7 ms·

"In 1997 federal funding for residencies was capped, forcing hospitals to either limit programmes or shoulder some of the financial burden of training their doc

• candiddevmike 3y ago
  This has led to is a rise in PAs and ARNPs for primary care, and scary things like CRNAs asking MDs for sign offs without a supervising anesthesiologist.
  • Empact 3y ago
    Is there a reason other than fear to think that CRNAs are ineffective at their jobs?
    • candiddevmike 3y ago
      They need a supervising physician, which should be an anesthesiologist. Surgical MDs do not have the same qualifications to sign off on their orders. The liability with CRNAs flows to the supervising physician, so most MDs tend to be very uncomfortable working with only CRNAs.
    • prh8 3y ago
      Not quite the question-- the real question is why would they be effective at the jobs of others? Doctors have 10-15 years of training, there's a reason for that.
• whaleofatw2022 3y ago
  My understanding is that at least at one point in the past the AMA lobbied either for the cap or to not fix the problem. Also inversely speaking, you don't really hear much about the AMA lobbying to -fix- the problem and given the frequency of this theory, you would think they would publicise it more. There is also the weird thing where, my understanding is that the hospitals can 'sell' the slots to each other and strangely they can fetch more than the funding in question. But really, so much of the medical residency industrial complex reminds me of a hazing ritual in and of itself.
  • 303uru 3y ago
    >reminds me of a hazing ritual in and of itself It's absolutely abusive and I cannot believe there's never been more of a push around patient advocacy. It's bad enough for the residents working 100 hours a week and getting fits of sleep in a shitty spare hospital room they share with multiple other residents. It's even worse for the patients receiving care from a tired, overworked resident.
    • phren0logy 3y ago
      There has been a push back, and hours are now capped well below 100 hours (maybe 60 hours a week now?) with limits on duration of shifts, also. When I trained the cap was 80 hours/week with a limit of 30 hours in a row.
      • 303uru 3y ago
        Where? I still see/hear of residents in the states working 80+. Many pulling 20-24 hours a day for 3 or more days a week, then additional coverage beyond that.
      • cpburns2009 3y ago
        The cap is still 80 hours/week. I'm not sure about the consecutive hour limit. It's at least 24 hours. That doesn't stop the residents I know from frequently having duty hour violations. In one case I know a resident had his hours manipulated by admin to under report them.
• klipt 3y ago
  Residency funding, and the fact that even fully trained foreign doctors have to redo residency to practice here. An American can marry a foreign doctor with 10 years experience, get their spouse a green card and everything, and they still can't work as a doctor without redoing residency like a fresh graduate.
  • willcipriano 3y ago
    Globalism for thee, protectionism for me.
    • moron4hire 3y ago
      That's not an example of globalism hypocrisy
      • willcipriano 3y ago
        Bring in foreign programmer: here's dozens of laws and programs to make that easy. Bring in foreign doctor: here's dozens of laws and programs to make that hard. Bring in foreign low skill labor: Laws? No human is illegal!
        • JumpCrisscross 3y ago
          Coding, farming and medicine have different stakes (in general). It makes sense to be pickier with the last than the first two.
          • willcipriano 3y ago
            Millions are protected to die simply due to lack of access to medical care. The doctors would have to be actively malicious to be worse than the alternative of no doctor.
            • JumpCrisscross 3y ago
• dublinben 3y ago
  Here's a recent report from the Congressional Research Service about this that provides a very detailed summary of how this works: https://crsreports.congress.gov/product/pdf/IF/IF10960 https://crsreports.congress.gov/product/pdf/IF/IF10960
• ejstronge 3y ago
  You are precisely correct - this is not an AMA issue. Funding for this is tied to Medicare/Medicaid and thus a political issue that does not turn based on what the AMA may request. In searching for the below table, it seems that there is some effort to use funds from other sources to pay for targeted slots[1] 1. https://www.aha.org/news/headline/2023-07-27-hhs-awards-15-grants-create-rural-medical-residency-programs https://www.aha.org/news/headline/2023-07-27-hhs-awards-15-g... Here's a breakdown for funding for one year in the recent past: https://www.ncbi.nlm.nih.gov/books/NBK248024/table/tab_3-1/?report=objectonly https://www.ncbi.nlm.nih.gov/books/NBK248024/table/tab_3-1/?...
