This! It's crazy how infrequently the stranglehold the AMA has on limiting the number of doctors is mentioned when we talk about the cost of medical care in the US. It's like we allow a single institution to create an artificial shortage of something and then act surprised when the cost of that thing goes through the roof.
Well, here's a couple of points. Ultimately, the decision of how many residency slots to fund comes down to Congress. Here's an older article that discuss how the cost of residency slots is covered, but it's essentially covered by Medicare:
Now, hospitals could just fund additional slots directly, but they don't. That's a problem as well. Over the years, there have been several bills introduced to increase this number. Here's an article about efforts in 2013 and 2015:
Generally speaking, they don't pass for a variety of reasons of which the AMA is only one.
I think it helps to understand that there's a large, complicated system that depends on this artificial supply limit and dismantling only a single section would not fix the rest. Universities make a huge amount of money with the tuition they charge medical students, which is much higher than for other degrees. They can charge this knowing that these students can absorb the debt using their future earnings, which are dependent on this limited supply. Mortgage companies have special home loans for physicians because they know this artificial supply and nature of physician contracts means that their money is nearly guaranteed. I could go on, but there many, many industries that depend on this system.
Again, I don't agree with this, but I think it helps to understand that it's not just the AMA who has a vested interest in keeping the status quo. Every industry who benefits from this system has interest in keeping it the same and actively lobby for it. Further, fixing this shortage problem necessarily means finding fixes for all of the other industries that depend on this money.
On top of this, even if we eliminate the soft cap on residency slots, it's not necessarily going to fix the problem with supply. The primary issue isn't lack of physicians, it's lack of family medicine physicians who want to work outside of large markets. While it depends on specialty, big markets like D.C., Seattle, and Denver can be very, very difficult for a physician to find a job. In fact, I know many physicians who live in these cities and then work remotely a week or two a month in a small town in a different state doing locums. They're paid a premium for such work and they enjoy it, but they'd never want to live in these places. Unless you want to force physicians to work in these markets, that problem doesn't change.
I'm sorry. I am incorrect and it was more a comment based on the lobbying efforts during the 1990s when the AMA lobbied for the cap. Thanks for the clarification.
I think this is the key, so much of of the problems physicians face were created by physician and their own lobbying. American Physicians are paid more then other countries by a lot [1] in large part because of high educational requirements that were supported by physicians. Resident burn out is awful, but the people pushing them to work insane hours aren't the hospital administrators, but older physicians who have the attitude that they went through it too. It's really hard for a physician from another country to immigrate to the US and practice, restrictions supported by, you guessed it, physicians!
If you really want to lower physician burn out and decrease health costs we need to increase the supply of physicians in this country, and you'll have to fight the existing physicians to do it.
As mentioned it's way easier for software developers to immigrate to the US, and there is no organization limiting the number of software engineers trained into the profession every year. There is an additional confounder in that the biggest and highest paying software companies are all located in the US and exporting products throughout the world, which is not how it works with physicians.
Except there is no organization limiting the number of software developers. In fact, I can't think of another field out there with so many free resources for one to educate and prove themselves a capable programmer.
Nurses make more in the us, then most doctors outside the us. There is a shortage of people in general in the usa, and we have the INS artificially limiting immigration for everyone.
While the AMA is guilty of limiting the number of doctors before, they have reversed their position are are now actively lobbying for more funding of residency slots.
An analysis of the Hippocratic Oath and its application in the modern day will turn up the same results as any other ethical standard. Selectively applied on criteria that would rarely be tolerated if openly stated, requiring unstated assumptions to avoid internal contradiction, and powerless to change human behavior as those who commit to upholding it will do so only for interpretations in their own image. While I do admit my view of ethics as a whole is quite cynical, I think one only needs to consider how many ethically bound actors have caused significant harm with unquestionably wrong actions to see that such cynicism has solid foundations.
In short, we should treat doctors no different than any other human in regards to how they operate and how to protect society from bad actors. One practical example is that doctors should follow the same rules and others with regards to child safety such as ensure a child is always accompanied by two unrelated adults and that patients and their parents should be willing to seek second opinions on anything a doctor does that they do not feel comfortable with.
As for the issue at hand, we should not assume doctors will behave more benevolently than any other industry with regards to self regulation and rent seeking(-esque) behavior.
Also to clarify, there are many selfish doctors who do their best to help others. I'm not questioning our doubting that. I'm speaking of groups in general and not of every single member.
I've been working in the field (software side) for a while and it is a little bit complicated. Some medical procedures absolutely require constant practice to maintain a very high level of quality and safety. Others don't. If you grow the number of residents by 10x, the total number of cases won't follow and you can end up with a more dangerous situation overall as every physician will be less qualified by virtue of practising less. That varies by specialty.
