4 ms·

Good point - I don't see why they're subsidized by the federal gvt at all, rather than the resident, the hospital, the AMA, etc.

by verteu 3y ago

whatshisface 3y ago
Med students don't have a lot of money, and hospitals are actually there (from their perspective, at least) to make money. The AMA doesn't have a lot of extra money either.
- bradleyjg 3y ago
  They don’t have a lot of money yet. They have a very high amount of lifetime earning potential compared to their peers in other countries (yes, even after debt service and malpractice insurance.)
  - esoleyman 3y ago
    Are you seriously asking residents to subsidize their own training working 60-80 hours a week [1] and being paid maybe $20-25/hr for 3-7 years while the hospitals make money from their services? If that were the case, then the only ones who would put up with such a system would be those who have rich families to back them up. I came from a blue collar background and my family could not help subsidize my training and I could not afford to live, make rent, or afford food if I had to pay for my training as well. There are so many other things that you are completely glossing over including annual income between generalists vs specialists, pediatricians vs non-pediatricians, reimbursement inequality from Medicare (has not kept up with inflation and is ~40% below inflation), Medicaid pays at best 10-15% on the dollar, and so on. American physicians also work almost teice as many hours as their European counterparts which would increase their incomes. [1] it’s considerably more because if you report it then the program can be in danger and lose its credentialing
    - tastyfreeze 3y ago
      > subsidize their own training working 60-80 hours a week [1] and being paid maybe $20-25/hr for 3-7 years while the hospitals make money from their services That sounds like an apprenticeship. Many other industries do exactly that. Why should doctors be different?
      - LunaSea 3y ago
        Because you don't work 60 to 80 hours a week during an apprenticeship.
        verteu 3y ago
        But why must medical residency require 60 to 80 hours per week of work? AFAICT, it's because residencies are competitive, because there aren't enough of them, because nobody wants to pay for them. (But you can't make them unpaid, because, by circular logic, they require 60 to 80 hours per week.) As an outsider, the whole system seems completely bizarre to me. > [AMA president] Dr. Richard Corlin has called for re-evaluation of the training process, declaring "We need to take a look again at the issue of why the resident is there."
        LunaSea 3y ago
        They don't but it's the current situation nonetheless because medical students are at the mercy of their resident doctors. If you don't do it, they will sack you, fail you or you won't find a job there.
        bradleyjg 3y ago
        It’s at the intersection of the medical cartel and the credential cartel. A giant pile of suck.
    - ElFitz 3y ago
      > American physicians also work almost teice as many hours as their European counterparts which would increase their incomes. I’d be curious as to where you got that. I was personally suprised to discover that in Germany, doctors in university hospitals can work up to 80 hours a week. https://www.sciencedirect.com/science/article/pii/S0168851023000568 https://www.sciencedirect.com/science/article/pii/S016885102... https://www.statista.com/statistics/1385440/physicians-work-hours-united-states/ https://www.statista.com/statistics/1385440/physicians-work-... https://medicalschoolexpert.co.uk/how-many-hours-do-doctors-work/ https://medicalschoolexpert.co.uk/how-many-hours-do-doctors-... https://www.theguardian.com/society/2019/jan/15/junior-doctors-working-past-shift-end-nhs-data-england https://www.theguardian.com/society/2019/jan/15/junior-docto... https://www.france24.com/en/france/20240219-france-s-foreign-doctors-suffer-insecurity-as-hospitals-struggle-to-stay-staffed https://www.france24.com/en/france/20240219-france-s-foreign... https://www.irdes.fr/EspaceAnglais/Publications/IrdesPublications/QES144.pdf https://www.irdes.fr/EspaceAnglais/Publications/IrdesPublica... https://facharztjetzt.de/24-7-guardians-unveiling-the-working-times-of-doctors-in-german-hospitals/ https://facharztjetzt.de/24-7-guardians-unveiling-the-workin...
- verteu 3y ago
  So hospitals won't pay to train their workforce because... they can save money by forcing Congress pay for it? > hospitals are actually there (from their perspective, at least) to make money Aren't most hospitals non-profit? (Disclaimer: These are genuine questions; I have very little knowledge of the medical system.)
  - HDThoreaun 3y ago
    > So hospitals won't pay to train their workforce because... they can save money by forcing Congress pay for it? They wont train their workforce because they would lose money doing it and can always hire people already trained. It's a tragedy of the commons which is why congress had to step in to subsidize. > Aren't most hospitals non-profit? Technically yes, but most are part of massive systems that are run by MBAs like traditional corporations.
  - me-vs-cat 3y ago
    >> hospitals are actually there (from their perspective, at least) to make money > Aren't most hospitals non-profit? "Non-profit" is not referring to how the company operates. "Non-profit" refers to the owners extracting profit. Of course there are extra pieces, such as regulated transparency, but "non-profit" as a category are not wholly the donation-supported organizations that first come to mind. In other words, if you are the owner of a successful non-profit, you'll have to simply pay yourself a market rate (TM) salary for such a successful executive as yourself. Instead of buying lavish Christmas presents like all those executives at greedy "profit" companies, your family members will only be able to get lucrative positions at your non-profit.

