There Was No Golden Age of Medicine

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makemoney2024 said:
I have been locuming at this one place since January and call for the past six months, could sometimes go most of the night. So they changed the call day from 2pm to 6am to 6pm-6am with 24 hour weekends. Winter call hours were manageable and occasionally long. I came back from vacation and was on call in July about half the time up there during a 12 day stint including a 24 hour Sunday. Each and every night of call night I worked 6 hours plus. First week I had 29 hours of OT, and second week had about 24 hours not including a weekend. I mean it just kept going and going and going.

I am getting too old for this. The money is great but this is ridiculous for a 100 bed hospital. And they want us, the anesthesia docs to push back against these surgeons who are lining up questionable emergency cases at all the off hours. Because admin is bleeding money. lol. I am a traveler. I am not gonna fight your surgeons. You guys have been letting them get away with BS emergency cases for decades and now you want travelers to help you?? They have less than half the anesthesiolgists they need so lots of locums.
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So I went back and actually finalized my hours for the second week. 30 hours of being awake and working during call hours on the second week. These are four weeknights between the hours of 6p-6a. Madness. 150 bed hospital but never more than 100 or so patients. OB ever only uses 5 birthing rooms and one pre op area, PACU has about 20% capacity on any given day. Have a surgeon who’s old school and loves doing stable Appys at night as well as an OB who pushes for CSections for everyone. And then of course the occasional traumas.
Part of the problem is we are so short staffed and inefficient in the daytime with long turnovers from nurses who are slow and inexperienced.
 
GravelRider said:
TL;DW: Already rich doctor with no kids and family to support develops a vision problem and retires on a full disability policy that allows him live in one of the most expensive areas of the country and rollerblade all day. He’s probably richer than most working physicians, but makes claims that he’s found the meaning of life. 🙄
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True, but he lives a very spartan life in a studio apartment. I'm fairly sure his clothes, cars, other frills, etc are less than all of us. Probably the only thing stopping an anesthesiologist from gliding into this life later in their career are children still being paid for, ie still at home or college expenses or in rehab from a screwed up doctor's kid life.
 
We'llBeDoneIn15Minutes said:
True, but he lives a very spartan life in a studio apartment. I'm fairly sure his clothes, cars, other frills, etc are less than all of us. Probably the only thing stopping an anesthesiologist from gliding into this life later in their career are children still being paid for, ie still at home or college expenses or in rehab from a screwed up doctor's kid life.
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A studio that costs more than probably 90% of homes in America. Good for him for not embracing the consumerist American lifestyle, but the carefree attitude towards enjoying life to its fullest is easy when you are very wealthy and have no other financial obligations towards dependents. It’s nice that people find his message inspiring, but let’s temper it with a little dose of reality. The vast majority of people can’t just quit their jobs and go rollerblading in Malibu for the rest of their lives.
 
GravelRider said:
A studio that costs more than probably 90% of homes in America. Good for him for not embracing the consumerist American lifestyle, but the carefree attitude towards enjoying life to its fullest is easy when you are very wealthy and have no other financial obligations towards dependents. It’s nice that people find his message inspiring, but let’s temper it with a little dose of reality. The vast majority of people can’t just quit their jobs and go rollerblading in Malibu for the rest of their lives.
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Totally get it. I feel that way about my own luck/advantages/lifestyle, things I didn’t always control. Either way, it’s even more of an imperative for someone like him, heck, all of us, to get to that level of understanding about what’s truly important in life, especially if we have all of those advantages. There’s no excuse.
 
NumTacos said:
Totally get it. I feel that way about my own luck/advantages/lifestyle, things I didn’t always control. Either way, it’s even more of an imperative for someone like him, heck, all of us, to get to that level of understanding about what’s truly important in life, especially if we have all of those advantages. There’s no excuse.
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Exactly. Every doctor I know feels overworked, yet every doctor I know has much more than I and could work much less if they simply would give up some possessions and accept having less.

