The 2020 Presidential Election Primary Thread

[Omaha 680]

NHS staff can refuse to treat racist or sexist patients under new rules

https://news.sky.com/story/nhs-staff...snt-sf-twitter





Also from this article:

Creative rationing.

[SeattleUte]

I am asking with absolute sincerity: are you trolling? You have to be, the link is just too funny. I am literally laughing so hard I am in tears.

The Jerusalem Post is supposed to be a reputable paper.

[Jeff Lebowski]

NHS staff can refuse to treat racist or sexist patients under new rules

https://news.sky.com/story/nhs-staff...snt-sf-twitter


Also from this article:

Yikes.

I know that for many brits, if you voted for Brexit, you are racist.

[SeattleUte]

I am asking with absolute sincerity: are you trolling? You have to be, the link is just too funny. I am literally laughing so hard I am in tears.

https://mediabiasfactcheck.com/the-jerusalem-post/

[tooblue]

https://mediabiasfactcheck.com/the-jerusalem-post/

The article includes the 2019 trailer for the movie The Hunt in it.

[ERCougar]

There will be an exodus, no doubt. But I'm not so sure on the 'mass' part. There's only a few beautiful places on earth paying premium dollar for docs. Most other places make it competitive, but they're still offering a salary. So if we all become salaried state employees here, there's not likely going to be a huge movement to get a salary elsewhere, unless you're moving to a beach. Or if you have a connection to another country.

"Mass" is probably overstating it--I'm doubtless projecting my experience. I have a bunch of expat friends and American doctors who are itching for the first excuse to get back, so I'm sure that colors my experience. I also see a ton of burnout with clinical medicine in general though, and people who are either closely eyeing or doing side gigs on a part time base, only staying in clinical stuff for the money. Take that incentive away and they're gone. But the bigger factor will be the shortages. Make things cheap and you increase demand, stop paying your suppliers and you cut supply. Bernie wants to fix this with NP's and PA's, and in some scenarios, that's probably appropriate. But you can't do that everywhere, and the NP training right now is so suspect that there are going to be huge problems with that.

This is no different than every celebrity who swore they would leave the US if Trump was elected. How many actually left:

https://www.theguardian.com/world/2018/jan/22/move-to-canada-celebrities-donald-trump

The one thing that did happen is this:



Our student in-take next fall will exceed 200 for programs that three years ago were budgeted for an in-take of 30 to 50 students maximum. 80% of the 200 students we will admit next fall are international students.

Except celebrities aren't being paid to move out of the country.


Also, New Zealand and its beaches are beautiful, but the water is ice cold. Better make that Australia.

A New Zealand dollar is worth 64 cents US. The Canadian dollar at the moment is worth 75 cents, but I have lived through times when it was only worth 64 cents. 300k in New Zealand dollars is not the same as 300k US dollars.

Pragmatically speaking, the situation dictates there will not be an exodus.

I'm really confused at your exchange rate point--do you think that we think we're signing contracts in American dollars?

I made about 1/2 of what I do in the US, after expenses, but before bonuses/overtime--in US dollars, cuz I can do math. For that, I had 10 weeks of paid vacation and CME, my work week was 40 hours, and 8 of those were protected non-clinical hours for charting and admin stuff (this is not paid in the US). I never worked after midnight unless I was called in, and for call, I was both paid for the call nights, and paid triple time for any actual time spent. I trained residents, so really, they did much of the work for me. It was easily the most pleasant work schedule I've ever had. I kind of lucked into that job, so not everyone could get that, but there are also higher paying jobs. I'm itching to get back as it is, but I really like my situation right now. But my job setup is probably in the 90th percentile of desirability. Plenty of people are looking for any excuse to get out. Cut their pay in half and watch what happens.

I am not sure how big the exodus would be, but that isn't the main issue. How many fewer people will decide not to pursue medicine as a career?

That's a good question also. I think it depends on if we can get a handle on financing medical school. If tuition is better controlled, then a smaller salary is not as big of deterrent. My daughter and her cohort of med school applicants made a lot of tough decisions about where to apply, that I never had to. That's not only because of the surge in tuition, but because of higher interest rates for loans.

I should say also, medicine has been deterring applicants for years. The main factors I hear local clinicians bitch about most are dealing with insurance companies, hospital bureaucracy, and governmental regulations. It's not the money, at least currently.

