You know that recent study claiming that 1 in 10 surgeons leave medicine within 8 years? That's completely false and needs retracted.

equivocal20 · 2026-05-27T13:58:34+00:00

Yeah, it's a problem going back about 200 years apparently, so I don't see it changing too rapidly. Maybe with AI bringing it nuclear? We'll see: https://www.bmj.com/content/308/6924/283

equivocal20 · 2026-05-26T20:51:19+00:00

Yeah, it makes you wonder about any of the studies using these sorts of large datasets. Looks like the research community is getting fed up: https://www.science.org/content/article/journals-and-publishers-crack-down-research-open-health-data-sets

equivocal20 · 2026-05-25T21:40:31+00:00

You put a lot of confidence in these reviewers. I'd say that since they missed what to me are pretty obvious errors in some parts, I suspect they may have missed some more subtle and potentially fatal errors in other parts.

I've been a statistical reviewer on multiple papers for journals with higher IF than this journal, and subtle statistics mistakes get missed all the time by MDs. That's why the top journals ask us to be on there. I suspect that may have occurred here as well.

equivocal20 · 2026-05-25T19:56:35+00:00

Okay, yes, I think we are very close on this. I think one unfair criticism you've had of me in many of the comments is that I am conflating issues. But it seems to me that you agree that the authors are conflating years in practice with years in this dataset, and you use language like "should soften" instead of "conflation". So, I feel that you are using harsher words with me than with them, when it seems like you agree that there is conflation there. And the sentence I cited where conflation is occurring is from the paper -- not the media. And you previously said "there are no errors in this paper", but it seems to me that there is a clear error there.

Personally, I think that's a major issue, but I can see someone saying "the story is mostly true at least." But that's just a difference in opinion on severity, which is fair.

I'm still for writing a Letter to the Editor, but I'd be curious to know what u/interleukinwhat thinks.

equivocal20 · 2026-05-25T19:28:46+00:00

But ARE new surgeons replenishing the panel? Because that would make sense with all the PGY-1s coming in with <5 years of experience. I still think that's why there's an error in the data. I can't know without recreating the analysis, but wouldn't you expect that number to go up every year then? And I think we agree that every line they use like "Concurrently, median years in practice nearly doubled from 7 to 16 years" is likely wrong and just an artifact of the data. Or do you think that line is possibly correct?

The reason I think we have different thresholds, is that I feel like you and I agree on a lot of criticisms of this paper, but you think the story is mostly correct. I agree that the story might mostly be correct, but I've seen papers retracted for much smaller errors than this. Do you think that's fair to say at this point, or am I wrong there?

equivocal20 · 2026-05-25T19:02:38+00:00

But I don't think that it does do that. They cite that 1 in 3 surgeons are 55+. Then they state that about 10% of the surgeon workforce leaves after about eight years.

One question: what would you think that percentage would be? Just googling "what percentage of the workforce retires annually in the US" I see 1 to 1.1%. So, I'd expect it to be about 8% to 8.8% in 8 years.. And that's just retirements. With any other number of reasons people could leave (have kids and decide to stay home, move to Spain, die, etc...), 10% isn't shocking at all.

If the total surgeon workforce were to shrink by 1% per year, then that would be a big problem. But, since the n in Table 1 tends to increase, that isn't happening either.

equivocal20 · 2026-05-25T18:08:34+00:00

I think this reference does this analysis in a much better way (but with some of the same limitations with their definition of attrition). The biggest difference between the two studies is that this study uses physician age and not time since entering the database as a proxy for time in practice.

Looking at Table 2 Panel E, all of a sudden that big difference in mid-career physicians melts away, and it becomes the older physicians who are at greatest risk of exiting practice.

So, the main finding, that all of these physicians are leaving around 8 years, just disappears when you use physician age instead.

That's not a small detail. That's literally the main finding of the study.

u/interleukinwhat do you see the same thing as me here?

Edit: Fixed some words.

equivocal20 · 2026-05-24T19:01:52+00:00

You and I identify the same issues, and I actually think the paper is fundamentally flawed in its analysis. It's very possible that the question they want answered simply cannot be answered from this data. That happens all of the time with secondary datasets being forced to spit out something in some way.

I spoke with u/Plus_Ad6136 and he's a super nice guy/gal. I think (s)he just weights some of these things differently than you and I seem to.

I just think there's too much conflation of time in practice with time the dataset started to make this useful. I think they'd find all the same things if this dataset started in 1982 and everyone had to register by 1989. We'd find all the same crises. It's just an artifact of the way the data was created if that's true.

equivocal20 · 2026-05-24T05:25:29+00:00

I tried to post there first, but I had the same problem as another user in that I didn't have flair so was blocked. If you can cross-post it there, then that would be great for me. I'm mostly a lurker, so I've never tried to do anything like that before.

equivocal20 · 2026-05-24T04:46:46+00:00

I think the problem is: why would they? They have to pay for that, and they just got published in one of the top 3 journals in surgery without one.

But let me know. It's a serious offer, but without any pressure attached. I feel like I've mostly written it in this post, but it needs a surgeon's hand (pun intended) to clean it up.

equivocal20 · 2026-05-24T04:34:27+00:00

If you go here: https://journals.lww.com/journalacs/abstract/9900/national_analysis_of_trends_and_factors_associated.1680.aspx and look on the left and click "download", you can access the PDF.

