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> one of the true reasons for short supply No, it's not. The reason for the short supply is the CAPPED number of advanced education spots after medical school.

> one of the true reasons for short supply No, it's not. The reason for the short supply is the CAPPED number of advanced education spots after medical school. Open up 100 more med schools with class sizes of 1000 each at half the cost or typical schools and you'd still end up with pretty much the same sized cohort of doctors with advanced training. Some states have looked into legislation allowing graduated med students to serve rural communities without having undergone a residency. I don't think this is widely available if available at all, nor do I think it's scalable.

nickpsecurity 2y ago
On that topic, do you have any proposals aside from lifting caps?
- HelloMcFly 2y ago
  I think of healthcare problems in America like a watershed: the issues are not the result of any one problem but a concentration of small, medium, and large problems that all drain into the same humongous river. Things that could happen (and let's just take more socialized medicine off the table since it will never happen): 1. Increasing caps (funding) for advanced education 2. Allowing Medicare to negotiate drug prices, it's preposterous that they cannot do this 3. Increase price transparency at hospitals to enable some downward pressure on prices. This is much harder than it sounds, not that it's my problem to solve. 4. Limit hospital system monopolies that given them too much leverage in price negotiation (though have to be careful not to give insurers too much negotiating power, delicate balance) 5. Cap out of pocket expenses, though I'm not sure how. 6. Standardize and simplify billing codes across the US, with more public visibility into them. Medical billing is currently an art, it should be a science. 7. Offer loan forgiveness to medical practitioners that serve for 10 years post-advanced training in a low-healthcare access communities. For what it's worth, I'd also place income-to-debt ratio restrictions on doctors' eligibility for public service loan forgiveness as well. 8. Sadly, if we won't let immigrant trainees stay and obtain citizenship in the US after training, we should stop allocating training spots to them. 9. Increase use of mobile clinics and/or transportation services. This would almost necessarily need to be government funded. 10. Reform malpractice insurance and litigation in a way that doesn't remove physician accountability but doesn't require such high overhead to be paid by everyone down the line. The above would help, but I don't know how much.
devilbunny 2y ago
> I don't think this is widely available if available at all It was, a long time ago. Then states started requiring an internship (first year of residency) for a full license - which is still generally the case in the US for graduates of US medical schools (foreign school grads regardless of citizenship usually have to complete at least three years of residency before getting a permanent license). Getting privileges at a hospital will nearly always require finishing a residency. That's a matter of the hospital's medical staff bylaws, so changing them is not really in the purview of the state except to prohibit discrimination based on a protected class - and "hasn't finished residency" isn't a protected class. It definitely would further ghetto-ize rural general practitioners. They wouldn't even be eligible to get a job outside of those rural clinics.

nickpsecurity 2y ago

On that topic, do you have any proposals aside from lifting caps?

HelloMcFly 2y ago
I think of healthcare problems in America like a watershed: the issues are not the result of any one problem but a concentration of small, medium, and large problems that all drain into the same humongous river. Things that could happen (and let's just take more socialized medicine off the table since it will never happen): 1. Increasing caps (funding) for advanced education 2. Allowing Medicare to negotiate drug prices, it's preposterous that they cannot do this 3. Increase price transparency at hospitals to enable some downward pressure on prices. This is much harder than it sounds, not that it's my problem to solve. 4. Limit hospital system monopolies that given them too much leverage in price negotiation (though have to be careful not to give insurers too much negotiating power, delicate balance) 5. Cap out of pocket expenses, though I'm not sure how. 6. Standardize and simplify billing codes across the US, with more public visibility into them. Medical billing is currently an art, it should be a science. 7. Offer loan forgiveness to medical practitioners that serve for 10 years post-advanced training in a low-healthcare access communities. For what it's worth, I'd also place income-to-debt ratio restrictions on doctors' eligibility for public service loan forgiveness as well. 8. Sadly, if we won't let immigrant trainees stay and obtain citizenship in the US after training, we should stop allocating training spots to them. 9. Increase use of mobile clinics and/or transportation services. This would almost necessarily need to be government funded. 10. Reform malpractice insurance and litigation in a way that doesn't remove physician accountability but doesn't require such high overhead to be paid by everyone down the line. The above would help, but I don't know how much.

devilbunny 2y ago

> I don't think this is widely available if available at all It was, a long time ago. Then states started requiring an internship (first year of residency) for a full license - which is still generally the case in the US for graduates of US medical schools (foreign school grads regardless of citizenship usually have to complete at least three years of residency before getting a permanent license). Getting privileges at a hospital will nearly always require finishing a residency. That's a matter of the hospital's medical staff bylaws, so changing them is not really in the purview of the state except to prohibit discrimination based on a protected class - and "hasn't finished residency" isn't a protected class. It definitely would further ghetto-ize rural general practitioners. They wouldn't even be eligible to get a job outside of those rural clinics.