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Please lobby the AMA to not artificially limit the supply of doctors by creating regulations around residency. I personally know of many people with MDs from In

Please lobby the AMA to not artificially limit the supply of doctors by creating regulations around residency. I personally know of many people with MDs from India who don't work here as physicians because they could not get a residency 'slot' in the Bay Area where their family lives. Relevant thread with links on StackExchange: 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...

tmh79 7y ago
to be fair, there are very few residency spots in the bay area in any specialty anyway. My wife went through the residency match program last year and the bay area programs are ultra competitive because it is a desireable place to live. Adding more residency slots is a good idea, but they're going to be spread across the US.
neonate 7y ago
Dean Baker has been arguing against this medical protectionism for years. Also as a factor why costs are so high.
nradov 7y ago
The AMA isn't limiting the supply of doctors. The actual limit is in the number of residency program slots funded by the US Federal government. If you actually want to increase the supply of doctors then lobby Congress for higher residency funding. https://www.ama-assn.org/press-center/press-releases/ama-fund-graduate-medical-education-address-physician-shortages https://www.ama-assn.org/press-center/press-releases/ama-fun...
- benjohnson 7y ago
  The AMA backs the residency requirement. In my opinion it potentially gives doctors bad habits: Tolerating a miserable sleep schedule, placing too much value on quick diagnosis, equating long hours with effectiveness, and perhaps not placing enough value on teamwork with nurses.
  - jac241 7y ago
    So once you graduate medical school, physicians should be able to practice without further specialty training? A first day MD should be able to manage patients on vents in the ICU, do crainotomies, and interventional or surgical heart valve replacements? Do you think 6+ years to train internal medicine specialists, surgeons, and radiologists is unnecessary?
    - toasterlovin 7y ago
      You're arguing against something the parent didn't say. They argued for removing the residency requirement. They didn't say there should be zero post-school training.
      - gamblor956 7y ago
        That is exactly what a residency is...
      - bigwavedave 7y ago
        Considering residency is the post-educational training you're referring to, I think the argument is relevant and valid.
        jdminhbg 7y ago
        It's not that hard to imagine a postgraduate training system for doctors that isn't the US residency program. The original poster did, in fact, present a false dilemma: that if you think the current system is bad, then you must oppose all postgraduate training.
        jac241 7y ago
        Fair assessment. Any thoughts to what could work as an alternative? For it flaws, overwork being the main one, I think other parts of residency make sense. Every year you advance further in a system of graduated responsibility until you become an attending. It would be nice if it were easier to switch fields or programs, but the different specialties do take care of different organ systems with their own unique pathology and skills needed for each.
- beambot 7y ago
  Apprenticeships in many (most?) fields are sponsored by the professional organization (akin to a guild) and paid for by laborers at lower-than-master wages. And yet, here is the AMA itself saying the problem lies with federal government funding. Curious. Seems like a convenient scapegoat.
  - Ensorceled 7y ago
    I think you are significantly underestimating how much a medical residency costs. Also, most apprentices end up working for/with the company/professional that trained them. I'm not sure there are many doctors who employ "apprentice/junior" doctors to work along side them the way a plumber/bricklayer/blacksmith/electrician would.
  - deleted 7y ago
    [deleted]
- merpnderp 7y ago
  This is propaganda by the AMA. They are the primary lobbying force on this issue to Congress and they help write most of the legislation. The AMA is the negotiating partner you'd deal with to get this issue corrected.
  - huherto 7y ago
    It sounds like AMA is working against the interest of Doctors. Sure they make more money, but they have a shitty quality of life.
    - abecedarius 7y ago
      The doctors they're probably working in the interests of are no longer residents. It'd be altruism to make prospective life better for prospective doctors.
- callmeal 7y ago
  Nice of them to change their minds after lobbying for that rule in the first place. https://www.washingtonexaminer.com/thanks-to-doctors-there-arent-enough-doctors https://www.washingtonexaminer.com/thanks-to-doctors-there-a...
- avocado4 7y ago
  That's a common misconception quoted by the medical cartel (i.e. MDs), among other ones such as "we should pay doctors 3x the amount Europeans get[1] because they study and burn out so much", which is a self-imposed problem. Congress funding for residency slots is a small part of the puzzle. The larger issues is the medical cartel making it so expensive to go through residency in the first place through excessive requirements. Here's an incomplete list of anti-competitive behaviors of medical cartel that push healthcare prices up in the US: 1. Restricting scope of practice for NPs and other midlevels 2. Restricting new facilities through Certificates of Need 3. Restricting immigration of foreign medical professionals from OECD countries through NCFMEA 4. Increasing costs & duration of medical education 5. Restricting patient's ability to obtain their open record digitally with the purpose of switching providers, or taking control of their health (good luck getting your imaging data from Kaiser if you ever want to leave them and seek better alternatives) 6. Restricting OTC availability of simple drugs available without doctor middlemen in other OECD countries 7. Restricting development of AI systems through data BAAs 8. Restricting scope and speed of processing for de novo and breakthru devices that automate work performed by physicians None of these have a valid patient safety counter-argument because essentially in every case there is a precedent of safe operation in other OECD countries. Other honorable mentions include: 1. Fighting against surprise billing legislation 2. Fighting against government's ability to negotiate rates 3. Fighting against public option 4. Fighting against any mention of moving away from fee-for-service [1] https://www.medscape.com/slideshow/2019-international-compensation-report-6011814 https://www.medscape.com/slideshow/2019-international-compen...
codekansas 7y ago
People underestimate how much of a problem is... There are so many qualified MDs who are underutilized or unable to go into the residency that they'd be most productive in simply because the supply of programs is kept artificially low

tmh79 7y ago

to be fair, there are very few residency spots in the bay area in any specialty anyway. My wife went through the residency match program last year and the bay area programs are ultra competitive because it is a desireable place to live. Adding more residency slots is a good idea, but they're going to be spread across the US.

