domain:papyrusrampant.substack.com?page=0?page=1?page=0
100ProofTollBooth
Dumber than a man, but faster than a dog.
36m ago
What's the long term upside of being a PA/NP? Are their managerial and executive equivalent roles for PAs/NPs? Beacuse while making $130k is great out of school and pretty good for a full career (inflation adjusted, of course) ... junior state department officials can build careers that end in Congress, advising /consulting F500 corporations, or just good old fashioned Sinecures at Think Tanks that can push them past $500k / yr. Sure, definitely not all of them will get there, but there's at least the possibility and the pre-established career path.
I'd argue that this is one of the defining features of the PMC approved career paths - that they all have the possibility of creating eye-watering levels of income (bonus points, however, if they have some way for you to pretend you're doing it out of genuine passion and not just for the money. This is why politics is so PMC attractive).
hydroacetylene
42m ago
Pilot training is so expensive that it probably evens out here(planes, man).
faceh
53m ago
Far as I know it's just based on some eligibility criteria. Giving more often in theory means more blood available (for others) for emergencies. I like to think I'm banking some karma.
100ProofTollBooth
Dumber than a man, but faster than a dog.
53m ago
Cool comment (seriously).
In your opinion what is the area of law that is at the optimization frontier for raw compensation and intellectual gratification? I have friends who do legal advisory work for the big banks, and they make crazy money, but they kind of hate everything. On the other hand, I know a guy from church who does small to medium local business law, fucking LOVES it, and makes more than enough money (though not Christmas-in-Aspen money). I have an older family friend who spent her whole career in family law and is now emotionally broken and sorta-kinda broke financially.
ulyssessword
58m ago
I assume they're talking about blood donation, not blood tests. When you go to donate, they test a drop for iron, and after your donation they test for a bunch of other stuff.
grognard
Intel Pentium III 450 / Nvidia Riva TNT2 Ultra / Corsair 128MB PC133 / ABIT BH6
58m ago
Do they have to be podcasts or can they also be visual? The Great Courses series is torrentable on 4chan’s /t/ board, just look for TTC:
100ProofTollBooth
Dumber than a man, but faster than a dog.
59m ago
Licensing is one thing, but self-selection signaling is another.
If I graduate from the American Samoa school of Law (that's a Better Call Saul reference) I can handle wills and whatnot, but no real going business concern is going to hire me for complex corporate litigation. If I, this hypothetical business owner, enjoy spending my weekends enjoying recreational Columbia narcotics, I'm going to hire the lawyer who is ex-DA's office and knows all the judges, instead of the one man libertarian law firm who will passionately argue about decriminalizing all drugs.
Basically, we're talking about signaling-credentialism. If a Lawyer went to Yale Law and now works at Latham & Watkins, he or she is probably quite good. If a banker went to Harvard and is now at Goldman Sachs, likewise*. For doctors, we don't quite have the same gradations. If you're an attending in any major metro hospital, you're roughly interchangeable outside of specialties.
I think what OP is saying is he'd like to see more doctors, even those who are the equivalents of Saul Goodman - they can write a prescription for some antibiotics, but you're not going to them for your hip replacement. I could be wrong tho (not op)
- They're good in the way that matters for these specific professions (law, banking) - they know the right people in the right places. Many of them are probably good at, you know, lawyerin' and finance and whatnot, but 80% of these jobs boil down to "yeah, I know that guy."
bonsaii
1hr ago
I think the problem here is that you often don't know what you're dealing with until you're already knee deep.
If we're keeping with the baseball analogy, the specialist is the guy you call when you already know you're up against the absolute best knuckleballers. The generalists are still out there dealing with most pitchers, who aren't the best at it but do mix in knuckleballs among fasts and curves. I guess the analogy I should have used is:
"If I'm betting my life on a baseball team, I want most of their batters to have at least gone up against a lot of knuckleballs in their life instead of a bunch of guys who've mostly only hit against fasts/curves and are going to be out there winging it for the first time if it turns out the opponent team has many solid knuckleball pitchers." (Sorry if this is bad baseball, I don't actually follow baseball)
I've seen the point made that this could also be due simply to Islamists being more than willing to kill for insults to their faith, like the Charlie Hebdo incident. Christians, especially today, have a more "turn the other cheek" attitude, and aren't so willing even to criticize blasphemy, much less to kill for it.
