Comment by michaelt | Hacker News Reader

Comment by michaelt | Hacker News Reader

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> What is interesting in the debate to me, is that I see a lot of IT work as blue collar work.

Society has loads of edge cases like this.

I broke my arm a few years back, went to hospital, and a surgeon put some titanium plates and screws in. The orthopaedic surgeon spends a lot of the day standing, they repeat similar work every day with minor variations, they can't work remotely, they're exposed to hazardous chemicals, they have face-to-face interactions with customers, they earn money by working rather than from investments or inheritance, they're union members, they get paid overtime, they wear blue employer-issued workwear, many do shift work, and they literally put in screws for a living.

And yet nobody would say surgeons are blue collar workers.

Maybe because of the $500k salaries, or the air-conditioned hospitals they work in, or because their status is equivalent to doctors who are pretty much the definition of upper-middle-class tie-wearing knowledge workers.

> they're union members, they get paid overtime

Very few surgeons are union members. They frequently work for outside groups and are paid per procedure. The ones that do work for the hospital on salary don’t get overtime.

>status is equivalent to doctors

They are doctors. Both in title and in function. Most surgeons only operate a couple days a week. The rest of their time they see patients in clinic, and an outside observer couldn’t tell the difference between their work environment and a primary care physician’s.

You are onto something though. My wife is an ER doctor and her job is very similar to blue collar service jobs (if you consider service jobs blue collar).

She doesn’t make her own schedule. She works insane shifts (one day she could work 7a-4p, the next 10p-7a). She interacts with patients directly all day.

The pay is a lot better, but the hours are worse than any retail job I’ve ever heard of, and you can’t call in sick. Her coworker was sick and could barely get out of bed, but she came in early to have a nurse give her an IV so she could power through her shift—that kind of thing is very common.

Plus you have the ultimate responsibility for every patient that comes through the door. You have to make sure you don’t miss anything serious every time—while at the same time, making sure that you don’t spend too much time with each patient. And the ER you’re working in is full because the floor is too full to admit new patients but the ER can’t just shut the door, so patients are boarding in the halls.

Oh and if you mess up, you can literally lose your house when a jury awards someone more than your malpractice insurance will cover.

They're going to be members of the American Medical Association and likely at least one of the American Academy of Orthopedic Surgeons, the American Board of Orthopedic Surgeons, and/or the American Council for Graduate Medical Education. The difference between these organizations and unions pretty much starts and ends with "negotiate collectively with your employer directly" because they all (especially the AMA and ACGME) act to keep salaries and prestige high.

They're not a union member the same way a teacher, police officer, or steam fitter is but they're not as far removed as your typical programmer, for example.

The American Medical Association, American Academy of Orthopedic Surgeons, the American Board of Orthopedic Surgeons, and the American Council for Graduate Medical Education are all unions

Powerful unions

None of those are unions. They are lobbying organizations and certification bodies.

The vast majority of doctors aren’t even members of the AMA.

Less than 20% of practicing physicians are members of the AMA.

As for medical specialty boards, getting board certified is much more like an engineer passing the PE exam than joining a union.

Also collective bargaining with your employer is the primary benefit of joining a union, and the primary purpose of joining a union. Without that function a union would be unrecognizable to the average union member.

All doctors,like all lawyers, are in a union in the sense that they cannot operate without approval from their peers. It's collusion by labor, but with patient outcomes being the supposed concern rather than pay (though obviously it is also precisely why doctors and lawyers get paid so much).

That’s very different from being in a union though. Without the collective bargaining process unions would be unrecognizable to most members. Doctors either negotiate directly with their employer, or take whatever prices Medicare and insurers will give them.

And currently the AMA’s position is that congress should fund more resident slots which is the limiting factor for the number of doctors.

>precisely why doctors and lawyers get paid so much

I don’t know that regulation is precisely why. It surely contributes, but doesn’t explain all of it.

Carpenters are very rarely regulated, HVAC technicians usually are. The training required is similar. The average salary difference is less than $10k a year.

Doctor’s (and lawyer’s) salaries vary drastically by specialty, and number of doctors in a specialty doesn’t explain all or even most of the pay disparity.

There are far fewer pediatric emergency medical physicians than GI docs, but GI docs make way more money. The extra income has nothing to do with restricted supply, it’s a side effect of the way insurers pay (by procedure and GI does way more procedures).

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