I'm not at the Spartan level of skater dude by a long shot, but I do live modest, same cars for 15 years, same modest starter home etc stuff like that, less than full time work x 2 decades, yes a fraction of Blades 401, but an abundance of free time that I've never thought twice that I should have worked more to have more.

Basically, "Fu** the Jones's" is my motto. (actually I just made that up this minute but it's now my credo going forward haha).
 
GravelRider said:
A studio that costs more than probably 90% of homes in America. Good for him for not embracing the consumerist American lifestyle, but the carefree attitude towards enjoying life to its fullest is easy when you are very wealthy and have no other financial obligations towards dependents. It’s nice that people find his message inspiring, but let’s temper it with a little dose of reality. The vast majority of people can’t just quit their jobs and go rollerblading in Malibu for the rest of their lives.
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I get what you're saying but I believe that's San Diego and a studio not on the water is very doable for doctors. We're anesthesiologists.
 
We'llBeDoneIn15Minutes said:
Exactly. Every doctor I know feels overworked, yet every doctor I know has much more than I and could work much less if they simply would give up some possessions and accept having less.

I'm not at the Spartan level of skater dude by a long shot, but I do live modest, same cars for 15 years, same modest starter home etc stuff like that, less than full time work x 2 decades, yes a fraction of Blades 401, but an abundance of free time that I've never thought twice that I should have worked more to have more.

Basically, "Fu** the Jones's" is my motto. (actually I just made that up this minute but it's now my credo going forward haha).
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Haha. I am the same way. I basically work part time now, but like you, I live within my means, and I still live extremely well, just not as many toys. I could probably even do with less, but working these days is actually kind of fun when you don’t have to do it full time.
 
We'llBeDoneIn15Minutes said:
I get what you're saying but I believe that's San Diego and a studio not on the water is very doable for doctors. We're anesthesiologists.
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Was this video in an Anesthesiology journal? It was a feel good puff piece published at a time when people were finally starting to feel good about the economy again. People had optimism. I wonder if they would have published that nonsense in 2008? 🤔
 
makemoney2024 said:
How so?
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Pretty much what @nimbus said. We have so much access to movies, shows, learning material, entertainment through computers and phones today. Internet is way faster. Cars are much better. Shopping is way more efficient. Access to much better food than just Applebee's and Claim Jumper. Grocery stores are better stocked. Better selection at grocery stores.
 
sloh said:
Pretty much what @nimbus said. We have so much access to movies, shows, learning material, entertainment through computers and phones today. Internet is way faster. Cars are much better. Shopping is way more efficient. Access to much better food than just Applebee's and Claim Jumper. Grocery stores are better stocked. Better selection at grocery stores.
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Yeah. Other stuff I don’t miss from the 1980s-whiteout, typewriters, drum brakes, pay phones, Dewey decimal system, compact discs, encyclopedias, VHS tapes, etc…lol
 
sloh said:
Pretty much what @nimbus said. We have so much access to movies, shows, learning material, entertainment through computers and phones today. Internet is way faster. Cars are much better. Shopping is way more efficient. Access to much better food than just Applebee's and Claim Jumper. Grocery stores are better stocked. Better selection at grocery stores.
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The internet has turned us into sloths. And stupid people. lol.
 
nimbus said:
No smartphones. Books and crossword puzzles were all they had.
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And we were less dumb. Sure the info about the world happenings is great but we have become sloths. Zombies. It’s a weird world. God knows I spend too much time online. Lol
 
makemoney2024 said:
The internet has turned us into sloths. And stupid people. lol.
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Eh, I'd argue the internet is a tool and its use can make one's life better or worse depending on how they use it. We can access UpToDate at the drop of a hat today to ensure we are practicing good medicine. For someone who is lazy and not the most intelligent scrolling through instagram all day, maybe their lives would be better off with no internet.
 
