5 ms·

The solution to difficulty booking doctors isn't to pontificate on how to allocate their time, the solution to difficulty booking doctors is to make more doctor

The solution to difficulty booking doctors isn't to pontificate on how to allocate their time, the solution to difficulty booking doctors is to make more doctors. There's lots of levers that could be pulled in the US. Cut down on undergraduate requirements, incentivize large health systems to fund more training (people like to complain that the federal government only funds a fixed number of residency slots, as if a trillion dollar industry is just absolutely helpless to do anything). Medical care suffers under the bizarre idea that central planning and capacity management will control costs. Meanwhile, costs are spiraling up and up and up. Train more doctors and all the stupid games being played to optimize their utilization start to go away, because it is less worth it when demand is less than supply.

NegativeLatency 4y ago
Just getting accepted to a medical school is pretty hard unless you’re amazing/very good at the tests. Had a cousin and a friend (both I would characterize as smart and hard working) take several years after undergrad and eventually “settle” for physicians assistant schools.
- j-bos 4y ago
  I personally want my doctors to be amazing and very good. For now tests are a fair proxy, it's the 8 years that seem ridiculous, esp when looking at non US countries.
  - ncallaway 4y ago
    > For now tests a a fair proxy for that Is it? Is there a study demonstrating the correlation to pre med test scores to patient outcomes?
    - j-bos 4y ago
      Personal intuition, feel free to dismiss.
      - NegativeLatency 4y ago
        I agree with your sentiment however it reminds me a lot of the leet code style interviews and all their downsides.
      - ncallaway 4y ago
        Makes sense, and seems like a sensible prior. It just strikes me as something that wouldn’t be particularly hard to answer with a detailed study, and probably is a pretty high value question to answer, so I wouldn’t be surprised if there was a study. Maybe I’ll poke around this weekend
  - lofatdairy 4y ago
    I would argue that having onerous tests are not a great proxy. Not only do they not necessarily measure how good a physician a student would be, but it also encourages undergraduates to intentionally enter easier/less rigorous coursework to focus more on the exam aspect (though GPA plays a large role as well). I'm sure a psych major may make a fine physician, but I don't want doctors to only be educated in a rather dubious field. If undergraduate education is only a stepping stone towards medicine, then just integrate medical education with undergraduate studies, rather than adding a ritualized acquisition of a bachelor's degree.
    - dogmatism 4y ago
      Nah, doesn't matter. There are still the pre-med requirements (organic chem etc -- recall recent bruhaha about that at ?NYU) that can't be sidestepped for easier courses
    - jmcgough 4y ago
      Everyone takes the same premed courses though, and you need to be able to teach yourself any MCAT content that wasn't covered by coursework. Sure people will game it, but it's your science GPA that counts, and having people from a diversity of backgrounds is a good thing.
      - deleted 4y ago
        [deleted]
spfzero 4y ago
I get what you're saying, but I don't think more doctors is the answer. Hospitals will only hire the absolute minimum number of doctors they can possibly get away with, other than the ones who actually bring in new business. This is the reason: as soon as the medical industry has established a consensus price for some procedure or other item of care, the hospital administration starts to work on figuring out how to do it for the least possible cost. The price has been set in stone, no need for further justification. Medicare or whoever WILL pay that much. The price is fixed so the only knob left to turn is cost, and cost will be reduced all the way down, until service is just above a level so poor that patients would decide to stay home.
- NegativeLatency 4y ago
  Possibly part of the problem then is having a for profit medical system?
ntonozzi 4y ago
.
- maxerickson 4y ago
  It's not illegal for other entities to fund residencies! I anticipated your argument in my other comment...
natosaichek 4y ago
Totally agree. Also, let people open more medical care facilities. Right now "Certificate of Need" legislation is killing lots of viable options for care _outside_ hospitals.
e40 4y ago
On why there are too few doctors: https://www.theatlantic.com/ideas/archive/2022/02/why-does-the-us-make-it-so-hard-to-be-a-doctor/622065/ https://www.theatlantic.com/ideas/archive/2022/02/why-does-t...
kudu 4y ago
> people like to complain that the federal government only funds a fixed number of residency slots, as if a trillion dollar industry is just absolutely helpless to do anything Agreed, but I would go further and say that if demand by students for the training provided by residency exceeds the demand by hospitals for the work provided by residents, I don't see why residents couldn't pay for their training just as they do for medical school. The whole "residency funding" thing seems like a red herring as an explanation. To be clear, I'm not saying that medical graduates should have to take on more debt to pay for residency, but rather that the reason this doesn't happen is not obvious according to typical economic reasoning.
- oaktrout 4y ago
  If you've spent on average ~200K for medical school, how willing will you be to pay to work for 3 to 8 more years before you get a paycheck? Resident doctors already make less than nurses with 4 year undergraduate degrees.
  - barry-cotter 4y ago
    So? People really, really want the prestige that goes with being a doctor. If they could pay for it they would. Physician compensation is heavily weighted towards middle and late career as it is and that hasn’t stopped people beating down the doors to get into medical school. Half the people who currently apply to medical school could look at how crap it is and decide not to and there would still be intense competition. The below article on how awful medicine and medical school are was written a decade ago and nothing has gotten better. People really like social status. https://jakeseliger.com/2012/10/20/why-you-should-become-a-nurse-or-physicians-assistant-instead-of-a-doctor-the-underrated-perils-of-medical-school/ https://jakeseliger.com/2012/10/20/why-you-should-become-a-n...
    - oaktrout 4y ago
      I know a lot of doctors and medical students, for the vast majority prestige is not a primary motivator, not sure why you think its the prestige motivating everyone. Knowing these people, I also get the feeling that if pay were worse / debt was higher they would have pursued alternate careers. If your goal is to make more physicians you don't want to make the job less desirable. There are already paid residency positions that go unfilled every year (not because there arent enough students, but because the students dont want them). I don't know why you think people would pursue positions that they have to pay for. To your other point on the intense competition: If half the people currently applying to medical school quit applying the quality of your average future doctor would drop.
deleted 4y ago
[deleted]
chromatin 4y ago
Although I agree with you on a distaste for the foolishness of central planning, lLet me provide an alternative perspective. A huge proportion of US physicians are already mediocre; a shocking number are bad. (Source: I am a physician.) Given this, I am concerned that further relaxation of standards in an effort to train more doctors won't lead to better outcomes.
- intelVISA 4y ago
  "But I want my doc to have a degree from medical school not some 3 month anatomy bootcamp..."
- toast0 4y ago
  > Given this, I am concerned that further relaxation of standards in an effort to train more doctors won't lead to better outcomes. The high standards certainly prevent people who are unable to meet the standars from practicing medicine, but they also prevent people who are able to but see the standards as unreasonably onerous and pursue something else. Some of those could have been great doctors but looked at the steps and said nope, I'm not going to go to med school, then hope I can get a residency, in which case I get to have a hellish schedule and little autonomy for at least three years, and then probably a hellish schedule and little autonomy for many more years.
- triceratops 4y ago
  Not making American doctors do 4-years of an undergraduate "premed" degree will not meaningfully lower standards. Nor will creating more residency slots. We don't need better outcomes. We will happily take the existing outcomes but cheaper.
  - cfu28 4y ago
    Is the point you're making here that removing the "premed" undergraduate degree (which doesn't exist) will somehow lead to reduced healthcare costs?
    - triceratops 4y ago

