Question on Medical School and Wage Potential for Earning to Give

post by eggman · 2013-09-27T05:40:36.234Z · score: 2 (5 votes) · LW · GW · Legacy · 19 comments

A friend of mine who may want to Earn to Give for the purposes of effective altruism mused 'The wages of American doctors seem inflated right now. I wonder if it is likely that the American health care system will be fixed by the time I am able to work there. If I do go to med school that is.'

Right now, he is an undergraduate student from, and living in, Canada. He is about half-way through a degree in computer science, but he is taking some biology electives. There is a good chance he will switch his major completely to biology, because he no longer believes he wants to become a programmer, and because he is very passionate biology and the study of life, and he would rather go into grad school for biology, or maybe medical school. If he already completed several credits from a previous major, and by December will have done 2 semesters worth of biology classes, I expect it will take him at least another 3 semesters to complete his degree, and/or complete the prerequisites for medical school. If he gets into medical school 2 years from now, it will take him another 4 years of medical-school+residency to be able to practice in the United States, and 2-3 years more than that if he specializes, or goes to a medical school in the Caribbean (where getting into them is apparently easier than mainland medical schools, but to complete the training takes six years). So, it would be at least 6-8 years from now before he is a practicing doctor in the United States.

So, does anyone have any ideas of how to go about the solving the initial problem? What is the likelihood that the wages of American doctors will deflate in the next 6-8 years due to major shifts in how the American medical system is run? What sorts of changes ought one be looking for to answer this question: political, bureaucratic, technological, or cultural change?

edit: my friend in question has expressed interest in this thread, so if you want to make recommendations about or discuss medical schools in the United States vs. other places, or in general, or about entering the medical profession vs.s other jobs, go ahead. Such valuable information would be appreciated. I don't yet know if he himself will participate in this discussion.

19 comments

Comments sorted by top scores.

comment by CarlShulman · 2013-09-27T06:37:40.619Z · score: 7 (7 votes) · LW · GW

American medical wages are above the world average, but medicine is one of the highest paid professions throughout the developed world, including in Canada (and yes, moreso than pharma PhD researchers on average, especially if one pursues a more lucrative specialty). Probably this should not be the determining factor.

The outside view would be that probably American medical wages will not plummet in the next 6-8 years, although that's a fairly irrelevant question (a career extends for decades).

or goes to a medical school in the Caribbean (where getting into them is apparently easier than mainland medical schools, but to complete the training takes six years)

These schools tend not to do as well in placements for residencies.

comment by ITakeBets · 2013-09-27T12:23:05.519Z · score: 6 (6 votes) · LW · GW

These schools tend not to do as well in placements for residencies.

This is a significant understatement-- ~95% of US MD students match into residencies; for foreign grads it's around 50% and likely to fall further. Don't go to med school abroad if you want to practice in the US.

Incidentally, I've just started med school in the US on a full tuition scholarship and am willing to answer questions related to admissions.

comment by Thrasymachus · 2013-09-28T16:28:50.157Z · score: 5 (5 votes) · LW · GW

I'm a doctor working in the UK, a few points.

1) As Carl notes, Medical wages in the US are particularly extravagant, but they are still pretty high in other places in the anglophone world, and high generally. Carl has done more research on this than me, but moving to practice in the US has significant transaction costs, which may make moving not-that-great on expectation. In summary, the short- and medium- term changes in medical reimbursement in the US shouldn't be a dominant consideration.

2) It is not clear to what degree medical wages are inflated. Ex ante, you'd be surprised if the optimal model of healthcare was designed around an elite corpus of highly skilled people people (doctors) in charge of almost all aspects of patient care, and involved in almost every interaction a patient has with the system. Corrections to that (in terms of increasing automation, division of labour with easier tasks handed off to lower-skilled staff) seem to be brewing in most healthcare systems, and may have a downward effect on wages. There's also the effect of immigration reform exerting further downward pressure on wages if the medical guild's protectionism can be broken. These may also give opportunities for leveraging these things, leading to possible increased variance in returns on medical careers (the 'job for life' model where everyone becomes a consultant/specialist of approximately similar rank may go, with 'superstars' presiding over more junior staff).

