[the_d3f4ult]

Being a physician is a horrible career move right now. As a former Math/CS major turned eye surgeon, I can't help but think about how much easier my life would be had I stuck with tech. It's hard to understand exactly how hard the job is until you've lived it. I saw 40 patient's in clinic today in 8 hours without lunch or any kind of downtime and then spent 2 hours at the hospital because a patient needed an emergent procedure. They might go blind despite my efforts and I have to live with that. I also may get sued, if they're feeling spicy, despite going to heroic lengths to help this person. My son was asleep before I got home.

There's just no reason to do the job when you can get the same compensation working remotely in tech. Looking through the "Who's Hiring" thread is soul-crushing. Physician salaries are the only ones that do not grow relative to inflation and have decreased year-on-year relative to inflation for decades.

I do believe that the rigorous training model leads to a higher quality of care and much deeper understanding of the disease process. But, why would anyone want to do the job? It's just not worth the liability anymore. That said, is anyone hiring an ophthalmologist with CS and Math degrees?

[trentnix]

I've no doubt the stress of your work is immense and the constant threat of litigation (and the expense of the insurance to fight it) can be overwhelming. As a recipient of multiple eye surgeries (I had strabismus as a kid), I am grateful for competent professionals like you. But I think you buried the lede.

In the 2010s I owned a high-end bicycle and sporting good store. It was 7 days of 10+ hours a day most weeks. And it was very nearly non-profit or barely-profit for most of its run. If you know anyone that owns a bike shop, you should give them a hug. They need it.

Nearly every Friday afternoon, just after lunch, a few of my customers who were physicians or surgeons would pull up in their Model X or Cayenne to get service for their 10k road bike they were taking to their vacation home for the weekend. On more than one occasion, one of them would exasperatedly tell me how much they envied me and how lucky I was to be doing what I "loved". As I confronted my busy, work-filled weekend cemented to the shop to deal with the fickle and spoiled public, I had to chuckle as they drove away in their luxury vehicles to their luxury vacation home with a nicer bike than my own.

In retrospect, I've concluded that the real problem they faced is they'd built a life dependent on a physician or surgeon's income. They were told they were building a castle, but instead they built a prison. The fact is, you just can't spend enough money to truly escape the stresses of your work, but you can certainly spend enough money to become shackled to it.

[haldujai]

> In retrospect, I've concluded that the real problem they faced is they'd built a life dependent on a physician or surgeon's income. They were told they were building a castle, but instead they built a prison. The fact is, you just can't spend enough money to truly escape the stresses of your work, but you can certainly spend enough money to become shackled to it.

This. All of a sudden you go from 70k/year as a senior resident to 400k/year+ as a specialist with no financial education. Add on a decade worth of burnout (especially in training but ~60% in attending physicians) and living in relative poverty (70k/year - interest on $200k in debt doesn't leave much) and you end up with a group of mostly financially illiterate people making up for lost time and depression by overspending on luxuries with their new found income.

If you can believe it I worked with people who made > 1m and started having anxiety that they couldn't cover their mortgages when covid slow-downs resulted in a 25% pay cut.

Physicians are well paid, and I don't mean to suggest otherwise, but it's a really shitty path to earn that paycheck if money is all you want out of the career considering what you give up to get there (e.g. all of your 20s and spending 5 years working 24 hour shifts every 3-4 days and 2/4 weekends) and how stressful the job can be.

Obviously this is a generalization, and no one is forcing them to overspend, but I strongly suspect an element of this spending pattern is driven by unhappiness/regrets based on interactions with colleagues. Medical training is a lot of (very) delayed gratification until you get to the end and realize it is no where near as fulfilling/satisfying as promised.

[analog31]

I know doctors who live a modest lifestyle, so it can be done. The leader of a band that I play in was an ER doctor for a while, then got a job at a walk-in care clinic, and retired at a young enough age to enjoy his retirement. During this entire time, he lived in a modest house, and mostly rode his bike to work. He lived within his means like the rest of us.

There's no law that you have to live a rich lifestyle. Part of that may be feeling the need to maintain the class status that you were born into, and that you expect your kids to be born into. Case in point, my friend came from a working class background.

[BurningFrog]

The grass is always greener in another profession, and my problems are always uniquely bad :)

[Ekaros]

I have to be honest and say working mostly in Security my pay is good enough and work is easy for me... Mostly I'm annoyed that my employer doesn't get enough projects for me...

I could be paid more, but I wonder would that be worth the extra effort.

[catchnear4321]

from over here it sure looks like mine are worse

[hotpotamus]

> They were told they were building a castle, but instead they built a prison.

The industry term is "golden handcuffs".

[chimeracoder]

> But I think you buried the lede.

> In retrospect, I've concluded that the real problem they faced is they'd built a life dependent on a physician or surgeon's income. They were told they were building a castle, but instead they built a prison. The fact is, you just can't spend enough money to truly escape the stresses of your work, but you can certainly spend enough money to become shackled to it.

I don't know why you're making the leap in assuming that, just because you knew some physicians and surgeons who seemed to be inflating their lifestyle to match a high income, that OP is necessarily doing the same. There's no indication in their post of any of that.

[trentnix]

I made the leap because of what the parent plainly stated:

> There's just no reason to do the job when you can get the same compensation working remotely in tech.

Same compensation. That’s the unique qualifier that was chosen. That’s certainly not no indication.

[giovannibonetti]

> In the 2010s...

I don't know how things are in the US, but here where I live in Brazil, my doctor friends always tell me how in medicine things aren't anymore as rosy as they were before. It seems like there has been a large increase in the supply of physicians by universities and the younger generations face way stiffer competition to move up the professional ladder than before.

[catchnear4321]

goodness gracious there is a lot to unpack here.

> As I confronted my busy, work-filled weekend cemented to the shop to deal with the fickle and spoiled public

> And it was very nearly non-profit or barely-profit for most of its run. If you know anyone that owns a bike shop, you should give them a hug. They need it.

some serious mental gymnastics to land this hypocrisy. someone else struggling differently? here’s an anecdote about how “their kind” are bad. incredible stuff.

read carefully, your comment suggests you don’t much like anyone other than bike shop owners.

maybe that’s why things felt so hard?

[trentnix]

Well Dr. Freud, I was just pointing out anecdotally that perspective is important. That’s all.

[catchnear4321]

yet your perspective seems to be that this doctor and all like them are inferior, your tone drips with it.

why do you think that is?

do you hate psychiatrists? your jump to using “Dr Freud” was rather interesting.

[weatherlite]

> There's just no reason to do the job when you can get the same compensation working remotely in tech. Looking through the "Who's Hiring" thread is soul-crushing. Physician salaries are the only ones that do not grow relative to inflation and have decreased year-on-year relative to inflation for decades.

What ? Most U.S physicians make 300K + after residency with job security set for life. The real bright ones, the "faang" doctors make close to a million. Show me anyone in tech who can have that guaranteed for him. You're basically guaranteed to join the millionaire club if you decide to work enough years even as a mediocre doctor. Yes its an extremely difficult job I have no argument there, but there's no comparison to tech in terms of compensation or job security.

[jimmydddd]

The job security issue is huge. Many of my tech and finance friends in their early 50's are getting pushed out of their jobs, while my physician friends in their 60's can keep their career as long as they want. A family member recently visited a dr. in his late 70's.

