6 ms·

In the USA/Canada number of doctors minted is caped by the cartel of doctors. That costs non-trivial money and lives lost. Source: https://thedailyeconomy.org/

by betaby 1y ago

In the USA/Canada number of doctors minted is caped by the cartel of doctors. That costs non-trivial money and lives lost. Source: https://thedailyeconomy.org/article/how-congress-created-the-doctor-shortage/ https://thedailyeconomy.org/article/how-congress-created-the... and many others

insane_dreamer 1y ago
That’s not a regulatory issue
- topkai22 1y ago
  Since the government (federal or state/local) authorizes those organizations to certify physicians and restricts medical care to only those who have been certified, it is.
- nick__m 1y ago
  What kind of issue it is then ? If a regulation permits the doctors associations to set the allowed number of doctors residency, naively it is a regulatory issue.
  - insane_dreamer 1y ago
    It's a funding issue. There aren't enough residency slots available given the number of medical school grads. Residency is a requirement to get a medical license--which is issued by the states, not the federal gov. The reason there aren't enough residency slots is because they are heavily subsidized by the federal gov and they put a cap on the funding. No one else wants to foot the bill, so the slots remain limited, thus the licenses remains limited.
- tptacek 1y ago
  It obviously is. A federal government policy decision caps the number of doctors we have, and another federal government policy decision restricts a huge number of basic medical services to those doctors.
  - insane_dreamer 1y ago
    The AMA is creating the bottleneck, not the government directly.
    - tptacek 1y ago
      When the government accepts AMA lobbying and sets a regulatory cap on the number of new residencies, it is regulating, and is fully culpable for doing so. Your logic basically defines the government away, treating it instead as the product of the influences acting on it.
      - insane_dreamer 1y ago
        > sets a regulatory cap on the number of new residencies there is no regulatory cap on the number of new residencies there is a cap on _federal funding_ for new residency slots; yes that impacts hospitals' willingness to add new positions, but it's _not_ the same as a regulatory cap
miltonlost 1y ago
While important, this is immaterial to the NBC article. The PE firms CUT the number of employees in ER rooms in this paper, so having more doctors wouldn't actually help out the problem that the NBC article is describing. "The increased deaths in emergency departments at private equity-owned hospitals are most likely the result of reduced staffing levels after the acquisitions, which the study also measured, said Dr. Zirui Song, a co-author and associate professor of health care policy and medicine at Harvard Medical School." The issue with American healthcare is the profit-seeking capitalists.
- jwilber 1y ago
  Well, it could be both. Having more doctors before cuts means having more after cuts.
  - leoc 1y ago
    And the more expensive a doctor is, the more you save by cutting one/the larger the total wage bill for doctors is for a fixed number of doctors, making that bill a higher proportion of total expenses and a higher priority for cuts/the fewer doctors you get for a fixed amount of money.
- khimaros 1y ago
  theoretically, wouldn't increasing the supply of doctors have a downward pressure on wages and thus make it cheaper to employ more of them?
  - banannaise 1y ago
    Sure, it would make it cheaper. Would that result in these companies employing more doctors to perform the same amount of care at higher quality, or would it result in them retaining the standard of care they're currently providing while taking home a larger profit margin?
    - mothballed 1y ago
pure_ambition 1y ago
I stand by this: Physicians in the US are some of the only people who are paid what they deserve, in terms of authentic human value delivered. And only in the US are they paid what they deserve. They deserve their semi-monopolistic trade union. Admin bloat is a far larger problem, and so are the pharmaceutical companies which get to charge the government whatever they want to develop new drugs that often are only marginally effective.
- mothballed 1y ago
  I'd have no problem if they were just a trade union. In fact they are a systemic machine of mass violence, capturing the regulatory apparatus of government to use men with guns to enforce their licensing regime which of course you must walk through the pearly gates of their institutions to be blessed under.
- 1980phipsi 1y ago
  Noah Smith has had some good posts on health care costs in the US over the past year https://www.noahpinion.blog/p/insurance-companies-arent-the-main https://www.noahpinion.blog/p/insurance-companies-arent-the-... https://www.noahpinion.blog/p/service-costs-arent-exploding-anymore https://www.noahpinion.blog/p/service-costs-arent-exploding-...
