Are you sure you can find that many more doctors? That they'll be any good?
Speaking from Romania: here medicine is prestigious. So many parents push their kids towards medicine. There's a glut of newly minted doctors every year, but rumour has it that the quality drops every year. Sure, they pass the exams and residency and what not, but... They're just not into medicine as much.
Do you want to get treated by such a person?
This year I had to go to a neurologist. I went to one locally, they dismissed me in 5 minutes, told me to take some vitamins basically. Went to another one in a much bigger city, they talked to me for an hour, ordered a ton of tests.
Would it help if we get a lot more of the first kind of doctors?
We do have qualified people to do the work of doctors, and they're called nurses. But arbitrary lines are drawn between what they can do and what doctors can do, just to maintain the existing salary structure.
If nurses are to do more of the work of physicians, nursing education needs to drastically change. Nurses are mostly taught the how of nursing and not the why of medicine. If you look at the curricula of DNP programs, which are often touted as a way to get nurses practicing with lots of autonomy in places where they are short on physicians, they're heavy on nonsense nursing theory and light on things that actually matter like pathophysiology and pharmacology.
We actually do have a better model in the form of physician assistants. They're taught the same kinds of things physicians are taught, just in less depth.
That is the kind of thing makes me wonder how much of "things that actually matter like pathophysiology and pharmacology" can be factored out into the automation land now.
AI isn't perfect, but even loosely scaffolded generalist systems show promise in the field of medicine now. And the alternative isn't some hypothetical "perfect healthcare" - the status quo is often closer to "nurses running near the limits of their competence" or "physicians stretched thin almost to the breaking point".
The fundamental problem of healthcare is that it struggles to scale. The need for well educated, well paid professionals is inescapable. Or, was inescapable? We might be at the point where this can start changing.
> That is the kind of thing makes me wonder how much of "things that actually matter like pathophysiology and pharmacology" can be factored out into the automation land now.
I would say not much. AI is still often wrong and a clinician needs to know when the LLM is saying something crazy. I think AI has the most promise for increasing the productivity of well trained professionals, not replacing them (or their training) entirely.
Human clinicians are also "often wrong", for a given definition of "often". "Get a second opinion" didn't originate with AI.
Are AIs wrong more often or less often?
Would the healthcare get better or worse if the "first opinion" was AI more often than not?
"Increasing the productivity" and "replacing them" is two sides of the same coin. If a human can do five times the work, because AI does most of the work and the human performs "exception handling"? You need less humans. And healthcare, historically, is almost always human-constrained. That's why you get insane wait times and overworked clinicians. Most other inputs scale more readily than human expertise.
Thus the impetus to figure out where "human expertise" can be substituted for that of a scalable machine system - and what would be the best ways to implement that.
I was replying to "how much of 'things that actually matter like pathophysiology and pharmacology' can be factored out into the automation land"
I'd argue they aren't being factored into automation land if they're still the responsibility of a human expert, even if there are fewer more productive human experts.
(Though I do think AI will have a role in pathophysiology and pharmacology, initially catching errors, and probably some day taking responsibility, but not soon.)
Yep. I haven’t seen an actual MD in quite some time. Instead my general care provider is a Nurse Practitioner and he’s been handling all my routine healthcare needs.
Hate to be cynical, but going by the stories a doctor in my personal circles tells me, "talked to me for an hour, ordered a ton of tests" could be more about billing the national healthcare fund for many tests, that may not be most useful, but carry best margins for the facility.
In my country, there's a big feud between cardiologists and radiologists right now, big enough to be a regular topic in national media. Inside sources tell me it has nothing to do with quality of care, and is entirely about the march of technology allowing radiologists to perform some diagnostics that previously required cardiological procedures, and those procedures happened to be the major funding source for the cardiology departments.
Which is why we need more doctors trained more cheaply who are earning less money. They have far too much labor power currently for a role that increasingly can be fulfilled by a pure “technician” style expertise.
Yes, but it's erupting now that it killed a golden goose for the "real doctors", and the problem here is not along the doctor/technician lines (radiology has doctors too), but along the specialty/hospital department divide, because those are effectively separate business units.
I'd like not to have to wait for three months to see a doctor to prescribe me the routine treatment for my routine illness, so yes, more mediocre doctors would be good for me. It would also unburden the doctors who are "really into medicine" so that they could spend their time on more difficult cases.
