35 ms·

Something I've never quite understood is why, in the UK, we cap the number of medical students per year. I've known very bright people who aspired to be doctors

• 2143 2y ago
  When I was studying in the US, my roommate was studying to become a "physician assistant" — a concept I think is brilliant. I don't think there's anything similar in my own country. But I was wondering if more physician assistants would help the doctors. Maybe they could take care of the paperwork and all those things as well.
• kvonhorn 2y ago
  Supply and demand. If you artificially cap the supply of doctors, then the doctors can ramp up their prices.
  • KittenInABox 2y ago
    I don't even think doctors want the cap, tbh. Your average emergency physician would take all the qualified help they can get.
    • lazyasciiart 2y ago
      Yes, but how many residents can each emergency physician train at once? Doctors are similar to apprentices for the last part of their training.
  • hollerith 2y ago
    That explains why doctors like the status quo. Insurers like it, too, because expensive tests and expensive procedures must be ordered by a doctor (at least if insurance is going to pay for it) and if the patient gives up on getting in to see a doctor, then the insurer does not need to pay for the expensive test or expensive procedure. In the US, employers like it, too, because they end up paying the insurance premiums for their employees.
    • tmpz22 2y ago
      And the schools prefer it (at least in the US) - limited highly paid doctors means they can charge exorbitant tuition.
      • ejstronge 2y ago
        > And the schools prefer it (at least in the US) - limited highly paid doctors means they can charge exorbitant tuition. What's the evidence for your position? Researchers who study this question have shown that the cost of medical education is significantly higher than the price assessed to students. In other words, having more medical students would cost schools money.
      • hollerith 2y ago
        I would've thought that the medical schools care about revenue, which is course can be increased both by raising tuition and by increase number of students.
  • abyssin 2y ago
    There is an article in Le Monde diplomatique of February 2024 that briefly tells the story of the first numerus closus in France in the sixties.
  • bsdz 2y ago
    Perhaps there's a little of that going on here in the UK. Doctors can certainly command a decent salary especially if they specialise, run private clinics etc. That said, I feel it's probably more complicated than that. Each place costs approx £230k (only £65k paid by student by way of loans). This means increasing supply is a costly endeavour. The government also says that they wish to maintain teaching and learning standards; although, I don't really buy that part.
    • tim333 2y ago
      Of course the UK government can avoid the training cost by hiring foreigners. From my personal experience maybe half the NHS doctors are from overseas.
      • jetbooster 2y ago
        Thank goodness we didn't make some insane political move that makes that harder then!
  • truculent 2y ago
    I'm not sure this really stands up in a UK context: https://www.nuffieldtrust.org.uk/sites/default/files/styles/og_image/public/2022-12/microsoftteams-image-10-.png?itok=yEiPoIby https://www.nuffieldtrust.org.uk/sites/default/files/styles/...
    • randomdata 2y ago
      Like he said, supply and demand. You are still at the mercy of what the customer is willing to pay. The customer will not pay an infinite amount, even for healthcare services. But it is undeniable that doctors are paid considerably more than most other jobs. This is why.
• nradov 2y ago
  Artificially limiting the supply of doctors is one way of rationing healthcare and holding down costs. Healthcare in the UK is largely funded through the NHS. Voters are already financially struggling and don't want to pay higher taxes. In some cases, even emergency patients are waiting hours in ambulances because hospitals are so overloaded. https://www.bbc.com/news/uk-england-cornwall-68171254 https://www.bbc.com/news/uk-england-cornwall-68171254
  • nextaccountic 2y ago
    Artificially limiting the supply of doctors drives the wages up. It's a common demand of doctors worldwide
    • refurb 2y ago
      Not if you're in the universal system where the government sets the payments. I do know that limiting the number of doctors is one of many mechanisms to limit healthcare spending. A doctor can only see so many patients in one day.
      • lesam 2y ago
        I’m in Canada. If there were enough doctors that doctor unemployment was 2%+, like a normal job, doctors here would get paid less. Also doctors might not burn themselves out working crazy hours. Instead, we have a dire shortage of doctors and people in government employed full time trying to recruit the limited supply. Doctors can’t move to the next hospital for more pay, but they can move to the next province, or to the US.
        • int_19h 2y ago
          Doesn't Canada (or maybe individual provinces) also have artificially imposed limits on how many new doctors there can be each year?
