tag:blogger.com,1999:blog-8358039.post2572780923523985719..comments2024-03-25T15:17:04.488-07:00Comments on Captain Capitalism: Before You Become a DoctorCaptain Capitalismhttp://www.blogger.com/profile/05620212946121617985noreply@blogger.comBlogger17125tag:blogger.com,1999:blog-8358039.post-74968984308824749922014-12-29T02:19:31.165-08:002014-12-29T02:19:31.165-08:00First year medical student.
Everything that guy p...First year medical student.<br /><br />Everything that guy posted about getting into med school is 100% correct. It was a SERIOUS pain in the ass. <br /><br />And for anyone thinking of primary care- DONT DO IT<br />Just the other day the law that had increased primary care physician income expired, and the "czar" or whatever basically said "Fuck you" to all primary care physicians, the reimbursement is not going back up- EVER<br /><br />No wonder all these docs aren't taking Medicare/Medicaid et al...they don't like getting fucked in the ass after years of hard work.<br /><br />Sometimes I get soft and think how nice it would be to be a Marcus Welby type generalist, but the reality of getting into an Allopathic (M.D. program) school in the USA is that you are a fool if you don't flee to high paying subspecialties where you aren't screwed over financially because you like caring for your fellow man. MS-1noreply@blogger.comtag:blogger.com,1999:blog-8358039.post-30217850013968053052014-12-28T07:19:24.303-08:002014-12-28T07:19:24.303-08:00Residents are subsidized because most private hosp...Residents are subsidized because most private hospitals won't pay for them. It's cheaper to hire a midlevel they can bully to save money than someone who actually thinks critically. It also is a money grab by the hospitals.<br /><br />Medicare pays $100-150k/year per resident a hospital trains. $10k of that is given to administration of the program, probably another $10k for the benefits (health insurance, etc,) for the resident. Average pre-tax salary of a resident is $45k/yr. The hospital pockets the rest.<br /><br />The payoff for the hospital is they have to be qualified to take Medicare payment, which is mostly a paperwork chase. For that, they get people they can push around for 3-8 years, dependent on specialty, up to 80 hours or more (off the books) a week to push more patients through their system, and gives them more people who have to pay for services.<br /><br />Working out the pay per hour, it is less than minimum wage a resident earns. The payoff depends on the specialty you choose. The primary care specialties have a poor ROI of them all.<br /><br />It's a different mindset to go into medicine. Empathy, along with a bit of masochistic streak to put of the rewards that come, and then only if you chose the right specialty.<br /><br />I got lucky with opportunities I optimized. I did some military time that paid for a lot of my medical education through various ways and the VA. While my colleagues are $300-400k in the hole for their combined education, I ended up just under $90k in debt. I just got accepted to where that debt will go away in a year or so. Most of them are buying McMansions they will not pay off for 30 years, putting them more in debt.<br /><br />I plan to rent for a year or so to see if I like the area, then think of buying a modest house outright or find a place elsewhere if I don't like the place. Thanks to what I have done, I would be eligible to retire early (like just over a decade,) and do what I want. Since it's just me, I have nothing more to do than save money or put the money into tangible assets as I need to. I would rather have my resources at the ready and portable enough to go anywhere if needed if something happens.<br /><br />The way I plan to live my life in front of these old feminists is to be somewhat akin to the promised land to Moses: Forever seeing it as a paradise, but never allowing them to enter it. Your story on the 30/40 something you turned down in a bar was something I look forward to happing to me, just to burn them down to the ground. I already do it, and the meltdown into gibberish is something sweet to behold after being blown off in my earlier education.Usagi Yojimbonoreply@blogger.comtag:blogger.com,1999:blog-8358039.post-39856763645424546522014-12-27T20:06:58.976-08:002014-12-27T20:06:58.976-08:00Um.... to all you talking about medical rackets......Um.... to all you talking about medical rackets.... Nope.<br /><br />Son one is doing Pharmacy and reckons he dodged the bullet as I have reminded him that I did not get my fellowship until I was in my late 30s and then took a pay drop to become a consultant in my field. <br /><br />And that is in NZ: in the commonwealth all medical schools are state run, you need an A+ average in first year to get into second year, and after six years you will have an MB, and face two intern years (house surgeon in the commonwealth) and then a minimum of five years specailty training. <br /><br />If you pass the exams first time: these exams have a 40 -- 70 % failure rate. And you cannot practice independently without passing them.<br /><br />But you get a reasonable wage for the 60 odd hours you will be working (and yes, that includes psychiatry). <br /><br />Consider medicine like the ministyr. Only do it as a calling. You would, financially, do far better setting up aa business.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-8358039.post-63752649379412886712014-12-27T14:00:59.202-08:002014-12-27T14:00:59.202-08:00Holy molly!