There's a graphic floating around comparing a UPS driver's net worth vs a physician. UPS driver at 60 hours a week stays ahead of a doctor until his 60s (of course, UPS is never going to let them work that much at overtime hours, but also, most doctors have more lucrative options). If you assume 300k of student debt and a 200k salary (about average for primary care), even putting 20% of your income into student debt won't hit a net worth of zero until your 40s. The opportunity cost to medicine is huge, and for most, it's really not a smart financial decision. For low paying specialties like oncology and rheumatology, it's really a pretty stupid one.

[Jeff Lebowski]

"Mass" is probably overstating it--I'm doubtless projecting my experience. I have a bunch of expat friends and American doctors who are itching for the first excuse to get back, so I'm sure that colors my experience. I also see a ton of burnout with clinical medicine in general though, and people who are either closely eyeing or doing side gigs on a part time base, only staying in clinical stuff for the money. Take that incentive away and they're gone. But the bigger factor will be the shortages. Make things cheap and you increase demand, stop paying your suppliers and you cut supply. Bernie wants to fix this with NP's and PA's, and in some scenarios, that's probably appropriate. But you can't do that everywhere, and the NP training right now is so suspect that there are going to be huge problems with that.







I'm really confused at your exchange rate point--do you think that we think we're signing contracts in American dollars?

I made about 1/2 of what I do in the US, after expenses, but before bonuses/overtime--in US dollars, cuz I can do math. For that, I had 10 weeks of paid vacation and CME, my work week was 40 hours, and 8 of those were protected non-clinical hours for charting and admin stuff (this is not paid in the US). I never worked after midnight unless I was called in, and for call, I was both paid for the call nights, and paid triple time for any actual time spent. I trained residents, so really, they did much of the work for me. It was easily the most pleasant work schedule I've ever had. I kind of lucked into that job, so not everyone could get that, but there are also higher paying jobs. I'm itching to get back as it is, but I really like my situation right now. But my job setup is probably in the 90th percentile of desirability. Plenty of people are looking for any excuse to get out. Cut their pay in half and watch what happens.





There's a graphic floating around comparing a UPS driver's net worth vs a physician. UPS driver at 60 hours a week stays ahead of a doctor until his 60s (of course, UPS is never going to let them work that much at overtime hours, but also, most doctors have more lucrative options). If you assume 300k of student debt and a 200k salary (about average for primary care), even putting 20% of your income into student debt won't hit a net worth of zero until your 40s. The opportunity cost to medicine is huge, and for most, it's really not a smart financial decision. For low paying specialties like oncology and rheumatology, it's really a pretty stupid one.

Oncology is low paying? Didn’t know that. That’s nuts.

[ERCougar]

I just noticed that I linked the wrong summary (same source, different subject). Here's the one on availability and wait times: https://askepticalhuman.com/politics...imes-rationing

[Pelado]

Oncology is low paying? Didn’t know that. That’s nuts.

I was about to post the same thing.

[Northwestcoug]

There's a graphic floating around comparing a UPS driver's net worth vs a physician. UPS driver at 60 hours a week stays ahead of a doctor until his 60s (of course, UPS is never going to let them work that much at overtime hours, but also, most doctors have more lucrative options). If you assume 300k of student debt and a 200k salary (about average for primary care), even putting 20% of your income into student debt won't hit a net worth of zero until your 40s. The opportunity cost to medicine is huge, and for most, it's really not a smart financial decision. For low paying specialties like oncology and rheumatology, it's really a pretty stupid one.

I might have posted this in another thread, but 300K for med school debt is quickly becoming outdated. Even if my daughter had gone to her state med school, her total debt would have been over that. The one she got accepted to was about 10K/year more expensive.

Because she worries about her future to a fault, she's already figured out the worst case scenario (assuming ~6-7% interest rate). She's looking at 500K after interest.

[ERCougar]

Oncology is low paying? Didn’t know that. That’s nuts.

I was about to post the same thing.

Yeah, that's not the best example, sorry. Pay is usually based on procedures more than brainpower, so specialists like cardiologists or gastroenterologists tend to make the most money. Oncology isn't among the lowest--it's probably more average among non-surgical specialties. Still, 6 years is a lot of training for not making a whole lot more than your average internist after three years. But, we still need those specialists.