If true, that's rather scary: it suggests that the only way to ensure tolerance of a belief system is to be uncompromising and violent in defense of it, because any weakness will be exploited even by people who consider themselves paragons of 'tolerance.'
I realize that sounds like a "Just Asking Questions" moment where I'm suggesting the opposite to justify something terrible, but I have a genuine fear that this is true and would consider it horrifying if it were. I would much rather we all get along, and I know the human being and fish can coexist peacefully.
grognard
Intel Pentium III 450 / Nvidia Riva TNT2 Ultra / Corsair 128MB PC133 / ABIT BH6
1hr ago
filled with toys I use on the weekends
Oh! Oh! What kind of toys?
grognard
Intel Pentium III 450 / Nvidia Riva TNT2 Ultra / Corsair 128MB PC133 / ABIT BH6
1hr ago
Why give blood every few months? Is that not excessive?
Here
1hr ago
The Gaetz drama did take the heat off of Hegseth, though, who is now having his own sex allegations circulate.
bonsaii
1hr ago
Suppose surgery X is only needed by P patients per year per hospital, but surgical residents on average need to do at least C cases under supervision to reach competency. If residency is Y years long and you have R residency spots per hospital, then R is limited to C > Y P R.
ToaKraka
Dislikes you
1hr ago
Instead of allowing (as engineers, bankers, and lawyers do) a big gradation of physicians, all of whom can call themselves the prestige title doctor but who vary widely in terms of competence, pay, and reputation in the profession
To what exactly are you referring here? As another commenter has pointed out, there are no official gradations of "licensed lawyer": all people who obtain a lawyer license are officially lumped together in a single group, though they are required (1 2) under their ethics code to refrain from actually practicing outside their respective areas of competence. The same is true (§ II.2) of licensed engineers, and the National Society of Professional Engineers is explicitly opposed to divvying up engineer licenses as you suggest has already been done. And I don't think there's such a thing as a "licensed banker".
Here
1hr ago
Isn't that what specialists are for, though? If you need a guy who knows what to do with a knuckleball, you go to that guy, who specialized in it. But if you're dealing with fastballs and curveballs, then your local guy is good enough.
There's a death of generalists in medicine underlying a lot of this, in part because everyone wants the guy who's good with knuckleballs. But not everyone is going to face a knuckleball, and you don't need to go to the specialist otherwise.
Here
1hr ago
There's also the pressure to publish and research while also being a doctor that downgrades the focus the profession has on actual patient care.
My friends jumping through the residency hoops rn are kind of frustrated about it; they have to explain their "side hustle" almost instead of being able to say "I just want to be a doctor" to get "good" residency spots.
I had severe and persistent shoulder pain a few years back, it would radiate down my arm to the point it it became actually debilitating. Went to urgent care, they did X-rays, a doc came in and felt around, asked me some questions, and looked at the X-ray results.
Said I likely had bursitis and gave me a scrip for muscle relaxers and painkillers, that BARELY got me through the next couple weeks until the pain went away.
Last year, the pain came back. This time I spoke to one of my Physical Therapist friends who I KNEW saw tons of patients a year. She agreed to do an exam for cash, then give me her thoughts and possible options.
Took her about 10-15 minutes of prodding around to diagnose elevated first rib and a muscle imbalance causing possible shoulder impingement.
She gave me some stretches to ease the discomfort, then some exercises to remedy the imbalance once the pain subsided. Took <1 week for the pain to alleviate, and after easing into the exercises everything started working even better than before. No drugs needed.
Sort of broke my last remaining faith in Doctors as the gatekeepers of health.
Quantumfreakonomics
1hr ago
This can’t be right. The number of doctors needed for any given discipline X should scale linearly with the number of cases in discipline X. If there are not enough cases to train doctors, then there is no doctor shortage.
Lol I think about the same thing from time to time.