Earlier you just need to find a doctor and they were probably good. Now you have to take your luck with many till you find a good one (if you are still alive by then)..
I don't know why people think that they can mass produce competence..
I have the impression that some people imagine that you can produce now 10x more doctors at the same cost that you were producing one doctor 10 years ago. Mostly because some tasks (even programming) got many times "more efficient" I feel people transfer to easy to other topics.
Even worse, education expenditure is decreasing for many countries! (see some examples: <a href="https://ourworldindata.org/grapher/education-spending?tab=line&country=USA%7EROU%7ENLD%7EJPN&spending_type=gdp_share&level=all" rel="nofollow">https://ourworldindata.org/grapher/education-spending?tab=li...)
There have always been a lot of incompetent and even dangerous doctors. It's just that patients weren't aware of this and tended to trust their doctor even when the actual care quality was terrible.
Ah yes and when doctors give everyone expensive tests because the patients are a bunch of drama queens who think they know better because they have a doctorate in Google the costs go up.
This is another one of those "kids these days" thing based on nothing but vibes. <a href="https://www.science.org/doi/10.1126/sciadv.aav5916" rel="nofollow">https://www.science.org/doi/10.1126/sciadv.aav5916
I'll give you some N=1 sample on older doctors since I'm also from Romania: a lot of these older doctors haven't opened a book in a very long time and are still using older practices instead of providing their patients with the latest and most effective treatments available because they're too lazy and/or prestigious to go and learn new things. Would you say that they "into medicine"?
> Would it help if we get a lot more of the first kind of doctors?
It would certainly help hypochondriacs a lot. Ordering "a ton of tests" needs to have some basis behind it, and doing it just to make the patient "feel seen" is not a great way to do your profession. People being dismissed quickly also happens in the US quite a lot, sometimes with disastrous results though it's not incredibly common, it's typically labeled under "diagnostic error" <a href="https://qualitysafety.bmj.com/content/23/9/727.long" rel="nofollow">https://qualitysafety.bmj.com/content/23/9/727.long
You get the same problems in the US with the attitudes of doctors.
In the US, medical school is extremely expensive (like $400,000 expensive). There are many people who are excellent doctors who are just priced out of the profession. If we could make medical school less expensive (by subsidizing it and by reducing the amount of instruction), we would probably get many more excellent doctors.
Half a million in debt is scary. Especially if you have any doubts that you can match and make it through residency at the end. It's even scarier if you come from a family making $50k/yr.
Don't they have to back these gigantic loans? That might deter people from going to medical school out of fear they're not gonna have what it takes and drop out halfway with huge debt.
Loans need to be repaid. I have many physician friends who graduated from medical school with 500k-750k in student loan debt (including debt from undergrad which compounded during medical school) with a combination of federal student aid as well as private loans anywhere from 8-10%. After graduating medical school, they completed 3-5 year residency programs earning somewhere in the ballpark of $50k-$60k salary. This is in an expensive northeast US market where such a salary barely covers basic living expenses, and as such their debt continued to compound. After completing residencies, they earn $175k-$200k salary which is about average for this area as an attending physician in their specialties (primary care related specialties like Family Medicine).
You do the math: over a 10 year repayment period with compound interest, their education cost them MILLIONS and they'll be well into their 40s before they start saving a dime for retirement. The cost and scarcity of medical education is extremely punitive to doctors and prices out many would-be great physicians. Many I know who have gone through this ended up regretting it due to the enormous financial burden they are saddled with for many years after becoming an attending.
Maybe folks believe these professions should be reserved to those who inherit great amounts of generational wealth.
If "only" 30% of graduates are graduating with over $300k in debt, that means that of the 30,000 graduates that graduate from both allopathic and osteopathic programs each year [1] there are almost 9,000 physicians that are high debt graduates. At high interest rates, that debt can easily grow by hundreds of thousands of dollars while you complete a residency program.
The resident salaries that you listed are an average taken across all specialties. Family Medicine is the lowest paid specialty with 2026 PGY-1 salaries at $58,500 (representing an increase of over 15% since 2021) [2] That is simply not enough to pay the cost of living in a state like Massachusetts where the median household income is more than double that [3] and the average rent in Boston metro is almost $40,000 annually [4]. Not only can you not afford to pay down your student loan debt, you are extremely likely to accrue additional consumer debt on things like credits cards or vehicles.