I will stick to ChemE.Holy molly! <br /><br />I will stick to ChemE.Anonymoushttps://www.blogger.com/profile/08992146563165636778noreply@blogger.comtag:blogger.com,1999:blog-8358039.post-17024026130428455672014-12-27T09:48:59.432-08:002014-12-27T09:48:59.432-08:00The prescription racket, run by the American Medic...The prescription racket, run by the American Medical Association and the Food and Drug Administration, deprives us from our medical rights.<br /><br />We are no longer allowed to self-medicate nor request certain tests. It always requires a doctor's approval.<br /><br />This looks pretty much like parasitic make-work to me. It's about control, extortion and prestige, not about genuine health care.<br /><br />We should replace doctors with technology and basic medical knowledge should be taught in school so that people become medically self-sufficient and consult doctors only when it's truly necessary.<br /><br />Could it be that the doctor's insistence on controlling everything and using the coercive power of the state to do so is what's driving health care costs through the roof ?<br /><br />Could it be if people had more medical freedoms and medical knowledge that health care costs would be significantly lower ?<br /><br />Finally, this looks like a profitable business opportunity for those who know electronics and programming.<br /><br />There is already many phone aps and peripherals that are used to diagnose health conditions and manage your health. Doctors in the future will face technological competition and general patient rebellion.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-8358039.post-281104273026036102014-12-27T03:59:34.794-08:002014-12-27T03:59:34.794-08:00From what I've heard, part of this is restrict...From what I've heard, part of this is restricted supply. The AMA approves existence of all medical schools; not the free market. They also create the hoops you have to jump through. I've heard it's been decades since a new medical school opened in 'murca.<br /><br />And from my experience, the majority of doctors out there are useless. I'm sure like cops and young single girls, there are a mythical few good ones out there. I haven't come across them yet.<br /><br />They can't keep appointment times or follow up. My wife waited 48 hours for her crap-bag doctor to call in the right prescription for her pain. That's after he was late for the appointment (I've only known one doctor who could keep an appointment time within 10 minutes) and spent about 2 minutes with her.<br /><br />This myth about "ask your doctor" is bullshit. What the hell can a doctor know about you while only spending 30 seconds to 2 minutes in the room with you? Doctors might as well use Skype except in cases where they actually HAVE to examine some physical ailment.Eric S. Muellerhttps://www.blogger.com/profile/11378001500010545127noreply@blogger.comtag:blogger.com,1999:blog-8358039.post-12406635795892918362014-12-26T23:23:40.308-08:002014-12-26T23:23:40.308-08:00Nearly 4 decades in the medical field....not an MD...Nearly 4 decades in the medical field....not an MD but as a specialist in radiology technology. Have known a LOT of doctors over the years. Many...perhaps most have in addition to the costs of schooling to deal with made the mistake of getting married to someone who was enamored with being married to a doctor. These types of marriages are DOOMED as the negatives of the career quickly outshine the status and money (and not all doctors make tons of money) and want out. Then the doc not only has professional costs to deal with but the added burden of the divorce costs PLUS frequently child support. And judges don't care about anything but your gross income.....THAT is what they use to decide how much the ex gets. I know plenty of MD's who live in a condo because they can't afford a house.Dannoreply@blogger.comtag:blogger.com,1999:blog-8358039.post-38378740518160238882014-12-26T16:33:47.343-08:002014-12-26T16:33:47.343-08:00My doctor just retired early - he got fed up with ...My doctor just retired early - he got fed up with all the constraints that the new ACA applies to care-giving and all the additional bureaucracy.<br /><br />Replacement is in his mid-50's - wonder how long he'll stay.<br /><br /><br /><br />Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-8358039.post-7712322338170483572014-12-26T15:30:35.150-08:002014-12-26T15:30:35.150-08:00Wow, great article. One point, there's a goof ...Wow, great article. One point, there's a goof in this line:<br /><br />-Overall one can expect to shell out $5-10 for the interview process alone.<br /><br />Is that 5k to 10k?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-8358039.post-5400231030662634842014-12-26T15:29:43.143-08:002014-12-26T15:29:43.143-08:00Wow, great article. One point, there's a goof ...Wow, great article. One point, there's a goof in this line:<br /><br />-Overall one can expect to shell out $5-10 for the interview process alone.<br /><br />Is that 5k to 10k?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-8358039.post-33753730071599789372014-12-26T13:17:20.829-08:002014-12-26T13:17:20.829-08:00The truly worrying thing about this valuable infor...The truly worrying thing about this valuable information is not the dubious financial and sacrificial barriers to entry for the medical profession. It is that a person who comes through this obstacle course will have spent their entire adult life focusing on just this one aspect.<br /><br />And yet, the best doctors possess that most valuable of human conditions, empathy. The best doctors know how to effectively listen to a patient. I fail to see how these two extremely important characteristics can be developed in a person who must spend a good part of their adult life completely self-absorbed in the pursuit of their own career. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-8358039.post-84592797956253786042014-12-26T13:15:14.200-08:002014-12-26T13:15:14.200-08:00Great post. I think it would be helpful to know wh...Great post. I think it would be helpful to know why medical school costs so much each year. Is it personnel, equipment, medical supplies? What can be done to reduce it (increase class size etc.)