Physician Shortage and Decreasing Admission Rates

[Seth Joo]

Economics is a poor predictor of human behavior. Plenty of people are willing to take a 50% (and sometimes even more) pay cut for the perks of living in a desirable area. A hospitalist in NYC will generally pull 200k, while in the sticks, you can easily make 300k. The other issue is that procedural specialties require volume that just isn't there in rural areas. No amount of saturation will make it worth it for a hand surgeon to relocate to an area with 80,000 people spread over 6 counties in NoDak.

NYC is an urban cesspool, I have no idea why people think New York is so great when its the most overrated and overcrowded American city, compare it to Boston which is cleaner, safer, and friendlier, has fewer neighborhoods that I would consider to be sketchy.

Another fact to consider that most alleged "New Yorkers" actually live in its surrounding suburbs, in Long Island, Westchester, Connecticut, Rockland, and New Jersey. Its just like Los Angeles where most people flee to the suburbs.

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[Lucca]

NYC is an urban cesspool, I have no idea why people think New York is so great when its the most overrated and overcrowded American city, compare it to Boston which is cleaner, safer, and friendlier, has fewer neighborhoods that I would consider to be sketchy.

Another fact to consider that most alleged "New Yorkers" actually live in its surrounding suburbs, in Long Island, Westchester, Connecticut, Rockland, and New Jersey. Its just like Los Angeles where most people flee to the suburbs.

In this thread, the entire state of Connecticut is a suburb of New York.


I see your point, but I had to point that out.

 

[Seth Joo]

In this thread, the entire state of Connecticut is a suburb of New York.


I see your point, but I had to point that out.

My ex-wife grew up in Greenwich, CT, her parents worked in New York, she considered herself a proud "New Yorker", I knew a lot of faux "New Yorkers" like her who grew up in surrounding suburbs, often very wealthy and sheltered neighborhoods. Even a city like Chicago, with some of the worst crime in America has some of the nicest suburban communities in the country with nearly zero violent crime. The same with Los Angeles, the suburbs of Orange County are pretty quiet and boring.

New York is okay to visit but living there is another story, the same goes for Los Angeles.

By the way I read North and South Dakota are supposed to be the two best states in America for healthy living. I always thought it was Colorado.

 

[Lucca]

My ex-wife grew up in Greenwich, CT, her parents worked in New York, she considered herself a proud "New Yorker", I knew a lot of faux "New Yorkers" like her who grew up in surrounding suburbs, often very wealthy and sheltered neighborhoods. Even a city like Chicago, with some of the worst crime in America has some of the nicest suburban communities in the country with nearly zero violent crime. The same with Los Angeles, the suburbs of Orange County are pretty quiet and boring.

New York is okay to visit but living there is another story, the same goes for Los Angeles.

By the way I read North and South Dakota are supposed to be the two best states in America for healthy living. I always thought it was Colorado.

I know people commute from various states. I'm in Texas where other states are something you read about in textbooks and see on the news sometimes but we're all fairly convinced they are a myth. I just thought it was hilarious that two other states were essentially just suburbs of a city lol

 

[Seth Joo]

I know people commute from various states. I'm in Texas where other states are something you read about in textbooks and see on the news sometimes but we're all fairly convinced they are a myth. I just thought it was hilarious that two other states were essentially just suburbs of a city lol

When I first met my ex-wife she first said she was from New York and then when I asked her what part she said Connecticut.

 

[Psai]

When I first met my ex-wife she first said she was from New York and then when I asked her what part she said Connecticut.

Didn't know that this was a thing

 

[Seth Joo]

Didn't know that this was a thing

I have classmates at AZCOM who come from Orange County and say they are from LA as well. I used to have classmates in undergrad who grew up in New Jersey but considered themselves "New Yorkers". I tend to be rigid when it comes to geography.

 

[Law2Doc]

When I first met my ex-wife she first said she was from New York and then when I asked her what part she said Connecticut.

Maybe if she didn't lie so much she wouldn't be your EX wife?

 

[68PGunner]

NYC is an urban cesspool, I have no idea why people think New York is so great when its the most overrated and overcrowded American city, compare it to Boston which is cleaner, safer, and friendlier, has fewer neighborhoods that I would consider to be sketchy.

Another fact to consider that most alleged "New Yorkers" actually live in its surrounding suburbs, in Long Island, Westchester, Connecticut, Rockland, and New Jersey. Its just like Los Angeles where most people flee to the suburbs.

