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The Moratorium on US Medical School Enrollment from 1980 to 2005 (2008)
- trynewideas 4y ago"In retrospect, we should have recognized that as the US population increases the number of US medical graduates should increase" is an all-timer.
- ssklash 4y agoI think the problem is not that they didn't recognize this fact, but that they intentionally ignored it in order to maintain an artificial scarcity of physicians, thereby ensuring higher wages.
- wolverine876 4y agoDid it say that in the article? I didn't see it. Is there evidence of that?
- darth_avocado 4y agoIs there another reason why having a surplus of doctors a problem?
- mbg721 4y agoIsn't "the existing doctors would be displeased" reason enough?
- wolverine876 4y agoThere are many possible reasons. Do you want to seriously explore them?
- noyoudumbdolt 4y agoIt’s pretty obvious why the doctor’s guild would prevent more medical school spots from being available.
- wolverine876 4y ago> It’s pretty obvious why ... That's never evidence and a well-labeled gateway to our own fallacy. There's a reason serious examination of an issue requires factual evidence in any field, from medicine to law to science, etc. IME, in areas I lack expertise, the truth is usually intuitive but an unexpected intuition. The only solution, the only source of truth, is evidence. Do I need to say this on HN? Sadly, it seems like it.
- noyoudumbdolt 4y agoThis is how every guild in history has operated. Every profession when it controls the supply of its own members seeks to limit it. The AMA can only furnish the weakest of excuses for this practice. They say it has to do with federal funding for residency programs. But there's no reason for residency programs to need federal funding at all. They generate more value for hospitals than they cost to run.
- wolverine876 4y agoThere's a reason evidence, not fact-free theories, is required. But now I see the name of your throwaway account. It's sad that you can't talk to other people respectfully.
- noyoudumbdolt 4y ago:'(
- lazide 4y agoI would hope they’d be smart enough to not write it down if they did.
- strawhatguy 4y agoIt didn’t no, but that’s the effect, and why it was so slow to change: the existing members benefited.
- wolverine876 4y agoIt's an hypothesis that's worth exploring because of the apparent effect you point out, which is I think is fact. Based on this discussion, I suspect nobody here knows any evidence. The very sad and dangerous issue is, they don't seem to care or grasp the fallibility of their subjective judgment. Some even turn to ridicule as an argument, which of course is irrelevant and obstructs the search for truth. Without truth, we are doomed. We only spin our wheels, sometimes excitedly, sometimes frantically, sometimes confidently - but it's all a waste of time and labor. We go nowhere; we gain nothing; we are in the same place tomorrow as today (or we may go backward). We don't even know what problems there are or how to solve them. (The claim that existing members benefit also needs evidence: Existing members express feeling very overworked, which doesn't corroborate the claim, and most analyses I see say the the money is going to the insurance companies and the hospital owners and managment.)
- avmich 4y agoIt would be interesting to predict a surplus of software engineers and sharply raise the requirements for applicants to engineering departments. At least the prediction of surplus of VCs in all other countries except US seems to be working well. /s
- passwordoops 4y agoThis is a case where the act itself is evidence of the intent. I know how insulting this is, but asking this question implies either the one asking shouldn't participate in discussions of any kind, or is involved in the corruption
- downrightmike 4y agoThat there are thousands of graduated doctors that can't get residencies because they went to school in the Caribbean, needs to be resolved. Get them in residencies and we will be on an accelerated resolution path.
- maxerickson 4y agoThe way to do this is a modest hospital tax. That way the funding is scaled to the size of the industry without reevaluating it year to year.
- giantg2 4y agoWe already do this sort of thing via Medicare. It's simply underfunded. It seems it would be more effective to expanded and properly manage the existing tax than start a new one. In theory, this would scale well based on population.
- maxerickson 4y agoTaxing hospital revenues aligns the tax with what you want it to reduce. I suppose it would end up in healthcare organizations working to have care classified as non-hospital to avoid the tax.
- giantg2 4y agoHow would it reduce staffing shortages? Hospitals wouldn't care if they pass it on to patients. It would be cheaper to continue to understaff since they'd pay the tax either way.
- giantg2 4y agoEven many domestic doctors have had difficulty getting residencies due to the funding structure.
- greggarious 4y ago> "In retrospect, we should have recognized that as the US population increases the number of US medical graduates should increase" is an all-timer. Meanwhile, there's no cap on law admissions, leading to malignant narcissists who couldn't make it in the humanities doubling down on chasing losses and feeling entitled to grift the vulerable at the barrel of a gun because they made they are too ornery to get good tips if they work customer service and can't figure out a terminal prompt to save their life.
- avmich 4y agoInteresting that while US population increased over the last century, at least the percentage of agricultural workers actually sharply decreased. Somehow productivity among medical professionals - also taking into account increased demand - didn't increase fast enough to get to similar decreases of doctors per capita.