My main point is that training to become a doctor carries so much financial risk that it selects against folks from poor socioeconomic backgrounds that would otherwise make great physicians. In 2018 the AAMC published a study showing that 51% of medical school matriculants were from families in the top quintile for family income [5] and if I were a betting man, I'd guess that proportion has only increased.
> At high interest rates, that debt can easily grow by hundreds of thousands of dollars while you complete a residency program.
Sure. But that’s not what you said. You said you had many fiends that graduated med school with $500k-$750k in debt. I think you were lying or your definition of many was highly exaggerated.
> That is simply not enough to pay the cost of living in a state like Massachusetts
$58k is the national average. Not the average in a high cost of living area like Massachusetts.
> My main point is that training to become a doctor carries so much financial risk that it selects against folks from poor socioeconomic backgrounds that would otherwise make great physicians.
There is almost zero financial risk.
Eventual graduation rate is 96%. Eventual match rate is around 99%.
Are there doctors that could have make more money going into finance sure. Are there doctors who are financially ruined, not meaningfully.
>In 2018 the AAMC published a study showing that 51% of medical school matriculants were from families in the top quintile for family income
1. Doctors kids are more likely to become doctors.
2. High income is correlated with intelligence and intelligence is partially heritable.
3. Kids from high income families are more likely to have extended family and friends who are editors who encourage them to become doctors.
4. Med school requires college and college and children from income families are much more likely to have college degrees.
5. Medical school entrance is competitive and high income kids are much more likely to go to better colleges.
6. High income kids are much more likely to have higher grades in college because they don’t have to work.
7. High income kids are much more likely to go to better high schools which impacts what college they get into and how well they do there.
The list goes on and on. The cost of medical school is so far down that list.
I don’t think accusations of lying add anything productive to the conversation, but thanks. We have different circles of friends with different financial circumstances and that’s OK. There are plenty of stories if you would care to read more:
Residency match rates for American graduates from American MD or DO programs are more like 93%. Also worth considering that thousands of Americans go abroad for medical school due to limited seats in the US. For American IMGs the match rate is only 70%. If you dig into things a little bit further, it’s actually worse than that because the figures do not include applicants who did not submit a rank list because they did not receive any interviews.
I agree that the vast majority are able to match into a residency program, but I certainly would not consider that “almost zero financial risk”
> I don’t think accusations of lying add anything productive to the conversation, but thanks. We have different circles of friends with different financial circumstances and that’s OK.
I think it’s more likely you’re just exaggerating. How many is many? If you personally know more than 5 doctors with $500k-$750k in debt after med school I’ll eat my hat.
That reddit link only had 7 actual doctors who claimed to have graduated with more than $500k in debt. In a post about high debt with 200+ comments in a subreddit for doctors.
And the OP mentioned in the comments that he was borrowing enough to pay for his “expensive” med school and to support himself, his stay at home wife, and their baby in an expensive area.
> Residency match rates for American graduates from American MD or DO programs are more like 93%
That’s only after primary march. Match rate after SOAP is 98%. Roughly half of the unmatched 2% get marched in the next max cycle which is where I got 99%. Of the remaining 1% most of those want to eventually place somewhere.
>For American IMGs
Yeah don’t go to a factory medical school in the Caribbean. It’s a bad idea.
It’s definitely almost 0 financial risk. The only real risk is that you just hate being a a doctor. But even in that case med school unlocks tons of opportunities outside of clinical practice.
The chance of you ending up suffering financial hardship is too small to consider in your decision making.
The real out of your control risks would be severe disability that prevents you from finishing med school or working (before you can afford disability insurance). But in the case it really doesn’t matter whether you owe $50k from undergrad or $250k from med school. You’re not paying either one back and you can actually bankrupt out of student loan debt in those cases.
"Are you sure you can find that many more doctors? That they'll be any good?
Speaking from Romania: ..."
The prior post was specifically talking about the US. (I assure you, arrogant dismissive doctors are also a thing in the US)
In the US, there are a number of things that artificially increase the barriers to becoming a doctor.
1) You typically need a four year college degree to apply to medical school
2) Medical schools are accredited by the AMA, which is controlled by doctors. The AMA makes it very difficult to start a new MD-granting medical school.
