hand, someone admitted to a fourth tier law school that didn't get a full scholarship is in all likelihood probably right smack dab in the middle of of the bell curve, and maybe a little bit on the left side. And there are accredited law schools that will admit anyone that has an undergraduate degree, no matter their GPA or LSAT score is. Once there, the school will do everything to make sure they graduate.

    As to why there are presumably a lot few American medical schools and many fewer spots, I would guess it has a lot to do with start up costs. Princeton could pretty much start its own law schools in a year or two if they wanted. I doubt it could do the same thing with a medical school.

    Replies: @Anonymous, @Hibernian

    Interesting testimony. Princeton has always been a notable case among the Ivy League, having as it does no medical, law, or business schools. (Even tiny Dartmouth has a business school, and a good one!)

    Not least because graduates of those three types of professional schools are generally well-situated when it comes time for alumni contributions. Yet Princeton has never hurt for funds.

    As you say, starting a new medical school from scratch would be difficult, but if any school could pull it off, I daresay it would be Princeton.

  165. @Joe Stalin
    @Lagertha

    The Democrat Dude Pritzker who is running for IL governor has a TV ad where he says our income tax is UNFAIR (5%) and that we NEED a PROGRESSIVE tax like all the stupid people in New York and California.

    This must be aimed at all the Blacks and big government Hispanics that are in need of ever more gibsmethat.

    Replies: @Anonymous

    Or perhaps he’s hinting that Illinois might one day decide to step up and start paying its bills…

  166. @Anon
    @Achmed E. Newman

    This shouldn't need explaining, but if you get a million dollars from the taxpayers, and your grandchildren have to pay a few thousand dollars back, you've come out way, way ahead. You appear to have missed the point of the OP entirely.

    The rest of your screed (aside from trouble understanding "T") is trivial stuff everyone knows. Now quit wasting everyone's time!

    Replies: @Achmed E. Newman

    Nope, you missed it now, too, but the other anonymous had probably never heard the saying from Adam Smith, but he seemed on the ball. You are just dense.

    Of course you can come out ahead by taking other people’s money via welfare or whatever. Adam Smith meant there is no free lunch for society. There are lots of people that really don’t get that. “This money is from the government” “It’s FREE money!”

    I did put 2 Trillion instead of 20 Trillion bucks, and I recognized that mistake only just now. I write it out longhand, as some don’t really get the magnitude of these dollar figures without seeing 20,000,000,000,000 – like that.

    duckduckgo’s got this one: “THERE! IS! NO! FREE! LUNCH!” from Adam Smith, economist.

  167. @Bill
    @Maj. Kong

    The issue isn't automation. There is no reason for, say, Walmart to have pharmacists --- one guy for every 20 stores available by phone would be fine. There is a legal requirement in (I think) every state for there to be a pharmacist physically present in a pharmacy. The pharmacists have a strong lobbying group, and they are allied with all the other medical professions' lobbying groups for "they came for the pharmacists and I said nothing . . ." reasons.

    Replies: @JackOH

    The full complement of Big Medicine’s Iron Pyramid includes the AMA, Big Pharma, the AHA, AHIP (group health insurance), and medical equipment makers, and other organizations, such as pharmacists. They are pretty much okay with seeing health care debate occupied by fringe issues and dubious, marginal solutions. They are fully in accord on the overall legitimacy of the existing health care system, and maintenance of the status quo. They are, I’m very confident, frightened by any close examination of what America’s group health insurance actually is, as but one example.

  168. @drt
    @Cwhatfuture

    As a surgeon in practice for 27 years, I can vouch for this comment. The rising number of female physicians coincides with the decline in prestige, power and income of American physicians, and has influenced the whole culture of medicine. Compared with earlier generations, young MDs are less hard working (but very good at taking written tests), relatively timid, and much more submissive. The majority want to be employed rather than have their own practices, and often are far less productive. At a recent dinner at a prestigious Boston hospital, I was amazed to hear a group of young doctors at my table trade tips on how to keep down the number of patients they had to see per day! When I was starting out, the conversation would have been trading tips on how to see more patients per day.

    BTW, my wife is a physician, and she agrees with the above.

    Replies: @Opinionator, @Brutusale

    Bertrand, Goldin and Katz on the causes of the “income gap”. I imagine it applies to MDs as much as MBAs; men are from neurosurgery, women are from pediatrics.

    https://scholar.harvard.edu/files/goldin/files/dynamics_of_the_gender_gap_for_young_professionals_in_the_financial_and_corporate_sectors.pdf

    Money shot: “Most interesting is why female MBAs have not done as well as their male peers.
    We identify three proximate reasons for the large and rising gender gap in earnings
    that emerges within a few years of MBA completion: differences in business school
    courses and grades; differences in career interruptions; and differences in weekly
    hours worked. These three determinants combined can explain 84 percent of the 31
    log point raw gender gap in earnings pooling across all the years following MBA
    completion. Because the relative importance of each factor changes with years since
    MBA completion, we explore the evolution in the earnings gap by sex by time since
    obtaining the MBA. We also compare women without any career interruptions and
    any children to all men.”

