7 ms·

We all want to uphold a system that limits medical school seats and won't create reliable immigration pathways for doctors to arrive here with just so doctors c

• bckr 1y ago
  What do you think voters should do? How do we increase the number of doctors?
  • brandonmenc 1y ago
    Stop charging $300k for the medical degree.
  • wagwang 1y ago
    Our society will continue to feel the civilizational tax of not having enough kids unless AI doctor becomes a thing.
    • tastyfreeze 1y ago
      So, do your part. Make babies! It's fun and rewarding.
  • isubkhankulov 1y ago
    The current doctor workforce is limited by a congressional cap on Medicare-funded educational slots. Apparently it was established in 1997 to prevent a surplus. Of course, the opposite happened because of demographics and increased lifespans.
    • dpkirchner 1y ago
      And as for what should voters do: they should choose people that are the most likely to improve the state of government.
    • triceratops 1y ago
      > Apparently it was established in 1997 to prevent a surplus. Perish the thought that we have slightly too many doctors. That can never be allowed! I can't believe they passed that shit with a straight face. I'll repeat what I've said before: no other profession in America requires a literal act of Congress to fund the training of new members. What's so special about doctors? Let anyone open a medical school if they meet standards. Give anyone an MD if they pass the exams and do the residencies, like lawyers. And while they're at it let doctors go to medical school straight out of high school like they do in every other country in the world (other than Canada, I think). You'll give every new doctor an additional 2 years in their career they would've spent in undergrad doing a useless "pre-med" degree (assuming medical school becomes 6 years of study after high school instead of 4 years after an undergrad degree).
      • wombatpm 1y ago
        There already are 6 yr programs. A school in Ohio has a 6 yr program where you graduate with a BS and MD.
      • nradov 1y ago
        You're missing the point. Anyone already can open a medical school if they meet standards. In fact, several new medical schools have opened in recent years. But that doesn't do anything to address the primary bottleneck, which is lack of residency slots. If you graduate from medical school with an MD you still can't practice medicine until you complete a residency program. Some schools do have accelerated combined BS/MD programs which can cut 1-2 years off the required total education.
        • triceratops 1y ago
          I'm aware and I thought it was implied in my comment that Medicare funding shouldn't be a limiting factor on residency slots, when I said "Every other profession manages to train new members without Congress". I guess that wasn't clear enough. I'd go so far as to pull all Medicare funding for residencies. Let each program figure it out themselves. Accelerated programs aren't the norm. They should be.
  • derbOac 1y ago
    In my opinion, we need to increase the number of admitted MDs and the number of residency spots. But more importantly, we need to also stop thinking of MDs as being necessary for a procedure or set of procedures, and focus instead on actual skill and experience for the procedure or service, and how one might get there. I guess what I'm suggesting is that the solution is not "increasing the number of doctors" but rather "increasing the number and types of providers". Some of those could be more MDs, but some of them could be other types of providers. We need to create alternate paths to MDs, and also increase the number of degree endpoints that result in similar kinds of independent practice authority within a given medical field. Let other types of providers provide a wider range of services — maybe with increased scrutiny over training pre and post degree, like MDs have.
    • sdenton4 1y ago
      A good analogy might be dentists - are there other spices of the medical profession that could be turned into more focused specialties with less total schooling?
      • Ekaros 1y ago
        Ophthalmology? Maybe dermatology. Or at least you could lose part of the training for them. Probably need still a few specialized people with full schooling. But could lot be done there with less?
      • derbOac 1y ago
        I'm most familiar with pharmacy and psychology as examples, although I think there are probably many other fields as well, maybe diagnostic radiology for example. I'm also aware of research on surgical specialists in areas of the world where physicians are scarce, focused on relatively minor surgeries, showing that these procedures can be done with the same outcomes if the providers have the right training. My guess is there is probably a way to encourage fields to come up with ideas that any given person out there outside the field wouldn't think of.
