Doctors & MBAs.
MBA types running health care insurance, hospital groups, etc take the brunt of the anger because that's where we see our dollars go most directly, due to the convoluted way we pay for healthcare here.
However, doctors are very well compensated, and in HCOL often enough to underwork & choose their own hours. And there is an entire cartel system to ensure we don't produce more doctors domestically via our educational system, nor do we allow doctors to immigrate from elsewhere and start practicing. So supply is artificially limited.
The really enterprising doctors then setup all sorts of alternative income streams, like building their own clinic with other specialists to which they then refer you for all procedures.
Then you have all the doctors pushing elective procedures when you just want to talk about health.
And finally don't forget all the free golf resort trips they get in the form of "conferences" paid for by pharmaceutical reps. Basically kickbacks. The opioid crisis relied on a lot of this in order to happen, and 1000s and 1000s of doctors failed the moral test.
Plenty of doctors went into it for the right reason, are overworked, and underpaid.. and I don't exactly want to say "its a choice" but.. the option not to be certainly exists..
> The really enterprising doctors then setup all sorts of alternative income streams, like building their own clinic with other specialists to which they then refer you for all procedures.
Hah. All of the large diagnostic imaging manufacturers, Siemens, GE, Philips, have formal programs for physicians to help them set up their own imaging practice - they'll help navigate Certificate of Need bureaucracy, they'll provide fantastic financing, they'll help you get set up with practice management.
And you, as a physician, if you also own a DI provider (or a stake in one) will go on to refer your patients for DI far more often than other providers do for patients with the same ICD-10 codes.
Doctors can rack up hundreds of thousands in debt just getting to the point where they can bill. Additionally, malpractice insurance is insanely expensive, as are rents in typical medical spaces. I can't see what doctors charge going down without addressing at least some of this.
Yes. I said they get paid well but I didn’t say that it is bad or makes them bad.
Educational costs and duration means putting their life on hold well past the point your median FAANGer is taking in big bucks. So they expect the pay to start paying down that debt & lost time.
But other countries get by without their doctors accruing a mountain of educational costs and time spent in apprentice like conditions.
AMA is a cartel.
Imagine if SWEs managed to create a certification process essentially locking out H1Bs and constrained the number of new SWEs domestically minted.
For sure, restructuring how we get doctors to a point where they can begin practicing is a necessary first step to addressing cost.
Throughout the discussions on the topic, the comparison with SWEs keeps sticking with me: there's no world where someone hacking together JS scripts should make more than someone healing human bodies (in terms of "real" take home pay, ie, after fees, debt payback, etc)
Arguably you are totally correct in that assertion of relative value to society.
It may actually be the case too, on average, in the US.
Note a quick google search says theres 1M doctors in the US and the average salary is somewhere in the $250-400K range depending on source.
Meanwhile Google also returns me "The average salary for a Software Engineer is $117654 per year in United States." - Indeed. Allegedly there's 4M of us weirdos here too.
When we get out of the staff engineer FAANG & Wall St tech bubble the $250k/500k/1M TC numbers don't really exist. And there's only so many seats within the bubble making those numbers anyway, what maybe 50-100K total out of a country of 4M SWEs.
Plenty of SWEs on Wall St never make more than $250k before "getting retired" (in the Bladerunner sense).
Likewise most SWEs working in Fortune 500 companies are clearly barely entering the six figure TC range.
> Additionally, malpractice insurance is insanely expensive
It really isn't. But it's a trope that helps the AMA's argument about limiting supply of new doctors.
Anesthesiologist average salary: $410K/year, average malpractice insurance: $13K.
Family practice: $250K, $10K.
Obstetricians: $390K/year, $42K.
Not that these aren't negligible amounts, but these are well within affordability AND only going down as more and more states implement caps on malpractice lawsuit payouts.
> these are well within affordability AND only going down as more and more states implement caps on malpractice lawsuit payouts
I don't know that I'd consider 10% in many cases "affordable", but you made the same point I was making: combatting the external influences on prices requires action.
And doctors can practice anywhere there’s human settlement. Choose whatever range of lifestyle they want with a cartel endorsed golden ticket to high average pay.
SWEs are generally fenced in to a few HCOL urban areas to earn high pay.
> Doctors have to comply with additional local public health regulations artificially limiting the number of medical staff.
This is a curious way of describing the lobbying and other efforts that doctor's OWN body, the AMA, aggressively and successfully continues to do to limit physician supply.
That particular call is coming from inside the house. And based on the AMA's history, leadership, and so forth, the majority of physicians are entirely onboard.
Huh? What has the Civil War to do with anything? What's the conspiracy theory?
It is open knowledge, acknowledged by the AMA themselves, that they have worked to limit physician supply for a long time. In fact, it's only recently that they're begrudgingly acknowledging that maybe, just maybe they've created a supply problem and system built around it that will take effort to unravel.
However, doctors are very well compensated, and in HCOL often enough to underwork & choose their own hours. And there is an entire cartel system to ensure we don't produce more doctors domestically via our educational system, nor do we allow doctors to immigrate from elsewhere and start practicing. So supply is artificially limited.
The really enterprising doctors then setup all sorts of alternative income streams, like building their own clinic with other specialists to which they then refer you for all procedures.
Then you have all the doctors pushing elective procedures when you just want to talk about health.
And finally don't forget all the free golf resort trips they get in the form of "conferences" paid for by pharmaceutical reps. Basically kickbacks. The opioid crisis relied on a lot of this in order to happen, and 1000s and 1000s of doctors failed the moral test.
Plenty of doctors went into it for the right reason, are overworked, and underpaid.. and I don't exactly want to say "its a choice" but.. the option not to be certainly exists..