    Of course, Mass General can afford to pay you pretty well because they save money, when compared to BMC and the Brigham, by paying their nurses less. They offered my girlfriend a job 3 years ago…for $35K less than she’s making now at BMC.

  169. @blah blah teleblah
    @Meretricious

    I imagine that even the affirmative action types that get into an American medical school are pretty smart compared to the rest of the population, almost certainly IQ above 115. On the other hand, someone admitted to a fourth tier law school that didn't get a full scholarship is in all likelihood probably right smack dab in the middle of of the bell curve, and maybe a little bit on the left side. And there are accredited law schools that will admit anyone that has an undergraduate degree, no matter their GPA or LSAT score is. Once there, the school will do everything to make sure they graduate.

    As to why there are presumably a lot few American medical schools and many fewer spots, I would guess it has a lot to do with start up costs. Princeton could pretty much start its own law schools in a year or two if they wanted. I doubt it could do the same thing with a medical school.

    Replies: @Anonymous, @Hibernian

    “Once there, the school will do everything to make sure they graduate.”

    I think you’re confusing the bad law schools with the good ones. The bad ones have historically had high attrition.

  170. @Opinionator
    @MadDog

    I would think that accounting would be a relatively less stressful occupation than law, medicine, or finance. Why do people find it stressful?

    Replies: @Hibernian, @E. Rekshun

    Tax season.

  171. @Olorin
    @jJay


    I have read elsewhere that medical schools are leaning toward applicants with liberal arts degrees over science degrees. My eldest wanted to be a doctor. Her adviser told her to switch majors from a BS in biology to a BA in biology with a bunch of crap classes that didn’t help her prep for her MCATs.
     
    Back in the 1980s I think it was, Bryn Mawr was (one of?) the first to pioneer the idea of the "nontraditional pre-med student." It looked IIRC as you say--lib arts degrees taking the MCAT with tons of coaching from mommy's/daddy's paid test-taking coaches.

    A friend of mine was referred to an orthopedic clinic for assessment for a joint replacement after living too many years with the painful toll of physical labor on his hips. He sent me an e-mail with the name of the physician he was assigned to by the clinic. Asked me whether I knew him. I didn't but used Duck Fu to see what I could learn.

    The guy was a newish black hire with a bachelor's degree in economics, a master's in something something studies, and an MD from a second-tier medical school. Friend asked what I thought. My read was that this guy was taught just enough to qualify him to saw joints out of Medicare patients using high tech tools that complete most of the procedure for him and let the billing clear. Whether the procedure goes well for the patient isn't the point--cashectomy of elders and the fed programs that support them is. If something goes wrong? Why heck, just bring them in for a "revision."

    Friend said, "I wondered about that. I went over to the clinic just to look around, and this guy's photo was in the main lobby, the atrium, the lobby of the ortho unit, and the web site and on all the handouts on the tabletops. They're really pushing him."

    I recommended someone from my alma mater at that same clinic. Who confided to the friend that "we are hiring people who aren't really surgeons." That entire part of that (Pugetopolis) city, by the way, is being developed into elderghetto hives for retired California escapees. Kind of a mobile goldrush where the mother lode is in bodies.

    And FWIW, Jeff Bezos hopes to be the tip top controller of everybody's medical records in the future. Search on

    Amazon skunkworks 1492

    Replies: @Hibernian

    I think medical schools require only basic physics, chemistry, biology, and possibly math courses. They have to be the “real” STEM courses that I took as an engineering undergrad, but they don’t need many of them.

    • Replies: @Achmed E. Newman
    @Hibernian

    The doctors I know took the chemistry, physics, and biology in order to be ready to pass the MCAT. I don't know if there was an organic chemistry requirement to get into med school, but again, it would help on the MCAT. Yeah, at least back then, your major could be anything.

    Replies: @Ivy

  172. @Anonymous
    @Anonymous

    That's assuming that we would have the current level of wealth, just distributed among 110 million instead of 330 million. We don't know what economic growth would have looked like if the population stayed constant over a century.

    Replies: @Nico, @Anonymous, @Opinionator, @bomag

    We don’t know what economic growth would have looked like if the population stayed constant over a century

    I’d classify the worship of economic growth as one of today’s problems.

    I suspect we’d have the same hedonic advancements as today.

    I’d certainly trade some standard of living for more elbow room… for myself AND my kids… and their kids.

