4 ms·

What do you think voters should do? How do we increase the number of doctors?

by bckr 1y ago

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.
      - nradov 1y ago
        If we pull Medicare funding for residency programs then the system will collapse. Most teaching hospitals are run by local governments or non-profit foundations. They simply don't have the resources to subsidize graduate medical education. The money has to come from somewhere. (And let's not have any stupid comments suggesting that residents should pay for it themselves. They're already tapped out in terms of student debt.)
        triceratops 1y ago
        If Medicare funding disappeared tomorrow the healthcare industry would figure out how to fund residents. The alternative is no new doctors. Nobody wants that. I'm not advocating pulling the plug overnight without planning an alternative. That would guarantee a collapse as you said. But announcing an expiration of the program would heavily incentivize all participants to figure something out. Residents make like $70k a year plus benefits. I'm sure the hospital bills their work for a lot more than that, even accounting for the time of attending physicians. Right now that profit margin probably subsidizes other loss-making activities in the hospital.
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.

What do you think voters should do? How do we increase the number of doctors?

by 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.
    - nradov 1y ago
      If we pull Medicare funding for residency programs then the system will collapse. Most teaching hospitals are run by local governments or non-profit foundations. They simply don't have the resources to subsidize graduate medical education. The money has to come from somewhere. (And let's not have any stupid comments suggesting that residents should pay for it themselves. They're already tapped out in terms of student debt.)
      - triceratops 1y ago
        If Medicare funding disappeared tomorrow the healthcare industry would figure out how to fund residents. The alternative is no new doctors. Nobody wants that. I'm not advocating pulling the plug overnight without planning an alternative. That would guarantee a collapse as you said. But announcing an expiration of the program would heavily incentivize all participants to figure something out. Residents make like $70k a year plus benefits. I'm sure the hospital bills their work for a lot more than that, even accounting for the time of attending physicians. Right now that profit margin probably subsidizes other loss-making activities in the hospital.

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.