That being said, it isn't clear whether doctors are a poor value proposition at the moment: some very speculative research I've done on the marginal health impact of additional doctors puts their 'cost per QALY' in line with marginal health technology expenditure, at least in the UK. Also, being a doctor is demanding across a variety of axes (intelligence, domain knowledge, social interaction), so they are more robust to disruption than most other jobs. So I doubt any dramatic change in salaries for doctors in the developed world anytime soon, but I'd predict they will go down rather than up.

3) Medical schools effectively select for intelligence, conscientiousness, integrity/appropriate behavior, social skills, and dedication to the profession. Due to competitiveness, medical schools can select far from the right tail. I'd guess there are better good opportunities in other EtG paths than medicine for any given level of ability, especially given the high upfront costs.

The cases where I think it would most likely be an optimal fit are for people who are 2ishSD above the mean in IQ, very conscientious, and good (but not exceptional) 'soft skills': you are smart and hardworking enough to have a good shot at medical school, but you aren't smart enough where you have a good chance of 'winning big' at a g-loaded tournament game (start-ups, finance, STEM), and you aren't socially good enough to win big at socially loaded tournament-games like business/entrepreneurship either.

4) The 'soft factors' are important for getting through medical school and staying in the job. You spend your time learning to memorize and apply large amounts of factual data. On the job, you need to be able to interact well with patients and colleagues from all backgrounds, you need to cope with episodes of high physical and emotional stress (examples from my first month of being a doctor: telling a patient they were going to die, telling a relative we were stopping active treatment of her husband for 60 years, being the first responder to a patient who had thrown up a liter of blood and was still doing so, CPR with relatives in the room screaming, trying to talk an extremely agitated person in alcohol withdrawal to let you give them drugs before they go into a life-threatening seizure, lots of seeing and examining dead bodies, body fluids, and body parts); you also need some threshold level of manual dexterity to perform basic procedures like taking blood etc. There are lots of upsides to being a doctor - I really enjoy it - but I think there are lots of people who would struggle despite being smart, hard working, and genuinely invested in their patient's wellbeing.

5) There are fair exit opportunities for medicine (Pharma, consulting, finance), so you aren't 'locked in' to a medical career.

comment by hyporational · 2013-09-30T03:51:04.921Z · score: 1 (1 votes) · LW · GW

telling a patient they were going to die, telling a relative we were stopping active treatment of her husband for 60 years, being the first responder to a patient who had thrown up a liter of blood and was still doing so, CPR with relatives in the room screaming, trying to talk an extremely agitated person in alcohol withdrawal to let you give them drugs before they go into a life-threatening seizure, lots of seeing and examining dead bodies, body fluids, and body parts)

One of the coolest parts of the job is realizing you've learned to be calm in these situations.

comment by hyporational · 2013-09-27T11:34:45.284Z · score: 5 (5 votes) · LW · GW

There are a couple of important questions you didn't raise.

Does he like working with people? Does he perform well under social pressure? Is he good at explaining things in simple terms? Would he like doing so every day? Would he like working in a team and maybe leading it? Would the strict social hierarchy of hospitals bother him? How does he handle sleep deprivation? Can he cope with constant uncertainty about his decisions? Can he handle killing/injuring people by accident?

he is very passionate biology and the study of life

Med school isn't generally about that. Would it be agony for him to memorize loads of facts without questioning/understanding them too much, then forget them because he doesn't need them for anything? Also, much of the stuff you have to memorize after the first 1-2 years has nothing to do with human biology. There are some challenging moments with complicated patients, but the work is mostly quite simple and algorithmic.

comment by Jabberslythe · 2013-09-29T22:19:02.994Z · score: 6 (6 votes) · LW · GW

I'm the guy eggman is referring to :) Thanks for all the info!

No I do not like working with people. I would aim for surgery or radiology for this reason. I currently do not perform well under social pressure but my anxiety should diminish with time. Yes, I think I am good at explaining things in simple terms. I prefer less social interaction. I could tolerate a strict hierarchy. I don't handle sleep deprivation well. I do not handle uncertainty particularly well. Yes, I think I could handle accidents better than most people.