  173. @Hibernian
    @Olorin

    I think medical schools require only basic physics, chemistry, biology, and possibly math courses. They have to be the "real" STEM courses that I took as an engineering undergrad, but they don't need many of them.

    Replies: @Achmed E. Newman

    The doctors I know took the chemistry, physics, and biology in order to be ready to pass the MCAT. I don’t know if there was an organic chemistry requirement to get into med school, but again, it would help on the MCAT. Yeah, at least back then, your major could be anything.

    • Replies: @Ivy
    @Achmed E. Newman


    organic chemistry requirement
     
    The doctors I know all took O Chem. The professors told them that it was a course to separate the wheat from the chaff, a way to winnow the list of all those budding pre-med majors.
  174. @Twinkie
    @Opinionator


    In which direction (if any) would this change push medical costs and physician incomes?
     
    The name of the game today is consolidation. This will undoubtedly lower physician compensation, as doctors become corporate employees. As for medical costs, you would think that consolidation ought to lower costs, but there are negative externalities that will increase overall costs. What is really being hurt by consolidation is geographic coverage - small towns can kiss those beautiful, friendly mid-sized hospitals goodbye. Those are bleeding money and doctors (as older ones retires and new ones do not move to the towns) and will be closed down and merged with others that are more solvent.

    By the way, this is all occurring along with several other trends such as increase in foreign medical doctors, nurse militancy (with those with doctorates in nursing demanding to be called "doctors" in a clinical setting), and a whole host of less-than positive practice conditions. Is it any wonder that smart, ambitious young Americans are increasingly avoiding medical schools?

    Replies: @candid_observer, @Johann Ricke

    Is it any wonder that smart, ambitious young Americans are increasingly avoiding medical schools?

    And yet MCAT scores — and I believe GPAs as well — are gradually creeping further and further up. Likewise, the USMLE scores are creeping up.

    All the evidence is that medicine is attracting more, not less, of the best and brightest.

    • Replies: @Twinkie
    @candid_observer


    And yet MCAT scores — and I believe GPAs as well — are gradually creeping further and further up. Likewise, the USMLE scores are creeping up.

    All the evidence is that medicine is attracting more, not less, of the best and brightest.
     
    Maybe. Or there is a range restriction/higher competition going on within a withering pool.
  175. @Pat Boyle
    @Almost Missouri

    I use Kaiser Permanente and have for more than twenty years. I originally had a Jewish doctor and I was well satisfied with him. But about ten or fifteen years ago all the Jewish and other Caucasian physicians vanished. Now all the medical staff are Asian.

    My doctor is Korean. He is very competent. As all readers of this blog surely know South Korea has the highest IQ population of any nation on earth. My doctor is no exception.

    Because I have so many frailties I have been served by many Kaiser doctors. All are not Korean. Some are Japanese and many are Chinese. I spent a week in the hospital last month. I discovered that most of the nurses are Filipino (at least the good ones). This is remarkable because Kaiser purports to be a black run organization. There are certainly a lot of black patients but the only black staff you ever see are those with their pictures on the walls or in the corporate brochures.

    Kaiser is a medical service in blackface.

    Replies: @Karl, @anon, @Chrisnonymous

    I discovered that most of the nurses are Filipino (at least the good ones).

    No offense, but you might not know which nurses are the good ones. The difference between good and bad nurses is in things that patients and family don’t usually see.

    • Replies: @Opinionator
    @Chrisnonymous

    Which is what? What are those things that make the difference?

    Replies: @Chrisnonymous

    , @Pat Boyle
    @Chrisnonymous

    There's something to what you say. Most of my experience in dealing with doctors and hospitals as a consultant/contractor has been with the doctors not the nurses. Nevertheless it wasn't difficult to notice that the black nurses tended to avoid working. Trust me the Filipino nurses do a better job.

    Replies: @Chrisnonymous

  176. @Bill
    @Chrisnonymous

    The good residencies tend to be treating NAMs. Urban, teaching hospitals are where the best residencies are.

    Replies: @Opinionator, @Chrisnonymous

    A lot of docs headed to Detroit and Atlanta then?

    • Replies: @Bill
    @Chrisnonymous

    I don't know about Detroit. Downtown Atlanta has good residency programs, however.

  177. @Opinionator
    @Bill

    What makes a residency a "good residency"?

    Replies: @Bill

    At an abstract level, the same sorts of things which make a university a good university. In principle, a good residency is a residency at which you learn a great deal about treating patients in a short time. In practice, the places where this happens become renown, and so good can also mean renown. Also in practice, a good residency is a residency which is disproportionately likely to lead to a good job (e.g. being hired by a good medical school, being hired by the Mayo Clinic, etc).

