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The medical establishment also artificially limits the number of doctors in order to keep salaries high. I live in Boston, arguably the top city for medical car

The medical establishment also artificially limits the number of doctors in order to keep salaries high. I live in Boston, arguably the top city for medical care in the US, and it is not uncommon to have a six month waiting list to see a specialist. People talk about prescription drugs being the cause of high medical costs in the US, but it’s really the hospitals and doctors that are driving the majority of the costs.

rscho 2y ago
Maybe I'm mistaken, but I don't think places like Boston are where docs earn the most ?
- deleted 2y ago
  [deleted]
- BenFranklin100 2y ago
  I made no claims regarding the geographical distribution of physician wages. I specifically claimed that wait times for specialists in Boston is on the order of months, which I speculate is due to the medical board artificially limiting the number of physicians.
  - rscho 2y ago
    But then, revenue does not correlate with scarcity anymore? To be clear, I think you're right up to a certain point, but it makes some sense to be very elitist about who can practice in what you'd like to be the medical 'pride of the nation'. Now, scarcity in other regions is another matter, where it makes sense to relax standards. How much you relax the standard is a matter of how low you accept to go in terms of quality.
analyte123 2y ago
Doctors don't seem to be driving the majority of the costs. After adjusting for inflation, doctors don't make much more than they did in 1984, yet the percentage of GDP spent on healthcare has almost doubled since then (and the real GDP has also doubled in that time). For example, see [1] where a general surgeon made an average of $118,689 in 1984 and a family practitioner $84,256. This would be $358k and $254k in 2024 dollars. Today in 2024 they make on average $423k and $272k respectively [2]. [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4192917/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4192917/ [2] https://www.whitecoatinvestor.com/how-much-do-doctors-make/ https://www.whitecoatinvestor.com/how-much-do-doctors-make/
- BenFranklin100 2y ago
  Thanks for the datapoint about physician inflation adjusted salaries, but I said ‘hospitals and doctors are driving the majority of the costs’. In 2023, hospitals and physician and clinical services made up just over half of costs: https://www.ama-assn.org/about/research/trends-health-care-spending https://www.ama-assn.org/about/research/trends-health-care-s... Nursing care added another 4.3%, and other personal health care expenditures (dental, medical equipment, and other professional services) added another 16.5%, or about 2/3 of total costs when all taken together. By the way, an average salary of $423K is pretty good, and a six month wait to see a specialist amounts to denial of medical care. Serious reform is needed.
  - tsimionescu 2y ago
    If doctors are not a major part of the cost, then saying "hospitals and doctors are a major part of the problem", while technically true, is disingenuous. It's like saying "Stalin and and his cat killed more than twenty million people" - technically true, but it assigns the cat an unwarranted part in this problem.
    - BenFranklin100 2y ago
      Two separate points were made. The first is that the numbers of doctors is limited in order to keep salaries. Which is true. The second is that hospitals and physician/clinical services were the majority of health care costs in the US. Which is also true. See link. All the rest of the logic you supplied yourself. Since you seem intent on sticking words in my mouth, I don’t think doctor are necessarily paid too much, and don’t think limiting their salaries will substantially affect health care costs. I do think doctor salaries probably will go down if their ranks weren’t artificially limited, but society would benefit, and doctors might too with a reduced workload. In fact, the overall proportion of medical costs given to physician salaries will likely go up if their ranks weren’t limited, albeit with each individual doctor making less.
- SkyPuncher 2y ago
  I can't remember the exact cost, but physician's salary/costs are less than 10% of healthcare spending. Cutting their salaries in half would have almost no perceivable impact on the cost of care.

rscho 2y ago

Maybe I'm mistaken, but I don't think places like Boston are where docs earn the most ?

deleted 2y ago
[deleted]
BenFranklin100 2y ago
I made no claims regarding the geographical distribution of physician wages. I specifically claimed that wait times for specialists in Boston is on the order of months, which I speculate is due to the medical board artificially limiting the number of physicians.
- rscho 2y ago
  But then, revenue does not correlate with scarcity anymore? To be clear, I think you're right up to a certain point, but it makes some sense to be very elitist about who can practice in what you'd like to be the medical 'pride of the nation'. Now, scarcity in other regions is another matter, where it makes sense to relax standards. How much you relax the standard is a matter of how low you accept to go in terms of quality.

analyte123 2y ago

Doctors don't seem to be driving the majority of the costs. After adjusting for inflation, doctors don't make much more than they did in 1984, yet the percentage of GDP spent on healthcare has almost doubled since then (and the real GDP has also doubled in that time). For example, see [1] where a general surgeon made an average of $118,689 in 1984 and a family practitioner $84,256. This would be $358k and $254k in 2024 dollars. Today in 2024 they make on average $423k and $272k respectively [2]. [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4192917/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4192917/ [2] https://www.whitecoatinvestor.com/how-much-do-doctors-make/ https://www.whitecoatinvestor.com/how-much-do-doctors-make/

BenFranklin100 2y ago
Thanks for the datapoint about physician inflation adjusted salaries, but I said ‘hospitals and doctors are driving the majority of the costs’. In 2023, hospitals and physician and clinical services made up just over half of costs: https://www.ama-assn.org/about/research/trends-health-care-spending https://www.ama-assn.org/about/research/trends-health-care-s... Nursing care added another 4.3%, and other personal health care expenditures (dental, medical equipment, and other professional services) added another 16.5%, or about 2/3 of total costs when all taken together. By the way, an average salary of $423K is pretty good, and a six month wait to see a specialist amounts to denial of medical care. Serious reform is needed.
- tsimionescu 2y ago
  If doctors are not a major part of the cost, then saying "hospitals and doctors are a major part of the problem", while technically true, is disingenuous. It's like saying "Stalin and and his cat killed more than twenty million people" - technically true, but it assigns the cat an unwarranted part in this problem.
  - BenFranklin100 2y ago
    Two separate points were made. The first is that the numbers of doctors is limited in order to keep salaries. Which is true. The second is that hospitals and physician/clinical services were the majority of health care costs in the US. Which is also true. See link. All the rest of the logic you supplied yourself. Since you seem intent on sticking words in my mouth, I don’t think doctor are necessarily paid too much, and don’t think limiting their salaries will substantially affect health care costs. I do think doctor salaries probably will go down if their ranks weren’t artificially limited, but society would benefit, and doctors might too with a reduced workload. In fact, the overall proportion of medical costs given to physician salaries will likely go up if their ranks weren’t limited, albeit with each individual doctor making less.
SkyPuncher 2y ago
I can't remember the exact cost, but physician's salary/costs are less than 10% of healthcare spending. Cutting their salaries in half would have almost no perceivable impact on the cost of care.