Med school isn't generally about that. Would it be agony for him to memorize loads of facts without questioning/understanding them too much, then forget them because he doesn't need them for anything? Also, much of the stuff you have to memorize after the first 1-2 years has nothing to do with human biology. There are some challenging moments with complicated patients, but the work is mostly quite simple and algorithmic.

That's bad news but not a deal breaker.

comment by hyporational · 2013-09-30T02:46:21.025Z · score: 3 (3 votes) · LW · GW

Surgery: you'll be working with at least 3-5 people in the operating room. You'll also have to examine lots of patients to determine whether they need surgery or not and alleviate their fears concerning the operations. Lots of treatments are becoming more conservative, i.e. no surgery at all. After surgery, you'll have to examine patients to assess their recovery and motivate them. Obviously there are surgeons who chose the specialty because they don't like working with people, and I think that's unfortunate, because they're doing a half assed job. Many surgeries are quite long, and require you to be standing hours at a time not necessarily in a very comfortable position. To become good, you'll have to specialize, so you'll be doing the same procedures over and over again.

Radiology: have you considered that this kind of image recognition is a low hanging fruit for a narrow A.I.? I considered radiology too, but this is one of the main reasons I won't anymore. Also, radiology is easy to do via the internet, so that might lower the earning potential if hospitals hire radiologists overseas. If you're doing ultrasounds or become an intervention radiologist, there will be a lot of patient interaction, if you're a neuroradiologist, pretty much none at all.

Pathology or forensic pathology: you'll usually work alone or with 1-2 other people. You'll have to explain the findings to other doctors and the patients relatives though. The earning potential isn't probably that high, in forensic pathology it might be, I don't know.

comment by Jabberslythe · 2013-09-30T22:26:21.146Z · score: 0 (0 votes) · LW · GW

That's a very good point about radiology being replaceable.

Hmm, would you say there is still less social interaction in surgery than most other specialties?

Many surgeries are quite long, and require you to be standing hours at a time not necessarily in a very comfortable position.

I can take physical discomfort,

To become good, you'll have to specialize, so you'll be doing the same procedures over and over again.

Yeah, I guess doing the same procedure over and over again might not be super interesting or educational.

comment by hyporational · 2013-10-01T13:09:35.719Z · score: 2 (2 votes) · LW · GW

If you just want to cut people up without talking to them and master anatomy and histology, pathology is the obvious way to go. It will be also more anatomically diverse than any surgical specialty, since you'll have to examine the whole body. The compensation doesn't seem too bad, about the middle of the field in earnings among all physicians.

http://www.medscape.com/sites/public/physician-comp/2012

comment by hyporational · 2013-10-01T12:47:09.541Z · score: 0 (0 votes) · LW · GW

Hmm, would you say there is still less social interaction in surgery than most other specialties?

The difference is qualitative, not quantitative. In the OR, you spend time with people you know and are expected to be more to the point. Small talk is the overwhelming norm even during surgeries, and it might get quite awkward if you communicated only the necessities. Patient interactions are on average briefer than in the conservative specialties, but you will correspondingly see more patients. The only real me-time in any specialty is paper work.

Oh, and the number one thing to protect you from lawsuits will be the rapport you build with your patients. In any specialty (or profession, for that matter), expect the most well-liked people to be paid the most.

comment by hyporational · 2013-09-30T03:21:29.174Z · score: 2 (2 votes) · LW · GW

A data point: I didn't like working with people, and still stupidly applied to med school thinking it didn't matter. Now I'm a doctor, and patient interaction is one of the things I enjoy the most. I think it's because my social skills improved. Go figure...

I still wouldn't recommend applying to med school to improve your social skills, though.

comment by Jabberslythe · 2013-09-30T22:10:24.711Z · score: 1 (1 votes) · LW · GW

That's a useful datapoint, thanks.

I social skills tend to improve over time and having good social skills makes social interaction more fun.

comment by metastable · 2013-09-30T02:07:24.089Z · score: 0 (0 votes) · LW · GW

No I do not like working with people. I would aim for surgery or radiology for this reason.