  - stackskipton 1y ago
    Linking blog articles that bury the lead behind paywall make it impossible to discuss anything. However, at the core, US insurance system is the problem because it gets compounded by government trying to regulate such a system, so people do not die needlessly, but not destroy these profit seeking enterprises. So, what you end up with is a massive mess that leaves everybody cranky.
- dantillberg 1y ago
  I appreciate the defense of doctors wages for great work; I would agree that many doctors absolutely deserve it and more. But this "semi-monopolistic trade union" not only inflates their wages (which maybe that's a good thing), but it also harms the lives of the population they purport to serve. Many (most imo) people in the US simply cannot afford the monopoly's prices, and the monopoly has little incentive to innovate. This cartel of doctors actively prevents lower-cost, more efficient alternatives from coming to market.
waiquoo 1y ago
US residency funding has not increased since 1997, and residency spots is the real chokepoint
- emchammer 1y ago
  According to the article, the caps were enacted because of a fear that the people might want too much healthcare. Do I even need to look into which party pushed this?
  - hollerith 1y ago
    [flagged]
    - emchammer 1y ago
      I’ll take it. I’ll take the flag. My comment was cynical and unfounded in the kind of discourse that we should see on HN. I will not edit it either. For posterity, I was thinking of the recent cutbacks to prevent “waste, fraud and abuse”, which, coming from a senator, should have been grounded in an even higher standard, rather than walking away from requests for clarification.
      - hollerith 1y ago
        I upvoted this comment :)
    - slg 1y ago
      A minute of research has led me to conclude the discussed limit which comes from the 1997 Balanced Budget Act[1] was, like most of these sorts of efforts, passed by a Republican controlled Congress with weak opposition from Democrats. Republicans in the House voted 219 for and 7 against with Democrats 51 for and 154 against[2]. There was even less resistance in the Senate with 52 Republicans for with 3 against and 21 Democrats for and 24 against[3]. OP's "suspicion" was not "unfounded" and there was in fact "one party... driving this policy more than the other." If your complaint is simply that OP speculated on this without evidence, you're just as guilty of flagging their comment based on your own speculation without any evidence. [1] - https://www.cms.gov/priorities/innovation/files/migrated-medicare-demonstration-x/cc_section4016_bba_1997.pdf https://www.cms.gov/priorities/innovation/files/migrated-med... [2] - https://clerk.house.gov/Votes/1997241 https://clerk.house.gov/Votes/1997241 [3] - https://www.govtrack.us/congress/votes/105-1997/s130 https://www.govtrack.us/congress/votes/105-1997/s130
nobodyandproud 1y ago
The older generation MDs screwed up here, but now insurances are heavily pushing NPs and PAs to take their place. The nursing orgs are naturally lobbying hard (MD and RN orgs have an icy relationship). The quality and capabilities of these noctors—calling themselves residents and even doctors and performing surgeries and general anesthesia—is a growing problem.
- mothballed 1y ago
  Better with noctors than nothing at all. I know that's a false dichotomy in the long run, but for the present it isn't, given the regulatory environment. PA/NP is basically backup plan for a lot of people that don't get into med school or don't anticipate they could.
  - nobodyandproud 1y ago
    I’d say it’s worse. Incompetent treatment is worse than not being treated at all. It’s not to say that noctors can’t be competent within a narrow domain; it’s that they’re being taught to increase their scope of treatment beyond their training. If it becomes common, then it’d be safer and more cost-effective to pay out of pocket and get treatment in another Westernized nation.
    - mothballed 1y ago
      I basically treat NP/PAs and doctors as a pulse with a DEA license attached. Once you realize you basically need to figure it out for yourself, for much of anything but surgery and meds, you'll realize you are better off with them vs having police put you in a tiny cage for ordering drugs without a prescription (in my state I can self order imagery and labs, so don't need docs for that). I consider their opinion totally disposable but they offer some stuff the government will imprison me for if I don't get the magic signature for. Just treat them as totally incompetent and nudge them where they need to go. No need to assume or rely on competence that may not exist.
      - 1y ago

