9 ms·

Why Does the US make it so hard to be a doctor?

huitzitziltzin 5y ago
Health economist here. This is a great piece top to bottom. There is no credible objection I'm aware of to any of the deregulation proposals included herein. The American Medical Association will object, because they don't want the competition because it will have a negative effect on its members' incomes. If you think health care is too expensive in the US, the changes proposed herein are Job 1. There is no reason why Mexican, Canadian, British, Indian, German, ... doctors should not be allowed to come and practice in the US with more than some cursory verification that they actually attended a medical school where they are from. There is no reason for anyone in the US to be denied a slot at medical school (not a particular medical school, but some medical school in general). One final note: please don't be fooled into have sympathy for the large debts doctors incur through medical school. This is not the population which is deserving of student debt relief. I'm happy to shorten their education, of course, but doctors are consistently among the very highest paid people in American society. Retiring even a million dollars in debt (much larger than any number in this article) is not that hard on a highly-paid specialists' salary, which can easily average half a million dollars per year. The author of the piece has proposed to do further pieces on an "Abundance Agenda" for the US. Essentially this looks at ways to increase supply in things which are currently expensive but don't have to be. I haven't read other parts of it but I strongly recommended following him and looking further into the idea.
- pfranz 5y ago
  > they don't want the competition because it will have a negative effect on its members' incomes. Is it the perception that increased competition will have negative effects on members' incomes or is that actually true? I swear I remember a story, study, allegory about a second doctor moving to town and both incomes went up.
  - huitzitziltzin 5y ago
    > Is it the perception that increased competition will have negative effects on members' incomes or is that actually true? Generally true in other areas. Health care is not that exceptional a market, though it is exceptional in several respects. We do generally observe in health care specifically that increases in market concentration increase prices. > I swear I remember a story, study, allegory about a second doctor moving to town and both incomes went up. I'll take a look if you can find it. It's possible. One story I can imagine would be something like: First Doctor can see more patients b/c he can send his more complicated patients to Second Doctor's specialty practice. And Second Doctor moved from a smaller town w/ fewer patients in the specialty. In the aggregate and outside of special cases more supply will bring prices down.
  - zozbot234 5y ago
    In theory, it could go the other way. More supply, better specialization among doctors, higher productivity at the margin, more income. The final effect is ambiguous. What is true is that patients would benefit, even if doctors were to earn more after all.
- syki 5y ago
  I have a hard time rectifying the claim that you are a health economist with the fact that you don’t appear to understand that the bottleneck for increasing the supply of doctors is the number of residency slots. Foreign medical school certifications are largely accepted at face value but graduating a foreign residency program largely is not. I think it’s pretty much universal that each country wants doctors to go through their own version of residency. My wife is a physician. She needs a large salary to pay off her large medical debt. When the medical debt is paid off her salary will still be large. A much more sensible system would to make medical school free so that the salaries don’t have to start off so high. There are people with hundreds of thousands in med school debt who didn’t match. We should feel sorry for those people.
