Nameless Range
Well-known member
That is really interesting and I didn’t know that.Massive can of worms here and one that might offend so I will try and be delicate.
There is also the prestige factor of hospitals/academic medicine.
There is an inverse relationship to the prestige of a hospital and how much an attending doctor makes.
For instance a cardiologist at MGH/UCSF/Hopkins/NYPres/Duke etc. will make 1/3 what a cardiologist in the deep south/midwest makes, that number get's even crazier if it's in private practice.
Maybe ~$220-250 at MGH and like $2mm private practice in the south, meanwhile the CEO of MGH is making over $6 million.
Now those academic hospitals are the hardest to get into for residency and to get a job at... so basically 'the best doctors' are making the least amount of money.
This is very nuanced and there are tons of very smart MDs who have seen the writing on the wall so this isn't completely accurate, but on the whole there is a negative correlation between MCAT/STEP scores and income.
This trend has gotten so nuts that in the last couple of years we have seen a number of major hospital MDs unionize. Penn, Seattle, UMich, MGH, etc.
I was more thinking about how there are parts of a hospital, critical parts, that really don’t make the hospital money – at least relative to other parts. A Behavioral Health Unit or Dialysis Unit, may barely break even, while an endoscopy unit or OR may rake in a large portion of the revenues of a hospital. What an Internist/Hospitalist makes annually vs what a GI Doc getting $300 a colonoscopy and doing 50 a week makes could be a heck of a difference. It’s not clear to me that one is “more important” than the other.
To @SAJ-99 's point, all else being equal, with a loved one’s life on the line, I would want the more educated person, but I suspect a diminishing return and question where that is. Anecdotally, I wonder if we overestimate education's influence on aptitude. On one hand, hospitals are not necessarily going cheaper with employees. The current trend with RNs is more and more facilities are requiring a bachelors degree. And it sort of makes sense. Out of the gate, RNs with BAs are better prepared that those with Associates degrees, but when you control for age and experience, those metrics level out over time.
Then I can see another perspective that makes sense for hospitals to go cheaper. There’s a lot of things that people aren’t allowed to do, that isn’t a function of real sound logic, but of the inertia of credentialling institutions and regulations limiting flexibility. It's almost as if we need new roles in the medical field. If something an RN making $50 an hour is doing could be done by a tech at $25 an hour, it would make sense to transition down to that. There are specific examples though, of massive pushback against that change in the name of keeping those $50 an hour jobs. And of course.
More than anything, as is the case with nearly all jobs – the vast majority of proficiency comes from on-the-job experience. Education is at least in part, a hoop medical professionals jump through to get that opportunity. What I wonder, and what others in the medical field I have spoken to have stated, is that whether the hoop is far too expensive and long relative to its value to the opportunity. I know that is way oversimplified as another truth is that those on-the-job learning venues have a shortage of their own.
All that said, I don’t even know what the the main drivers are of increased medical costs. People way smarter than me write books about the subject that disagree with one another. At the end of the day, a lot of medicine is so Goddamn miraculous that it borders on priceless. When a few years back, my daughter spent the better part of a month in the hospital after nearly dying from a burst appendix we mistook for a stomach bug, I would’ve gone bankrupt to save her life and it would have been worth it. It only ended up costing a couple hundred thousand dollars, and what they did was a miracle and well worth it though the money I paid was only a portion of the bill, and the whole bill got paid from money from somewhere in the black hole (to me) of the insurance industry.
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