While the stereotypical surgeon may be gruff/demanding/efficient/decisive, most surgeons are required to work in and even lead teams. The profession selects for aggressiveness and confidence, not for loners (though there are obviously some in any profession). Medical training prior to specialization will be exceptionally challenging if you dislike working with people.

Pathology might be a medical specialty where you were able to indulge your love of biology while working in relative solitude, but that's a pretty narrow slice of the pie to target. Per your concerns about ROI, radiology is probably the medical specialty in the US most likely to deflate in the next several years, given that wages are exceptionally high and that there are few material barriers preventing radiographs from being read by physicians in other time zones, or even other countries.

comment by ChristianKl · 2013-09-27T13:38:33.083Z · score: 3 (3 votes) · LW · GW

to biology, because he no longer believes he wants to become a programmer, and because he is very passionate biology and the study of life, and he would rather go into grad school for biology, or maybe medical school.

Doctors don't engage into the study of life. That's not their role. Does he want to be an academic?

There are plenty of biology research projects where programming skills are very useful.

comment by eggman · 2013-09-29T09:54:31.184Z · score: 0 (0 votes) · LW · GW

He believes he might want to be an academic. I believe he is more passionate about biology as a field of study than he is committed to the visceral prospect of having the resolve to grind through years of research that may not be the most rewarding. He is a utilitarian who is as concerned with helping others, particularly animals, a la Brian Tomasik, and seems to care about that as much or more than his drive to study a particular subject. I don't know if his concern for welfare generalizes to a motivation for a career of triage and care that medicine provides, or if he is merely in it for the potential to affect the world with influence, and money, or both.

comment by shminux · 2013-09-27T05:49:11.668Z · score: 2 (10 votes) · LW · GW

Figuring out expected future wages is a fool's errand. He should do what he likes and good at. If he is passionate about biology, and not medicine, than he should stay away from medicine. A biologist in a pharmaceutical company is paid quite well and lives a lot less stressful life than a medical doctor.

comment by Tuxedage · 2013-09-27T07:26:37.464Z · score: 8 (10 votes) · LW · GW

I'm not sure that's good advice. 80,000 hours has given pretty good arguments against just "doing what you're passionate about".

Passion grows from appropriately challenging work. The most consistent predictor of job satisfaction is mentally challenging work (2). Equating passion with job satisfaction, this means that we can become passionate about many jobs, providing they involve sufficient mental challenge. The requirements for mentally challenging work, like autonomy, feedback and variety in the work, are similar to those required to develop flow. This suggests that a similar conclusion will hold if we believe that being passionate is closely connected with the ability to enter states of flow. If, however, you don’t think flow and job satisfaction are the same thing as passion, then you can still agree that…

There are better targets to aim for. We’re not only bad at predicting what will make us happy, but more easily detectable predictors of job satisfaction exist (autonomy, feedback, variety, making a difference etc). This suggests it would be more useful to aim at these predictors rather than directly at what we think we’re passionate about. Similarly, it could be more useful to focus on being good at what you do. First, this is a more positive mindset, focused on contributing rather than taking. Second, being good at what you do makes you better placed to ask for engaging work.

Related: http://80000hours.org/blog/63-do-what-you-re-passionate-about-part-2

comment by RomeoStevens · 2013-09-28T13:49:13.794Z · score: 1 (1 votes) · LW · GW

Hourly wages for doctors aren't very high when medical school loans and hours worked are taken into account. This is made up for by the fact that doctors can simply work more hours and continue to get paid unlike most other jobs. Same deal with lawyers.

comment by Ishaan · 2013-09-28T00:31:58.126Z · score: 1 (1 votes) · LW · GW

I'd say that it doesn't matter if the wages are inflated - as long as the wages aren't deflated, everything will be fine. Even if doctors got paid exactly the amount that a perfectly efficient market would predict, that would still be quite a large amount.

By the way, make sure he talks to a good adviser. To my knowledge, as long as you take certain classes (Calc, O-chem, etc) you can get into medical school without a biological science degree. As for graduate school, my impression is that people in computer sciences are typically very well received in many biological contexts (bio bioinformatics, bio engineering, etc). There are many biologists who can't code and would love a grad student who can. There's a possibility that your friend need not bother switching majors and should just hurry up and graduate, go straight into bio-grad/med