3) Medical school in the US is very competitive to get in. They are likely turning away a lot of people who could complete the degree.
4) Since 1997, the federal government has a fixed number of Medicare (Medicare is a federal health insurance program for people over 65) supported residency positions. That number was basically flat for 25 years. We lost about 20% per capita of doctors being trained with support from this program. The caveat to this is that the total number of residents per capita has increased over time, particularly the past 15 years or so. My understanding is that they are less likely to be fully funded, so they spend more money getting trained, and then have higher students loans (on average graduating with debt above 200k going back to the late 2000s) that they need to pay off, so they charge more.
And you can add to this that it can be very difficult to be a doctor in another country and come to the US to practice here.
I totally dont by the "no medicare funds for training". A doctor will see you for 10min (perhaps another 10min prep) and bill $1000. If you doubt this, just check your EOB statements from the insurance company or check your deductible history.
The entire salary for the resident can be earned back in 3-4 days. You still have 360 days left to pay back admin overhead, facility overhead, supplies, etc. That is earned back in the next several weeks. After that, the next ~300 days of the year are profit.
In states with balance billing, the doctor can set any price and bill you for the remaining figure with a balance bill. In NY and NJ these can be thousands or tens of thousands. If you dont pay, it goes to collection and the provider still gets 10 to 15 cents on the dollar. So no...the $75k annual salary of a resident is not a barrier to training more doctors according to any math i'm seeing. What am I missing?
What seems more likely is that supply is artificially constrained to increase scarcity and prices.
First, private practice docs see patients with very good employer provided insurance, but residents are largely seeing patients that private practices wont see - patients who are far too medically complex to fit into a 10 minute slot and who also have particularly stingy insurance.
So as opposed to a private practice doc who is seeing 30 patients per day and billing an a average of $250 to $300 per patient (certainly not $1000 - that is unrealistic in my experience), a resident is seeing more like 10 to 15 patients per day (30 minute slots) and billing less than $100 per patient.
Second, residents have to be supervised. You have not included the salary of the physicians supervising them in your calculation.
Third, and I have mentioned this many times before on HN, training is limited by chiefly by the number of training sites that can offer quality training. For example, most hospitals will not see a single case of Guillan-Barre in a single year. Would you want to be treated by a nuerologist who trained at such a hospital? This is why neurology training is generally limited to places with a high volume of neurologic cases that would be considered rare at the average hospital, and these hospitals can only accommodate so many residents. Even for general medicine, you probably do not want to be treated by a doctor who trained at a hospital where any case that passed a certain complexity was transferred out to a bigger center.
On top of these, a few things with the training process also jump out to me from a "can we attract smart and motivated people to this work" point of view: the sheer cost of medical school that creates an imperative for high pay down the line, coupled with a real chance that you can wind up without a residency match but still owe all that money for school, and in particular the grueling nature of the residency system, currently capped at only 80 hours/week since 2003, because people were working >100 and making mistakes.
There are arguments that these are factors that filter out the people who are not sufficiently motivated, but it's hard for me to imagine there aren't a lot of bright young people who might be interested in medicine, but see one of the various paths that exist today to making doctor-level money with only an undergraduate degree and in an environment that doesn't require a working schedule that actively harms your health.
Yep, it's a huge risk. If a student enters medical school and realizes halfway through that they don't want to be a doctor then they're still stuck with a huge debt and no way to pay it off. It's not like undergraduate education where you can fairly easily switch majors from chemistry to mathematics or whatever.
> Would it help if we get a lot more of the first kind of doctors?
Depends? Did the tests actually find anything, or did they just make you feel better?
I had a talk with my GP about this at some point, and he more or less told me that he can just say "Go home, rest, come back in two weeks if it doesn't get better.", and 95% of the time that'll be exactly what is necessary. The hard part of his job is figuring out which of the visits are those 5%.
So you're saying limiting the number of doctors work better?
Speaking from Poland, we see the same outcome: doctors rushing patients out after 5 minutes. The reasons may be different, though: since COVID, many doctors here have, in my view, become more arrogant and focused on money. Over the past few months, an uproar over doctors’ pay has swept through Polish social media.
Reports have emerged of doctors billing for overlapping work under multiple contracts. In one case, a doctor’s records showed 72 hours of work in a single day!
