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There is no reason the federal government needs to pay resident salaries. There is no reason residents need to make $50k/yr in NYC. There is no reason medical s

by pc86 2y ago

There is no reason the federal government needs to pay resident salaries. There is no reason residents need to make $50k/yr in NYC. There is no reason medical school needs to cost $400,000 for someone to make $200k/yr as a family med doc. Who gives a shit about the dignity of the profession? The AMA gate keeps medical schools and residency slots "to maintain the dignity of the profession" while people wait weeks or months to see a physician who hasn't cracked a journal open in 20 years and just refers them to a specialist anyway. I'm not saying doctors shouldn't make a lot of money, they absolutely should. There should also be twice as many of you. Med school slots are not limited by how many qualified people want to be doctors, they're limited by bureaucratic bullshit. Plenty of people meet all your ridiculous requirements and more yet don't become doctors simply because the seats are full.

ninetyninenine 2y ago
I hear what you’re saying, and of course, there’s always room to improve the system. But let’s not pretend economics doesn’t exist. If there were twice as many of us, we simply wouldn’t be worth as much. Not because we’d be less capable — but because value is determined not just by skill, but by rarity. Flood the market with physicians, and suddenly, the decade I spent sacrificing my youth, relationships, and financial sanity becomes… just a long, expensive hobby. We didn’t endure that gauntlet so that healthcare could be as available as tap water. Yes, med school is expensive. Yes, resident salaries are lean — especially in NYC. But that’s part of the process. It creates a kind of gravity around the profession. It filters out those unwilling to bear the cost of commitment. You say plenty of people are qualified. I don’t doubt that. But the profession is not merely about who can do it — it’s about who is willing to pay to do it, in every possible way. And as for doctors who haven’t cracked open a journal in 20 years — well, isn’t that the beauty of the system? They don’t have to. The structure itself protects them. We’ve built an ecosystem where even if a physician isn’t on the cutting edge, the mere fact that they exist — credentialed, licensed, and allowed to operate within this curated bottleneck — means they remain valuable. If the goal is universal access, then yes, by all means, widen the gates. But just know: the moment everyone can see a doctor anytime, anywhere, the profession stops being a calling — and starts being customer service. And I didn’t sign up to wear a headset. So no — there shouldn’t be twice as many of us. There should be just enough that when you finally get an appointment, it means something.
- pc86 2y ago
  > We didn’t endure that gauntlet so that healthcare could be as available as tap water. "I worked really hard so it doesn't matter if people die for want of care if it means I will make $450k/yr instead of $500k/yr." > let’s not pretend economics doesn’t exist I would argue you're the one arguing against economics, or at least arguing for artificial barriers to a free market. Yes, if there are more physicians then physicians will make less. But if you make $500k/yr because a cartel is artificially limited who can compete with you, and making it harder than it needs to be to get your credentials, and making it artificially more expensive to get those credentials, you haven't earned $500k. > And as for doctors who haven’t cracked open a journal in 20 years — well, isn’t that the beauty of the system? They don’t have to. The structure itself protects them. We’ve built an ecosystem where even if a physician isn’t on the cutting edge, the mere fact that they exist — credentialed, licensed, and allowed to operate within this curated bottleneck — means they remain valuable. I've typed this word a few times and deleted it because I really don't want this to be an inflammatory comment, but this is an absolutely disgusting mindset. The system that allows someone who got their medical degree when doctors had a preferred brand of cigarette to maintain a lucrative practice simply because they have a particular credential or license without requiring that they stay up-to-date cannot be called "beautiful" by any sane or ethical person. I worry that you think I'm arguing for some system where doctors make $40k/yr and you can call a GP office at 2 PM and get an appointment for 2:15. That's not at all what I'm arguing. I don't know your specialty but you can't make $400, 500, 900k/yr and pretend that letting people who are qualified to be doctors become doctors regardless of some arbitrary seat limit implemented by the AMA and artificial scarcity will mean you suddenly have to "wear a headset." You and I both know that's completely disingenuous framing and not even remotely what would happen. What would actually happen, for the first 7 years at least, is nothing. And beyond that, private practices would be able to accept new patients, hospitals would be able to staff their positions, and people would be able to access health care without having to wait months for an appoint. Your whole comment smacks of "I don't care if you need a wait 5 weeks for an MRI, and then another month for a radiologist to read it, I want to be able to buy my Lexus in cash instead of having to finance it."
nradov 2y ago
There's no reason the federal government needs to pay resident salaries — except that no other major player is willing to do it. Hospital cost accounting is always kind of squishy and confusing but on average it seems that teaching hospitals lose money on their residency programs, so they need some kind of subsidy to make up the difference. Most of these teaching hospitals are run by local governments or non-profit foundations. Where will the money come from? There are a small number of residency slots funded by other sources but those are only a fraction.

