5 ms·

It seems like we just need more doctors, no? The AMA is notorious for trying to limit the number of new doctors. They do that more than much of anything to do w

It seems like we just need more doctors, no? The AMA is notorious for trying to limit the number of new doctors. They do that more than much of anything to do with public health.

lotsofpulp 3y ago
Supposedly, AMA reversed course in 2019: https://www.ama-assn.org/press-center/press-releases/ama-fund-graduate-medical-education-address-physician-shortages https://www.ama-assn.org/press-center/press-releases/ama-fun... https://www.openhealthpolicy.com/p/medical-residency-slots-congress https://www.openhealthpolicy.com/p/medical-residency-slots-c... But don't know how much is talk versus walk. It is not clear to me why only the US Federal Congress can fund residencies. Surely, with how much doctors can earn, a private underwriter would be willing to finance a residency. https://www.washingtonian.com/2020/04/13/were-short-on-healthcare-workers-why-doesnt-the-u-s-just-make-more-doctors/ https://www.washingtonian.com/2020/04/13/were-short-on-healt...
- nradov 3y ago
  It's not just talk. In recent years the AMA has actively lobbied Congress to increase funding for residency programs (graduate medical education). Anyone can fund residencies. If a wealthy donor has enough money to spare, a teaching hospital would probably be willing to create an endowed residency slot in their name. And there is already some private funding, although it is a tiny fraction of Medicare funding. Commercial payers (medical insurers) also indirectly subsidize residencies by reimbursing teaching hospitals at higher rates than other facilities for the same procedures. None of the other major healthcare industry players have a direct incentive to fund residencies. https://www.chcf.org/wp-content/uploads/2018/08/GuideGraduateMedicalEducationFunding.pdf https://www.chcf.org/wp-content/uploads/2018/08/GuideGraduat...
screye 3y ago
> trying to That's an understatement. It is blatant and deliberate.
- danlugo92 3y ago
  Is it greed? Is it all doctos tacitly agreeing to this so they can get bigger paychecks?
  - whiterknight 3y ago
    Yes. They sign up for big salary at hospital where their schedule is managed for them.
  - givemeethekeys 3y ago
    The individual doctors don't have much choice when they're heavily indebted by the time they become doctors. We (the AMA?) regulate where a doctor gets their education in order to become a doctor. This gives schools a lot of power. It also gives hospitals a lot of power when those doctors work insane shifts during their rotations.
    - nradov 3y ago
      The AMA is only a private professional association. They have some political influence but no regulatory authority. Medical schools have to be accredited so that's one limiting factor. But the real bottleneck today is more lack of slots in graduate medical education (residency) programs. Every year there are some students who graduate with an MD but can't practice medicine because they don't get matched to a residency program. To expand the supply we have to start there. https://www.ama-assn.org/education/gme-funding/save-graduate-medical-education https://www.ama-assn.org/education/gme-funding/save-graduate...
      - givemeethekeys 3y ago
        Maybe they should be able to gain experience abroad towards their accreditation. Win win win. They get accredited. The country receiving them gets well-educated help. We end up with more doctors.
  - screye 3y ago
    If you scour my archives, I once made a heavily down voted post about how 'doctors were evil'. It was obviously meant to be provocative and tongue in cheek. But all medical boards are exclusively run by doctors, so you have to assign blame to the profession for doctor NIMBYism. Imo, it's another case of : "you can't get someone to understand something, if their wealth depends on them not understanding it."
whiterknight 3y ago
The problem is doctors are expensive so the management is economizing their time.
- tylerrobinson 3y ago
  You’re being downvoted because that’s baked into the parent comment; the suggested solution is to increase the supply of doctors.
  - whiterknight 3y ago
    The parent comment doesn’t state it explicitly, and suggests it’s the managements fault. One of the problems is that regulations require MD oversight but not necesssrily performing all operations. That’s a good thing but forces them into a role where they hover for a few minutes then get rushed to the next supervision activity. So there are lots of dials to play with in addition to supply.
- dillydogg 3y ago
  In my experience in the clinic, the attendings are spending an incredible amount of their time doing busywork required by management instead of actually caring for patients.
  - whiterknight 3y ago
    Interesting. If you had to weight it towards legal compliance or productivity surveillance which would you say?
    - dillydogg 3y ago
      Maybe letting them see patients? I feel like this is a false dichotomy. I guess legal compliance of I had to choose, so it wouldn't lead to insane numbers of patients per hour
      - whiterknight 3y ago
AtlasBarfed 3y ago
The AMA is one of the four pigs at the trough of US healthcare: 1) Insurance companies - extract profit from the usual insurance model applied to healthcare. 2) Drug/Device companies - extract maximum profit from patent monopolies, FDA regulatory capture, and marketing. 3) Malpractice lawyers - use regressive law precedent to maximize individual payout and lawyer billing to the detriment of everyone else 4) AMA/Providers - restrict supply, and maximize billing for services Really, none of these pigs have the interests of overall public health in mind: - Insurance companies are incentivized to maximize the cost of insurance and deny coverage as much as possible, like any insurance company vertical. Obviously this results in denial of care. However, an insurance company is motivated to reduce provider costs and possibly to incentivize preventative care. Insurance companies are also vertically integrating into owning provider facilities to solidify local monopolies (so people HAVE to use their insurance if they live in an area) and to be able to impose cost cuts to actual providers. - Drug/Device companies are incentivized to maximize the profits from 20 years of provided patent monopolies, often exploiting desperate people looking for relief from maladies, but the cost is usually beyond the ability of individuals to afford. Lawyers are incentivized to bill/get percentages of settlements and maximize awards of "damages" regardless of the overall impact to health services costs and the implicit denial of care that involves. However, these orgs, while generally not doing the core science of new treatment modalities (universities do that), they do help usher treatments through safety review. - Trial lawyers are incentivized to maximize their patient damages and billing, which obviously is transferred to higher costs for all. Lawyers are one of the few hammers to get insurance companies to properly pay out, keep hospitals from devolving into managerial corruption, and keep Drug/Device companies from fudging the numbers. - And the AMA/Providers are incentivized to maximize the billing for their services, overbill for often superfluous services, resist any intermediate level profession (Nurse Practitioners, etc) from devaluing their law-enforced professional monopoly, and incentivized to not address general health of patients but rather bill with expensive specialist care rather than help patients maintain wellness that averts serious illness. In my experience no provider ever cared about how much their services cost the patient, until it became apparent the patient could no longer pay. Then their economic awareness of the cost of care become VERY APPARENT. The AMA is criminally complicit in restricting supply of doctors, which it very well knows raises the cost of medical services and of course denies care to people on the aggregate. Each of the four pigs simply points to other pigs as someone to blame and lobbies with maximum force to prevent any threat to their gravy train. To address US healthcare costs will generally require all four pigs: a public insurance option (at a minimum). Reduce patent length or invalidate patents, and with cases like unpatented production that has been monopolized (epipen, insulin) enforce antitrust. Fix prices if necessary. Obviously trial lawyers awards should be capped. Finally, nurse practitioners and AI expert systems used to decrease costs, and supply of doctors increased vastly. Overall, government needs to address the total lack of preventative care.