Back when I moved to a new area and had to face the terrifying fear of finding a new doctor, dentists, etc. all on my own, I spent a couple hours of research to find a doctor who accepted my insurance, was located conveniently close to my home, and seemed sufficiently competent from the dubiously reliable reviews and ratings systems there are for doctors (this shouldn't be difficult? There should be some easy way to ascertain if they've ever fucked over a patient or not?). The appointment had to be made a month or so out. I saw him a grand total of twice. Each time I waited about 20 minutes to be seen. I think I spent a total of 15 minutes in his presence. The first time he asked me all the standard health screening questions, including Tobacco use. I truthfully said that I'd had a cigar earlier that year, which he marked down on my sheet and noted "that might make it harder for you to get life insurance." Sent me to go get the standard battery of tests one gets as part of a general physical exam.
Second time, X months later I came back so he could review lab test results with me. All seemed good (BMI a little high but I COULD HAVE TOLD YOU THAT), and I requested politely that he make it clear that I am not a tobacco user, and he was good enough to remove that from the sheet. Hours of research and waiting to talk to the guy for <15 minutes and be told I'm in great health, if a little heavy.
Never went back. Felt like the time investment was simply not worth the so-called 'preventative' benefits. What was the point of him and me being in the same room other than allowing him to show face and justify however much he was billing to my insurance co.? Every single measurement he took could have been done by a nurse, any information he needed to diagnose could be provided without me having to make the appointment and such. I can give blood, turn my head and cough, and get X-rays done somewhere else and send them to him for review without needing to coordinate our busy schedules to coincide.
That's how lab tests work! I go to a location that has plentiful availability, they do some tests and send the results to the Doc. Surely he could have looked them over and sent back some recommendations or concerns as needed. He can presumably do that from the comfort of his home, even!
If I feel something physically wrong with me and it doesn't go away, I go to urgent care and get attention on the spot. If I want to know about some given metric about my body I can usually purchase or borrow a tool that will give me acceptable measurements, then punch those into google (or, more recently, ChatGPT). As somebody with no chronic health issues I simply don't see the value-add of having a primary doctor that will just tell me things I already know, but with the authority of an M.D.
I give blood every few months and they do a mini-physical that allows me to have a small insight into my health going back for years, so its not like I'm just sticking my head in the sand!
Now, OTOH I kind of love my Dermatologist. Visits last <30 minutes, about 10 of those she's physically present, and the entire time she's actually doing examination of the relevant organ. I pay in cash, I get another appointment 1 year out, and that's that. If something out of the ordinary is noticed, she can write the scrip and I can usually physically see the improvement the treatments bring.
I wonder how much of the prestige for doctors is still driven by all the Primetime shows that portray doctors as various types of savants or at least dedicated, hard workers who are subject to insane pressures and generally rise to the occasion. It probably makes the layperson think its GOOD that we limit who can be a doctor. "Doctors have to be like top 10% for intelligence and capable of working insane hours, that's not something just anybody can do!!"
Nevermind that the shortage of doctors is the reason they get insane hours and plenty of people in the top 10% for intelligence would avoid the field BECAUSE of that.
hydroacetylene
1hr ago
I think the heavily hispanic areas swung towards Trump as a side effect of hispanics regarding themselves as having more in common with their white counterparts, leading them to vote with their coworkers and immediate bosses. This change has been more or less predictable for decades now even if most of the voices calling attention to it have done so prematurely.
hydroacetylene
1hr ago
I mean, scientologists are mostly white, and everyone thinks they're stupid and delusional.
Rov_Scam
1hr ago
This is because being an NP/PA is considered a low-status job in PMC circles; not merely lower status than being a doctor, but lower status than being an engineer, a lawyer, a banker, a consultant, an accountant, a mid-level federal government employee, a hospital administrator, a B2B tech salesman etc, even if the pay is often similar. To become a PA as a native born member of the middle / upper middle class is to broadcast to the world, to every single person you meet, that you couldn’t become a doctor (this isn’t necessarily true, of course).
