Another solution is allow more doctors to be licensed so they don't need to be as overworked.
https://www.ama-assn.org/press-center/press-releases/ama-fun...
[1] - https://en.wikipedia.org/wiki/Medical_resident_work_hours
That plus the throughput of residents is going to be much lower than a trained physician.
As such, Medicare pays a "training institution" premium for all billing. It's a small bomb (5%?) but pays for the resident.
The ones that don't nickel and dime their patients, or even engage in outright billing fraud.
Do you really want to move more hospitals to the latter form of doing business? Because they would be a huge net loss for everyone except the hospital CEOs.
That's absolutely fascinating if so.
One theory I've heard that sounds plausible is that
a) insurers do not pay anywhere near what hospitals bill to uncovered patients
b) hospitals do not even expect patients to pay the whole bill, but more like 20% of it, so it is always good to contest the bill
So the problem is that hospitals are cash-strapped for systemic reasons, but can't get it from insurers or the state because those have contracts in place. So hospitals try to squeeze uninsured patients as much as they can with inflated bills, with predictably horrifying consequences. Insurers don't mind because that makes the case for buying insurance even stronger.
So one solution might be to pay for poor/homeless care via state/federal budgets. This could cover poor people up to an income level that can afford insurance.
Fun fact, if you're unable to pay the full amount most hospitals will do almost ANYTHING to stop from having to send your bill to collection. Even if you say 'I'll pay $50/month forever' thats way better than they'll get from the debt agency that buys your debt.
I honestly can't name more than a handful of large or small startups that do anything remotely valuable. And the ones that do provide actual value don't operate at a loss...
https://hbr.org/2017/10/how-u-s-hospitals-and-health-systems...
Residency is a job and should be interviewed for and selected like any other job.
In a similar way, there are students who spend $200k to go to college, then go to law school, wanting to practice in a certain area of law, and find out at the end that the only job they can get is poorly paying or in an area they don't want to live.
At the same time, it does seem like medical internship conditions and pay are ridiculously terrible, underpaid, way overworked.
On second thought maybe it would make sense to only subsidize the residency programs that are financially unsustainable but necessary, like family medicine or non-subspecialty internal medicine. Downside to this could be that hospitals could choose to not have residents and exacerbate the physician shortage.
looks at the two grant proposals I'm on right now arguing for exactly that
If Hospitals and practices paid for their own residencies, they could lower overall costs, and perhaps work on deals with people to encourage them to stay, etc.
This is simply false. Paying for their own residencies would increase hospital costs since they don't currently pay for residency positions, and they're already free to work on deals to encourage residents to stay post-residency, including, for example, supplementing residents' pay.
Because an Association of Doctors with no Doctors to represent seems like a rather sad sight doesn't it?
Also, considering it is the main force behind setting the barrier to entry, it seems like a bad idea to cut them off from the consequences of the policies they push for by letting them off the hook in terms of not having a fundamental part to play in the training up of new medical talent.
It isn’t a solved problem because not all above is the case. The catch is that Boards will not train more than a few people in order to limit supply and keep wages up
Excuses like “oh the government won’t pay the resident” are shallow excuses — these are highly profitable (for the hospital) positions, not volunteer positions. They are self financing assuming the barriers to spots are removed.
Non-matching graduates constitute a miniscule percentage, and almost none are from US medical schools. And something like 96% of them (cannot find the journal study at the moment) find physician work within 3 years of graduating.
Revenue or profit, who cares, but tax them and then spend the money on residencies.
Or just stop funding any residencies through Medicare and VA. Of course, that relies on the industry deciding to avoid the doctor shortage getting worse.
[1] https://www.livemint.com/news/india/15-700-more-mbbs-seats-s...
I think we need a solution to two problems: First, figure out how to pay people (the hospital, the students/residents themselves, and the hospital attending physicians who spend their time teaching) to train physicians. Second, figure out how many clinical/surgical encounters a physician in training needs to truly be competent when they complete their training. This is more of a problem for surgeons, as they need x number of cases before they feel comfortable doing that procedure on their own.
For the first problem, there are smarter people than myself who pose solutions. CMS (and DHHS) pay for most of this in the US, and is a fixed amount each year with few changes since 1995. So an obvious solution without trashing our current system would be to just have Congress authorize more funding, about $100k/yr/new resident they are willing to pay for. Hospitals should also consider adding their own funding to pay for more residency spots, which is already happening. Note that hospitals bid on the hahnemann hospital (drexel) residents for about the $100k asking price ($55m for ~550 residents).
For the second, you have to decide how many years you want doctors to be training for, at their reduced salary. If you increase training time, you can achieve the clinical/surgical volume needed to become proficient, at the risk of keeping residents at the hospital for longer than they really want. You could seek out more volume at satellite clinics, but then you force the trainees to have to travel, which makes that specific training program less desirable (at least, it does for me)
Grossly over-simplified, I know.
This seems like the sort of thing that should be widely studied, but I can't find the terms to get nice Google Scholar results. In my field we do this sort of assessment for the users of (fairly low-risk) medical devices. It requires a team and is quite work-intensive to assess, but the stakes for insurance providers are high enough that this must already be known....
What a useless step. Why not just have these wait times (and other info) publicly available so people can look them up?
Doctors can decide to set up practices in the area in their own.
Patients can see and ask who’s the hold up is. Is the pay too low? Some crazy liability laws? Whatever.
With this publicly available, it’s much easier to compare service across the state/nation/world without having to be on the inside.
If the NEA restricted the number of teachers the same way the medical industry limits the number of doctors I'd say yes, this is a perfect analogy. Since they don't, then it's a bad analogy.
> Doctors can decide to set up practices in the area in their own.
Not sure about private practices, but hospitals can't just open up without the current hospitals in an area agreeing that it's under served.
> Patients can see and ask who’s the hold up is. Is the pay too low? Some crazy liability laws? Whatever.
> With this publicly available, it’s much easier to compare service across the state/nation/world without having to be on the inside.
If your city limited the number of auto mechanics and granted the guild of car repair persons control over who was allowed to become a mechanic and they only allowed one garage to open up in your town, you would correctly identify this as rent seeking behavior and not a market failure. The choices at that point would be to dissolve their monopoly on auto repair or to create conditions that would encourage their normal human behavior to attenuate the rent seeking. Do you really want to dissolve the AMA? Or would you rather encourage the AMA membership to change their behavior to not artificially limit the supply of doctors?
My solution doesn't give central orders about how to fix the problem, it simply creates a penalty when there is a problem. If the various practitioners realized they could be 20% more efficient while still maintaining quality that would be fine. Or they could create more practitioners. That would also be fine. The problem was created by the industry, the industry can fix the problem.
Really?
If you can't differentiate between hospitals and the healthcare system, you should probably spend more time reading comments in this thread than writing them.