If your average per request in the application layer is say 20ms. Your p50 is probably 10-15ms and your p99 is probably something like 80ms. p99.9 is probably a good bit higher than that.
If your site is highly interactive, everyone using it is going to regularly run into actions that take long enough that they notice them, and it won’t feel snappy.
Let’s say you went all out and wrote the application layer in C with purely static allocation. You could easily see a p50 around 1-2ms and a p99 of 3-5ms. (This is obviously dependent on the app).
Even with an average time spent waiting in the database of 80ms, you’ve already made a noticeable difference.
That’s not even mentioning the biggest impact, which is that you can likely get by with far fewer application servers.
Now does it make even more sense to optimize your queries? Yes. Definitely. But with faster application stack you can start moving more things into the application layer and out of the database which is generally harder to scale.
And if you have or can build endpoints that don’t hit your database at all, those will actually be 10x faster than before every time.
That's because the process to have any chance in the competition to become a doctor is arduous and there's no consolation prize.
If you aspire to work at FAANG and fail you can be a software developer somewhere else. If you aspire to be a doctor and aren't admitted to med school, those years of education, volunteering, shadowing, test prep, etc. are fairly useless.
And even if you succeed, the hours are as bad as can be and the pay isn't much better than FAANG. It's not a logical choice unless you really want it, while software dev is (was?) a great career choice even if you don't care about software.
For all these reasons, a lot of people are filtered out long before applying to med school.
You’re making my argument for me. The percentage of people who are actively trying to get into FAANG but don’t is higher than the percentage of people actively trying to become doctors.
It’s more selective. So comparing FAANG salaries to the average doctor salary isn’t useful. To find something equally selective, you’d need to pick a higher paid subset of doctors.
Here's why that's a silly comparison: the percentage of people on the general election ballot for US President who don't make it is lower than the percentage of people who are actively trying to get into FAANG but don’t make it. Does that mean US President is less selective? Obviously not, because that's the last of many filters for President and there are essentially no filters before "I'll send a resume to FAANG".
In the same way, there are many filters before filling out a med school application.
Anyway I can't see any way anyone could believe the "median software developer" writing CRUD web pages or in-house apps is comparable to the average physician.
It’s called physicians assistants and nurse practitioners. They are essentially exactly what’s you’re talking about. They make less and they have less training.
In most countries that do this training is longer which that total training time is only 1-2 years shorter.
So you’re doing a few things.
1. Moving more training from cheaper colleges to more expensive medical schools.
2. Moving the filter from undergrad to medical school
3. There is no national curriculum in US high schools, so essentially the first 2 years is getting everyone on the same footing. Removing this without changing high school, puts students at poor high schools at an even greater disadvantage.
Many of the programs you listed don’t cut any time off. They’re just a special pipeline program that can help you get into med school.
Of the ones that do save time, most cut 1 year off not 2. And they do it by having students take more than a full time load during undergrad.
It’s essentially the same thing as taking an extra class or 2 every semester so you can finish undergrad in 3 years instead of 4.
I randomly sample 15 of the programs listed there and 14 were 8 year programs. Only 1 had an optional 7 year program (if you were willing to take more than full time load or go to school in summmer). And there were no 6 year programs.
In the SF Bay Area there's a town called Milpitas. There's a gigantic island next to it made of garbage. A government funded study has been running for over 10 years now trying to determine why Milpitas smells. They have not yet been successful. You see, succeeding means getting funding withdrawn from the study.
Is it? If I ran an organization whose members' salaries depended on my lobbying taking its time to produce as little of a result as possible - would I really want to do a good job? Or if I did - would I remain the head of said organization for very long?
So it’s not that they’re actively lobbying against more residency slots, it’s that they aren’t lobbying for it hard enough.
What you’ve done is constructed an argument where no matter what position the AMA takes, they are the bad guys.
> salaries depended on my lobbying taking its time to produce as little of a result as possible
This doesn’t make sense. How would the AMA board communicate this to their voting members when all of their communications say that they doing all they can to increase resident funding.
How about the first board to vote to change their position 30 years ago? How would the voting members know that they were planning on slow walking their new position?
Do you think they have a secret doctor only communication channel where they tell them “don’t worry guys we’re not trying that hard”. Because without that if your premise is correct all of the members would have voted them out ASAP.
Also how is the AMA (which only represents about 15% of doctors btw) preventing hospitals from effectively lobbying for an increase? They have a huge financial interest in more resident funding.
If you took 30 years to deliver a project - would you still have your job? The fact that the AMA is still around means this is not one of the axes they are evaluated on. Classic misaligned incentives.
Loans need to be repaid. I have many physician friends who graduated from medical school with 500k-750k in student loan debt (including debt from undergrad which compounded during medical school) with a combination of federal student aid as well as private loans anywhere from 8-10%. After graduating medical school, they completed 3-5 year residency programs earning somewhere in the ballpark of $50k-$60k salary. This is in an expensive northeast US market where such a salary barely covers basic living expenses, and as such their debt continued to compound. After completing residencies, they earn $175k-$200k salary which is about average for this area as an attending physician in their specialties (primary care related specialties like Family Medicine).
You do the math: over a 10 year repayment period with compound interest, their education cost them MILLIONS and they'll be well into their 40s before they start saving a dime for retirement. The cost and scarcity of medical education is extremely punitive to doctors and prices out many would-be great physicians. Many I know who have gone through this ended up regretting it due to the enormous financial burden they are saddled with for many years after becoming an attending.
Maybe folks believe these professions should be reserved to those who inherit great amounts of generational wealth.