  - allcentury 5y ago
    The limit of residency slots is in the article. > A much more sensible system would to make medical school free so that the salaries don’t have to start off so high. That's not how any labor market works. Your salary isn't determined by how much debt you rack up. Doctor's salary's are high because the supply of doctor's is so low (especially primary care). The article covers all the points you're debating (much better than I).
    - lupire 5y ago
      Primary care is a low paying job because nurses and PAs can provide primary care.
    - N1H1L 5y ago
      > That's not how any labor market works. Your salary isn't determined by how much debt you rack up. True, or else college dropouts from a private school will have higher incomes than a state school undergrad, which is not the case at all.
    - syki 5y ago
      My response was about the claim that OP is a health economist while not understanding where the bottleneck in the supply for doctors comes from. I believe you are incorrect as it pertains to doctor salaries. Demand is high and supply relatively low. That is true but this isn’t the only factor that goes into determining pay. That’s an overly simplistic view of things. Supply/demand does not account for everything in this situation. If med students came out of med school with zero debt then the healthcare industry could make being a doctor sufficiently lucrative with salaries that are smaller than they currently are. Lowering the salary a bit in this scenario would not lower supply. You should read about David Carr’s work.
- deleted 5y ago
  [deleted]
- commandlinefan 5y ago
  > doctors are consistently among the very highest paid people in American society Isn't that at least in part because there's so little competition though?
- throwaway4220 5y ago
  > This is not the population which is deserving of student debt relief. Residents don’t need debt relief but they also don’t need hostility. look up FAANG salaries and TC I will bet you undergrad education will get debt relief
haspoken 5y ago
https://archive.is/GjMsG https://archive.is/GjMsG
gota 5y ago
A medical doctor Just letting lurkers know the article is not about PhD programs or academia in general, as I half expected
tiahura 5y ago
The U.S. spent $3,795.4 billion on health care in 2019 - where did it go? https://www.ama-assn.org/sites/ama-assn.org/files/styles/related_article_stub_image_1200x800_3_2/public/2021-04/2019-where-money-goes-chart.jpg https://www.ama-assn.org/sites/ama-assn.org/files/styles/rel...
willcipriano 5y ago
Most common jobs in Congress? Doctor and lawyer. Oddly enough those are the only things we don't have H1B style programs for. Programmers we import by the truckload, no problem. Suggest that a African clinic doctor is fine to treat your ear infection and everyone is up in arms.
react_burger38 5y ago
One interesting thing to note is that Medicare (US gov't paid healthcare for the elderly) pays hospitals DOUBLE the price for the same procedures that an MD can do in her own clinic. They pay this supposedly so that hospitals can take in patients who can't afford to pay in the emergency room, etc. But to me this is another one of those cases where poor government policy boosts prices. Hospitals already have an incentive to buy up small practices to reduce competition, but if hospitals are paid double the price for the same procedure compared to an ambulatory clinic, the government is just incentivizing concentration in the market.
react_burger38 5y ago
Another thing the US could do to reduce prices is to give people the option for certain expensive procedures (hip transplants, knee replacements, etc.) to be done outside the US by qualified doctors. Then the patient could get a discount on their insurance every month or get an incentive from medicare that splits the savings with the patient.