    There are two (or three) levels to the learning. First, you learn all the routine stuff. Common diseases and what to do about them. Common personality types of patients and how to deal with them. How to work in the institutional structures of modern medicine. This stuff you can learn pretty much anywhere. This sort of routine medicine can be practiced by anyone with an above average intelligence and some training. We use doctors to do it largely because the law mandates that.

    Second, you learn all the exceptional stuff. Uncommon diseases or uncommonly hard cases of common diseases. Difficult patient types. Difficult institutional environments. Third, if you want to think of it as distinct, you learn how to tell the first from the second. This sort of medicine requires that you actually know human physiology and can apply what you know. This second/third level you learn best when surrounded by difficulties and under the direction of good attending physicians (where good means good at applying their experience and knowledge of physiology to particular difficult cases).

    The hospitals full of difficult/interesting cases are, for both historical and current reasons, urban tertiary referral centers—places where difficult cases get sent. As an example, if you want to learn how to sew up gunshot wound victims before they bleed to death, you want to learn in the hospital closest to a black ghetto. Want to know how to recognize and treat chronic alcoholism combined with exposure and malnutrition? There is no substitute for the hospital near the local homeless hangout. The hospital all the other hospitals send their most difficult cases to is usually the one affiliated with the biggest nearby university. The doctors the other doctors send their most difficult cases to practice at the university hospital. For historical reasons, these tend to be in urban centers.

    I’m simplifying above, but it’s the general idea.

    • Replies: @Opinionator
    @Bill

    Thanks.

  178. NYT, 06/30/17 – Doctor Opens Fire at Bronx Hospital, Killing a Doctor and Wounding 6

    A disgruntled doctor armed with an AR-15 rifle and wearing a lab coat went on a rampage on Friday in the Bronx hospital where he had worked, killing a doctor and wounding six other people — five of them seriously — before setting himself on fire and shooting himself in the head…

    Dr. Bello was hired in August 2014… and left in February 2015, in lieu of being terminated. The police said he resigned after an accusation of workplace sexual harassment…

    In 2004, Dr. Bello was arrested and charged with sex abuse and unlawful imprisonment after a 23-year-old woman told officers he had grabbed her crotch area outside a building on Bleecker Street in Manhattan and tried to penetrate her through her underwear, a law enforcement official said. The woman told officers that Dr. Bello had lifted her up in the air and dragged her while saying, “You’re coming with me.”

    Court records indicate that Dr. Bello pleaded guilty to unlawful imprisonment in the second degree, a misdemeanor, and was sentenced to community service. The felony sexual abuse charge was dismissed…

    Dr. Bello was a graduate of Ross University School of Medicine on the Caribbean island of Dominica…

    The NYT repeatedly hid the fact that Dr. Bello was an African immigrant .

  179. @Chrisnonymous
    @Pat Boyle


    I discovered that most of the nurses are Filipino (at least the good ones).
     
    No offense, but you might not know which nurses are the good ones. The difference between good and bad nurses is in things that patients and family don't usually see.

    Replies: @Opinionator, @Pat Boyle

    Which is what? What are those things that make the difference?

    • Replies: @Chrisnonymous
    @Opinionator

    Despite what most patients and family think, a modern registered nurse's job is not really making the patient comfortable, fetching food and drink, etc. Nurses' jobs are about monitoring patient conditions and keeping medical providers informed, protecting patients from errors, oversight, and neglect, and managing other staff such as practical nurses, nursing assistants, radiology techs, and respiratory therapists.

    The amount of work that's involved in doing this is constantly monitored and updated in a hospital, and nurses are assigned to patients (or patients to nurses) in such a way that they have a lot of work but not too much.

    The responsibilities and assignments combine in ways such that nurses cannot give equal time to every patient. For a relatively healthy and independent patient, a nurse may go a whole shift with only a cursory exam and occasional medicine administration, while another, sicker patient in that nurse's assignment may take up almost all the time in the shift.

    Also, there is a huge amount of paperwork for nurses now. If you're in a hospital and walk up to a table with a group of nurses who are laughing together, they may be sitting around chatting or they may be working on documentation and chatting while doing that routine but unavoidable task.

    Once you get beyond entry-level competence issues like being able to identify fluid in lungs with a stethoscope or remember when it's appropriate not to administer the medications prescribed by the doctor, the main difference between a good and bad nurse is probably time management skills--something not transparent to patients and family members.

    Replies: @Opinionator

  180. @Chrisnonymous
    @Pat Boyle


    I discovered that most of the nurses are Filipino (at least the good ones).
     
    No offense, but you might not know which nurses are the good ones. The difference between good and bad nurses is in things that patients and family don't usually see.