Meanwhile, the Polish Chamber of Physicians and Dentists (NIL) continues to defend caps on medical school admissions, adding fuel to the national debate.
estearum · · focus · HN ↗
There's no solution other than training a lot, lot, lot, lot more doctors.
Their salaries need to be lower, training needs to be cheaper and faster, and we need a lot more of them.
rolisz · · focus · HN ↗
Speaking from Romania: here medicine is prestigious. So many parents push their kids towards medicine. There's a glut of newly minted doctors every year, but rumour has it that the quality drops every year. Sure, they pass the exams and residency and what not, but... They're just not into medicine as much.
Do you want to get treated by such a person?
This year I had to go to a neurologist. I went to one locally, they dismissed me in 5 minutes, told me to take some vitamins basically. Went to another one in a much bigger city, they talked to me for an hour, ordered a ton of tests.
Would it help if we get a lot more of the first kind of doctors?
postalcoder · · focus · HN ↗
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wl · · focus · HN ↗
We actually do have a better model in the form of physician assistants. They're taught the same kinds of things physicians are taught, just in less depth.
ACCount39 · · focus · HN ↗
AI isn't perfect, but even loosely scaffolded generalist systems show promise in the field of medicine now. And the alternative isn't some hypothetical "perfect healthcare" - the status quo is often closer to "nurses running near the limits of their competence" or "physicians stretched thin almost to the breaking point".
The fundamental problem of healthcare is that it struggles to scale. The need for well educated, well paid professionals is inescapable. Or, was inescapable? We might be at the point where this can start changing.
leereeves · · focus · HN ↗
I would say not much. AI is still often wrong and a clinician needs to know when the LLM is saying something crazy. I think AI has the most promise for increasing the productivity of well trained professionals, not replacing them (or their training) entirely.
ACCount39 · · focus · HN ↗
Are AIs wrong more often or less often?
Would the healthcare get better or worse if the "first opinion" was AI more often than not?
"Increasing the productivity" and "replacing them" is two sides of the same coin. If a human can do five times the work, because AI does most of the work and the human performs "exception handling"? You need less humans. And healthcare, historically, is almost always human-constrained. That's why you get insane wait times and overworked clinicians. Most other inputs scale more readily than human expertise.
Thus the impetus to figure out where "human expertise" can be substituted for that of a scalable machine system - and what would be the best ways to implement that.
leereeves · · focus · HN ↗
I'd argue they aren't being factored into automation land if they're still the responsibility of a human expert, even if there are fewer more productive human experts.
(Though I do think AI will have a role in pathophysiology and pharmacology, initially catching errors, and probably some day taking responsibility, but not soon.)
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TeMPOraL · · focus · HN ↗
In my country, there's a big feud between cardiologists and radiologists right now, big enough to be a regular topic in national media. Inside sources tell me it has nothing to do with quality of care, and is entirely about the march of technology allowing radiologists to perform some diagnostics that previously required cardiological procedures, and those procedures happened to be the major funding source for the cardiology departments.
estearum · · focus · HN ↗
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lolakutty · · focus · HN ↗
Earlier you just need to find a doctor and they were probably good. Now you have to take your luck with many till you find a good one (if you are still alive by then)..
I don't know why people think that they can mass produce competence..
vladms · · focus · HN ↗
I have the impression that some people imagine that you can produce now 10x more doctors at the same cost that you were producing one doctor 10 years ago. Mostly because some tasks (even programming) got many times "more efficient" I feel people transfer to easy to other topics.
Even worse, education expenditure is decreasing for many countries! (see some examples: <a href="https://ourworldindata.org/grapher/education-spending?tab=line&country=USA%7EROU%7ENLD%7EJPN&spending_type=gdp_share&level=all" rel="nofollow">https://ourworldindata.org/grapher/education-spending?tab=li...)
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cbg0 · · focus · HN ↗
I'll give you some N=1 sample on older doctors since I'm also from Romania: a lot of these older doctors haven't opened a book in a very long time and are still using older practices instead of providing their patients with the latest and most effective treatments available because they're too lazy and/or prestigious to go and learn new things. Would you say that they "into medicine"?
> Would it help if we get a lot more of the first kind of doctors?
