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Hi, I'm a doc. Just wanted to add a few corrections: The AMA (American Medical Association) has nothing to do with residency slots. Residency slots are funded b

Hi, I'm a doc. Just wanted to add a few corrections: The AMA (American Medical Association) has nothing to do with residency slots. Residency slots are funded by CMS. I am in a shortage speciality, and we have been pushing for more residency slots for a long time. While there are probably some physicians who are self-interested enough to oppose this, I think it's unfair to characterize them as even a significant minority. Even if you think of physicians as ruthlessly self-interested, this still wouldn't serve us as the shortage has largely led to the influx of people with a small fraction of the clinical training (such as nurse practitioners) taking roles traditionally filled by doctors. Interestingly, they are not generally held to the same standard of care, so I'd hardly call that a boon to patients, either.

hhs 7y ago
Thanks for adding your views, this is useful. On the AAMC site, there's also a piece called "GME Funding and Its Role in Addressing the Physician Shortage" that talks about the point you rightly make about pushing for more residency slots. It's here: https://news.aamc.org/for-the-media/article/gme-funding-doctor-shortage/ https://news.aamc.org/for-the-media/article/gme-funding-doct.... On the residency point, it adds: "As part of the multi-pronged approach to alleviating the doctor shortage we also need additional federal support to produce about 3,750 more doctors a year by lifting the cap on federally funded residency training positions. Teaching hospitals are operating 10,000 residency positions without Medicare support, but cuts to Medicare and other clinical reimbursements jeopardize the ability of teaching hospitals to cross-subsidize with clinical revenue these positions. The AAMC strongly supports bipartisan GME legislation introduced in both the House of Representatives and the Senate, the Resident Physician Shortage Reduction Act of 2019 (H.R. 1763, S. 348), which takes an important step towards alleviating the physician shortage by gradually providing 15,000 Medicare-supported GME residency positions over a five-year period. However, legislation alone will not relieve the doctor shortage. In addition, the AAMC supports non-GME incentives and programs, including Conrad 30, the National Health Service Corps (NHSC) and Public Service Loan Forgiveness (PSLF), and Title VII/VIII, which are used to recruit a diverse workforce and encourage physicians to practice in shortage specialties and underserved communities."
klipt 7y ago
There are tons of highly qualified doctors in other developed countries (EU, Australia, etc) who could earn more in the US, what stops them from practicing here if we have a shortage?
- sigstoat 7y ago
  they're not licensed to practice medicine in the US. and last i checked they can't transfer their licenses easily, or at all.
- planetburgess 7y ago
  They might also prefer to work in a better medical system.
jseliger 7y ago
It's not clear the extent to which CMS funding, or high levels of CMS funding, is necessary: https://www.nytimes.com/2013/12/15/business/solving-the-shortage-in-primary-care-doctors.html https://www.nytimes.com/2013/12/15/business/solving-the-shor...: Dr. Wilensky says that most likely, hospitals lose money on residents in the first year, when the doctors just out of med school waste a lot of time and money on unnecessary tests and treatments. But residents’ value goes up rapidly because the learning curve is steep, while their salary increases are not. In fact, one data point that suggests hospitals are currently making a lot of money on the more seasoned residents is the quantum leap in compensation on the day doctors convert their status from trainee to attending physician, under a new job contract. How can a doctor be worth paying only $60,000 on Friday and then at least twice that on Monday? Does the doctor’s marginal revenue product — that is, how profitable the doctor is for the employer — actually surge that much? We don’t know exactly how profitable individual residents are for hospitals because the hospitals can’t or won’t do the complicated accounting to figure it out, at least not publicly. But we can guess, at least, where hospitals believe they make the most money, based on how they’ve allocated their residency slots (both those Medicare subsidizes, and the 17,000 additional jobs that health care organizations have managed to create through other funding in the last decade). Hospitals are not eager to find out the truth—I wonder why? Certainly doubling or tripling one's salary upon graduation indicates that later-year residents are highly profitable. Most simply, the match should end and hospitals should be allowed to bid competitively on residents, just like they do for every other job. Then the market will clear and we'll see how much they're actually worth. First-year resident salaries may decline but I bet third-year resident salaries increase. It's not clear the extent to which less educated medical providers are a problem: https://www.upi.com/Study-finds-no-difference-in-care-between-physicians-clinicians/9991488221321/ https://www.upi.com/Study-finds-no-difference-in-care-betwee... or https://annals.org/aim/article-abstract/2716077/intermediate-diabetes-outcomes-patients-managed-physicians-nurse-practitioners-physician-assistants?doi=10.7326%2fM17-1987 https://annals.org/aim/article-abstract/2716077/intermediate...

