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