    • Auracle 1y ago
      To prove your point, I believe the last time I went to an ENT to get my nose cauterized for bloody noses cost my insurance around $500 or so. That's for a 5 minute "procedure" I could easily do at home with the right equipment.
  • directevolve 1y ago
    We should factor medical tasks into a larger number of specialized roles akin to phlebotomists and dental techs. These roles should perform highly in-demand, relatively straightforward and repetitive tasks that don’t require complex medical decision-making, where training can be efficiently scaled up. An example that currently doesn’t exist would be a specialist who can prescribe short term courses of drugs like methodone for opioid addiction as a bridge to longer term care by a doctor. This would enable us to have bridges to treatment readily available all over cities whenever an addict walks in ready, perhaps only for that moment in time, to start treatment.
• randycupertino 1y ago
  Other industries benefit as well from the lack of credientialing pathway for foreign MDs, because they end up taking under market salary roles in things like pharmacovigilance, sales, clindev, med affairs and other roles in biotech and pharma. I have a Bulgarian MD doing a vendor manager role for central lab and he is criminally underpaid for how overqualified he is. One time at a client dinner I asked him if he misses using his MD and he was like, "It's better than nothing and doing this contract PM role is still 10x more than I would be making being an actual doctor in Bulgaria."
• deepsun 1y ago
  Not "we all want", but especially doctors themselves want less competition (even when they say they are overworked). There were multiple similar stories on that, e.g. "Thousands of doctors in South Korea took to the streets of Seoul on Sunday to protest the government's plans to increase medical school admissions." from 2024. Similar stories from Nepal and Bangladesh. The most interesting part of that is that population typically sides with the doctors, not the government, for some reason.
  • accurrent 1y ago
    My understanding is that in many countries the biggest blocker to increasing number of doctors is the fact that there aren't enough doctors to teach. Unlike CS where we can simply increase the number of seats in. A course with medical school there are real bottlenecks on things like cadavers and mentors.
    • vasco 1y ago
      And intelligence combined with ability to deal with people and enough grit, memory and sleep deprivation resistance to pass medical school. Maybe medical school itself needs to change to make the role easier and split the functions into easier ones that more people can do.
      • FireBeyond 1y ago
        Right. Medical school in other countries is certainly not a walk in the park. But nor is it the hellacious endeavor it can be in the US, especially then as an early resident.
      • mattkrause 1y ago
        Yes! After I finished grad school (electrophysiology and imaging in large animal models, so seemingly relevant experience), I thought about becoming a clinician. However, I wasn't even eligible to apply to med school because it had been 5 years since I took an introductory biology or physics class (with lab!). It seems I was qualified enough to teach in a medical school but not to be a student. A faster scientist -> practitioner pathway would be such an obvious win-win: it'd help with the overcrowded academic job market AND relieve clinical shortages, but most of the emphasis seems to be on getting MDs into research instead.
• hinkley 1y ago
  There are nurses that can write prescriptions now. That seems to be how we are addressing the issue. The internet asserts that there are pathways from NP to MD, but I’m not close enough to the problem to make heads or tails of how realistic the path is. Is it legitimate or a sop?
  • khuey 1y ago
    > The internet asserts that there are pathways from NP to MD, but I’m not close enough to the problem to make heads or tails of how realistic the path is. The path (at least in the US, YMMV elsewhere) is "go to medical school".
  • FireBeyond 1y ago
    I hope not. As with everything, YMMV. As an experienced paramedic, I have not any issue with experienced nurses going the route of NP. But there are also zero-to-hero schools that will take you out of high school and have you as an NP in 5 years, able to prescribe medications (in many states, without any physician supervision). There's a happy medium. I have the same feeling about zero-to-hero paramedic strip mall schools that will turn you out in under a year and 1,000 hours whereas others will require you to have 2,000+ patient contacts as an EMT before they'll even admit you to a 1,800 hour course.
