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Hospitals are suddenly short of young doctors because of visa ban
- basicplus2 6y agoMaybe just maybe new young doctors should be treated (like not be worked to death) and paid properly then there would be plenty of people willing to take up the profession and there would not be a shortaage
- golem14 6y agoAgreed that working conditions are atrocious and have been for years. But getting new doctors domestically from scratch will take years, and the article argues that there’s just not enough time for that.
- syshum 6y agoThey have had said that for decades which was more than enough time to address the underlying issues. This will always be excuse "we have to act now, because X is terrible if we dont"
- Feolkin 6y agoThe problem with that line of thinking is how it creates systems like the H1-B and doesn't really solve the problem of "we aren't educating enough doctors". Instead of thinking both long-term and short-term, the solution that's chosen now to solve the problem becomes the permanent solution going forward, and the solution for now is attracting foreign doctors instead of fixing medical education locally.
- catalogia 6y ago> Maybe just maybe new young doctors should be treated (like not be worked to death) and paid properly It seems to me, the tradition of working residents to the point of sleep exhaustion is a form of institutional hazing, perpetuated by people that endured it because "I did it, why shouldn't they?" I'm not sure how you crack that nut.
- GordonS 6y ago> I'm not sure how you crack that nut With regulation - for example, there could be a law that prevents doctors working more than 12 hours in a 24 hour period. Come to think of it, surely something like this exists already?
- salawat 6y agoAll that does is ensure no one gets fairly compensated for 12+ hours work, and shifts the complexity down the chain to accountants as people managers try to find other ways to compensate people for their extra effort. People don't stop being sick 12 hours in. It also unfairly hamstrings smaller practices with fewer covered professionals. Work gets offloaded from the covered individual to uncovered people in order to maximize the amount of work the covered individual can get done in that time span, or people start getting really particular about what is practicing and what isn't. Hate to sound like a broken record with other folks in the thread, but nothing is fundamentally changing the game with that regulation, just who pays the complexity tax at any one time does. So ball bustingly frustrating how bloody interconnected everything is while remaining so broad it's nigh-impossible to model within the confines of your own head. I say this as someone whose occupation centers around being able to very quickly jump between distinct verticals and subsystems while maintaining the capability to project the consequences of a change in one vertical through subsequently connected verticals. Everything seems to come back to a form of dynamic equilibrium where as long as you don't stare too hard the thing behaves well, but the closer you look the chaotic it becomes.
- GordonS 6y ago> All that does is ensure no one gets fairly compensated for 12+ hours work, and shifts the complexity down the chain to accountants as people managers try to find other ways to compensate people for their extra effort. People don't stop being sick 12 hours in. Sorry, but this stance seems like part of the problem. Doctors shouldn't be working more than 12 hours at a time, for rather obvious safety reasons. People don't stop being sick, sure - that means you change the system so there are more doctors working fewer hours, rather than making doctors work insane hours that risk patients and are terrible for doctors' mental health and wellbeing.
- rcpt 6y agoThey tried but everything medicine is hyper political in this country > The antitrust class-action lawsuit Jung v. AAMC alleged collusion to prevent American trainee doctors from negotiating for better working conditions. The working conditions of medical residents often involved 80- to 100-hour workweeks. The suit had some early success, but failed when the U.S. Congress enacted a statute exempting matching programs from federal antitrust laws https://en.m.wikipedia.org/wiki/Jung_v._Association_of_American_Medical_Colleges https://en.m.wikipedia.org/wiki/Jung_v._Association_of_Ameri...
- raverbashing 6y agoThe "bootcamp"/"student filter" culture is strong in the medical field. The bad conditions on residencies is only part of it (long shifts, low pay, attrition, etc)
- bawana 6y agoWe could make more doctors if medical school tuition was lower and new doctors were paid more than a garbage man. But The cabal that is the hospital and pharma lobby won’t allow it
- newacct583 6y agoMedian residency salary for a doctor in the US is something like $65k (probably about twice what sanitation workers make, though I'm too lazy to look it up). That's somewhat low relative to other jobs requiring the same education, but not particularly out of range. Lawyers do better at that stage of their careers for sure, but we have plenty of post-docs making far less. I don't see that this is much of an argument in context.
- claudeganon 6y agoWhat’s the average monthly debt payment for a typical resident? That will tell you a lot more about what their actual income looks like.