by pc86 2y ago

ninetyninenine 2y ago

I hear what you’re saying, and of course, there’s always room to improve the system. But let’s not pretend economics doesn’t exist. If there were twice as many of us, we simply wouldn’t be worth as much. Not because we’d be less capable — but because value is determined not just by skill, but by rarity. Flood the market with physicians, and suddenly, the decade I spent sacrificing my youth, relationships, and financial sanity becomes… just a long, expensive hobby. We didn’t endure that gauntlet so that healthcare could be as available as tap water. Yes, med school is expensive. Yes, resident salaries are lean — especially in NYC. But that’s part of the process. It creates a kind of gravity around the profession. It filters out those unwilling to bear the cost of commitment. You say plenty of people are qualified. I don’t doubt that. But the profession is not merely about who can do it — it’s about who is willing to pay to do it, in every possible way. And as for doctors who haven’t cracked open a journal in 20 years — well, isn’t that the beauty of the system? They don’t have to. The structure itself protects them. We’ve built an ecosystem where even if a physician isn’t on the cutting edge, the mere fact that they exist — credentialed, licensed, and allowed to operate within this curated bottleneck — means they remain valuable. If the goal is universal access, then yes, by all means, widen the gates. But just know: the moment everyone can see a doctor anytime, anywhere, the profession stops being a calling — and starts being customer service. And I didn’t sign up to wear a headset. So no — there shouldn’t be twice as many of us. There should be just enough that when you finally get an appointment, it means something.

pc86 2y ago
> We didn’t endure that gauntlet so that healthcare could be as available as tap water. "I worked really hard so it doesn't matter if people die for want of care if it means I will make $450k/yr instead of $500k/yr." > let’s not pretend economics doesn’t exist I would argue you're the one arguing against economics, or at least arguing for artificial barriers to a free market. Yes, if there are more physicians then physicians will make less. But if you make $500k/yr because a cartel is artificially limited who can compete with you, and making it harder than it needs to be to get your credentials, and making it artificially more expensive to get those credentials, you haven't earned $500k. > And as for doctors who haven’t cracked open a journal in 20 years — well, isn’t that the beauty of the system? They don’t have to. The structure itself protects them. We’ve built an ecosystem where even if a physician isn’t on the cutting edge, the mere fact that they exist — credentialed, licensed, and allowed to operate within this curated bottleneck — means they remain valuable. I've typed this word a few times and deleted it because I really don't want this to be an inflammatory comment, but this is an absolutely disgusting mindset. The system that allows someone who got their medical degree when doctors had a preferred brand of cigarette to maintain a lucrative practice simply because they have a particular credential or license without requiring that they stay up-to-date cannot be called "beautiful" by any sane or ethical person. I worry that you think I'm arguing for some system where doctors make $40k/yr and you can call a GP office at 2 PM and get an appointment for 2:15. That's not at all what I'm arguing. I don't know your specialty but you can't make $400, 500, 900k/yr and pretend that letting people who are qualified to be doctors become doctors regardless of some arbitrary seat limit implemented by the AMA and artificial scarcity will mean you suddenly have to "wear a headset." You and I both know that's completely disingenuous framing and not even remotely what would happen. What would actually happen, for the first 7 years at least, is nothing. And beyond that, private practices would be able to accept new patients, hospitals would be able to staff their positions, and people would be able to access health care without having to wait months for an appoint. Your whole comment smacks of "I don't care if you need a wait 5 weeks for an MRI, and then another month for a radiologist to read it, I want to be able to buy my Lexus in cash instead of having to finance it."

nradov 2y ago

There's no reason the federal government needs to pay resident salaries — except that no other major player is willing to do it. Hospital cost accounting is always kind of squishy and confusing but on average it seems that teaching hospitals lose money on their residency programs, so they need some kind of subsidy to make up the difference. Most of these teaching hospitals are run by local governments or non-profit foundations. Where will the money come from? There are a small number of residency slots funded by other sources but those are only a fraction.