Would competitive specialties be competitive if everyone made the same?

[HikingDO]

How many bright people are expending their lives figuring out how to get people to click on ads? What a waste.

Not picking on this post in particular, but why do some people believe that just because you were born smart or became smart as a child you have an obligation to do something that benefits society? If it’s what you want for yourself, and you’re not hurting others, what’s wrong with doing cosmetic surgery or getting someone to click on an ad? So only those that aren’t “smart” get to choose their own path in life?

[The White Coat Investor]

How many bright people are expending their lives figuring out how to get people to click on ads? What a waste.

Wow. That's cynical. I'm in the process of hiring someone and that's absolutely part of their job. The job description says "Graphic Designer" and their degree is in Business Marketing.

It takes all kinds to make the world go round.

[The White Coat Investor]

i think students are getting the message that a career in EM is not just adrenaline rushes followed by long periods of mountaineering for $400k

Throw in a few turkey sammiches and a lot of belly pain and that still seems a pretty good description.

[The White Coat Investor]

have to decide if you want standing in your community as a doctor - neurosurgeons and obstetricians get it, EM and pathology do not.

This might make a difference among doctors, but clearly not among society in general. In my neighborhood is a pediatrician, a physiatrist, an ENT, an ortho/back surgeon, a radiologist, and two emergency docs. As near as I can tell, none of us have "standing in our community as a doctor" that is any higher than any of the others.

[Shant]

Wow. That's cynical. I'm in the process of hiring someone and that's absolutely part of their job. The job description says "Graphic Designer" and their degree is in Business Marketing.

It takes all kinds to make the world go round.

I suppose it is cynical. I just despair at the amount of talent and effort being dumped into making apps that are really advertising vehicles that are a net negative to the lives of their users because it's easier and cheaper than working on something like the old Bell Labs or GE did. Or even just a better mousetrap.

[Auric goldfinger]

Not picking on this post in particular, but why do some people believe that just because you were born smart or became smart as a child you have an obligation to do something that benefits society? If it’s what you want for yourself, and you’re not hurting others, what’s wrong with doing cosmetic surgery or getting someone to click on an ad? So only those that aren’t “smart” get to choose their own path in life?

Sounds like the bones of a P.H.D. thesis in philosophy. You’re wasting your time in medicine

[MPMD]

This might make a difference among doctors, but clearly not among society in general. In my neighborhood is a pediatrician, a physiatrist, an ENT, an ortho/back surgeon, a radiologist, and two emergency docs. As near as I can tell, none of us have "standing in our community as a doctor" that is any higher than any of the others.

eh, i don't know.

i definitely grew up in a smaller town where there was a subset of doctors who everyone knew and respected. they had a lot of clout. that's still true at most hospitals. if you (WCI) want to leave your CMO isn't even going to know unless you happen to be friends or you're on a committee. if that spine surgeon is trying to leave it's going to be known and there are very likely going to be convos about possible retention. i know at least 2 rainmaker docs (both surgeons) who work in medium sized communities in private practice and they only talk to the CEO of the health system when they have issues.

even now i know people who are very high profile doctors in their community. it's still a thing. and there are plenty of docs who enjoy that and i don't pathologize it. my FIL is a pretty well known doc in his town and the town is slap full of people who will come hug him in the grocery store.

[childay]

my FIL is a pretty well known doc in his town and the town is slap full of people who will come hug him in the grocery store.

Well count me out on the whole community standing thing..

[CM]

my FIL is a pretty well known doc in his town and the town is slap full of people who will come hug him in the grocery store.

That sounds like a nightmare. Please pay no attention to me in the grocery store.

[TheDangerZone]

I trained in general surgery, then 3 years of plastics, with fellowships in burn, craniofacial, hand, and micro vascular. So, you could say I was overqualified to do breast augmentations and face lifts. Reconstructive surgeons are to be respected. Unfortunately, cosmetics is the “dark side,” where it takes the technical acumen of a chimpanzee to do the procedures. After 4000+ augmentations it was a bit of an epiphany.

Fair enough. With regards to oculoplastics, there are a plenty of functional issues such as orbital tumors, ptosis, entropion, thyroid eye disease, facial palsies, orbital cellulitis, etc. that take up quite a bit of the average practice. Some do lean more towards cosmetics but I believe this is potentially much less common than other plastics oriented fields. I don’t think my oculoplastics colleagues are wannabes whatsoever.

