4 ms·

> Everyone complains about the cost of healthcare and nobody asks why the AMA operates like a cartel. That's not entirely a bad thing. It would be bad for Med

by ardy42 6y ago

> Everyone complains about the cost of healthcare and nobody asks why the AMA operates like a cartel. That's not entirely a bad thing. It would be bad for Medicine to turn out like Law, with a huge glut of unemployable graduates after a long, expensive training program (IIRC, an intense 7 years post-college, minimum). There's a need to balance demand with the need for all (or nearly all) the graduates to be able to find a job. Also, you're neglecting Osteopathic schools, which aren't controlled by the AMA but graduate students with the same practice rights. > The number of doctors allowed to graduate hasn't changed in 40 years. Do you have any data to back that claim up? The Association of American Medical Colleges says enrollment rates are increasing: > In response to concerns that a projected doctor shortage could impact patient care, the AAMC in 2006 called on medical schools to increase first-year enrollment by 30%. That target was reached in 2018-19, when first-year matriculation reached 21,622 students. Osteopathic schools increased their enrollment by 164% during this same time period, with 8,124 first-year students enrolled. (https://www.aamc.org/news-insights/us-medical-school-enrollment-rises-30 https://www.aamc.org/news-insights/us-medical-school-enrollm...)

salawat 6y ago
Enrollment != graduation and licensure. More people may be interested but nobody can practice until after residency, and you have a large pool of hopefuls basically in a lottery for residency slots. You can get all the theory, but not be able to get the requisite practicum. Even if you do get a slot, you also get treated like a stevedore from what I have heard.
- ardy42 6y ago
  > Enrollment != graduation and licensure. > More people may be interested but nobody can practice until after residency, and you have a large pool of hopefuls basically in a lottery for residency slots. But my understanding is that residency capacity is matched to graduating class sizes, at least in the US. The selectivity is intentionally placed up front (at med school admission) so the path is clear to residency and licensure as long as the student doesn't totally fall apart (which the selectivity is supposed to guard against). IIRC, it's foreign medical school graduates may have trouble getting a US residency.
  - salawat 6y ago
    That is not my understanding at all, as that would imply we never have med school admissions without a residency slot, and I have seen many mentions over the years about how the great bottleneck is not med school admissions, but residency slots. https://www.fiercehealthcare.com/practices/more-medical-students-than-ever-but-more-residency-slots-needed-to-solve-physician https://www.fiercehealthcare.com/practices/more-medical-stud... https://health.wusf.usf.edu/npr-health/2019-07-03/american-medical-students-less-likely-to-choose-to-become-primary-care-doctors https://health.wusf.usf.edu/npr-health/2019-07-03/american-m... The above sources indicate residency matching is decoupled from graduation from Med school, and if I recall correctly, there is actually a legal cap on the number of residency slots. https://www.aha.org/news/headline/2019-03-14-bill-add-15000-medicare-funded-residency-slots-introduced-house https://www.aha.org/news/headline/2019-03-14-bill-add-15000-... So everything I've seen suggests we actually have a dysfunctional system with no up front brakes. Our Medical education system maximizes fiscal extraction from hopefuls, but the residency slots don't scale elastically or in any way matched with demand. Quite literally, it seems to take an act of Congress to change the calculus of residency slots. I could still be wrong, and welcome the removal of the veil of mistaken impressions, but that's the gist of my current understanding.
stocknoob 6y ago
Why do some professions get the benefit of cartel protection? Note that pharmacists don't have such restrictions and have similar training. For the data, I had done a quick search and found this (which only goes to 2010): https://www.researchgate.net/figure/Trends-in-the-Number-of-U-S-Medical-School-Graduates-Practicing-in-Primary-Care-by_fig1_311249183 https://www.researchgate.net/figure/Trends-in-the-Number-of-... However, digging more, even the AAMC is saying you need residency slots: https://www.medicaleconomics.com/view/enrollment-rates-rise-us-medical-schools-s-only-half-battle https://www.medicaleconomics.com/view/enrollment-rates-rise-... Increasing first-year enrollment is a good first step, but doesn't move the needle on the number of doctors who can actually practice because the number of residencies is still limited.
- ardy42 6y ago
  > However, digging more, even the AAMC is saying you need residency slots: Which are determined by federal government Medicare funding, btw. From your link: > 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. So maybe this is more of a "call your congressman" issue.
  - willcipriano 6y ago
    Your congressman probably listens to the AMA more so than you when it comes to medical matters, here is one example of what they have to say on the subject I could find with a quick search: > In March 1997, months before the Balanced Budget Act was enacted, the AMA even suggested reducing the number of US residency positions by approximately 25% from 25,000 to fewer than 19,000. “The United States is on the verge of a serious oversupply of physicians,” said the AMA and other physicians’ groups in a joint statement. Since most states require at least some residency training for medical licensure, reducing the number of residency positions would curtail the supply of doctors in the US. > Fast forward two decades, and what once seemed like a glut now looks like a shortage. The growth in the number of residency positions—and thus the number of doctors—slowed after the passage of the Balanced Budget Act. From 1997 to 2002, the number of residents in the US increased by just 0.1%. Although the number of positions has increased since then, each year thousands of residency applicants fail to secure a position. Factor in an aging population and a projected increase in demand for health care services, and the US is now forecasted to experience a shortage of 46,900 to 121,900 physicians by 2032. Absent a meaningful response from Congress, it will be doctors—particularly residents—and their patients who pay the price. - https://qz.com/1676207/the-us-is-on-the-verge-of-a-devastating-doctor-shortage/ https://qz.com/1676207/the-us-is-on-the-verge-of-a-devastati...