NegativeLatency 4y ago

Just getting accepted to a medical school is pretty hard unless you’re amazing/very good at the tests. Had a cousin and a friend (both I would characterize as smart and hard working) take several years after undergrad and eventually “settle” for physicians assistant schools.

j-bos 4y ago
I personally want my doctors to be amazing and very good. For now tests are a fair proxy, it's the 8 years that seem ridiculous, esp when looking at non US countries.
- ncallaway 4y ago
  > For now tests a a fair proxy for that Is it? Is there a study demonstrating the correlation to pre med test scores to patient outcomes?
  - j-bos 4y ago
    Personal intuition, feel free to dismiss.
    - NegativeLatency 4y ago
      I agree with your sentiment however it reminds me a lot of the leet code style interviews and all their downsides.
    - ncallaway 4y ago
      Makes sense, and seems like a sensible prior. It just strikes me as something that wouldn’t be particularly hard to answer with a detailed study, and probably is a pretty high value question to answer, so I wouldn’t be surprised if there was a study. Maybe I’ll poke around this weekend
- lofatdairy 4y ago
  I would argue that having onerous tests are not a great proxy. Not only do they not necessarily measure how good a physician a student would be, but it also encourages undergraduates to intentionally enter easier/less rigorous coursework to focus more on the exam aspect (though GPA plays a large role as well). I'm sure a psych major may make a fine physician, but I don't want doctors to only be educated in a rather dubious field. If undergraduate education is only a stepping stone towards medicine, then just integrate medical education with undergraduate studies, rather than adding a ritualized acquisition of a bachelor's degree.
  - dogmatism 4y ago
    Nah, doesn't matter. There are still the pre-med requirements (organic chem etc -- recall recent bruhaha about that at ?NYU) that can't be sidestepped for easier courses
  - jmcgough 4y ago
    Everyone takes the same premed courses though, and you need to be able to teach yourself any MCAT content that wasn't covered by coursework. Sure people will game it, but it's your science GPA that counts, and having people from a diversity of backgrounds is a good thing.
    - deleted 4y ago
      [deleted]

spfzero 4y ago

I get what you're saying, but I don't think more doctors is the answer. Hospitals will only hire the absolute minimum number of doctors they can possibly get away with, other than the ones who actually bring in new business. This is the reason: as soon as the medical industry has established a consensus price for some procedure or other item of care, the hospital administration starts to work on figuring out how to do it for the least possible cost. The price has been set in stone, no need for further justification. Medicare or whoever WILL pay that much. The price is fixed so the only knob left to turn is cost, and cost will be reduced all the way down, until service is just above a level so poor that patients would decide to stay home.

