6 ms·

The biggest problem is just the AMA. They limit the number of doctors in America, so there are just too few. This drives up the salaries for the few doctors w

by tdees40 13y ago

The biggest problem is just the AMA. They limit the number of doctors in America, so there are just too few. This drives up the salaries for the few doctors who live the tell the tale (but certainly don't want to go into primary care, when other more lucrative jobs are on offer), and drives up the hours for everyone. Making it easier to become a doctor would improve things immediately (especially given the recent research that makes it clear that nurse practitioners do just fine).

deleted 13y ago
[deleted]
- selmnoo 13y ago
  > To pay this off in 10 years, the monthly payment would be on the order of $3400. Once employed, hospitals agree on some arrangement in which they help pay sometimes up to as much as 50% of their loans (HRSA alone pays $170k in loan repayment to primary care docs for 5 years of service in a shortage area). And I don't know what kind of doctors you guys have been hanging out with, but most make way more than $300k after only a handful of years of experience. > It's not unheard of for some medical students to have loan debt exceeding $300k. True, but as it turns out, most doctors are sons and daughters of rich folks (at least that's what sister tells me, who's doing her residency now). So those loan debt episodes are being paid by mommies and daddies, and it's rather rare for these doctors to ever feel the pangs of financial pain in their time.
  - dfc 13y ago
    > True, but as it turns out, most doctors are sons and daughters of rich folks > (at least that's what sister tells me, who's doing her residency now). Lets pretend that anecdata is useful and assume that it is generalizable to the entire population of med students. Do you think the prevalence of rich kids is alarming? Possibly an indication that something needs to change in the financing of healthcare or healthcare education? ADDENDUM Feel free to ignore this: (obviously you are morally bound to respond to the above;) The way you speak about being the sons and daughters of rich kids seems to indicate that you and your sister feel separate from that group. Did you come from an affluent family?
    - deleted 13y ago
      [deleted]
    - selmnoo 13y ago
      Yes, clearly it is a problem that only the rich are able to have the resources to get ahead. But this is a much bigger problem than who's able to become a doctor and who's not, it has to do (imo) with the greater issues of society, like new parents being unable to provide high quality preschool education, mom and dad still working when kids are teenagers and need attention and guidance, and so on. I'm a fan of quasi-socialistic, progressive-taxing to ensure everyone gets the resources. I'm from a brown immigrant family. Brown/Asian immigrants seem to be exceptions everywhere, in that they're usually poor starting out and still persevere and make it through medical schools and whatever else. My family now is doing quite okay, but is probably still below the average residency student's family. The way it looks to me (anecdata), the average residency student's family has a household income of 1mil+. My family's household income is barely 200k, so make of that what you will.
    - ZachPruckowski 13y ago
      I'd say that a prevalence of rich kids is alarming, and not from an equality perspective or anything. It's alarming because an advanced and specialized economy like ours is at its most efficient when people are doing the jobs they're best suited for. If I'm well-suited to be a DBA and I'm instead doing something I'm much less well-suited for (like sales) then it's a societal net-loss[1]. Unless we assume there's a reason that the people who are best-suited or at least well-suited to be doctors are disproportionately rich, then we're probably winding up with poor/middle-class folks who'd make excellent doctors doing some other job they're less good at. [1] This is not and should not be read as an argument that DBAs > sales or anything to that effect.
  - nathanvanfleet 13y ago
    Yes, and who is complaining about how inner city minorities can't pay their medical school bills. Answer is that they never had the resources to get into it no matter how interested they were in it. So this sounds more of a tiny violin "wish I became a banker, like my dad" sort of thing.
  - cloverich 13y ago
    > but most make way more than $300k after only a handful of years of experience. 'Eh, not really [1]. Most will wind up in the upper $100k region (most being in some form of primary care). Not after a handful of years, but 4+ yrs college, 4+ yrs medical school, then bare minimum 3 year residency (with most 4+), with each step an order of magnitude more difficult. > most doctors are sons and daughters of rich folks Many are, but since we're in the anecdata game, none of my friends were. Not going to lose sleep over it, upper $100's is plenty to compensate for high debt in the long run. But to pretend its not extremely stressful for most is to be misinformed. Lastly: > 5 years of service in a shortage area After spending the last 2 years in a qualifying region (though not for that purpose); topping off 12 yrs of post-high school with another 5 living somewhere you'd rather not be (to be polite) is no small feat. Thats 35 yrs old before you get a shot at living and working somewhere reasonable. [1] http://www.medscape.com/features/slideshow/compensation/2013/public http://www.medscape.com/features/slideshow/compensation/2013...