- Eisenstein 4y agoA more efficient plow can increase agricultural yields and a machine that can automatically core apples will remove the need for people to core the apples -- is there an equivalent for medical diagnostics?
- toast0 4y agoBetter tests and more access to diagnostic tools helps medical productivity to some degree, although unnecessary testing pushes the other way. And sometimes better diagnostics leads to more interventions which may mean more labor (and sometimes better outcomes too)
- maxerickson 4y agoWhen it works, imaging (x-ray, CT, MRI, etc.) is ridiculously effective. There's also stuff like figuring out that bacterial infections are a big contributing factor in ulcers. Once doctors believed it was true, interventions got a lot more effective.
- manholio 4y agoI always wondered: ok, the US medical system is atrociously expensive and inaccessible, but where does all that money go? Surely a surgery cannot really cost half a million dollars, can it? Well, when a large number of patients are effectively outbidding each other over an insufficient pool of medical professionals, then yes, it really can cost that much, not necessarily by making doctors absurdly rich (probably some of that too), but in the sense that price gouging structures will surely emerge to capture that surplus.
- kneebonian 4y agoDon't forget a large chunk of it is going to three or four layers of middlemen for everything that happens that need to get their cut.
- pixelmonkey 4y agoMost doctors aren't getting "absurdly rich" in medicine, at least not anymore, and certainly not by tech industry standards. (Source: I am a medspouse who works in tech outside of SV.) Most of the money is going to private insurance companies and their non-med staff, as well as hospital administrators.
- jbullock35 4y ago> Most doctors aren't getting "absurdly rich" in medicine, at least not anymore, and certainly not by tech industry standards. (Source: I am a medspouse.) "Absurdly rich" is too vague to be meaningful. But on average, in the United States, doctors are better-paid than those in the tech industry. And it is not a close call. See https://news.ycombinator.com/item?id=30047116 https://news.ycombinator.com/item?id=30047116 for links to tables from the Bureau of Labor Statistics. At Hacker News, we may overestimate tech salaries (thinking too much of FAANG salaries, for example). And like most Americans, we may underestimate doctors' wages.
- throwaway6734 4y agoNot to mention that doctors are paid in cash and not stock
- classichasclass 4y agoTook me three years to get in. Great MCATs (if I do say so myself) but screwed around my freshman year in undergrad and paid dearly for it on my GPA. In the end it was a professor I was doing research work for who knew the dean of admissions at the school that I eventually matriculated at, and put in a good word for me.
- greggarious 4y agoFun fact: Ted Bundy also compensated for GPA with recommendations.
- Eisenstein 4y agoIs that a joke? If it is I don't get it. If it isn't I don't understand what the relevance is, since Ted Bundy was never to my knowledge in medical school.
- greggarious 4y agoI thought they’re both terminal degrees with legal power over others? He was most certainly physically inside one at points ;-) Edit: I guess a form of a joke, but more of a funny fact
- zahma 4y agoI feel that. As someone who’s going back to med school well out of undergrad, I have no doubt that even with good MCAT scores, I’m still going to need to be lucky to find the right med school who will appreciate my atypical profile. I feel like I’m competing with teenage prodigies for coveted spots.
- classichasclass 4y agoThat's exactly whom you're competing with. The MCAT got me interviews in which the first question was, "what's up with your GPA?" Invariably I'd end up on the waiting list. This was in the late 1990s.
- lostlogin 4y agoWhy does osteopathy get a mention in this at all? Does anyone use them interchangeably?
- pixelmonkey 4y agoThis Wikipedia page will answer your question. It's specific to the US medical system: https://en.wikipedia.org/wiki/Comparison_of_MD_and_DO_in_the_United_States https://en.wikipedia.org/wiki/Comparison_of_MD_and_DO_in_the...
- lostlogin 4y agoThat was my first go to, followed by a search for evidence it ever works. The TLDR was that it’s showing promise that it might work for musculoskeletal pain. https://www.bmj.com/company/newsroom/promising-evidence-that-osteopathy-may-relieve-musculoskeletal-pain/ https://www.bmj.com/company/newsroom/promising-evidence-that...
- carbocation 4y agoRight, but what most DOs actually do is just practice regular medicine, not osteopathy. (At least, the ones I interact with at major medical centers.) Like, unless you looked at the degree, you wouldn't notice.
- chromatin 4y agoWell, if you read the article, osteopathic schools did not participate in the moratorium. SO, it seems like a pretty crucial distinction in the context of this article.
- lostlogin 4y ago> Well, if you read the article That’s how I knew they were mentioned. I have never know anyone who has been treated by an osteopath rather than a medical doctor (or whatever you call the conventional training). They are not equivalent in any of the medical systems I have been involved with.
