People evaluate pay to quality of life at work ratio, not just pay (although it is most commonly referred to as pay to avoid writing or saying all of that out).
You cannot expect a person to come out of school at 30 to 35 years old with $300k+ of debt after working 80 hour weeks during their 20s and slaving away in residency and not expect a decent pay to quality of life at work ratio.
If you do not increase quality of life to make up for lower pay, you will end up with less driven or less capable people. Note that quality of life also includes security of income, which can reduce that type of stress.
I agree and I think that supports the idea that salary alone is a bad metric for skills. Many people will take a lower pay to support a mission they are passionate about. To claim that makes them lower skilled or that they couldn’t get a higher paying job elsewhere is an overly simplified mental model. Sometimes the job itself is what leads to the higher quality of life.
No one is passionate about taking care of too many patients and making sure they document everything to the T to prioritize not being sued for millions of dollars.
This is a different argument. And there are plenty of people who put up with the bad parts of a job because the good parts are rewarding. Nobody should be so naive to think every job is all rainbows and puppy breath.
If your stance is that the healthcare system needs improvement, I’d agree. If your point is that the best doctors are the people who have money as their top priority, I’d disagree. I’d extend the latter to say, we may not get a better healthcare system by just paying people more. Throwing more money at a bad system tends to make a worse system.
Do you think we’d get better doctors if we could create a new system that lets them focus the majority of their effort on patient care, or if we kept the current system and just gave all physicians pay raises?
>Throwing more money at a bad system tends to make a worse system.
There are most likely decreasing returns on both ends of the scale.
>Do you think we’d get better doctors if we could create a new system that lets them focus the majority of their effort on patient care, or if we kept the current system and just gave all physicians pay raises?
"A new system" is too nebulous, but step by step reform is the obvious way forward. From decreasing unnecessary requirements for new doctors (there must be a way to not have to completely sacrifice one's 20s and early 30s and still become a doctor), to tort reform that allows for sensible judgments, to increasing funding for residency and medical schools to allow for higher supply of doctors, etc.
Also, doctor pay (per hour or per patient) has been declining in real terms for many, many years now. Which is not bad in and of itself, but when you are simultaneously decreasing remuneration and quality of life at work, intelligent people will pick up on that signal to look elsewhere to sell their services.
A lot of US healthcare is performed by smart people from poorer countries who just want a chance for their kids to grow up in the USA. That the country relies on that arbitrage has always been ridiculous to me.
I agree with basically all of this. The one distinction I would make is that the pay reduction is real terms is across all kinds of domains so I don’t think it’s particularly unique of physicians, but part of a larger issue. Same with the cost of education/training etc. In other words, I think the healthcare issues you highlight may be emblematic of bigger systemic problems.
With all that said, it’s still a different argument than “pay = ability”. Put differently: the $ amount in TFA could be used to increase Congress member pay from $174k to $10MM each. Do you think that would result in better politicians?
I do think substantially increasing Congress’s pay would result in better politicians. Dishonest people who are only in it for the money can find plenty of ways to profit from the office. As it stands, $174k is not a whole lot of money for a job that requires a ton of travel to the extent of basically requiring you to own two houses. This low pay means that non-wealthy members of Congress have a hard time of it. Non-wealthy people who would be good in Congress but don’t want to have that much hardship will bow out, or work around it with corruption. Low pay selects for rich and corrupt politicians. Someone who just wants to be in Congress to make a sweet $10 million in honest pay would be infinitely better than most of the people there right now.
>Low pay selects for rich and corrupt politicians.
Ignoring all the other non-salary pay they get, I'll buy that low pay can select for rich politicians because it means you can't rely on your Congressional salary to make ends meet. But it only selects for corrupt politicians if the main motivation is to make money. That is the presupposition that seems to frame your whole argument, and the one I have been pushing back on since the original comment. That sentiment undergirds the premise that pay is commensurate with ability. We can create systems that don't select for people with a primary motivation related to financial gain. $10MM salaries ain't it, though.
Someone who just wants to be in Congress to make a sweet $10 million in honest pay would be infinitely better than most of the people there right now.
This just doesn't make sense in the context of what you've previously said. Based on your above post, you're saying low pay selects for corruption because they're in it for the money. But giving $10MM a year selects for people who are in it for the money, meaning you have the same problem. I fail to see how that selects for better people than are there currently if it gives the same incentives.
If you re-read my original comment, I advocate for a "reasonable" salary, but not one that selects for people who have money as their primary motivation. I think there's an argument that $174k/yr is not reasonable for Congress person. We could increase that (and there are proposals to do so*) while also having the guardrails in place that don't disproportionately select for people who care more about money than their constituents.
*I suspect there is more at play than just Congressional salary. E.g., the civil servant salary ceiling is pegged to Congressional pay, so there are second-order effects to consider.
> But it only selects for corrupt politicians if the main motivation is to make money.
Everyone has some motivation for money. So this introduces bias towards the corrupt at any level. That’s especially true for a pay level that really is not enough for the expenses the job requires.
You seem to be assuming that being in it for the money implies corruption. I don’t think that’s even remotely true. There are plenty of honest people who value high pay. As it currently stands, Congress attracts dishonest people who are in it for the money because there are plentiful opportunities to make money dishonestly in that job. It doesn’t attract honest people who are in it for the money, because the honest pay sucks. If you pay them really well then that second category will compete for positions. It won’t be corrupt people versus true believers, it’ll be corrupt people versus true believers and honest people who want a well paid job. This would be far better than what we have now.
People evaluate pay to quality of life at work ratio, not just pay (although it is most commonly referred to as pay to avoid writing or saying all of that out).
You cannot expect a person to come out of school at 30 to 35 years old with $300k+ of debt after working 80 hour weeks during their 20s and slaving away in residency and not expect a decent pay to quality of life at work ratio.
If you do not increase quality of life to make up for lower pay, you will end up with less driven or less capable people. Note that quality of life also includes security of income, which can reduce that type of stress.