    Replies: @Opinionator, @Pat Boyle

    There’s something to what you say. Most of my experience in dealing with doctors and hospitals as a consultant/contractor has been with the doctors not the nurses. Nevertheless it wasn’t difficult to notice that the black nurses tended to avoid working. Trust me the Filipino nurses do a better job.

    • Replies: @Chrisnonymous
    @Pat Boyle

    Probably Filipino nurses have more incentive to work hard. Rules are different for every state, but usually signing up for the board exams that are necessary for permission to work in the US is connected to sponsorship of some kind--from a hospital, school, etc. I suspect a lot of Filipino nurses are in a kind of indentured servitude. (Not that they should be here--send them home!) See my reply to Opinionator--I have no doubt black nurses are, in general, less competent, but competence is hard to judge by seeing whether someone is moving briskly or not.

  181. @songbird
    I have a solution: telemedicine.

    Replies: @DCThrowback

    http://www.teladoc.com

    $40 for a consult, cheaper than the reg doc

  182. @Twinkie
    @Hawk

    Your list is excellent, but it doesn't address one of the fundamental problems with medical insurance - that is, it does not work like any other insurance program (auto, flood, etc.) in that it is EXPECTED to be used and used frequently. That is not a sustainable model for any form of insurance. If an insurance payout is expected and expected frequently, the premium, by economic logic, cannot be low-cost.

    What we ought to do is to untie medical insurance from employment and switch people back to an older model in which they pay for a very low cost (and tax-deductible) catastrophic insurance for unforeseen events and pay cash for "routine" services. And, as heartless as it sounds, even the catastrophic insurance should cost more - a lot more - for those with very unhealthy habits, e.g. alcohol/drug abuse, cigarette smoking, gluttony (morbidly overweight), STD's, etc. We should not subsidize life choices and behaviors that are all but guaranteed to worsen health outcomes and dramatically increase the chance of incurring medical costs.

    Medicare/Medicaid should be abolished and the truly needy people (e.g. children in poverty) should receive subsidies for purchasing the catastrophic insurance.

    Replies: @Opinionator, @E. Rekshun

    Good points!

    medical insurance – that is, it does not work like any other insurance program (auto, flood, etc.) in that it is EXPECTED to be used and used frequently.

    I’m not so sure about this. I would guess that males, say, aged 18 – 65, avoid preventive care and seldom go to the doctor. Men just die. I haven’t been for a check-up in five years, though I have a full employer-funded plan. On the other hand, females of all ages have many ailments (imaginary and otherwise) and need lots of attention (medical and otherwise).

    catastrophic insurance

    Obamacare outlawed catastrophic medical insurance plans.

    Medicare/Medicaid should be abolished and the truly needy people (e.g. children in poverty) should receive subsidies for purchasing the catastrophic insurance.

    Good idea. Sounds very reasonable and probably much more effective and much less costly. Medicaid fully covers pre-natal care and pregnancy for eligible women. So, I guess a catastrophic plan should include this coverage as well.

  183. @Twinkie
    @drt


    Historically American medicine generally attracted alpha males–who were aggressive
     
    Spoken like an old-time surgeon (ortho or urology?)... from the good ol' paternalistic days of medicine when married doctors slept with nurses, lorded over the OR like tyrants, didn't tell patients the bad news ("it's better for them not to know") and otherwise covered up mistakes.

    They did not want a career of peonage, which is what employment by companies or hospitals leads to.
     
    Guess what, old doc? Young doctors don't want peonage either. But they didn't work summer jobs to pay for medical school in the 1960's, face huge liabilities, and lucrative partnerships are fast disappearing, in large part due to the selfish greed of the older doctors (instead of passing on the partnerships to the younger generation, they are reaping a one-time windfall for themselves by selling the practices to large companies and hospitals). So what are they supposed to do, what with their huge debts and no prospect of partnerships? Not work?

    I have a profound sympathy for doctors - I happen to sit on the board of a large medical system and previously was a co-founder of a medical device company - but my sympathy is not for the older self-styled "alpha male" doctors, but to today's physicians who face challenges which the older generation couldn't even imagine.

    Replies: @Opinionator, @E. Rekshun

    Spoken like an old-time surgeon (ortho or urology?)… from the good ol’ paternalistic days of medicine when married doctors slept with nurses, lorded over the OR like tyrants, didn’t tell patients the bad news (“it’s better for them not to know”) and otherwise covered up mistakes.

    …and smoked!

  184. @Opinionator
    @MadDog

    I would think that accounting would be a relatively less stressful occupation than law, medicine, or finance. Why do people find it stressful?

    Replies: @Hibernian, @E. Rekshun

    I would think that accounting would be a relatively less stressful occupation than law, medicine, or finance. Why do people find it stressful?