  - nilkn 13y ago
    Odd, you must have replied concurrently with my deleting my post. If I ever delete something here on HN, I always double-check first to make sure that it hasn't received replies first to avoid this situation. It's only by casually re-reading this thread a day later that I amusingly discovered by deleted post had received a reply. =] > most make way more than $300k after only a handful of years of experience. I was referring to family physicians. They do not make this sort of money on average, especially not just out of residency. There are numerous serious physician compensation reports that will confirm this.
- commandar 13y ago
  >Granted, the salary will probably hit $200k with some years of experience More if they're specialty and/or surgical. One of the side effects of most hospitals being organized as non-profits is that they have to disclose the compensation level of their five highest-compensated, non-board/officer employees. I know at my hospital (mid-size, 250k metro area, ~$35k median income) that number ranges from $750k-1.2M. Granted, most doctors aren't making anywhere near that, but it was pretty surprising to me when I looked up our 990 out of curiosity. I do think an MD, especially a specialist, stands a much better chance of making that sort of money than any given software engineer, though.
  - judk 13y ago
    Those top 5 have nothing to do with doctor salaries. The top 5 at any software company of 1000+ engineers to better than that.
    - deleted 13y ago
      [deleted]
    - commandar 13y ago
      It specifically surprised me because we're not a huge hospital in a particularly large market. We're a good hospital, but we're by no means renowned. If you want that, you drive a couple of hours north to a number of the best (inter)national facilities available. tl;dr - I suspect that there are more doctors as a percentage of that workforce earning, say, 400-500k+ than there are software engineers doing the same.
  - will_work4tears 13y ago
    I dunno, I saw some statistics that put the median salary of a GP at 130k. That's in the Seattle Metro area too. Certainly some of the top make much more, but there are obviously programmers that make 400k too, but I can't expect that myself, or say that if you are a programmer you'll likely make that much.
    - commandar 13y ago
zavi 13y ago
It would be interesting to see some data and in depth analysis on this subject to tell apart unfounded conspiracy claims from an actual problem that needs to be addressed.
pessimizer 13y ago
Phil Ochs - A.M.A. Song https://www.youtube.com/watch?v=6lkvswrSRAE https://www.youtube.com/watch?v=6lkvswrSRAE
deleted 13y ago
[deleted]
- deleted 13y ago
  [deleted]
wehadfun 13y ago
could you expand
FD3SA 13y ago
The worst part about this set up is that increasing the number of doctors won't actually reduce healthcare costs, but paradoxically, increase them. This is because doctors in the USA make money through ordering tests and exams, rather than just spending face time with patients, as the article points out. There was an excellent Time [1] article on this phenomenon. To make matters worse, Canada is suffering the effects of the American system. Doctors licensed in Canada are encouraged to go to the USA (particularly specialists), by the allure of much higher salaries. In order to prevent a vicious brain drain, the Canadian Medical Association must pay doctors as much as they can to stay and practice in the country. As such, Canadian healthcare costs have been skyrocketing due to specialist salaries soaring ever higher to compete with American rates. Comparing physician salaries in the US and Canada with other commonwealth countries like Australia and the UK provides a clearer picture as to what is going on. The American healthcare system is completely and utterly FUBAR. It needs to be torn down and rebuilt based on a functioning healthcare system from another country. 1. http://time.com/198/bitter-pill-why-medical-bills-are-killing-us/ http://time.com/198/bitter-pill-why-medical-bills-are-killin... (Unfortunately, it is now paywalled)
- msandford 13y ago
  There's a million fixes for that. Ultimately it needs to be the patients that are in charge of the payment. As it stands there are no published prices (or they're bogus, if your published prices are 3x what insurance companies pay it's not a real price) for anything so nobody can shop around. That means there is no competitive pressure on the non-critical, non-life-threatening things that are expensive-ish but possible to pay out of pocket. And that means that nobody can circumvent insurance. And that means that doctors have to keep spending $58 to process a form that will net them a $20 to $30 copay and maybe another $50 worth of reimbursement? So the doc nets between $30 and $40. Call it $35 and multiply by 5 (12 min per patient) and the doc is billing out at $175 per hour provided he teleports from one exam room to the next. There are a great many people who could afford to pay $100 cash (or equivalent) for a doctors visit, for say 30 minutes with a doctor. So that's $200 per hour. Major medical plans (for big stuff) coupled with health savings accounts will empower patients to ask "do I really need this" with a price sheet in hand and a real conversation about the benefits vs the costs. Right now that happens approximately zero.
