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>doctors are cogs in a much larger healthcare system run by suits for purposes that one suspects have more to do with money than medicine. Is that actually acc

>doctors are cogs in a much larger healthcare system run by suits for purposes that one suspects have more to do with money than medicine. Is that actually accurate? The American Medical Association (the Physician cartel/trade association) bribes/lobbies about equal as hospitals/owners. They also legally reduce supply using their private, unelected, ACGME. If we use lobbying numbers, they are just as obsessed with money as the owners.

kyouens 1y ago
I am a doctor and I run a graduate medical education program. The constraining resource is generally funding, not limits imposed by ACGME. For example, my program is ACGME-approved for two trainees per year, but we have funding for one.
- ambicapter 1y ago
  Who decides the funding?
  - kyouens 1y ago
    Funding is mostly controlled by the federal government, via Medicare and Medicaid, and if I am not mistaken the funding levels are set by Congress.
    - nradov 1y ago
      You are not mistaken. Contrary to the conspiracy theories you see on here about the AMA, lately they have been lobbying Congress to increase funding for residency programs because that is the primary bottleneck to producing new physicians. https://savegme.org/ https://savegme.org/
      - lesuorac 1y ago
        So after studying for a decade a soon-to-be physician needs to go through a government funded job in order to qualify as a physician? Why don't the hospitals just pay the cost of their staff like every other apprenticeship program? (or add it into the list of student debt that doctor requires).
        nradov 1y ago
        Anyone who graduates from medical school with an MD / DO degree needs to complete several years of graduate medical education (residency) at a teaching hospital in order to become a physician legally authorized to practice medicine. Most residency slots are funded by Medicare, although some are funded by other sources. Teaching hospitals are usually run by non-profit corporations, or by state or local governments. While internal accounting is always a bit fuzzy and opaque they simply don't have the money to pay residents directly. Most residents generate less revenue than they cost to train. And hospitals don't have the freedom to raise prices to cover the cost of running residency programs. Thus the need for subsidies. If we force prospective doctors to take on even more debt then we'll likely end up with an even worse shortage. Current levels of student debt are already unsustainable, at least for many specialties.
        lesuorac 1y ago
        > Most residents generate less revenue than they cost to train. Is this just a thresholding issue? What substantially changes about the resident from year 1 to 3? Can you chop residency up into different tiers where they don't need somebody watching them do stitches once they're no longer the lowest tier? I find it extremely suspicious that a sector with so much money in it can't figure out how to make apprenticeships profitable but an electrician can.
        nradov 1y ago
        You seem to be confusing amount of money with actual control. Electrical contractors can charge any price they want (subject to customer demand). Hospitals, especially teaching hospitals, have no such freedom. Medicare reimbursement rates are fixed by government fiat. This is not a free market. Residencies are already chopped up into tiers. Those with more experience have more clinical and administrative autonomy. But for the most part, Medicare doesn't allow hospitals to directly bill for work done by residents. With a few limited exceptions, all of their work has to be supervised and signed off by a qualified attending physician. This training and supervision is extremely expensive. Any major reforms will have to come at the federal government policy level. This is not a problem that medical schools and teaching hospitals can solve by themselves.
- resource_waste 1y ago
  Why is the government paying for graduate education? I paid for my own graduate education.
  - maxwell-neumann 1y ago
    The costs would be utterly extortionate otherwise.
    - resource_waste 1y ago
      No. Don't let the cartel propagate this lie.

kyouens 1y ago

I am a doctor and I run a graduate medical education program. The constraining resource is generally funding, not limits imposed by ACGME. For example, my program is ACGME-approved for two trainees per year, but we have funding for one.

ambicapter 1y ago
Who decides the funding?
- kyouens 1y ago
  Funding is mostly controlled by the federal government, via Medicare and Medicaid, and if I am not mistaken the funding levels are set by Congress.
  - nradov 1y ago
    You are not mistaken. Contrary to the conspiracy theories you see on here about the AMA, lately they have been lobbying Congress to increase funding for residency programs because that is the primary bottleneck to producing new physicians. https://savegme.org/ https://savegme.org/
    - lesuorac 1y ago
      So after studying for a decade a soon-to-be physician needs to go through a government funded job in order to qualify as a physician? Why don't the hospitals just pay the cost of their staff like every other apprenticeship program? (or add it into the list of student debt that doctor requires).
      - nradov 1y ago
        Anyone who graduates from medical school with an MD / DO degree needs to complete several years of graduate medical education (residency) at a teaching hospital in order to become a physician legally authorized to practice medicine. Most residency slots are funded by Medicare, although some are funded by other sources. Teaching hospitals are usually run by non-profit corporations, or by state or local governments. While internal accounting is always a bit fuzzy and opaque they simply don't have the money to pay residents directly. Most residents generate less revenue than they cost to train. And hospitals don't have the freedom to raise prices to cover the cost of running residency programs. Thus the need for subsidies. If we force prospective doctors to take on even more debt then we'll likely end up with an even worse shortage. Current levels of student debt are already unsustainable, at least for many specialties.
        lesuorac 1y ago
        > Most residents generate less revenue than they cost to train. Is this just a thresholding issue? What substantially changes about the resident from year 1 to 3? Can you chop residency up into different tiers where they don't need somebody watching them do stitches once they're no longer the lowest tier? I find it extremely suspicious that a sector with so much money in it can't figure out how to make apprenticeships profitable but an electrician can.
        nradov 1y ago
        You seem to be confusing amount of money with actual control. Electrical contractors can charge any price they want (subject to customer demand). Hospitals, especially teaching hospitals, have no such freedom. Medicare reimbursement rates are fixed by government fiat. This is not a free market. Residencies are already chopped up into tiers. Those with more experience have more clinical and administrative autonomy. But for the most part, Medicare doesn't allow hospitals to directly bill for work done by residents. With a few limited exceptions, all of their work has to be supervised and signed off by a qualified attending physician. This training and supervision is extremely expensive. Any major reforms will have to come at the federal government policy level. This is not a problem that medical schools and teaching hospitals can solve by themselves.
resource_waste 1y ago
Why is the government paying for graduate education? I paid for my own graduate education.
- maxwell-neumann 1y ago
  The costs would be utterly extortionate otherwise.
  - resource_waste 1y ago
    No. Don't let the cartel propagate this lie.