    Hibernian is correct – tax season – if you’re preparing tax returns for an accounting firm. And tax season if four months of six or seven ten-hour days. Moreover, what I’ve found is that the accounting firms, from low-end to the Big 4, hire loads of new accounting grads and work them to death year-round, while at the same time the new grads also prepare to take the CPA.

    Similar to law, most accountants working for an accounting firm will never make partner and will leave after a few years to take a Chief Accountant, Controller, or CFO job with one of the firm’s clients.

    Nonetheless, accounting is the language of business and makes a great foundation for a career in any industry in corporate America or the government, education, or non-profit sectors. I’d recommend accounting to any young person trying to figure out what they want to do. And the CPA exam acts somewhat as a barrier to entry to the immigrants.

    • Replies: @Opinionator
    @E. Rekshun

    Thanks.

  185. @Twinkie
    @Opinionator


    In which direction (if any) would this change push medical costs and physician incomes?
     
    The name of the game today is consolidation. This will undoubtedly lower physician compensation, as doctors become corporate employees. As for medical costs, you would think that consolidation ought to lower costs, but there are negative externalities that will increase overall costs. What is really being hurt by consolidation is geographic coverage - small towns can kiss those beautiful, friendly mid-sized hospitals goodbye. Those are bleeding money and doctors (as older ones retires and new ones do not move to the towns) and will be closed down and merged with others that are more solvent.

    By the way, this is all occurring along with several other trends such as increase in foreign medical doctors, nurse militancy (with those with doctorates in nursing demanding to be called "doctors" in a clinical setting), and a whole host of less-than positive practice conditions. Is it any wonder that smart, ambitious young Americans are increasingly avoiding medical schools?

    Replies: @candid_observer, @Johann Ricke

    Your list is excellent, but it doesn’t address one of the fundamental problems with medical insurance – that is, it does not work like any other insurance program (auto, flood, etc.) in that it is EXPECTED to be used and used frequently.

    Based on what I’ve seen about the difference between published prices and what insurance companies pay (i.e. much less), insurance also distorts pricing for individuals without insurance. Insurance companies use monopsony power to compress prices to a fraction of what uninsured individuals pay. That is why self-insuring (i.e. saving up the premiums for future medical expenses instead of buying insurance) is so risky, and possibly non-viable – it exposes the uninsured individual to paying many multiples of what an insurance company would pay for the same procedure and the same drugs.

    • Replies: @Twinkie
    @Johann Ricke

    Yes. Corporations reap some economy of scale (esp. for older employees) when dealing with insurance companies. We need to de-couple health insurance with employment. Corporations should be free to subsidize their employees' purchase of insurance if they so chose, but should not deal directly with insurance companies. All health insurance should be individually purchased. When large corporations and individuals co-exist in the health insurance market, there is enormous distortions in pricing in favor of the former.

  186. @Opinionator
    @Chrisnonymous

    Which is what? What are those things that make the difference?

    Replies: @Chrisnonymous

    Despite what most patients and family think, a modern registered nurse’s job is not really making the patient comfortable, fetching food and drink, etc. Nurses’ jobs are about monitoring patient conditions and keeping medical providers informed, protecting patients from errors, oversight, and neglect, and managing other staff such as practical nurses, nursing assistants, radiology techs, and respiratory therapists.

    The amount of work that’s involved in doing this is constantly monitored and updated in a hospital, and nurses are assigned to patients (or patients to nurses) in such a way that they have a lot of work but not too much.

    The responsibilities and assignments combine in ways such that nurses cannot give equal time to every patient. For a relatively healthy and independent patient, a nurse may go a whole shift with only a cursory exam and occasional medicine administration, while another, sicker patient in that nurse’s assignment may take up almost all the time in the shift.

    Also, there is a huge amount of paperwork for nurses now. If you’re in a hospital and walk up to a table with a group of nurses who are laughing together, they may be sitting around chatting or they may be working on documentation and chatting while doing that routine but unavoidable task.

    Once you get beyond entry-level competence issues like being able to identify fluid in lungs with a stethoscope or remember when it’s appropriate not to administer the medications prescribed by the doctor, the main difference between a good and bad nurse is probably time management skills–something not transparent to patients and family members.

    • Replies: @Opinionator
    @Chrisnonymous

    Thanks.

  187. @Pat Boyle
    @Chrisnonymous

    There's something to what you say. Most of my experience in dealing with doctors and hospitals as a consultant/contractor has been with the doctors not the nurses. Nevertheless it wasn't difficult to notice that the black nurses tended to avoid working. Trust me the Filipino nurses do a better job.

    Replies: @Chrisnonymous

    Probably Filipino nurses have more incentive to work hard. Rules are different for every state, but usually signing up for the board exams that are necessary for permission to work in the US is connected to sponsorship of some kind–from a hospital, school, etc. I suspect a lot of Filipino nurses are in a kind of indentured servitude. (Not that they should be here–send them home!) See my reply to Opinionator–I have no doubt black nurses are, in general, less competent, but competence is hard to judge by seeing whether someone is moving briskly or not.