pg_is_a_butt 13y ago
thanks obama
araftery 13y ago
I disagree. The problem is frankly that we've come to expect too much from modern medicine. Doing a triple bypass surgery on a 90-year-old is expensive, plain and simple. Yes, we can save his life, but we have to be willing to pay the cost—and we aren't. Medicare is a monopsony. They represent such a large share of patients for many practices that they set their own prices. And when people expect medicare both to pay for their triple bypass and not to go broke at the same time, what we get bankrupt hospitals and over-worked doctors. Being more responsible about the way we apportion healthcare is the only reasonable option.
- karmajunkie 13y ago
  I don't know any cardiologists who would perform that kind of surgery on a 90yo.
  - deleted 13y ago
    [deleted]
rdmcfee 13y ago
Coming from the healthcare marketing field, I can tell you there are many doctors who are looking for more patients. Especially specialists.
deleted 13y ago
[deleted]
mudil 13y ago
I am a doctor, an anesthesiologist. I don't like AMA. But to blame AMA is a complete nonsense. (AMA really is just an insurance and loan agency, just like AARP.) The real problem is government regulation of our profession, of the whole clinical process, and of devices and medications. Those of you who go up in arms when government sticks its nose in your internet business, should imagine how it is to deal with the government that is there all the time for us. For example, how about trying to bill Medicare for a surgery, when one phrase--one phrase-- is missing from the documentation, and I don't get a penny for a 4 hour surgery?
- sizzle 13y ago
  http://www.scpr.org/programs/airtalk/2014/04/15/6508/ http://www.scpr.org/programs/airtalk/2014/04/15/6508/ can you comment on this radio segment please?
- mudil 13y ago
  The Association of American Medical Colleges (www.aamc.org) sets number of medical students, and not AMA.
  - riahi 13y ago
    The number of medical students is wholly irrelevant to the conversation at hand. We currently have more residencies than medical students, so spots are filled by foreign medical grads. However, in about 2-3 years, there will be more American medical students than there will be residency spots. Still have the same problem: the bottleneck in training is the residency. So, blaming the AMA or AAMC for keeping medical student numbers down is pointless. They are not the final gatekeeper for the creation of doctors. Residency training is that gatekeeper.
    - autokad 13y ago
      last year there were more grads than residency spots.
- thecage411 13y ago
LiweiZ 13y ago
From a demand/supply perspective involving only patients and doctors, it seems correct. I actually have the similar thought. But can anyone provide more dimensions of this "market"?
riahi 13y ago
I hate to make this a common refrain, but I make this same comment every time I see a comment like yours: The supply of doctors is not restricted by the AMA. The supply of doctors is determined by the number of residency spots available to new graduates; that number is entirely determined by the Centers for Medicare and Medicaid (CMS). Thanks to the Balanced Budget Act of 1997, Graduate Medical Education (GME) was dramatically slowed due to decreases in Medicare funding of residency positions. [1] As long as we require physicians to be US trained and to have completed a US residency, the bottleneck will be GME funding. To fix that, the AMA or any other concerned citizen can lobby Congress for an increase. [1]: http://jama.jamanetwork.com/article.aspx?articleid=182532 http://jama.jamanetwork.com/article.aspx?articleid=182532
- Retric 13y ago
  Why exactly must the government pay for it? It seems obvious if it's a net cost it really should be paid for by the students. Also, if you could go to med school without an undergraduate degree you can increase the number of years a doctor could work thus lowering costs and increasing supply at the same time.
  - riahi 13y ago
    Well, someone has to pay the salaries of medical trainees. Who would you suggest do it? Since the establishment of Medicare/Medicaid, CMS pays hospitals a set amount per year per resident. I suppose you could mandate that teaching hospitals be forced to foot the bill themselves, but most teaching hospitals have disproportionately high Medicaid and uninsured patient populations, so they aren't exactly swimming in cash. Note: I'm editing my post, as you have edited yours. Well, if you make students pay additional tuition / take loans for living expenses during residency training, then you can kiss goodbye the thought of ever fixing the doctor shortage. Think about what you're advocating here: Someone who just took out a $160k unsubsidized loan at 5.4% (variable) interest now has to increase his/her loan burden just. to. eat. for another 3-7 years while interest is accruing on that initial medical school balance. Does this seem like a sustainable system to you? Man, I thought HN/Silicon Valley/Tech Industry was all up in arms at the unjustness of the unpaid internship...