It would certainly help hypochondriacs a lot. Ordering "a ton of tests" needs to have some basis behind it, and doing it just to make the patient "feel seen" is not a great way to do your profession. People being dismissed quickly also happens in the US quite a lot, sometimes with disastrous results though it's not incredibly common, it's typically labeled under "diagnostic error" <a href="https://qualitysafety.bmj.com/content/23/9/727.long" rel="nofollow">https://qualitysafety.bmj.com/content/23/9/727.long
account42 · · focus · HN ↗
Hard to tell when you don't let us know which of those doctors ended up solving the issues that made you seek a doctor.
Dismissive doctors are bad but so are those that waste your time and risk complications from unnecessary invasive tests.
elil17 · · focus · HN ↗
In the US, medical school is extremely expensive (like $400,000 expensive). There are many people who are excellent doctors who are just priced out of the profession. If we could make medical school less expensive (by subsidizing it and by reducing the amount of instruction), we would probably get many more excellent doctors.
sarchertech · · focus · HN ↗
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sarchertech · · focus · HN ↗
The average med school debt is half that and only 30% of borrowers end up owning $300k or more.
Fewer than 1% of us med school graduates never find a slot. And that includes people who start families, move into industry etc and voluntarily leave.
The bottleneck is residency slots not med school slots.
elil17 · · focus · HN ↗
Right, because they are paying for it out of pocket
Herrum · · focus · HN ↗
sarchertech · · focus · HN ↗
Also the bottleneck is residency slots, so even if this is the case, it wouldn’t change anything.
tossstone · · focus · HN ↗
You do the math: over a 10 year repayment period with compound interest, their education cost them MILLIONS and they'll be well into their 40s before they start saving a dime for retirement. The cost and scarcity of medical education is extremely punitive to doctors and prices out many would-be great physicians. Many I know who have gone through this ended up regretting it due to the enormous financial burden they are saddled with for many years after becoming an attending.
Maybe folks believe these professions should be reserved to those who inherit great amounts of generational wealth.
sarchertech · · focus · HN ↗
The average debt is a little over $200k. Only 30% of graduates have over $300k in debt and they are considered high debt graduates.
Family Medicine salaries are above $200k in every state in the nation for full time doctors.
None of the doctors I know come from families with generational wealth.
Here is the nationwide average for resident salaries by year and its higher in higher cost of living areas.
Program year 1—$68,166.
Program year 2—$70,499.
Program year 3—$73,301.
Program year 4—$77,593.
Program year 5—$81,807.
Program year 6—$84,744.
Program year 7—$89,187.
Program year 8—$94,215.
Your entire picture is inaccurate.
tossstone · · focus · HN ↗
The resident salaries that you listed are an average taken across all specialties. Family Medicine is the lowest paid specialty with 2026 PGY-1 salaries at $58,500 (representing an increase of over 15% since 2021) [2] That is simply not enough to pay the cost of living in a state like Massachusetts where the median household income is more than double that [3] and the average rent in Boston metro is almost $40,000 annually [4]. Not only can you not afford to pay down your student loan debt, you are extremely likely to accrue additional consumer debt on things like credits cards or vehicles.
My main point is that training to become a doctor carries so much financial risk that it selects against folks from poor socioeconomic backgrounds that would otherwise make great physicians. In 2018 the AAMC published a study showing that 51% of medical school matriculants were from families in the top quintile for family income [5] and if I were a betting man, I'd guess that proportion has only increased.
1. <a href="https://www.kff.org/state-health-policy-data/state-indicator/total-medical-school-graduates/" rel="nofollow">https://www.kff.org/state-health-policy-data/state-indicator...
2. <a href="https://www.inspiraadvantage.com/blog/how-much-do-medical-residents-get-paid" rel="nofollow">https://www.inspiraadvantage.com/blog/how-much-do-medical-re...
3. <a href="https://fred.stlouisfed.org/series/MEHOINUSMAA672N" rel="nofollow">https://fred.stlouisfed.org/series/MEHOINUSMAA672N
4. <a href="https://www.zillow.com/rental-manager/market-trends/boston-ma/" rel="nofollow">https://www.zillow.com/rental-manager/market-trends/boston-m...
5. <a href="https://www.aamc.org/media/9596/download" rel="nofollow">https://www.aamc.org/media/9596/download
sarchertech · · focus · HN ↗
Sure. But that’s not what you said. You said you had many fiends that graduated med school with $500k-$750k in debt. I think you were lying or your definition of many was highly exaggerated.