Good point - I don't see why they're subsidized by the federal gvt at all, rather than the resident, the hospital, the AMA, etc.

by verteu 3y ago

Good point - I don't see why they're subsidized by the federal gvt at all, rather than the resident, the hospital, the AMA, etc.

whatshisface 3y ago

Med students don't have a lot of money, and hospitals are actually there (from their perspective, at least) to make money. The AMA doesn't have a lot of extra money either.

bradleyjg 3y ago
They don’t have a lot of money yet. They have a very high amount of lifetime earning potential compared to their peers in other countries (yes, even after debt service and malpractice insurance.)
- esoleyman 3y ago
  Are you seriously asking residents to subsidize their own training working 60-80 hours a week [1] and being paid maybe $20-25/hr for 3-7 years while the hospitals make money from their services? If that were the case, then the only ones who would put up with such a system would be those who have rich families to back them up. I came from a blue collar background and my family could not help subsidize my training and I could not afford to live, make rent, or afford food if I had to pay for my training as well. There are so many other things that you are completely glossing over including annual income between generalists vs specialists, pediatricians vs non-pediatricians, reimbursement inequality from Medicare (has not kept up with inflation and is ~40% below inflation), Medicaid pays at best 10-15% on the dollar, and so on. American physicians also work almost teice as many hours as their European counterparts which would increase their incomes. [1] it’s considerably more because if you report it then the program can be in danger and lose its credentialing
  - tastyfreeze 3y ago
    > subsidize their own training working 60-80 hours a week [1] and being paid maybe $20-25/hr for 3-7 years while the hospitals make money from their services That sounds like an apprenticeship. Many other industries do exactly that. Why should doctors be different?
    - LunaSea 3y ago
      Because you don't work 60 to 80 hours a week during an apprenticeship.
      - verteu 3y ago
        But why must medical residency require 60 to 80 hours per week of work? AFAICT, it's because residencies are competitive, because there aren't enough of them, because nobody wants to pay for them. (But you can't make them unpaid, because, by circular logic, they require 60 to 80 hours per week.) As an outsider, the whole system seems completely bizarre to me. > [AMA president] Dr. Richard Corlin has called for re-evaluation of the training process, declaring "We need to take a look again at the issue of why the resident is there."
        LunaSea 3y ago
        They don't but it's the current situation nonetheless because medical students are at the mercy of their resident doctors. If you don't do it, they will sack you, fail you or you won't find a job there.
        bradleyjg 3y ago
        It’s at the intersection of the medical cartel and the credential cartel. A giant pile of suck.
  - ElFitz 3y ago
    > American physicians also work almost teice as many hours as their European counterparts which would increase their incomes. I’d be curious as to where you got that. I was personally suprised to discover that in Germany, doctors in university hospitals can work up to 80 hours a week. https://www.sciencedirect.com/science/article/pii/S0168851023000568 https://www.sciencedirect.com/science/article/pii/S016885102... https://www.statista.com/statistics/1385440/physicians-work-hours-united-states/ https://www.statista.com/statistics/1385440/physicians-work-... https://medicalschoolexpert.co.uk/how-many-hours-do-doctors-work/ https://medicalschoolexpert.co.uk/how-many-hours-do-doctors-... https://www.theguardian.com/society/2019/jan/15/junior-doctors-working-past-shift-end-nhs-data-england https://www.theguardian.com/society/2019/jan/15/junior-docto... https://www.france24.com/en/france/20240219-france-s-foreign-doctors-suffer-insecurity-as-hospitals-struggle-to-stay-staffed https://www.france24.com/en/france/20240219-france-s-foreign... https://www.irdes.fr/EspaceAnglais/Publications/IrdesPublications/QES144.pdf https://www.irdes.fr/EspaceAnglais/Publications/IrdesPublica... https://facharztjetzt.de/24-7-guardians-unveiling-the-working-times-of-doctors-in-german-hospitals/ https://facharztjetzt.de/24-7-guardians-unveiling-the-workin...
verteu 3y ago
So hospitals won't pay to train their workforce because... they can save money by forcing Congress pay for it? > hospitals are actually there (from their perspective, at least) to make money Aren't most hospitals non-profit? (Disclaimer: These are genuine questions; I have very little knowledge of the medical system.)
- HDThoreaun 3y ago
  > So hospitals won't pay to train their workforce because... they can save money by forcing Congress pay for it? They wont train their workforce because they would lose money doing it and can always hire people already trained. It's a tragedy of the commons which is why congress had to step in to subsidize. > Aren't most hospitals non-profit? Technically yes, but most are part of massive systems that are run by MBAs like traditional corporations.
- me-vs-cat 3y ago
  >> hospitals are actually there (from their perspective, at least) to make money > Aren't most hospitals non-profit? "Non-profit" is not referring to how the company operates. "Non-profit" refers to the owners extracting profit. Of course there are extra pieces, such as regulated transparency, but "non-profit" as a category are not wholly the donation-supported organizations that first come to mind. In other words, if you are the owner of a successful non-profit, you'll have to simply pay yourself a market rate (TM) salary for such a successful executive as yourself. Instead of buying lavish Christmas presents like all those executives at greedy "profit" companies, your family members will only be able to get lucrative positions at your non-profit.