6 ms·

I think you’re giving way too much credit to medical associations to rig the game in their favor. They exert enough influence over all fifty states and the vari

by zahma 2y ago

I think you’re giving way too much credit to medical associations to rig the game in their favor. They exert enough influence over all fifty states and the various private institutions to systemically deny training to qualified candidates? The fact is it’s extremely expensive and time consuming to train physicians. There isn’t enough space. Third and fourth year med students are going to far-flung hospitals to have hands-on experience because staying in the larger cities means they’re competing for access to training with residents. All of this factors in to the cost and limited space of med school classes. It’s sad, but we would have to reinvent how we train physicians to address the limitations.

llamaimperative 2y ago
You just spend more money to scale the program. Funding for the residency program has been frozen since the late 90s, the demand for doctors has not been.
- pc86 2y ago
  You can't "just" spend more on residency training without also "just" making med school classes bigger. You can't "just" expand med school classes without "just" increasing teaching staff, who are 9 times out of 10 physicians themselves. And very few physicians are going to willingly turn down $500k/yr clinical jobs to teach for a fraction of that.
  - llamaimperative 2y ago
    You’re describing problems that are all solved by money.
    - pc86 2y ago
      And time. You double the number of residency slots but it will take years to fill them if you increase med school size at the same time, a type of coordination that is very unlikely.
      - aristus 2y ago
        30 years is a lot of time. I agree with GP. Starting back then would have been best; starting now would be second. I live in a country that has twice the number of medical school graduates per 100k population than the US, and unsurprisingly compared to the US it's easier to get general medical and specialist attention.
      - llamaimperative 2y ago
        Oh okay. Guess we’ll just continue to have 1997 level supply of doctors forever. I don’t even know what argument you’re trying to make here? It’ll take time to solve? Yeah, obviously. That’s why we should start ASAP and given that we don’t have a time machine, that’d mean right now.
      - matthewdgreen 2y ago
        The supply of new doctors (and residents) should at least keep pace with population growth. For whatever reason, we spent nearly two decades keeping this number flat even as population grew by 70 million. We shouldn't have to double these numbers, they all should have organically increased at a reasonable pace. But for a variety of reasons they didn't and now we have to fix the problem.
- zahma 2y ago
  Why do we blame this on medical lobbies when it appears to be the same issue across the board for funding state education departments?
  - llamaimperative 2y ago
    Because it’s a different issue with different principals involved. Does the federal government set the national number of teachers who can be trained each year?
    - zahma 2y ago
      I have no idea, but that’s not the point. The funding they put into each state’s education budget, combined with that state’s policy effectively limits hiring.
willcipriano 2y ago
> They exert enough influence over all fifty states and the various private institutions to systemically deny training to qualified candidates? Politicians "trust the experts" and the American Medical Association says... The flaw is the AMA is just a union for doctors not a body that represents patients in any way.
- nradov 2y ago
  The American Medical Association says ... we need more doctors and Congress should increase Medicare funding for residency programs. https://savegme.org/ https://savegme.org/
  - pc86 2y ago
    Which is pointless without also increasing the number of medical student slots.
    - nradov 2y ago
      The AMA doesn't control the number of medical student slots either. They have no regulatory or accreditation authority. Medical schools are free to add more students, and several entire new medical schools have opened in the past few years. https://www.deborahgutmanmd.com/blog/new-medical-schools-updated-december-2022 https://www.deborahgutmanmd.com/blog/new-medical-schools-upd... The immediate bottleneck really is in residency programs. Every year, some students graduate with an MD/DO degree but are unable to practice medicine because they don't get matched to a residency program.
      - rtaylorgarlock 2y ago
        Exactly: I want to see more/newer data on residency programs and placement rates per resident (MD, DO, IMG), because last I checked, residency spots (and the bottleneck created by limited Medicare funding, which I find interesting considering the profit created by residents) were the primary bottleneck; medical schools have every incentive to open new spots as quickly as humanly possible considering the ludicrous pricing they charge. We're firmly into 'money printer' territory for medical schools and their cost of operation.
shkkmo 2y ago
> I think you’re giving way too much credit to medical associations to rig the game in their favor. They exert enough influence over all fifty states and the various private institutions to systemically deny training to qualified candidates? The underlying fact that the AMA is directly responsible for the doctor shortage in the USA is historically accurate. 20 years ago the AMA believes we were heading towards a doctor surplus and heavily lobbied and for fewer medical schools, caps on federal funding for residencies and big cuts to the available residencies. The AMA has reversed course and no longer supports these positions but the damage has been done, both to our supply of doctors and to their own reputation. However, even today the AMA supports many policies that keep taks that other professionals could perform the sole purview of doctors (which excacerbates the suppoy problem they helped create.)
- pc86 2y ago
  I am wildly in favor of expanding the number of medical schools, expanding med school class sizes, expanding residency slots and funding per resident. None of this means I want decisions now made by someone who does 4 years of college, 4 years of med school, 3-7 years of residency and potentially fellowship on top of that to instead be made by a nurse "under the supervision" of a doctor. If you're a doctor of one specialty and you want to change specialties, you have to redo residency and maybe fellowship. If you're a nurse and you want to change specialties the training is either on-the-job or measured in days/weeks.
  - shkkmo 2y ago
    > one of this means I want decisions now made by someone who does 4 years of college, 4 years of med school, 3-7 years of residency and potentially fellowship on top of that to instead be made by a nurse "under the supervision" of a doctor. That is indeed the AMA the talking point to justify their stance. However my problem with the AMA here isn't that they support some scope restrictions (clearly many decisions do require full training) but that they strongly support ALL scope restrictions without data to support such a rigid hardline stance. They do this even when the loosening scope restrictions would decrease cost and increase availability without any harm to patient outcomes. This absolutely exacerbates the physician supply problem that the AMA created. If the AMA actually care about the physician supply issues in the country, it would work with state and federal regulators to identify which scope restrictions can safely be loosened.
philwelch 2y ago
> They exert enough influence over all fifty states and the various private institutions to systemically deny training to qualified candidates? Yes. What’s difficult to believe about this? People respond to incentives. The incentive for every physician is to maintain a shortage of physicians, therefore improving the job security and earning potential of every physician. The only way this could be done is if the physicians formed some sort of cartel that could control how many people were allowed to become physicians. This is what the AMA is and what it verifiably does.