sloh said:
Eh, I'd argue the internet is a tool and its use can make one's life better or worse depending on how they use it. We can access UpToDate at the drop of a hat today to ensure we are practicing good medicine. For someone who is lazy and not the most intelligent scrolling through instagram all day, maybe their lives would be better off with no internet.
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Agree. I was being pessimistic in realizing how we walk around like drones all the time with our faces buried in our phones. People hardly interact anymore.
But you are correct. There are obviously positives.
 
makemoney2024 said:
The internet has turned us into sloths. And stupid people. lol.
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Sloths yes.
Stupid for the masses. Far more intelligent at our level, particularly if new knowledge intrigues you.

You can do just about anything with a degree from Google/YouTube University. Man I rewired half my house off the Internet. Hasn't burned down yet haha.
 
We'llBeDoneIn15Minutes said:
Sloths yes.
Stupid for the masses. Far more intelligent at our level, particularly if new knowledge intrigues you.

You can do just about anything with a degree from Google/YouTube University. Man I rewired half my house off the Internet. Hasn't burned down yet haha.
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Same! I also repaired my 2yo POS Samsung washing machine by watching a how to video on YouTube and ordering $40 of parts from Amazon.
 
nimbus said:
Same! I also repaired my 2yo POS Samsung washing machine by watching a how to video on YouTube and ordering $40 of parts from Amazon.
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Where I live all work has gone the way of greedy contractors and a horde of poorly trained uneducated immigrant labor that is supposed to get every job done as fast as possible, quality be damned. It has incentivized me to be quite the DIY guy, and the internet made that possible.
 
GassYous said:
And those guys are still out there doing everything sans fellowship: peds, cards, etc.
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aneftp said:
Absolutely. Got one doc almost 68. Does hearts.

Now they don’t even use ultrasound for their lines. . They do it old fashion style and just as fast or even faster without ultrasound. They also do subclavian old fashion way.

They do everything. Peds also
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We have one guy in our practice who did a cardiac fellowship when echo was very rudimentary. He trained with biplane probes (you got 0 or 90 degrees) before Omniplane probes came out. The resolution was bad and echo was not used for every case. He does hearts, peds (but not pedi hearts), and pain. He’s also a board examiner.
 
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makemoney2024 said:
Agree. I was being pessimistic in realizing how we walk around like drones all the time with our faces buried in our phones. People hardly interact anymore.
But you are correct. There are obviously positives.
Click to expand...
Some of us avoided interaction with people long before smart phones. 🙂

The sum total of all human knowledge in your hands at all times. Pretty great.
 
makemoney2024 said:
Samsung needs to stick to phones. Their appliances are total trash.
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Apparently LG is the same. I had an antique Sears washer dryer set that lasted 3 moves and 25 years that never gave me one problem, just looked really outdated as I upgraded the house. The cool looking LG is pretty much identical to Samsung and after 2 years I'm ready for the repairs as everyone tells me they will be needed soon.

Same with the Samsung fridge/freezer. I've been warned long after that unit is dead and buried the 25 year old Kenmore it replaced will keep working problem free.
Progress... 🙄🤷‍♂️
 
We'llBeDoneIn15Minutes said:
Apparently LG is the same. I had an antique Sears washer dryer set that lasted 3 moves and 25 years that never gave me one problem, just looked really outdated as I upgraded the house. The cool looking LG is pretty much identical to Samsung and after 2 years I'm ready for the repairs as everyone tells me they will be needed soon.

Same with the Samsung fridge/freezer. I've been warned long after that unit is dead and buried the 25 year old Kenmore it replaced will keep working problem free.
Progress... 🙄🤷‍♂️
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We're buying LG washing machines for our new place because Wirecutter rated them the best. Don't tell me this! We have ancient Maytags in our current place that have been bullet-proof.
 
