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Residency slots are the limiting factor, not medical school slots. There's no point increasing medical school slots if you're going to create a bunch of people

Residency slots are the limiting factor, not medical school slots. There's no point increasing medical school slots if you're going to create a bunch of people shut out on Match Day with $200K+ in debt. It should be noted that licensing requirements of doctors mean that medical school graduates are also competing against foreign Blaming the AMA is a dated view. I believe that used to be the case, but certainly isn't any longer. They are in favor of legislation that would increase the number of residency slots.[1] edit: Forgot to add that US medical school grads aren't only competing against each other for residency slots. Foreign doctors that want to practice in the US also have to do a residency here due to licensing requirements. [1]: https://www.ama-assn.org/content/ama-applauds-members-congress-efforts-modernize-graduate-medical-education https://www.ama-assn.org/content/ama-applauds-members-congre...

chimeracoder 10y ago
> Blaming the AMA is a dated view. I believe that used to be the case, but certainly isn't any longer It's both dated and wrong. The AAMC, not the AMA, formerly capped the number of medical students in the country. But over ten years ago, they decided to lift the cap. As you said, though, the residency slots are the bottleneck, so exactly what has happened is that we now have even more people graduating with debt from medical school who are unable to train in residency and eventually practice medicine. Residency funding is subsidized by Medicare, so they're the ones who have the power to expand GME, if they want to.
SilasX 10y ago
If there really is excess demand for a kind of labor, then the labor can borrow enough to pay for it; it wouldn't make sense to blame an insufficient subsidy as a bottleneck.
- chimeracoder 10y ago
  > If there really is excess demand for a kind of labor, then the labor can borrow enough to pay for it; You're right, but the reason that doesn't happen is that the price (ie, expected future earnings) is effectively fixed[0], and the current trajectory of that is already on the threshold of discouraging people from entering the field. As it is, a person who enters medical school at the age of 22 can reasonably expect to pay off their final student loan payment in their 40s[1]. That's a pretty hefty gamble to take at that age - you're assuming (against all evidence![2]) that medicine will continue to pay roughly the same in the future as it does today, and based on that assumption, you have to be willing to take a gamble that won't even break even until you're past normal childbearing age. That's a really tough sell, and I say this not hypothetically, but from experience. It's similar to the "engineering shortage" in Silicon Valley - we know for a literal fact that the largest companies colluded to suppress wages, but simultaneously complain that they can't find enough workers that price. Except, we don't have to take out large amounts of debt before we can start working, whereas would-be doctors do. [0] Not exactly fixed, but far from an actually competitive market that would allow proper consumption smoothing like you describe [1] There are a lot of factors that determine this, like which specialty you choose, and where you practice, but that's a pretty reasonable rule-of-thumb estimate for someone who's still only thinking of applying to medical school in the first place. [2] Physician earnings have been dropping steadily over the last few decades
  - SilasX 10y ago
    Thank you, that's the first responsive answer I've gotten when I've asked the question of how a subsidy can be relevant to a well paying field; usually, I get a bunch of further confusions in the response and an insistence that I must lack critical domain knowledge (that they can't can't explain either). With that said, why do you say doctor wages are fixed (and forseeably so)? Is there a variance in pay and legit competition for doctors and so on? Also, I don't see why the long loan repayment period or anything else suggests doctor wages are hitting the "too low to get people into the field" level. Remember, there are still far more qualified people than med schools are willing to accept, which means there's still excess supply (in the sense that there isn't in SV tech labor). Plus, being an MD has a level of prestige that doesn't show up in the wage, and which has numerous fringe benefits (like easier loan terms, since they know you'll probably always find employment).
    - chriskanan 10y ago
      I wonder if hospitals are not pushing for more residency slots due to sufficient labor. Residents generally make barely minimum wage for the number of hours they work (often 60-80 hours per week). They aren't allowed to work more than 80 per week, but apparently for many positions that's done anyway because they don't have time to do all their patient notes at work.

chimeracoder 10y ago

> Blaming the AMA is a dated view. I believe that used to be the case, but certainly isn't any longer It's both dated and wrong. The AAMC, not the AMA, formerly capped the number of medical students in the country. But over ten years ago, they decided to lift the cap. As you said, though, the residency slots are the bottleneck, so exactly what has happened is that we now have even more people graduating with debt from medical school who are unable to train in residency and eventually practice medicine. Residency funding is subsidized by Medicare, so they're the ones who have the power to expand GME, if they want to.

SilasX 10y ago

If there really is excess demand for a kind of labor, then the labor can borrow enough to pay for it; it wouldn't make sense to blame an insufficient subsidy as a bottleneck.

chimeracoder 10y ago
> If there really is excess demand for a kind of labor, then the labor can borrow enough to pay for it; You're right, but the reason that doesn't happen is that the price (ie, expected future earnings) is effectively fixed[0], and the current trajectory of that is already on the threshold of discouraging people from entering the field. As it is, a person who enters medical school at the age of 22 can reasonably expect to pay off their final student loan payment in their 40s[1]. That's a pretty hefty gamble to take at that age - you're assuming (against all evidence![2]) that medicine will continue to pay roughly the same in the future as it does today, and based on that assumption, you have to be willing to take a gamble that won't even break even until you're past normal childbearing age. That's a really tough sell, and I say this not hypothetically, but from experience. It's similar to the "engineering shortage" in Silicon Valley - we know for a literal fact that the largest companies colluded to suppress wages, but simultaneously complain that they can't find enough workers that price. Except, we don't have to take out large amounts of debt before we can start working, whereas would-be doctors do. [0] Not exactly fixed, but far from an actually competitive market that would allow proper consumption smoothing like you describe [1] There are a lot of factors that determine this, like which specialty you choose, and where you practice, but that's a pretty reasonable rule-of-thumb estimate for someone who's still only thinking of applying to medical school in the first place. [2] Physician earnings have been dropping steadily over the last few decades
- SilasX 10y ago
  Thank you, that's the first responsive answer I've gotten when I've asked the question of how a subsidy can be relevant to a well paying field; usually, I get a bunch of further confusions in the response and an insistence that I must lack critical domain knowledge (that they can't can't explain either). With that said, why do you say doctor wages are fixed (and forseeably so)? Is there a variance in pay and legit competition for doctors and so on? Also, I don't see why the long loan repayment period or anything else suggests doctor wages are hitting the "too low to get people into the field" level. Remember, there are still far more qualified people than med schools are willing to accept, which means there's still excess supply (in the sense that there isn't in SV tech labor). Plus, being an MD has a level of prestige that doesn't show up in the wage, and which has numerous fringe benefits (like easier loan terms, since they know you'll probably always find employment).
  - chriskanan 10y ago
    I wonder if hospitals are not pushing for more residency slots due to sufficient labor. Residents generally make barely minimum wage for the number of hours they work (often 60-80 hours per week). They aren't allowed to work more than 80 per week, but apparently for many positions that's done anyway because they don't have time to do all their patient notes at work.