[The White Coat Investor]

eh, i don't know.

i definitely grew up in a smaller town where there was a subset of doctors who everyone knew and respected. they had a lot of clout. that's still true at most hospitals. if you (WCI) want to leave your CMO isn't even going to know unless you happen to be friends or you're on a committee. if that spine surgeon is trying to leave it's going to be known and there are very likely going to be convos about possible retention. i know at least 2 rainmaker docs (both surgeons) who work in medium sized communities in private practice and they only talk to the CEO of the health system when they have issues.

even now i know people who are very high profile doctors in their community. it's still a thing. and there are plenty of docs who enjoy that and i don't pathologize it. my FIL is a pretty well known doc in his town and the town is slap full of people who will come hug him in the grocery store.

One hospital and one town is one hospital and one town. Every other chief of the medical staff at my hospital is an emergency doc. We're the longest tenured group at the hospital. We're the only ones who have been here since it opened. We're like a dynasty. Others come and go but we just stay.

But you're right that the hospital admin cares more about stuff that brings money into the hospital. Ours is just smart enough to realize that 50% of what comes in comes in via the ED, including all the strokes (including the LVOs), traumas, and STEMIs. There's a lot of money in those three categories, especially in our well insured population.

[Tim]

I never thought of derm or any other specialty as more or less prestigious.

Lucrative, competitive, sure. But prestige, as in higher social standing or greater respect or admiration for their perceived achievements? Weird.

But obviously lots of people believe in that crap, along with money it basically make our world go round. Kind of sad, isn't it?

Interesting take. Weird?
Competition seems to be a basic human nature, with yourself and with others.
How is score kept? Just curious, no champion or just participation trophies?
BTW, any doc is a “winner” by some system. I don’t consider that weird.

[HikingDO]

Sounds like the bones of a P.H.D. thesis in philosophy. You’re wasting your time in medicine

Meh, maybe so. Maybe most of us are, honestly.

[FIREshrink]

eh, i don't know.

i definitely grew up in a smaller town where there was a subset of doctors who everyone knew and respected. they had a lot of clout. that's still true at most hospitals. if you (WCI) want to leave your CMO isn't even going to know unless you happen to be friends or you're on a committee. if that spine surgeon is trying to leave it's going to be known and there are very likely going to be convos about possible retention. i know at least 2 rainmaker docs (both surgeons) who work in medium sized communities in private practice and they only talk to the CEO of the health system when they have issues.

even now i know people who are very high profile doctors in their community. it's still a thing. and there are plenty of docs who enjoy that and i don't pathologize it. my FIL is a pretty well known doc in his town and the town is slap full of people who will come hug him in the grocery store.

Sorry to burst your bubble, those docs aren't more "highly respected", they're more "highly compensated", and it's the money they bring in, not their "standing", that the hospital would lament losing.

As for recognition in the community, I'm also in a semi-small town hospital and the docs who are most loved in the grocery store are 1. Dr T, the orthopedist who has done everyone's knees for forty years, and 2. All the family docs and OBs who have delivered everyone's babies for forty years, and 3. The PCPs who have seen everybody, their kids, and their kids' kids for three generations. Seems to have nothing to do with money or standing, but with human relationships. And to my mind, that's how it should be.

[Hatton]

eh, i don't know.

i definitely grew up in a smaller town where there was a subset of doctors who everyone knew and respected. they had a lot of clout. that's still true at most hospitals. if you (WCI) want to leave your CMO isn't even going to know unless you happen to be friends or you're on a committee. if that spine surgeon is trying to leave it's going to be known and there are very likely going to be convos about possible retention. i know at least 2 rainmaker docs (both surgeons) who work in medium sized communities in private practice and they only talk to the CEO of the health system when they have issues.

even now i know people who are very high profile doctors in their community. it's still a thing. and there are plenty of docs who enjoy that and i don't pathologize it. my FIL is a pretty well known doc in his town and the town is slap full of people who will come hug him in the grocery store.

I guess we need a definition of standing. Community and hospital. I also think this comes and goes. I used to have a large party at Christmas attended by the CEO and CMO. IS that standing? Not sure. I was personal friends with a couple of hospital VPs which helped me keep health insurance after I retired. Standing or just friendship??