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The AMA doesn't restrict the number of people in medical school, you're thinking of residency slots, and they don't restrict that either. They're in favor of ex

The AMA doesn't restrict the number of people in medical school, you're thinking of residency slots, and they don't restrict that either. They're in favor of expanding the number of residencies available since everyone knows there is a shortage of doctors. The restriction comes from funding since it's all Federal dollars to pay for the training. https://www.ama-assn.org/press-center/press-releases/ama-builds-efforts-expand-funding-graduate-medical-education-0 https://www.ama-assn.org/press-center/press-releases/ama-bui... Congress, and more specifically right now, the Republican Senate is the only thing holding up funding tens of thousands of more slots (the bills are cosponsored by ~130 congresspeople, of which 100+ are Democrats and by 17 Senators, of which 15 are Democrats) https://www.congress.gov/bill/115th-congress/house-bill/2267/cosponsors?searchResultViewType=expanded https://www.congress.gov/bill/115th-congress/house-bill/2267... https://www.congress.gov/bill/115th-congress/senate-bill/1301 https://www.congress.gov/bill/115th-congress/senate-bill/130...

wonder_er 6y ago
If the parent's comment is true, I wouldn't trust the AMA to market itself honestly. Ditto for legislative solutions. There's too much conflict of interest, susceptibility to lobbying, non-representation of marginalized groups or those who would be doctors but are not because of troubling practices, etc. From Mises.org[0] To accomplish the twin goals of artificially elevated incomes and worship by patients, AMA formulated a two-pronged strategy for the labor market for physicians. First, use the coercive power of the state to limit the practices of physician competitors such as homeopaths, pharmacists, midwives, nurses, and later, chiropractors. Second, significantly restrict entrance to the profession by restricting the number of approved medical schools in operation and thus the number of students admitted to those approved schools yearly. AMA created its Council on Medical Education in 1904 with the goal of shutting down more than half of all medical schools in existence. (This is the Council having its 100th anniversary celebrated in Chicago this weekend.) In six years the Council managed to close down 35 schools and its secretary N.P. Colwell engineered what came to be known as the Flexner Report of 1910. The Report was supposedly written by Abraham Flexner, the former owner of a bankrupt prep school who was neither a doctor nor a recognized authority on medical education. Years later Flexner admitted that he knew little about medicine or how to differentiate between different qualities of medical education. Regardless, state medical boards used the Report as a basis for closing 25 medical schools in three years and reducing the number of students by 50% at remaining schools. The article is thoroughly footnoted. One might take exception with specifics, but it seems hard to argue that the above is not approximately correct. [0]: https://mises.org/library/100-years-medical-robbery https://mises.org/library/100-years-medical-robbery Edit: I see the downvotes, but don't see the justification. I know Mises is an often-unpopular resources, but the above article is well-researched. If there are problems with the line of reasoning, I'd love to hear your perspective on it.
- MereInterest 6y ago
  Though I can believe there being a preference toward reducing competition, their argument is weakened by including homeopaths as maligned groups. Homeopaths are not competitors with physicians, as that would imply that homeopaths provide medical treatment. At best, homeopaths provide a placebo. At worst, they actively poison customers (e.g. belladonna teething tablets) and prevent them from seeking out actual medical care.
  - wonder_er 6y ago
    I believe the article addresses approximately your point: AMA's initial drive to increase physician incomes was motivated by increasing competition from homeopaths (AMA allopaths use treatments--usually synthetic--that produce effects different from the diseases being treated while homeopaths use treatments--usually natural--that produce effects similar to those of the disease being treated). [...] Apart from reversing rapidly declining incomes, allopaths also wanted to rescue their public reputations, which quite reasonably suffered given their proficiency in killing patients through such crude practices as bloodletting ("exsanguination") or mercury injections (poisoning). You're right - homeopaths were competitive with allopaths. But in the late 1800s (when most of the doctors/homeopaths grew up) the state-of-the-art physician was not much better (and perhaps often far worse) than what you are judging homeopaths.
  - nmca 6y ago
    Whether homeopathy works (it doesn't) doesn't have a huge amount of bearing on whether homeopaths compete in the market with physicians (they do), because their customers are seeking the same thing.
- learc83 6y ago
  Because your excerpt starts with "To accomplish the twin goals of artificially elevated incomes and worship by patients." The thoroughly footnote supporting the latter part of that sentence is supposedly comes from something written by The Massachusetts Medical Society, but actually comes from a speech written by a single physician over half a century before the rise of the AMA's Council on Medical Education. And it does not say that mankind "should be 'looked upon by the mass of mankind with a veneration almost superstitious.', as is stated. It doesn't even get the year of publication of the quote right. Packing an article with footnotes doesn't mean a damn thing. Other footnotes include such thorough scholarship as this one time an unnamed Chemistry instructor told me off the record that white men have a harder time getting into med school with mediocre scores than black women do, and editorialized quotes from sources where neither a long enough quote, or enough information on the source is provided to lookup the full quote.
dcolkitt 6y ago
> The AMA doesn't restrict the number of people in medical school, you're thinking of residency slots, and they don't restrict that either. There's a very simple solution to this problem that requires nothing other than the stroke of a pen: allow residents from OECD nations to practice medicine in the US. There's nothing magical about an American residency. Countries like France, Britain, Israel, Korea, New Zealand, Czechia, Costa Rica, Chile, and Portugal have better health outcomes than the US. Obviously there's nothing deficient about how doctors are being trained in Prague or Santiago or Seoul. Yet American doctors have by far the highest compensation of any country in the world. Demand meet supply. Let's open up our borders and let doctors from qualified countries come here to practice. Many would flood our shores for significantly higher wages. We'd solve the doctor shortage over night. Of course the AMA absolutely knows this. That's why they vehemently lobby against any change to the residency requirement. The AMA is a self-interest political lobby, just like any other interest group. They look out for the interest of doctors at the expense of patients. The issue about residency expansion being blocked is just a red herring. There's no reason the US can't outsource its residency training to other, much lower wage countries that are already producing superior physicians.
- doktorhladnjak 6y ago
  Only problem is American medical students take on massive student loans while those in other countries often have their tuition subsidized by their governments. Instead of paying for medical education via taxes, we pay via employers, insurance premiums, deductibles and Medicare taxes.
  - 908B64B197 6y ago
    That's a problem (paying for training and loosing their doctors) for foreign countries, not the US.
wittyreference 6y ago
> They're in favor of expanding the number of residencies available since everyone knows there is a shortage of doctors. They were in favor of restricting slots some 25-40 years ago. The facts have changed, but the memeplex hasn’t.
abeppu 6y ago
My mistake. After reading your response, I tried to go back and find where I had originally heard that the AMA contributed to a bottleneck at the med school level. While it is true that the AMA (one side of the LCME partnership) has a role direct role in accreditation of medical schools (which does restrict the number of medical students, albeit not at the level of stipulating a number of seats), it does seem like residencies are the more important bottleneck. However, a meaningful fraction of those residencies are filled by people (including Americans) who did medical school overseas. I read this as suggesting that there are still not enough seats in American med schools, but that foreign institutions have stepped up to provide that training.
sukilot 6y ago
Why do federal dollars pay for all the training?
- mikeyouse 6y ago
  It's extremely expensive to pay to train residents, so somebody needs to pay for it.. We incentivize 'teaching hospitals' to use their most expensive and valuable employees spending time as mentors to train the next generation of physicians by paying those hospitals to host residents.