  • lolinder 2y ago
    This doesn't make a lot of sense as an explanation for the policy—if there were more doctors trained that doesn't require that they find jobs, but it does make it easier for hospitals to replace their doctors if and when they need to, and likely at a lower price. If healthcare costs were the reason I'd expect the government to cap the number of doctors they employ now, not try to guess how many doctors they'll wish they could employ in six years.
• paxys 2y ago
  Because doctors' associations and regulatory bodies (like AAMC in the US) lobby to keep it that way to keep the value of their profession up.
  • dmead 2y ago
    And then make young residents work themselves to death.
  • ejstronge 2y ago
    > Because doctors' associations and regulatory bodies (like AAMC in the US) lobby to keep it that way to keep the value of their profession up. This isn't true of the AAMC position in the US today, and when it was true in the 90s, there were many articles about an upcoming oversupply of physicians. First, US medical school graduating classes are smaller in number than the number of available residency positions. So every year, the US is importing physicians trained in other countries. Next, residency positions (required to practice in the US) are funded by the US government. You could readily contact your US representatives about the problem you perceive - if this a legitimate concern for you. Additionally, US residency positions don't need to be funded by any government body, at all! Hospitals need 'simply' show that there is enough patient volume to support educating additional residents. This is another avenue where you can intervene, if this is indeed something you care about. Lastly, 'advanced practice providers' are filling in large amounts of the deficits in physicians in primary care providers. So focusing on the number of physicians is to ignore the huge growth of NPs and PAs - some of whom can function without a physician in some parts of their practice. I see many people blame 'the AAMC' for healthcare problems, but worry that not many appreciate the lack of a role the AAMC plays in the number of providers in America.
    • paulddraper 2y ago
      When was the over supply.
      • ejstronge 2y ago
        > When was the over supply. A google search for '1990s physician oversupply' will give you many articles, like this one: https://www.bmj.com/content/312/7026/269.1 https://www.bmj.com/content/312/7026/269.1
• dogmatism 2y ago
  NHS is in a process of replacing doctors with physician assistants
• dzink 2y ago
  The training of each doctor takes a lot of resources, especially specific numbers of cases necessary for each of the specialists who do surgery of any kind. If a surgeon does not do a procedure on a regular basis they lose skill in it and the less practice a doctor has had in a field, the worse their outcomes. So if you get 10 whipples in a year in an area and you have too many surgeons or hospitals taking less than 1 per year, without one getting more than a number of cases a year, all of them will be bad and your mortality will be high.
• arp242 2y ago
  Your own link contains your answer: > Expanding the cap on medical and dental school places is complicated by the cost of training, current university and clinical placement capacity, and the current number of clinically qualified academic staff who design and deliver courses. Furthermore, the NHS actually needs the funds to hire staff. The core problem is that people are getting older with more complex health care requirements, that more and more conditions become treatable, that healthcare is often expensive, and that no one wants to pay for it.
  • bsdz 2y ago
    I don't really feel it does. Sure I can see the costs involved complicate things. However, doubling the cap will likely introduce some economies of scale, surely that would reduce training costs. Also capacity would grow to meet training demand; Universities are always keen for more students. Also increasing the working pool will ultimately lead to more "clinically qualified academic staff". All this might become irrelevant with technology replacing GPs/Physicians. Perhaps in 10 years time we'll be examined by robots at our local pharmacy.
    • arp242 2y ago
      > All this might become irrelevant with technology replacing GPs/Physicians. Perhaps in 10 years time we'll be examined by robots at our local pharmacy. lolno. Aside from the fact that AI is nowhere near good enough, we can't really build robots anywhere close to the dexterity required to do many of the physical actions. Also people like having human contact. "Economies of scale" only works well for things like manufacture, and is much more limited for many other things. It certainly doesn't reduce the cost of actually paying a yearly salary to these people, or ensuring you have enough places (hospitals) for the to work at, which isn't cheap either. There are some small advantages one can take here on there, but in general, it scales fairly linearly. This is not just me saying that, your own link, again, says that. Training 10 junior devs really is about 10 times as much work as training 1. Maybe slightly less because you can group some things, but not too much. And training 20 junior devs is about twice as much work as training 10. It really is just a funding issue – which is what everyone has been saying for years. Labour wants to increase spots by abolishing non-doms – we'll see if that works when they win the election. Otherwise feel free to stand for election and propose the n% tax hike required for all of this and see how well that goes.