How about the fact that everything closes by midnight in Boston? I have been to both NYC and Boston. I would take NYC over Boston 10/10. Boston is a nice place, but NYC beats it by a mile when it comes to culture diversity.

 

[Seth Joo]

Maybe if she didn't lie so much she wouldn't be your EX wife?

Greenwich, Connecticut is a wealthy suburb not far outside of New York City, her parents worked in Manhattan during the day. In fact many people who live there work in New York during the day. I would not call her a liar. New York is a great tourist city, but Boston is a better everyday life city.

 

[Law2Doc]

Greenwich, Connecticut is a wealthy suburb not far outside of New York City, her parents worked in Manhattan during the day. In fact many people who live there work in New York during the day. I would not call her a liar.

It's very much a New Yorker mindset to regard other states as their suburbs. In fact that perception is shared by very few from those other states, who are usually commuting from there knowing full well that they are not part of the NY community and with the expressed goal of NOT living in NY and the headaches that go along with that.

And yeah when you called her bluff and she said Connecticut you caught her in a lie.

 

[68PGunner]

What I'm saying is that the distribution problem will be solved with an oversupply of doctors that will force salaries so low that doctors will have to leave San Francisco, Manhattan, and Hawaii and move to rural Wisconsin and South Dakota. but I don't want that to happen, because salaries will then be very low across the board and we will all be very unhappy.



Right, he'll stay in NY for 200k. But if there were so many hospitalists in NY that there were absolutely no jobs, or if NY jobs were now paying only 100K, and rural jobs 300k, or maybe 200 k, he'll have to move or he won't be able to pay his bills. So there is a gradient now, but at some greater gradient, or at some level of salary so low that you can't live comfortably, doctors will have to move.

I'm saying that it's a mistake to think that doctors are somehow magically immune from economic pressure. They are not. Why do you think doctors sign up for IPOs and PPOs and take deeply discounted rates from insurance companies? Because otherwise they will lose the patients, not because they want to help the insurance companies out. When there's enough pressure, doctors close their practices and take jobs as employees. They move to where the jobs are.



Actually, there's probably plenty of work for a hand surgeon in rural areas, due to agricultural trauma.

More importantly, specialists will revert to a more generalist practice if it will get them a more lucrative practice. So, if that ortho hand surgeon is offered a better job somewhere else for general ortho, the hand surgeon will take that job and do general ortho. I know lots of doctors who don't use their fellowships, because they can get a better job if they do the specialty and not the subspecialty. I'm in a large multispecialty group, and the nature of the practice requires many subspecialists to take call and do cases that are in the specialty, and not subspecialty, because of the needs of the group. They would never do those cases in their own practice, but in order to have this otherwise desirable job, they compromise. Similarly, doctors even now move to undersirable or 3rd or 4th choice locations because the job is otherwise desirable. If economic pressures get larger, they will be more willing to move.



Old-fashioned economics made incorrect assumptions. Modern Behavioral Economics is a great predictor of "irrational" behavior. I highly recommend books by Dan Arielli, Levitt and Dubner, and Daniel Kahneman, who won the Nobel Prize in economics for developing the field of behavioral economics.

I think you're oversimplifying the thought process. If physician salary suddenly becomes $100K, schools have to drastically cut down on tuition or there will be significant decrease of enrollments. Everything in life with regards to both the supply and demand sides of things have a certain elasticity, which makes certain alternatives more attractive at certain prices. This is coming from a dude that shorted crude at $150 in 2008 to $40, and the JPY at .78 USD in 2012. I'm not unfamiliar to the economic concepts that you're applying to this debate.

 

[Seth Joo]

It's very much a New Yorker mindset to regard other states as their suburbs. In fact that perception is shared by very few from those other states, who are usually commuting from there knowing full well that they are not part of the NY community and with the expressed goal of NOT living in NY and the headaches that go along with that.

Los Angeles has a similar mindset to New York, nearly half of my class from AZCOM is from Southern California, many of whom are from affluent Orange County, but when you ask them where they are from, they usually say LA, even though they are not really from LA.

 

[68PGunner]

It's very much a New Yorker mindset to regard other states as their suburbs. In fact that perception is shared by very few from those other states, who are usually commuting from there knowing full well that they are not part of the NY community and with the expressed goal of NOT living in NY and the headaches that go along with that.

And yeah when you called her bluff and she said Connecticut you caught her in a lie.

