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The doctor shortage has to do with the American Medical Associate (AMA), a cartel, that successfully lobbied to reduce the number of residencies available for d

• EGreg 7y ago
  And yet people like Ben Shapiro continue to insist that it is single payer that will lead to less doctors... If doctors collectivize, then shouldn’t patients?
  • lucifirius 7y ago
    Single payer in the UK has already led to doctor shortages, so I'm not sure what point you're trying to make. There's many ways to get to a shortage, cartels and single payer are but two.
    • seppin 7y ago
      > Single payer in the UK has already led to doctor shortages Source? The only news i've read of shortages are Brexit related.
      • goatinaboat 7y ago
        There have been “shortages” of doctors and nurses forever, the usual newspapers were panicking about it in the 80s (source: was there, read them). Probably someone will be along in a minute to say they remember it from the 60s too! Fun fact: the doctors were the biggest obstacle to the foundation of the NHS and they disappear into private practice at the first opportunity.
        • seppin 7y ago
          That's a lot of talk. How many people in the UK don't have access to medical care due to, say shortages vs how many in the US die every year b/c they cannot afford care?
    • 9HZZRfNlpR 7y ago
      It's similarly capped in the UK. Upper middle class always knows how to protect their wages, only programmers want voluntarily more people competing for their wages. It's so welcoming field. Also it costs tons, can't compare it with America but compared to other fields. Hence they import doctors when there are shortages.
  • dantheman 7y ago
    I think it'd be best if we removed the power of the AMA; allowed the ability to fast track foreign medical staff (doctors, nurses, specialists). Allowed medical schools to control their curriculum more, allow new ones, change the residency system. One simple change would be to create a 6 year BS/MD degree that students could start directly from high school -- many other countries do this.
• lettergram 7y ago
  Came here to say the same thing. They were intentionally (and arguably still are) limiting the number of doctors admitted to medical school and number of graduate/medical schools. https://skeptics.stackexchange.com/questions/4561/does-the-ama-limit-the-number-of-doctors-to-increase-current-doctors-salaries https://skeptics.stackexchange.com/questions/4561/does-the-a...
  • devoply 7y ago
    I also heard that doctor's salaries in general are significantly impacted by hospitals and insurance companies and it's hard to make the same sort of money now as you could in the past. Is there any truth to this?
    • skybrian 7y ago
      I don't know, but apparently they make a lot more in the United States than in most other countries? https://journal.practicelink.com/vital-stats/physician-compensation-worldwide/ https://journal.practicelink.com/vital-stats/physician-compe...
      • Scoundreller 7y ago
        Usually. But there can be a lot of variation amongst the specialties, to the point where practicing in the US isn’t the best option.
        • wolco 7y ago
          Curious where it isn't the best option. A lot of other countries have more restrictions which forces down wages. My guess would be somewhere without taxes?
    • user5994461 7y ago
      For reference, it's $200-400k base for anybody with a medecine degree right out of school, depending on the specialty. https://h1bdata.info/highestpaidjob.php https://h1bdata.info/highestpaidjob.php If you thought Silicon Valley engineers had it well, think again. The 500-1000k doctors are real and listed right there, unlike the mythical staff engineer who hit the jackpot at a GAFA and can only live in the valley. Keep in mind that H1B workers are always paid 10-20% less than local workers, so doctors actually make more than these numbers.
• mrep 7y ago
  I don't work in the healthcare industry so I have no skin in the game, but in what situations do you consider labor cartels ok because unions are exactly that and many people here seem to advocate them. Becoming a doctor from what I have read sounds like a horrible return on investment: You have to delay real wages for like 8 years while you get educated, those 8 years make you massively in debt, once you become a doctor, you have to pay off those 8 years of debt while also paying massive insurance rates. I'm not suprised doctors are trying to secure some wages after 8 years of investing in themselves while going massively in debt.
  • zanny 7y ago
    I doubt many on HN of all places are for legally mandated unions, which are the ones that produce true cartel like behavior. Most unions maintain authority through their collective bargaining alone - to abstain from the union would mean the loss of most of your workforce, and thus you must negotiate with the union. Except if you want to call unions cartels because they negotiate on behalf of their members with employers than anyone trying to barter in business is engaging in cartel like behavior. Its deconstructive because in practice unions only exist to counteract the power imbalance between worker and employer. A cartel in business forms not to counteract power imbalance through collective action but to monopolize existing power. You might call those origin points irrelevant but they make the world of difference to me. In the absence of unions labor is almost universally exploited. In their presence, businesses are hopefully and sometimes forced to bargain on more equal footing. Thats a net benefit. A business cartel likewise exists to imbalance what was closer to equilibrium and thus is a net negative.
  • wolco 7y ago
    The 8 years could be streamlined but it's setup to weed out many and tire out the remaining. Many of the brightest most curious people get turned off by the process the people that remain are the ones who could stand the beatdown. Then they get out start working and have to see 25,000 people a year (100/day) as a gp. There is a huge burnout process going on. I see so many doctors try to make a business on shark tank/dragons den work or they try to become media personalities. Many seem stuck because the job isn't what many would expect. They have invested heavily time/effort in study, they have high debt and they have increased expectations from family/community.
• TuringNYC 7y ago
  Plot a graph: 1970 to now: US Population (or US senior citizen population) 1970 to now: Medical schools 1970 to now: Medical school graduates 1970 to now: Medical Resident spots for "shortage" specialties I'm willing to bet the shortage is due to these plots not growing proportionally. Also, you cant increase medical school graduates w/o also increasing resident spots, otherwise, graduates go into other fields.