- daveaiello 4y agoOne thing that appears to be unmentioned in this journal article is the explosion of nurse practitioners, physician assistants, and other medical professionals with "different" educational and training standards. The impact that these people have had on primary and specialty care disciplines in the United States is huge, with both good and bad implications for cost control and quality of care. One could argue that the explosion of nurse practitioners has had a greater recent impact in these fields than the near tripling of osteopathic medicine graduates over the 25 years covered in the article.
- kneebonian 4y agoThat's something interesting I've found over my much time sitting in hospitals. It seems like NPs are just Drs lite edition. But I question if we need all the training we currently have for doctors I remember reading a SSC article about how they don't require undergrad degrees in many countries and their drs. perform at the same levels. Seems like in the US we just brought in NPs to fill the gaps instead.
- darth_avocado 4y agoThe cost aspect is overblown. NPs and the other alphabet soup of primary care providers charge almost the same as an MD. And the quality of care isn’t the same. You end up getting the general “pop a Tylenol” or “I’ll give you a referral to a specialist” for the money you pay, which either makes the problems worse and/or expensive anyway.
- giantg2 4y agoI generally agree. There are some scenarios where NPs or PAs are useful. Some may even be good. My personal experience has found them lacking... multiple times. And the charge has been the same since the practice is the one billing and charges the same whether you see a doctor or other provider.
- darth_avocado 4y agoThat has been my experience too. The only time I book appointments with NPs is when I know I need a specialist and want to skip the whole dance of “let’s do some tests and then determine that you need a specialist who will order the same tests”. It’s a cheat code to get better healthcare by working with the system.
- SuperNinKenDo 4y agoAny time a professional class decides that there needs to be an urgent restriction of supply for their skillset, it should be treated with a kind of skepticism touching on scorn. I don't accept the mea culpa for stuff like this. The author even acknowledges that there were obvious signs that they were wrong, and yet they persisted for over 20 years. Who can imagine what incentive structure possibly led them to make this mistake? I guess it'll be one of life's persisting mysteries.
- ibeckermayer 4y agoBingo. The fact that the law even allows for such a protection racket is an indictment of the law.
- dsfyu404ed 4y agoWell of course they don't call it a protection racket or sandbagging supply when they're pitching it. They make vague statements about quality of work, safety, keeping "bad guys" out, etc. and YouPeople(TM) eat it up without the slightest thought about the tradeoffs because you like the face value of what you here.
- SuperNinKenDo 4y agoSame arguments that any trade guild makes, but most guilds were working- and middle-class affairs. The powers that be only seem to accept these arguments when they're made by the upper-crust of society. Like favours like and all that I suppose.
- dsfyu404ed 4y agoMost of the blue collar trades have been pretty successful getting their protectionist regulation passed.
- SuperNinKenDo 4y ago
- mistrial9 4y agoat least when the Doctors were really needed, the AMA Doctors were "safe and effective"
- betaby 4y agoSame in Canada. Most of provinces keep enrollment well below of the speed of the population growth.
- Eisenstein 4y agoThose curious, as I was, about what 'allopathic' and 'osteopathic' medicine are may benefit from this article: * https://en.wikipedia.org/wiki/Comparison_of_MD_and_DO_in_the_United_States https://en.wikipedia.org/wiki/Comparison_of_MD_and_DO_in_the... My takeaway is that they are essentially the same today, but there was a much larger difference decades ago, centering around the patient as a focus of medicine vs the treatment of illnesses. Corrections and clarifications welcome.
- classichasclass 4y agoThat's basically correct to a first approximation. Osteopathic schools do have some additional training in spinal manipulation as the article says but the curricula are now substantially identical otherwise and in the vast majority of states both have the same scope of practice. Relatively few DOs do spinal work anymore (none of the ones I know do, in fact), and even those that still offer it limit it to pain syndromes; compare with quack chiropracty. Some of us were MDs and some were DOs in residency and we were instructed and treated identically by our attendings.
- maxerickson 4y agoThis failure is 100% on the government. Regulators should expect the guild to act in their own interests. Ultimately, it's the government that makes it difficult to practice medicine without the correct credentials, for more or less good reason, which means that the government better make damn sure they don't screw it up. It's probably not particularly possible to force one of the private entities to do anything. It should be plenty possible to empower an additional private entity (or substitute a public one).
- dsfyu404ed 4y agoThe failure is on the people who don't harass their politicians and make noise when the politicians cave to the guilds' lobby. Seriously, try arguing against time consuming and expensive professional license requirements, let alone for relaxation of current requirements around here and see where it gets you. Your comments will be unwelcome if applied to any trade other than software. People very much buy into the various trade organization's marketing.
- giantg2 4y agoWouldn't the government failure be on the thing they fail to mention - funding for residencies?