by tdees40 13y ago

deleted 13y ago

[deleted]

selmnoo 13y ago
> To pay this off in 10 years, the monthly payment would be on the order of $3400. Once employed, hospitals agree on some arrangement in which they help pay sometimes up to as much as 50% of their loans (HRSA alone pays $170k in loan repayment to primary care docs for 5 years of service in a shortage area). And I don't know what kind of doctors you guys have been hanging out with, but most make way more than $300k after only a handful of years of experience. > It's not unheard of for some medical students to have loan debt exceeding $300k. True, but as it turns out, most doctors are sons and daughters of rich folks (at least that's what sister tells me, who's doing her residency now). So those loan debt episodes are being paid by mommies and daddies, and it's rather rare for these doctors to ever feel the pangs of financial pain in their time.
- dfc 13y ago
  > True, but as it turns out, most doctors are sons and daughters of rich folks > (at least that's what sister tells me, who's doing her residency now). Lets pretend that anecdata is useful and assume that it is generalizable to the entire population of med students. Do you think the prevalence of rich kids is alarming? Possibly an indication that something needs to change in the financing of healthcare or healthcare education? ADDENDUM Feel free to ignore this: (obviously you are morally bound to respond to the above;) The way you speak about being the sons and daughters of rich kids seems to indicate that you and your sister feel separate from that group. Did you come from an affluent family?
  - deleted 13y ago
    [deleted]
  - selmnoo 13y ago
    Yes, clearly it is a problem that only the rich are able to have the resources to get ahead. But this is a much bigger problem than who's able to become a doctor and who's not, it has to do (imo) with the greater issues of society, like new parents being unable to provide high quality preschool education, mom and dad still working when kids are teenagers and need attention and guidance, and so on. I'm a fan of quasi-socialistic, progressive-taxing to ensure everyone gets the resources. I'm from a brown immigrant family. Brown/Asian immigrants seem to be exceptions everywhere, in that they're usually poor starting out and still persevere and make it through medical schools and whatever else. My family now is doing quite okay, but is probably still below the average residency student's family. The way it looks to me (anecdata), the average residency student's family has a household income of 1mil+. My family's household income is barely 200k, so make of that what you will.
  - ZachPruckowski 13y ago
    I'd say that a prevalence of rich kids is alarming, and not from an equality perspective or anything. It's alarming because an advanced and specialized economy like ours is at its most efficient when people are doing the jobs they're best suited for. If I'm well-suited to be a DBA and I'm instead doing something I'm much less well-suited for (like sales) then it's a societal net-loss[1]. Unless we assume there's a reason that the people who are best-suited or at least well-suited to be doctors are disproportionately rich, then we're probably winding up with poor/middle-class folks who'd make excellent doctors doing some other job they're less good at. [1] This is not and should not be read as an argument that DBAs > sales or anything to that effect.
- nathanvanfleet 13y ago
  Yes, and who is complaining about how inner city minorities can't pay their medical school bills. Answer is that they never had the resources to get into it no matter how interested they were in it. So this sounds more of a tiny violin "wish I became a banker, like my dad" sort of thing.
- cloverich 13y ago
  > but most make way more than $300k after only a handful of years of experience. 'Eh, not really [1]. Most will wind up in the upper $100k region (most being in some form of primary care). Not after a handful of years, but 4+ yrs college, 4+ yrs medical school, then bare minimum 3 year residency (with most 4+), with each step an order of magnitude more difficult. > most doctors are sons and daughters of rich folks Many are, but since we're in the anecdata game, none of my friends were. Not going to lose sleep over it, upper $100's is plenty to compensate for high debt in the long run. But to pretend its not extremely stressful for most is to be misinformed. Lastly: > 5 years of service in a shortage area After spending the last 2 years in a qualifying region (though not for that purpose); topping off 12 yrs of post-high school with another 5 living somewhere you'd rather not be (to be polite) is no small feat. Thats 35 yrs old before you get a shot at living and working somewhere reasonable. [1] http://www.medscape.com/features/slideshow/compensation/2013/public http://www.medscape.com/features/slideshow/compensation/2013...
- nilkn 13y ago
  Odd, you must have replied concurrently with my deleting my post. If I ever delete something here on HN, I always double-check first to make sure that it hasn't received replies first to avoid this situation. It's only by casually re-reading this thread a day later that I amusingly discovered by deleted post had received a reply. =] > most make way more than $300k after only a handful of years of experience. I was referring to family physicians. They do not make this sort of money on average, especially not just out of residency. There are numerous serious physician compensation reports that will confirm this.
commandar 13y ago
>Granted, the salary will probably hit $200k with some years of experience More if they're specialty and/or surgical. One of the side effects of most hospitals being organized as non-profits is that they have to disclose the compensation level of their five highest-compensated, non-board/officer employees. I know at my hospital (mid-size, 250k metro area, ~$35k median income) that number ranges from $750k-1.2M. Granted, most doctors aren't making anywhere near that, but it was pretty surprising to me when I looked up our 990 out of curiosity. I do think an MD, especially a specialist, stands a much better chance of making that sort of money than any given software engineer, though.
- judk 13y ago
  Those top 5 have nothing to do with doctor salaries. The top 5 at any software company of 1000+ engineers to better than that.
  - deleted 13y ago
    [deleted]
  - commandar 13y ago
    It specifically surprised me because we're not a huge hospital in a particularly large market. We're a good hospital, but we're by no means renowned. If you want that, you drive a couple of hours north to a number of the best (inter)national facilities available. tl;dr - I suspect that there are more doctors as a percentage of that workforce earning, say, 400-500k+ than there are software engineers doing the same.
- will_work4tears 13y ago
  I dunno, I saw some statistics that put the median salary of a GP at 130k. That's in the Seattle Metro area too. Certainly some of the top make much more, but there are obviously programmers that make 400k too, but I can't expect that myself, or say that if you are a programmer you'll likely make that much.
  - commandar 13y ago

