10 ms·

I never really understood why the US has quotas intentionally preventing students who are skilled enough from getting education here.

by lnanek2 12y ago

kingnothing 12y ago
The AMA has limits to protect the income and quality of doctors.
- chimeracoder 12y ago
  First, quality is not the (only) reason the AMA used to limit the number of doctors. The AMA is a convenient scapegoat thanks to the catchy song about it, but it's actually not relevant here[0]. Secondly, the real limiting factor now is not the AMA but the AAMC[1]. They serve as the current bottleneck for increasing the number of people who receive the MD degree. However, getting an MD doesn't mean that you can practice medicine. Technically, you haven't even been trained to practice yet - that happens during residency[2]. The bottleneck for the number of practicing physicians (as opposed to the number of MDs) is what is really relevant. That is capped by the number of residency positions available. These are funded through Medicare, so the real limiting factor is the government spending allocated towards Medicare which funds residency positions. So, blame the AAMC, blame Medicare, blame the government, or blame Congress, but don't blame the AMA, since they aren't the bottleneck for increasing the number of practicing physicians. (And one can easily make the argument that increasing the number of medical school students while keeping the number of residency positions open constant is a waste of money). As for reducing the costs, that's easier said than done. The amount of time it takes to train someone to (e.g) be a good cardiologist is significant, and the length of time alone makes the costs very significant - trying to shave off a few pennies here and there is really just a drop in the bucket. The only way to lower these costs appreciably would be to lower the amount of time it takes to train in these specialties, but that comes with a number of risks. Already there have been a number of lawsuits arising from overworked and sleep-deprived residents making mistakes, and it's a tough sell politically to say "Your cardiologist spent 33% less time training to receive a bargain degree. Any loss in quality that impacts your health is just a side-effect of keeping health costs low."[3] [0] It's also misleading to imply that the AMA seeks to keep income for doctors high. The relationship between doctors and the AMA is complicated, but fairly rocky and sometimes downright acrimonious. Keeping incomes high is (if anything) a side-effect of the AMA's practices, not a goal. (And if it were, the AMA would be failing heavily at this goal, as physician income has been declining steadily for many years now in most states). [1] https://skeptics.stackexchange.com/questions/4561/does-the-ama-limit-the-number-of-doctors-to-increase-current-doctors-salaries https://skeptics.stackexchange.com/questions/4561/does-the-a... [2] Which only gives you the ability to practice in a limited capacity - any specialties or subspecialties will require a fellowship, which can be as much as 10 years of training after receiving the M.D.
  - jfoutz 12y ago
    Really showing my blind ignorance here. I'm not exactly a fan of for profit hospitals, but why wouldn't they open up vast numbers of residency positions? I'd assume they can charge whatever they want for resident's time, and add enough peer review to keep malpractice costs down. I'd also assume it's much cheaper to use a resident than a (not sure of the term) practicing physician (?)
    - chimeracoder 12y ago
      > I'd assume they can charge whatever they want for resident's time, and add enough peer review to keep malpractice costs down. I'd also assume it's much cheaper to use a resident than a (not sure of the term) practicing physician (?) Residents are certainly cheaper than attending physicians, and this is what they already do (Scrubs is, I have been told by many, a very accurate depiction of what a hospital actually looks like in this regard). Residents are already paid what amounts to minimum wage or less when you factor in the amount of time they spend. (Keep in mind that they are also paying back medical school loans off of this same stipend). I'm not sure what you mean by "add enough peer review", but attending physicians are already responsible for residents, but even then the threat of malpractice is already incredibly high. The short answer is that, as any engineer who's ever hired a bunch of interns at once knows, no matter what you do, training residents costs more money on average than it saves. That's why the government has to foot the bill already - if hospitals could find a way to keep their costs lower with this strategy, I guarantee you it'd be one of the first things they did.
    - blue11 12y ago
      The ratio of attending physicians to residents must be relatively low, something like 1:4, so a hospital cannot get more residency spots approved unless it also hires more attending physicians.
      - hackuser 12y ago
        > a hospital cannot get more residency spots approved unless it also hires more attending physicians. If there is a shortage of attending physicians, then we need more residents.
hackuser 12y ago
As I understand it, there's a quota of med school spots, and it doesn't increase with the population. Perhaps it's a way of keeping doctor's incomes high (by reducing competition) and maintaining exclusive status?
- pokpokpok 12y ago
  exclusive status and 80hr work weeks
  - copperx 12y ago
    I wonder if any doctor would be willing to get half their $250k for half the work hours.
    - nilkn 12y ago
      I spoke with a radiologist once who took half of his $640k in exchange for working only 7 months out of the year (20 weeks of vacation).
    - chimeracoder 12y ago
      Physicians working in private practice have that choice. Though the fact that those private practices are going out of business and are steadily being bought by hospitals is probably a sign as to the long-term viability of private practice as a business model[0]. Don't look at the salary of a physician, because not all doctors are salaried, and even for the ones that are, net worth is a much more meaningful measurement. $250K is a little high for some specialties, and it depends heavily on the part of the country. In any case, once you factor in the massive debt from medical school (plus the amount of time that physicians spend making essentially minimum wage while training in residency), the answer is that many doctors can't afford to make much less than they currently are[1]. (Also keep in mind that most statistics you see for "salary" for private practices are really more equivalent to revenue, since physicians in private practice obviously aren't salaried. Oftentimes, these numbers include only some, not all, of the costs of maintaining a practice.) [0] This is a trend that is over a decade old (depending on the part of the country) but accelerated in recent years (before the ACA, though the ACA has also contributed to this trend as well) [1] http://www.cbsnews.com/news/1-million-mistake-becoming-a-doctor/ http://www.cbsnews.com/news/1-million-mistake-becoming-a-doc...
nilkn 12y ago
The actual bottleneck today is with residency spots. With that knowledge, it's really for the best that medical school enrollment is limited. The situation law schools find themselves in is not an enviable one. I don't think it would be good for anyone to send students to medical school, make them suffer and struggle for four years (doubly so because they weren't as strong students to begin with), ask them to take on hundreds of thousands of dollars of debt, and then say, "oh, you can't practice medicine because we just don't have enough residencies anymore."
cma 12y ago
Protectionism for the top, free trade for the bottom.
x0x0 12y ago
It's really smart to ensure that at the end of a very long and pricy education, essentially every qualified doctor who wants to be a doctor can get a job as a doctor. Plus many med schools lose money or break even, and residencies are a big cost for hospitals, etc.
- hackuser 12y ago
  > It's really smart to ensure that at the end of a very long and pricy education, essentially every qualified doctor who wants to be a doctor can get a job as a doctor. Why? No other professionals get this guarantee. What about physics or history Ph.D.'s?

