7 ms·

Trying to convince medical students to practice in rural/underserved communities by trying to appeal to altruism is clearly not working when many of them may be

Trying to convince medical students to practice in rural/underserved communities by trying to appeal to altruism is clearly not working when many of them may be half a million dollars in debt. It's such a big problem but it seems like there are no easy solutions in sight. Even debt relief programs are clearly not enough. Or perhaps there just aren't enough doctors to begin with.

8bitsrule 6y ago
'New bill would forgive medical-school debt for Covid-19 health workers' https://abcnews.go.com/US/bill-forgive-medical-school-debt-covid-19-health/story?id=70509644 https://abcnews.go.com/US/bill-forgive-medical-school-debt-c... It's called the 'The Student Loan Forgiveness for Frontline Health Workers Act.' Introduced by Rep. Carolyn Maloney (D-N.Y.) on Tuesday
EliRivers 6y ago
Perhaps delegating authority to issue immigrant work visas to counties in such cases. Get skilled staff from overseas. Sure, there are ways it could be done badly and go wrong, but it could be done right.
- ashtonkem 6y ago
  While in principle that makes sense, I think in reality it wouldn’t work. First, rural counties are not prepared to run their own immigration systems. That kind of work is centralized for several good reasons. Second, they’d still have to compete with richer counties, who would also love to reduce their health care costs. The price overall might drop a bit, but ultimately I think more urbanized counties would tend to win out over rural counties in such a system.
- lonelappde 6y ago
  Where are the unemployed foreign doctors?
  - vsskanth 6y ago
    They don't need to be unemployed, just be paid much higher than what they make in their home country
  - ashtonkem 6y ago
    Visas for skilled immigrants rarely are given to the unemployed, largely because skilled workers very rarely go without work in most countries. Usually these immigrants are looking for a safer or better life in America for themselves or their families.
  - renewiltord 6y ago
    Don't need the unemployed. Go for the best. Brain drain the world like America did right after WW2. Suck the best up and put them here. Don't even have to do very much, just liberalize skilled immigration and pull everyone who wants to come who has degrees in nations with equivalent systems. Canadian medical staff, for instance, should be able to instant-transfer. Forget the small ball with licence reciprocity between states. Licence reciprocity between nations. They will come. Just let them.
    - justinclift 6y ago
      Why the heck would "the best" people from overseas want to work in the US?
      - floor2 6y ago
        Because, contrary to the constant anti-America sentiments shared across social media, the US remains one of the best places to live in the world. You're not going to see a massive influx of doctors leaving Switzerland, Germany or the UK to come to the US because those countries are all very similar quality of life. However, the world is bigger than handful of Western European nations which are gleefully looking down their noses at Trump-era America, and there are literally billions of intelligent, hard working, educated people across Africa, Asia, South America and Eastern Europe who would see their lives improve in every way by moving to the US.
kmonsen 6y ago
Why should we convince them on altruism and not by paying them more? I thought USA was all about the market deciding where resources should go?
- lonelappde 6y ago
  Because rural life is fundamentally economically inefficient, so they can't pay more. Transportation and overhead is too expensive. It only works if its subsidized by altruism of the urban economy, or a huge portion of locals learn the skills for themselves.
  - skoskie 6y ago
    Sounds like the modern day definition of socialism, which is largely rejected by rural populations, as evidenced by voting patterns. It seems logical to allow people who reject a the system that provides them care to endure the consequences of that decision.
    - gumby 6y ago
      Actually it’s unclear how the people in the article would vote as that section of Georgia was subject to de facto voting restrictions in the last two elections.
  - _bxg1 6y ago
    The way I see it is, a rural economy has to be propped up by at least one "export" of some kind. This usually isn't informational; the information economy gravitates toward urban centers. Whether or not the information economy has to stay in urban centers is unclear, but it seems to be the case right now. Traditionally that export has been mining, manufacturing, and/or farming. Things that require lots of cheap space and labor and not much else. The first two have taken deep dives in the past few decades. This makes rural life, in many places, simply uneconomical. Without something bringing money into the town, people don't have money to spend on local services. Healthcare is an expensive local service. If we leave it up to the market, the answer is often simply "don't live in a rural area". I'm not saying we should just leave it up to the market, though many would, but I think these are the base facts. Edit: I hadn't actually read the article yet and I hope the above doesn't come off as insensitive in relation to the OP's tone. But I still think it's the truth. Rural America right now is the most broken part of our country's broken system. Something fundamental has to change.
nradov 6y ago
We have a serious and growing shortage of primary care physicians, mostly due to insufficient federal funding for residency programs. Every year some students who graduate from medical school are unable to practice because they can't get matched to a residency slot. Ask Congress to increase funding for those programs. It would also help to expand the ranks of physician assistants and nurse practitioners. It doesn't take a full physician to diagnose a middle ear infection or wrap up a sprained ankle.
Barrin92 6y ago
there are no easy solutions but there are straight-forward solutions. In the short term, have the state incentivize doctors to move through loan forgiveness programs. In the middle and long term, incentivize people to move to urban areas, build more housing, and culturally stop glorifying suburban and rural life. (And stop supporting it by subsidizing single home ownership and so forth).
- HeyLaughingBoy 6y ago
  In response to a post about a pandemic where the "approved response" is to self-quarantine, you are suggesting that people should be incentivized to live in high-density areas? Putting aside the benefits of living in a city for the moment, I have to say that such a response appears to be somewhat tone-deaf. [shrug] Anyway, it seems that the State paying off medical student debt in return for a certain amount of service to a particular population (a.k.a. the Joel Fleischmann experience) is an efficient use of tax dollars. I admit to only knowing of one person in this situation, but she enjoyed working in the area where she was assigned so much that after her commitment was fulfilled, she stayed on. And even if she hadn't, the community was still well served for the time she was there. I don't know how widespread this practice is, though.
  - Barrin92 6y ago
    > I have to say that such a response appears to be somewhat tone-deaf. You can self quarantine in a city as well as in a rural area. I think we shouldn't blame urban life for what was botched policy. Taiwan, Singapore, Beijing, they all did just fine. Short of a zombie apocalypse I'd always rather be in a city and in close proximity to quality care (in particular relevant for the elederly) than somewhere else. After all, other diseases haven't stopped existing. If you are in a rural remote area, if you have a heart attack you're pretty much done for. Not to mention even getting good dental care can be difficult. Also shifting the mindset in the US is a decades long endeavour, fascination with pastoral or bucolic lifestyles is deeply ingrained.