Health economist here. This is a great piece top to bottom. There is no credible objection I'm aware of to any of the deregulation proposals included herein. The American Medical Association will object, because they don't want the competition because it will have a negative effect on its members' incomes. If you think health care is too expensive in the US, the changes proposed herein are Job 1. There is no reason why Mexican, Canadian, British, Indian, German, ... doctors should not be allowed to come and practice in the US with more than some cursory verification that they actually attended a medical school where they are from. There is no reason for anyone in the US to be denied a slot at medical school (not a particular medical school, but some medical school in general). One final note: please don't be fooled into have sympathy for the large debts doctors incur through medical school. This is not the population which is deserving of student debt relief. I'm happy to shorten their education, of course, but doctors are consistently among the very highest paid people in American society. Retiring even a million dollars in debt (much larger than any number in this article) is not that hard on a highly-paid specialists' salary, which can easily average half a million dollars per year. The author of the piece has proposed to do further pieces on an "Abundance Agenda" for the US. Essentially this looks at ways to increase supply in things which are currently expensive but don't have to be. I haven't read other parts of it but I strongly recommended following him and looking further into the idea.

pfranz 5y ago
> they don't want the competition because it will have a negative effect on its members' incomes. Is it the perception that increased competition will have negative effects on members' incomes or is that actually true? I swear I remember a story, study, allegory about a second doctor moving to town and both incomes went up.
- huitzitziltzin 5y ago
  > Is it the perception that increased competition will have negative effects on members' incomes or is that actually true? Generally true in other areas. Health care is not that exceptional a market, though it is exceptional in several respects. We do generally observe in health care specifically that increases in market concentration increase prices. > I swear I remember a story, study, allegory about a second doctor moving to town and both incomes went up. I'll take a look if you can find it. It's possible. One story I can imagine would be something like: First Doctor can see more patients b/c he can send his more complicated patients to Second Doctor's specialty practice. And Second Doctor moved from a smaller town w/ fewer patients in the specialty. In the aggregate and outside of special cases more supply will bring prices down.
- zozbot234 5y ago
  In theory, it could go the other way. More supply, better specialization among doctors, higher productivity at the margin, more income. The final effect is ambiguous. What is true is that patients would benefit, even if doctors were to earn more after all.
syki 5y ago
I have a hard time rectifying the claim that you are a health economist with the fact that you don’t appear to understand that the bottleneck for increasing the supply of doctors is the number of residency slots. Foreign medical school certifications are largely accepted at face value but graduating a foreign residency program largely is not. I think it’s pretty much universal that each country wants doctors to go through their own version of residency. My wife is a physician. She needs a large salary to pay off her large medical debt. When the medical debt is paid off her salary will still be large. A much more sensible system would to make medical school free so that the salaries don’t have to start off so high. There are people with hundreds of thousands in med school debt who didn’t match. We should feel sorry for those people.
- allcentury 5y ago
  The limit of residency slots is in the article. > A much more sensible system would to make medical school free so that the salaries don’t have to start off so high. That's not how any labor market works. Your salary isn't determined by how much debt you rack up. Doctor's salary's are high because the supply of doctor's is so low (especially primary care). The article covers all the points you're debating (much better than I).
  - lupire 5y ago
    Primary care is a low paying job because nurses and PAs can provide primary care.
  - N1H1L 5y ago
    > That's not how any labor market works. Your salary isn't determined by how much debt you rack up. True, or else college dropouts from a private school will have higher incomes than a state school undergrad, which is not the case at all.
  - syki 5y ago
    My response was about the claim that OP is a health economist while not understanding where the bottleneck in the supply for doctors comes from. I believe you are incorrect as it pertains to doctor salaries. Demand is high and supply relatively low. That is true but this isn’t the only factor that goes into determining pay. That’s an overly simplistic view of things. Supply/demand does not account for everything in this situation. If med students came out of med school with zero debt then the healthcare industry could make being a doctor sufficiently lucrative with salaries that are smaller than they currently are. Lowering the salary a bit in this scenario would not lower supply. You should read about David Carr’s work.
deleted 5y ago
[deleted]
commandlinefan 5y ago
> doctors are consistently among the very highest paid people in American society Isn't that at least in part because there's so little competition though?
throwaway4220 5y ago
> This is not the population which is deserving of student debt relief. Residents don’t need debt relief but they also don’t need hostility. look up FAANG salaries and TC I will bet you undergrad education will get debt relief

haspoken 5y ago

https://archive.is/GjMsG https://archive.is/GjMsG

gota 5y ago

A medical doctor Just letting lurkers know the article is not about PhD programs or academia in general, as I half expected

tiahura 5y ago

The U.S. spent $3,795.4 billion on health care in 2019 - where did it go? https://www.ama-assn.org/sites/ama-assn.org/files/styles/related_article_stub_image_1200x800_3_2/public/2021-04/2019-where-money-goes-chart.jpg https://www.ama-assn.org/sites/ama-assn.org/files/styles/rel...

willcipriano 5y ago

Most common jobs in Congress? Doctor and lawyer. Oddly enough those are the only things we don't have H1B style programs for. Programmers we import by the truckload, no problem. Suggest that a African clinic doctor is fine to treat your ear infection and everyone is up in arms.

react_burger38 5y ago

One interesting thing to note is that Medicare (US gov't paid healthcare for the elderly) pays hospitals DOUBLE the price for the same procedures that an MD can do in her own clinic. They pay this supposedly so that hospitals can take in patients who can't afford to pay in the emergency room, etc. But to me this is another one of those cases where poor government policy boosts prices. Hospitals already have an incentive to buy up small practices to reduce competition, but if hospitals are paid double the price for the same procedure compared to an ambulatory clinic, the government is just incentivizing concentration in the market.

react_burger38 5y ago

Another thing the US could do to reduce prices is to give people the option for certain expensive procedures (hip transplants, knee replacements, etc.) to be done outside the US by qualified doctors. Then the patient could get a discount on their insurance every month or get an incentive from medicare that splits the savings with the patient.