How do medical boards throttle residency programs? The biggest limiting factor today is the Medicare funding cap.
https://news.aamc.org/for-the-media/article/gme-funding-doct...
https://news.aamc.org/for-the-media/article/gme-funding-doct...
Given billing rates, "we dont have money" is a very convenient answer for why there arent more residents (and hence more future supply of doctors.) Heck, given the wild profit of a resident, I'd personally fund their annual salary for a share of the annual billings.
The real answer is...current doctors, specifically specialty boards must actually be willing to train a resident, however they are funded (medicare, by hospitals, by me, etc.) -- and specialty boards do not. It would increase supply and decrease their future wages. Openings are very carefully throttled to create artificial scarcity.
Medical specialty boards are essentially cartels.
This is hard to imagine as a technologist because we largely operate in a free market. Anyone can enter the market and opt to work for less money than you. A foreign worker can try to do your job for less. The job can be off-shored.
Medical resident positions are wildly profitable entities, so "funding gap" sounds like a boogieman excuse.
Medical resident positions are so wildly profitable, that if any medical board was willing to train residents/fellows, i'm certain I can get VC/PE/HF funding to fund those spots and no one would have to worry about funding gaps. Who wouldn't want to fund a position that produces 10x revenues?!
I'd be willing to bet that for many residencies (cosmetic derm, spinal surgery, ortho, radioiology) residents would be willing to work for absolutely free given the massive windfall they expect in 5yrs time.
"Medicare funding gaps" are boogieman excuses provided by the AMA and medical specialty boards to not train doctors, especially specialists and sub-specialists and create artificial scarcity and increase their own wages.
Residents are trained in teaching hospitals, most of which are non-profit. So VC/PE/HF funding isn't applicable. The federal government provides the majority of funding for residency slots and there is a hard cap.
Teaching hospitals certainly could fund more resident slots themselves but they generally choose to spend their money on other priorities like new MRI machines or free care for indigent patients or shiny new buildings named for major donors. Hospital budgeting decisions are made by business executives and BoD members just like any enterprise; they aren't controlled by the AMA or medical boards.
Training residents isn't as profitable as you think; there are huge overhead expenses for supervision, insurance, equipment, and support staff. But if you don't believe me then feel free to get VC funding, found a new for-profit teaching hospital, obtain AGCME accreditation, and hire a thousand residents. I expect you'll find the economics don't work but maybe you'll disrupt the industry and make a fortune?
The true threat is companies crushing smaller rivals, because that's how in the long term you end up in a situation where there aren't thousands of tech companies because no one can compete without the assent of one of the major ones, and they prefer to destroy you or compete with you or buy you out than let you grow independently. And that's how salaries could fall in the long-term. But you tell people that supporting walled gardens and closed proprietary services could lower their long-term salary and they don't hear you, because they're after the quick buck today.
The AMA is actually evil. They’ve probably killed people in America though their protectionism. A truly banal evil : the pursuit of increased physician salaries.