[JJMcJ]

A 50 year old physician or lawyer, if they are good, is at the absolute top of their profession and can 90% expect work another ten or twenty or more years still earning top dollar.

A 50 year old non-management programmer? Look forward to having 23 year olds asking if you know what an array is for the rest of your work life.

[dangwhy]

> A 50 year old non-management programmer? Look forward to having 23 year olds asking if you know what an array is for the rest of your work life.

Fuck. That made anxious. I am close to that age.

Also, my middle manager friends are having much harder time finding a job than programmer types. Don't know if its just them or if its a trend.

[BlackjackCF]

Don’t be anxious.

The best programmers I’ve ever worked with and deeply respect are the ones in their late 50s, early 60s. They’re unflappable when it comes to outages. They’ve seen it all. They work more sustainably and methodically to get stuff done.

[cosmodisk]

No need to. If your experience is solid, there's plenty of work for consultants. Not those types, who walk in and get told to create a CRUD app, but those who can advise on tech, its implications on the business, the risks, etc.

[moneywoes]

Any resources for finding these opportunities?

[weatherlite]

A.I is gonna change the job market so deeply I wouldn't worry much. It's futile to worry, we simply don't know what's coming we only know it will change everything.

[falters]

Quoting ('someone's on the Internet' (-) Messages I read in the last days...):

"And, because the bosses don't want to raise wages?

This is why AI hype is big right now. There's a lot of companies hoping to hawk a snake-oil 'solution' to lower productivity that doesn't require raising wages.

Given that most government accounting is single entry and most macro (-economic-solution) does not really recognise the role of money in the economy, this is in itself quite revolutionary stuff

It's pretty sickening to see how much money is allocated in developed Capitalist economies to (disturbing-kick people-) scams like AI.

On June 15 a session titled 'The New World Economy — Not Global, But Interconnected' will take place as part of the business program on the St. Petersburg International Economic Forum 2023

'It is about an authoritarian communist regime that gave up communist economic policy, but not in other segments. But... It's still a communist country'

> They were told they were building a castle, but instead they built a prison.

The industry term is 'golden handcuffs.'"

...maybe and i hope so there is something to learn from regards...

[weatherlite]

I don't agree about lawyers actually. If you haven't made it into something close to partner level or have extremely valuable knowledge and skillset you'll be seen as a liability. There's plenty of people in their late 20s to early 40s who will be preferred over you. Same goes for most jobs actually, doctors are the outliers. For now...wait till A.I makes progress in medical circles.

[singleshot_]

One fact I can add to your knowledge is that at my firm, the lawyers who have been practicing longest have the highest billable rate.

One more is that I very, very rarely ask any 29 year old lawyers at my firm any questions, although I love them dearly. When I need someone to review my work or answer a ticklish question, I seek out 72 year olds and ask them. I'm not sure who clients prefer but when it comes to legal problems I prefer elder lawyers.

[weatherlite]

Yes they are partner level. How many 50 year old lawyers has your firm hired recently? Ones who haven't advanced to partner?

[candiddevmike]

It's interesting that places value seniority and experience so much more in medicine vs tech. Things change daily in both fields--new procedures, new findings--yet tech seems to have far more ageism. Why is an older doctor so much more valuable than an older developer?

[haldujai]

I wouldn't say they're valued, the compensation is (with some nuance) based on a work-unit/fee-code which is the same for all of us. The academic component goes up for relevant physicians like it does for any professor-type role.

Doctors work longer mostly because you can't fire them unless they're negligent/incompetent (for various reasons including that most are self-employed/contractors either individually or as a group).

The only value the hospital places on seniority is that you know the local practice patterns so there's less of a learning curve as compared to someone ewer.

> Things change daily in both fields--new procedures, new findings--yet tech seems to have far more ageism.

We have continuing medical education requirements but the reality is most of medicine is designed to be easy and guideline based. Weird and wonderful stuff benefits from experience.

> Why is an older doctor so much more valuable than an older developer?

A 60 year old surgeon is still taking out an appendix, just with newer tools than when they were 30, for the same amount of money as a newer one. I would imagine an older developer would want to be more well-compensated and have career growth focusing on things like architecture or having a team but I defer to practicing developers for their input on why they're not valued.

[sarchertech]

When it comes to value, when my wife interviews for a job (she’s a physician) they fly her out and spend a day taking her to see the sights, so they convince here how great the city is. Then they take her out to a fancy dinner and woo her some more.

When I interview at a new job as a very senior engineer (and relatively well known I in my area), I get to jump through 7 rounds of interviews where someone asks me the equivalent of medschool exam questions.

If I’m lucky my connections might let me whittle the interview rounds down to 5.

There may be 20 people in any given tech stack/industry who are valued the way my wife is by employers.

[haldujai]

> When it comes to value, when my wife interviews for a job (she’s a physician) they fly her out and spend a day taking her to see the sights, so they convince here how great the city is. Then they take her out to a fancy dinner and woo her some more.

Interesting, are these in underserved areas? I just went through interviewing for a new job and despite being in an in-demand subspecialty with desperate employers the most I got was a dinner after the 2nd round interview but no one covered my travel. Do you mind if I ask what kind of physician she is? I clearly picked incorrectly.

> When I interview at a new job as a very senior engineer (and relatively well known I in my area), I get to jump through 7 rounds of interviews where someone asks me the equivalent of medschool exam questions.

> If I’m lucky my connections might let me whittle the interview rounds down to 5.

Why do you think that's the case? Is it a compensation issue or is there age-ism/an assumption that only a 25 y/o engineer can be "10x". I periodically see posts about the challenges facing older developers on HN but I didn't last long enough in tech to understand it.

[catchnear4321]

> Why is an older doctor so much more valuable than an older developer?

which would you take with you on a one way trip to a desert island?

that’s a meaningless question, it assumes their jobs are their siloed experience, and that nothing outside of job is real.

training. licensing. you can’t just go become a doctor. yes, there can be new doctors, cheaper, maybe better, maybe not. but the funnel is finite.

got a computer? or a smartphone? device with screen and input? with a little work, you’re gonna be writing code in no time. call yourself an engineer and mostly nobody gets mad that you have no license, no certification, possibly no degree. because none of that matters.

no, that isn’t capturing nuance, context, or detail. just the macro. it’s enough.

[singleshot_]

> which would you take with you on a one way trip to a desert island?

How long are we going to be there?

[catchnear4321]

well, given that it is a one way trip, that’s largely up to you and your travel companion.

[cronix]

I've heard of the "tech bro" stereotype (and seen it many times first hand), but struggle to recall a "doc bro" or equivalent one. I've also never heard of the term "culture fit" when discussing a potential hire in the medical industry like I do tech, software specifically. I wonder if the majority of the types of people who go into tech are different than the majority that go into medicine.

> It's interesting that places value seniority and experience so much more in medicine vs tech

I don't think the tech world devalues seniority as much as they despise people older than them and not of the same generation(ish).

All big generalities and of course don't fit every situation/company/person.

[streptomycin]

Stereotypically, surgeons are the doc bros.

[catchnear4321]

I, too, watched the early 2000s medical sitcom Scrubs, featuring the beloved Dr. Todd.

[treis]

And orthopedics specifically are the broiest of the doc bros

[algkkb]

“When you hear hoof beats think of horses – not zebras”. Old doctors won't catastophize and scare you as much but are in my opinion more likely to misdiagnose a rare disease.

[rs999gti]

> Why is an older doctor so much more valuable than an older developer?