Honestly, I always thought that Greenwich is like some rich paradise in NY for rich NYC millionaires and billionaires.

 

[Goro]

Cincinnatians very much consider Florence, KY as a suburb!

It's very much a New Yorker mindset to regard other states as their suburbs. In fact that perception is shared by very few from those other states, who are usually commuting from there knowing full well that they are not part of the NY community and with the expressed goal of NOT living in NY and the headaches that go along with that.

And yeah when you called her bluff and she said Connecticut you caught her in a lie.

 

[Law2Doc]

Los Angeles has a similar mindset to New York, nearly half of my class from AZCOM is from Southern California, many of whom are from affluent Orange County, but when you ask them where they are from, they usually say LA, even though they are not really from LA.

Depends if they think you know the area. If you don't know So. Cal. then LA may simply be the closest frame of reference. It's easier than going down the "I live in X" "where's that", "near LA" line of inquiry.

 

[Seth Joo]

Depends if they think you know the area. If you don't know So. Cal. then LA may simply be the closest frame of reference. It's easier than going down the "I live in X" "where's that", "near LA" line of inquiry.

Orange County's suburbs were built for affluent people who wanted to escape the social problems of Los Angeles but that being said there are plenty of exclusive and secluded enclaves in Los Angeles as well.

Boston seems to be the only major American city that still seems to retain its middle class within its city limits. San Diego might be the only other.

 

[WingedOx]

Orange County's suburbs were built for affluent people who wanted to escape the social problems of Los Angeles but that being said there are plenty of exclusive and secluded enclaves in Los Angeles as well.

Boston seems to be the only major American city that still seems to retain its middle class within its city limits. San Diego might be the only other.

define "middle class"

 

[deleted716403]

I don't get why some people love saying they're from NY or LA, etc. even though they obviously aren't. Makes no difference to me; as if I judged them on where they're from...

 

[Law2Doc]

...
Boston seems to be the only major American city that still seems to retain its middle class within its city limits...

Nah, tons of people commuting in from Cohasset and other similar bayside communities.

 

[WingedOx]

Nah, tons of people commuting in from Cohasset and other similar bayside communities.

Yeah, no way if you're saying "the entire" or even "most of" the middle class. As for any middle class, Chicago would beat Boston in pure numbers easily even just factoring in the NW neighborhoods. (you could also fit the land area of Boston inside Chicago 8 times). Same with Philly.

 

[bc65]

I think you're oversimplifying the thought process. If physician salary suddenly becomes $100K, schools have to drastically cut down on tuition or there will be significant decrease of enrollments. Everything in life with regards to both the supply and demand sides of things have a certain elasticity, which makes certain alternatives more attractive at certain prices. This is coming from a dude that shorted crude at $150 in 2008 to $40, and the JPY at .78 USD in 2012. I'm not unfamiliar to the economic concepts that you're applying to this debate.

That might be what you would do, but as I noted already, the collapse of the market for lawyers has had a relatively modest effect on law school attendance, and in fact law school tuition has continued to rise through 2015. The top 1/3 of law schools have had an increase in the number of students. Lower tier law schools have modestly decreased enrollments, but some of those schools aren't even accredited ( Some states allow you to take the bar exam without going to law school, hence the unaccredited schools. ) If doctor salaries dropped significantly, what you might see is a decrease in Caribbean students, which are somewhat comparable to the lower tier law schools.

The median lawyer salary is $77,000, but many, if not most, law school graduates don't find any job at all requiring a legal degree, and those salaries of zero $ don't appear in the statistics. Many law graduates end up earning minimum wage, and yet they still keep coming.

The fact is that there are enough people whose motivation to become a doctor is not at all based on economic factors, people who just want to be a physician and help people, along with plenty of immigrant parents who will push their children into medicine regardless of any arguments to the contrary, that I don't believe that any degree of salary decrease would make a difference, at least not for a generation or more. And some lawyers, and some doctors, will always be outliers, and so people will keep applying because they assume that they will be that winner.

This is coming from a dude that shorted crude at $150 in 2008 to $40, and the JPY at .78 USD in 2012. I'm not unfamiliar to the economic concepts that you're applying to this debate

BTW, you should stop betting on individual stocks or commodities. Almost all fund managers, including hedge fund managers, under perform the market over time. Everyone always brags about their winners, but they never talk about their losers, despite the fact that someone is on the other end of every transaction. It's just like people who come back from the casino. They all always tell you they won, and yet, somehow, the casinos still manage to make money.