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Doctors are part of a guild. They artificially limit the number of doctors available by capping the number of medical schools, which also allows the existing sc

• briholt 9y ago
  Let psychologists prescribe common, low-risk psych drugs (instead of scarcer psychiatrists), let optometrist prescribe glasses, etc.
  • electriclove 9y ago
    Please let me buy contact lenses or a CPAP without a prescription
    • skizm 9y ago
      You can get the same brands of contacts from UK websites shipped to the US very easily (and cheaply). I know a few people who do this and they haven't had any problems yet.
    • gruturo 9y ago
      You need a prescription to buy contacts? Weird. In 3 European countries I’m familiar with they are a supermarket item (literally) or anyway simply an over the counter item from pharmacies and opticians’ shops
  • greedo 9y ago
    Optometrists can prescribe glasses...
  • chimeracoder 9y ago
    > Let psychologists prescribe common, low-risk psych drugs (instead of scarcer psychiatrists), What the hell? No, there's no way you want a psychologist to be prescribing medication. They receive absolutely no medical training whatsoever. If you want psychiatric drugs without going to a psychiatrist, find a GP or NP. They're at least trained to practice medicine, even if they're not specifically trained in psychiatry.
    • didgeoridoo 9y ago
      You probably should not get psychiatric drugs from a GP or NP without first being assessed by a psychologist. While GPs have meds training, they aren’t trained in how medication fits into a larger psychological treatment plan to actually address the underlying issue. This is equivalent to demanding OxyContin from your GP for a recurring knee problem, rather than seeing an orthopedist to find out what’s actually wrong.
      • chimeracoder 9y ago
        > You probably should not get psychiatric drugs from a GP or NP without first being assessed by a psychologist. While GPs have meds training, they aren’t trained in how medication fits into a larger psychological treatment plan to actually address the underlying issue. I'm not telling anyone to do anything, but the idea of going to a psychologist for prescription drugs is beyond ridiculous. > This is equivalent to demanding OxyContin from your GP for a recurring knee problem It's worse - it's like demanding Oxycontin from your personal trainer at the gym. At least your GP went to medical school and did residency training.
        • didgeoridoo 9y ago
          I think you missed my point. I’m not saying psychologists should prescribe meds. I’m saying that medicating psychological problems should not be done in the absence of an appropriate diagnosis of those problems. This can be done only by a psychiatrist or psychologist (edit: and most psychiatrists aren’t trained in testing either, and will generally refer you to a testing psychologist if they think your problems are complex in nature). GPs and NPs do not have appropriate training in diagnosis.
  • beep_boop_beep 9y ago
    This exactly highlights my point from above. People who have no idea about an industry saying how that industry should be regulated. The reason we have different professions withing the medical industry is because of the years of training it takes to specialise in that area and get to a level of competency in that field. Optometrists in the UK already prescribe glasses and contact lenses, I'm not familiar with the US system for glasses prescriptions but having to see more than one person seems... Illogical and expensive. Nurses already push meds. After a suitably qualified and experienced doctor has assessed the patients records, seen or read a history and decided on a course of treatment. A nurse is not capable and should not be expected to know that level of detail about drug interactions and treatment pathways, that is literally what the doctor is for. Not everyone has the capacity / interest to know all this stuff, but we still need staff to tend to and care for our patients. Hence we have nurses. Not to be disrespectful to nurses because they do incredible work and are essential to the medical industry and patient care but I happen to know quite a few nurses and doctors through friends and what I've come to realise is that anyone who can follow an instruction can become a nurse. And there are a lot of bad nurses. Thankfully not just anyone can become a doctor in the western world, because we have stringent regulations and laws. The major contributing factor that adds cost to medicine are patents. Companies artificially inflating the prices of drugs and medical devices, not wages on the front line.
• ryanSrich 9y ago
  As it stands right now, I have to disagree with letting nurses or PAs do more "doctor things". Their training isn't anywhere close to what it needs to be. Also, the term nurse is very loaded to your average patient. You could be talking about a CNA with 16 weeks of training, or a DNP with 8 years of schooling.
  • certifiedloud 9y ago
    I've never heard anyone equate a CNA with a nurse.
    • JshWright 9y ago
      Hell, I've heard CNA's do that...
      • FireBeyond 9y ago
        "I'm a nurse!" "Okay... I guess Bob the EMT over here, he's a physician!"
