4 ms·

Part of the problem is you can thank the stranglehold the AMA has around the US healthcare system to keep the number of doctors artificially low so their salari

by itg 11y ago

Part of the problem is you can thank the stranglehold the AMA has around the US healthcare system to keep the number of doctors artificially low so their salaries remain ridiculously high. Here's another example: https://www.washingtonpost.com/business/economy/new-machine-could-one-day-replace-anesthesiologists/2015/05/11/92e8a42c-f424-11e4-b2f3-af5479e6bbdd_story.html https://www.washingtonpost.com/business/economy/new-machine-... "Anesthesiologists tried to stop Sedasys. They lobbied against it for years, arguing no machine could possibly replicate their skills or handle an emergency if something went wrong. Putting someone to sleep is an art, they said. Too little sedation, and the patient feels pain. Too much, and the patient dies. Anesthesiology requires four years of training after medical school, meaning careers might not launch until the doctors are in their 30s. It’s one reason the profession’s median salary is $277,000 a year, according to research firm Payscale."

jjoonathan 11y ago
Before we start squabbling over whether the fault lies with the AMA in particular (this topic has come up before) let me propose that instead we discuss the more general and more relevant claim "the USA overtrains its doctors, creating needless scarcity."
- fluxquanta 11y ago
  >"the USA overtrains its doctors, creating needless scarcity." What about the increase in physicians assistants and nurse practitioners, who seem to be taking over in the scene of less serious, more routine healthcare?
HarryHirsch 11y ago
the stranglehold the AMA has around the US healthcare system to keep the number of doctors artificially low On the other hand, wages in IT suffer from an overabundance of indentured H1-B labourers, held on the very short leash of the US immigration system. This should demonstrate the importance of union representation, even at the high end of the qualification scale.
pkaye 11y ago
I read another article a long while back on how cardiologists used to be paid considerable amounts for their skills in open heart surgery. Then later non-evasive techniques were developed and some of them were not happy because it all became more routine that heroic skills were no longer needed. There is always some degree of thinking what is best for yourself instead of your patient.
Symmetry 11y ago
Other notable problems with our medical system would be the RBRVS[1] and Nixon's scheme to limit hospital competition[2]. [1]https://en.wikipedia.org/wiki/Resource-based_relative_value_scale https://en.wikipedia.org/wiki/Resource-based_relative_value_... [2]https://en.wikipedia.org/wiki/Certificate_of_need https://en.wikipedia.org/wiki/Certificate_of_need
- HarryHirsch 11y ago
  Other people would think that fixed reimbursement rates are a feature - it's what they do in my country to hold down costs, and it works well. You can ask to be paid beyond published rates, but you better have a good case when you present the bill to the insurance company. As far as overbuilding hospitals goes, you'd think that physicians and administrators will try to fill those beds at any cost, cost that is billed to patients and the taxpayer. Hospital overcapacity is not like airline overcapacity.
  - squozzer 11y ago
    The Roemer Effect has never been proven, as no country has ever had the luxury of too many hospital beds. It's based on a certain plausible logic - similar to saying welfare makes people lazy - but no one has ever presented evidence to support either.
    - HarryHirsch 11y ago
      Looking through Pubmed (!) you find many papers that are in favour of the Roemer Effect.
chimeracoder 11y ago