  • idontpost 3y ago
    [dead]
• wombat-man 3y ago
  A former roommate of mine was a doctor in residency. They were paying him peanuts and grinding as much work out of him as they could. I think this was maybe 5 years ago and he was at 65k or so in a major metro in the US. So if you're a hospital, and you can get cheap doctors in residency who basically need to work whatever workload you give them, why wouldn't they hire as many of them as they could? I figure the limiting factor should be their ability to manage them, not federal funding. They are paying pennies on the dollar for doctor labor that they are NOT giving patients a discount on.
  • nradov 3y ago
    You figure wrong. Hospitals require residents to do a lot of work, but they can't bill Medicare/Medicaid or private insurers for much of that work. Hospitals can't afford to just hire more.
  • HDThoreaun 3y ago
    Residencies all lose money. That's why they're subsidized. My family member is a chair of a residency and the business analysts are constantly trying to close it because it takes time away from the doctors and doesn't provide anything to the bottom line.
    • wl 3y ago
      My partner did a second residency. Medicare doesn't fund second residencies, so she had to get an unfunded spot. At least with her second residency, they have those unfunded spots precisely because they're profitable. Maybe it's not all programs, but certainly some of them are profitable.
• s1artibartfast 3y ago
  It is the same issue. The AMA has lobbied to limit federal funding for medical residency. This is the bottleneck. The fundamental problem is that the US government should not be in the business of funding residencies to begin with. That should the on the hospitals. Right now the problem is that no hospitals want pay the 150k cost for residency when there is the option for the federal government or another hospital to pay it. It basically leads to a tragedy of the commons/prisoners dilemma, where all the hospitals defect and try to fight for limited grants. This article has some general details: https://thesheriffofsodium.com/2022/02/04/how-much-are-resident-physicians-worth/#:~:text=Governmental%20subsidies,additional%20revenue%20stream%3A%20governmental%20subsidies https://thesheriffofsodium.com/2022/02/04/how-much-are-resid....
  • ejstronge 3y ago
    Do you have evidence of this lobbying? It does not stand to reason, since care provided by residents is quite cheap to hospitals from the perspective of labor. Hospitals have no obligation to hire the residents they produce, so an optimal behavior would seem to be training many residents and not hiring them.
    • renewiltord 3y ago
      It's interesting how truth can disappear over time. They were out and proud about it back then. Here: https://www.washingtonpost.com/archive/politics/1997/03/09/rx-for-physician-glut-pay-hospitals-not-to-train-new-ones/f0514eed-3e43-4a19-8f09-6264acafd9a5/ https://www.washingtonpost.com/archive/politics/1997/03/09/r... > Last week a powerful coalition of medical groups, including the American Medical Association and the Association of American Medical Colleges -- the umbrella group for medical schools -- proposed their own plan. Their idea is to limit residency slots financed by Medicare to the number needed for the 17,000 annual graduates of U.S. medical schools. There's other things like this that folks say "Well, where's the evidence?" and the truth is that the evidence was all around us back then. Now that people have changed their minds on this stuff, it's harder to find as the perpetrators go quiet about it. And you have to search the past which isn't that easy. I'm sure the pandemic response will be similarly rewritten, especially the business about telling people masks don't work because they wanted to make sure that average people won't take masks that they wanted to keep for healthcare people. That's being rewritten in front of me to say "Oh there's no evidence that masks ever worked and that's why they said that". Where's the evidence? Well, in many cases, it was everywhere. Truth casts a small shadow on time. The motivated sceptic stands purely in the light.
• nonameiguess 3y ago
  Residents are still doing work. The notion that they should be federally-funded, rather than just getting paid for doing that work directly through the proceeds of whatever patients get charged for that work, seems dubious to me. I'd also be skeptical of a claim that available slots are more of a limiter compared to the fact that propective physicians are looking at 4 years of post-graduate education followed by 3-9 years of working 100 hour weeks for $30-40k a year before they can get licensed. I once considered becoming a doctor when I was still a teen, and I'm quite confident I could have gotten into medical school and qualified for a residency somewhere, but it was the decade of hazing while being paid like a ranch hand that dissuaded me.