My sister-in-law is a PA, and I'm friends with several others. I have no idea what you mean from the suggestion that PA's have lower status than any of these other people. Maybe because some people confuse them with medical assistants, but people who don't know the difference aren't among those whose opinions I care about. A lot of them end up being PAs not because they couldn't cut it as doctors, but because doctors themselves warned them against med school. The option is going to school for 4 years after college, spend another 4 years working ridiculous hours for poverty wages, and finally get to be a real doctor some time in your 30s. At this point you're in so much debt that the higher salary only allows for the kind of lifestyle a normal college grad would have, not that it matters anyway, because you're still spending all your time at work.
And who is exactly looking down on PAs anyway? I'm a lawyer. I don't know what you do exactly, except that it's in finance, but unless you're in senior management I'm going to go ahead and pull rank here. I don't sit in some sad fucking cubicle or worse, some trendy-looking open office. I have a private office—an actual private one, not one of those manager offices with the window or frosted glass door that's expected to be open unless you're on the phone or discussing something sensitive—that's almost large enough to include a sofa and has sports memorabilia and custom photo prints on the walls and a large picture window with a view of a forest. I have my own secretary, and an army of paralegals will stop what they're doing if they're needed. If I need something printed I call someone else and have them bring it to me. I get printouts of most things because my work space cannot be limited to two screens. I have a bookshelf full of binders I prepare for each case (I'd have someone do this for me, but I don't trust them to not fuck it up). I have people send emails on my behalf, and people stop by my office with stuff for me to sign. I don't do anything that could be conceivably described as "real work". 90% of my job is drafting informal memos that aren't assigned by a superior or even directed to anyone in particular but are simply placed in the file for my own edification and so there's a record of my thoughts in case another attorney needs to look at the case. Most of my actual time is spent looking through documents and pacing my office thinking about things so I can make a decision. The only supervision I deal with is case assignments and who is covering depositions and court appearances, if there's a scheduling issue there. I don't deal with project managers assigning me work and emailing me every five minutes.
Beyond work, I live in a 3-bedroom house in an upscale area that's filled with toys I use on the weekends pursuing expensive hobbies. So please tell me who exactly I'm supposed to be looking down on. A guy who runs a crane in a steel mill? A video editor? The owner of a dog grooming business? A low-level financial analyst for a large company? A schoolteacher? A mechanical engineer? An audiologist? A registered nurse? A college professor? An accountant who does asset valuations? The guy you call before you dig? A middle manager for the IRS? The guy who works for a large bank who's described his job to me several times and I still don't know what he does? These are all friends of mine, and I could go on, but this gives you an idea of what my social circle looks like. There are no doctors or lawyers I regularly see socially, though my cousin is a Worker's Compensation attorney. I don't know anyone, even among lawyers, who engages in the kind of ostentatious spending that's meant to signal status. I know people who are really into things like craft beer, but that doesn't correlate with income. I personally drink High Life and Coors Banquet as my regular quash. I don't think PAs are below me. And I'm not one of those unrealistic egalitarians who think that I'm everyone's equal; I wouldn't date a girl who worked at McDonalds (or, realistically, one who didn't have a professional job), but that's about as far as it goes for most people. I don't ask what people do for a living before I decide if I'm going to be friends with them.
Instead of allowing (as engineers, bankers and lawyers do) a big gradation of physicians, all of whom can call themselves the prestige title doctor but who vary widely in terms of competence, pay and reputation in the profession...
There are no gradations of lawyers in the US. Once you pass the bar you're allowed to handle anything any client is willing to give you. You might not exactly be qualified to do so, but all the ethical canons say about that is that you have to familiarize yourself with the relevant law. Medicine, by contrast, has actual board certified specialties that require specific training.
In the book Where's my Flying Car?! The author does a great breakdown of how, because of over-regulation, general aviation died by the 1960s. If it hadn't, he lays out a good case that a pilot's license would be roughly equivalent of (good) driver's education for the same cost, and hundreds of thousands more people would probably fly. It would reshape highway systems and transportation in general.
Regulation doesn't just slow existing business / industry, it aborts new ones from forming and developing before they ever have a chance (emotive metaphor definitely used on purpose)
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