The lower barrier to entry that the developer has?

[dangwhy]

> Things change daily in both fields-

This is not true ?

[ChainOfFools]

As someone in the midst of a difficult career pivot from tech to medicine, I confirm that this is the primary motivation for making the switch at this stage of my life.

[hn976827]

Difference is that in tech you can retire with 50. Few people who still work at 70 do so by choice.

[FrustratedMonky]

That is BS, a big load of BS. There are a ton of people in tech that struggle, and reach 50 just to be nearly living on the street. This thread must have a lot of top FAANG's managers posting this morning.

[hn976827]

> There are a ton of people in tech that struggle, and reach 50 just to be nearly living on the street.

In the literal sense I doubt that. If they are "nearly living on the street" then they seem to have issues handling money. Literally everybody else around then is making less and is not in the street either. Or are you saying that the lady behind the Walmart cashier or the pizza place guy or the girl moving the office lawn all make more than the tech guy? Hardly.

In the figurative sense, sure, some of them may not have a big detached single-family house with two big BMWs in front, but if anything below that is considered "nearly living on the street" then it's your perspective that needs some adjusting, not mine.

[FrustratedMonky]

Perhaps I was over-stating. But it is true, that tech people retiring at 50 and living comfortably is a real small minority, not some common occurrence like everyone in tech is swimming in gold. Living on street was hyperbole, but I do see a lot of tech people working long hours, on -call 24-7, dealing with bad bosses, all because of the 'fear' of living on the street. So maybe they aren't close to the street. And if over 50, that fear drives the 'do-whatever-it-takes-even-if-pulling-another-weekend'. It isn't some golden retirement, that is so bogus. Its like there is some assumption that everyone in tech got stock options at google.

[MichaelZuo]

An above average eye surgeon in the US with a few years of experience is the rough equivalent of a middle manager in terms of age and could be in terms of rarity.

[Mordisquitos]

So can many physicians. Furthermore, I'm willing to bet that most doctors in the 50–70 age group that continue to work do so not because they cannot retire, but rather because they do not want to retire because they find their practice fulfilling.

[hansthehorse]

Many of the doctors at the VA I go to are retired then took the VA job. They see 8 to 10 patients a day and spend between 20 to 30 minutes with each. They work 8am to 4pm and go home. On the other hand surgeons and their support staff have crazy schedules.

[haldujai]

Not true, some do (stereotypically the surgeon with 4 ex wives and children that don’t know them) but it really depends on your country/practice pattern.

On one extreme Canadian physicians are (generally) ineligible for pension/retirement benefits. Many US private practice jobs are the same. Academic US jobs usually have some form of retirement support.

Add in the opportunity cost of not earning income until you’re 30+ as well as loans and I don’t think it’s a fair characterization to say “most physicians in the 50-70 age range want to work”, especially full time and considering burnout rates of ~50-60%.

Can’t speak about Europe which has very different compensation structure and debt burden.

[sarchertech]

> Many US private practice jobs are the same.

Where are you getting this from? The vast majority of doctors have access to the same kinds of fixed benefit retirement plans as people in other industries have.

[Spooky23]

If you got on the FANG train around the time they dropped the standards and kept the comp going.

Tech is boom/bust. Ask a grandpa who worked for DEC in the 80s how that worked out for him.

[8b16380d]

That’s not true at all.

[chimeracoder]

> What ? Most U.S physicians make 300K + after residency

Most US physicians also pay for a lot of work-related expenses out-of-pocket (insurance, continuing ed, etc), and due to the nature of tax codes, most that often is not actually deductible in practice (particularly since they'll usually end up paying AMT).

There's a lot of variance depending on which specialty you choose and where you work, but as a point of reference: most new attending physicians in metro areas are actually netting less than an engineer in the same area who has been working since graduating college[0]. (And that's before you factor in any student debt, or the opportunity cost of forgoing ~10 years of gainful employment).

> with job security set for life.

May have been true 40 years ago, but definitely not true today, especially for certain fields.

[0] If two people graduate college at the same time, and one goes into medicine and the other goes to work as an engineer, the engineer will easily reach career level (senior) by the time the other person is done with their residency.

[nradov]

All true, but the unemployment rate for licensed physicians is virtually zero. They can always find some kind of job, although they might have to move somewhere undesirable.

[PheonixPharts]

Even now 300k TC is pretty easy to get for any competent engineer wanting to work for a publicly traded company that can get comp in RSUs.

It's also very easy to get a 200k+ remote eng job, even now, that will allow you to spend as much time with your family as you like, rarely have you working past 5pm, and working in predictable, relatively low stress (potentially fun!) problems all day.

The job security is a good point, but job security isn't as meaningful for extremely high stress jobs since the risk of burnout is much higher. Doesn't matter if it's easy to get work if you find that work destroying your personal life.

[soared]

Your circle of 2/300k engineers does not represent average people. 99% of Americans should not be able to get a faang job even if the exact park was laid in front of them before college.

[PheonixPharts]

I have never worked for a FAANG company, or anything close, and can usually not get in the front door at any "prestigious" company.

In my last round of interviews nearly all startups/small companies I talked to where offering 200k+ for remote senior engineers. It's not hard to break 200k remote as a software engineer.

If you're not there I highly recommend you start looking around, even in this market, rather than simply dismissing this comp as "prestigious faang only". Personally I think the 500k+ TCs are going to disappear for all but the rarest of cases (this is closer to what FAANG engs that I know make), but 200k+ is likely to be the baseline for the foreseeable future for experienced software engineers.

[candiddevmike]

I do hiring for small companies, no one is paying that much. 130-150k is base for seniors. Also seeing a decrease in US based developer jobs, lots of offshoring happening. I'm halfway considering moving to Costa Rica and running a firm down there.

[PheonixPharts]

They must be very small because I don't know of anyone hiring senior devs in that range. Even those smaller, early stage companies I know are offering at least 150-190k base, and they struggle to hire.

However if you're dealing with dev roles that are being actively outsourced I suspect you're dealing with an entirely different class of software jobs.

[VirusNewbie]

Do you make 300k? You said it was “easy to get” so surely you’re above that?

[PheonixPharts]

Yes and so do all of my teammates and every senior engineer at a publicly traded company you've likely never heard of.

Again it's pretty standard anywhere in tech right now, startup or otherwise, to get 200k base + equity. Technically most startups I've chatted with also offer 300k+ TC... but that assumes the equity component eventually becomes liquid.

Around 200k base is very easy to get anywhere right now, and getting larger than that is a factor of how liquid your equity is. If you join a publicly traded company you should easily be able to get 200k base + 100k/year of RSUs

And to be clear: I'm talking about Senior Engineer level in the US. Most of these roles I've looked at are remote so the NY/SV part is not necessary.

edit: your profile says you work at a FAANG so this should be old news for you.

[jandrewrogers]

FWIW, 200-300k is not that uncommon far outside of FAANG or the usual tech cities for experienced senior engineers with current skills. We are not even talking startups necessarily but boring industrials and other companies no one thinks of as tech companies. Every large business is being forced to be much tech savvier and this reality has diffused high-paying tech jobs among a much wider range of companies and locales.

You are correct on one point: most Americans don't have the skills for these jobs. That is why these jobs pay so well, almost definitionally.