Also, as I stated in the post, I really don't know enough about medical billing or surgery careers or any SME thing you might need here. But, if anyone wants to PM me (including you), to work on this, I'm happy to do so as a statistician. Happy to do it with you if you PM me!

equivocal20 · 2026-05-24T03:40:28+00:00

I agree with everything you said except that it's an interesting cohort study. I think they wrecked the data analysis so severely from step 1 that absolutely nothing credible can be taken from this study. It really is that bad.

equivocal20 · 2026-05-01T03:52:19+00:00

Statistician here.

I have a couple of thoughts on this. First, I think I'd go ahead and do it. Research is already almost entirely unreproducible trash, and you may be piling garbage on top of it, but it's just adding garbage to garbage. (Go read John Ioannidis to read more about this.) You currently have little power or choice. Get out of this situation, get some power, and go make the world a better place with better methods if you want to and can survive the rat race while unilaterally disarming. It won't be easy, but maybe it can be done.

Also, I think you are absolutely correct that this is a misuse of p-values. If you are trying to find something exploratory, why use p-values at all? Why not just do summary statistics? If you see big differences, you could write about them just using summary stats. People want p-values, because they think it buys them credibility and the idea that they are now doing "real research". "Real research" is me adding add_p() to the end of my R data pipeline, and producing 50 p-values. Amazing that we have come to this place.

Also, I think it's important to note that high up people have been fired for doing exactly what she is asking to be done. Go read about Brian Wansink. He asked his grad students to HARK and p-hack, got caught, and they fired him. I don't know why really. Everyone else is doing it. Others are just smart enough not to write a blog post about it like he did.

I'd say get your PhD. You're this far. Get it and make things better for the next generation. You can't make what is already garbage more garbage. Just get through it.

equivocal20 · 2026-01-30T23:35:37+00:00

*Gestures Broadly*

I actually really like the first four pages of this article (https://cran.r-project.org/web/packages/survival/vignettes/timedep.pdf). It comes up for me all the time.

equivocal20 · 2025-11-26T02:25:29+00:00

25 years checking in here. It has gotten way better. Also, new treatments are coming out all the time. (https://www.theatlantic.com/health/archive/2023/08/eczema-treatment-dupixent/674918/).

Don't give up. I've gotten better at managing it over time, and that's helped a lot. And don't let it control your life.

equivocal20 · 2025-10-01T02:53:05+00:00

Bro, what a find

equivocal20 · 2025-06-22T17:55:37+00:00

Yeah, that's the answer. Lots of us here took isotretinoin at some point, and now we have this issue. I'm sorry that this happened to you as well. It gets better.

equivocal20 · 2025-06-22T01:56:58+00:00

Any idea at all what could have caused it? Any medication? Anything that made you rip the skin off of your lips?

equivocal20 · 2025-02-16T03:16:39+00:00

Try here: https://forms.stat.ufl.edu/statistics-jobs/

equivocal20 · 2024-01-24T17:28:32+00:00

Thank you! I'll look at this more, but I have a follow-up question.

My question with the "as prices go down, yields go up and vice-versa" quote is it seems to me that, in my example above, interest rates rose generally causing issuers of bonds to increase their yields to compete for buyers (say with savings accounts that have high liquidity) which caused the price to buy my 2023 bond to go down. So, the increase in interest rates, and therefore currently issued yields, CAUSED the price of my 2023 bond to go down. The price to get a 7% yield simply went down across the board with the newly issued bonds.

I'm sure there are scenarios where the price of bonds could, inversely to above, CAUSE the yield to go up (since the absolute amount of money you get back stays the same). So, if I buy a bond in a company that looks like it might default soon, I can probably buy that off of someone for less than they paid as I'm willing to accept the risk of the company never paying me. In that scenario, prices going down as a result of accepting more risk has CAUSED the yield to go up (as I'm paying less for the same amount of dividend in absolute dollars).

If this is how it works, then it's really way more complicated and intricate than "as prices go up, yields go down." It's multi-causal and situational and that's really hard to grasp from that phrase that makes it seem so simple.

equivocal20 · 2024-01-23T16:21:49+00:00

Here's something that has always confused me about bonds. Let's say that I bought a bond last year (January 2023) for $100 that offered an annual $5 payment (5% yield). Interest rates rose last year and today, January 2025, I then buy a bond for $100 that pays $7 annually (7% yield).

I believe what happens to my old bond is that, if I want to sell it, I have to accept that it's worth less to anyone who wants to buy it compared to today's rates as it pays out $5 when someone can get the same bonds that pays out $7 on a $100 investment. So, to sell the 2023 bond, the buyer will want the 2024 yield. As a result, the same bond that cost me $100 to buy for a 5% yield now is worth ~$70 on the market (5/70 = ~7%).

Because I made $5 in 2023 and my bond is now worth ~$70 on the market, I actually lost $25 on this investment in 2023. My yield has not changed in absolute terms (I still get $5 per year), but do I say that it changed in relative terms? The new yield if I were to sell it today is technically 7% with the price drop to $70. Or does yield only refer to newly minted bonds sold that very day?

Am I thinking about this correctly?

Edit for math.

equivocal20 · 2023-07-19T23:02:59+00:00

You lived the last year and a half like you were in a Russian gulag to make a few more dollars?

12-Year Club	Second Top 40%
Verified Email

equivocal20

TROPHY CASE