zavi 13y ago

It would be interesting to see some data and in depth analysis on this subject to tell apart unfounded conspiracy claims from an actual problem that needs to be addressed.

pessimizer 13y ago

Phil Ochs - A.M.A. Song https://www.youtube.com/watch?v=6lkvswrSRAE https://www.youtube.com/watch?v=6lkvswrSRAE

deleted 13y ago

[deleted]

deleted 13y ago
[deleted]

wehadfun 13y ago

could you expand

FD3SA 13y ago

The worst part about this set up is that increasing the number of doctors won't actually reduce healthcare costs, but paradoxically, increase them. This is because doctors in the USA make money through ordering tests and exams, rather than just spending face time with patients, as the article points out. There was an excellent Time [1] article on this phenomenon. To make matters worse, Canada is suffering the effects of the American system. Doctors licensed in Canada are encouraged to go to the USA (particularly specialists), by the allure of much higher salaries. In order to prevent a vicious brain drain, the Canadian Medical Association must pay doctors as much as they can to stay and practice in the country. As such, Canadian healthcare costs have been skyrocketing due to specialist salaries soaring ever higher to compete with American rates. Comparing physician salaries in the US and Canada with other commonwealth countries like Australia and the UK provides a clearer picture as to what is going on. The American healthcare system is completely and utterly FUBAR. It needs to be torn down and rebuilt based on a functioning healthcare system from another country. 1. http://time.com/198/bitter-pill-why-medical-bills-are-killing-us/ http://time.com/198/bitter-pill-why-medical-bills-are-killin... (Unfortunately, it is now paywalled)

msandford 13y ago
There's a million fixes for that. Ultimately it needs to be the patients that are in charge of the payment. As it stands there are no published prices (or they're bogus, if your published prices are 3x what insurance companies pay it's not a real price) for anything so nobody can shop around. That means there is no competitive pressure on the non-critical, non-life-threatening things that are expensive-ish but possible to pay out of pocket. And that means that nobody can circumvent insurance. And that means that doctors have to keep spending $58 to process a form that will net them a $20 to $30 copay and maybe another $50 worth of reimbursement? So the doc nets between $30 and $40. Call it $35 and multiply by 5 (12 min per patient) and the doc is billing out at $175 per hour provided he teleports from one exam room to the next. There are a great many people who could afford to pay $100 cash (or equivalent) for a doctors visit, for say 30 minutes with a doctor. So that's $200 per hour. Major medical plans (for big stuff) coupled with health savings accounts will empower patients to ask "do I really need this" with a price sheet in hand and a real conversation about the benefits vs the costs. Right now that happens approximately zero.