  • toomuchtodo 9y ago
    > As it stands right now, I have to disagree with letting nurses or PAs do more "doctor things". Their training isn't anywhere close to what it needs to be. Sort of. What people in this thread refer to when they say nurses should do more "doctor things" is a nurse practitioner: https://en.wikipedia.org/wiki/Nurse_practitioner https://en.wikipedia.org/wiki/Nurse_practitioner If you needed an experience ranking, it would look like this: CNA -> Registered Nurse -> Nurse Practitioner -> MD (think of an MD as a commissioned officer in the military, whereas a nurse practitioner is a non-commissioned office who rose through the ranks but is still slightly below a commissioned office in ranking) Source: Mother was a registered nurse TL;DR Leveling up nurses around the country to "nurse practitioner" and having them take on more traditional doctor responsibilities is a solid path to success versus churning out more doctors overloaded with debt
    • AlgorithmicTime 9y ago
• chimeracoder 9y ago
  > Doctors are part of a guild. They artificially limit the number of doctors available by capping the number of medical schools They do not. You may be confusing the AMA (which less than 25% of doctors even belong to) with the AAMC. The latter does cap the number of medical school positions nationwide, but they've also made a concerted effort over the last ten years to increase that number steadily. But even if they eliminated that cap entirely, it wouldn't matter, because the number of medical school slots isn't a bottleneck for the number of practicing physicians. The number of residency slots is, and the funding gap for that comes from Medicare, which is responsible for funding them. Unless more residency programs are funded, increasing the number of medical school positions would simply increase the number of people who have medical school debt and aren't licensed or trained to practice medicine, which would be even worse, > which also allows the existing schools to crank costs to astronomical levels (“don’t worry, you’ll make enough to pay it back”). Hardly - in fact, there's already been significant downward pressure on these, because the debt level is already at the tipping point. Today, the typical person who enters medical school can expect to pay off their medical school debt in their 40s. That level of debt load is already having a negative impact on qualifications for medical school applicants (who wants to be past child-bearing age by the time they've paid off their debt, when they can just go into another better-paying field without any of that)?
  • zellyn 9y ago
    Is this part of the article incorrect? > In recent years, the number of medical residents has become so restricted that even the American Medical Association is pushing to have the number of slots increased. The major obstacle at this point is funding. It costs a teaching hospital roughly $150,000 a year for a residency slot. Most of the money comes from Medicare, with a lesser amount from Medicaid and other government sources. The number of slots supported by Medicare has been frozen for two decades after Congress lowered it in 1997 at the request of the American Medical Association and other doctors’ organizations.
    • jjoonathan 9y ago
      Does it cost $150k/yr of actual concrete costs or does it cost $150k/yr because that's what they're used to receiving and they want the gravy train to continue?
• cloverich 9y ago
  > One thing that would help is letting non-MD’s, such as nurses or physicians assistants, do more “doctor” things. An alternative scenario is to train doctors more quickly and effectively for primary care positions. Currently, to become a family practice doctor, you need 4 years of undergrad, 4 years of medical school (much of it not geared towards primary care), and then 3 years of residency. Instead, students could be started earlier, with immediate exposure to primary care (working internships) and education focused towards practical medical aspects of primary care. It would take far less than 11 years and arguably give them much more exposure and training that's directly applicable. I'd wager you'd get both higher quality care and lower costs.
  • sliverstorm 9y ago
    It still makes sense to have a hierarchy of capabilities. You see this in many places in medicine, e.g. EMT, EMT-I, paramedic, with the RN-MD divide being one of the more notable gaps. IMO the fact that RN's wind up with tacit approval to perform certain proceedures and make certain decisions that the MD is nominally supposed to, is a clue it would indeed be suitable.
  • seem_2211 9y ago
    I don't understand the requirement for the initial 4 years of undergrad before you enter medical school here. All it seems to do is increase the debt burden for doctors & their time it takes to get into actually practicing medicine.
  • dguest 9y ago
    I can't agree more with this, especially with respect to undergrad. I've taught hundreds of undergrads about ohm's law so that they could go on to become doctors. And that was one of the more useful skills they learned. They also took classes on western legal theory and renaissance art and modern Russian literature. Don't get me wrong: some doctors need hard science skills, but while I want my neurologist to understand ion channels I don't need that from my orthopedic surgeon. As for the liberal arts base, personally I'd rather have a doctor who entered medical school 4 years earlier, and had a chance realize that med school wasn't for them 4 years earlier. With our current system, acing the MCAT means that you will be a doctor if you want to be one. And once you're in medical school you've sunk too much into education to back out and try something else.