- newacct583 6y agoIf you're going to include long term assets then you need to include the rest of the career too. That's the way residents actually look at the problem, after all. "Doctors" do well. Residents struggle a bit in comparison, but not really that much relative to their other post-graduate-degree compatriots.
- tsco77 6y ago$200/300. Everyone uses income based repayment plans. It's literally impossible to make standard payment plan monthly payments on a residents salary (assuming a average debt). Those payments don't even reach the principle though, so it's more just kicking the can down the road.
- ponker 6y agoDid you mean half of what sanitation workers make? Garbage men are making way more than $65k in urban centers.
- vsskanth 6y agoSince residency spots have to be funded through Medicare, I was under the impression that they are very competitive essentially making them a zero sum game. If less get through on a visa, the spots will just be filled up by natives. Or is it that there just aren't enough native applicants (like grad school) ?
- tryptophan 6y agoThere are not enough usa grads to fill all the training spots. However, some usa grads do not match to a spot, around 1%, which makes lots of US educated doctors (rightfully) really mad. You get random foreign doctors going to state sponsored schools with openly nepotistic admissions sometimes getting spots over people who trained here. Imo the solution is more us medical schools opening, which is slowly happening. It is however not so easy to do so due to the (rightfully imo) high requirements.
- vsskanth 6y agoInteresting, I wasn't aware 1% don't get matched. Is it because of some minimum score needed in medical school exams ?
- tryptophan 6y agoThe application process is highly convoluted and not very well designed. Some people just fall through the cracks. But yes, also a small number of people just don't have the intellectual ability to handle it, although schools do a lot of screening to minimize this. Graduation rates at schools are typically 100%, with maybe 1 person every other year failing out.
- vsskanth 6y agoThanks for the insight.
- programmertote 6y agoIf one does not get matched and one is a citizen (or a green card holder), s/he really must have a lower than average USMLE score and/or GPA in med school. Or s/he made a mistake in shooting for too high of a program (e.g., trying to get into UPenn/JHU program when one's score isn't that good). Foreign medical graduates who scores above 65-70th percentile have no problem getting into residency programs (I've made a comment above with more details as to how I know all this). For a green card holder, you just need to get ~60th percentile of the USMLE score (which translates to about 240+ in step 2 CK and step 3 USMLE scores). All I wanted to say is that the bar isn't too high for a US citizen to get into a residency. That doesn't mean though that the path to get into residency is easy. It is extremely convoluted and requires a lot of persistence and planning. That's where (along the way) people fall through the cracks.
- jacquesm 6y agoGood. That way other countries can hold on to their most needed doctors.
- logicchains 6y ago> Good. That way other countries can hold on to their most needed doctors. And those doctors don't get a say in where they want to live?
- ballenf 6y agoBrain drain is a huge problem for countries on the cusp -- countries where taxpayers foot the bill for most education. Forced labor isn't the answer, but taking away some of the incentives to leave will certainly help.
- bzb3 6y agoMaybe they should pay their doctors better so they don't leave.
- woopwoop 6y agoI usually agree that "brain drain" arguments are nonsense, but the United States really badly overpays for medical care because of our horribly dysfunctional system, so I'm a bit more sympathetic to them in this particular case.
- heavenlyblue 6y agoThey pay their doctors in fee education, which is what - 300K in the US?
- HPsquared 6y agoOr - make them pay for their training costs if they leave.
- jeffreyrogers 6y agoYou don't have a right to live in any country you want to.
- klyrs 6y agoThis might kick off a small golden age for the countries the doctors are returning to, at great cost in american lives and permanent disability in this time of crisis. Who knew Trump's policies would be so magnanimous and self-sacrificing. Does he get a Nobel prize now?
- splintercell 6y agoOnly if this translates to them permanently living in these countries, and not eventually coming to the u.s.
- newsclues 6y agoWhile it may harm America short term, but there could be long term benefits from reversing the brain drain into America if it leads to more prosperity and stability in developing regions and eventually new trade partners.
- heavyset_go 6y agoIt's almost as if the AMA shouldn't heavily limit residencies such that only a constrained amount of young people are able to enter the ranks and become doctors.
- tryptophan 6y agoIt's almost as if they don't. There are more residency slots than there are American med school grads.
- heavyset_go 6y agoMaybe there would be more American grads if their prospects were better and the foreign competition wasn't so fierce.
- iso1210 6y agoArtificially increasing scarcity in a market is always a good move
- sjg007 6y agoThe AMA regulates medical school admissions.