> That is simply not enough to pay the cost of living in a state like Massachusetts
$58k is the national average. Not the average in a high cost of living area like Massachusetts.
> My main point is that training to become a doctor carries so much financial risk that it selects against folks from poor socioeconomic backgrounds that would otherwise make great physicians.
There is almost zero financial risk.
Eventual graduation rate is 96%. Eventual match rate is around 99%.
Are there doctors that could have make more money going into finance sure. Are there doctors who are financially ruined, not meaningfully.
>In 2018 the AAMC published a study showing that 51% of medical school matriculants were from families in the top quintile for family income
1. Doctors kids are more likely to become doctors.
2. High income is correlated with intelligence and intelligence is partially heritable.
3. Kids from high income families are more likely to have extended family and friends who are editors who encourage them to become doctors.
4. Med school requires college and college and children from income families are much more likely to have college degrees.
5. Medical school entrance is competitive and high income kids are much more likely to go to better colleges.
6. High income kids are much more likely to have higher grades in college because they don’t have to work.
7. High income kids are much more likely to go to better high schools which impacts what college they get into and how well they do there.
The list goes on and on. The cost of medical school is so far down that list.
tossstone · · focus · HN ↗
<a href="https://www.reddit.com/r/whitecoatinvestor/comments/1jayeai/are_med_students_really_in_this_much_debt/" rel="nofollow">https://www.reddit.com/r/whitecoatinvestor/comments/1jayeai/...
Residency match rates for American graduates from American MD or DO programs are more like 93%. Also worth considering that thousands of Americans go abroad for medical school due to limited seats in the US. For American IMGs the match rate is only 70%. If you dig into things a little bit further, it’s actually worse than that because the figures do not include applicants who did not submit a rank list because they did not receive any interviews.
I agree that the vast majority are able to match into a residency program, but I certainly would not consider that “almost zero financial risk”
<a href="https://www.nrmp.org/about/news/2026/03/nrmp-releases-results-of-the-2026-main-residency-match-for-more-than-38000-future-residents/" rel="nofollow">https://www.nrmp.org/about/news/2026/03/nrmp-releases-result...
sarchertech · · focus · HN ↗
I think it’s more likely you’re just exaggerating. How many is many? If you personally know more than 5 doctors with $500k-$750k in debt after med school I’ll eat my hat.
That reddit link only had 7 actual doctors who claimed to have graduated with more than $500k in debt. In a post about high debt with 200+ comments in a subreddit for doctors.
And the OP mentioned in the comments that he was borrowing enough to pay for his “expensive” med school and to support himself, his stay at home wife, and their baby in an expensive area.
> Residency match rates for American graduates from American MD or DO programs are more like 93%
That’s only after primary march. Match rate after SOAP is 98%. Roughly half of the unmatched 2% get marched in the next max cycle which is where I got 99%. Of the remaining 1% most of those want to eventually place somewhere.
>For American IMGs
Yeah don’t go to a factory medical school in the Caribbean. It’s a bad idea.
It’s definitely almost 0 financial risk. The only real risk is that you just hate being a a doctor. But even in that case med school unlocks tons of opportunities outside of clinical practice.
The chance of you ending up suffering financial hardship is too small to consider in your decision making.
The real out of your control risks would be severe disability that prevents you from finishing med school or working (before you can afford disability insurance). But in the case it really doesn’t matter whether you owe $50k from undergrad or $250k from med school. You’re not paying either one back and you can actually bankrupt out of student loan debt in those cases.
fusslo · · focus · HN ↗
We have the Public Service Loan Forgiveness program where qualifying public servants pay 10 years of their loans and the rest is forgiven tax free.
Removing financial stress from doctors seems like a public good most people could get behind
nradov · · focus · HN ↗
nradov · · focus · HN ↗
<a href="https://students-residents.aamc.org/medical-school-admission-requirements/medical-schools-offering-combined-baccalaureate-md-programs-state-and-program-length-2025-2026" rel="nofollow">https://students-residents.aamc.org/medical-school-admission...
bookofjoe · · focus · HN ↗
juujian · · focus · HN ↗
1980phipsi · · focus · HN ↗
The prior post was specifically talking about the US. (I assure you, arrogant dismissive doctors are also a thing in the US)
In the US, there are a number of things that artificially increase the barriers to becoming a doctor.