• rr808 2y ago
  An associated problem is that bright people from rural or poor areas who are really passionate about being a doctor dont get the right grades to get in. Middle class kids in cities get in because its a good career but dont really like it that much and definitely dont want to work outside their city. My brother worked as a doctor until his thirties then quit, such a waste of training.
  • space_oddity 2y ago
    If I think about it.. it's unfortunate that access to medical education and careers can be limited by factors such as socioeconomic background or geographical location... If I understand correctly
  • jajko 2y ago
    In Switzerland, at least for the french part, most of the doctors are not Swiss anymore. It literally became white collar immigrant job. Wife is one of those and sees the problem very clearly due to speaking about this with both (those few) swiss colleagues and the rest - its simply not attractive career path for locals, too much suffering and risk for relatively little reward. Those bright enough go to law, IT and similar. Speaking for my wife, she had to wade through absolutely brutal first 10 years for absolutely no good reason (she ain't no neurosurgeon, just internal medicine GP with FMH), no personal life at all at the prime of her life. 50 work week in contract (when average here is 42), reality with all required bureaucracy goes to 60-70, for everybody, consistently, unpaid (illegal here but who cares, state owns the hospital), often much more and catching up with tons of bureaucracy/billing at home. Add night shifts, which most of us elsewhere have no experience with, that mess you up for many further days. You are a fraction of yourself, mentally and physically, for easily a week, more if you had to go through say 4-5 in a row. These are the conditions that we put repeatedly people who have full control over life and death and health of their patients, often without further supervision, hoping they somehow magically never ever make a mistake, and when they do, folks immediately cry a murder and families sue to hell with massive dollar signs in their eyes. You complain about that, or that you spend whole weekend being on call 48h unable to do anything really for literally 20 USD altogether (price of a canteen lunch here), including when you have to come and work 10-hour shift? You are put under pressure, shushed for being a pussy if you complain, told to toughen up since previous generations had it even tougher, and they somehow got through. Nobody mentions how horrible parents those absent folks were, how burned out they often were, quietly weeping or drinking themselves into oblivion. Well yes, those that didn't just quit, didn't go insane, didn't commit suicide, sure they got through. And now enjoy seeing young going through a bit milder version of the same. Of course there are insane amounts of money involved, but its always between insurance and hospital, doctors get less than capable IT folks for much less work. I am IT guy and consider this utterly fucked up wrong. A good friend of ours sued the hospital (biggest public in Switzerland) for breaking basic Swiss law consistently like that, he was first but quickly gathered tons of other doctors. IIRC hospital finally caved in, a bit, but he is gone from it for good to private sector. Twice the pay, half the crap. I could go on and on like this, a lot of doctor friends in our circles. It ain't some dream job, (at least a bit well-placed) IT job is a blessing in comparison. /rant
• disambiguation 2y ago
  idk why doesn't my startup hire twice as many people? wouldn't we get the work done twice as fast and make twice as much money?
  • hazbot 2y ago
    With doctors you can parallelize treating different patients pretty easily.
• gravescale 2y ago
  Training places are already rammed to the gills, there aren't enough places to put substantially more students. Junior doctors already have to compete to get training slots even vaguely where they live and if they miss that they simply have to physically move to a different city. Medical training isn't as simple as just adding a lecture theatre and a few classrooms, or even a whole university building faculty of lecturers and admin. You also need a hospital (and GP surgeries etc) to be attached as well as enough senior staff to train them when they are there. That training is very intensive on trainer:trainee ratios and the senior staff are also in critically short supply as the ones who were trained up when there was training capacity (which, to be fair, was a time when it was far cheaper to train a medical student), are retiring by the thousands and many newer junior doctors quit or emigrate as a result of their experiences up to that point. Hospitals cost absurdly large amounts of money, especially in the UK where there are consultancies and layers of subcontracting for everything. So the infrastructure costs of adding even a few hundred student places is astronomical. Due to strategic underinvestment (or ideological sabotage, or governance incompetence, depending on outlook) there is now a self-reinforcing problem: not enough hospitals and staff to train doctors to beef up existing hospital staffing or work in hypothetical new hospitals even if a money firehose was turned on. Rather than having a tall glass of concrete and doing the hard thing, which will still take decades to manifest, what the government is currently doing is a rerun of Healthcare Assistants where more care is delegated to much cheaper-to-train staff. Plus quite a bit of