- take_a_breath 6y agoWe could ask all other countries to stop training physicians because we can’t. Not sure that would solve the supply constraint, though.
- wittyreference 6y agoNot exactly. Most of the unmatched spots are in transitional year slots, which are meant to fulfill the first-year requirement of residencies that start in year 2 (e.g., some optho residencies), or just provide some time to circle the runway because you didn't successfully match. These aren't real residency spots. There's no excess of residency training slots if you exclude the transition year slots.
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- ykevinator 6y agoAll they have to do is lift the ama quota and we'll have twice as many doctors
- bnchrch 6y agoMaybe open up more med schools and drop the excessive volunteering requirements. It only serves to filter out the talented with a poor economic background.
- wittyreference 6y agoWe already have an excess of medical schools. We have a shortage of residency training spots; we have med students every year that are stuck as non-practicing physicians because of this. Residency training spots are, while not a snap of the fingers to increase, not difficult - if congress was willing to actually legislate the increase in funding, as it comes through CMS.
- treis 6y agoThere's no real reason for the government to be funding residency slots. Residents are profitable for hospitals and the slots are objectively valuable things. Hahnemann Hospital shut down and auctioned off their residency slots for 1 million per slot. In other words, the right to hire a resident and collect their subsidy is worth 1 million dollars. The government is a convenient scapegoat to protect a system that restricts the supply of doctors to maintain their wages.
- space_fountain 6y agoWhat is the system then? Do hospitals being made out of doctors not want to do it? Is the bottle neck actually at a different stage?
- treis 6y agoTo put it in tech terms, imagine if the FAANGs + 20 other big software companies had universities. Along comes the government and says that the only way for you to be a programmer is to work at one of these companies for 3-7 years. Oh yeah, and the FAANGs et.al. have an anti-trust exemption that allows them to collude on wages/benefits. Pretty clear why that system gets abused. The result is that doctors have to pay 50k+ tuition for 4 years and then get paid (relatively) crap wages for 3-7. After that, they make bank because of how hard it is to become a doctor. Existing doctors have been all to happy to pull the ladder up behind them. They continue to make it harder and harder to become a doctor by extending the training time. As a recent example, to work in a pediatric hospital now requires an addition two years time as a fellow. Of course, no current pediatrician is going to be required to do more training. Just anyone that wants to enter the field and compete now has to accept an additional two years of lower wages. The linchpin holding this all together is the government license requirements for doctors. Take that away and it all crumbles.
- drocer88 6y agoEmployers are complaining about a "labor shortage"? Just raise wages. That will send the proper signal to labor to train for the job. This is the same for any other product or service in the economy.
- dicomdan 6y agoUS doctors make 3 times as much as doctors in France. It's not a salary problem, but artificial limits on supply on all levels of the pipelines. https://www.medscape.com/slideshow/2019-international-compensation-report-6011814 https://www.medscape.com/slideshow/2019-international-compen...
- heavenlyblue 6y agoHow much do French doctors owe their government after graduation vs US doctors?
- throw_m239339 6y ago0€. Med school is "free" as no debt for students in France. It's tough but it's "free". But some politicians are trying very hard to adopt the American model.
- programmertote 6y agoSay you owe 300K in med school loan. On average, a doctor in the US makes ~230-250K (even if the doctor does not have a speciality). If one lives in Los Angeles, CA with 250K/year income (in CA metropolitan areas, generalist doctors usually make more than 250K/year; it's more like 280K/year minimum), the take home pay would be ~160K. How long do you think it would take for someone to pay back the 300K loan? If one is financially responsible, it would take at most 5 years to pay it back. So by the time one becomes a full-blown doctor at age 32 (usually in the US, it only takes ~12 years to become a generalist doctor, who specializes in Internal Medicine, from the time s/he graduates from high school), s/he is making 250K. I wish I could make something like that as a programmer, but we know that that kind of salary is reserved for people who work for FAANG and/or are at the top of their game in the software field. For doctors, that is just the starting salary. This is all to say that I disagree that the medical debt is much of a concern for US doctors once they become one. It is the unnecessarily convoluted path, which they have to take to become a doctor, that is more of the problem.
- tomohawk 6y agoThe problem is that H1-B exists. Instead of that, expand green cards to people who want to immigrate and have desirable skills. H1-B is mostly used to offshore jobs anyway. It allows offshoring companies to bring in captive workers to learn the skills/jobs to be offshored, and then to send them back. That is not a benefit to the US, and taxpayers should not be footing the bill for it.
