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> Recently, her hospital’s dermatology program received more than 600 applications for four residency slots. Perhaps if supply of dermatologists was not so str
by amluto 2y ago
> Recently, her hospital’s dermatology program received more than 600 applications for four residency slots.
Perhaps if supply of dermatologists was not so strongly limited, prices and wait times would improve.
- wyldfire 2y agoI doubt that limit is an artificial one. Hospitals don't need 600 dermatologists on staff. I think this is yet another factor of capitalism: selfish interests of individual corporations being in tension with the people's interests of having affordable healthcare. Other developed countries seem to have said "yeah, we recognize that nationalizing healthcare will result in insurance companies and hospitals making less money. But that's what has to happen for the people to be able to get the care they need." Every time it comes up in the US, nationalized healthcare is demonized in some media. But it just feels like a facade perpetrated by the hospitals and insurance companies (and now private equity) who stand to lose the most. If it's good enough for veterans and retirees, why can't it be good enough for the rest of us? Maybe it's because when the government pays the bill, they don't just roll over and accept $EXORBITANT_FEE after $EXORBITANT_FEE - they negotiate and get some reasonable value.
- eppp 2y agoThey dont need 600 dermatologists on staff. They need residency slots. These people aren't asking to work for the hospital permanently, they just have to check the residency box that is artificially limited by gatekeepers.
- ninetyninenine 2y agoIt is a bit of a logistical issue shoving 600 dermatology interns into a hospital. Make it a law that all doctor offices need one or two residency slots. That should alleviate the problem in time due to compounding growth.
- alistairSH 2y agoResidencies are funded via Medicare. If you want more doctors, you need to convince Congress to fund those spots. Or, convince the industry to fund the slots itself, without the reliance on Uncle Sam's largess.
- woooooo 2y agoOn Medicare's time horizon, losing money funding those residencies for 10-20 years actually could be a great deal if it bends the cost curve.
- nradov 2y agoYou've got to be kidding. There's no way that a regular doctor's office could provide adequate graduate medical education. Residents are taught in teaching hospitals.
- ninetyninenine 2y agoI have no context. I’m just a layman. Maybe force every doctor office by law to be a teaching hospital of some sort. They get paid 500K, seems to be a good form of taxation on an undeserved salary.
- ninetyninenine 2y agoOr maybe form a mentorship program. Every intern once they complete their training must train two other doctors to completion before they can genuinely practice. They must do this at the teaching hospital. That hospital will then have enough support staff to maintain a large load of interns as the compounding growth continues. Of course the growth has to level off at some point. But yeah.
- nradov 2y agoYou've got to be kidding. Physician offices don't have the facilities or the breadth of practice to function effectively as teaching hospitals. Even most hospitals aren't teaching hospitals. And as for conscripting physicians and forcing them to train residents, that's a completely bizarre and unrealistic suggestion. Forcing someone to teach and mentor who doesn't want to do it will guarantee bad results. And many practicing physicians don't live anywhere near a teaching hospital. Who are you to decide how much salary someone deserves? I think you deserve $4 an hour. That seems fair to me. In the real world fairness to subjective. What actually matters is negotiating power. The most straightforward way to reduce physician negotiating power is for Congress to increase graduate medical education funding through Medicare. Income in the $500K range is already in the 35% tax bracket (plus any state income tax) so doctors are paying quite a bit; Congress just chooses to spend that money on other priorities. https://savegme.org/ https://savegme.org/
- infecto 2y agoPresumably a derm. resident is doing rounds related to dermatology. I am guessing this is similar to other specialized fields that don't have large volume in resident setting.
- Cumpiler69 2y ago>Other developed countries seem to have said The other developed countries doing this don't pay dermatologists 500k though.
- Shatnerz 2y agoPerhaps this is because supply isn't being artificially restricted?
- Cumpiler69 2y agoDoctors' profession have artificial barriers to entry and keep the supply limited, in many other countries, but even with those, they won't dream to earn anywhere near 500k.
- quantumwoke 2y agoThis is not true, and you should look at private practice in Canada, Australia, and to a lesser extent U.K.
- Cumpiler69 2y agoIt's 100% true where I'm from in Europe. The government opens up only a fixed number of residencies positions every year regardless of how many more students graduate (cartel behavior from the national Doctors' association). My cousin graduated med-school last year and is still unemployed because no hospital had a place for her. Private practices don't fix that issue since they're not designed to be part of the medical teaching cycle. So a lot of young doctors have to emigrate to other EU countries where they can find spots to practice.
- quantumwoke 2y agoThis is orthogonal to your GP point which was about salary. There are a lot of issues with the teaching pipeline AFAIUI so it is difficult to comment on n=1 examples.