wonder_er 6y ago

If the parent's comment is true, I wouldn't trust the AMA to market itself honestly. Ditto for legislative solutions. There's too much conflict of interest, susceptibility to lobbying, non-representation of marginalized groups or those who would be doctors but are not because of troubling practices, etc. From Mises.org[0] To accomplish the twin goals of artificially elevated incomes and worship by patients, AMA formulated a two-pronged strategy for the labor market for physicians. First, use the coercive power of the state to limit the practices of physician competitors such as homeopaths, pharmacists, midwives, nurses, and later, chiropractors. Second, significantly restrict entrance to the profession by restricting the number of approved medical schools in operation and thus the number of students admitted to those approved schools yearly. AMA created its Council on Medical Education in 1904 with the goal of shutting down more than half of all medical schools in existence. (This is the Council having its 100th anniversary celebrated in Chicago this weekend.) In six years the Council managed to close down 35 schools and its secretary N.P. Colwell engineered what came to be known as the Flexner Report of 1910. The Report was supposedly written by Abraham Flexner, the former owner of a bankrupt prep school who was neither a doctor nor a recognized authority on medical education. Years later Flexner admitted that he knew little about medicine or how to differentiate between different qualities of medical education. Regardless, state medical boards used the Report as a basis for closing 25 medical schools in three years and reducing the number of students by 50% at remaining schools. The article is thoroughly footnoted. One might take exception with specifics, but it seems hard to argue that the above is not approximately correct. [0]: https://mises.org/library/100-years-medical-robbery https://mises.org/library/100-years-medical-robbery Edit: I see the downvotes, but don't see the justification. I know Mises is an often-unpopular resources, but the above article is well-researched. If there are problems with the line of reasoning, I'd love to hear your perspective on it.