[foobiekr]

It is trivial, in the US, for someone to work at the older large tech companies and get over $300k just by staying in the job. Your typical SWEIII is making $220k base with a 20% bonus and gets roughly 50k/3 RSU grants each year. After 3 years, that's $50k annual due to stacking. This for relatively easy big company roles, and not even lead.

[wonderwonder]

To be fair, I think op was referring to engineers specifically. You don't need Faang to make 200k as a sr. Look at non tech focused fortune 500 companies. 200k is available to sr engineers, even remote if US based

[foobiekr]

Exactly. Longevity is much greater outside of tech.

[trashface]

This viewpoint is just plain crazy. If you worked in tech you'd be totally disposable, just like all the rest of us programming drones. Hit 40-50 and boom, unless you've transitioned into management, suddenly no one wants to hire you, or if they do its half of what you were making before.

Your MD degree and the AMA literally writing laws on your behalf limits labor supply competition like nothing in tech. You may have noted 250K+ tech layoffs in last year or so. Many of those people could probably code circles around you. Where are the physician layoffs? There aren't any.

If you want fewer hours, work fewer hours. What are they going to do, fire you? They can't. There is a shortage as this notes.

[haldujai]

Physicians are disposable too, look at what happened with primary care, nephrology, anesthesia and is starting in radiology where private equity firms move in and outsource physician care to allied health professions and create an “eat what you kill environment”.

In other countries like Canada it’s also near impossible to get a job in a surgical specialty (and until 2 years ago other ones like radiology), especially in a desirable city despite huge shortages and backlogs because our jobs use a lot of expensive resources.

> If you want fewer hours, work fewer hours. What are they going to do, fire you? They can't.

They can, many jobs set a minimum FTE you can work.

They also reduce fee codes (with a system known as relative value units/RVUs) so you have to work harder to make the same money. We’re at the mercy of payers in US/Can.

My specialty (radiology) has had work-unit compensation periodically slashed over the last 10 years (20-30%) that’s been offset by reading more cases (and to a lesser extent technological advances making reading faster although studies have gotten far more complicated to read with modern treatments).

There’s also the increasing clinical demand and generally caring about the humans on the other end. I don’t want to read 50-90 CT scans on a ER shift but I have to because the studies are being ordered, the patients need their reports, and we don’t have enough radiologists.

[djmips]

The grass is always greener. Most Canadian software engineers are getting paid much less for the same work as across the border. Currently there are layoffs, hiring freezes and pay increase freezes. Canadian software engineers make less than doctors. FAANG salaries are a thing but you have to be willing to move to the US in order to attempt to achieve that.

[haldujai]

Yes, if you consider non NYC/SV salaries physicians come out ahead in the vast majority of cases, we earn more or less the same no matter where we live.

I’m happy with my compensation but I’m also happy with my job/not optimizing solely for it. My point is that if I was I would have chosen a different career.

I also left Canada to make less in the US as a physician because I wanted more work/life balance and not to be working in a system constantly on the brink of collapse. The hospital I trained at was on “life or limb critical capacity” so often I had to set up an e-mail filter to send it to my junk.

Speaking of hiring freezes, from 2010-2020 the only jobs for radiologists were in small towns or undesirable locations, it’s better now for rads. Most surgeons and proceduralists (cardiology being a horrible one) still can’t find jobs in major metros without 2+ fellowships and at least one somewhere prestigious. It’s still hard with that.

As in all things, it really depends what you want in life. But if you have the aptitude to reach the highest levels of physician income and have mobility you’re probably skilled enough to have done the same in other professions (e.g. finance, software) with an easier (physically speaking) path and less opportunity cost.

[moneywoes]

Any reading on these PE driven radiology changes?

[wrp]

This needs explanation. If there is such an extreme shortage of talent, why can't doctors demand better terms, e.g. shorter hours?

[haldujai]

Sometimes they do, look at the UK strike for an example although the environment here is no where near as toxic.

One of the shortage issues is that it takes 9-12 years to train a specialty physician. For example we need more radiologists today but we can’t fix that until we increase residency spots which won’t impact the job market for 6 years so until then I’m reading more than I want to, even though I’d gladly work less for less total compensation.

Someone has to do the work though and I can’t just say “not me” and leave the studies unreported. There is a human on the other end who needs care.

[LadyCailin]

They can, just not alone. If they were to unionize in sufficient numbers, there would be nothing to do but meet the demands. But “unions are bad” is the prevailing belief in the US, not to mention the huge amount of efforts that companies and the government go through to suppress them.

[nradov]

Many physicians still work in sole proprietorships or partnerships. From an employment perspective they are management, not labor.

Some physicians working as employees of large provider organizations are unionized. The government doesn't do anything to suppress this. Rather the opposite.

https://jamanetwork.com/journals/jama/article-abstract/27949...

[MichaelZuo]

This is what I don't get, if there was such an extreme shortage then the average visit to a family doctor should cost hundreds of dollars.

[moneywoes]

Curious, are there any other fields with laws built to limit competition. Lawyers?

[carabiner]

> That said, is anyone hiring an ophthalmologist with CS and Math degrees?

As someone who recently transitioned to a tech role, I'd urge you to focus on applying to companies related to your existing fields (ophthalmology, medicine, surgery, and their derivatives) who happen to be seeking SWE's, rather than general tech companies. Especially Series A, B, C startups. Look up all the companies that make your equipment or the software that you use, and go to their jobs pages. See anything that is tech or tech adjacent: swe, swe test, qa engineer, automation engineer, data engineer, anything mentioning python or javascript. The job market is the worst in 20 years and so the only companies that gave me the light of day were the ones in my previous field (energy and mechanical engineering).

[FrustratedMonky]

This. This is best advice. I can't imagine there isn't some software company that could use a doctor-SWE combo. Usually SWE struggle not knowing the subject matter they are coding about. It is the subject matter experts that they need.

[iancmceachern]

This, I work with these people all day. There are tons of medical device and medtech companies that need people with both medical and technical backgrounds.

[haldujai]

Even large corporations, Matt Lungren is a notable radiologist with a tech background and was hired at AWS and is now CMIO at Microsoft + Nuance.

[nradov]

Companies in the healthcare technology space typically prefer to hire physicians as product managers rather than engineers. There's a shortage of product managers who understand clinical workflows. Lots of job openings.

[xvedejas]

The biggest complaint I always hear from people in the medical field is the long hours. It sure sounds to me like that (and thus any knock-on problems) could be solved by more practitioners, spreading the work around. I can't speak for you, but personally, a proper work-life balance in comparison to these horror stories is surely worth a possible salary cut?

[lostlogin]

> It sure sounds to me like that (and thus any knock-on problems) could be solved by more practitioners, spreading the work around.

Sort of. The equipment is so expensive that the actual solution is usually to work the rooms and equipment harder. Night shifts, early starts and evening work are actually shit.

[whimsicalism]

That makes no sense, if the capital is expensive then you should hire more labor.

[lostlogin]

That is literally what I'm saying. Staff are worked harder as shifts are introduced. It is not a nice way to work. Sure, it helps reduce the number of patients, but it destroys work/life balance and that is what the OP was raising as an issue.

It is also hard to get patients to agree to having tests done at 5am or 9pm, so it's a case of diminishing returns. The staff penal rates go up too, so the squeeze comes from all sorts of directions.

[greiskul]

> It is also hard to get patients to agree to having tests done at 5am or 9pm, so it's a case of diminishing returns.