- brentis 6y agoIt's become a horrible profession in US. Radiologists used to have bit of cachet now are required to review 300+ MRIs/x-rays a Day. No wonder they need insurance to cover the error rate.
- PhantomGremlin 6y agoOne would have to be crazy to want to become a radiologist in the US. In addition to what you mentioned, remote radiology has been here for quite a while. Jobs are being outsourced to to "scabs" in low wage countries. A definite race to the bottom.
- brentis 6y agoTrue. On top of all that Watson / etc are supposedly more accurate for several cancers already. Given IBM, probably still have a few decades before they can effectively get to market. ;)
- KoftaBob 6y agoThis is an artificially created shortage. The number of doctors entering the system every year is limited by the number of residency spots. Because resident salaries are paid for by the CMS Medicaid fund, the number of residency spots are therefore limited by how many spots the American Medical Association is able to negotiate with Congress. Congress needs to increase funding to residencies so they can do a better job of keeping up with demand for doctors. Thankfully, this is being worked on: "The number of residency positions has increased only 1% a year, far lower than the 52% growth in medical school spots since 2002, the AAMC said. Federally supported residency training slots have been capped by Congress for more than 20 years, limiting the spots for medical school graduates to undergo additional training in a residency program before they can practice medicine. To increase the supply of doctors in the U.S., the AAMC supports a multipronged approach, including passage of legislation by Congress that would provide a modest but critical increase in the number of federally supported graduate medical education positions. A bill, the Resident Physician Shortage Reduction Act of 2019, is awaiting action in both the Senate and the House of Representatives. It would gradually provide 15,000 Medicare-supported residency positions over a five-year period starting in 2021."
- invalidOrTaken 6y agoBoo effing hoo, my brother is ~300K in debt and making 60K a year at 31, and now is considering leaving medicine. I don't see why I'm supposed to feel sorry for hospitals here.
- vikramkr 6y agoYou look at how much McKinsey will pay you and look at how much money corporate pays, and it becomes a tough deal to stay in medicine if you're even a bit financially motivated. Schools like NYUs new free med school and adaptations like nurse practitioners for primary care are the only way this field will survive.
- 3pt14159 6y agoThis is really surprising to me as a Canadian. I was told that doctors in the States earn way more than doctors here.
- vikramkr 6y agoWay more debt + years of residency to let that debt pile on makes earning more in the end irrelevant. And you can only really be financially free in a few specialties that pay you enough. If you become a primary care doctor, you're only making 160k a year. You can make more in areas where doctors are in short supply. That's not enough to pay off 300k in debt compounding at 7-8% a year for years before you can start paying into it, especially when you also have to pay 7500+ a year in malpractice insurance costs. You've also spent so long getting tot hat point that you're probably around 31 years old, meaning you might be starting a young family around then and cant fit everyone in a cheap studio apartment anymore.
- BeetleB 6y ago> If you become a primary care doctor, you're only making 160k a year. There are many more lucrative choices than PCP that don't require specialization. A friend of mine was making $250-350K/yr as a hospitalist - no specialization needed. Just the usual 3 years of residency. The real issue is that doctors don't want to live where the work is lucrative (rural areas in Midwest, etc).
- JoshTko 6y agoInteresting how most of this thread pretty much exclusively focuses on problems with AMA vs the Visa ban itself.
- vsskanth 6y agoThere's quite a bit of anti-work-visa sentiment in HN, primarily because they assume it increases supply and reduces pay. So, It's implicitly assumed that the visa ban is not the cause behind the doctor shortage - its expensive medical school, low resident pay and a limit on residency spots (blamed on AMA lobbying). The hypothesis here (I don't necessarily fully agree with this) is if the path to becoming a doctor is expanded with removing limits on residency slots, more pay and less debt, more natives will choose to become doctors.
- mountainboot 6y agoAs has been pointed out here, the shortage is because of the AMA, not because of the visa situation.
- rcpt 6y agoIf you're interested in the dynamics of the residency match Brian Carmody has a good blog https://thesheriffofsodium.com/2019/03/02/the-etiology-of-application-fever/ https://thesheriffofsodium.com/2019/03/02/the-etiology-of-ap...
- 42droids 6y agoThe country which haven’t figured out yet that it needs immigration is bound to fail. Reality doesn’t care much about your political ideology.