> Part of the problem is you can thank the stranglehold the AMA has around the US healthcare system to keep the number of doctors artificially low so their salaries remain ridiculously high. The AMA is a common scapegoat, except that the AMA has literally nothing to do with the number of of doctors supply-side. You're probably thinking of the AAMC, which has nothing to do with the AMA, and is responsible for the number of medical students who graduate each year from the US. Except the AAMC has very deliberately and openly increased the number of medical student slots each year for over a decade, specifically with this goal in mind. But even this is a moot point, because the number of people gradating with MDs is not the bottleneck - the problem is that doctors can't practice medicine until they complete a residency program. We graduate more medical students every year than we have residency slots available, so increasing the number of graduates even further will have no effect. Increasing the number of residency slots is up to Medicare, because Medicare funds residency programs nationwide.
- jessaustin 11y ago
  Does this mean there is an ever-growing population of "post-doc" physicians, stuck in labs or other non-patient-facing situations? What numbers are we talking about?
  - chimeracoder 11y ago
    > What numbers are we talking about? In 2015 there were 41,000+ applicants for ~30,000 residency positions[0]. I don't have the 2015 numbers for medical schools, but in 2014, there were 18,000 graduates in the US[1]. Increasing the number of medical school graduates in the US would mean that a larger percentage of residency slots are taken by people who went to school in the US but not the total number of residents. Ironically, this would actually be a bad thing cost-wise, since foreign medical schools are usually cheaper and students carry a lower debt load[2]. > Does this mean there is an ever-growing population of "post-doc" physicians, stuck in labs or other non-patient-facing situations? Yes. You are likely to see them take jobs in industry - e.g. at a pharmaceutical or insurance company, but on the business side, since they're not licensed to practice. (Nor are they even qualified - medical school teaches essential knowledge for doctors, but they receive basically no training on actual clinical practice. All of that happens during residency). It's worth noting that not all doctors want to practice medicine - for example, people in an MD/PhD program often go into research, and that's a good thing. But if we're talking about increasing the supply of practicing physicians, increasing the number of medical school applicants in the US makes literally zero difference. [0] http://www.nrmp.org/press-release-2015-residency-match-largest-on-record-with-more-than-41000-applicants-vying-for-over-30000-residency-positions-in-4756-programs/ http://www.nrmp.org/press-release-2015-residency-match-large... [1] https://www.aamc.org/download/321532/data/factstable27-2.pdf https://www.aamc.org/download/321532/data/factstable27-2.pdf [2] These aren't necessarily "foreign" students either; it's quite common for people in the US to go to medical school in the Caribbean and then come back for their residency.
knughit 11y ago
$277K/yr doesn't sound too bad, compared to lawyers and finance folks and business VPs. That's not why healthcare costs so much. Even if you booked 1 anesthesiologist for a whole day long massively intensive surgery, that's only about $2k of your cost
Omniusaspirer 11y ago
This comment is not only factually wrong (It's not the AMA) but misleading as well. The typical medical student today leaves med school $250k in debt at 8% interest then spends years in a residency where they make $50-60k working 80+ hours per week in a likely high cost of living area. If they started schooling immediately after high school they probably won't actually make that 270k (median, so many starting out are lower) until they're 30+ years old. Contrast that to a completely mediocre web dev who can pull 100k+ at 21 putting in 40-50 hours a week and do you really still think physicians are overpaid? Keep in mind the majority end up in family or internal medicine working 60+ hours a week for ~$175k/yr. Going to medical school is a massive financial risk with an incredibly uncertain future. If you want a human punching bag then turn your gaze towards hospital administrators, pharmaceutical executives, and exploitative vendors. The actual hospital employees are just as much victims of the healthcare shit show as members of the public are.