In the US? With health care prices as they are? There are people that travel to entirely other countries for access to health. I'm plenty sure lots wouldn't mind at all to have an exam at 9pm if it meant it was way cheaper.

[lostlogin]

New Zealand. The issue is that the reimbursement is the same whenever the scan is done, but staffing costs more at night (so scans kind of need to cost more at night).

Reading what an MRI costs in the US, I do wonder if a trip to NZ for the scan would actually be cheaper.

[shadowofneptune]

The question is what you are angling for. If your goal is, sincerely, to provide better service, then you won't get it. Keep in mind that with so many patients nowadays being eligible for Medicare, the money will come in anyway. Nursing homes got the brunt of the attention for their quality of care, but with hospitals facing the same population the same management techniques come too.

I work as a nurse on nights and everything said above has been quite accurate. A textbook understanding of... well anything really, does not serve someone well now.

EDIT: Also these companies now often run pharmacies, investment systems, healthcare programs... patient care is by no means the biggest earner.

[throwaway173738]

> EDIT: Also these companies now often run pharmacies, investment systems, healthcare programs... patient care is by no means the biggest earner.

Are you referring to companies like Optum in the US?

They own entire medical systems(Everett Clinic in Washington), an insurance company(United Healthcare), and a pharmacy(Optum Rx) as subsidiaries so if there’s a problem everyone can point fingers and nothing gets done. This seems to be the new model for healthcare in the US.

[shadowofneptune]

Optum is an extreme example, but it's all of them. The non-profits run the same as the for-profits, and have converged more and more since 2000 or so.

[2b3a51]

UK: there was a proposal to introduce weekend surgery to make better use of operating theatres. The problem is staffing the facilities. Lead times on training people are long. And in UK the training process is not cheap and has significant up-front costs for the people being trained. Nurses as well as surgeons.

We used to have bursaries to cover the cost of training for nurses, but, austerity and all.

[Retric]

That seems backwards, unless you also need to be preforming more surgeries and thus need more people. Instead reduce the number of operating theaters while keeping a similar number of people. Net result same amount of operations, but lower capital expenditure.

Of course you now need to pay people more to be working in the weekends, but that’s a different question.

[2b3a51]

Yes, the UK needs more surgery capacity.

[whimsicalism]

If you are unable to supply enough surgeons for the surgeries people actually need, something has gone terribly wrong with your price signaling mechanism.

Perhaps this is a problem with the UK system.

[lostlogin]

> Perhaps this is a problem with the UK system.

It’s a problem everywhere isn’t it? There aren’t enough surgeons and the price is too high.

[haldujai]

The expensive labor isn’t physicians and infrastructure/capital expenditures aren’t the barrier either.

It’s nursing costs and bed counts.

Look at Canada for an example, we have unemployed surgeons and interventional radiologists/cardiologists with surgical backlogs > 1 year.

We have the rooms, the hospital I trained at had 90 operating rooms but only 4 are funded for after-hours and on weekends, the rest run 8am-4am but no nursing money for the OR, recovery room, or patient wards.

[whimsicalism]

Research indicates the "unemployed surgeon" problem in Canada is more folklore than reality. [0] AFAICT, Canada has a shortage of physicians. [1] That unemployed people exist at all is not evidence that there is no labor crunch.

[0]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5866140/ [1]: https://www.cbc.ca/news/politics/canada-turning-away-home-gr...

That you are not running these rooms as much as possible indicates some failure in pricing/profit seeking, but I have no idea how the Canadian medical system works.

[haldujai]

From the Royal College (our specialty accreditation society)[0]:

> 11-18% of newly certified specialists cannot find work at the time of their certification.

> 75% of those who are continuing training do so because they think this will make them more employable.

[0] https://www.royalcollege.ca/ca/en/health-policy/building-med...

From your first reference:

> Traditional unemployment is rare; underemployment is not.

> Eleven per cent of the cohort described themselves as primarily locum surgeons. When asked why they did locums, the most common responses were “waiting for a job to open up at locum site” (46%) followed by “could not get the staff job that I wanted” (23%).

It's not unemployment in the traditional sense, in the medical community it looks like a liver surgeon (2 years of extra training) doing appendectomies in a small town or a neurosurgeon forced into only doing spine work (both need monitored beds +/- ICU). Or doing multiple fellowships until you find something.

Sure you can work as a locum (temp) or go to [very undesirable location doing general work] if you're in a specialty like general surgery that allows for that kind of practice environment. Tough luck if you're a cardiac surgeon/interventional cardiologist or oncologic subspecialist of any kind that needs high nursing support, inpatient beds and expensive instruments.

Note that these training positions are mostly all funded by the government in Canada and allocated based on their needs assessment (so it's not people choosing some unemployable niche by choice per se).

> AFAICT, Canada has a shortage of physicians.

We have a shortage of primary care physicians (because no one wants to do it), we have enough specialists by body count but no jobs/rooms for them (see underemployment points and how many go to the US).

> I have no idea how the Canadian medical system works.

Hospitals are run by the provincial governments. Physician compensation also comes from the same ministry but not out of the hospital's budget with "fixed professional fees" set by the single payer.

> That you are not running these rooms as much as possible indicates some failure in pricing/profit seeking

This has truth to it, the hospital's incentive is to prioritize their budget and they have little incentive to maximize throughput.

Due to funding nuances they're essentially incentivized to prioritize acute/emergent care (which gets some extra $) and have less throughput for things with consumables (like procedures) that come out of the hospital's budget.

It's pretty common for Canadian surgeons to admit someone to facilitate a surgery so we can use an "emergency OR room" even though they don't need the bed. Entirely wasteful but from the hospital's perspective the bed is paid for (we're constantly at capacity, there's no reality where a bed is unused) and a broken bone admitted unnecessarily doesn't cost anything extra as they don't particularly need nursing or have nearly as many consumable costs like a person hospitalized for acute illness.

[FrustratedMonky]

Think that is the point. If their is expense equipment, high capital. Then companies will try to maximize the current labor first, grind them down, before taking the leap to hire more labor. Like running 2, 10 hour shifts, with few hours downtime, will be better than running 3, 8 hour shifts, at 24 hour uptime. The incentive is to stretch labor head count out, before adding more.

[matheusmoreira]

> more practitioners

His other complaint was about the stagnant wages. More doctors will only compound that problem.

[Traubenfuchs]

Your income is relatively insane (multiple 100k), you have ultimate job security even in old age, opening a private practice makes your income essentially open ended depending on how much hard work you put in, you can help your loved ones and yourself to better navigate health care, will always receive priority treatment and probably have the job with the highest social standing that exists.

I don‘t know what it is with doctors world wide having zero awareness of their maximum privilege and zero perspective on how their average and median fellow citizens do.

Yes it‘s hard, but so are many, many other jobs you don‘t hear much about.

[iancmceachern]

Like farmers

[smarmgoblin]

I dropped out of an MD/PhD program after I passed Step 1, it’s hard to articulate exactly how it felt staring down the barrel of a career in medicine but this is sort of what I feared.

Since I’ve been in tech I’ve been laid off several times, and it’s not clear that compensation or demand will always be as hot as it is right now. I’m not complaining but if you take any satisfaction in actually helping people, there’s a real possibility you won’t find that anymore.

That said, you have options. If you’re willing to work at a junior or mid-level role, companies probably won’t care much what you did before. Maybe wait til the next boom in hiring happens, jump on the hype train. With your technical skills there’s probably some very unique research roles you could fill if you’re interested in that lifestyle — although the compensation is not super appealing. If it doesn’t work out, I feel like you could go back to surgery right?