It seems like we just need more doctors, no? The AMA is notorious for trying to limit the number of new doctors. They do that more than much of anything to do with public health.

lotsofpulp 3y ago

Supposedly, AMA reversed course in 2019: https://www.ama-assn.org/press-center/press-releases/ama-fund-graduate-medical-education-address-physician-shortages https://www.ama-assn.org/press-center/press-releases/ama-fun... https://www.openhealthpolicy.com/p/medical-residency-slots-congress https://www.openhealthpolicy.com/p/medical-residency-slots-c... But don't know how much is talk versus walk. It is not clear to me why only the US Federal Congress can fund residencies. Surely, with how much doctors can earn, a private underwriter would be willing to finance a residency. https://www.washingtonian.com/2020/04/13/were-short-on-healthcare-workers-why-doesnt-the-u-s-just-make-more-doctors/ https://www.washingtonian.com/2020/04/13/were-short-on-healt...

nradov 3y ago
It's not just talk. In recent years the AMA has actively lobbied Congress to increase funding for residency programs (graduate medical education). Anyone can fund residencies. If a wealthy donor has enough money to spare, a teaching hospital would probably be willing to create an endowed residency slot in their name. And there is already some private funding, although it is a tiny fraction of Medicare funding. Commercial payers (medical insurers) also indirectly subsidize residencies by reimbursing teaching hospitals at higher rates than other facilities for the same procedures. None of the other major healthcare industry players have a direct incentive to fund residencies. https://www.chcf.org/wp-content/uploads/2018/08/GuideGraduateMedicalEducationFunding.pdf https://www.chcf.org/wp-content/uploads/2018/08/GuideGraduat...

screye 3y ago

> trying to That's an understatement. It is blatant and deliberate.