by itg 11y ago

jjoonathan 11y ago

Before we start squabbling over whether the fault lies with the AMA in particular (this topic has come up before) let me propose that instead we discuss the more general and more relevant claim "the USA overtrains its doctors, creating needless scarcity."

fluxquanta 11y ago
>"the USA overtrains its doctors, creating needless scarcity." What about the increase in physicians assistants and nurse practitioners, who seem to be taking over in the scene of less serious, more routine healthcare?

HarryHirsch 11y ago

the stranglehold the AMA has around the US healthcare system to keep the number of doctors artificially low On the other hand, wages in IT suffer from an overabundance of indentured H1-B labourers, held on the very short leash of the US immigration system. This should demonstrate the importance of union representation, even at the high end of the qualification scale.

pkaye 11y ago

I read another article a long while back on how cardiologists used to be paid considerable amounts for their skills in open heart surgery. Then later non-evasive techniques were developed and some of them were not happy because it all became more routine that heroic skills were no longer needed. There is always some degree of thinking what is best for yourself instead of your patient.

Symmetry 11y ago

Other notable problems with our medical system would be the RBRVS[1] and Nixon's scheme to limit hospital competition[2]. [1]https://en.wikipedia.org/wiki/Resource-based_relative_value_scale https://en.wikipedia.org/wiki/Resource-based_relative_value_... [2]https://en.wikipedia.org/wiki/Certificate_of_need https://en.wikipedia.org/wiki/Certificate_of_need

HarryHirsch 11y ago
Other people would think that fixed reimbursement rates are a feature - it's what they do in my country to hold down costs, and it works well. You can ask to be paid beyond published rates, but you better have a good case when you present the bill to the insurance company. As far as overbuilding hospitals goes, you'd think that physicians and administrators will try to fill those beds at any cost, cost that is billed to patients and the taxpayer. Hospital overcapacity is not like airline overcapacity.
- squozzer 11y ago
  The Roemer Effect has never been proven, as no country has ever had the luxury of too many hospital beds. It's based on a certain plausible logic - similar to saying welfare makes people lazy - but no one has ever presented evidence to support either.
  - HarryHirsch 11y ago
    Looking through Pubmed (!) you find many papers that are in favour of the Roemer Effect.

chimeracoder 11y ago

> Part of the problem is you can thank the stranglehold the AMA has around the US healthcare system to keep the number of doctors artificially low so their salaries remain ridiculously high. The AMA is a common scapegoat, except that the AMA has literally nothing to do with the number of of doctors supply-side. You're probably thinking of the AAMC, which has nothing to do with the AMA, and is responsible for the number of medical students who graduate each year from the US. Except the AAMC has very deliberately and openly increased the number of medical student slots each year for over a decade, specifically with this goal in mind. But even this is a moot point, because the number of people gradating with MDs is not the bottleneck - the problem is that doctors can't practice medicine until they complete a residency program. We graduate more medical students every year than we have residency slots available, so increasing the number of graduates even further will have no effect. Increasing the number of residency slots is up to Medicare, because Medicare funds residency programs nationwide.

jessaustin 11y ago
Does this mean there is an ever-growing population of "post-doc" physicians, stuck in labs or other non-patient-facing situations? What numbers are we talking about?
- chimeracoder 11y ago
  > What numbers are we talking about? In 2015 there were 41,000+ applicants for ~30,000 residency positions[0]. I don't have the 2015 numbers for medical schools, but in 2014, there were 18,000 graduates in the US[1]. Increasing the number of medical school graduates in the US would mean that a larger percentage of residency slots are taken by people who went to school in the US but not the total number of residents. Ironically, this would actually be a bad thing cost-wise, since foreign medical schools are usually cheaper and students carry a lower debt load[2]. > Does this mean there is an ever-growing population of "post-doc" physicians, stuck in labs or other non-patient-facing situations? Yes. You are likely to see them take jobs in industry - e.g. at a pharmaceutical or insurance company, but on the business side, since they're not licensed to practice. (Nor are they even qualified - medical school teaches essential knowledge for doctors, but they receive basically no training on actual clinical practice. All of that happens during residency). It's worth noting that not all doctors want to practice medicine - for example, people in an MD/PhD program often go into research, and that's a good thing. But if we're talking about increasing the supply of practicing physicians, increasing the number of medical school applicants in the US makes literally zero difference. [0] http://www.nrmp.org/press-release-2015-residency-match-largest-on-record-with-more-than-41000-applicants-vying-for-over-30000-residency-positions-in-4756-programs/ http://www.nrmp.org/press-release-2015-residency-match-large... [1] https://www.aamc.org/download/321532/data/factstable27-2.pdf https://www.aamc.org/download/321532/data/factstable27-2.pdf [2] These aren't necessarily "foreign" students either; it's quite common for people in the US to go to medical school in the Caribbean and then come back for their residency.

knughit 11y ago

$277K/yr doesn't sound too bad, compared to lawyers and finance folks and business VPs. That's not why healthcare costs so much. Even if you booked 1 anesthesiologist for a whole day long massively intensive surgery, that's only about $2k of your cost

Omniusaspirer 11y ago

This comment is not only factually wrong (It's not the AMA) but misleading as well. The typical medical student today leaves med school $250k in debt at 8% interest then spends years in a residency where they make $50-60k working 80+ hours per week in a likely high cost of living area. If they started schooling immediately after high school they probably won't actually make that 270k (median, so many starting out are lower) until they're 30+ years old. Contrast that to a completely mediocre web dev who can pull 100k+ at 21 putting in 40-50 hours a week and do you really still think physicians are overpaid? Keep in mind the majority end up in family or internal medicine working 60+ hours a week for ~$175k/yr. Going to medical school is a massive financial risk with an incredibly uncertain future. If you want a human punching bag then turn your gaze towards hospital administrators, pharmaceutical executives, and exploitative vendors. The actual hospital employees are just as much victims of the healthcare shit show as members of the public are.