A Deep Breath said:
I commend WCI guy for presenting a data driven case for his argument, but I’m skeptical. From the top comment on his article, “In my community a large house on the lake just sold for way more than I could ever afford as an anesthesiologist, but it had been owned by a family physician for decades.” Maybe it’s confirmation bias, but this is a widespread phenomenon in my experience.

After adjusting for inflation, real estate often costs 2-3x as much as it did in 1985. However, this doesn’t fully explain why fewer of the most expensive homes in any given community seem to be owned by doctors nowadays. Even if we make the same amount of money, it’s not going as far. We‘ve been pushed down the economic hierarchy.
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The prices of certain things doctors want to buy has just appreciated much faster then inflation (and doctor salaries). I'm no economic historian, but I also suspect there has been a rise in the upper middle class as pathways to this have increased, increasing competition/cost for "luxury" goods. As industries like finance and tech took off, there were a lot of millionaires made that in the past might have just been working in regular corporate jobs for mid salaries.

Real estate in HCOL or vacation areas is a big example. A ton of doctors in my parents generation owned big (relatively speaking) houses in the bay area and cabins at lake Tahoe. No longer affordable to docs starting out now. Real estate in many small communities? Stayed stable/declined.

We also don't pay attention to the many things are are, relatively speaking, more affordable. Food is cheap and plentiful and available year round. You can pay for a (frugal) vacation in europe with a day's work. Smartphones that do literally everything are a given. Your 30k Tesla smokes your dad's 100k porsche off the line. You can impulse buy a 70" flat screen and so on.
 
cchoukal said:
We're buying LG washing machines for our new place because Wirecutter rated them the best. Don't tell me this! We have ancient Maytags in our current place that have been bullet-proof.
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We've had our LG washer and dryer for 7 years now, still going strong
 
cchoukal said:
We're buying LG washing machines for our new place because Wirecutter rated them the best. Don't tell me this! We have ancient Maytags in our current place that have been bullet-proof.
Click to expand...
But more Maytag. Or Whirlpool. Basically buy from appliance makers that have always made appliances. Even that is not a guarantee with all this new digital products.
I bought Samsung, lasted less than two years never could get the hot water going and they blamed it on my 60 year old house and itswater pipes. Moved houses and the same problem. Then it completely died. Bought a whirlpool and right at the one year mark it started acting wierd. Kept stopping midcycle and leaving a tub full of water that I had to drain. I kept having to plug and unplug to get it going. Eventually I thought I was gonna have to buy another one before two years and magically the problems went away. FOR NOW. I am now in year three.
They don’t make them like they used to. If this one breaks down I am gonna find an old school non energy efficient Speed Queen from some used dealer. Because this is some B.S.
 
makemoney2024 said:
But more Maytag. Or Whirlpool. Basically buy from appliance makers that have always made appliances. Even that is not a guarantee with all this new digital products.
I bought Samsung, lasted less than two years never could get the hot water going and they blamed it on my 60 year old house and itswater pipes. Moved houses and the same problem. Then it completely died. Bought a whirlpool and right at the one year mark it started acting wierd. Kept stopping midcycle and leaving a tub full of water that I had to drain. I kept having to plug and unplug to get it going. Eventually I thought I was gonna have to buy another one before two years and magically the problems went away. FOR NOW. I am now in year three.
They don’t make them like they used to. If this one breaks down I am gonna find an old school non energy efficient Speed Queen from some used dealer. Because this is some B.S.
Click to expand...