8bitsrule 6y ago

'New bill would forgive medical-school debt for Covid-19 health workers' https://abcnews.go.com/US/bill-forgive-medical-school-debt-covid-19-health/story?id=70509644 https://abcnews.go.com/US/bill-forgive-medical-school-debt-c... It's called the 'The Student Loan Forgiveness for Frontline Health Workers Act.' Introduced by Rep. Carolyn Maloney (D-N.Y.) on Tuesday

EliRivers 6y ago

Perhaps delegating authority to issue immigrant work visas to counties in such cases. Get skilled staff from overseas. Sure, there are ways it could be done badly and go wrong, but it could be done right.

ashtonkem 6y ago
While in principle that makes sense, I think in reality it wouldn’t work. First, rural counties are not prepared to run their own immigration systems. That kind of work is centralized for several good reasons. Second, they’d still have to compete with richer counties, who would also love to reduce their health care costs. The price overall might drop a bit, but ultimately I think more urbanized counties would tend to win out over rural counties in such a system.
lonelappde 6y ago
Where are the unemployed foreign doctors?
- vsskanth 6y ago
  They don't need to be unemployed, just be paid much higher than what they make in their home country
- ashtonkem 6y ago
  Visas for skilled immigrants rarely are given to the unemployed, largely because skilled workers very rarely go without work in most countries. Usually these immigrants are looking for a safer or better life in America for themselves or their families.
- renewiltord 6y ago
  Don't need the unemployed. Go for the best. Brain drain the world like America did right after WW2. Suck the best up and put them here. Don't even have to do very much, just liberalize skilled immigration and pull everyone who wants to come who has degrees in nations with equivalent systems. Canadian medical staff, for instance, should be able to instant-transfer. Forget the small ball with licence reciprocity between states. Licence reciprocity between nations. They will come. Just let them.
  - justinclift 6y ago
    Why the heck would "the best" people from overseas want to work in the US?
    - floor2 6y ago
      Because, contrary to the constant anti-America sentiments shared across social media, the US remains one of the best places to live in the world. You're not going to see a massive influx of doctors leaving Switzerland, Germany or the UK to come to the US because those countries are all very similar quality of life. However, the world is bigger than handful of Western European nations which are gleefully looking down their noses at Trump-era America, and there are literally billions of intelligent, hard working, educated people across Africa, Asia, South America and Eastern Europe who would see their lives improve in every way by moving to the US.