I never really understood why the US has quotas intentionally preventing students who are skilled enough from getting education here.

by lnanek2 12y ago

I never really understood why the US has quotas intentionally preventing students who are skilled enough from getting education here.

kingnothing 12y ago

The AMA has limits to protect the income and quality of doctors.

chimeracoder 12y ago
First, quality is not the (only) reason the AMA used to limit the number of doctors. The AMA is a convenient scapegoat thanks to the catchy song about it, but it's actually not relevant here[0]. Secondly, the real limiting factor now is not the AMA but the AAMC[1]. They serve as the current bottleneck for increasing the number of people who receive the MD degree. However, getting an MD doesn't mean that you can practice medicine. Technically, you haven't even been trained to practice yet - that happens during residency[2]. The bottleneck for the number of practicing physicians (as opposed to the number of MDs) is what is really relevant. That is capped by the number of residency positions available. These are funded through Medicare, so the real limiting factor is the government spending allocated towards Medicare which funds residency positions. So, blame the AAMC, blame Medicare, blame the government, or blame Congress, but don't blame the AMA, since they aren't the bottleneck for increasing the number of practicing physicians. (And one can easily make the argument that increasing the number of medical school students while keeping the number of residency positions open constant is a waste of money). As for reducing the costs, that's easier said than done. The amount of time it takes to train someone to (e.g) be a good cardiologist is significant, and the length of time alone makes the costs very significant - trying to shave off a few pennies here and there is really just a drop in the bucket. The only way to lower these costs appreciably would be to lower the amount of time it takes to train in these specialties, but that comes with a number of risks. Already there have been a number of lawsuits arising from overworked and sleep-deprived residents making mistakes, and it's a tough sell politically to say "Your cardiologist spent 33% less time training to receive a bargain degree. Any loss in quality that impacts your health is just a side-effect of keeping health costs low."[3] [0] It's also misleading to imply that the AMA seeks to keep income for doctors high. The relationship between doctors and the AMA is complicated, but fairly rocky and sometimes downright acrimonious. Keeping incomes high is (if anything) a side-effect of the AMA's practices, not a goal. (And if it were, the AMA would be failing heavily at this goal, as physician income has been declining steadily for many years now in most states). [1] https://skeptics.stackexchange.com/questions/4561/does-the-ama-limit-the-number-of-doctors-to-increase-current-doctors-salaries https://skeptics.stackexchange.com/questions/4561/does-the-a... [2] Which only gives you the ability to practice in a limited capacity - any specialties or subspecialties will require a fellowship, which can be as much as 10 years of training after receiving the M.D.
- jfoutz 12y ago
  Really showing my blind ignorance here. I'm not exactly a fan of for profit hospitals, but why wouldn't they open up vast numbers of residency positions? I'd assume they can charge whatever they want for resident's time, and add enough peer review to keep malpractice costs down. I'd also assume it's much cheaper to use a resident than a (not sure of the term) practicing physician (?)
  - chimeracoder 12y ago
    > I'd assume they can charge whatever they want for resident's time, and add enough peer review to keep malpractice costs down. I'd also assume it's much cheaper to use a resident than a (not sure of the term) practicing physician (?) Residents are certainly cheaper than attending physicians, and this is what they already do (Scrubs is, I have been told by many, a very accurate depiction of what a hospital actually looks like in this regard). Residents are already paid what amounts to minimum wage or less when you factor in the amount of time they spend. (Keep in mind that they are also paying back medical school loans off of this same stipend). I'm not sure what you mean by "add enough peer review", but attending physicians are already responsible for residents, but even then the threat of malpractice is already incredibly high. The short answer is that, as any engineer who's ever hired a bunch of interns at once knows, no matter what you do, training residents costs more money on average than it saves. That's why the government has to foot the bill already - if hospitals could find a way to keep their costs lower with this strategy, I guarantee you it'd be one of the first things they did.
  - blue11 12y ago
    The ratio of attending physicians to residents must be relatively low, something like 1:4, so a hospital cannot get more residency spots approved unless it also hires more attending physicians.
    - hackuser 12y ago
      > a hospital cannot get more residency spots approved unless it also hires more attending physicians. If there is a shortage of attending physicians, then we need more residents.

