Comment by jerlam
3 months ago
> Sounds like a doctor?
Not disagreeing, but the US also has a doctor shortage for at least a decade that it is seemingly unable to fix.
3 months ago
> Sounds like a doctor?
Not disagreeing, but the US also has a doctor shortage for at least a decade that it is seemingly unable to fix.
There are multiple reasons for the doctor shortage but it's at least partly intentional. The primary bottleneck on producing new physicians is the number of residency program slots: every year some students graduate with an MD but are unable to practice medicine because they can't get matched to a residency slot (some do get matched the following year). Most residency programs are funded through Medicare and Congress has refused to significantly increase that budget for years. But here's the trick. By limiting the number of doctors they also hold down the cost of Medicare claims. If a Medicare beneficiary can't get an appointment because there are no doctors available then no claim will be generated and the federal government doesn't have to pay anything.
https://savegme.org/
I love how that page is from the AMA, the organization that is largely responsible for pushing Congress to institute the residency caps in the first place because they feared too many physicians would drive down existing physician's incomes.
Crazy how they present as a guild but behave like a cartel.
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This is fucked.
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My simple understanding is that the width of the bottleneck is controlled by existing doctors who are (unfortunately) monetarily motivated to limit the supply of new doctors.
Nope, your understanding is mostly wrong. It's primarily controlled by Congress in the form of Medicare limits on residency funding. And to a lesser extent by the management of teaching hospitals. Most of those people aren't doctors.
At one point the AMA lobbied Congress for those funding limits but they reversed position on that years ago.
https://savegme.org/
Ah damn, looks like my understanding was incorrect. Thanks for the link, that's very illuminating!
The USA restricts the number of positions for medical schools and residencies. It's a problem that money could solve.
There is no restriction on medical school admissions. It's really just residencies.
There are no artificial restrictions on residency slots. The Federal government funds a fixed number of slots, but states and hospitals also fund residencies. The "shortage" has much to do with geography and specialty--the money and interest is working in specialties on the coasts, not as a GP in rural towns. People who are rejected are typically vying for slots in high-demand areas and specialties; they often could have been accepted if they had applied elsewhere.
One answer would be to raise GP salaries, but that's difficult, especially if you're self-funding residencies and already paying out the nose for specialists and other inflated expenses deemed necessary in modern healthcare systems. Kaiser California imports medical school graduates from abroad for their in-house residency programs, which is presumably cheaper than raising salaries to draw more US resident candidates.
Kaiser arguably points the way forward. As an HMO--a vertically integrated healthcare system--there's greater financial incentive to self-fund residencies. When insurers, hospitals, and doctors are all at arms length from each other, the financial incentives don't align very well, thus the "need" for outside funding (i.e. the government) of residencies.
Note that unfunded residencies are also a thing, where the resident is responsible for sourcing the funds for their salary and expenses.
My understanding is that this is a distinction that doesn't make a difference? Without a residency, can you become a doctor?
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The supply of doctors is limited by the AMA and state MA, to avoid excess doctors = price competition
And part of the problem there is that money and profit got introduced in the healthcare system.
In other countries people become doctors because they want to heal others. Not because they want to become wealthy. In the US doctors spend half of their time haggling with the insurance companies.
I mean going to school for 10 years only to be in debt for 100K-300K+ dollars, and not have a good idea of whether you will be able to pay that back... is a massive problem. Most countries don't have this issue, for example. They have an abundance of doctors and engineers, because people who actually want to do those things, are able to pursue those careers without financial investment. We are snubbing an entire generation of people and then acting surprised when the very obvious consequences of those actions start to come back to bite us. Its the definition of insanity.
It's hardly "most countries". The USA is about average for developed countries in terms of physicians per capita. We're higher than France, Belgium, UK, Japan, Canada, etc.
https://data.worldbank.org/indicator/SH.MED.PHYS.ZS?most_rec...
> They have an abundance of doctors and engineers
They are usually paid several times less than people doing the same jobs in US.
But in other countries they dont need to pay so much for social system, insurance or healthcare, kindergarden and so on.. You can not always compare everything with money, when there is a lot around it.
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But their cost of life is also lower.
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I don't really see why that would be a problem.
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