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The problem with having non-science people run an organisation of science people is self explanatory. In the Netherlands they have outsourced the organisation

The problem with having non-science people run an organisation of science people is self explanatory. In the Netherlands they have outsourced the organisation and managment of health care to the doctors themselves (roughly speaking). It is often cited as one of the main reasons the Netherlands rank #1 in health care ratings over the years.

seibelj 8y ago
In the US, the American Medical Association is run by doctors and they artificially limit the supply new doctors by capping the number of medical schools. So sometimes having the fox guard the henhouse is not the best way to save money.
- epmaybe 8y ago
  The AMA doesn't directly govern the number of medical schools in this country. That would be the LCME (Liaison Committee on Medical Education), which is sponsored by the AMA and American Association for Medical Colleges. It's also important to note that the number of medical schools isn't really artificially limited by the LCME, as they will accredit most any medical school that meets the accreditation standards. On top of that, medical students in the US have to undergo a residency before becoming fully licensed physicians. These residencies are accredited by the Accreditation Council for Graduate Medical Education (ACGME), a separate organization. However, while the ACGME can accredit these programs, the majority of funding for training resident physicians comes from the federal government (department of health and human services, center for medicare and medicaid services), and is capped by the Balanced Budget Act of 1997 (modified in 1999 to accommodate the rural physician shortage). Today, this costs the federal government around $11 billion each year for all of the residents in the country. The real question, then, is who we can point to as the bottleneck for new doctors in this country. I found this article enlightening, but it may be behind a paywall: https://www.ncbi.nlm.nih.gov/pubmed/28919221 https://www.ncbi.nlm.nih.gov/pubmed/28919221
  - marcoperaza 8y ago
    The AMA controls enough seats on that board to prevent new schools/seats from being created. And the idea that an industry as profitable as medicine needs the taxpayer to fund its training is preposterous. This is just a deflection from the AMA's role.
    - mentalhealth 8y ago
      a profession as wealthy as medicine needs the taxpayer to fund its training is preposterous Most doctors already come from wealthy families (specifically, they have doctor parents) because in addition to the tuition of medical school, there are a variety of other expenses (board examination fees, the undergraduate requirement, interview expenses for both medical school and residency) that are difficult to fund without assistance. Also, compensation for physicians is not what you seem to think it is outside of subspecialized fields, and the expense of medical school (and the opportunity cost of residency) means that physician shortages in the general disciplines will only continue to get worse as medical students realize the only way they can pay back their loans is to subspecialize. Also, medical schools are primarily limited by number of faculty, and it's difficult to find doctors for med school faculty roles... because they're so poorly compensated in comparison to other opportunities. If you want more doctors, first provide incentives for doctors to teach, then provide funding for those who normally don't see medical school as an available opportunity, then incentivize people to go into general disciplines, then properly compensate residents so they're not throwing away ten years of potential income, then complain about how "doctors are overpaid but there's also a big shortage of them".
      - marcoperaza 8y ago
        The rest of us have to compete in a free market for our skills. Why not doctors? I agree that the undergrad requirement is absurd. But it is also just another part of the system that increases entry-barriers and leads to all of these problems, but makes the field more lucrative for a big segment of those who get through it.
        8y ago
- vkou 8y ago
  It doesn't matter how many medical schools or students exist, if there aren't enough residency positions for them. And the AMA does not control the number of residency positions.
  - FireForce 8y ago
    Podiatry in the US has this problem in a big way.
glfharris 8y ago
Something similar happened in the UK with GPs, and it's been one of the least popular health reforms ever to take place.
- DanBC 8y ago
  (England, not UK) Not sure why you got downvoted. The Lansley Reforms - where Primary Care Trusts were abolished and replaced by Clinical Commissioning Groups which are run by GPs and are responsible for commissioning most of the NHS services (about 2/3 of the budget) - are known to have caused severe disruption to English NHS services.
amatecha 8y ago
Huh, coincidentally I just heard a couple hospitals in Netherlands are closing on short notice due to bankruptcy[0]... I'm sure there's a lot more backstory there, but it doesn't sound like #1-tier healthcare when that's happening. hehe ;) [0] https://www.dutchnews.nl/news/2018/10/slotervaart-hospital-stops-new-admissions-lelystad-hospital-may-have-buyer/ https://www.dutchnews.nl/news/2018/10/slotervaart-hospital-s...
isostatic 8y ago
Netherlands, a high density country without the added costs of delivering healthcare to remote places, spends 30% more per head on healthcare than the UK. That has a far higher outcome on healthcare than taking doctors away from patients to run hospitals.

