5 ms·

Not a direct response to what you said, but since this is a common discussion on HN, I just want to get some facts straight pre-emptively: 1) The AMA has nothi

Not a direct response to what you said, but since this is a common discussion on HN, I just want to get some facts straight pre-emptively: 1) The AMA has nothing to do with limiting the supply of doctors in the US 2) The AAMC (not the AMA) formerly limited the number of medical students per-year in the US, but they stopped this practice sometime around 2004 with the stated goal of increasing the number of medical school graduates. 3) Even if we doubled the number of medical school graduates overnight, we still would not have more practicing physicians in the US, because the bottleneck occurs during residency (after medical school) - there are a very limited number of residency slots. 4) Residency programs in the US are funded by the federal government through Medicare, so increasing the number of practicing physicians would require increasing funding to hospitals that offer residency programs by increasing spending on Medicare. This is both politically complicated and incredibly expensive (training a resident is very cost-intensive when you look at the big picture). So yes, there is definitely an issue with the number of practicing physicians in the US, but fixing it requires Congressional authorization to increase spending (and not just by a little), so it's unlikely to change anytime soon.

mahyarm 12y ago
So how about a residency system that doesn't depend on medicare government funding? Or accepting foreign residency programs? I wouldn't think canadian, scandianvian, british, german, australlian, etc residencies and doctors should be considered invalid for example. From what I know, even being a Sweden trained doctor makes it hard to transfer into the USA and get a licence. Residents from what I know are not well paid, what makes it a profit cost center for them that they require government funding for it?
- pc86 12y ago
  I've heard of residents being paid as little as $25-30k/yr. The issue is largely that you have an attending physician making a great deal of money (compared to the median US, not necessarily for a doctor) who spends the majority of his or her time teaching, watching, and fixing what the resident does. You can easily have a hospital/government (not sure what the funding split is) spending $500k/yr for $100k/yr in productivity.
- idaniboy 12y ago
  The reason why foreign residency programs aren't considered valid in the US is quality control, from both competency and medico-legal standpoints. If you were CEO of a private practice or hospital in New York City, who would you hire? A grad straight out of a US residency or one out of Swedish residency? The safer bet is the one straight out of US residency for numerous reasons: you can more easily trust and call his references, he has already likely taken the US medical licensing exams, you don't have to give him an English comprehension test, familiar with the mess that is US medical system, etc...
  - mahyarm 12y ago
    As a CEO of a hospital that wants to make money I would hire the Swedish grad for less and give him a 4 month US legal medical mess class for a lot less in cost that wouldn't involve a doctor. Since I'm known as a hospital that accepts non-us residency people, I can save a lot of money until the market resolves this inefficiency. Also there are the other 5 anglo countries, which will have no problems with english. Many of these UK, german, etc grads could also be people from the US originally, so there wont be english competency problems there. Many europeans also have excellent english on average, like germans and scandianvians. It would be miles ahead of the average non-west euro immigrant software engineer that is very common in the USA. QC and skills wise, I don't have much worries from these top tier countries medical practices. Do you freak out if you have to go to a hospital in Sweden because the doctors may be bad!?
maxerickson 12y ago
Is there some reason that hospitals can't fund the programs themselves? Or do they just choose not to? More usefully, what could be done to get hospitals to fund the programs? Some hospital systems have billions of net income, they can clearly afford to fund at least a few residencies.
- fnordfnordfnord 12y ago
  > Some hospital systems have billions of net income, they can clearly afford to fund at least a few residencies. What incentive, economic or otherwise, exists that would cause them to do that?
  - maxerickson 12y ago
    Yes, that was the question I was asking in the previous sentence. I wouldn't be surprised if hospitals were able to benefit from cheaper doctors though.
  - rhizome 12y ago
    Public benefit.
- sytelus 12y ago
  Couldn't it be same incentive why we like interns in tech? In tech, we love internships and most top companies go out of their way to have attractive internship programmes. This allows you to (1) filter future hires much better than hour long interview (2) lot of less complicated stuff can be offloaded to them (3) well, yeah, cheap labor (4) much better cultural training (5) young energetic employees with passion to improve things.
  - crpatino 12y ago
    If consumers of IT products were given the right to potentially sue for every bug that resulted in adverse situations arising for them, the whole industry would collapse in less than a year. Now, put yourself in the shoes of a company/NGO that arose to fill in the abandoned niche afterwards. Would you be willing to take in a junior employee and let it do unsupervised work? Would the affordability, cultural fitness or "passion" of said junior employee make a big factor in your decision?
droopyEyelids 12y ago
What are the expenses involved in a med student's residency? From the outside it looks like they do a full doctor's work, but are only paid 40k a year.