?<br /><br />Why do medical residents need subsidized slots, as opposed to being paid from hospital revenue or allowing the residents to work at a discount?<br /><br />I know undergrad degrees can be completed in two years or less with appropriate AP credits, but is it possible to speed up the pace at which medical information is conveyed or limit it to what is actual used (i.e. Psychiatrists probably don't deliver babies often)? How can it best be reformed? Dannoreply@blogger.comtag:blogger.com,1999:blog-8358039.post-33772618182101389872014-12-26T13:10:31.691-08:002014-12-26T13:10:31.691-08:00Aaron I am a physician and can only say that you w...Aaron I am a physician and can only say that you would have to be crazy to enter Medicine. The effort vs payout is a very poor return unless you hit the right residency (specialty) at the right time. For fields like family practice and pediatrics you are better off being a plumber or teacher. Lawrence Kotlikoff has done the analysis and total employment earnings are higher in teaching and plumbing vs family medicine. Some fields like gynecologic oncology can pay quite well ($1 million plus year) but the window of those earnings is quite small and all specialties are vulnerable to getting whacked by cuts from Medicare. Thus you can enter a high payout specialty only to find it decimated by government rules changes. My own field of pathology has suffered through several of these in my 22 year career. By luck I managed to avoid these but if my timing had been poor I could have ended up unemployed for long periods of time. Of course Obamacare makes Medicine an even bigger crap shoot.<br /><br />By the way I am a resident of Minnesota and am retiring this March. I have had it with the weather, the Socialism and the high taxes. I am moving South and retiring. Most of my colleagues would like to join me but are wage slaves due to their high spending and trophy wives and some even own horse farms.<br /><br />Best of luck I enjoy reading your columns.wesley mouchhttps://www.blogger.com/profile/15781017536059504121noreply@blogger.comtag:blogger.com,1999:blog-8358039.post-19655540734553729722014-12-26T13:09:34.310-08:002014-12-26T13:09:34.310-08:00Aaron I am a physician and can only say that you w...Aaron I am a physician and can only say that you would have to be crazy to enter Medicine. The effort vs payout is a very poor return unless you hit the right residency (specialty) at the right time. For fields like family practice and pediatrics you are better off being a plumber or teacher. Lawrence Kotlikoff has done the analysis and total employment earnings are higher in teaching and plumbing vs family medicine. Some fields like gynecologic oncology can pay quite well ($1 million plus year) but the window of those earnings is quite small and all specialties are vulnerable to getting whacked by cuts from Medicare. Thus you can enter a high payout specialty only to find it decimated by government rules changes. My own field of pathology has suffered through several of these in my 22 year career. By luck I managed to avoid these but if my timing had been poor I could have ended up unemployed for long periods of time. Of course Obamacare makes Medicine an even bigger crap shoot.<br /><br />By the way I am a resident of Minnesota and am retiring this March. I have had it with the weather, the Socialism and the high taxes. I am moving South and retiring. Most of my colleagues would like to join me but are wage slaves due to their high spending and trophy wives and some even own horse farms.<br /><br />Best of luck I enjoy reading your columns.wesley mouchhttps://www.blogger.com/profile/15781017536059504121noreply@blogger.comtag:blogger.com,1999:blog-8358039.post-66427780736022349232014-12-26T13:06:47.969-08:002014-12-26T13:06:47.969-08:00Wow. As someone considering a career shift - with ...Wow. As someone considering a career shift - with medicine as a possibility - this is truly eye-opening. Over the long haul this training system seems insupportable in terms of both financial and time cost.<br /><br />I have heard that becoming a PA is a decent alternative -- much less schooling at a cost of lower pay and responsibility.Jeffnoreply@blogger.comtag:blogger.com,1999:blog-8358039.post-20602508303574214782014-12-26T12:09:35.065-08:002014-12-26T12:09:35.065-08:00Under those circumstances it would be impossible f...Under those circumstances it would be impossible for anyone to have a child AND spend any significant time with them. Your spouse would have to be the primary caregiver or you would have to ship them off to strangers to be raised.<br /><br />In other words, the Cosby Show took place in a world run by magic and unicorn farts.TroperAnoreply@blogger.comtag:blogger.com,1999:blog-8358039.post-86168839797738350932014-12-26T12:03:18.515-08:002014-12-26T12:03:18.515-08:00As a second yr medical student at a private instit...As a second yr medical student at a private institution (also getting an MPH in Biostatistics and Informatics that is mostly covered by a scholarship), I can agree with just about everything that is said. As someone looking to go the Infectious Disease route (maybe CDC) and/or get into health information field, an MPH (in something real like Biostatistics or Epidemiology) is helpful. However, I have added up the costs and know that minimalism will be the name of the game for sometime post-graduation. It is a choice we all have to make at some point if there is something we really want to pursue. Fortunately, men can play the "mating & dating" game a little longer than women due to basic biology (although this may not be as extensive as some in the 'Sphere would suggest). So, there is less pressure on a male physician to start a family sooner than female physicians. As a guy, most of the women I have met in medicine are cordial and decent; however, they are too career focused in many cases to be marriage material. Anyways, great & spot-on post! Lieutenant out! Anonymousnoreply@blogger.com