There is also the money. Sure you can train 10-100x physicians, but total compensation won't grow as fast, and so you should see lower overall wages (supply and demand). But it's still more complicated than that, because some people choose not to undergo X or Y procedure for various reasons, insurers don't cover or whatever. So even if you could train enough doctors to fulfil the whole population's needs, that doesn't mean you will have: 1. enough equipment, material, operating rooms, etc to do the procedures 2. enough supporting staff, and on and on.
The most common reason I hear from MDs against training much more doctors is the first one I gave you: less practice means a more dangerous practice.
My own opinion is relatively simple. Medical schools should stop screening applicants as much and let students join freely.
Medical schools are all about getting well-rounded individuals who did extra-curriculars etc. They usually view it as a good thing that you have life experiences outside of medicine, like working or studying an entirely different subject. However it works one-way: you can't (generally) just go to med school, learn the subject matter and then move on to another field, enriching _that_ one with your experience. I have come to believe that if we are to see any improvement, med school will have to open up just like every other discipline. The current system of stressing out students for a few years before even being allowed in the classroom is, IMO, partly responsible for the job dissatisfaction that you see.
Now freeing up med school admissions does not mean allowing everybody to _practice_ medicine. Prospective students would actually get a chance to learn the material for a few years before having to interview for internships. So instead of filtering _before_ med school and forcing a huge sunk cost psychological barrier to students, you can let the students figure out by themselves if they actually enjoy the subject matter. It's not a perfect solution but I am quite certain that society as a whole would benefit. It is entirely unfair that medical knowledge (not practice) is restricted to a lucky few.
I am also from the field (POLST management for hospitals). Do you think it would be useful to sort the type of medical procedures by difficulty to make that more known to the market?
Not really IMO as that has a certain level of subjectivity that could lead to endless argumentation. What's truly needed from my limited perspective is democratization of medical schooling. I've met MDs who are trying to make it with their startup who only went through medical school because of other people's expectations and an immensely stressful sense of sunk cost that had to be avoided at all cost. If they could have studied 2-3 years and then made the change to programming, for example, that would have made much more sense to them.
I take issue with the closed entrance door policy. I'd rather see selective internships than selective pre-screening.
From the article, "And, it turns out that most (more than 95 percent) U.S. graduates did match in a residency program." Generally speaking, the U.S. residency program prioritizes and favors physicians graduating from U.S. medical schools.
The 95% number comes when you only look at US med school based candidates. That suggests a much smaller gap between demand and supply.
The rate for an intentional candidate matching into an American program is in the 50% to 60% range. Lots of doctors want to come work in the US, but residency programs simply do not have the capacity to accept them.
Yes. The residency programs are heavily weighted toward and really designed to ensure that every graduate from an American medical school has the ability to enter the residency program. Those to who attend the Caribbean schools or who are trained at a variety of other institutions abroad are given what is left over.
Personally, I have mixed feelings about this. I don't really mind the federal government giving priority to graduates from American schools. Frankly, the federal government likely gave them the loans to attend, so it helps to get that money paid back, which will only happen if these graduates become attending physicians and residency is a requirement for this to happen. On the other hand, the U.S. denies reciprocity from virtually all physicians from abroad outside of Canada. In order to practice in the U.S., physicians need to repeat their residency in an American program and it can be difficult for them to get a residency in a specialty in which they already practice. This is wasteful and I'd like to see a process to expedite this process as long as we can ensure these incoming physicians understand the American standard of care, which is differs between countries, for better or for worse.
All that said, the U.S. doesn't need more physicians in general. They need more physicians in certain specialties like family practice who want to live in small markets. Simply flooding the market with more physicians won't guarantee that this will happen.
That's a complicated question. Let's say you're working on a software project that's running late. Does that indicate you should through more software developers at it?
The problem with medicine is that you have a culture of perfectionism in a field where random bad shit naturally happens all the time, and there's a great amount of human suffering. On top of that, perfectionism helps a lot, in the short run, even though it may be toxic in the long run.
Adding more doctors isn't like adding more developers to a software project. Additional doctors can treat new patients in parallel without affecting the work that other doctors are doing.
Right, do you guys know if there is a bird's eye view platform on the net that talks about which region in US is under staffed in terms of physicians? People may be migrating to the cities for jobs and end up in under staffed areas. That could be good information for migrants.
No, the correct analogy would be that you're working on millions of independent software projects and are having trouble handling them all. In which case it would obviously help to add engineers.