kmonsen 6y ago

Why should we convince them on altruism and not by paying them more? I thought USA was all about the market deciding where resources should go?

lonelappde 6y ago
Because rural life is fundamentally economically inefficient, so they can't pay more. Transportation and overhead is too expensive. It only works if its subsidized by altruism of the urban economy, or a huge portion of locals learn the skills for themselves.
- skoskie 6y ago
  Sounds like the modern day definition of socialism, which is largely rejected by rural populations, as evidenced by voting patterns. It seems logical to allow people who reject a the system that provides them care to endure the consequences of that decision.
  - gumby 6y ago
    Actually it’s unclear how the people in the article would vote as that section of Georgia was subject to de facto voting restrictions in the last two elections.
- _bxg1 6y ago
  The way I see it is, a rural economy has to be propped up by at least one "export" of some kind. This usually isn't informational; the information economy gravitates toward urban centers. Whether or not the information economy has to stay in urban centers is unclear, but it seems to be the case right now. Traditionally that export has been mining, manufacturing, and/or farming. Things that require lots of cheap space and labor and not much else. The first two have taken deep dives in the past few decades. This makes rural life, in many places, simply uneconomical. Without something bringing money into the town, people don't have money to spend on local services. Healthcare is an expensive local service. If we leave it up to the market, the answer is often simply "don't live in a rural area". I'm not saying we should just leave it up to the market, though many would, but I think these are the base facts. Edit: I hadn't actually read the article yet and I hope the above doesn't come off as insensitive in relation to the OP's tone. But I still think it's the truth. Rural America right now is the most broken part of our country's broken system. Something fundamental has to change.

nradov 6y ago

We have a serious and growing shortage of primary care physicians, mostly due to insufficient federal funding for residency programs. Every year some students who graduate from medical school are unable to practice because they can't get matched to a residency slot. Ask Congress to increase funding for those programs. It would also help to expand the ranks of physician assistants and nurse practitioners. It doesn't take a full physician to diagnose a middle ear infection or wrap up a sprained ankle.

Barrin92 6y ago

there are no easy solutions but there are straight-forward solutions. In the short term, have the state incentivize doctors to move through loan forgiveness programs. In the middle and long term, incentivize people to move to urban areas, build more housing, and culturally stop glorifying suburban and rural life. (And stop supporting it by subsidizing single home ownership and so forth).

HeyLaughingBoy 6y ago
In response to a post about a pandemic where the "approved response" is to self-quarantine, you are suggesting that people should be incentivized to live in high-density areas? Putting aside the benefits of living in a city for the moment, I have to say that such a response appears to be somewhat tone-deaf. [shrug] Anyway, it seems that the State paying off medical student debt in return for a certain amount of service to a particular population (a.k.a. the Joel Fleischmann experience) is an efficient use of tax dollars. I admit to only knowing of one person in this situation, but she enjoyed working in the area where she was assigned so much that after her commitment was fulfilled, she stayed on. And even if she hadn't, the community was still well served for the time she was there. I don't know how widespread this practice is, though.
- Barrin92 6y ago
  > I have to say that such a response appears to be somewhat tone-deaf. You can self quarantine in a city as well as in a rural area. I think we shouldn't blame urban life for what was botched policy. Taiwan, Singapore, Beijing, they all did just fine. Short of a zombie apocalypse I'd always rather be in a city and in close proximity to quality care (in particular relevant for the elederly) than somewhere else. After all, other diseases haven't stopped existing. If you are in a rural remote area, if you have a heart attack you're pretty much done for. Not to mention even getting good dental care can be difficult. Also shifting the mindset in the US is a decades long endeavour, fascination with pastoral or bucolic lifestyles is deeply ingrained.