    • novok 1y ago
      It's really tiring how the medical profession can't do what engineering does with jr engineers and pay them a living wage as they gain experience and still do economically valuable work.
• onlyrealcuzzo 1y ago
  > If doctors don't have enough time, then there aren't enough doctors. It's not until around 1950 that medicine becomes a virtually guaranteed path to being in the top 1-2%. It's not until the late 70s that it's viable for anyone almost anyone (people without already wealthy parents). It's not until the late 90s that the average person who cares about nothing but money has figured out that medicine is a virtually guaranteed ticket to being "rich". I think the problem stems from there being too many people in the profession that care about almost nothing but having a lot of money - which isn't any different from most professions where you can make a ton of money. I do believe that the vast majority of doctors, especially older ones, AT THE VERY LEAST have decent intentions. But even a very small percentage of wildly greedy people can damage a system severely. I'm not sure how you put Pandora back in the box here. At the end of the day, good doctors are providing a service of almost unlimited value. Modern medicine is basically a miracle if you're literally about to die.
  • fn-mote 1y ago
    I disagree with most of the argument in the parent > I think the problem stems from there being too many people in the profession that care about almost nothing IMO you need to substantiate this claim. > even a very small percentage of wildly greedy people can damage a system severely This is medicine you're talking about. If the doctor doesn't have contact with patients, they aren't affecting them. I just cannot follow the claim that a greedy doctor can have an outsized effect. What is the mechanism? (Half a joke, to make my point:) Greedy doctors aren't like greedy venture capitalists... It seems like they can only suck $500k out of the system every year.
    • ridgeguy 1y ago
      There are amplifiers that increase the suck. One is physician ownership of diagnostic clinic(s). A strong tendency to order tests can be remarkably enriching, way more than a paltry $500K.
      • epmaybe 1y ago
        Isn't that a Stark law violation?
• s5300 1y ago
  [dead]
• wnc3141 1y ago
  You're absolutely right. However that salary is 1) not adjusting with inflation and 2) I'd argue is required to offset medical school debts and deferred employment
• cladopa 1y ago
  Well, in the US doctors are rich. Something completely different to most of the rest of the world. US doctors are not that good compared with a German or French doctor, they could be as bad as bad doctors in other countries.
  • framerjohn 1y ago
    > US doctors are not that good compared with a German or French doctor Any evidence to back this up? Granted, I’ve had some bad docs in the U.S., but the trick is to get good recommendations from people that work with the better doctors.
    • bix6 1y ago
      https://www.commonwealthfund.org/publications/fund-reports/2024/sep/mirror-mirror-2024 https://www.commonwealthfund.org/publications/fund-reports/2...
    • golem14 1y ago
      Just anecdotal, but I visited Shanghai this summer and toured a top clinic - from my perspective, their standard of care is on par with, if not better, than many large (and quite good) groups like Sutter Health or Straub. The doctors there were educated in the U.S. and Germany (Massachusetts and Munich if memory serves). Plus, if you can wait, treatment is nearly free, but you can get same day service for many procedures, like overnight ecg, for say $100 -$200.
      • seanmcdirmid 1y ago
        Chinese public hospitals, at least ten years ago, didn’t provide nursing assistant care, so families would be responsible for cleaning and feeding someone in the hospital. Private hospitals are another matter, and when I lived in Beijing, I would go private even for ER services. And the private hospitals were pretty affordable, most of the doctors were foreign or foreign trained, most Chinese med students go to the public hospitals for residencies and after they graduate (my wife has a cousin in Shanghai finishing up her Med degree now). The program is different, it’s a 5 year degree plus residency, though you can go for a masters or PhD also (many doctors do), I think the American system of medical school is the odd one out. Private health insurance had a cap (~$100k/year) for some reason. I thought that was risky.
• downrightmike 1y ago
  Voters voted to close rural hospitals, which Ironically means they get no healthcare themselves and cities will have more doctors. Stupid is as stupid does.