by betaby 1y ago

insane_dreamer 1y ago

That’s not a regulatory issue

topkai22 1y ago
Since the government (federal or state/local) authorizes those organizations to certify physicians and restricts medical care to only those who have been certified, it is.
nick__m 1y ago
What kind of issue it is then ? If a regulation permits the doctors associations to set the allowed number of doctors residency, naively it is a regulatory issue.
- insane_dreamer 1y ago
  It's a funding issue. There aren't enough residency slots available given the number of medical school grads. Residency is a requirement to get a medical license--which is issued by the states, not the federal gov. The reason there aren't enough residency slots is because they are heavily subsidized by the federal gov and they put a cap on the funding. No one else wants to foot the bill, so the slots remain limited, thus the licenses remains limited.
tptacek 1y ago
It obviously is. A federal government policy decision caps the number of doctors we have, and another federal government policy decision restricts a huge number of basic medical services to those doctors.
- insane_dreamer 1y ago
  The AMA is creating the bottleneck, not the government directly.
  - tptacek 1y ago
    When the government accepts AMA lobbying and sets a regulatory cap on the number of new residencies, it is regulating, and is fully culpable for doing so. Your logic basically defines the government away, treating it instead as the product of the influences acting on it.
    - insane_dreamer 1y ago
      > sets a regulatory cap on the number of new residencies there is no regulatory cap on the number of new residencies there is a cap on _federal funding_ for new residency slots; yes that impacts hospitals' willingness to add new positions, but it's _not_ the same as a regulatory cap

miltonlost 1y ago

While important, this is immaterial to the NBC article. The PE firms CUT the number of employees in ER rooms in this paper, so having more doctors wouldn't actually help out the problem that the NBC article is describing. "The increased deaths in emergency departments at private equity-owned hospitals are most likely the result of reduced staffing levels after the acquisitions, which the study also measured, said Dr. Zirui Song, a co-author and associate professor of health care policy and medicine at Harvard Medical School." The issue with American healthcare is the profit-seeking capitalists.

jwilber 1y ago
Well, it could be both. Having more doctors before cuts means having more after cuts.
- leoc 1y ago
  And the more expensive a doctor is, the more you save by cutting one/the larger the total wage bill for doctors is for a fixed number of doctors, making that bill a higher proportion of total expenses and a higher priority for cuts/the fewer doctors you get for a fixed amount of money.
khimaros 1y ago
theoretically, wouldn't increasing the supply of doctors have a downward pressure on wages and thus make it cheaper to employ more of them?
- banannaise 1y ago
  Sure, it would make it cheaper. Would that result in these companies employing more doctors to perform the same amount of care at higher quality, or would it result in them retaining the standard of care they're currently providing while taking home a larger profit margin?
  - mothballed 1y ago

pure_ambition 1y ago

I stand by this: Physicians in the US are some of the only people who are paid what they deserve, in terms of authentic human value delivered. And only in the US are they paid what they deserve. They deserve their semi-monopolistic trade union. Admin bloat is a far larger problem, and so are the pharmaceutical companies which get to charge the government whatever they want to develop new drugs that often are only marginally effective.