1) You typically need a four year college degree to apply to medical school
2) Medical schools are accredited by the AMA, which is controlled by doctors. The AMA makes it very difficult to start a new MD-granting medical school.
3) Medical school in the US is very competitive to get in. They are likely turning away a lot of people who could complete the degree.
4) Since 1997, the federal government has a fixed number of Medicare (Medicare is a federal health insurance program for people over 65) supported residency positions. That number was basically flat for 25 years. We lost about 20% per capita of doctors being trained with support from this program. The caveat to this is that the total number of residents per capita has increased over time, particularly the past 15 years or so. My understanding is that they are less likely to be fully funded, so they spend more money getting trained, and then have higher students loans (on average graduating with debt above 200k going back to the late 2000s) that they need to pay off, so they charge more.
And you can add to this that it can be very difficult to be a doctor in another country and come to the US to practice here.
TuringNYC · · focus · HN ↗
The entire salary for the resident can be earned back in 3-4 days. You still have 360 days left to pay back admin overhead, facility overhead, supplies, etc. That is earned back in the next several weeks. After that, the next ~300 days of the year are profit.
In states with balance billing, the doctor can set any price and bill you for the remaining figure with a balance bill. In NY and NJ these can be thousands or tens of thousands. If you dont pay, it goes to collection and the provider still gets 10 to 15 cents on the dollar. So no...the $75k annual salary of a resident is not a barrier to training more doctors according to any math i'm seeing. What am I missing?
What seems more likely is that supply is artificially constrained to increase scarcity and prices.
b38484848 · · focus · HN ↗
Anyone here should be familiar with the ""sAfEtY"" argument at this point.
Calavar · · focus · HN ↗
Several things.
First, private practice docs see patients with very good employer provided insurance, but residents are largely seeing patients that private practices wont see - patients who are far too medically complex to fit into a 10 minute slot and who also have particularly stingy insurance.
So as opposed to a private practice doc who is seeing 30 patients per day and billing an a average of $250 to $300 per patient (certainly not $1000 - that is unrealistic in my experience), a resident is seeing more like 10 to 15 patients per day (30 minute slots) and billing less than $100 per patient.
Second, residents have to be supervised. You have not included the salary of the physicians supervising them in your calculation.
Third, and I have mentioned this many times before on HN, training is limited by chiefly by the number of training sites that can offer quality training. For example, most hospitals will not see a single case of Guillan-Barre in a single year. Would you want to be treated by a nuerologist who trained at such a hospital? This is why neurology training is generally limited to places with a high volume of neurologic cases that would be considered rare at the average hospital, and these hospitals can only accommodate so many residents. Even for general medicine, you probably do not want to be treated by a doctor who trained at a hospital where any case that passed a certain complexity was transferred out to a bigger center.
[deleted] · · focus · HN ↗
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macNchz · · focus · HN ↗
There are arguments that these are factors that filter out the people who are not sufficiently motivated, but it's hard for me to imagine there aren't a lot of bright young people who might be interested in medicine, but see one of the various paths that exist today to making doctor-level money with only an undergraduate degree and in an environment that doesn't require a working schedule that actively harms your health.
nradov · · focus · HN ↗
nradov · · focus · HN ↗
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Aeolun · · focus · HN ↗
Depends? Did the tests actually find anything, or did they just make you feel better?
I had a talk with my GP about this at some point, and he more or less told me that he can just say "Go home, rest, come back in two weeks if it doesn't get better.", and 95% of the time that'll be exactly what is necessary. The hard part of his job is figuring out which of the visits are those 5%.
rudolftheone · · focus · HN ↗
Speaking from Poland, we see the same outcome: doctors rushing patients out after 5 minutes. The reasons may be different, though: since COVID, many doctors here have, in my view, become more arrogant and focused on money. Over the past few months, an uproar over doctors’ pay has swept through Polish social media.
Reports have emerged of doctors billing for overlapping work under multiple contracts. In one case, a doctor’s records showed 72 hours of work in a single day!
Meanwhile, the Polish Chamber of Physicians and Dentists (NIL) continues to defend caps on medical school admissions, adding fuel to the national debate.
M95D · · focus · HN ↗