3 ms·

> but to get more doctors Have you found that magic fountain of endless doctors?

uniqueuid 3y ago
Sure, it's very easy! Just do things that prevent burnout (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8834764/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8834764/) and the job gets more attractive, drawing more students and producing less attrition: - Valuing work gives meaning (money, appreciation) - Autonomy gives feeling of control - Managing burden prevents overwork, exhaustion and fatigue
- dirtyhippiefree 3y ago
  > Sure, it's very easy! I have issues when someone says a complicated issue can be solved easily…realistic expectations…
  - user_7832 3y ago
    The answers to some problems may be easy to know but difficult to implement, due to political/financial will etc. For eg we know how to reduce emissions, but it's still a challenge. In such cases advocacy and raising awareness can be helpful.
  - inglor_cz 3y ago
    "Easy to describe" is very different from "easy to do". It reminds me of the famous "just eat less and exercise more", the alleged simple solution to the global obesity epidemic.
- nradov 3y ago
  Sounds good, but healthcare already constitutes 17% of US GDP. And with an aging population, spending has been growing faster than the rate of inflation. Most of the funding ultimately comes from governments, self-insured employers, and individual patients. Those groups have no appetite for spending more. The bottleneck right now in producing more US physicians is lack of Medicare funding for residency slots (graduate medical education). Every year some students graduate from accredited medical schools with an MD but are unable to practice because they don't get matched to a residency program. Congress hasn't significantly increased funding in years. https://savegme.org/ https://savegme.org/
  - novok 3y ago
    The entire medicare residency slot system seems a bit self inflicted, why hasn't an alternative system popped up? Also this is a global problem, not just the USA. You look at videos of student doctors in the UK for example and there are similar abusive schedules. https://www.youtube.com/watch?v=KE1XwEMGm0I https://www.youtube.com/watch?v=KE1XwEMGm0I
    - kwhitefoot 3y ago
      Read Adam Kay's "This is going to hurt" [1]. It was made into a miniseries. I read the book and it was so horrifying that I couldn't face watching the dramatisation. It doesn't seem to be such a big problem here in Norway where things like working time directives are taken much more seriously. [1] https://en.wikipedia.org/wiki/This_Is_Going_to_Hurt https://en.wikipedia.org/wiki/This_Is_Going_to_Hurt
malux85 3y ago
Yeah it’s called correct incentives - I look at the over work, and insane stress levels that doctors suffer and I say “NO THANKS” I am definitely not the only one
WalterBright 3y ago
The AMA only allows a fixed number of seats in medical school. There also can be tiers of medical doctors. Most doctoring work is routine, and can be handled by a more of a medical tech.
- nradov 3y ago
  False. The AMA has no regulatory or accreditation authority over medical schools. Schools can admit as many students as they want. The bottleneck right now in producing more US physicians is lack of Medicare funding for residency slots (graduate medical education). Every year some students graduate from accredited medical schools with an MD but are unable to practice because they don't get matched to a residency program. Congress hasn't significantly increased funding in years. At one point the AMA did lobby Congress to limit the number of slots but they have since reversed that stance and are now lobbying for higher residency funding. https://savegme.org/ https://savegme.org/ There are already tiers of clinicians. Much routine care can be delivered by Physician Assistants or Nurse Practitioners working under a Physician's supervision. Specific limits on their services are set at the state level.
  - beau_g 3y ago
    Why do residency programs require subsidies, are resident doctors each a large net financial loss to a hospital? I can't think of many other career paths where someone out of school is so underprepared for the job that the business could not employ them without someone else footing the bill, doesn't seem like a reasonable system that will sustain itself in the long term. I suppose pilots are a bit like this but they typically take the financial risk on themselves to some degree or get the taxpayer funded training via the military.
    - nradov 3y ago
      Hospital accounting is always messy. There's no simple way to determine whether a particular program is profitable or not; it comes down to how the accountants allocate overhead costs. But the fact that publicly owned and non-profit teaching hospitals aren't voluntarily expanding their residency training programs is strong evidence that they operate at a loss. Very few other career paths have such an extensive body of knowledge, licensing requirements, and low tolerance for errors. Law is maybe a bit similar in that new associates in most firms are worse than useless, and training them sucks up a lot of time from senior associates and partners. But law firms aren't subject to price fixing, so they have more freedom to raise their rates in order to cover those costs.
yokaze 3y ago
That's a straw man. We do not need "endless doctors" just more (or some way to use them more efficiently). The number of doctors are limited by the pipeline to educate them. Most countries I know, the number of people admitted to study medicine exceeds the number people wanting to study medicine vastly exceeds the positions to do so, and admissions are highly competitive. To a point, I'd say, that it is becoming ridiculous. So, there is not a lack of people wanting to become doctors, but a lack of people allowed to even start to study to become one.
eviks 3y ago
If you didn't cut the "limits" from the quote, you might've found a hint on how to answer your question without any magic involved. For such a small profession the general talent pool is endless indeed unless you... limit

