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> The US pays about twice per nurse or doctor in the system, and part of that is because the US pays nearly twice for most skilled work. which is in turn becau

by paulmd 4y ago

> The US pays about twice per nurse or doctor in the system, and part of that is because the US pays nearly twice for most skilled work. which is in turn because in the US an average GP comes out of medical school with $200k-300k of student debt that has to have interest serviced and paid off within some 10-20 year timespan. That cost ultimately ends up being borne by the patient and their insurance. unfortunately the US is very resistant to the idea of education reform in general, very very resistant to student debt relief, and very very very resistant to student debt relief for "high earners" like doctors and lawyers, even when a huge chunk of that earn is going to debt service. But there is a shortage of doctors and we're doing everything in our power to make the path unattractive for new students. And this time the problem isn't even the AMA - the AMA agrees there is a problem and is onboard with expanding the pipeline... it's just not all that attractive a profession anymore when you can make equal/higher compensation (after considering the debt) in software or other fields. doctors are still extremely well-paid professionals in other countries, but if we tackle the cost of education we can get our numbers down much closer to theirs. conversely if you push salaries too low then servicing $200-300k of student debt won't be realistic and the path becomes even less attractive. medical care is probably the single most complex political problem in the US because it's basically at the nexus of every single social and political problem we have. doctors are too expensive... because they're trucking around a quarter million of student loan debt from our shitty education system. we spend way too much on end-of-life care and not enough on earlier care... because seniors vote. we have way too much overhead due to the multi-payer insurance system and the market-driven pricing system's overheads... and all those insurance companies are huge lobbyists too. Drug and device costs are out of control... because the US doesn't allow conditioning of regulatory approval on price negotiations, or reimportation from other countries, etc. It's just every single political problem in the US in a single field all at once and every hand is dipping into the till as much as they can get away with, and it's politically infeasible to slap the hands that are necessary to slap to actually get costs reduced.

jahewson 4y ago
A debt of 1 to 1.5 years salary does not go very far to explain why US doctors are paid double what they would be in other countries. The US brought this problem upon itself by cutting medical school funding in the 1980s to reduce the number of doctors and keep salaries high. That situation remained until 2005. Now we have too few doctors, too few schools, and a generation that grabbed all the money for themselves and is now retiring.
- galangalalgol 4y ago
  My understanding is that the largest portion of the discrepancy with other nations is the price of facilities. And that those facilities cost much more at non-profit hospitals (which is most of them). The hypothesis is that administration compensation is proportional to procedures performed, but money taken in can't be kept, so it is pumped back into facilities perpetuating the cycle.
QuarterReptile 4y ago
>the US is very resistant to the idea of education reform in general, I suspect almost all Americans are interested in education reform, but are split between two opposing directions: getting rid of nondischargeable, subsidized federal loans; or making the whole thing run on federal money.
ceeplusplus 4y ago
Probably because the people pushing for free college etc tend to be ones studying the humanities, which gives people a bad impression of the whole thing. People make fun of Fox News touting lesbian dance studies majors, but the reality is most people don't support funding your bullshit gender studies degree with their tax dollars. > the AMA agrees there is a problem and is onboard with expanding the pipeline Oh come on, they could start by accepting everyone with a 3.5+ and decent MCAT instead of requiring that you have a 3.95, volunteering experience, clinical experience, and near perfect MCATs. The path is unattractive because it's filled with bullshit requirements that don't matter. On top of this most med schools discriminate against their largest pool of potential top students: Asians. It's well known if you're Asian you need much higher MCATs and GPA to get into med school. How many people have been pushed out of considering medicine because of this?
- ejb999 4y ago
  >>Oh come on, they could start by accepting everyone with a 3.5+ and decent MCAT instead of requiring that you have a 3.95, volunteering experience, clinical experience, and near perfect MCATs. The path is unattractive because it's filled with bullshit requirements that don't matter. I for one am glad that it s hard for doctors to get into med school - allowing less qualified people to practice medicine sure doesn't sound like a recipe for good outcomes. As far as the non-academic 'bullshit requirements' as you put it, they matter - last thing you want is someone going to med school because they were above average smart, and there parents told them to goto med school (it happens) - much better to have people that have been in the trenches dealing with medical issues at some level who know what they are getting into - i.e. people who perhaps were a nurse first, or EMT or paramedic, or even a non-skilled person who provided personal care to dementia patients in nursing home - just being smart isn't enough to be a good doctor - doctors deal with a lot of things that most of society would find distasteful - better to weed out those folks before they ever set foot on campus taking up the slot of someone else that is more well rounded and proven they are not choosing medicine just because it pays well and their parents pushed them to it.
  - ceeplusplus 4y ago

by paulmd 4y ago

jahewson 4y ago

A debt of 1 to 1.5 years salary does not go very far to explain why US doctors are paid double what they would be in other countries. The US brought this problem upon itself by cutting medical school funding in the 1980s to reduce the number of doctors and keep salaries high. That situation remained until 2005. Now we have too few doctors, too few schools, and a generation that grabbed all the money for themselves and is now retiring.

galangalalgol 4y ago
My understanding is that the largest portion of the discrepancy with other nations is the price of facilities. And that those facilities cost much more at non-profit hospitals (which is most of them). The hypothesis is that administration compensation is proportional to procedures performed, but money taken in can't be kept, so it is pumped back into facilities perpetuating the cycle.

QuarterReptile 4y ago

>the US is very resistant to the idea of education reform in general, I suspect almost all Americans are interested in education reform, but are split between two opposing directions: getting rid of nondischargeable, subsidized federal loans; or making the whole thing run on federal money.

ceeplusplus 4y ago

Probably because the people pushing for free college etc tend to be ones studying the humanities, which gives people a bad impression of the whole thing. People make fun of Fox News touting lesbian dance studies majors, but the reality is most people don't support funding your bullshit gender studies degree with their tax dollars. > the AMA agrees there is a problem and is onboard with expanding the pipeline Oh come on, they could start by accepting everyone with a 3.5+ and decent MCAT instead of requiring that you have a 3.95, volunteering experience, clinical experience, and near perfect MCATs. The path is unattractive because it's filled with bullshit requirements that don't matter. On top of this most med schools discriminate against their largest pool of potential top students: Asians. It's well known if you're Asian you need much higher MCATs and GPA to get into med school. How many people have been pushed out of considering medicine because of this?

ejb999 4y ago
>>Oh come on, they could start by accepting everyone with a 3.5+ and decent MCAT instead of requiring that you have a 3.95, volunteering experience, clinical experience, and near perfect MCATs. The path is unattractive because it's filled with bullshit requirements that don't matter. I for one am glad that it s hard for doctors to get into med school - allowing less qualified people to practice medicine sure doesn't sound like a recipe for good outcomes. As far as the non-academic 'bullshit requirements' as you put it, they matter - last thing you want is someone going to med school because they were above average smart, and there parents told them to goto med school (it happens) - much better to have people that have been in the trenches dealing with medical issues at some level who know what they are getting into - i.e. people who perhaps were a nurse first, or EMT or paramedic, or even a non-skilled person who provided personal care to dementia patients in nursing home - just being smart isn't enough to be a good doctor - doctors deal with a lot of things that most of society would find distasteful - better to weed out those folks before they ever set foot on campus taking up the slot of someone else that is more well rounded and proven they are not choosing medicine just because it pays well and their parents pushed them to it.
- ceeplusplus 4y ago