neonate 7y ago

Dean Baker has been arguing against this medical protectionism for years. Also as a factor why costs are so high.

nradov 7y ago

The AMA isn't limiting the supply of doctors. The actual limit is in the number of residency program slots funded by the US Federal government. If you actually want to increase the supply of doctors then lobby Congress for higher residency funding. https://www.ama-assn.org/press-center/press-releases/ama-fund-graduate-medical-education-address-physician-shortages https://www.ama-assn.org/press-center/press-releases/ama-fun...

benjohnson 7y ago
The AMA backs the residency requirement. In my opinion it potentially gives doctors bad habits: Tolerating a miserable sleep schedule, placing too much value on quick diagnosis, equating long hours with effectiveness, and perhaps not placing enough value on teamwork with nurses.
- jac241 7y ago
  So once you graduate medical school, physicians should be able to practice without further specialty training? A first day MD should be able to manage patients on vents in the ICU, do crainotomies, and interventional or surgical heart valve replacements? Do you think 6+ years to train internal medicine specialists, surgeons, and radiologists is unnecessary?
  - toasterlovin 7y ago
    You're arguing against something the parent didn't say. They argued for removing the residency requirement. They didn't say there should be zero post-school training.
    - gamblor956 7y ago
      That is exactly what a residency is...
    - bigwavedave 7y ago
      Considering residency is the post-educational training you're referring to, I think the argument is relevant and valid.
      - jdminhbg 7y ago
        It's not that hard to imagine a postgraduate training system for doctors that isn't the US residency program. The original poster did, in fact, present a false dilemma: that if you think the current system is bad, then you must oppose all postgraduate training.
        jac241 7y ago
        Fair assessment. Any thoughts to what could work as an alternative? For it flaws, overwork being the main one, I think other parts of residency make sense. Every year you advance further in a system of graduated responsibility until you become an attending. It would be nice if it were easier to switch fields or programs, but the different specialties do take care of different organ systems with their own unique pathology and skills needed for each.
beambot 7y ago
Apprenticeships in many (most?) fields are sponsored by the professional organization (akin to a guild) and paid for by laborers at lower-than-master wages. And yet, here is the AMA itself saying the problem lies with federal government funding. Curious. Seems like a convenient scapegoat.
- Ensorceled 7y ago
  I think you are significantly underestimating how much a medical residency costs. Also, most apprentices end up working for/with the company/professional that trained them. I'm not sure there are many doctors who employ "apprentice/junior" doctors to work along side them the way a plumber/bricklayer/blacksmith/electrician would.
- deleted 7y ago
  [deleted]
merpnderp 7y ago
This is propaganda by the AMA. They are the primary lobbying force on this issue to Congress and they help write most of the legislation. The AMA is the negotiating partner you'd deal with to get this issue corrected.
- huherto 7y ago
  It sounds like AMA is working against the interest of Doctors. Sure they make more money, but they have a shitty quality of life.
  - abecedarius 7y ago
    The doctors they're probably working in the interests of are no longer residents. It'd be altruism to make prospective life better for prospective doctors.
callmeal 7y ago
Nice of them to change their minds after lobbying for that rule in the first place. https://www.washingtonexaminer.com/thanks-to-doctors-there-arent-enough-doctors https://www.washingtonexaminer.com/thanks-to-doctors-there-a...
avocado4 7y ago
That's a common misconception quoted by the medical cartel (i.e. MDs), among other ones such as "we should pay doctors 3x the amount Europeans get[1] because they study and burn out so much", which is a self-imposed problem. Congress funding for residency slots is a small part of the puzzle. The larger issues is the medical cartel making it so expensive to go through residency in the first place through excessive requirements. Here's an incomplete list of anti-competitive behaviors of medical cartel that push healthcare prices up in the US: 1. Restricting scope of practice for NPs and other midlevels 2. Restricting new facilities through Certificates of Need 3. Restricting immigration of foreign medical professionals from OECD countries through NCFMEA 4. Increasing costs & duration of medical education 5. Restricting patient's ability to obtain their open record digitally with the purpose of switching providers, or taking control of their health (good luck getting your imaging data from Kaiser if you ever want to leave them and seek better alternatives) 6. Restricting OTC availability of simple drugs available without doctor middlemen in other OECD countries 7. Restricting development of AI systems through data BAAs 8. Restricting scope and speed of processing for de novo and breakthru devices that automate work performed by physicians None of these have a valid patient safety counter-argument because essentially in every case there is a precedent of safe operation in other OECD countries. Other honorable mentions include: 1. Fighting against surprise billing legislation 2. Fighting against government's ability to negotiate rates 3. Fighting against public option 4. Fighting against any mention of moving away from fee-for-service [1] https://www.medscape.com/slideshow/2019-international-compensation-report-6011814 https://www.medscape.com/slideshow/2019-international-compen...

codekansas 7y ago

People underestimate how much of a problem is... There are so many qualified MDs who are underutilized or unable to go into the residency that they'd be most productive in simply because the supply of programs is kept artificially low