Would competitive specialties be competitive if everyone made the same?

[Hatton]

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.

Very much agree that community standing comes from long term personal relationships.

[AR]

Correction. I think you mean the smartest minds should go into math and physics. And sometimes they go into finance but that’s a stretch to say the smartest minds go into finance over medicine as a blanket statement. I can’t prove this but I know it to be true- those in finance will have a lower IQ than physicians as a group. Even if you sample the top 5% most intelligent outliers, I also believe that it would show higher IQ in medicine vs. finance within this 5% group. Math and physics I can’t really dispute. The smartest minds should go into those fields. Whether that is the reality is debatable. But certainly if you sample the top 5% in those fields, it would undoubtedly show higher intelligence than medicine. Finance no way. Finance requires a rung seeking personality type. Finance nerds are maybe making good money but they arent making billions unless they are the top 0.0001% who created a company and happen to be brilliant.

I kind of agree with this, but I think when people say "finance" in this context, they're not talking about the branch manager at your local credit union, which is most definitely finance. Finance is so broad, that just carving out the top 5% is not enough. Maybe top 0.5% and then you get a meaningful comparision.

There are a good number of top level math guys who just decided that finance was more lucrative than professional math. So, that's is what they do. So I guess when I say finance, it's the type of finance career path that a decent Math PhD would have access to. Which is a very small slice of the "finance" unverse.

[Zaphod]

There is a decent amount of medicine that is merely toiling- doing something for the sake of doing something. Some actions driven by patients, some by physicians, some by malpractice.

It's how APPs can get similar outcomes to alot of problems with less knowledge. The human body can tolerate a lot (but not everything). (To add: I don't think APPs have the same level of knowledge or critical thinking skills, and the ones that are good have been working closely with a physician who has appropriately trained them to be an extension of the physician).

.

Few

[Panscan]

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.

True regarding the high income generators and their associated influence but those are what 5-10% of the staff? Basically just surgical and medical specialists that bring in the big bucks for the systems. Rest of the people just moving meat. Outside of those I think everyone standing pretty similar.

[Zaphod]

Correction. I think you mean the smartest minds should go into math and physics. And sometimes they go into finance but that’s a stretch to say the smartest minds go into finance over medicine as a blanket statement. I can’t prove this but I know it to be true- those in finance will have a lower IQ than physicians as a group. Even if you sample the top 5% most intelligent outliers, I also believe that it would show higher IQ in medicine vs. finance within this 5% group. Math and physics I can’t really dispute. The smartest minds should go into those fields. Whether that is the reality is debatable. But certainly if you sample the top 5% in those fields, it would undoubtedly show higher intelligence than medicine. Finance no way. Finance requires a rung seeking personality type. Finance nerds are maybe making good money but they arent making billions unless they are the top 0.0001% who created a company and happen to be brilliant.

It is not, like medicine, how many jobs do you think there are for those with the qualifications in the pure vs. finance? Tl;dr, there are more phds than academic positions.

You do not need to rung seek as a phd/trader. And why is billions your threshold for making money, especially when talking about medicine which is really capped and most phd trader types are taking home top tier physician level pay at a much younger age. We're not talking analysts here, who still can make mid 6 figures by late 20s.

As for IQ, given finance is a very broad field with tons of people and less selective than medicine, 100% thats likely the case. For the top 5% I would bet 100% against it, since you're talking some of the smartest math/phsics PhD people in the world, the Simons, thorpes, etc...you cant throw a pen without hitting a rocket scientist.

[Tim]

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??

Respect has many interpretations. The most valuable is respect that had been earned.
Side note, respect is not necessarily a “role model” as well as stated by a brilliant philosopher, Charles Barkley:
Charles wanted to tell parents, 'I can't be a role model for your kid. Your kid doesn't know me. I can be an athletic hero, but a role model should be a mom, a dad, an aunt, an uncle, someone the kid has contact with.“
Context as Hatton stated is important. Fame and fortune.

[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??

[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.

[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.

[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.

[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.

[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.

[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.

[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..

[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.