Sure, it's very easy! Just do things that prevent burnout (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8834764/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8834764/) and the job gets more attractive, drawing more students and producing less attrition: - Valuing work gives meaning (money, appreciation) - Autonomy gives feeling of control - Managing burden prevents overwork, exhaustion and fatigue

dirtyhippiefree 3y ago
> Sure, it's very easy! I have issues when someone says a complicated issue can be solved easily…realistic expectations…
- user_7832 3y ago
  The answers to some problems may be easy to know but difficult to implement, due to political/financial will etc. For eg we know how to reduce emissions, but it's still a challenge. In such cases advocacy and raising awareness can be helpful.
- inglor_cz 3y ago
  "Easy to describe" is very different from "easy to do". It reminds me of the famous "just eat less and exercise more", the alleged simple solution to the global obesity epidemic.
nradov 3y ago
Sounds good, but healthcare already constitutes 17% of US GDP. And with an aging population, spending has been growing faster than the rate of inflation. Most of the funding ultimately comes from governments, self-insured employers, and individual patients. Those groups have no appetite for spending more. The bottleneck right now in producing more US physicians is lack of Medicare funding for residency slots (graduate medical education). Every year some students graduate from accredited medical schools with an MD but are unable to practice because they don't get matched to a residency program. Congress hasn't significantly increased funding in years. https://savegme.org/ https://savegme.org/
- novok 3y ago
  The entire medicare residency slot system seems a bit self inflicted, why hasn't an alternative system popped up? Also this is a global problem, not just the USA. You look at videos of student doctors in the UK for example and there are similar abusive schedules. https://www.youtube.com/watch?v=KE1XwEMGm0I https://www.youtube.com/watch?v=KE1XwEMGm0I
  - kwhitefoot 3y ago
    Read Adam Kay's "This is going to hurt" [1]. It was made into a miniseries. I read the book and it was so horrifying that I couldn't face watching the dramatisation. It doesn't seem to be such a big problem here in Norway where things like working time directives are taken much more seriously. [1] https://en.wikipedia.org/wiki/This_Is_Going_to_Hurt https://en.wikipedia.org/wiki/This_Is_Going_to_Hurt

malux85 3y ago

Yeah it’s called correct incentives - I look at the over work, and insane stress levels that doctors suffer and I say “NO THANKS” I am definitely not the only one

WalterBright 3y ago

The AMA only allows a fixed number of seats in medical school. There also can be tiers of medical doctors. Most doctoring work is routine, and can be handled by a more of a medical tech.

nradov 3y ago
False. The AMA has no regulatory or accreditation authority over medical schools. Schools can admit as many students as they want. The bottleneck right now in producing more US physicians is lack of Medicare funding for residency slots (graduate medical education). Every year some students graduate from accredited medical schools with an MD but are unable to practice because they don't get matched to a residency program. Congress hasn't significantly increased funding in years. At one point the AMA did lobby Congress to limit the number of slots but they have since reversed that stance and are now lobbying for higher residency funding. https://savegme.org/ https://savegme.org/ There are already tiers of clinicians. Much routine care can be delivered by Physician Assistants or Nurse Practitioners working under a Physician's supervision. Specific limits on their services are set at the state level.
- beau_g 3y ago
  Why do residency programs require subsidies, are resident doctors each a large net financial loss to a hospital? I can't think of many other career paths where someone out of school is so underprepared for the job that the business could not employ them without someone else footing the bill, doesn't seem like a reasonable system that will sustain itself in the long term. I suppose pilots are a bit like this but they typically take the financial risk on themselves to some degree or get the taxpayer funded training via the military.
  - nradov 3y ago
    Hospital accounting is always messy. There's no simple way to determine whether a particular program is profitable or not; it comes down to how the accountants allocate overhead costs. But the fact that publicly owned and non-profit teaching hospitals aren't voluntarily expanding their residency training programs is strong evidence that they operate at a loss. Very few other career paths have such an extensive body of knowledge, licensing requirements, and low tolerance for errors. Law is maybe a bit similar in that new associates in most firms are worse than useless, and training them sucks up a lot of time from senior associates and partners. But law firms aren't subject to price fixing, so they have more freedom to raise their rates in order to cover those costs.

yokaze 3y ago

That's a straw man. We do not need "endless doctors" just more (or some way to use them more efficiently). The number of doctors are limited by the pipeline to educate them. Most countries I know, the number of people admitted to study medicine exceeds the number people wanting to study medicine vastly exceeds the positions to do so, and admissions are highly competitive. To a point, I'd say, that it is becoming ridiculous. So, there is not a lack of people wanting to become doctors, but a lack of people allowed to even start to study to become one.

eviks 3y ago

If you didn't cut the "limits" from the quote, you might've found a hint on how to answer your question without any magic involved. For such a small profession the general talent pool is endless indeed unless you... limit