[cmhamill]

I'd like to add another point to this: in the case of doctors, you've also got to include the various types of doctors. (As the son of a general practitioner, I'm particularly sensitive about this.)

General practitioners make wildly less than the various specialists which abound in the medical profession. Now, GPs can certainly make a good living; in rich areas >$200,000 a year isn't uncommon. At the same time, for, say, dermatologists, >$200,000 is the average salary [1].

(I, for one, think this is backwards: GPs, both in private practices and as hospitalists, are the primary diagnosticians and almost certainly save more lives than any other kind of doctor.)

And don't even get me started on residency; doctors deserve every ounce of geld they get for putting up with that.

Anyone, not directly relevant to OP, but I think that saying, "hey, doctors and lawyers are rich, we should be too" is a bit off the mark. Many doctors are rich. Not all.

[drivingmenuts]

I'll hazard a guess that specialists tend to see patients with specific insurance-covered issues, and those issues are the expensive ones. GPs deal with everything and not all of those ailments are worth much, billing-wise, yet take the same amount of time.

Or, 1 hour of a GPs time will usually result in a lower-return ailment than a Specialists 1 hour of time.

Or the problem of the Craftsman vs. Assembly-Line Worker. It may be better product, but you can't make 'em as fast. In this case, the Assembly Line people only deal with expensive items.

[cmhamill]

Yeah, I think you're absolutely right. Insurance really drives this, too: HMOs, especially, are constantly pushing for GPs to receive less and less for a given procedure. Combined with the role insurance companies play in (effectively) deciding what a patient does or doesn't "need,* insurance post-1990 has been trying very hard to convince doctors to do a worse job.

My father, for example, had a practice for over 20 years in a small, working and lower-middle class town. He was notorious for taking patients in late and for long waiting times. And everyone wanted to see him. He was also notorious, as it were, for consistently finding and correctly diagnosing issues that other doctors failed to find. He talked to patients about the health in detail, with physicals often taking an hour or more. He would "forget" to charge folks who he knew were struggling to make ends meet.

For over ten years, this worked fine. My family was, frankly, rich, with yearly salary approaching $200,000 dollars at times. Starting in the 1990s, my father ran into HMOs, head-on, if you will. Over the next ten years, his monthly salary consistently decreases until his overhead exceeded his revenue, and was forced out of private practice.

Now, my Dad might not have been the model of an efficient capitalist, but he was a damn fine doctor. I, at least, think it's a damn shame that we live in a world where that kind of care is systematically eradicated.

So, yes, I think it is that GPs deal with "less expensive" issues, but that's also because they deal with every issue. The goal of a medical system should be to avoid entirely expensive issues. The fact that specialists are employed frequently enough (i.e., demand is high enough) that their labor is worth so much is a systematic failing of the medical system.

[drivingmenuts]

What happened to your father is just plain wrong.

Growing up, we had a family doctor that we went to for everything and he referred us to a specialist if need be, but otherwise, he handled everything (which was pretty rare, luckily).

I'm slowly trying to establish the same relationship with a new doctor here (well, technically a Nurse-Practictioner).

[mahyarm]

Why does medicine have the hazing ritual known as residency?

[jbarmash]

My wife is a physician, so let me chime in. It's not so much a hazing ritual but a very carefully constructed mentorship program. It's intense, and in some cases maybe overly so, but the goal is to immerse them into the environment, and to provide a lot of experience, while being carefully supervised by more experienced doctors. After three years of this, you come out really knowing you stuff.

In software, we don't really have structured learning like this, which is unfortunate. Something that would be great to have to really make us into a true profession.

[BerislavLopac]

Perhaps we will, once that software development has as much history and tradition as medicine does.

[velihall]

Don't we, to a small degree already? They are called implementations. Often over promised, under-staffed and under-scheduled time-wise. Long hours are spent, a truckload is learned, experience is gained, etc. Unfortunately, there doesn't seem to be a 3-year limit.

[bmelton]

That's actually fairly common in fields where mistakes can be dangerous. Most places refer to it as apprenticeship, but it's fairly common in even less glamorous trades like electrical work, carpentry, etc.

[mahyarm]

The difference as far as I know, is that apprentices have normal working hours, while residents are sleep deprived to counterproductive levels and they could be barred from becoming a doctor at the end of it. If residents had normal hours like the rest of the doctors, I wouldn't nearly be nearly as apprehensive about it.