mothballed 1y ago
I'd have no problem if they were just a trade union. In fact they are a systemic machine of mass violence, capturing the regulatory apparatus of government to use men with guns to enforce their licensing regime which of course you must walk through the pearly gates of their institutions to be blessed under.
1980phipsi 1y ago
Noah Smith has had some good posts on health care costs in the US over the past year https://www.noahpinion.blog/p/insurance-companies-arent-the-main https://www.noahpinion.blog/p/insurance-companies-arent-the-... https://www.noahpinion.blog/p/service-costs-arent-exploding-anymore https://www.noahpinion.blog/p/service-costs-arent-exploding-...
- stackskipton 1y ago
  Linking blog articles that bury the lead behind paywall make it impossible to discuss anything. However, at the core, US insurance system is the problem because it gets compounded by government trying to regulate such a system, so people do not die needlessly, but not destroy these profit seeking enterprises. So, what you end up with is a massive mess that leaves everybody cranky.
dantillberg 1y ago
I appreciate the defense of doctors wages for great work; I would agree that many doctors absolutely deserve it and more. But this "semi-monopolistic trade union" not only inflates their wages (which maybe that's a good thing), but it also harms the lives of the population they purport to serve. Many (most imo) people in the US simply cannot afford the monopoly's prices, and the monopoly has little incentive to innovate. This cartel of doctors actively prevents lower-cost, more efficient alternatives from coming to market.

waiquoo 1y ago

US residency funding has not increased since 1997, and residency spots is the real chokepoint

emchammer 1y ago
According to the article, the caps were enacted because of a fear that the people might want too much healthcare. Do I even need to look into which party pushed this?
- hollerith 1y ago
  [flagged]
  - emchammer 1y ago
    I’ll take it. I’ll take the flag. My comment was cynical and unfounded in the kind of discourse that we should see on HN. I will not edit it either. For posterity, I was thinking of the recent cutbacks to prevent “waste, fraud and abuse”, which, coming from a senator, should have been grounded in an even higher standard, rather than walking away from requests for clarification.
    - hollerith 1y ago
      I upvoted this comment :)
  - slg 1y ago
    A minute of research has led me to conclude the discussed limit which comes from the 1997 Balanced Budget Act[1] was, like most of these sorts of efforts, passed by a Republican controlled Congress with weak opposition from Democrats. Republicans in the House voted 219 for and 7 against with Democrats 51 for and 154 against[2]. There was even less resistance in the Senate with 52 Republicans for with 3 against and 21 Democrats for and 24 against[3]. OP's "suspicion" was not "unfounded" and there was in fact "one party... driving this policy more than the other." If your complaint is simply that OP speculated on this without evidence, you're just as guilty of flagging their comment based on your own speculation without any evidence. [1] - https://www.cms.gov/priorities/innovation/files/migrated-medicare-demonstration-x/cc_section4016_bba_1997.pdf https://www.cms.gov/priorities/innovation/files/migrated-med... [2] - https://clerk.house.gov/Votes/1997241 https://clerk.house.gov/Votes/1997241 [3] - https://www.govtrack.us/congress/votes/105-1997/s130 https://www.govtrack.us/congress/votes/105-1997/s130

nobodyandproud 1y ago

The older generation MDs screwed up here, but now insurances are heavily pushing NPs and PAs to take their place. The nursing orgs are naturally lobbying hard (MD and RN orgs have an icy relationship). The quality and capabilities of these noctors—calling themselves residents and even doctors and performing surgeries and general anesthesia—is a growing problem.

mothballed 1y ago
Better with noctors than nothing at all. I know that's a false dichotomy in the long run, but for the present it isn't, given the regulatory environment. PA/NP is basically backup plan for a lot of people that don't get into med school or don't anticipate they could.
- nobodyandproud 1y ago
  I’d say it’s worse. Incompetent treatment is worse than not being treated at all. It’s not to say that noctors can’t be competent within a narrow domain; it’s that they’re being taught to increase their scope of treatment beyond their training. If it becomes common, then it’d be safer and more cost-effective to pay out of pocket and get treatment in another Westernized nation.
  - mothballed 1y ago
    I basically treat NP/PAs and doctors as a pulse with a DEA license attached. Once you realize you basically need to figure it out for yourself, for much of anything but surgery and meds, you'll realize you are better off with them vs having police put you in a tiny cage for ordering drugs without a prescription (in my state I can self order imagery and labs, so don't need docs for that). I consider their opinion totally disposable but they offer some stuff the government will imprison me for if I don't get the magic signature for. Just treat them as totally incompetent and nudge them where they need to go. No need to assume or rely on competence that may not exist.
    - 1y ago