MereInterest 6y ago
Though I can believe there being a preference toward reducing competition, their argument is weakened by including homeopaths as maligned groups. Homeopaths are not competitors with physicians, as that would imply that homeopaths provide medical treatment. At best, homeopaths provide a placebo. At worst, they actively poison customers (e.g. belladonna teething tablets) and prevent them from seeking out actual medical care.
- wonder_er 6y ago
  I believe the article addresses approximately your point: AMA's initial drive to increase physician incomes was motivated by increasing competition from homeopaths (AMA allopaths use treatments--usually synthetic--that produce effects different from the diseases being treated while homeopaths use treatments--usually natural--that produce effects similar to those of the disease being treated). [...] Apart from reversing rapidly declining incomes, allopaths also wanted to rescue their public reputations, which quite reasonably suffered given their proficiency in killing patients through such crude practices as bloodletting ("exsanguination") or mercury injections (poisoning). You're right - homeopaths were competitive with allopaths. But in the late 1800s (when most of the doctors/homeopaths grew up) the state-of-the-art physician was not much better (and perhaps often far worse) than what you are judging homeopaths.
- nmca 6y ago
  Whether homeopathy works (it doesn't) doesn't have a huge amount of bearing on whether homeopaths compete in the market with physicians (they do), because their customers are seeking the same thing.
learc83 6y ago
Because your excerpt starts with "To accomplish the twin goals of artificially elevated incomes and worship by patients." The thoroughly footnote supporting the latter part of that sentence is supposedly comes from something written by The Massachusetts Medical Society, but actually comes from a speech written by a single physician over half a century before the rise of the AMA's Council on Medical Education. And it does not say that mankind "should be 'looked upon by the mass of mankind with a veneration almost superstitious.', as is stated. It doesn't even get the year of publication of the quote right. Packing an article with footnotes doesn't mean a damn thing. Other footnotes include such thorough scholarship as this one time an unnamed Chemistry instructor told me off the record that white men have a harder time getting into med school with mediocre scores than black women do, and editorialized quotes from sources where neither a long enough quote, or enough information on the source is provided to lookup the full quote.

dcolkitt 6y ago

> The AMA doesn't restrict the number of people in medical school, you're thinking of residency slots, and they don't restrict that either. There's a very simple solution to this problem that requires nothing other than the stroke of a pen: allow residents from OECD nations to practice medicine in the US. There's nothing magical about an American residency. Countries like France, Britain, Israel, Korea, New Zealand, Czechia, Costa Rica, Chile, and Portugal have better health outcomes than the US. Obviously there's nothing deficient about how doctors are being trained in Prague or Santiago or Seoul. Yet American doctors have by far the highest compensation of any country in the world. Demand meet supply. Let's open up our borders and let doctors from qualified countries come here to practice. Many would flood our shores for significantly higher wages. We'd solve the doctor shortage over night. Of course the AMA absolutely knows this. That's why they vehemently lobby against any change to the residency requirement. The AMA is a self-interest political lobby, just like any other interest group. They look out for the interest of doctors at the expense of patients. The issue about residency expansion being blocked is just a red herring. There's no reason the US can't outsource its residency training to other, much lower wage countries that are already producing superior physicians.

doktorhladnjak 6y ago
Only problem is American medical students take on massive student loans while those in other countries often have their tuition subsidized by their governments. Instead of paying for medical education via taxes, we pay via employers, insurance premiums, deductibles and Medicare taxes.
- 908B64B197 6y ago
  That's a problem (paying for training and loosing their doctors) for foreign countries, not the US.

wittyreference 6y ago

> They're in favor of expanding the number of residencies available since everyone knows there is a shortage of doctors. They were in favor of restricting slots some 25-40 years ago. The facts have changed, but the memeplex hasn’t.

abeppu 6y ago

My mistake. After reading your response, I tried to go back and find where I had originally heard that the AMA contributed to a bottleneck at the med school level. While it is true that the AMA (one side of the LCME partnership) has a role direct role in accreditation of medical schools (which does restrict the number of medical students, albeit not at the level of stipulating a number of seats), it does seem like residencies are the more important bottleneck. However, a meaningful fraction of those residencies are filled by people (including Americans) who did medical school overseas. I read this as suggesting that there are still not enough seats in American med schools, but that foreign institutions have stepped up to provide that training.

sukilot 6y ago

Why do federal dollars pay for all the training?

mikeyouse 6y ago
It's extremely expensive to pay to train residents, so somebody needs to pay for it.. We incentivize 'teaching hospitals' to use their most expensive and valuable employees spending time as mentors to train the next generation of physicians by paying those hospitals to host residents.