• cybersnowflake 7y ago
  Yep, everybody and their mother that I went to school with aspired to become a doctor. There should be absolutely no shortage. Getting to more reasonable numbers doesn't seem like it would worsen the already abysmal quality we're getting now with sleepwalking insanely overworked physicians.
  • TuringNYC 7y ago
    >> Yep, everybody and their mother that I went to school with aspired to become a doctor. There should be absolutely no shortage. There is a shortage...sort of...there is a very limited quota of Medical Resident spots opened up by various AMA medical boards (read: cartel.) There are a line of aspiring physicians, but they can only practice as board certified specialists if the boards open up seats, and there is a forced constrained supply (probably to increase wages for those inside the club.)
• HillaryBriss 7y ago
  the real genius of the AMA was finding a way to drastically slow the global MD population as it tried to correct the imbalance by entering the US and setting up practice.
• RyanAF7 7y ago
  Damn, i was all hyped up to spit the AMA shade. Nice.
• anovikov 7y ago
  Maybe they are doing it for a reason? Suppose you are 16 now and choosing a profession. Due to exceptionally long training times for doctors, you will become a doctor so will make good money, by 30, which will be in 2033. By then, most boomers will die off and the demand for doctors will collapse, so you will find yourself will a million dollar student debt and no prospects of employment good enough to repay it. It's cyclic.
  • user5994461 7y ago
    Most of the doctors are boomers themselves and getting retired, or dying as you said. The shortage is not about to get better.
    • speedplane 7y ago
      > Most of the doctors are boomers themselves and getting retired, or dying as you said. The shortage is not about to get better. The market for doctors is fairly constant, it's very difficult to mint new doctors. Even if a state or university went through the enormous undertaking to create a new med-school, they would, at best, create 200-300 new doctors a year, a drop in the bucket. The real solution is in alternative degrees like Physician Assistants or Nurse Practitioners. They can get degrees at half the cost of doctors and yet do 80% of a doctor's work. Any real cost reductions in U.S. healthcare will have to include these alternative healthcare providers.
      • HillaryBriss 7y ago
        yes. and please let it be noted that MD associations in California opposed a law that would have allowed Nurse Practitioners to operate autonomously (as they do in some states)
  • pvaldes 7y ago
    > you will find yourself will a million dollar student debt In USA. Definitely not in EU (currently, although there is a increasing pressure to dismantle and privatize university) On the other hand, robotic solutions are competing for more and more roles in Hospitals. We have robotic helpers for surgeons yet. At some point in the near future they will start replacing many people and this factor should be included in the picture. Specialists will do online surgeries in all country without spending the time traveling from one hospital to other. The future can need less doctors for treating the same people.
• runamok 7y ago
  And they actively prevent nurse practitioners and nurses from performing many functions they're perfectly capable of doing.
  • yumraj 7y ago
    Such as?
    • o09rdk 7y ago
      Most, if not all, primary care functions can be performed just as well by nurse practitioners, physician assistants, or other types of providers, especially if you allow for additional postgraduate training. There are three basic ways the AMA cartel hurts healthcare: 1. First, as others have pointed out, there is an significant artificial restriction in supply of physicians. Many more people could be admitted to medical school, successfully finish training, and practice well than there are now. 2. There's an artificial restriction in the supply of providers, and more deeply, an artificial restriction in the schema we have about who we get services from and how they're trained. The AMA uses FUD to reinforce a model where the only appropriate training model is undergraduate -> MD -> residency -> post residency, and because almost everything pertaining to well-being is health, those who have undergone that training model supercede others regardless of training history. At least in the US, we don't really question this assumption at all, even though there's no evidence it's superior to a different model that has different routes, like undergraduate -> specialty training -> broadening of training, or undergraduate -> broad non MD medical training -> additional training. Mix and match however you want. Whenever other provider types have broadened their training (dentists, psychologists, optometrists, etc.) there has always been pushback from the AMA, and the scientific evidence has never supported that pushback. So why not allow LPNs, PAs, pharmacists, optometrists, dentists, psychologists, audiologists, etc. to broaden their scope of practice, with the appropriate background and training? The insistence on the undergrad -> MD -> residency model becomes even more absurd when you consider how brief MD training programs are becoming. It's not uncommon for them to only have 2 or even 1.5 years of academic coursework, with the rest clinical training, so how is that actually different from, say, a PA with additional years of experience in practice? Especially when you consider PA programs often require more medical experience before entering than medical school entrants -- it's all 1.5-2 years of coursework plus years of hands-on supervised clinical training. 3. This cartel actually hurts physicians as well, by increasing their workloads to impossible extents, and by creating artificial restrictions in specialty certification. This gets a lot less attention and is maybe harder to explain, but the licensure and specialty certification requirements are also getting more and more absurd, to the point that in many specialties they no longer realistically reflect actual skill, and are simply ways to further increase the rent-seeking advantages within medicine, and to line the pockets of the AMA and specialty organizations. Practice and provider regulations, in my opinion, are one of the major drivers of healthcare costs in the US, and it almost never gets any discussion, because it's immediately shutdown. The argument is "if you in any way increase the supply of providers providing care, under any other model than an MD, people will get hurt." I say this as someone who has worked in healthcare and has many immediate family working in healthcare, in a variety of roles, from nurses, to physicians, to other professional roles. (See also: opioid crisis and cannabis regulation for how well our current regulatory system is working.)
• bluedino 7y ago
  What is the reason for so many doctors coming to the US from India and the Middle East?