[beefytee]

. The opportunity cost to medicine is huge, and for most, it's really not a smart financial decision. For low paying specialties like oncology and rheumatology, it's really a pretty stupid one.

No wonder I had to wait 4 months to get into a rheumatologist.

[tooblue]

I'm really confused at your exchange rate point--do you think that we think we're signing contracts in American dollars?

I made about 1/2 of what I do in the US, after expenses, but before bonuses/overtime--in US dollars, cuz I can do math. For that, I had 10 weeks of paid vacation and CME, my work week was 40 hours, and 8 of those were protected non-clinical hours for charting and admin stuff (this is not paid in the US). I never worked after midnight unless I was called in, and for call, I was both paid for the call nights, and paid triple time for any actual time spent. I trained residents, so really, they did much of the work for me. It was easily the most pleasant work schedule I've ever had. I kind of lucked into that job, so not everyone could get that, but there are also higher paying jobs. I'm itching to get back as it is, but I really like my situation right now. But my job setup is probably in the 90th percentile of desirability. Plenty of people are looking for any excuse to get out. Cut their pay in half and watch what happens.

If you are being paid in US dollars, then it's no contest; leave and take full advantage of living abroad and whatever 90th percentile job you can find. But if you are not being paid in US dollars, then it's about buying power. I make a good wage doing what I do for where I live and in context to the current economy. We carry a little too much debt, but otherwise live comfortably.

Bluntly, if I made the same amount I make in US dollars, and if I lived in the US my buying power would be double what it is now. I could save more, retire earlier, and do more with the 44 days paid of vacation I have. That is what I am talking about. We make choices/sacrifices, and one of them is having significantly less disposable income. The payoff is access to universal health care, superior schools from elementary to high school, and generally better infrastructure such as better roads for example.

You sound like the adventurous type, willing to travel and embrace different ways of doing things; someone unconvinced by the dogma of American exceptionalism. But that also means you are an exception, and as such I believe you have misjudged just how many is "plenty of people."

[Northwestcoug]

If you are being paid in US dollars, then it's no contest; leave and take full advantage of living abroad and whatever 90th percentile job you can find. But if you are not being paid in US dollars, then it's about buying power. I make a good wage doing what I do for where I live and in context to the current economy. We carry a little too much debt, but otherwise live comfortably.

Bluntly, if I made the same amount I make in US dollars, and if I lived in the US my buying power would be double what it is now. I could save more, retire earlier, and do more with the 44 days paid of vacation I have. That is what I am talking about. We make choices/sacrifices, and one of them is having significantly less disposable income. The payoff is access to universal health care, superior schools from elementary to high school, and generally better infrastructure such as better roads for example.

You sound like the adventurous type, willing to travel and embrace different ways of doing things; someone unconvinced by the dogma of American exceptionalism. But that also means you are an exception, and as such I believe you have misjudged just how many is "plenty of people."

Bro, I'm very sympathetic to your view of Canadian living. But even I cringe at this.

[swampfrog]

The article includes the 2019 trailer for the movie The Hunt in it.

The article is just re-hashing of The Project Veritas videos of several Bernie staffers saying stupid things which came out a few weeks ago. That socialist extremists exist who believe that capitalism and/or conservatism needs to be torn down and that those that don't believe need re-education is a given and not controversial. As in all political machines, the most extreme will pick a candidate that is closest to their views and join their campaign. During times of severe polarization, more than usual feel emboldened to be vocal about it. Combine that with social media/internet vehicles for delivery, finding the extremists, recording them, and publishing the result is not likely too hard.

When Trump had far-right activists advocating for him, the left demanded he denounce them, this is an example of it playing out the other direction, as it always has on both sides. It's standard political posturing. Find the most extreme and trot it out in public as an example of the average. Demand the other side repent.

The movie is just mentioned as an example of the state of political extremism in the US being transmitted via popular culture--the movie is itself intended as a satire of US political polarization.

https://www.hollywoodreporter.com/heat-vision/universal-sets-release-hunt-controversy-1278642

In an exclusive interview with The Hollywood Reporter, producer Jason Blum and screenwriter Damon Lindelof defend the film as a satirical take on a divided country: "None of us were interested in taking sides with this movie."

It accomplished exactly what satire is intended to accomplish.