4 ms·

AAMC will never let this happen.

wang_li 7y ago
Having 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 ago
  Your 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 ago
    It'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 ago
      Why wouldn't they respond by raising prices until they always have free spots available?
- david38 7y ago
  This 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 ago
  If 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.

Having 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 ago
Your 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 ago
  It'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 ago
    Why wouldn't they respond by raising prices until they always have free spots available?
david38 7y ago
This 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 ago
If 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.