7 ms·

> “competition” won’t improve it or control it because there is always a supply side shortage of provision. Why is there always a supply-side shortage?

anon291 4mo ago
Because the American Medical Association artificially restricts residency spots in hospitals. There's really not much more to it. This explains the proliferation of NPs, PA-Cs, etc acting as GPs. In reality, we simply need more doctors, so we should uncap the # of spots.
- EvanAnderson 4mo ago
  This can't be stated enough. I should have my comment w/ citations on standby, but I don't. The AMA was concerned in the 90s re: "oversupply" of doctors and the impact on doctor salaries, lobbied the Republicans (around the "Contract with America" timeframe) and got language limiting NIH-funded residency slots codified. The AMA is backpedaling on that stance now but the damage is already done.
  - anon291 4mo ago
    A reasonable compromise would be a scheduled increase in the number of slots until it is eventually uncapped. Yes, this will reduce doctors salaries in the long-term. You know what else reduces doctor salaries? Importing medical doctors from foreign countries with worse wages and working conditions, and then grinding these individuals to the ground under the threat of immigration. The market finds a way, whether the AMA wants it or not. As Americans get richer, many are even just going to foreign countries to get treatment. I know several 'third world' countries have fairly good medical care available for very cheap.
    - Legend2440 4mo ago
      Doctors salaries should be reduced, as should nurses and dentists. We pay them nearly twice as much in the US as in countries with socialized medicine.
      - dd8601fn 4mo ago
        As part of a policy position, I'm guessing that, "Doctors and nurses make too much money" ain't exactly a slam dunk.
    - sagarm 4mo ago
      Foreign doctors have to go through residency in the US.
- esbranson 4mo ago
  What does the AMA have to do with the Clinton-era cap on federal DGME and IME residency payments? New York spends billions every year, California spends none. These are choices that Congress and California make every year, not the AMA.
polski-g 4mo ago
Because human labor is supply side constrained. There's only so many doctors, only so many MRI machines, so many valve stents, so many syringes. Everything on earth is supply constrained.

anon291 4mo ago

Because the American Medical Association artificially restricts residency spots in hospitals. There's really not much more to it. This explains the proliferation of NPs, PA-Cs, etc acting as GPs. In reality, we simply need more doctors, so we should uncap the # of spots.

EvanAnderson 4mo ago
This can't be stated enough. I should have my comment w/ citations on standby, but I don't. The AMA was concerned in the 90s re: "oversupply" of doctors and the impact on doctor salaries, lobbied the Republicans (around the "Contract with America" timeframe) and got language limiting NIH-funded residency slots codified. The AMA is backpedaling on that stance now but the damage is already done.
- anon291 4mo ago
  A reasonable compromise would be a scheduled increase in the number of slots until it is eventually uncapped. Yes, this will reduce doctors salaries in the long-term. You know what else reduces doctor salaries? Importing medical doctors from foreign countries with worse wages and working conditions, and then grinding these individuals to the ground under the threat of immigration. The market finds a way, whether the AMA wants it or not. As Americans get richer, many are even just going to foreign countries to get treatment. I know several 'third world' countries have fairly good medical care available for very cheap.
  - Legend2440 4mo ago
    Doctors salaries should be reduced, as should nurses and dentists. We pay them nearly twice as much in the US as in countries with socialized medicine.
    - dd8601fn 4mo ago
      As part of a policy position, I'm guessing that, "Doctors and nurses make too much money" ain't exactly a slam dunk.
  - sagarm 4mo ago
    Foreign doctors have to go through residency in the US.
esbranson 4mo ago
What does the AMA have to do with the Clinton-era cap on federal DGME and IME residency payments? New York spends billions every year, California spends none. These are choices that Congress and California make every year, not the AMA.

polski-g 4mo ago

Because human labor is supply side constrained. There's only so many doctors, only so many MRI machines, so many valve stents, so many syringes. Everything on earth is supply constrained.