- epmaybe 6y agoI am a medical resident. I'd be very surprised if the ban affected a significant number of foreign educated residents, as most programs require their incoming residents to be there for orientation before July 1. Our orientation was mid June. I doubt you'd move last minute, as it does take a few days to settle down. Also, if your program doesn't understand and help you get to this county after matching you to their program, it's now a problem that encompasses the program as well as the politics of the visa ban. Ninja edit: I will however note some personal anecdotes of some resident friends impacted by the h4 dependent visa, that are having trouble renewing due to the virus, and have to put their training on hold for the time being.
- caseysoftware 6y agoShh... don't let facts harm the narrative.
- epmaybe 6y agoI mean, I still think that the immigration guidelines were pretty poorly implemented and caused a lot of unnecessary stress/confusion. I just don't think a ton of residents are actually in a precarious position right now.
- xbar 6y ago<large, systemic problem> Because of <recent, specific reason> Is free market residency a better long term solution for that market, rather than expanding imported skilled labor?
- oblio 6y agoFor medical stuff free market anything is a recipe for disaster. You want a bit of free market with solid government oversight. Letting the market self correct in 10-20-80 years works for making chewing gum or PCs or toilet paper, but not for human lives.
- flowerlad 6y agoPart of the problem is the unnecessarily long path to becoming a doctor in the US. It takes 4 years longer in the US, compared to UK, to become a doctor. In the US medical school is a graduate program, which means students must obtain a bachelor’s degree before going on to medical school. The subjects US students study vary: earning a “pre-med” degree is not necessarily required to qualify for medical school. In fact, medical students can and do major in everything from mathematics to physics, even music! Becoming a doctor in the US takes a minimum of 11 years: 4 years to obtain an undergraduate degree, followed by 4 years to complete medical school then 3 years of residency. Compare that to UK: There the study of medicine starts at the undergraduate level. After spending between 5 years in medical school, students earn their bachelor’s degree and enter the workforce as junior doctors. They then spend 2 years in the “foundation programme,” which is intended to reinforce what they have learned at the university in a professional environment. That's a total of 7 years to become a doctor in the UK. The difference is the 4 years US students spend obtaining an undergraduate degree before starting medical school. This seems wasteful. Eliminating this requirement will reduce the amount of debt medical students accumulate, and encourage more people to become doctors.
- koheripbal 6y ago> 4 years US students spend obtaining an undergraduate degree before starting medical school. This seems wasteful. While it's not required, the majority of students DO follow a pre-med program that allows them to take Biology, Organic chem, Chemistry, Physics, Psychology, etc... These aren't wasted years, for the majority of medical students. I think the solution is more about having more medical schools and reinforcing STEM for younger students so that the supply can keep up with demand. One of the reasons so many foreign students go into medicine is because they come from countries with very strong culture of STEM education at a young age - something that's not done in the majority of US school districts.
- arcticbull 6y ago> These aren't wasted years, for the majority of medical students. They aren't wasted but they're not necessary either, and I think that was the point. Let's say I wanted to become a general contractor, but for some reason that's a graduate program. I spend 4 years taking civil engineering. Did I waste my time learning about concrete... no, probably not, but it is necessary to do my job? Also no. It's also hard to equate your "stronger early focus on STEM" with a pre-med program. If all it takes is teaching biology and math a little earlier, is that 4 years really the best use of time?
- IknowIamRight 6y agoThis is good. The developed world should stop pulling high skilled workers like doctors from the 3rd world. The 3rd world needs them if they are ever to develop. The developed world should figure out how to create more doctors from their own countries
- koheripbal 6y agoDoctors are a service industry. So the way to afford to pay them more is to develop 3rd world economies.
- oblio 6y agoWhy doesn't the US have a points based immigration system?
- kyawzazaw 6y agoThe faux selling point of American Dream. Experienced a lot of this sentiment in questions on the subreddit.
- angry_octet 6y agoIt's astounding that the HN readership has become completely captured by labour economics concerns, even to the exclusion of considering a critical shortage of critical workers DURING A PANDEMIC. The point is that the Trump admin political posturing on immigration is causing a shortage of doctors, and people will die because of that.
- novok 6y agoI think were angry about both. At least I am.
- propogandist 6y ago>The point is that the Trump admin political posturing on immigration is causing a shortage of doctors, and people will die because of that. it's more complicated than just getting Trump out. The 'orange man bad' narrative is getting out of control.