• alkonaut 9y ago
  Doctors are a guild everywhere so this isn’t the big difference. They always want to limit the number of new doctors. Perhaps in the US they wield more power? Public medical schools should just educate more doctors and make it cheaper and lower risk to become one. Add a few thousand more spots in state universities and fill them via full scholarships. A simple solution to the management of doctors’ time is to hire secretaries to do administrative tasks that otherwise take a lot of time. We have that here now (a recent invention) with a 2 year education.
• yosyp 9y ago
  My pet theory is that the long-term reasoning for artificially limiting the number of residencies/medical school spots is to avoid an oversupply of healthcare professionals after the baby-boomers die off in 15-20 years. Sure, there is tremendous strain (and consequently profit to be made) in the system now, at the expense of overworked doctors with limited interaction with their patients. But if the supply of doctors met market demand _right now_, in 20 years there would be an over supply. An over supply of doctors would introduce a new set of problems associated with lower salaries and eventually lower quality of care (see Soviet Union). So in a way, this artificial market manipulation of the supply of doctors is forcing innovation and timing the population market, and betting on medical advances that will eliminate many doctor visits through preventative medicine or computer asssisted diagnostics. Essentially the AMA is lobbying to prevent a scenario that created the artificial STEM shortage myth in the 1990's that new career scientists have still not recovered from.
  • JamesBarney 9y ago
    How did having too many doctors cause an decrease in quality of care in the Soviet Union? And the AMA is lobbying for decreased slots because it increases their salary. American doctor's pay is way out of line with the rest of the developed world.
• jostmey 9y ago
  Agreed! The whole system is in need of an overhaul. Why don't students start off medical school right away in undergrad? Who the F* wants to wait until they are 30 years old before they finish school?
  • lloyd-christmas 9y ago
    Humanities majors score the highest on the MCATs out of med school applicants and matriculants, followed by Math/Stats. In last place? Pre-Med. https://www.aamc.org/download/321496/data/factstablea17.pdf https://www.aamc.org/download/321496/data/factstablea17.pdf
    • gergles 9y ago
      Selection bias.
      • lloyd-christmas 9y ago
        That's kind of my point. How would an 18 year old know what they actually want to do without having spent some time studying it and other things? I went into school with intention of becoming a doctor and had changed my mind 2 years in. That's an expensive mistake if I hadn't been at a liberal arts school.
    • barry-cotter 9y ago
      So? Those extra four years of education for people who want to be doctors are mostly waste, an elaborate hazing ritual. Make undergraduate entry to medical school a five or six year programme, like in Europe. The increase in physician career years will swamp any plausible decline in incoming student quality, even if they just admit students straight from high school to the current US med school system.
• deleted 9y ago
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• uttles 9y ago
  Amen to this. Like every other government regulation, government interference in the medical field simply limits competition and protects entrenched interests, it does not keep people safe (and that is not the real intention.)
• mljoe 9y ago
  Importantly, the costs of our medical system relative to other systems will never be fixed until we fix this problem. But this is the hardest problem to fix, because nobody wants to talk about it. It's political suicide.
  • sjg007 9y ago
    It probably self perpetuates b/c the AMA and doctor lobby have enough excess money to buy out members of Congress.
• yequalsx 9y ago
  My wife is a doctor. She is just over a year out of residency. She makes around $300,000 per year. It's a lot of money. She has to make that much money because the U.S. has stupidly decided to burden doctors with massive med school debt. Her debt is $400,000. When she pays off her debt her salary won't go down. People expect to make more in successive years. Hence large salaries are going to be normative unless there is drastic change in the system. It would be much better for the country, and for my wife, if her debt were wiped out and she made a lot less money. We'd be happy for that. Whatever system is going to be in place will require some form of rationing. Prior to Obamacare that rationing was done on the basis of money, and whether or not a person was lucky enough to have a job that had health benefits. Obamacare is an attempt at free market forces whilst providing care for most people. It's somewhat better now than in the past but not ideal. I think universal, government funded healthcare is the most moral and economical option.