  188. @candid_observer
    @Twinkie


    Is it any wonder that smart, ambitious young Americans are increasingly avoiding medical schools?
     
    And yet MCAT scores -- and I believe GPAs as well -- are gradually creeping further and further up. Likewise, the USMLE scores are creeping up.

    All the evidence is that medicine is attracting more, not less, of the best and brightest.

    Replies: @Twinkie

    And yet MCAT scores — and I believe GPAs as well — are gradually creeping further and further up. Likewise, the USMLE scores are creeping up.

    All the evidence is that medicine is attracting more, not less, of the best and brightest.

    Maybe. Or there is a range restriction/higher competition going on within a withering pool.

  189. @Johann Ricke
    @Twinkie


    Your list is excellent, but it doesn’t address one of the fundamental problems with medical insurance – that is, it does not work like any other insurance program (auto, flood, etc.) in that it is EXPECTED to be used and used frequently.
     
    Based on what I've seen about the difference between published prices and what insurance companies pay (i.e. much less), insurance also distorts pricing for individuals without insurance. Insurance companies use monopsony power to compress prices to a fraction of what uninsured individuals pay. That is why self-insuring (i.e. saving up the premiums for future medical expenses instead of buying insurance) is so risky, and possibly non-viable - it exposes the uninsured individual to paying many multiples of what an insurance company would pay for the same procedure and the same drugs.

    Replies: @Twinkie

    Yes. Corporations reap some economy of scale (esp. for older employees) when dealing with insurance companies. We need to de-couple health insurance with employment. Corporations should be free to subsidize their employees’ purchase of insurance if they so chose, but should not deal directly with insurance companies. All health insurance should be individually purchased. When large corporations and individuals co-exist in the health insurance market, there is enormous distortions in pricing in favor of the former.

  190. @Achmed E. Newman
    @Hibernian

    The doctors I know took the chemistry, physics, and biology in order to be ready to pass the MCAT. I don't know if there was an organic chemistry requirement to get into med school, but again, it would help on the MCAT. Yeah, at least back then, your major could be anything.

    Replies: @Ivy

    organic chemistry requirement

    The doctors I know all took O Chem. The professors told them that it was a course to separate the wheat from the chaff, a way to winnow the list of all those budding pre-med majors.

  191. @Chrisnonymous
    @Bill

    A lot of docs headed to Detroit and Atlanta then?

    Replies: @Bill

    I don’t know about Detroit. Downtown Atlanta has good residency programs, however.

  192. @E. Rekshun
    @Opinionator

    I would think that accounting would be a relatively less stressful occupation than law, medicine, or finance. Why do people find it stressful?

    Hibernian is correct - tax season - if you're preparing tax returns for an accounting firm. And tax season if four months of six or seven ten-hour days. Moreover, what I've found is that the accounting firms, from low-end to the Big 4, hire loads of new accounting grads and work them to death year-round, while at the same time the new grads also prepare to take the CPA.

    Similar to law, most accountants working for an accounting firm will never make partner and will leave after a few years to take a Chief Accountant, Controller, or CFO job with one of the firm's clients.

    Nonetheless, accounting is the language of business and makes a great foundation for a career in any industry in corporate America or the government, education, or non-profit sectors. I'd recommend accounting to any young person trying to figure out what they want to do. And the CPA exam acts somewhat as a barrier to entry to the immigrants.

    Replies: @Opinionator

    Thanks.

  193. @Chrisnonymous
    @Opinionator

    Despite what most patients and family think, a modern registered nurse's job is not really making the patient comfortable, fetching food and drink, etc. Nurses' jobs are about monitoring patient conditions and keeping medical providers informed, protecting patients from errors, oversight, and neglect, and managing other staff such as practical nurses, nursing assistants, radiology techs, and respiratory therapists.

    The amount of work that's involved in doing this is constantly monitored and updated in a hospital, and nurses are assigned to patients (or patients to nurses) in such a way that they have a lot of work but not too much.

    The responsibilities and assignments combine in ways such that nurses cannot give equal time to every patient. For a relatively healthy and independent patient, a nurse may go a whole shift with only a cursory exam and occasional medicine administration, while another, sicker patient in that nurse's assignment may take up almost all the time in the shift.

    Also, there is a huge amount of paperwork for nurses now. If you're in a hospital and walk up to a table with a group of nurses who are laughing together, they may be sitting around chatting or they may be working on documentation and chatting while doing that routine but unavoidable task.