pg_is_a_butt 13y ago

thanks obama

araftery 13y ago

I disagree. The problem is frankly that we've come to expect too much from modern medicine. Doing a triple bypass surgery on a 90-year-old is expensive, plain and simple. Yes, we can save his life, but we have to be willing to pay the cost—and we aren't. Medicare is a monopsony. They represent such a large share of patients for many practices that they set their own prices. And when people expect medicare both to pay for their triple bypass and not to go broke at the same time, what we get bankrupt hospitals and over-worked doctors. Being more responsible about the way we apportion healthcare is the only reasonable option.

karmajunkie 13y ago
I don't know any cardiologists who would perform that kind of surgery on a 90yo.
- deleted 13y ago
  [deleted]

rdmcfee 13y ago

Coming from the healthcare marketing field, I can tell you there are many doctors who are looking for more patients. Especially specialists.

deleted 13y ago

[deleted]

mudil 13y ago

I am a doctor, an anesthesiologist. I don't like AMA. But to blame AMA is a complete nonsense. (AMA really is just an insurance and loan agency, just like AARP.) The real problem is government regulation of our profession, of the whole clinical process, and of devices and medications. Those of you who go up in arms when government sticks its nose in your internet business, should imagine how it is to deal with the government that is there all the time for us. For example, how about trying to bill Medicare for a surgery, when one phrase--one phrase-- is missing from the documentation, and I don't get a penny for a 4 hour surgery?

sizzle 13y ago
http://www.scpr.org/programs/airtalk/2014/04/15/6508/ http://www.scpr.org/programs/airtalk/2014/04/15/6508/ can you comment on this radio segment please?
mudil 13y ago
The Association of American Medical Colleges (www.aamc.org) sets number of medical students, and not AMA.
- riahi 13y ago
  The number of medical students is wholly irrelevant to the conversation at hand. We currently have more residencies than medical students, so spots are filled by foreign medical grads. However, in about 2-3 years, there will be more American medical students than there will be residency spots. Still have the same problem: the bottleneck in training is the residency. So, blaming the AMA or AAMC for keeping medical student numbers down is pointless. They are not the final gatekeeper for the creation of doctors. Residency training is that gatekeeper.
  - autokad 13y ago
    last year there were more grads than residency spots.
thecage411 13y ago

LiweiZ 13y ago

From a demand/supply perspective involving only patients and doctors, it seems correct. I actually have the similar thought. But can anyone provide more dimensions of this "market"?

riahi 13y ago

I hate to make this a common refrain, but I make this same comment every time I see a comment like yours: The supply of doctors is not restricted by the AMA. The supply of doctors is determined by the number of residency spots available to new graduates; that number is entirely determined by the Centers for Medicare and Medicaid (CMS). Thanks to the Balanced Budget Act of 1997, Graduate Medical Education (GME) was dramatically slowed due to decreases in Medicare funding of residency positions. [1] As long as we require physicians to be US trained and to have completed a US residency, the bottleneck will be GME funding. To fix that, the AMA or any other concerned citizen can lobby Congress for an increase. [1]: http://jama.jamanetwork.com/article.aspx?articleid=182532 http://jama.jamanetwork.com/article.aspx?articleid=182532

Retric 13y ago
Why exactly must the government pay for it? It seems obvious if it's a net cost it really should be paid for by the students. Also, if you could go to med school without an undergraduate degree you can increase the number of years a doctor could work thus lowering costs and increasing supply at the same time.
- riahi 13y ago
  Well, someone has to pay the salaries of medical trainees. Who would you suggest do it? Since the establishment of Medicare/Medicaid, CMS pays hospitals a set amount per year per resident. I suppose you could mandate that teaching hospitals be forced to foot the bill themselves, but most teaching hospitals have disproportionately high Medicaid and uninsured patient populations, so they aren't exactly swimming in cash. Note: I'm editing my post, as you have edited yours. Well, if you make students pay additional tuition / take loans for living expenses during residency training, then you can kiss goodbye the thought of ever fixing the doctor shortage. Think about what you're advocating here: Someone who just took out a $160k unsubsidized loan at 5.4% (variable) interest now has to increase his/her loan burden just. to. eat. for another 3-7 years while interest is accruing on that initial medical school balance. Does this seem like a sustainable system to you? Man, I thought HN/Silicon Valley/Tech Industry was all up in arms at the unjustness of the unpaid internship...