9 ms·

I 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

I 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 ago
They 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 ago
  It 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 ago
    Residencies 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 ago
      On 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 ago
    You'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 ago
      I 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 ago
        Or 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 ago
        You'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/
        2y ago
- infecto 2y ago
  Presumably 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 ago
  Perhaps this is because supply isn't being artificially restricted?
  - Cumpiler69 2y ago
    Doctors' 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 ago
      This is not true, and you should look at private practice in Canada, Australia, and to a lesser extent U.K.
      - Cumpiler69 2y ago
        It'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 ago
        This 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 ago
I 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 ago
There 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 ago
  A 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 ago
    If 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 ago
      Out of curiosity, how were new doctors being trained before Medicare existed?
      - bryanlarsen 2y ago
        AFAICT, 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 #)

eppp 2y ago

They 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 ago
It 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 ago
  Residencies 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 ago
    On 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 ago
  You'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 ago
    I 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 ago
      Or 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 ago
      You'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/
      - 2y ago
infecto 2y ago
Presumably 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 ago
Perhaps this is because supply isn't being artificially restricted?
- Cumpiler69 2y ago
  Doctors' 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 ago
    This is not true, and you should look at private practice in Canada, Australia, and to a lesser extent U.K.
    - Cumpiler69 2y ago
      It'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 ago
        This 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 ago

I 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 ago

There 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 ago
A 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 ago
  If 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 ago
    Out of curiosity, how were new doctors being trained before Medicare existed?
    - bryanlarsen 2y ago
      AFAICT, 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 #)