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.
https://economix.blogs.nytimes.com/2013/12/17/how-medicare-s...
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:
https://www.the-hospitalist.org/hospitalist/article/122261/h...
Here's another one for this year:
https://www.aha.org/news/headline/2019-03-14-bill-add-15000-...
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.