noise about "AI" bring used to allow them to sweat the asset of the staff they do have by, for example having one radiologist verifying AI findings rather than a pair-based system. Which will all work "kinda ok" and let them punt the problems at least into the next government's domain when they lose the next election and can spend 5 years screaming from the Opposition benches about the mess. But you cannot do it forever (or the hail-Mary works, there's an AI revolution and you can actually run a hospital with an app, 2 agency nurses, a few smart plugs and an AWS instance). Of course "doing the hard thing" would be easy to say if it was just the NHS, but there's the same structural degradation in everything. So you also need to spend billions on education. That's the same general problem - shortage of facilities and not enough existing staff to train new staff and the ones you do train quit. Schools are currently one something like a near-500-year replacement rate (50 per year, 24000 total) and that's without considering population growth or even the hundreds of schools that need rebuilding because they're made of RAAC. Then roads need billions to repair the accumulating damage. The railways need huge investment and staffing. Energy is the same - virtually no supply of domestic nuclear design engineers mean they get absolutely rinsed on even squinting in the direction of a drawing of reactor (though Hinkley Point C cost spiral is currently EDF's problem, not the taxpayer and green energy is actually a rare success story). Defence is similar (e.g. ships being retired because they need the staff elsewhere). At least some water networks are collapsing into a multi-billion hole after private dividend extraction. So that money firehose has a lot of work to do, even if they would turn it on. Which is ideological poison apparently.
• catlikesshrimp 2y ago
  My life experience showed me that allowing more people in lead to less capable people in. Less capable students graduate as worse doctors. And doctors who came from more wealthy families usually do much better, regardless of their prowess. I won't go into details, it is unnecessary. The end result is that the health practice degrades overall, and social inequality strenghtens. I think nobody is happy with the former reason.
  • novok 2y ago
    The standards have gone up considerably compared to 20 years ago. I'd say return to the standards of 20-40 years ago at similar admission rates , remove leetcoding equivalents such as volunteering in Africa and A++ on organic chemistry (which you never use at an A++ level as a doctor) and everything will be just fine.
  • Anthony-G 2y ago
    I haven’t downvoted you but I’ve actually found the opposite to be the case. I’ve come across quite a few medical doctors who seem to lack the ability to listen to their patients – or the interest in investigating the cause of problems. I got the impression that they came from wealthy backgrounds and are the type of people who do well in exams and became doctors purely for the monetary return and social prestige. It’s disappointing to realise that I, as a system administrator, put more effort into investigating and solving IT problems for co-workers than some doctors put into investigating serious medical and health problems. On the other hand, I’ve met a few intelligent, gifted and empathetic people who really wanted to be doctors or nurses but weren’t so good at rote memorisation. As a result, they didn’t obtain the necessary “points” to get one of the very limited places in medical courses.
• JackeJR 2y ago
  one reason is to make sure that the best and brightest are distributed amongst different industries.
• raincole 2y ago
  In many countries they have a cap of the number of medical students. You might want to check what is happening in Korea rn.
• toldyouso2022 2y ago
  It's the same in the US, Italy, etc Doctors are a cartel receiving a monopoly from the State. That's all there is to it, really
  • trixjo 2y ago
    [dead]
  • Solvency 2y ago
    but.. why?
    • ketzo 2y ago
      It’s extremely beneficial to the people who are already doctors (dramatically increases salary, prestige, power), and that is a powerful group in most societies.
      • sslayer 2y ago
        Also, being a coveted occupation ensures that there will always be a pool of people fighting for it. Scarcity drives demand.
        • alfiedotwtf 2y ago
          Not always. If I sell garden gnomes wearing knitted hats, but I only make three a year and sell to only people who drive yellow cars, I doubt I could earn a decent living off this
          • bravura 2y ago
            Don’t be obtuse. You’re comparing garden gnomes with healthcare.
            • alfiedotwtf 2y ago
              I mentioned garden gnomes as an example of how supply side economics and “scarcity drives demand” doesn’t work.
• galahad_ 2y ago
  Because you can't just set a higher number of students per year, for more students you have to create more facilities first. It's not like IT, where you can learn everything pretty well basically just with a study program, books and online lectures. As a medical student you have to do a lot of practical stuff with things that you don't get at home.
  • smallmancontrov 2y ago
    Facilities can be built. Training programs can be expanded. Those are reasons why programs can't be doubled this year, but inside of a few years it's all possible. This problem has been cooking for decades. What actually happened was cartel shit. 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...