by ardy42 6y ago

salawat 6y ago

Enrollment != graduation and licensure. More people may be interested but nobody can practice until after residency, and you have a large pool of hopefuls basically in a lottery for residency slots. You can get all the theory, but not be able to get the requisite practicum. Even if you do get a slot, you also get treated like a stevedore from what I have heard.

ardy42 6y ago
> Enrollment != graduation and licensure. > More people may be interested but nobody can practice until after residency, and you have a large pool of hopefuls basically in a lottery for residency slots. But my understanding is that residency capacity is matched to graduating class sizes, at least in the US. The selectivity is intentionally placed up front (at med school admission) so the path is clear to residency and licensure as long as the student doesn't totally fall apart (which the selectivity is supposed to guard against). IIRC, it's foreign medical school graduates may have trouble getting a US residency.
- salawat 6y ago
  That is not my understanding at all, as that would imply we never have med school admissions without a residency slot, and I have seen many mentions over the years about how the great bottleneck is not med school admissions, but residency slots. https://www.fiercehealthcare.com/practices/more-medical-students-than-ever-but-more-residency-slots-needed-to-solve-physician https://www.fiercehealthcare.com/practices/more-medical-stud... https://health.wusf.usf.edu/npr-health/2019-07-03/american-medical-students-less-likely-to-choose-to-become-primary-care-doctors https://health.wusf.usf.edu/npr-health/2019-07-03/american-m... The above sources indicate residency matching is decoupled from graduation from Med school, and if I recall correctly, there is actually a legal cap on the number of residency slots. https://www.aha.org/news/headline/2019-03-14-bill-add-15000-medicare-funded-residency-slots-introduced-house https://www.aha.org/news/headline/2019-03-14-bill-add-15000-... So everything I've seen suggests we actually have a dysfunctional system with no up front brakes. Our Medical education system maximizes fiscal extraction from hopefuls, but the residency slots don't scale elastically or in any way matched with demand. Quite literally, it seems to take an act of Congress to change the calculus of residency slots. I could still be wrong, and welcome the removal of the veil of mistaken impressions, but that's the gist of my current understanding.

stocknoob 6y ago

Why do some professions get the benefit of cartel protection? Note that pharmacists don't have such restrictions and have similar training. For the data, I had done a quick search and found this (which only goes to 2010): https://www.researchgate.net/figure/Trends-in-the-Number-of-U-S-Medical-School-Graduates-Practicing-in-Primary-Care-by_fig1_311249183 https://www.researchgate.net/figure/Trends-in-the-Number-of-... However, digging more, even the AAMC is saying you need residency slots: https://www.medicaleconomics.com/view/enrollment-rates-rise-us-medical-schools-s-only-half-battle https://www.medicaleconomics.com/view/enrollment-rates-rise-... Increasing first-year enrollment is a good first step, but doesn't move the needle on the number of doctors who can actually practice because the number of residencies is still limited.

ardy42 6y ago
> However, digging more, even the AAMC is saying you need residency slots: Which are determined by federal government Medicare funding, btw. From your link: > 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. So maybe this is more of a "call your congressman" issue.
- willcipriano 6y ago
  Your congressman probably listens to the AMA more so than you when it comes to medical matters, here is one example of what they have to say on the subject I could find with a quick search: > In March 1997, months before the Balanced Budget Act was enacted, the AMA even suggested reducing the number of US residency positions by approximately 25% from 25,000 to fewer than 19,000. “The United States is on the verge of a serious oversupply of physicians,” said the AMA and other physicians’ groups in a joint statement. Since most states require at least some residency training for medical licensure, reducing the number of residency positions would curtail the supply of doctors in the US. > Fast forward two decades, and what once seemed like a glut now looks like a shortage. The growth in the number of residency positions—and thus the number of doctors—slowed after the passage of the Balanced Budget Act. From 1997 to 2002, the number of residents in the US increased by just 0.1%. Although the number of positions has increased since then, each year thousands of residency applicants fail to secure a position. Factor in an aging population and a projected increase in demand for health care services, and the US is now forecasted to experience a shortage of 46,900 to 121,900 physicians by 2032. Absent a meaningful response from Congress, it will be doctors—particularly residents—and their patients who pay the price. - https://qz.com/1676207/the-us-is-on-the-verge-of-a-devastating-doctor-shortage/ https://qz.com/1676207/the-us-is-on-the-verge-of-a-devastati...