  • vasilipupkin 9y ago
    If you make 300k and live frugally so that you can save 50% of your salary, can't you pay it off in 4-5 years ? By 35-40 you can be debt free, no?
    • yequalsx 9y ago
      Taxes and whatnot account for 50% of her salary. She does need to save for retirement and one must include more than just the federal income tax rate to calculate how much is taken out in taxes. There's FICA, state taxes, and state sales taxes and property taxes. There is also rent, food. She can not save put 50% of her salary toward her student loans. That said, she can pay it off relatively quickly. However, after 4 years undergrad, 4 years med school, and 4 years of residency it's time to live, no? What's the point of it all if you don't actually make enough to live a little until you are 40? A way better system would be to just provide for higher education and not burden people with debt. Instead a large salary is needed to pay the large debt but the large salary is permanent and the debt is not. Save a lot more money buy just properly funding higher education.
      • 9y ago
• dominotw 9y ago
  > They artificially limit the number of doctors available by capping the number of medical schools, Also not accepting qualifications from other countries. UK has tons of Indian doctors. Lets get them here too, I don't get why we dont already do this.
  • unionjack22 9y ago
    We do. In fact we make them redo their 3-4 residencies and following that, dangle the promise of a Green Card after seven years and send them to the god forsaken underpaid rural shitholes American trained doctors have fled because of the inadequacy of the cash salaries(taxed at reg brackets unlike our execs and bankers) relative to student debt and medical practice overhead. How do I know this? Because this is how I came to America.
• TimPC 9y ago
  I used to be a big believer in freer markets in these areas, but all the places that are cheaper appear to use monopsomy power to drive down costs which is kind of the opposite. Even if there is a widely competitive market you don't get to make informed choices, negotiate and leave for elsewhere when you have a bad hospital or surgeon in a priority case. It's also far easier for people to make irrational choices when dealing with their health. As far as filling cavities, many fillings literally amount to cutting a tooth open inserting a material and reattaching the piece that was cut. Common complications include hitting nerves. Allowing assistants to do this on fairly limited training seems to be a very poor idea -- I've changed dentists because of complications from a filing and the inability to fix it, and I wouldn't wish the complications on someone.
• beep_boop_beep 9y ago
  The thing that goes through my mind when I hear people talk about delegating more procedures to less qualified staff is... What happens when the dental nurse slips up and causes bleeding or hits a nerve and causes loss of feeling / facial paralysis. Does she run and grab a suitably qualified dentist and pull him away from the procedure they are currently performing? People don't seem to realise that the reason we entrust certain people with certain jobs is not because that highly qualified person has done x procedure x numbers of times, it's because they have a very deep and thorough understanding of any complications and what to do when things go wrong. Not just in medicine but in engineering and many other critical professions where decisions cost lives. What you're talking about when you say deregulating is vastly increasing risk. There's a reason why current regulations exist and were created in the first place, because at one time they didn't exist and people died or became seriously ill. I'd be genuinely interested to know what medical procedures people here would be happy to have a nurse perform rather than a doctor.
• SkyPuncher 9y ago
  > They artificially limit the number of doctors available by capping the number of medical schools, which also allows the existing schools to crank costs to astronomical levels This is such bullshit. Nobody is artificially limiting the numbers. Schools are accepting and graduating more doctors than available residency programs. Right now the biggest bottleneck in the process is the number of residency spots. There simply isn't enough bandwidth for hospitals to teach graduating medical students to become independently licensed doctors. Medical schools will happily push as many students as possible through (and they are with new schools opening). The problem is training a resident is extremely expensive and comes with a lot of overhead. The government pays hospitals about $110k to per residency position. While this incentivizes some hospitals, many are facing issues with finding willing and qualified staff to come teach at their hospitals. It's hard to convince an established doctor to take a pay cut and take on more work to train students.
  • bob_theslob646 9y ago
    >Medical schools will happily push as many students as possible through (and they are with new schools opening). How is this even allowed?
    • SkyPuncher 9y ago
      I meant it as a hyperbole to demonstrate schools aren't the issue. They won't just happily push students through as they have high standards to meet. Schools do have a bit more flexibility in scheduling and resource management that can allow them increases in capacity if so demanded.
• johnohara 9y ago
  It's always good to remember that D.D.S. stands for Doctor of Dental Surgery. Filling cavities is a lot more advanced than taking x-rays, scraping plaque and polishing enamel.