by zahma 2y ago

llamaimperative 2y ago

You just spend more money to scale the program. Funding for the residency program has been frozen since the late 90s, the demand for doctors has not been.

pc86 2y ago
You can't "just" spend more on residency training without also "just" making med school classes bigger. You can't "just" expand med school classes without "just" increasing teaching staff, who are 9 times out of 10 physicians themselves. And very few physicians are going to willingly turn down $500k/yr clinical jobs to teach for a fraction of that.
- llamaimperative 2y ago
  You’re describing problems that are all solved by money.
  - pc86 2y ago
    And time. You double the number of residency slots but it will take years to fill them if you increase med school size at the same time, a type of coordination that is very unlikely.
    - aristus 2y ago
      30 years is a lot of time. I agree with GP. Starting back then would have been best; starting now would be second. I live in a country that has twice the number of medical school graduates per 100k population than the US, and unsurprisingly compared to the US it's easier to get general medical and specialist attention.
    - llamaimperative 2y ago
      Oh okay. Guess we’ll just continue to have 1997 level supply of doctors forever. I don’t even know what argument you’re trying to make here? It’ll take time to solve? Yeah, obviously. That’s why we should start ASAP and given that we don’t have a time machine, that’d mean right now.
    - matthewdgreen 2y ago
      The supply of new doctors (and residents) should at least keep pace with population growth. For whatever reason, we spent nearly two decades keeping this number flat even as population grew by 70 million. We shouldn't have to double these numbers, they all should have organically increased at a reasonable pace. But for a variety of reasons they didn't and now we have to fix the problem.
zahma 2y ago
Why do we blame this on medical lobbies when it appears to be the same issue across the board for funding state education departments?
- llamaimperative 2y ago
  Because it’s a different issue with different principals involved. Does the federal government set the national number of teachers who can be trained each year?
  - zahma 2y ago
    I have no idea, but that’s not the point. The funding they put into each state’s education budget, combined with that state’s policy effectively limits hiring.