mahyarm 12y ago

So how about a residency system that doesn't depend on medicare government funding? Or accepting foreign residency programs? I wouldn't think canadian, scandianvian, british, german, australlian, etc residencies and doctors should be considered invalid for example. From what I know, even being a Sweden trained doctor makes it hard to transfer into the USA and get a licence. Residents from what I know are not well paid, what makes it a profit cost center for them that they require government funding for it?

pc86 12y ago
I've heard of residents being paid as little as $25-30k/yr. The issue is largely that you have an attending physician making a great deal of money (compared to the median US, not necessarily for a doctor) who spends the majority of his or her time teaching, watching, and fixing what the resident does. You can easily have a hospital/government (not sure what the funding split is) spending $500k/yr for $100k/yr in productivity.
idaniboy 12y ago
The reason why foreign residency programs aren't considered valid in the US is quality control, from both competency and medico-legal standpoints. If you were CEO of a private practice or hospital in New York City, who would you hire? A grad straight out of a US residency or one out of Swedish residency? The safer bet is the one straight out of US residency for numerous reasons: you can more easily trust and call his references, he has already likely taken the US medical licensing exams, you don't have to give him an English comprehension test, familiar with the mess that is US medical system, etc...
- mahyarm 12y ago
  As a CEO of a hospital that wants to make money I would hire the Swedish grad for less and give him a 4 month US legal medical mess class for a lot less in cost that wouldn't involve a doctor. Since I'm known as a hospital that accepts non-us residency people, I can save a lot of money until the market resolves this inefficiency. Also there are the other 5 anglo countries, which will have no problems with english. Many of these UK, german, etc grads could also be people from the US originally, so there wont be english competency problems there. Many europeans also have excellent english on average, like germans and scandianvians. It would be miles ahead of the average non-west euro immigrant software engineer that is very common in the USA. QC and skills wise, I don't have much worries from these top tier countries medical practices. Do you freak out if you have to go to a hospital in Sweden because the doctors may be bad!?

maxerickson 12y ago

Is there some reason that hospitals can't fund the programs themselves? Or do they just choose not to? More usefully, what could be done to get hospitals to fund the programs? Some hospital systems have billions of net income, they can clearly afford to fund at least a few residencies.

fnordfnordfnord 12y ago
> Some hospital systems have billions of net income, they can clearly afford to fund at least a few residencies. What incentive, economic or otherwise, exists that would cause them to do that?
- maxerickson 12y ago
  Yes, that was the question I was asking in the previous sentence. I wouldn't be surprised if hospitals were able to benefit from cheaper doctors though.
- rhizome 12y ago
  Public benefit.
sytelus 12y ago
Couldn't it be same incentive why we like interns in tech? In tech, we love internships and most top companies go out of their way to have attractive internship programmes. This allows you to (1) filter future hires much better than hour long interview (2) lot of less complicated stuff can be offloaded to them (3) well, yeah, cheap labor (4) much better cultural training (5) young energetic employees with passion to improve things.
- crpatino 12y ago
  If consumers of IT products were given the right to potentially sue for every bug that resulted in adverse situations arising for them, the whole industry would collapse in less than a year. Now, put yourself in the shoes of a company/NGO that arose to fill in the abandoned niche afterwards. Would you be willing to take in a junior employee and let it do unsupervised work? Would the affordability, cultural fitness or "passion" of said junior employee make a big factor in your decision?

droopyEyelids 12y ago

What are the expenses involved in a med student's residency? From the outside it looks like they do a full doctor's work, but are only paid 40k a year.