- maxerickson 4y agoManufacturers don't rely on the government to train engineers. It's probably reasonable that the government is involved in funding the training of doctors (it's a huge payor), but it's certainly not the only potential mechanism.
- giantg2 4y ago"potential" It seems to be the primary mechanism currently. They've failed to significantly increase this funding and have earmarked a percentage of slots for foreign students.
- 4y ago
- Robotbeat 4y agoWe should import massive numbers of doctors from overseas with a streamlined short-term training program to get them up to speed with how things are done in the US. If existing graduates get mad about the recent surge of workers in their field pulling wages down, some student loan forgiveness can be done for recent graduates most affected and most indebted. Solve the problem with abundance.
- epicureanideal 4y agoThe UK has tried that with mixed results. Doctors who have trouble understanding their patients, sometimes falsified credentials bought from corrupt administration at home country universities, etc.
- funstuff007 4y ago> In retrospect, we should have recognized that as the US population increases the number of US medical graduates should increase. I suspect the same problem exists among elite-tier university enrollment sizes.
- Ekaros 4y agoHmm, not sure. Wouldn't it make more sense for number of elite-tier universities to change?
- funstuff007 4y agomaybe so. 30 years ago I don't think Northeastern would have been considered elite tier. But based on its current acceptance rates, it's getting pretty close.
- giantg2 4y agoDid I miss it or did this article not talk about the real issue - residency funding. Who cares if MDs are restricted if you can still graduate DOs? The bigger issue would be funding for residency and the new competition (if you can call it that when a % are earmarked for foreign students) of foreign students for the already tight budget.
- lr4444lr 4y agoUnbelievable that in this country we effectively let the medical union entirely gatekeep the qualifications to practice. It's a legally sanctioned cartel, and should be taken to task on RICO grounds.
- xyst 4y agohttps://www.popehat.com/2016/06/14/lawsplainer-its-not-rico-dammit/ https://www.popehat.com/2016/06/14/lawsplainer-its-not-rico-...
- giantg2 4y agoHow does your argument apply to DOs? My understanding is that this is only talking about MDs. Edit: why disagree? It seems to me the parent doesn't understand this topic as their argument does not make sense.
- AtlasBarfed 4y agoThere are four pigs at the trough of US healthcare. Insurance companies, drug/medical device makers, lawyers, and doctors/AMA. Here we have the AMA / profession of doctor restricting the supply for absolutely no good reason. Complicit in this? How many of the medical schools are state universities and receive federal funding for education AND via payment for services? Outrageous. I've personally worked for an insurance company, a device maker, and had a roommate that was a specialist doctor, so I have some familiarity of each of those three pigs. Insurance companies present low profitability to the stock market, but have GIGANTIC executive classes and executive compensation. The MBA class controls the profits there. Medical device/drug makers have both a gigantic MBA vampire caste, and device monopolies via patents and other tricks that produce their huge profitability and cost. Many of those companies were started by pure engineer/bioscience people in the beginning but long have been taken over by the MBA finance people and basically perform rent seeking and cartel economics. Medical providers in the US are so strongly incentivized towards specialization. Would you rather make 100,000$ as a vanilla doc, or 500-700,000 a year as a specialist? Yeah. The fourth, trial lawyers, seem to be the most hated, but I suspect it is the smallest of the four, but it is the one I have the least direct experience with. Of course, who's fault is the high cost of medical care? Point at the other three pigs at the trough. The only good news, and this is true of almost all policy in the US, is that there is opposition between the insurance providers to control costs, and the providers/drug companies to increase revenue. But insurance companies are on the forefront of denial of service to its customers (DEATH PANELS!!!!), as well as monopolization of local hospitals/facilities to increase their margins as well.
- dsfyu404ed 4y agoRegulators are the fifth pig. The amount of resources that flow and careers that exist to make sure all the paperwork involved in this bloated mess is filled out properly probably counts for at least as much as the lawyers.
- derbOac 4y agoHospital administration is increasingly the sixth. For profit hospitals drive up costs even holding everything else constant, and even for-profit management schemas and motives are trickling into nonprofit hospitals and clinics. Mergers are decreasing real choice in many areas as well.
- faangiq 4y agoLet’s hear about the moratorium on incompetent and corrupt hospital administrators.
- 3D25157725 4y agoFor any interested, here[1] is the late Milton Friedman's take on how we might protect against quacks, frauds, and snake-oil salesmen posing as doctors if government didn't step in to limit the supply of medical doctors in the name of quality control. I realize it's not exactly what the article is discussing, but it's certainly relevant for all the same reasons. This is during the Q&A of his lecture "The Economics of Medical Care", given to the very people who would most object to his ideas: [1] https://www.youtube.com/watch?v=rWlk9HreE7U&t=2279s https://www.youtube.com/watch?v=rWlk9HreE7U&t=2279s