willcipriano 2y ago

> They exert enough influence over all fifty states and the various private institutions to systemically deny training to qualified candidates? Politicians "trust the experts" and the American Medical Association says... The flaw is the AMA is just a union for doctors not a body that represents patients in any way.

nradov 2y ago
The American Medical Association says ... we need more doctors and Congress should increase Medicare funding for residency programs. https://savegme.org/ https://savegme.org/
- pc86 2y ago
  Which is pointless without also increasing the number of medical student slots.
  - nradov 2y ago
    The AMA doesn't control the number of medical student slots either. They have no regulatory or accreditation authority. Medical schools are free to add more students, and several entire new medical schools have opened in the past few years. https://www.deborahgutmanmd.com/blog/new-medical-schools-updated-december-2022 https://www.deborahgutmanmd.com/blog/new-medical-schools-upd... The immediate bottleneck really is in residency programs. Every year, some students graduate with an MD/DO degree but are unable to practice medicine because they don't get matched to a residency program.
    - rtaylorgarlock 2y ago
      Exactly: I want to see more/newer data on residency programs and placement rates per resident (MD, DO, IMG), because last I checked, residency spots (and the bottleneck created by limited Medicare funding, which I find interesting considering the profit created by residents) were the primary bottleneck; medical schools have every incentive to open new spots as quickly as humanly possible considering the ludicrous pricing they charge. We're firmly into 'money printer' territory for medical schools and their cost of operation.

shkkmo 2y ago

> I think you’re giving way too much credit to medical associations to rig the game in their favor. They exert enough influence over all fifty states and the various private institutions to systemically deny training to qualified candidates? The underlying fact that the AMA is directly responsible for the doctor shortage in the USA is historically accurate. 20 years ago the AMA believes we were heading towards a doctor surplus and heavily lobbied and for fewer medical schools, caps on federal funding for residencies and big cuts to the available residencies. The AMA has reversed course and no longer supports these positions but the damage has been done, both to our supply of doctors and to their own reputation. However, even today the AMA supports many policies that keep taks that other professionals could perform the sole purview of doctors (which excacerbates the suppoy problem they helped create.)

pc86 2y ago
I am wildly in favor of expanding the number of medical schools, expanding med school class sizes, expanding residency slots and funding per resident. None of this means I want decisions now made by someone who does 4 years of college, 4 years of med school, 3-7 years of residency and potentially fellowship on top of that to instead be made by a nurse "under the supervision" of a doctor. If you're a doctor of one specialty and you want to change specialties, you have to redo residency and maybe fellowship. If you're a nurse and you want to change specialties the training is either on-the-job or measured in days/weeks.
- shkkmo 2y ago
  > one of this means I want decisions now made by someone who does 4 years of college, 4 years of med school, 3-7 years of residency and potentially fellowship on top of that to instead be made by a nurse "under the supervision" of a doctor. That is indeed the AMA the talking point to justify their stance. However my problem with the AMA here isn't that they support some scope restrictions (clearly many decisions do require full training) but that they strongly support ALL scope restrictions without data to support such a rigid hardline stance. They do this even when the loosening scope restrictions would decrease cost and increase availability without any harm to patient outcomes. This absolutely exacerbates the physician supply problem that the AMA created. If the AMA actually care about the physician supply issues in the country, it would work with state and federal regulators to identify which scope restrictions can safely be loosened.

philwelch 2y ago

> They exert enough influence over all fifty states and the various private institutions to systemically deny training to qualified candidates? Yes. What’s difficult to believe about this? People respond to incentives. The incentive for every physician is to maintain a shortage of physicians, therefore improving the job security and earning potential of every physician. The only way this could be done is if the physicians formed some sort of cartel that could control how many people were allowed to become physicians. This is what the AMA is and what it verifiably does.