Ah, TG, I was afraid this was another Plank on Jeremiah Wright and his conspiracy theories on AIDS. Reading this is like passing the 1969 marble slab at the Vietnam Memorial. End in sight

Reminds me of the Seinfield episode when Jerry was dating a doctor, who with great satisfaction, told him that she had saved a life that day.  Jerry later finds out that her speciality is dermatology "Oh, so you saved a life, Dr. pimple-popper?"  Turns out she had detected skin cancer early in a patient, thus saving his life.

But seriously, tep, thanks for raising Wright in what was, up until then, a Wright-free post.

Anyway, wouldn't UHS be better treated by someone with a master's degree in Pomade Studies than by someone with a medical doctorate in dermatology?

Seriously, the nation needs to create more combined undergrad-MD 6-year programs and then provide a free ride, 100% loan forgiveness, for any qualified grad of same programs who commits to say a 10 year career in internal or family medicine in underserved areas of the country.

The target applicant for such a program would be a bright, hardworking, idealistic first-generation-in-college high achiever. If we could set up and fund 100 or so programs across the nation that would do more good than a 1000 Harvard scholarships.

Um, I suspect it has less to do with the merits of the specialities in terms of content and more to do with lifestyle.

In Med school, everyone knows that the ROAD to relaxation is:

Radiology

Opthamology

Anesthesiology

Dermatology

These are the specialties with few emergencies and/or very modest time commitments relative to the compensation.

If you really want to suffer, be a surgeon or (worst of all, from what I hear) a transplant surgeon.

So says my wife, the surgeon.

Tep- interesting, how does residency figure into your thinking?

One of the things plastic surgeons really like, since much of their work is for elective surgery, they don't have to deal with insurance companies.  It's a cash business. Like Tiffany's.

Alternative medicine has been extremely effective in treating my uncombable hair syndrome.  But I wish someone would find a way to cure my ungrowable beard disorder.

And I second tep on that marvelous idea.  Hell, I'd be tempted to pack up and do that myself.  

Yes, many many thousands of good and smart young people would leap at this opportunity, which means that we could not only fill the gaps in medical coverage (btw, do a similar one for dentists, who also are ignoring lots of areas of the country) but also ensure an extremely high quality pool of family docs. Win-win-win

These data--how many doctors choose which specialties--sing upon their swings, their yellow plummage starkly bright against the blackened walls of the surrounding coal mine.

What's that? Have they stopped singing?

No single data point is relevant; only collectively does their significance instruct.  Fresh from med school and the apprentice's rotation, the young doctor goes for the bucks. We should not expect him or her to do otherwise, altruistically. Altruism in this case begets dirty data. Who among us would be so selfless? Don't all raise your hands at once.

Give us instead the gruesome big picture: a society where many can afford to have tummies tucked while others can't afford to have tummies filled. Nothing wrong with the former, as long as everything is wrong with the latter.

Ignore the latter and no amount of nip and tuck can turn the beast into a beauty.

What I want to know is, when will they develop a technique for the grafting of back hair onto one's head?  Kills two birds with one stone.  

classic, Mr Y. One for the archives (if they can ever be made to work again)

I've often wondered why anyone would choose proctology, defined as "a medical specialty that deals with disorders of the rectum and anus"

Then again, even assholes deserve health care.

post a test comment

dubyadoute, good to see ya hereabouts. Your post reminds me that I need to go back on my fiber regimen:

Age and weight and slothful rot have turned my nether tubes in knots.

Simple sugars fill my guts; gas leaks out in mere put-puts.

Bursting like an angry Hulk, I reached for morning's added bulk.

I need fiber every day; william's psyllium paves the way.

People out of medical school want to work the hours they want, earn the money they want, and have the autonomy they want. Not unreasonable...so do I. However, I don't also expect to be deferred to as a caring healer and respected because of my dedication. It's not a coincidence that nobody likes lawyers or bankers; you trade money for respect.

BTW: this idiotic belief that physicians are graduating with huge debts that require them to work at lucrative specialties. Bah. A debt of $240,000, carried at 6%, costs $1200/month. I'll be glad to agree that an MD is worth $25k more than a bright college graduate. Next? The really dedicated people, and the really smart people, are busy getting PhDs in biochemistry and molecular biology, working 100 hours a week, doing it because they like it rather than because it pays well, and aren't whining.

People out of medical school want to work the hours they want, earn the money they want, and have the autonomy they want. Not unreasonable...so do I. However, I don't also expect to be deferred to as a caring healer and respected because of my dedication. It's not a coincidence that nobody likes lawyers or bankers; you trade money for respect.