NegativeLatency 4y ago
Possibly part of the problem then is having a for profit medical system?

ntonozzi 4y ago

maxerickson 4y ago
It's not illegal for other entities to fund residencies! I anticipated your argument in my other comment...

natosaichek 4y ago

Totally agree. Also, let people open more medical care facilities. Right now "Certificate of Need" legislation is killing lots of viable options for care _outside_ hospitals.

e40 4y ago

On why there are too few doctors: https://www.theatlantic.com/ideas/archive/2022/02/why-does-the-us-make-it-so-hard-to-be-a-doctor/622065/ https://www.theatlantic.com/ideas/archive/2022/02/why-does-t...

kudu 4y ago

> people like to complain that the federal government only funds a fixed number of residency slots, as if a trillion dollar industry is just absolutely helpless to do anything Agreed, but I would go further and say that if demand by students for the training provided by residency exceeds the demand by hospitals for the work provided by residents, I don't see why residents couldn't pay for their training just as they do for medical school. The whole "residency funding" thing seems like a red herring as an explanation. To be clear, I'm not saying that medical graduates should have to take on more debt to pay for residency, but rather that the reason this doesn't happen is not obvious according to typical economic reasoning.

oaktrout 4y ago
If you've spent on average ~200K for medical school, how willing will you be to pay to work for 3 to 8 more years before you get a paycheck? Resident doctors already make less than nurses with 4 year undergraduate degrees.
- barry-cotter 4y ago
  So? People really, really want the prestige that goes with being a doctor. If they could pay for it they would. Physician compensation is heavily weighted towards middle and late career as it is and that hasn’t stopped people beating down the doors to get into medical school. Half the people who currently apply to medical school could look at how crap it is and decide not to and there would still be intense competition. The below article on how awful medicine and medical school are was written a decade ago and nothing has gotten better. People really like social status. https://jakeseliger.com/2012/10/20/why-you-should-become-a-nurse-or-physicians-assistant-instead-of-a-doctor-the-underrated-perils-of-medical-school/ https://jakeseliger.com/2012/10/20/why-you-should-become-a-n...
  - oaktrout 4y ago
    I know a lot of doctors and medical students, for the vast majority prestige is not a primary motivator, not sure why you think its the prestige motivating everyone. Knowing these people, I also get the feeling that if pay were worse / debt was higher they would have pursued alternate careers. If your goal is to make more physicians you don't want to make the job less desirable. There are already paid residency positions that go unfilled every year (not because there arent enough students, but because the students dont want them). I don't know why you think people would pursue positions that they have to pay for. To your other point on the intense competition: If half the people currently applying to medical school quit applying the quality of your average future doctor would drop.

deleted 4y ago

[deleted]

chromatin 4y ago

Although I agree with you on a distaste for the foolishness of central planning, lLet me provide an alternative perspective. A huge proportion of US physicians are already mediocre; a shocking number are bad. (Source: I am a physician.) Given this, I am concerned that further relaxation of standards in an effort to train more doctors won't lead to better outcomes.

intelVISA 4y ago
"But I want my doc to have a degree from medical school not some 3 month anatomy bootcamp..."
toast0 4y ago
> Given this, I am concerned that further relaxation of standards in an effort to train more doctors won't lead to better outcomes. The high standards certainly prevent people who are unable to meet the standars from practicing medicine, but they also prevent people who are able to but see the standards as unreasonably onerous and pursue something else. Some of those could have been great doctors but looked at the steps and said nope, I'm not going to go to med school, then hope I can get a residency, in which case I get to have a hellish schedule and little autonomy for at least three years, and then probably a hellish schedule and little autonomy for many more years.
triceratops 4y ago
Not making American doctors do 4-years of an undergraduate "premed" degree will not meaningfully lower standards. Nor will creating more residency slots. We don't need better outcomes. We will happily take the existing outcomes but cheaper.
- cfu28 4y ago
  Is the point you're making here that removing the "premed" undergraduate degree (which doesn't exist) will somehow lead to reduced healthcare costs?
  - triceratops 4y ago