- angry_octet 6y agoIt's not a 'narrative', he literally is bad, and he definitely is exacerbating a physician shortage.
- deleted 6y ago[deleted]
- samfisher83 6y agoWe have people people with 3.7 gpas and 31 on their MCAT that can't get into medschool. I don't think it's an issue of not having enough people trying to be doctors.
- PhantomGremlin 6y agoThis is not a new problem. I knew US citizens that went to foreign medical schools (think Spain) 50 years ago because it was so hard to get into US schools. The beauty then (don't know if it's true now) is it was simple to get US residency on return. Just go work for a trauma center in a run-down area in Brooklyn. Shootings galore on a daily basis. You never run out of new patients.
- conservmillen 6y agoThis year our greedy hospital administrators hired 2,685 non-US citizen graduates of foreign medical schools. During this time, there were 1,218 US MD seniors, 826 US MD graduates, 613 DO seniors, 326 DO graduates and 2013 US citizen graduates of foreign medical schools who applied for these training positions but weren’t hired. The government should clarify that they won’t be relaxing visa rules. Hospitals should interview and hire Americans from the above pool. I’m sure the people complaining in the news article are decent doctors: they should busy themselves treating coronavirus patients in their own countries rather than pushing a false narrative in the US media that Americans are dying because a few foreign doctors weren’t allowed into the country.
- throwawy061820 6y agoIt's idiotic the US would bar skilled workers of any category, but the story is even worse than blocking foreign medical students from (already far too limited) residency slots. Even if they were able to come here to train, there likely wouldn't be jobs waiting for them on the other side. My wife is a chief resident at a top-ranked program in Emergency Medicine (Level I hospital with volume of 100k+ pts annually, multiple sites, etc.). Perfect USMLE scores, etc. She's good at what she does. A few years ago we considered her career fortunate because it is stable and portable: the demand for emergency medical care is inelastic and perpetual, and she could likely get a job almost anywhere paying a salary high enough to live comfortably. She is finishing her training this year and just started looking for a job, only to discover a horrifying truth: almost no hospitals are hiring physicians specialized in emergency medicine. Let that sink in. In the middle of a global pandemic, when the medical system is overwhelmed by undifferentiated patients, hospitals are not trying to expand the number of doctors on the front-line. It's bananas. The reason for this is entirely financial; high-reimbursement procedures are not being carried out in adequate volume, and treating patients with COVID-19 is not revenue generating when a plurality are uninsured/under-insured and treated by mandate due to EMTALA. Medicaid/medicare payments barely keep the lights on, and there simply aren't enough insured patients transiting the hospital to support staffing up to respond to pandemic conditions. It's maddening. Universal healthcare would go a long way to solving the problem, but sacrifices will need to be made on the hospital side as well, with lower salaries for providers and (largely ossified and inept) administrators. The pandemic pushed hospital financials into the red. Physician groups in myriad specialties across the country have taken voluntary or required salary cuts to help the system stay afloat, but something has to give at a societal level. If we had better national leadership, this crisis would be an opportunity to rethink how we pay for and deliver healthcare in this country, but we don't, so it it's all a giant slow-speed car crash. The future is not bright unless we get the pandemic under control, but that too looks like a dumpster fire thanks to politicization of life-saving control measures. If I were a foreign medical grad, I'd be smart to complete my training in any country other than the US—at least for the foreseeable future. (and other countries, if you're listening: this is a great time to make it easy for high-skill workers from the US to obtain work visas and citizenship)
- ikiris 6y ago
- persaspiration 6y agoUS citizens can start med school right after graduating high school at an English program in Poland. Understandably this is out of the realm of reality for many people but for those who are adventurous the ROI is simply astounding. I've met people who have done so and had no issues starting residency when people they went to high school with are already in massive debt and just starting med school in the US.
- tehjoker 6y agoThe US has a doctor shortage because the entire system is designed to make it expensive and difficult to become one in order to legitimize high salaries. The US has arcane rules like only allowing US residencies to practice in the US unlike basically every other country. Students go in expecting to do good in the world, are put through a grinder, and come out thinking fuck everything at least I get paid. The system self-perpetuates instead of increasing the number of physicians, reducing pay to the mere low hundreds of thousands, making medical school not only free but paid, and reducing work load and redundant overlaps to increase patient safety (as turn over between shifts is one of the most dangerous times of day). The AMA until very recently also was a key opponent of Medicare for All, so there's that lovely bubble of reaction sitting there too.