danlugo92 3y ago
Is it greed? Is it all doctos tacitly agreeing to this so they can get bigger paychecks?
- whiterknight 3y ago
  Yes. They sign up for big salary at hospital where their schedule is managed for them.
- givemeethekeys 3y ago
  The individual doctors don't have much choice when they're heavily indebted by the time they become doctors. We (the AMA?) regulate where a doctor gets their education in order to become a doctor. This gives schools a lot of power. It also gives hospitals a lot of power when those doctors work insane shifts during their rotations.
  - nradov 3y ago
    The AMA is only a private professional association. They have some political influence but no regulatory authority. Medical schools have to be accredited so that's one limiting factor. But the real bottleneck today is more lack of slots in graduate medical education (residency) programs. Every year there are some students who graduate with an MD but can't practice medicine because they don't get matched to a residency program. To expand the supply we have to start there. https://www.ama-assn.org/education/gme-funding/save-graduate-medical-education https://www.ama-assn.org/education/gme-funding/save-graduate...
    - givemeethekeys 3y ago
      Maybe they should be able to gain experience abroad towards their accreditation. Win win win. They get accredited. The country receiving them gets well-educated help. We end up with more doctors.
- screye 3y ago
  If you scour my archives, I once made a heavily down voted post about how 'doctors were evil'. It was obviously meant to be provocative and tongue in cheek. But all medical boards are exclusively run by doctors, so you have to assign blame to the profession for doctor NIMBYism. Imo, it's another case of : "you can't get someone to understand something, if their wealth depends on them not understanding it."

whiterknight 3y ago

The problem is doctors are expensive so the management is economizing their time.

tylerrobinson 3y ago
You’re being downvoted because that’s baked into the parent comment; the suggested solution is to increase the supply of doctors.
- whiterknight 3y ago
  The parent comment doesn’t state it explicitly, and suggests it’s the managements fault. One of the problems is that regulations require MD oversight but not necesssrily performing all operations. That’s a good thing but forces them into a role where they hover for a few minutes then get rushed to the next supervision activity. So there are lots of dials to play with in addition to supply.
dillydogg 3y ago
In my experience in the clinic, the attendings are spending an incredible amount of their time doing busywork required by management instead of actually caring for patients.
- whiterknight 3y ago
  Interesting. If you had to weight it towards legal compliance or productivity surveillance which would you say?
  - dillydogg 3y ago
    Maybe letting them see patients? I feel like this is a false dichotomy. I guess legal compliance of I had to choose, so it wouldn't lead to insane numbers of patients per hour
    - whiterknight 3y ago

AtlasBarfed 3y ago

The AMA is one of the four pigs at the trough of US healthcare: 1) Insurance companies - extract profit from the usual insurance model applied to healthcare. 2) Drug/Device companies - extract maximum profit from patent monopolies, FDA regulatory capture, and marketing. 3) Malpractice lawyers - use regressive law precedent to maximize individual payout and lawyer billing to the detriment of everyone else 4) AMA/Providers - restrict supply, and maximize billing for services Really, none of these pigs have the interests of overall public health in mind: - Insurance companies are incentivized to maximize the cost of insurance and deny coverage as much as possible, like any insurance company vertical. Obviously this results in denial of care. However, an insurance company is motivated to reduce provider costs and possibly to incentivize preventative care. Insurance companies are also vertically integrating into owning provider facilities to solidify local monopolies (so people HAVE to use their insurance if they live in an area) and to be able to impose cost cuts to actual providers. - Drug/Device companies are incentivized to maximize the profits from 20 years of provided patent monopolies, often exploiting desperate people looking for relief from maladies, but the cost is usually beyond the ability of individuals to afford. Lawyers are incentivized to bill/get percentages of settlements and maximize awards of "damages" regardless of the overall impact to health services costs and the implicit denial of care that involves. However, these orgs, while generally not doing the core science of new treatment modalities (universities do that), they do help usher treatments through safety review. - Trial lawyers are incentivized to maximize their patient damages and billing, which obviously is transferred to higher costs for all. Lawyers are one of the few hammers to get insurance companies to properly pay out, keep hospitals from devolving into managerial corruption, and keep Drug/Device companies from fudging the numbers. - And the AMA/Providers are incentivized to maximize the billing for their services, overbill for often superfluous services, resist any intermediate level profession (Nurse Practitioners, etc) from devaluing their law-enforced professional monopoly, and incentivized to not address general health of patients but rather bill with expensive specialist care rather than help patients maintain wellness that averts serious illness. In my experience no provider ever cared about how much their services cost the patient, until it became apparent the patient could no longer pay. Then their economic awareness of the cost of care become VERY APPARENT. The AMA is criminally complicit in restricting supply of doctors, which it very well knows raises the cost of medical services and of course denies care to people on the aggregate. Each of the four pigs simply points to other pigs as someone to blame and lobbies with maximum force to prevent any threat to their gravy train. To address US healthcare costs will generally require all four pigs: a public insurance option (at a minimum). Reduce patent length or invalidate patents, and with cases like unpatented production that has been monopolized (epipen, insulin) enforce antitrust. Fix prices if necessary. Obviously trial lawyers awards should be capped. Finally, nurse practitioners and AI expert systems used to decrease costs, and supply of doctors increased vastly. Overall, government needs to address the total lack of preventative care.