hackuser 12y ago

As I understand it, there's a quota of med school spots, and it doesn't increase with the population. Perhaps it's a way of keeping doctor's incomes high (by reducing competition) and maintaining exclusive status?

pokpokpok 12y ago
exclusive status and 80hr work weeks
- copperx 12y ago
  I wonder if any doctor would be willing to get half their $250k for half the work hours.
  - nilkn 12y ago
    I spoke with a radiologist once who took half of his $640k in exchange for working only 7 months out of the year (20 weeks of vacation).
  - chimeracoder 12y ago
    Physicians working in private practice have that choice. Though the fact that those private practices are going out of business and are steadily being bought by hospitals is probably a sign as to the long-term viability of private practice as a business model[0]. Don't look at the salary of a physician, because not all doctors are salaried, and even for the ones that are, net worth is a much more meaningful measurement. $250K is a little high for some specialties, and it depends heavily on the part of the country. In any case, once you factor in the massive debt from medical school (plus the amount of time that physicians spend making essentially minimum wage while training in residency), the answer is that many doctors can't afford to make much less than they currently are[1]. (Also keep in mind that most statistics you see for "salary" for private practices are really more equivalent to revenue, since physicians in private practice obviously aren't salaried. Oftentimes, these numbers include only some, not all, of the costs of maintaining a practice.) [0] This is a trend that is over a decade old (depending on the part of the country) but accelerated in recent years (before the ACA, though the ACA has also contributed to this trend as well) [1] http://www.cbsnews.com/news/1-million-mistake-becoming-a-doctor/ http://www.cbsnews.com/news/1-million-mistake-becoming-a-doc...

nilkn 12y ago

The actual bottleneck today is with residency spots. With that knowledge, it's really for the best that medical school enrollment is limited. The situation law schools find themselves in is not an enviable one. I don't think it would be good for anyone to send students to medical school, make them suffer and struggle for four years (doubly so because they weren't as strong students to begin with), ask them to take on hundreds of thousands of dollars of debt, and then say, "oh, you can't practice medicine because we just don't have enough residencies anymore."

cma 12y ago

Protectionism for the top, free trade for the bottom.

x0x0 12y ago

It's really smart to ensure that at the end of a very long and pricy education, essentially every qualified doctor who wants to be a doctor can get a job as a doctor. Plus many med schools lose money or break even, and residencies are a big cost for hospitals, etc.

hackuser 12y ago
> It's really smart to ensure that at the end of a very long and pricy education, essentially every qualified doctor who wants to be a doctor can get a job as a doctor. Why? No other professionals get this guarantee. What about physics or history Ph.D.'s?