“Smart” homes are good and all until they increase complexity so much that they are simply not worth it. Too many places in the chain to break. I find this to be similar with resistance training. Bunch of new fancy machines in gyms these days but the basics (dumbbells and barbells) tend to work better/best.
 
sloh said:
“Smart” homes are good and all until they increase complexity so much that they are simply not worth it. Too many places in the chain to break. I find this to be similar with resistance training. Bunch of new fancy machines in gyms these days but the basics (dumbbells and barbells) tend to work better/best.
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I hate smart homes TBH. When I moved into my 40 year old house the old owner had a smart thermostat. My agent and I sat there and could not figure it out for over 10 minutes. Luckily the owner was nice enough to let us know to call him for anything up to 14 days?? or so bc I bought the house without actually seeing it. And I requested “dumb” thermostat. He came and changed it thankfully.
My BF house has one and it is often a pain. I do like his smart front door lock though.
I am old school though in many ways and do free weights at the gym.
 
makemoney2024 said:
I hate smart homes TBH. When I moved into my 40 year old house the old owner had a smart thermostat. My agent and I sat there and could not figure it out for over 10 minutes. Luckily the owner was nice enough to let us know to call him for anything up to 14 days?? or so bc I bought the house without actually seeing it. And I requested “dumb” thermostat. He came and changed it thankfully.
My BF house has one and it is often a pain. I do like his smart front door lock though.
I am old school though in many ways and do free weights at the gym.
Click to expand...

This whole discussion reminds me of these memes haha: x.com
IMG_1855.png

IMG_1856.png
 
makemoney2024 said:
I hate smart homes TBH. When I moved into my 40 year old house the old owner had a smart thermostat. My agent and I sat there and could not figure it out for over 10 minutes. Luckily the owner was nice enough to let us know to call him for anything up to 14 days?? or so bc I bought the house without actually seeing it. And I requested “dumb” thermostat. He came and changed it thankfully.
My BF house has one and it is often a pain. I do like his smart front door lock though.
I am old school though in many ways and do free weights at the gym.
Click to expand...

I like being able to time things like having the dishwasher or laundry machine run right before I wake up.
 
makemoney2024 said:
I hate smart homes TBH. When I moved into my 40 year old house the old owner had a smart thermostat. My agent and I sat there and could not figure it out for over 10 minutes. Luckily the owner was nice enough to let us know to call him for anything up to 14 days?? or so bc I bought the house without actually seeing it. And I requested “dumb” thermostat. He came and changed it thankfully.
My BF house has one and it is often a pain. I do like his smart front door lock though.
I am old school though in many ways and do free weights at the gym.
Click to expand...
i love my smart home, i spent serious cash making everything automated. one less thing to worry about....until the internet goes out lool
 
DoctwoB said:
The prices of certain things doctors want to buy has just appreciated much faster then inflation (and doctor salaries). I'm no economic historian, but I also suspect there has been a rise in the upper middle class as pathways to this have increased, increasing competition/cost for "luxury" goods. As industries like finance and tech took off, there were a lot of millionaires made that in the past might have just been working in regular corporate jobs for mid salaries.

Real estate in HCOL or vacation areas is a big example. A ton of doctors in my parents generation owned big (relatively speaking) houses in the bay area and cabins at lake Tahoe. No longer affordable to docs starting out now. Real estate in many small communities? Stayed stable/declined.

We also don't pay attention to the many things are are, relatively speaking, more affordable. Food is cheap and plentiful and available year round. You can pay for a (frugal) vacation in europe with a day's work. Smartphones that do literally everything are a given. Your 30k Tesla smokes your dad's 100k porsche off the line. You can impulse buy a 70" flat screen and so on.
Click to expand...

After looking into this more, it seems the answer is mostly that there’s a new class above the professional class, fueled by the industries you mention. I think this new class dominates whichever real estate markets they want to. Doctors only own the best houses in small towns the new class doesn’t desire. I suppose it’s somewhat obvious to anyone who cares, but I’m surprised this societal change isn’t more widely discussed.
 
makemoney2024 said:
I hate smart homes TBH. When I moved into my 40 year old house the old owner had a smart thermostat. My agent and I sat there and could not figure it out for over 10 minutes. Luckily the owner was nice enough to let us know to call him for anything up to 14 days?? or so bc I bought the house without actually seeing it. And I requested “dumb” thermostat. He came and changed it thankfully.
My BF house has one and it is often a pain. I do like his smart front door lock though.
I am old school though in many ways and do free weights at the gym.
Click to expand...