• mschuster91 9y ago
  > The entire health system from top to bottom would benefit immensely from free market forces. lolnope. Free market sooner or later ends up screwed because humans are inherently greedy and will cut corners to make more profit. The corner cutting is bad enough in IT security, I do not want to see this in any health related stuff. The free market may be fine for most stuff in a society - but the corner stones of society must be regulated as hell: transportation infrastructure, water, electricity, telecommunication, medicine and education.
• inopinatus 9y ago
  Absolutely not. Non-MDs don't have slightly less medical knowledge, they have orders of magnitude less. This proposal will cost lives, and since you've just promoted it, it's now blood on your hands.
• DoodleBuggy 9y ago
  This is such a strange comment. > Doctors are part of a guild. They artificially limit the number of doctors available by capping the number of medical schools, which also allows the existing schools to crank costs to astronomical levels Your thesis is that a cabal operated by doctors is limiting more doctors from getting acceptance into med school as well as intentionally preventing more medical schools from opening, with the goal of inflating their student loans to such astronomical levels so they can have the privilege of graduating with ridiculous debt loads they'll be lucky to pay off by the time they're 50 years old? That's.... fascinating. > One thing that would help is letting non-MD’s, such as nurses or physicians assistants, do more “doctor” things. They do, are you in the USA? It's actually quite challenging to see an MD without direct pay or concierge, or without seeing a specialist (in which case be prepared to wait 2-5 months, depending on their specialty). When was the last time you went to a primary care office, urgent care, or similar clinic in the USA, and had a visit with an actual doctor (MD) and not a PA, NP, RN, or similar non-MD? Doctors are so rationed in much of the USA that many obstetric or surgical followups are handled entirely by a completely unrelated RN or PA instead of the very doctor who performed the actual procedure on that patient. And the boomers haven't even retired and reached medicare age yet, imagine what the doctor shortage will look like in another 5, 10, 15 years.
• sgt101 9y ago
  Also a lot of people would be killed, some promptly by charlatan idiots, others more slowly by charlatans with half a brain.
• evoloution 9y ago
  "Doctors are part of a guild. They artificially limit the number of doctors available by capping the number of medical schools, which also allows the existing schools to crank costs to astronomical levels (“don’t worry, you’ll make enough to pay it back”)." - True (in principle). But even with so much filtering, I have encountered not so bright doctors practicing and it is not a pretty sight... Plus you have to consider the time investment, apart from money, there is lost time and opportunities. Take a typical cardiologist for example: 4 years undergrad + 1 year research or something else to beef up CV + 4 years medical school + 3 years of internal medicine + consider 1 year chief residency to beef up CV + 3 years cardiology fellowship. That's 14-16 years either getting in debt or being underpaid. "One thing that would help is letting non-MD’s, such as nurses or physicians assistants, do more “doctor” things. Dentists, a similar profession, is going apeshit that states are trying to let specially licensed assistants (but non-DMDs) do slightly more advanced work like fill cavities.[0]" - That's were market forces are driving us anyway, it is happening. As long as you are OK with everyone being seen by a PA or NP... Most people though that support what you said kind of feel like this is "for the other people" but for themselves they "demand" to be seen by a doctor when they are seen by a PA or an NP. Don't get me wrong PAs and NPs are fine for 95% of everything that needs to be done but they simply lack the knowledge and the training to troubleshoot complicated problems and what makes it worse is that many times they cannot even detect that it is beyond them. "The entire health system from top to bottom would benefit immensely from free market forces." - There is a free market for medical services in the upper bracket and doctors are making even more there. In the end, perfect is the enemy of good...
• partycoder 9y ago
  Think about this: - A CS student graduates around age 24. - A physician finishes their formation around age 30 or more. How is this important? - 6+ more years of substantial pay / debt - No real salaries for 6+ years - Around 6+ years of fewer professional experience as your target occupation. By the time the physician is done with all the preparation, the CS student may be already a senior engineer and may have vested stock options. If we add up those things, we could say that's equivalent to not having a salary for like 10 years, relative to the CS guy. What is the incentive for going through all that? higher pay.
  • 1stranger 9y ago
    People do not do a strict cost benefit analysis when deciding their line of work. See: English majors. The market is being distorted by lack of residencies. This could possibly also distort the cost of medical school. It is not an undersupply problem of people wanting to be a doctor.