[matheusmoreira]

> it’s hard to articulate exactly how it felt staring down the barrel of a career in medicine

Yeah. I used to enjoy this blog, written by a person who hated US medical school:

https://web.archive.org/web/20101218031844/http://www.medsch...

[SamoyedFurFluff]

> That said, is anyone hiring an ophthalmologist with CS and Math degrees?

I’m surprised you can’t leverage this into a product role or a consulting role for startups in the medical space. You know shit about med systems!!

[SongofEarth]

It can be really hard to leverage this combination of skills, the demand for cross-discipline talents is usually much lower than for a single skill set, but also much deeper when the demand exists, it's going to take some serious searching to find a match but likely it's worth it. There was HN post about working with radiologists when building a AI diagnosis company:

https://news.ycombinator.com/item?id=36111596

May be try talk to some similar AI companies is a good idea, at this time the pay can be really good.

[throwaway173738]

In the US medical device companies usually have a board of practitioners to give advice about the state of the art and the challenges with existing practice in the field. You can also start building your own device or system and plan to sell it, but you should find someone to consult on how to lobby the FDA and CMS as early as possible, because some devices get stuck in De Novo or PMA for years, and that’s a big risk to take. You’ll also need to have a long term plan for how the company will grow as you get closer to regulatory approval. A “product role” in these companies is very heavy on managing regulatory approval and making sure the company doesn’t get sued.

[lostlogin]

I know an eye surgeon who wrote a piece of software that streamlined the referral process for cataract surgery.

It’s a seriously big deal in his world.

When domain experts write make their own tools, the results are so much better than when an outsider does it for them.

[moneywoes]

Curious if you have a link

[NemoNobody]

I understand your situation - it's all of our lives too. Nobody that works for a living has had a raise compared to inflation, all of us have less than we ought to.

Tech is a terrible place to be employed right now - at least you will still have a job for the foreseeable future.

Plus, if your income is around the average eye surgeon salaries in the US (250k-300k according to some random website) - your income places you in the 97th percentile.

I'm not saying you should suck it up and deal with it - not at all, this is wrong and you feel the way you do for a reason. It isn't your fault anymore than it's someone's fault for getting stuck at a dead end job.

We are all in the same boat... except for those in super yachts.

The truth is simply that most people are far worse off than you. Except for the billionaires, we are all poor.

[epicureanideal]

> Physician salaries are the only ones that do not grow relative to inflation

Same has been happening to software engineers for the last 10 years at least. Salaries go up but not as fast as inflation.

I’ve gotten higher titles and more responsibility over the years but inflation is still winning compared to 5+ years ago.

> That said, is anyone hiring an ophthalmologist with CS and Math degrees?

As soon as the job market recovers I think you’ll have no problem finding a job in software.

[TheCoelacanth]

Last 10 years? You must be joking. Software engineer salaries have done much better than inflation over the past ten years. If yours personally hasn't, you should have been asking for a raise or looking for a new job.

Over the past one year, they've probably done worse.

[epicureanideal]

Do you have some statistics for this? Also, most of the inflationary damage was done in the last 3 years.

Unless 10 years ago you started at a very low salary I don’t think they’ve gone up significantly after inflation. If you were already a senior engineer 10 years ago for example.

[latency-guy2]

Use BLS. Compensation for the average employee profile of "Software Developer" has far exceeded inflation.

I can't remember the exact timeframe, but roughly 2016 - 2022, salary for the profile of Developer has gone from ~$86k to ~$130k mean. I think that beats inflation quite significantly.

[epicureanideal]

Ok, so that fits with what I'm noticing among my peers. The lower and middle salary range of developers is continuing to increase, but not a lot ($86k in 2016 is equivalent to $110k now), whereas the high end is not increasing very much or is losing to inflation slightly (people who were already earning $150-200k or more base salary in 2016, the start of the reference range you mentioned).

[brutusborn]

Same has been happening to all labour. At least in Aus I think labour’s share has been going down since the 80s

[s1artibartfast]

Look at medical device and pharma companies with a strong optha pipeline.

I work with maybe 2 dozen retinal surgeons, and it seems like a pretty cushy gig. High 6 figure salary, mostly working from home, providing input for clinical trials and product development. Some do it part time and still maintain private practices.

[hn976827]

> Physician salaries are the only ones that do not grow relative to inflation

Spoken with the true conviction of a position of privilege, and blinded by the very same. (No pun intended.)

Hint: The majority of U.S. citizens have it worse than you.

[throwaway173738]

So what? Making a doctor’s life better doesn’t preclude making everyone else’s life better. I think we should buoy everyone who isn’t in the capital class. This crab bucket mentality has got to go.

[hn976827]

Totally. The criticism was that the post responded to literally claimed that physicians have it worst of all since everybody elses compensation has been growing more than inflation. Which is just nonsense.

[mixmastamyk]

> soul-crushing tech salaries

No one really gets those (statistically). I never did, despite being great at what I do. Basically a lottery system where the one lucky person who did the same exact problem two days ago wins.

[speakfreely]

I've found it's really about your negotiation and your confidence to ask for it. I've hired software engineers and frequently talk with others who do hiring, and I can confirm there's plenty of people who are making $120-140k who could've come in at $160-180k+ just by asking for it.

[mixmastamyk]

Sure, but doc is most likely talking about the $300k folks with 500k TCO at BigTech. Not the ones slaving away at Initrode.

[nostrademons]

Tech is temporary, though. The reason salaries (and profits) are so high is because tech companies, when successful, displace whole industries and capture the revenue in a more labor-efficient way. But once the industry has been displaced, you don't need the software engineers anymore. Eventually the tech company becomes a dinosaur that the finance department milks for profits and share buybacks, and then gets replaced by a younger, hotter tech company.

If you ask 40+ year old software engineers, the biggest problem with the profession is the need to re-train every 5-10 years or face obsolescence. I'm in my early 40s, been doing this 20 years, and I've re-trained 4 times on new technology before finally switching into management. I just had an emergency medical procedure done. My surgeon graduated medical school in 1981, before I was born. He's able to learn one set of skills and then keep milking it for 40+ years.

[akkartik]

This whole comment needs a big "citation required". It's all anecdotes and speculation.

Tech displaces industries, yes, but in the history of tech there has never been a company that stopped needing software engineers.

If you ask your surgeon he'll tell you how many times he feels he's retrained in his 40 year career. It's not going to be 0.

And don't your two paragraphs contradict each other? Isn't the need to retrain every 5-10 years a big sign that software engineers are not going anywhere?

I would agree with everything you wrote if it was prescriptive rather than normative. I would like software engineers to work themselves out of a job. And I'd like technology to be stable so we can focus on something besides the tech aspect of a company. But that seems poles apart from the world we live in.

[haldujai]

I agree, I left a FAANG and startup to pursue medicine (not that finances were my motivation) and my co-founder who went back to a FAANG is earning more than most physicians now.

I’m far removed from this work environment now but at 10 years of SWE in a FAANG one seems to be making ~$350k-400k in total compensation? Not sure how many make it to L6 or higher, I defer to other commenters here.

If you consider the competitiveness of high earning jobs (especially in desirable markets, probably the top 20% of candidates), the opportunity cost during a decade of training I would imagine a similar %ile candidate in CS would be making more in major cities.