seibelj 8y ago

In the US, the American Medical Association is run by doctors and they artificially limit the supply new doctors by capping the number of medical schools. So sometimes having the fox guard the henhouse is not the best way to save money.

epmaybe 8y ago
The AMA doesn't directly govern the number of medical schools in this country. That would be the LCME (Liaison Committee on Medical Education), which is sponsored by the AMA and American Association for Medical Colleges. It's also important to note that the number of medical schools isn't really artificially limited by the LCME, as they will accredit most any medical school that meets the accreditation standards. On top of that, medical students in the US have to undergo a residency before becoming fully licensed physicians. These residencies are accredited by the Accreditation Council for Graduate Medical Education (ACGME), a separate organization. However, while the ACGME can accredit these programs, the majority of funding for training resident physicians comes from the federal government (department of health and human services, center for medicare and medicaid services), and is capped by the Balanced Budget Act of 1997 (modified in 1999 to accommodate the rural physician shortage). Today, this costs the federal government around $11 billion each year for all of the residents in the country. The real question, then, is who we can point to as the bottleneck for new doctors in this country. I found this article enlightening, but it may be behind a paywall: https://www.ncbi.nlm.nih.gov/pubmed/28919221 https://www.ncbi.nlm.nih.gov/pubmed/28919221
- marcoperaza 8y ago
  The AMA controls enough seats on that board to prevent new schools/seats from being created. And the idea that an industry as profitable as medicine needs the taxpayer to fund its training is preposterous. This is just a deflection from the AMA's role.
  - mentalhealth 8y ago
    a profession as wealthy as medicine needs the taxpayer to fund its training is preposterous Most doctors already come from wealthy families (specifically, they have doctor parents) because in addition to the tuition of medical school, there are a variety of other expenses (board examination fees, the undergraduate requirement, interview expenses for both medical school and residency) that are difficult to fund without assistance. Also, compensation for physicians is not what you seem to think it is outside of subspecialized fields, and the expense of medical school (and the opportunity cost of residency) means that physician shortages in the general disciplines will only continue to get worse as medical students realize the only way they can pay back their loans is to subspecialize. Also, medical schools are primarily limited by number of faculty, and it's difficult to find doctors for med school faculty roles... because they're so poorly compensated in comparison to other opportunities. If you want more doctors, first provide incentives for doctors to teach, then provide funding for those who normally don't see medical school as an available opportunity, then incentivize people to go into general disciplines, then properly compensate residents so they're not throwing away ten years of potential income, then complain about how "doctors are overpaid but there's also a big shortage of them".
    - marcoperaza 8y ago
      The rest of us have to compete in a free market for our skills. Why not doctors? I agree that the undergrad requirement is absurd. But it is also just another part of the system that increases entry-barriers and leads to all of these problems, but makes the field more lucrative for a big segment of those who get through it.
      - 8y ago
vkou 8y ago
It doesn't matter how many medical schools or students exist, if there aren't enough residency positions for them. And the AMA does not control the number of residency positions.
- FireForce 8y ago
  Podiatry in the US has this problem in a big way.

glfharris 8y ago

Something similar happened in the UK with GPs, and it's been one of the least popular health reforms ever to take place.

DanBC 8y ago
(England, not UK) Not sure why you got downvoted. The Lansley Reforms - where Primary Care Trusts were abolished and replaced by Clinical Commissioning Groups which are run by GPs and are responsible for commissioning most of the NHS services (about 2/3 of the budget) - are known to have caused severe disruption to English NHS services.

amatecha 8y ago

Huh, coincidentally I just heard a couple hospitals in Netherlands are closing on short notice due to bankruptcy[0]... I'm sure there's a lot more backstory there, but it doesn't sound like #1-tier healthcare when that's happening. hehe ;) [0] https://www.dutchnews.nl/news/2018/10/slotervaart-hospital-stops-new-admissions-lelystad-hospital-may-have-buyer/ https://www.dutchnews.nl/news/2018/10/slotervaart-hospital-s...

isostatic 8y ago

Netherlands, a high density country without the added costs of delivering healthcare to remote places, spends 30% more per head on healthcare than the UK. That has a far higher outcome on healthcare than taking doctors away from patients to run hospitals.