- infecto 2y agoI am not sure how you connect the first part of your idea to the last. Would this not also be a problem in single payer systems? The article does not do a great job of it but it would be interesting to see the billings split between cosmetic and medical. The article is already on how the field is booming because of cosmetics, one of the interviewed doctors does not even accept insurance. This has nothing to do with capitalism vs socialized healthcare and all to do with cosmetic procedures which would mostly not be covered under a single payer style system anyway.
- alistairSH 2y agoThere is absolutely an artificial cap on the number of residencies (across specialties, not unique to dermatology). The majority of residency slot are funded through Medicare - Congress has effectively placed an artificial cap on the number of spots. From what I gather, Congress set the current low limit due to lobbying from the AMA something like 30 years ago. The AMA has since changed its tune and wants more slots to alleviate shortages in some regions and specialties, but the funding has not materialized.
- maxerickson 2y agoA lack of government funds is not a cap! What would they do if the government didn't fund any slots, just shrug and decide they didn't need doctors? Note that I'm not opposed to the government funding lots more slots, I am objecting to the presumption that government funding is the only possible way to make a doctor.
- nradov 2y agoIf the government didn't fund any slots then graduate medical education programs would charge the residents themselves instead of paying them a salary. Then physicians would finish their education $1M in debt instead of $500K (or whatever) today. World that be an improvement? There are a small number of residency slots funded by non-profit foundations but those are a drop in the bucket. None of the other major players in the national healthcare system have an incentive to pay for this stuff.
- otterley 2y agoOut of curiosity, how were new doctors being trained before Medicare existed?
- bryanlarsen 2y agoAFAICT, way back in the day hospitals and clinics did residencies out of a desire for free/cheap labor, the same reason that some firms provide internships in other fields today. Nowadays the costs and obligations of providing a residency far exceed the benefits of the lower cost labor.
- paulddraper 2y ago> Hospitals don't need 600 dermatologists on staff. But imagine how available and inexpensive dermatologists would be. (Okay, let's not say 600, but let's say 2x or 4x the current #)
- readthenotes1 2y agoApparently cosmetic dermatology is not regulated so you can go through residency in some other residency program and set up your shingle selling Botox, at least where I live.
- pc86 2y agoMy wife is a physician and she knows one or two otherwise very intelligent, well-respected, skilled surgeons who just do Botox because it's more lucrative.
- bookofjoe 2y agoAlso: way better hours (no nights/weekends/holidays); less likelihood of malpractice lawsuits along with far lower medical malpractice insurance rates; much less stress; happier patients.
- bnlxbnlx 2y agoSounds soul crushing to me :( I so wish people would choose what to do based on what makes sense to them based on care for the whole.
- pc86 2y agoDid you decide what to do for a living "based on care for the whole?" I suspect like most people it was mentally looking at a Venn diagram intersection of "what am I smart enough to do?", "what do I enjoy doing?", "what pays me the most, or well enough that I can do at least as well as my parents?" How many people who get into surgery would still do it with all the same education, testing, training, and licensure requirements if it paid $100k/yr? My guess is not many. If you're in a highly litigious state in a high-risk specialty your malpractice insurance alone could be more than that. It's not surprising to see smart people leave risky positions with pretty objectively bad work-life balance for more money, less stress, and better WLB.
- jmcgough 2y agoMany people go into medicine wanting to do good, but then after a couple years of working 100 hours a week for a gen surg residency you realize that this isn't sustainable, especially if you want to start a family.
- quantumwoke 2y agoThe problem is not limited supply but rather the ability to train sufficient supply in a reasonable timeframe which necessitates attending pay cuts (because they can't do as much work) and creation of funded structured training programs with good teachers and case mix. Source: my wife is a doctor
- scld 2y agoIncreasing the time and cost of the training is how the supply is limited.
- quantumwoke 2y agoCan you expand on this? I don't think this is the whole story. Perhaps a concrete example would help.
- scld 2y agoIn something as large as a nation's regulated medical industry, I agree that no one thing will be the whole story. However a concrete example is the "pulling up the ladder behind you" effect of regulatory capture. There are more people who want to become doctors than our country allows to become doctors. Our current state of affairs regarding compulsory medical residency programs is a result of years of increasing the barriers to entry (for good or bad reasons, doesn't really matter). Now it's up to Congress to pass Medicare reform laws to update their funding for the residency programs, but that has just not happened (one of the major I-told-you-sos when dealing with government intervention). It's probably not the case that we want to completely deregulate, however a major consequence of almost any regulatory intervention that operates on the basis of increasing credentialism is that we will end up with some % less than ideal supply.