With that said physician income is relatively similar in metro vs cheaper COL areas so if you wanted to work in non-tech cities or smaller metros specialty physicians would probably make more.

With that said, with the hours and work intensity I put in now I could probably do 2 FTE SWE jobs (at least comparing to what it was like 10+ years ago).

[VirusNewbie]

Most people cannot last 10 years in FAANG. It’s up or out.

[MichaelZuo]

It's a pretty reasonable expectation for the 95th percentile. IDK how that translates to surgeons, maybe 70th-80th percentile?

[haldujai]

Hard to compare, the "high-income" specialties are either brutally intense (e.g. neurosurgery, cardiac surgery, vascular surgery), competitive (plastics, derm, radiology) or both (ortho).

The competitive ones are variable with ~50-80% match rates for US MD graduates. Generally hard to get employed in desirable markets (especially NYC, LA, SF, Boston) unless you trained around there so the "desirable" programs are harder to match to but numbers aren't released. Some residency programs are toxic dumpster fires.

Attrition is hard to gauge because once you're in you're kinda stuck due to loans, sunken cost etc. Completely made-up but I would consider any of the intense specialties to represent at least the top 10%ile of physicians for a combination of aptitude and work-ethic/masochism.

[djmips]

But is that high paid era over?

[haldujai]

Could be. Could also happen in medicine (many think the golden era for compensation is nearing its end)

A decade ago nephrologists in a dialysis unit were making high 6 figures until private-equity moved in and now they make 1-200k.

[dsr_]

"I saw 40 patient's in clinic today in 8 hours without lunch or any kind of downtime"

You want to give better care to patients, which means more time per visit and at least three breaks per day (morning, lunch and afternoon). You want to have more coworkers so that you can have consistent on-call work. Increasing the quality of your life-work balance will improve the quality of your work.

As a resident, you likely did 24 hour shifts -- or worse. That was just hazing: nobody does their best work while sleep-deprived, and training in it doesn't improve things. You need reform throughout the system.

You need a union. And one of the things that union needs to focus on is getting more people into this line of work.

[FredPret]

Just as an aside, I imagine there would be cool medical device startups working on smart glasses / artificial eyes.

They probably wouldn’t even advertise for an ophthalmologist/ CS / Math person, because I think there’s probably only the one of you!

[rcarr]

With the rise of AR/VR this guy could probably make bank in the coming years.

[theGnuMe]

>That said, is anyone hiring an ophthalmologist with CS and Math degrees?

I mean there's a bunch of AI stuff/hype now, you could probably find something if you want to leverage your MD? I imagine you'd have a lot of insight into what would actually work well in practice and improve outcomes.

I just skimmed your comment history, so you already know about AI diagnostics e.g. https://health.google/caregivers/arda/

And worldcoin probably needs an opthamologist who can help ensure the retina id scans are stable... there are also a lot of retina scan companies anyway for digital identification that probably need an opthamologist. It may be as simple as keeping a set of scans over time so you reauthenticate in person and get your token updated like when you get a passport renewed for example. But maybe there's other stuff like preventing adversarial attacks.

Or maybe robotic surgery? Or maybe start your own? You might be able to patent something even.

This being HN, the world is your oyster and all.

[catchnear4321]

> But, why would anyone want to do the job?

> I do believe that the rigorous training model leads to a higher quality of care and much deeper understanding of the disease process.

you somewhat answer your own question in the prior sentence. maybe not want, maybe called, or cared, maybe something else. not that it is binding or permanent, not that it should be.

but for all of the words spent about how it is a bad choice, how it has harmed you directly, how the money isn’t great, you’re bringing up positives, for patients.

you sound burned out. that’s not a criticism, nor should it be a badge of honor. maybe i have totally misjudged, but the career choice doesn’t sound like a purely financial decision for you.

even if not, even if i misjudge this, you, you did that ten hour plus death march. you gave your best efforts though that patient may go blind anyway, though they may feel punitive about it towards you.

you still did it. someone had to. by your own words, the patient NEEDED the procedure. you needed to go home, and be with family.

the patient got the procedure.

in case no one else has said it, or joining in with anyone that already has:

thank you, stranger.

[Pigalowda]

You’re on the wrong forum to complain about the medical field. These SWE think you’re a privileged complaining brat (ironic) who breezed through the 15 years of school and training and don’t deserve anything but disrespect. You’re part of the medical cartel and for the most part, they despise you. Your salary is deemed too high and you are expensive overhead that needs to be decreased - hence the outrage and popularity of these articles here.

You must know this? Have you not seen their comments on HN medical threads? So vocal and often horribly wrong it would be comical if it wasn’t so depressing.

I’m not going to one up you with my own sob story, but it’s like you say for all of us everywhere in the US - but you can really only complain to other MDs. Outsiders will demand you work more, get paid less, get sued more, and grovel. They hate us, so don’t complain to them. In the end they will get what they want - automated service by LLM combined with other diagnostic software and nursing. They will then complain for the return of the human physician. It’s so typical.

You are perfectly suited to giving them automated service. Just spitballing and probably wrong - have an optho specific app with an LLM and maybe a plug in smart phone device that has object detection/instance segmentation for diabetic retinopathy. Cataracts detection might be secondary? There’s plenty of products for retinopathy and looks like Inception networks do fine for cataracts. Other eye pathologies that are easily visually diagnosed are on the table too. Why see 40 patients when you could see 150 and the LLM/app have done the referral, initial screening questionnaire, and your nurses/MAs write your note/rx/orders etc. Ideally you should be like a dentist (they clearly figured this out already). You walk into the patient’s room do a quick eye exam, say what needs to happen, don’t answer any questions, and walk out. They hate you already anyways, might as well lean into it.

- Currently an imaging fellow in the cartel.

[belmarca]

Becoming a physician is a choice. Choosing your specialty is a choice as well (to an extent). Staying a physician is also a choice. And an immense privilege.

I have great respect for physicians I have worked with in IT for years. However I do not have patience for this sort of argument. You can always find another job if you'd like to, like everybody else. And unlike the majority of the population, you can set yourself up to have the financial freedom to do so.

No "sane" person "hates" doctors. They just don't pity them.

---

BTW, the tech FOMO is just FOMO. Grass is greener. Software engineering can be very exciting (just like medicine), but also very boring (just like medicine). Compensation is a really bad metric. If you value your time off, then don't become a physician. Sounds to me like some people just can't ever be fulfilled (usually the more privileged)!

[MobiusHorizons]

In my experience, most of the outrage against the medical system is that it is so expensive, and has such variable outcomes. I don’t think overworking doctors (even more than they already are) is the solution, but I do feel something has to give. What do you think is the problem. What could be productively changed that would make access to healthcare more affordable?

[nradov]

The simplest thing we could do to make access to healthcare more affordable is that Congress could increase Medicare funding for residency program slots. That would boost the number of practicing physicians within a few years.

https://savegme.org/

[iancmceachern]

The simplest thing they could do would be to get rid of insurance companies. They add no value to the system, but take plenty

[haldujai]

I remain optimistic that some people here are open to learning so I still try sometimes.

- Also a radiologist who gets told I’m egregiously overpaid when [insert immature AI tech] can definitely do my job better.

[Pigalowda]

I am not optimistic here. This is the lion’s den - I’m here to see what the predators have in store for us. Back in early residency it exposed me to CNN and real time object detectors and a co-resident and I made a little proof of concept app that detects ICD/PM on CXR.