    • fasa99 2y ago
      I agree with this - in the US we have nurses picking up doctor roles (e.g. anesthesia), hours-worked caps, PAs (physician assistants) also picking up doctor roles, tons of international physicians coming for underserved specialities (family medicine, pediatrics, psych, etc). And of course, residents super overworked. I think it speaks for itself that making medicine 2x - 3x more people per year would help the problem. Yes, there's a "sweet spot" where quality of doctors would drop, but there's also a sweet spot where services rendered drop due to overwork, and we're on the far side of that one
      • smallmancontrov 2y ago
        Yep, and it'll get worse before it gets better. The boomer wave will (continue to) hit faster than we can grow the system. The best time to fix it was a decade ago when everyone saw it coming, but the second best time is now.
      • bts327 2y ago
        “…doctor roles (e.g. anesthesia)…” Anesthesia has primarily been a nursing role, and it’s been this way since the American civil war. Physicians didn’t really want any part of it early on as it wasn’t very prestigious or lucrative. Nurse anesthetists have historically provided and continue to provide the vast majority of anesthetics, in the US at least.
• neffy 2y ago
  I can't find anything to support this online, but I do distinctly remember reading once that the cap on medical student places goes back to the founding of the NHS and negotiations between the government and the BMA. (One of the issues at the time was persuading doctors to join the plan, and they were afraid of a drop in income). It's fairly trivial to analyse population vs. medical student places and see where the problem lies - there was an expansion in training places a few years ago, but it's a pipeline problem, and doesn't get fixed overnight. If somebody really wanted to fix things, there would probably need to be some kind of accelerated training of doctors and nurses for a few years.
• olivierduval 2y ago
  In France, like in others countries, we have the same kind of problem. So much actually that we "import" medics from other countries !!!! Lastly, the gov finally acknowledged the problem and tried to suppress the "numerus closus" (limiting the number of medecine students) but the problem is now that... there's - not enough teachers and not enough room in universities - not enough position in hospital for "internship" (not sure if it's the right word) because theses interns have to be managed by experienced medics - it takes a loooooong time to make a doctor - "young" doctors don't want to spend countless hours without personal life like previous generation did... so more doctors are needed ! And the problem is even more pregnant for out-of-hospital doctors (particularily outside of cities) Right now, the gov strategy is to try to give more and more power for nurses, pharmacists to limit load on doctors (and cost for social services)... but sometimes doctors may spot specific symptoms where others may not
• randomdata 2y ago
  Supply management. It’s how you keep incomes artificially high.
• trixjo 2y ago
  [dead]
• matheusmoreira 2y ago
  > Something I've never quite understood is why, in the UK, we cap the number of medical students per year. To keep salaries high. I'm brazilian. In recent years, brazilian medical schools have been "democratized", so to speak. The number of medical schools has exploded and acceptance of doctors from neighboring south american countries has been facilitated. About 50 thousand new doctors enter the market every year. Result? Pathetic salaries. Actual unemployment. Doctors fighting each other over the shittiest jobs with the worst working conditions. Doctors becoming Uber drivers. Complete loss of the prestige the profession once enjoyed. Rampant charlatanism and unethical conduct. Badly educated doctors who kill their patients. Dishonest doctors promising miracle cures on Instagram because that's what gets them engagement and therefore patients. There is no reason whatsoever to become a doctor under these conditions. Too much responsibility, too little reward. You're better off doing literally anything else. Society needs to carefully consider the needs of those who will be responsible for other people's lives. When responsibility does not equal reward, it's pointless. My society chose to treat those people with absolute contempt. The results are plain to see.
  • int_19h 2y ago
    This just goes to show yet again that healthcare and markets are largely incompatible if you want to have good outcomes and ethical treatment of people.
  • Anthony-G 2y ago
    Thanks for contributing that point. It’s good to have one data point for what happens when there are no restrictions. I’m from Ireland and have the same experience as most of the rest of the commentators on this thread, i.e., we have a chronic shortage of doctors – and nurses – in our health system. This has been the case for as long as I’ve been alive but it’s got much worse in the last decade or so. It’s interesting to see how universal this problem is – aside from the odd country like Brazil where the pendulum seems to have swung too far in the opposite direction. It’d be nice to know if any country has found a happy medium.
    • matheusmoreira 2y ago