hhs 7y ago

Thanks for adding your views, this is useful. On the AAMC site, there's also a piece called "GME Funding and Its Role in Addressing the Physician Shortage" that talks about the point you rightly make about pushing for more residency slots. It's here: https://news.aamc.org/for-the-media/article/gme-funding-doctor-shortage/ https://news.aamc.org/for-the-media/article/gme-funding-doct.... On the residency point, it adds: "As part of the multi-pronged approach to alleviating the doctor shortage we also need additional federal support to produce about 3,750 more doctors a year by lifting the cap on federally funded residency training positions. Teaching hospitals are operating 10,000 residency positions without Medicare support, but cuts to Medicare and other clinical reimbursements jeopardize the ability of teaching hospitals to cross-subsidize with clinical revenue these positions. The AAMC strongly supports bipartisan GME legislation introduced in both the House of Representatives and the Senate, the Resident Physician Shortage Reduction Act of 2019 (H.R. 1763, S. 348), which takes an important step towards alleviating the physician shortage by gradually providing 15,000 Medicare-supported GME residency positions over a five-year period. However, legislation alone will not relieve the doctor shortage. In addition, the AAMC supports non-GME incentives and programs, including Conrad 30, the National Health Service Corps (NHSC) and Public Service Loan Forgiveness (PSLF), and Title VII/VIII, which are used to recruit a diverse workforce and encourage physicians to practice in shortage specialties and underserved communities."

klipt 7y ago

There are tons of highly qualified doctors in other developed countries (EU, Australia, etc) who could earn more in the US, what stops them from practicing here if we have a shortage?

sigstoat 7y ago
they're not licensed to practice medicine in the US. and last i checked they can't transfer their licenses easily, or at all.
planetburgess 7y ago
They might also prefer to work in a better medical system.

jseliger 7y ago

It's not clear the extent to which CMS funding, or high levels of CMS funding, is necessary: https://www.nytimes.com/2013/12/15/business/solving-the-shortage-in-primary-care-doctors.html https://www.nytimes.com/2013/12/15/business/solving-the-shor...: Dr. Wilensky says that most likely, hospitals lose money on residents in the first year, when the doctors just out of med school waste a lot of time and money on unnecessary tests and treatments. But residents’ value goes up rapidly because the learning curve is steep, while their salary increases are not. In fact, one data point that suggests hospitals are currently making a lot of money on the more seasoned residents is the quantum leap in compensation on the day doctors convert their status from trainee to attending physician, under a new job contract. How can a doctor be worth paying only $60,000 on Friday and then at least twice that on Monday? Does the doctor’s marginal revenue product — that is, how profitable the doctor is for the employer — actually surge that much? We don’t know exactly how profitable individual residents are for hospitals because the hospitals can’t or won’t do the complicated accounting to figure it out, at least not publicly. But we can guess, at least, where hospitals believe they make the most money, based on how they’ve allocated their residency slots (both those Medicare subsidizes, and the 17,000 additional jobs that health care organizations have managed to create through other funding in the last decade). Hospitals are not eager to find out the truth—I wonder why? Certainly doubling or tripling one's salary upon graduation indicates that later-year residents are highly profitable. Most simply, the match should end and hospitals should be allowed to bid competitively on residents, just like they do for every other job. Then the market will clear and we'll see how much they're actually worth. First-year resident salaries may decline but I bet third-year resident salaries increase. It's not clear the extent to which less educated medical providers are a problem: https://www.upi.com/Study-finds-no-difference-in-care-between-physicians-clinicians/9991488221321/ https://www.upi.com/Study-finds-no-difference-in-care-betwee... or https://annals.org/aim/article-abstract/2716077/intermediate-diabetes-outcomes-patients-managed-physicians-nurse-practitioners-physician-assistants?doi=10.7326%2fM17-1987 https://annals.org/aim/article-abstract/2716077/intermediate...