  • Whoppertime 1y ago
    And voters 4 years ago voted for an open border which filled emergency rooms and denied American Citizens from recieving treatment in American Hospitals. The emergency room wait times have been dropping since January of this year
    • downrightmike 1y ago
      Troll
    • ethbr1 1y ago
      See how those numbers go when premiums spike due to expiring ACA funding & Medicaid cuts.
    • JumpCrisscross 1y ago
      > emergency room wait times have been dropping since January of this year Source?
• hopelite 1y ago
  That is a backwards and likely self-serving perspective. You want to not only deprive foreign countries and populations of their doctors so that they can come serve American interests from having mismanaged the supply and the demand for doctors, all while having imported around 60 million foreign nationals in the last 25 years alone, which has only contributed to extra pressures and taxation of the medical field and has contributed to driving up costs for medical services in America. So again, where do you want to get these doctors from that are in excess in their own countries, in order to bring them to the USA in order to serve American interests, while harming the communities you want to deprive them of?
  • scrps 1y ago
    Or alternatively foreign countries don't value their doctors enough for them to stick around and so they don't... Are you saying someone is suggesting forcing them to come to the west or should people not be allowed to move where they want and can contribute? The US needs more doctors and if there are foreign trained qualified doctors they should be able to practice, healthcare is a free market system or so I am told, labor goes where it gets paid. Also given the much higher wages in the west, sending a portion to relatives back home often does quite a bit to alleviate suffering and stimulate some economic activity. On top of all of that the US govt could step in an increase supply of doctors in various ways, the medical industry could stop artificially keeping supply low to drive wages up, the medical industry could totally opt out of a free market model and operate like a public service. I am sure there are plenty of different solutions I am leaving off.
• nradov 1y ago
  There is no limit on the number of medical school seats. The primary bottleneck for producing new practicing physicians is actually the number of residency program slots. Every year, some students graduate from medical school but are unable to practice medicine because they don't get matched. (Some of them do get matched the following year.) https://savegme.org/ https://savegme.org/
  • novok 1y ago
    And who exactly, historically lobbied for that low limit to limit doctor supply? Why the AMA and other similar organizations! And these kinds of issues seem more global than not.
    • nradov 1y ago
      True, but the AMA reversed its position some years ago and has been lobbying Congress for increased Medicare residency program funding. However, Congress hasn't acted due to budget concerns.
    • sarchertech 1y ago
      The last time the AMA lobbied for capping residency slots was almost 30 years ago. The vast majority of doctors practicing today weren’t even in the field back then.
      • hollerith 1y ago
        That may be true, but insurers continue to lobby for capping, and in the US most large employers are "insurers" in the sense that although they might outsource the administration of the health plans of their employees, they basically pay the entire cost of the care. Although doctor pay is only a small fraction of the total cost of health care, limiting doctor availability is an effective way to limit total cost because most expensive health care goods and services require a doctor to order or prescribe the good or service. I.e, until the patient gets enough time with the doctor for the doctor to realize that the good or service is necessary, the insurer does not need to pay for the good or service.
• matheusmoreira 1y ago
  > there aren't enough doctors Be very careful with what you're suggesting and to what degree. I live in a country that has taken "we need more doctors" to the max and opened hundreds of new medical schools backed by student loans. As a result, the medical profession has become a shadow of its former self. It used to be that only the best students would be selected for medical school. Nowadays any moron can become a doctor. Pay is nosediving since about 40 thousand new doctors enter the market every year or so. Emergency rooms are supposed to attract the most experienced, most cold blooded doctors in the field. Here they have turned into total shit jobs that only attract the heavily indebted and quite possibly incompetent newly minted doctors. Do you know how much damage a stupid indebted inexperienced doctor can cause? People are going to fucking die. I'm actually afraid of getting sick. > If there are more doctors, they will need to need to spread further into regions where they're in demand. Yeah, that's essentially my country's strategy. Squeeze doctors so much they'll have no choice but to relocate to the literal Amazon jungle in search for jobs. Would you like to live in the jungle? Raise a family there? I sure as hell wouldn't. There's a reason the doctors are all concentrated in the capital. Same reason why people migrate to the capital. No one actually wants to live in some undeveloped shithole. "They will need" betrays the fact you think you're qualified to dictate the careers and life paths of an entire category of people. That borders on magical thinking: if you squeeze them, then they'll do what you want the way you want it. No such deal exists. People have any number of options laid out for them. They can just as easily give up on medicine altogether, take their capital and start a business instead. I've actually seen a few do just that. Buy trucks and start a goddamn logistics business because medicine wasn't cutting it anymore.
