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> Medicare reimbursement levels are sufficient to support most medical practices. Big Nope. Most practices have fairly fixed costs: Medical malpractice Faci

> Medicare reimbursement levels are sufficient to support most medical practices. Big Nope. Most practices have fairly fixed costs: Medical malpractice Facilities rent, or mortgage Front office IT & EMR Privileging/Credentialing Practice CME/required education The only highly variable cost is physician compensation, and considering the limited availability, this will merely cause the retirements and limited access to specialists. Perhaps you have some evidence to support your extraordinary claim? I'll provide evidence to the contrary, based on Hospitals and practices refusing to accepting Medicaid [1] patients, or, not accepting/limiting medicare patients[2], [3], [4] The simple fact is, there is a limited supply of physicians, and many of them don't want to practice the higher volume, 5 minutes per patient, 5 minutes for notes x 12 hours a day type of practice. Not only is the higher volume more dangerous for the patient, it is also more risky for the medical provider, both in terms of quality of life, and also, the risk of an error, or inadequate information exchange. [1] https://www.reliasmedia.com/articles/147019-when-hospitals-refuse-to-see-medicaid-patients https://www.reliasmedia.com/articles/147019-when-hospitals-r... [2] https://www.investopedia.com/articles/personal-finance/100215/what-do-when-your-doctor-doesnt-take-medicare.asp https://www.investopedia.com/articles/personal-finance/10021... [3] https://www.verywellhealth.com/doctors-accept-medicare-insurance-3976280 https://www.verywellhealth.com/doctors-accept-medicare-insur... [4] https://www.hlc.org/news/more-physicians-no-longer-seeing-medicare-patients/ https://www.hlc.org/news/more-physicians-no-longer-seeing-me...

toomuchtodo 5y ago
> there is a limited supply of physicians If the AMA isn't going to fix the physician and residency pipeline, could we not offer visas to physician immigrants who meet first world medical credentialing standards to deepen the supply and therefore support demand? If supply is the issue, we should fix the supple, not destroy necessary demand.
- nradov 5y ago
  The AMA isn't responsible for the bottleneck in residency slots. We should be asking Congress to increase funding. https://www.ama-assn.org/press-center/press-releases/ama-fund-graduate-medical-education-address-physician-shortages https://www.ama-assn.org/press-center/press-releases/ama-fun...
  - toomuchtodo 5y ago
    I stand corrected. Thank you for pointing out my mistake.
- OrvalWintermute 5y ago
  > could we not offer visas to physician immigrants who meet first world medical credentialing standards Basically, you are saying American trained doctors only then, as American doctors are much better trained. Because my experience is that a physician immigrant has to do the following: Receive ECFMG verification Complete missing medical education requirements Study a boatload! Pass US medical licensing exams 1 & 2 Find a residency (matching) Go through Residency again Obtain certification from ECFMG start practicing, or Complete Fellowship, then start practicing
  - toomuchtodo 5y ago
    > Basically, you are saying American trained doctors only then, as American doctors are much better trained. Considering how much healthcare costs in the US and the quality of care received [1], I assert American doctors are not better trained, simply that they are more expensive and there are less of them per capita than other OECD countries [2] [3] [4]. I'm suggesting bypassing the undersized US doctor development pipeline until it is fully funded to produce enough doctors to meet demand and drive down costs. https://www.ajmc.com/view/the-quality-of-us-healthcare-compared-with-the-world https://www.ajmc.com/view/the-quality-of-us-healthcare-compa... ("A 2014 report from the Commonwealth Fund revealed continued trends that were along the same lines—despite the implementation of the Affordable Care Act (ACA) in the interim. In the report, the US “ranked last overall among 11 industrialized countries on measures of health system quality, efficiency, access to care, equity and healthy lives.” Significantly, the US was noted to have the highest costs while also displaying the lowest performance.") [2] https://data.worldbank.org/indicator/SH.MED.PHYS.ZS?most_recent_value_desc=true https://data.worldbank.org/indicator/SH.MED.PHYS.ZS?most_rec... [3] https://www.fiercehealthcare.com/practices/how-u-s-stacks-up-against-other-countries-doctors-healthcare https://www.fiercehealthcare.com/practices/how-u-s-stacks-up... ("When it comes to practicing physicians, there are only two physicians for every 1,000 Americans, nearly half the ratio of countries with nationalized public healthcare. Countries with nationalized systems saw the greatest increase in the number of physicians relative to their population.") [4] https://www.medicaresupplement.com/content/global-healthcare-resources/ https://www.medicaresupplement.com/content/global-healthcare...

toomuchtodo 5y ago

> there is a limited supply of physicians If the AMA isn't going to fix the physician and residency pipeline, could we not offer visas to physician immigrants who meet first world medical credentialing standards to deepen the supply and therefore support demand? If supply is the issue, we should fix the supple, not destroy necessary demand.

nradov 5y ago
The AMA isn't responsible for the bottleneck in residency slots. We should be asking Congress to increase funding. https://www.ama-assn.org/press-center/press-releases/ama-fund-graduate-medical-education-address-physician-shortages https://www.ama-assn.org/press-center/press-releases/ama-fun...
- toomuchtodo 5y ago
  I stand corrected. Thank you for pointing out my mistake.
OrvalWintermute 5y ago
> could we not offer visas to physician immigrants who meet first world medical credentialing standards Basically, you are saying American trained doctors only then, as American doctors are much better trained. Because my experience is that a physician immigrant has to do the following: Receive ECFMG verification Complete missing medical education requirements Study a boatload! Pass US medical licensing exams 1 & 2 Find a residency (matching) Go through Residency again Obtain certification from ECFMG start practicing, or Complete Fellowship, then start practicing
- toomuchtodo 5y ago
  > Basically, you are saying American trained doctors only then, as American doctors are much better trained. Considering how much healthcare costs in the US and the quality of care received [1], I assert American doctors are not better trained, simply that they are more expensive and there are less of them per capita than other OECD countries [2] [3] [4]. I'm suggesting bypassing the undersized US doctor development pipeline until it is fully funded to produce enough doctors to meet demand and drive down costs. https://www.ajmc.com/view/the-quality-of-us-healthcare-compared-with-the-world https://www.ajmc.com/view/the-quality-of-us-healthcare-compa... ("A 2014 report from the Commonwealth Fund revealed continued trends that were along the same lines—despite the implementation of the Affordable Care Act (ACA) in the interim. In the report, the US “ranked last overall among 11 industrialized countries on measures of health system quality, efficiency, access to care, equity and healthy lives.” Significantly, the US was noted to have the highest costs while also displaying the lowest performance.") [2] https://data.worldbank.org/indicator/SH.MED.PHYS.ZS?most_recent_value_desc=true https://data.worldbank.org/indicator/SH.MED.PHYS.ZS?most_rec... [3] https://www.fiercehealthcare.com/practices/how-u-s-stacks-up-against-other-countries-doctors-healthcare https://www.fiercehealthcare.com/practices/how-u-s-stacks-up... ("When it comes to practicing physicians, there are only two physicians for every 1,000 Americans, nearly half the ratio of countries with nationalized public healthcare. Countries with nationalized systems saw the greatest increase in the number of physicians relative to their population.") [4] https://www.medicaresupplement.com/content/global-healthcare-resources/ https://www.medicaresupplement.com/content/global-healthcare...