I feel like well done smart devices make life better. Problem is that so many are clunky and poorly done they end up being frustrating.
 
DoctwoB said:
The prices of certain things doctors want to buy has just appreciated much faster then inflation (and doctor salaries). I'm no economic historian, but I also suspect there has been a rise in the upper middle class as pathways to this have increased, increasing competition/cost for "luxury" goods. As industries like finance and tech took off, there were a lot of millionaires made that in the past might have just been working in regular corporate jobs for mid salaries.

Real estate in HCOL or vacation areas is a big example. A ton of doctors in my parents generation owned big (relatively speaking) houses in the bay area and cabins at lake Tahoe. No longer affordable to docs starting out now. Real estate in many small communities? Stayed stable/declined.

We also don't pay attention to the many things are are, relatively speaking, more affordable. Food is cheap and plentiful and available year round. You can pay for a (frugal) vacation in europe with a day's work. Smartphones that do literally everything are a given. Your 30k Tesla smokes your dad's 100k porsche off the line. You can impulse buy a 70" flat screen and so on.
Click to expand...
Exactly. Friend bought a condo overlooking the ocean in Santa Monica for 500k mid 90s now worth 2.8m today.

Aspen ski ticket 1987 for 35 dollars now well into the 200s. Inflation since around these times for doctor "stuff" is far more than the reported 150-200%

www.aspentimes.com

When the fight over ski pass prices began

ASPEN - Twenty-five years ago was the summer and fall of Aspen's discontent.There was mounting concern about funky, affordable, free-market housing getting gobbled throughout town for construction of high-priced
www.aspentimes.com www.aspentimes.com
 
nimbus said:
Yeah. Other stuff I don’t miss from the 1980s-whiteout, typewriters, drum brakes, pay phones, Dewey decimal system, compact discs, encyclopedias, VHS tapes, etc…lol
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CDs? You were a gadget guy ahead of the game! When I think 80s I think vinyl albums and cassette decks.

And while typewriters seem ancient, remember how cool it was when correction ribbons came out replacing white out? That was up there with the invention of the wheel as far as typing college term papers go.
 
NITRAS said:
I feel like well done smart devices make life better. Problem is that so many are clunky and poorly done they end up being frustrating.
Click to expand...
And when they get it just right they load up the next model up with a ton of useless smart crap. When I buy a phone I spend a lot of time turning off every "convenience" short cut. Scroll through text messages at 2am touching it just the wrong way you are now dialing someone who lets you know the next day how pissed off they were about that.
 
GassYous said:
Apparently the dishwasher is more environmentally friendly and efficient. Uses way less water and detergent.
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Similar thing with showers.

there's a clear negative relationship between water pressure and consumption. More powerful showers use less water overall. A higher pressure shower gets people feeling clean faster. Turns out low pressure showers don't conserve water after all, so there's another attempt to reduce demand that backfired.
 
GassYous said:
Apparently the dishwasher is more environmentally friendly and efficient. Uses way less water and detergent.
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I don’t know if I but that research. I mean my dishwasher runs 133 on normal. That’s two hours. That’s less water. My BF runs > 200minutes and it’s the same brand just a different model I guess. Sure some of it drying time but I bet water is running for almost two good hours. I don’t know if I buy that propaganda!! 🤣🤣
 
makemoney2024 said:
I don’t know if I but that research. I mean my dishwasher runs 133 on normal. That’s two hours. That’s less water. My BF runs > 200minutes and it’s the same brand just a different model I guess. Sure some of it drying time but I bet water is running for almost two good hours. I don’t know if I buy that propaganda!!
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It usually uses the same water for most of the cycle and ends with clean water. I think the last time I looked into this, if you had 8 or more dishes it was more efficient to use the dishwasher.
 
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