  • siva7 1y ago
    Not to dismiss your claims but the profession is tightly regulated in every developed country in the world. So even if there was an oversupply of doctors in your country, the high bar to getting licensed ( med school and afterwards specialist training) is still the same for everyone.
    • matheusmoreira 1y ago
      > the high bar to getting licensed ( med school and afterwards specialist training) is still the same for everyone Oversupplying doctors will lower that bar one way or another. Medical schools are a bottleneck? Race them to the bottom. Fund hundreds of them so that it's always possible for any student to find one that'll accept them. Problem solved. Now the medical licensing process has become the bottleneck. Millions will be spent on lobbying in order to subvert it via whatever means. Once that's done, medical specialization will turn into the bottleneck. Repeat. No system retains its integrity when you inject billions into it via loans. And that's just financial interests. Factor in the fact reelections of politicians might very well ride on their providence of more doctors to the population. Just look at the post I replied to: > This is a problem that we as voters should start to act upon. That's the sort of populism that could very well decide elections. Politicians do not give a shit about anything other than reelection, least of all the quality of the doctors their voters are getting. They will always be able to afford the best care. Realize that it's against my interests to warn citizens of developed nations about this. If I were a socipathic person, I would be praising their openness since it could facilitate my own immigration into their countries. I genuinely don't want to watch other people suffer the same fate.
• darth_avocado 1y ago
  This assumes that having more doctors will fix the problems and I can tell you it won’t. I’ve unfortunately had to experience what’s described in the article multiple times in recent years, with the only silver lining that I’m not dead yet. Majority of doctors simply do not go beyond the textbook definition of “standard of care”. You tell them this doesn’t feel like flu? Nope go back with Tylenol and come back if gets worse. Still not getting better 10 days later and you tell them your sinuses are clogged and hurting? Let’s get you Flonase and send you back. Finally you’re half conscious and in the ER almost 3 weeks in? Ohh my bad, should’ve started antibiotics a while ago. Get transferred to a new urgent care because the one that sent you back with a Tylenol yesterday can’t take you in today because you got worse? Let’s start from scratch and tell you exactly what you heard yesterday and refuse to do more tests. Most doctors I’ve had to interact with are laughably clueless when it comes to even slightly non standard illnesses. They are highly opinionated and refuse to do things differently. And surprisingly the only good doctors that I’ve encountered are the older ones, sometimes closer to retirement. Maybe something went horribly wrong in the past 50 years but the new ones are terrible. No wonder people lose their lives when they get sent back home with NyQuil and Tylenol.
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  • NoMoreNicksLeft 1y ago
    There was a shift in attitude to where physicians are managing livestock instead of caring for people. It's not great when some of the livestock die, but that's what livestock does... oh well. The psychology of that shift is complicated, multiple factors that are difficult to tease out. But the bad news is that the shift is likely irreversible, it's lasted long enough that the current doctors teach it to the new incoming residents.
    • mschuster91 1y ago
      The problem at the root is the financialization of everything. Public hospitals are one thing, there incentive structures revolve around saving money - yeeting patients out of the door far faster than you'd have don in the past, to a large degree made possible by new operation technologies (minimally invasive surgeries). But private run hospitals? They see you as a cash cow, extract as much money as possible from you. And yes, often enough that includes outright billing fraud.