If "only" 30% of graduates are graduating with over $300k in debt, that means that of the 30,000 graduates that graduate from both allopathic and osteopathic programs each year [1] there are almost 9,000 physicians that are high debt graduates. At high interest rates, that debt can easily grow by hundreds of thousands of dollars while you complete a residency program.
The resident salaries that you listed are an average taken across all specialties. Family Medicine is the lowest paid specialty with 2026 PGY-1 salaries at $58,500 (representing an increase of over 15% since 2021) [2] That is simply not enough to pay the cost of living in a state like Massachusetts where the median household income is more than double that [3] and the average rent in Boston metro is almost $40,000 annually [4]. Not only can you not afford to pay down your student loan debt, you are extremely likely to accrue additional consumer debt on things like credits cards or vehicles.
My main point is that training to become a doctor carries so much financial risk that it selects against folks from poor socioeconomic backgrounds that would otherwise make great physicians. In 2018 the AAMC published a study showing that 51% of medical school matriculants were from families in the top quintile for family income [5] and if I were a betting man, I'd guess that proportion has only increased.
> At high interest rates, that debt can easily grow by hundreds of thousands of dollars while you complete a residency program.
Sure. But that’s not what you said. You said you had many fiends that graduated med school with $500k-$750k in debt. I think you were lying or your definition of many was highly exaggerated.
> That is simply not enough to pay the cost of living in a state like Massachusetts
$58k is the national average. Not the average in a high cost of living area like Massachusetts.
> My main point is that training to become a doctor carries so much financial risk that it selects against folks from poor socioeconomic backgrounds that would otherwise make great physicians.
There is almost zero financial risk.
Eventual graduation rate is 96%. Eventual match rate is around 99%.
Are there doctors that could have make more money going into finance sure. Are there doctors who are financially ruined, not meaningfully.
>In 2018 the AAMC published a study showing that 51% of medical school matriculants were from families in the top quintile for family income
1. Doctors kids are more likely to become doctors.
2. High income is correlated with intelligence and intelligence is partially heritable.
3. Kids from high income families are more likely to have extended family and friends who are editors who encourage them to become doctors.
4. Med school requires college and college and children from income families are much more likely to have college degrees.
5. Medical school entrance is competitive and high income kids are much more likely to go to better colleges.
6. High income kids are much more likely to have higher grades in college because they don’t have to work.
7. High income kids are much more likely to go to better high schools which impacts what college they get into and how well they do there.
The list goes on and on. The cost of medical school is so far down that list.
I don’t think accusations of lying add anything productive to the conversation, but thanks. We have different circles of friends with different financial circumstances and that’s OK. There are plenty of stories if you would care to read more:
Residency match rates for American graduates from American MD or DO programs are more like 93%. Also worth considering that thousands of Americans go abroad for medical school due to limited seats in the US. For American IMGs the match rate is only 70%. If you dig into things a little bit further, it’s actually worse than that because the figures do not include applicants who did not submit a rank list because they did not receive any interviews.
I agree that the vast majority are able to match into a residency program, but I certainly would not consider that “almost zero financial risk”
> I don’t think accusations of lying add anything productive to the conversation, but thanks. We have different circles of friends with different financial circumstances and that’s OK.
I think it’s more likely you’re just exaggerating. How many is many? If you personally know more than 5 doctors with $500k-$750k in debt after med school I’ll eat my hat.
That reddit link only had 7 actual doctors who claimed to have graduated with more than $500k in debt. In a post about high debt with 200+ comments in a subreddit for doctors.
And the OP mentioned in the comments that he was borrowing enough to pay for his “expensive” med school and to support himself, his stay at home wife, and their baby in an expensive area.
> Residency match rates for American graduates from American MD or DO programs are more like 93%
That’s only after primary march. Match rate after SOAP is 98%. Roughly half of the unmatched 2% get marched in the next max cycle which is where I got 99%. Of the remaining 1% most of those want to eventually place somewhere.
>For American IMGs
Yeah don’t go to a factory medical school in the Caribbean. It’s a bad idea.
It’s definitely almost 0 financial risk. The only real risk is that you just hate being a a doctor. But even in that case med school unlocks tons of opportunities outside of clinical practice.
The chance of you ending up suffering financial hardship is too small to consider in your decision making.
The real out of your control risks would be severe disability that prevents you from finishing med school or working (before you can afford disability insurance). But in the case it really doesn’t matter whether you owe $50k from undergrad or $250k from med school. You’re not paying either one back and you can actually bankrupt out of student loan debt in those cases.
Half a million in debt is scary. Especially if you have any doubts that you can match and make it through residency at the end. It's even scarier if you come from a family making $50k/yr.
Don't they have to back these gigantic loans? That might deter people from going to medical school out of fear they're not gonna have what it takes and drop out halfway with huge debt.
If your average per request in the application layer is say 20ms. Your p50 is probably 10-15ms and your p99 is probably something like 80ms. p99.9 is probably a good bit higher than that.
If your site is highly interactive, everyone using it is going to regularly run into actions that take long enough that they notice them, and it won’t feel snappy.
Let’s say you went all out and wrote the application layer in C with purely static allocation. You could easily see a p50 around 1-2ms and a p99 of 3-5ms. (This is obviously dependent on the app).
Even with an average time spent waiting in the database of 80ms, you’ve already made a noticeable difference.
That’s not even mentioning the biggest impact, which is that you can likely get by with far fewer application servers.
Now does it make even more sense to optimize your queries? Yes. Definitely. But with faster application stack you can start moving more things into the application layer and out of the database which is generally harder to scale.
And if you have or can build endpoints that don’t hit your database at all, those will actually be 10x faster than before every time.
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