    Once you get beyond entry-level competence issues like being able to identify fluid in lungs with a stethoscope or remember when it's appropriate not to administer the medications prescribed by the doctor, the main difference between a good and bad nurse is probably time management skills--something not transparent to patients and family members.

    Replies: @Opinionator

    Thanks.

  194. @Bill
    @Opinionator

    At an abstract level, the same sorts of things which make a university a good university. In principle, a good residency is a residency at which you learn a great deal about treating patients in a short time. In practice, the places where this happens become renown, and so good can also mean renown. Also in practice, a good residency is a residency which is disproportionately likely to lead to a good job (e.g. being hired by a good medical school, being hired by the Mayo Clinic, etc).

    There are two (or three) levels to the learning. First, you learn all the routine stuff. Common diseases and what to do about them. Common personality types of patients and how to deal with them. How to work in the institutional structures of modern medicine. This stuff you can learn pretty much anywhere. This sort of routine medicine can be practiced by anyone with an above average intelligence and some training. We use doctors to do it largely because the law mandates that.

    Second, you learn all the exceptional stuff. Uncommon diseases or uncommonly hard cases of common diseases. Difficult patient types. Difficult institutional environments. Third, if you want to think of it as distinct, you learn how to tell the first from the second. This sort of medicine requires that you actually know human physiology and can apply what you know. This second/third level you learn best when surrounded by difficulties and under the direction of good attending physicians (where good means good at applying their experience and knowledge of physiology to particular difficult cases).

    The hospitals full of difficult/interesting cases are, for both historical and current reasons, urban tertiary referral centers---places where difficult cases get sent. As an example, if you want to learn how to sew up gunshot wound victims before they bleed to death, you want to learn in the hospital closest to a black ghetto. Want to know how to recognize and treat chronic alcoholism combined with exposure and malnutrition? There is no substitute for the hospital near the local homeless hangout. The hospital all the other hospitals send their most difficult cases to is usually the one affiliated with the biggest nearby university. The doctors the other doctors send their most difficult cases to practice at the university hospital. For historical reasons, these tend to be in urban centers.

    I'm simplifying above, but it's the general idea.

    Replies: @Opinionator

    Thanks.

  195. @Moshe
    I oppose any immigration to this country at all. I don't care for "engineering qualifications" or any of that bullshit. Don't allow them in. Even with a greencard.

    And the Dreamers have got to go, and the one million asians taking slots in our best universities that belong to US - Americans.

    I make only two exceptions.

    1) If there is a total slaughter sonewhere, like in Syria, we can take in refugees -- TEMPORARILY.

    Before these people are saved they must make a video recording about why they choose to escape to America EVEN THOUGH THEY KNOW AND HAPPILY ACCEPT THE FACT THAT THEY WILL ONLY STAY IN CAMPS.

    Obviously these camps will be comfortable, large, and humane. ANS THEY ALSO SPEAK INTO THE VIDEO WHY THEY HAPPILY ACCEPT THE REQUIREMENT TO LEAVE WITHIN 4 YEARS, AND WHAT THEIR PLANS WILL BE THEN.

    They will also be part of the American economy of course. Of course they can not pay back all of the generosity that we graciously give them, but they will be taxed to the highest degree realistically possible.

    II)

    My other acception is DOCTORS!!

    Homecare Philippians are a problem because they will bring their families and be a burden to us. But Doctors make a lot of money. They will give our country more than they receive.

    And we need them and we want them.

    PhD's doing medical research too.

    LONGER LIFE AND BETTER HEALTH is the one thing worthy of being important. And in vast numbers.

    The more of these people we have here the more competitive the field will be. Also we NEED them. Have you seen an emergency room lately?? Sometimes they stay there, packed one mattress against the other, for 2 whole days.

    Allow them in.

    Replies: @Opinionator

    Wouldn’t it be better to produce homegrown doctors?

  196. @Alden
    @Guy de Champlagne

    Those pocket notebooks already exist for about 30 medical jobs. They are check lists to do for any kind of patient presentation and what to do in each instance. Present presents A, do XYZ If result is B, do C

    They are the simplest manuals. They give standard practice. I got a sizeable malpractice settlement by simply going to a Borders book store and buying the orthopedic notebook for dummies. Around 9 Asian women drs didn't do what was required. That notebook of standard procedure proved they were idiots.

    Doctors and therapists often malpractice. I advise everyone to look on amazon or a barnes and noble and find the notebooks for what ever medical problem you have. There are many incompetent Drs, nurses, technicians and therapists around who don't do what they are supposed to do.

    So get those notebooks. There are many kinds. The best are called RN notebooks, LVN notebooks, Ortho notebooks, pediatrics notebooks etc.

    Point is, there are numerous manuals, but medics often don't follow standard procedure

    Replies: @Ivy

    Good advice, pursuing a variation now against an AA practitioner.

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