BTW: this idiotic belief that physicians are graduating with huge debts that require them to work at lucrative specialties. Bah. A debt of $240,000, carried at 6%, costs $1200/month. I'll be glad to agree that an MD is worth $25k more than a bright college graduate. Next? The really dedicated people, and the really smart people, are busy getting PhDs in biochemistry and molecular biology, working 100 hours a week, doing it because they like it rather than because it pays well, and aren't whining.

The hairy ball theorem shows that uncombable hair syndrome is universal and incurable.

According to wikipedia:

-- The hairy ball theorem of algebraic topology states that there is no nonvanishing continuous tangent vector field on the sphere. [Uh, let's just skip this sentence.] This is famously stated as "you can't comb a hairy ball flat". It was first proved in 1912 by Brouwer.

This is why math and science students have that unkempt look. They KNOW their hair is uncombable so they don't waste their time.

On a more serious note the phrase missing from this discussion is price control - either through government fiat or by insurance company negotiation. The reason plastic surgeons make so much money is that plastic surgery is usually not covered either through Medicare or by private insurance. This means that there is no real pressure to keep prices under control so that as long as supply is kept under control and demand maintained there is a lot of money to be made.

The failure to control pricing in plastic surgery shows the perils of removing pricing expertise from the purchasing side and making individuals responsible for negotiating prices for their healthcare at the point of use. That just perpetuates a sellers market.

Why not call a spade a spade? Many fields in medicine provide the opportunities that dermatology offers to clinicians that are described in the article, such as expertise in a field, the ability to directly impact a patient's well being and appearance, and even reasonable work hours. The big difference is pay. Dermatology has two big advantages in this regard. Specialties that are primarily procedure based are easy to compensate, and the faster the procedure, the more often in can be performed, ala Botox injections. Also, by limiting their involvement in the other aspects of patient's diseases, dermatologists can see a lot more patients. On the other hand, fields that require spending a longer time with patients, whether due to the complexity of their diseases or for education, cannot compete in the current environment. As a pediatric rheumatology fellow, my field provides everything that medical school applicants write in their essays - helping the most vulnerable patients, exciting new research in a developing field, occasional procedures such as injections, and the ability to keep regular hours and a family life. Yet, like other poorly compensated fields, there are barely 200 pediatric rheumatologists in the US, with vast regions not having a single practitioner. A dermatologist can easily see 30 new patients in an afternoon, I feel that I am committing malpractice if I see more than 4 because of the extensiveness of the illnesses and the education involved. Unfortunately, since there is no good compensation mechanism for such visits, many medical specialties, such as mine, remain understaffed. At the end of the day, physicians are human too and respond to the same economic principles that affect everyone else. If we accept that our best and brightest continue to become dermatologists and plastic surgeons, then little needs to be changed, but if, as a society, we decide on other priorities, then changing the way of reimbursement will change the flow of physicians.

And AlanK, yes, the PhD track is rough with little compensation, but there is a world of a difference between the 80hr+ work weeks with overnight calls every 3-4 nights and the comparable time that PhDs spend in a lab or on a computer. And PhD's (after their infinite years as "students") do flock to industry and start-ups where they generally do ok as well. All I can say, is that when I was 22 (1996), I was making $100,000 as a computer programmer. 12 years later, I've accumulated $200,000 in debt, make half that, and have another 5 years before I'm done with my training, and will make that same $100,000 (in 1996 dollars) (yet, do not in any way regret my decision).

Uncombable hair syndrome:

www.bbc.co.uk/.../Harry-Potter.jpg

Approves.

The stub post for this thread was only semi-serious, so forgive my fully-serious comment, BUT the point of the NY Times article was not, as claimed, that "all med students are going into dermatology and plastic surgery instead of general medicine," rather that dermatology and plastic surgery are the MOST COMPETITIVE specialties.  They're not competitive because everybody's going into these specialties, but because more people want to go into them than there are residency positions available.

Derm has always been a popular "lifestyle" specialty.  The relative competitiveness of plastics, though, probably has as much to do with the extremely limited number of training programs as it does with the overall popularity of the specialty.  At many centers, plastics remains a fellowship-level training program which surgeons may undertake only after they've undergone a 5-7 course of training in general surgery.

n.b. "plastic surgery" is not a synonym for "cosmetic surgery."  While many board certified plastic surgeons practice cosmetic surgery, in some cases to the exclusion of all else, plastics involves the much less glamorous and much more important work of skin grafts and myocutaneous flaps to close big, sometimes chronic wounds, the reattachment of severed body parts, and hand surgery.

Another way to increase the stock of  "non ROAD"  practioners would be to not allow all those Mexican and Carribean med school grads back into the country unless they signed an agreement to practice family medicine.