So I think there’s value to me here - just no value in proselytizing and apologetics. They don’t like us and are here to eliminate us.

[haldujai]

I don’t view it as adversarial. I’ve had productive conversations on HN including some which gave me NLP approaches I hadn’t considered.

Engineers (including myself when I had a health-tech startup before my MD) tend to misunderstand the problem space (simply put they consider radiology a classification task and assume ground truth labels exist/are even possible like for object recognition) so it seems easy to them, but I don’t believe the intent is nefarious.

Perhaps it’s my naivety but I think most smart people at least partly care at improving society on some level (even if they want to make a lot of money doing it) and the physician-services budget is a large line-item that seems like an easy target rather than the ??? to improve inefficiencies and outcomes.

Without a doubt the AI-enabled radiologist will render the non-AI rad obsolete but it won’t replace our profession. I don’t believe anyone with the skillset and experience in the relevant AI tech believes that it will eliminate radiologists (other than maybe Hinton), certainly isn’t the attitude of the pure CS supervisors I’ve had in my training (or the folks I collaborate with now).

[speakfreely]

> They don’t like us and are here to eliminate us.

Don't take it personally. They're even trying to eliminate themselves [0].

[0] https://github.com/features/copilot

[labcomputer]

Cry me a river. How horrible it must be to have perfect job security, as close as you can get to tenure, unless you massively fuck up. Oh, and an automatic 1% salary.

> but you can really only complain to other MDs. Outsiders will demand you work more, get paid less, get sued more, and grovel.

Oh yes, this is exactly what I want. I don't care about anything my GP does, except whether they kiss my feet when I schedule an appointment. How do you know me so well?

[noleetcode]

Would you be willing to share your story of how you made the switch? CS major here considering going into medicine (despite your best efforts to convince otherwise :) ) but the general coursework wasn't something I targeted in school all those many years ago.

[mvanlonden]

We’re hiring founding engineers at Develop Health! https://jobs.lever.co/develophealth.io?utm_source=hackernews...

[iancmceachern]

Yes! The prior authorization process is so broken! I've been battling Blie Shield for months in a effort to fix theirs

[aiphex]

This might sound crude, but a man who becomes a physician (and especially a surgeon) gets his pick of the most attractive mates as well as a high social status for life. That's pretty strong motivation for many.

[singleshot_]

Respectfully, the "reason to do the job" is that you help people see. That's pretty cool. I understand the rest of the experience is pretty poor, but you do have a pretty fair amount of "helping people" potential at work.

If you worked in tech, you could help people see... advertisements. That's potentially more lucrative but it's gotta be depressing after a life of that to reflect on one's life work.

[GiorgioG]

I know this probably won’t make you feel better because you know this, but you’re actually making a huge impact on the quality of people’s lives. I work in tech (though not at a FAANG company) and my wife decided to go back to school (now that the kids are relatively self-sufficient) and she is hospice nurse. She gets home exhausted from 13-14 hour shifts. Having said that she feels so much more satisfaction than I ever have writing code to update a value in a database.

[TacticalCoder]

I've got friends and family that are physicians and they also work a lot. They're in the EU so at least the "getting sued" part is close to non-existent (there's still a risk but typically only if there's a real fuckup). At least one of them also complain that the job isn't paid well enough and that the job kinda lost some of its luster.

But...

> There's just no reason to do the job when you can get the same compensation working remotely in tech.

Compared to serving ads and/or engaging in surveillance capitalism, at least there's a lot of comfort in that they're doing (and you 're doing) a useful job.

So I know it's not much but thanks a huge lot for what you're doing.

[matheusmoreira]

> Looking through the "Who's Hiring" thread is soul-crushing.

I know how you feel. I gave up on tech as a teenager and I still wonder what would've happened if I had stuck with it. Feels like it's impossible to switch careers now.

Where I live practicing medicine used to be a respectable profession but that's completely changed for the worse in the last 20 years. The communists currently running my country are literally quoted saying "we must create a new generation of leftist doctors who accept working for less". They flooded the job market with doctors.

[mavelikara]

> They flooded the job market with doctors.

US doctors have to put in long hours because there aren't enough of them. Are things different in your country?

[matheusmoreira]

Yes. Same hours but nosediving pay because we now have an infinite amount of deeply indebted doctors fresh off medical school competing for the same jobs. Wages are literally decreasing year upon year for the average brazilian medic. Workload is also increasing because healthcare managers are starting to interfere more and more in patient care. They want 10 minute consults.

[mavelikara]

So hours are long, and the number of Drs in the market are increasing. Are the number of patients increasing, or the time consumed by each increasing, or unemployment among Drs increasing?

[matheusmoreira]

> Are the number of patients increasing

The number of patients is literally never ending. It's a property of the decentralized public health system. If you have resources to spare, patients will be sent to you. No matter how much time and money you pour into healthcare, it's never enough. It's as if demand instantly scaled to exceed capacity.

> or the time consumed by each increasing

On the contrary, it's reducing. Cheap fast consults in popular clinics are now the norm. Doctors are doing more in less time for less money. The numbers are embarrassing, especially when converted to USD. The only consolation is it's still pretty good due to our low cost of living.

Brazilian software developers working for american companies for a salary that would be inhumane to an american put doctors here to shame. I'm talking 2-4x, depending on the company and exchange rate. It wasn't like this before.

> unemployment among Drs increasing?

A few years ago I saw someone joke about doctors driving Ubers for the first time. It's looking more and more likely each year. I'm also seeing doctors simply abandon the profession straight up.

[mavelikara]

Thank you for explaining.

> Brazilian software developers working for american companies for a salary that would be inhumane to an american put doctors here to shame. I'm talking 2-4x, depending on the company and exchange rate. It wasn't like this before.

It sounds to me that this is really the root cause of your unhappiness, rather than more doctors entering the market. We had a similar situation in India too, but over time the wealth gets spread around. The software engineers will too, after all, need healthcare and they will be willing to spend more on it given their higher disposable incomes.

[merek]

Thanks for sharing. A couple of questions if I may:

For a typical surgeon in the US, how common are lawsuits from patients?

Do you have plans to run your own clinic (if not already doing so)? If so, would this address some of your current issues (work hours, compensation) at the risk of having to operate your own business?

[the_d3f4ult]

> For a typical surgeon in the US, how common are lawsuits from patients?

Not very common. Pretty much everyone gets sued at some point in their career, but it's rare to break through the malpractice insurance ceiling. That said, it's always in the back of your mind and when it happens it messes with you psychologically.

>Do you have plans to run your own clinic (if not already doing so)? If so, >would this address some of your current issues (work hours, compensation) at the >risk of having to operate your own business?

It's complicated. While being your own boss has a lot of perks, the path to ownership is not straightforward anymore in the current era of private equity. Some of the things that suck are not related to the financial aspects.

[czbond]

> Pretty much everyone gets sued at some point in their career, but it's rare to break through the malpractice insurance ceiling.

Attorneys don't want to ruin a doctor's career by going above the limit of their malpractice into personal funds. They target the policy as their bogey and work from there.

[fragmede]

https://www.gene.com/scientists/ophthalmology

[mensetmanusman]

Is working for half time for half the salary an option?

[iancmceachern]

These people might:

https://www.arcscan.com/

I can make an intro if you're serious

[jasmer]

Most devs are not earning anywhere near what a doctor is.