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Another solution is allow more doctors to be licensed so they don't need to be as overworked.
by pkaye 7y ago
Another solution is allow more doctors to be licensed so they don't need to be as overworked.
- sodosopa 7y agoIs that from lowering educational requirements or from lowering standards?
- christophilus 7y agoNeither. It’s from removing artificial caps.
- sodosopa 7y agoThanks for the clarification.
- rednerrus 7y agoAAMC will never let this happen.
- wang_li 7y agoHaving waited several months to get an appointment with a urologist in the PNW, I thought of a solution to this problem. Anytime the waiting time to see a practitioner of a particular specialty exceeds some predetermined time, the top marginal income tax rate for those who practice that specialty becomes 90% until the wait times are within the desired range of 2-4 weeks. It won't take long for the current practitioners to demand that schools produce more graduates. The artificial scarcity is bullshit and we shouldn't put up with it.
- refurb 7y agoYour solution is to use punitive tax rates on people so they'll lobby the people who actually decide how many slots there are? Really?
- wang_li 7y agoIt's industry trade organizations that limit the number of slots at medical schools and residencies. A punitive tax on the members of the organization that has artificially limited the number of practitioners seems perfectly targeted.
- wolco 7y agoWhy wouldn't they respond by raising prices until they always have free spots available?
- david38 7y agoThis is the most insane idea I’ve ever heard. That’s like taxing teachers for overcrowded classrooms to induce them to lobby teaching schools. What a useless step. Why not just have these wait times (and other info) publicly available so people can look them up? Doctors can decide to set up practices in the area in their own. Patients can see and ask who’s the hold up is. Is the pay too low? Some crazy liability laws? Whatever. With this publicly available, it’s much easier to compare service across the state/nation/world without having to be on the inside.
- wang_li 7y ago> That’s like taxing teachers for overcrowded classrooms to induce them to lobby teaching schools. If the NEA restricted the number of teachers the same way the medical industry limits the number of doctors I'd say yes, this is a perfect analogy. Since they don't, then it's a bad analogy. > Doctors can decide to set up practices in the area in their own. Not sure about private practices, but hospitals can't just open up without the current hospitals in an area agreeing that it's under served. > Patients can see and ask who’s the hold up is. Is the pay too low? Some crazy liability laws? Whatever. > With this publicly available, it’s much easier to compare service across the state/nation/world without having to be on the inside. If your city limited the number of auto mechanics and granted the guild of car repair persons control over who was allowed to become a mechanic and they only allowed one garage to open up in your town, you would correctly identify this as rent seeking behavior and not a market failure. The choices at that point would be to dissolve their monopoly on auto repair or to create conditions that would encourage their normal human behavior to attenuate the rent seeking. Do you really want to dissolve the AMA? Or would you rather encourage the AMA membership to change their behavior to not artificially limit the supply of doctors? My solution doesn't give central orders about how to fix the problem, it simply creates a penalty when there is a problem. If the various practitioners realized they could be 20% more efficient while still maintaining quality that would be fine. Or they could create more practitioners. That would also be fine. The problem was created by the industry, the industry can fix the problem.
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- merpnderp 7y agoIf you taxed 90% of the doctor's top marginal rate, wouldn't they just work long enough to get to that rate, then take the rest of the year off? You overestimate the lobbying power of doctors and underestimate how much suffering this would cause.
- zionic 7y agoThe medical cartel will never allow that. They have a complete stranglehold on both licensing and education.
- anovikov 7y agoWhy doesn't government intervene? Say, by handing out green cards on arrival to every doc from a certain list of "rich" countries, filling the void very quickly? Or even by making medical education a state monopoly and leave it up to the state to decide who to license?
- wobbly_bush 7y agoThe recent Indian government has been doing something loosely on these lines - drastically increasing the number of student capacity in public medical colleges [1] [1] https://www.livemint.com/news/india/15-700-more-mbbs-seats-soon-in-75-new-colleges-5-things-to-know-1567049776772.html https://www.livemint.com/news/india/15-700-more-mbbs-seats-s...
- conanbatt 7y agoYou mean stop intervening. The state is acting by not allowing the immigration of doctors and not recognizing education abroad
- anovikov 7y agoWhy don't people protest? I mean, the U.S. is a democratic country and has a strong system designed to lobby for or against anything. Most people except docs themselves should be concerned with this, why is there no lobbying movement to change things? It should be a no-brainer to fund.
- tutuca 7y agoOh no! you said goverment intervention!! Burn the heretic! (I'm joking but I guess that's why you got so many downvotes)
- mirthflat83 7y agoThe real problem is the profit-driven hospitals that are overworking doctors. More doctors don’t mean hospitals suddenly employing more doctors.
- conanbatt 7y agoMost hospitals are non-profits.
- mirthflat83 7y agoOnly in name.
- pc86 7y agoAnd tax status. And business structure. And decision-making. And liability. And every other measure that determines it. If you can't differentiate between hospitals and the healthcare system, you should probably spend more time reading comments in this thread than writing them.
- mirthflat83 7y agoYes, that is how it is supposed to work, I am aware thank you.
- epmaybe 7y agoI love this in theory, but there's a lot of externalities that prevent that from happening. Apologies if I'm missing something, I'm a medical student (soon to be resident) that tries not to think about this too hard. I've thought to comment on this in the past, as this conversation pops up on HN relatively often. I think we need a solution to two problems: First, figure out how to pay people (the hospital, the students/residents themselves, and the hospital attending physicians who spend their time teaching) to train physicians. Second, figure out how many clinical/surgical encounters a physician in training needs to truly be competent when they complete their training. This is more of a problem for surgeons, as they need x number of cases before they feel comfortable doing that procedure on their own. For the first problem, there are smarter people than myself who pose solutions. CMS (and DHHS) pay for most of this in the US, and is a fixed amount each year with few changes since 1995. So an obvious solution without trashing our current system would be to just have Congress authorize more funding, about $100k/yr/new resident they are willing to pay for. Hospitals should also consider adding their own funding to pay for more residency spots, which is already happening. Note that hospitals bid on the hahnemann hospital (drexel) residents for about the $100k asking price ($55m for ~550 residents). For the second, you have to decide how many years you want doctors to be training for, at their reduced salary. If you increase training time, you can achieve the clinical/surgical volume needed to become proficient, at the risk of keeping residents at the hospital for longer than they really want. You could seek out more volume at satellite clinics, but then you force the trainees to have to travel, which makes that specific training program less desirable (at least, it does for me) Grossly over-simplified, I know.
- endogui 7y ago> Second, figure out how many clinical/surgical encounters a physician in training needs to truly be competent when they complete their training. This seems like the sort of thing that should be widely studied, but I can't find the terms to get nice Google Scholar results. In my field we do this sort of assessment for the users of (fairly low-risk) medical devices. It requires a team and is quite work-intensive to assess, but the stakes for insurance providers are high enough that this must already be known....
- 7y ago
- TuringNYC 7y agoDoctors, by way of Boards, limit supply as a way of keeping up wages. They are not overworked because of some lack of sufficiently interested individuals — they are overworked because few others are let into the club.