Maybe open up more med schools and drop the excessive volunteering requirements. It only serves to filter out the talented with a poor economic background.
If you want more doctors, lobby your government to increase residency training funding.
Maybe drop the requirement that "only" governments fund residency slots?
They could say this is the quick fix but the long term solution is different.
The AMA is a guild and the doctor shortage is their fault.
They are a labor organization that's intentionally limiting supply.
A few weeks later I read an article about a new cuneiform tablet that had just been translated. The oldest translated writing in the world, at the time. Evidently the brick-making guild hadn't been training enough young apprentices and the price of construction was becoming excessive. They wanted the king to step in. It was the same trick! This was literally the oldest trick in all of recorded history!
I am still somewhat adjacent to the biomedical scene and I've heard that the AMA has reversed course recently -- but I don't know the degree to which the new words correspond to actual actions. In any case, the sentiment is correct: if they don't become part of the solution, they will be seen as part of the problem when the eye of Sauron turns in their direction, and the terms imposed on them will be much worse than the terms that could otherwise have been arranged.
There's a huge opportunity in the market for providing low cost care that has fewer regulations and restrictions.
Honestly, I don't know if it will work or not, but I think it's interesting they're trying to take advantage of the (frankly ridiculous) medical situation in the US right now.
Why would you ever choose to be a doctor over an employee at a FAANG? It would be worse for your mental and physical health, and now the pay isn’t even much higher for doctors.
1) People tend to compare FANG to family medicine. It wouldn't be more apt to compare the average tech worker making 100-200k to family medicine, or compare to some of the more competitive specialties.
2) Salaries are underestimated by many people. The best source is the MGMA is is often used to negotiate salaries by the hiring side. Unfortunately the data is expensive to access so few have it - there's an older screenshot someone took [1]. Further, these are biased lower since academic medicine and part time researchers tend to make less. You can also tailor you're career with more flexibility. Want to make $1M? Go for it. Want to work 2 weeks a year and still bring in 2-300k? Go for it.
Now if you want to live in NY or SF tech will pay more as medicine pays more as you get more rural.
I do know people who were engineers for a decade plus, and they had to do a year of coursework (special medicine program) before applying to med school.
If it's something you personally are interested in, happy to talk more.
1) if US goes with taxpayer funded healthcare, expect pay to go down similar to other developed countries with taxpayer funded healthcare. Because there will be no negotiating power.
2) with the ACA framework, it’s a race for insurers, hospitals, and physicians groups to get as big as they can do they can gain as much negotiating power as they can. I can see it with all the M&A in the hospital and provider space, and the rule of thumb is “the closer you are to the money, the more you make”. In this case, insurers will hold the money, so it will be at their mercy that they approve or deny payments for certain procedures.
The American people themselves don’t have enough money to continue paying for this gravy train, and the government was picking up the slack, but I think that’s going to be over soon.
The CVS/Aetna vertical integration model is interesting too, as they are talking about adding doctors to their stores to make it a one stop shop. Insurance, provider, medicine all in one, similar to Kaiser.
And then there’s doctor groups who are able to pump out more work from one doctor by using physician assistances and nurse practitioners to actually see patients “supervised” by one doctor, but the doctor never actually sees the patient.
The NP/PA practice is also a growing concern amongst doctors. Those groups are advocating for independent practice despite reduced training.
I'll admit, I'm a fairly stereotypical introvert tech guy and tend to judge people more than I should. Talking to patients has a way of shifting your views. I used (and I suppose still do a bit) to judge alcoholics, drug users, and other preventable conditions. But you realize how they really are a result of social or medical circumstance and I think for that reason many doctors are willing to sacrifice some pay. Hell I went into medicine for the security and money (mostly, plus more academic stimulation than software), as taboo as that is, and I'd be ok with it.
That said I think specialty medicine pay is fairly safe. Fact is supply is limited, right thing or not.
But yes it appears the median doctor gets paid somewhat more than I thought. Although only a few of the surgical specialties outstrip my personal compensation, I would guess I'm a good deal above the median for software engineers and the median engineer is probably only in the same neighborhood as the median doctor, not above.
People also bring up malpractice but a good employment contract will include that with tail coverage.
However, for cardiologists, anesthesiologists, neurosurgeons, etc. you probably want a higher education standard.
For example, for an appendectomy, a non-teaching hospital might be reimbursed $4,500. If you’re a teaching hospital you get an extra 1.3% (too lazy to look up exact number, but it’s quite small), so $4,559. And that’s for every procedure at the hospital, whether the resident was involved or not.
Seems like a more direct, “here is $80,000 for each residency spot” would make things a bit more transparent?
Residency training spots are, while not a snap of the fingers to increase, not difficult - if congress was willing to actually legislate the increase in funding, as it comes through CMS.
The government is a convenient scapegoat to protect a system that restricts the supply of doctors to maintain their wages.
Pretty clear why that system gets abused. The result is that doctors have to pay 50k+ tuition for 4 years and then get paid (relatively) crap wages for 3-7. After that, they make bank because of how hard it is to become a doctor.
Existing doctors have been all to happy to pull the ladder up behind them. They continue to make it harder and harder to become a doctor by extending the training time. As a recent example, to work in a pediatric hospital now requires an addition two years time as a fellow. Of course, no current pediatrician is going to be required to do more training. Just anyone that wants to enter the field and compete now has to accept an additional two years of lower wages.
The linchpin holding this all together is the government license requirements for doctors. Take that away and it all crumbles.
https://www.reddit.com/r/Residency/comments/hdx3gw/no_laughi...
Based on what I've read, I suspect residents are very profitable for hospitals, even if they use a significant portion of the grant.
To become a full-blown doctor in the US, one has to jump too many hoops and hurdles including -- 1. maintaining 3.8+ GPA (out of 4.0 max) in undergrad while paying overpriced college tuition (which encourages students to take relatively easy course load other than the required ones like organic chemistry, biochem, a couple of basic math and physics classes, etc.); 2. pay yet another loads of money to attend med school, which is where you actually begin to learn something relatively useful; 3. volunteer unpaid at various research and/or healthcare institutions to beef up one's resume (which is only affordable/possible if you are well-connected and/or have money to volunteer); 4. pay exorbitant and unnecessary exams (each 8-9 hours long spanning sometimes 2 days for Step 3 USMLE: https://www.princetonreview.com/med-school-advice/usmle) that promotes rote learning (and you forget what you memorized ~2 months after the exam anyway); 5. pay a lot of money to apply for residency programs while footing the bill (hotels and air travels) yourself to go around the country for residency interviews; 6. spend 3 years (minimum) in residency while spending ~60+ hours per week in your first year doing the grunt work that no senior doctors want to do (e.g., night shifts/floats) 7. maybe spend another 2+ years in fellowships if you want to be a specialist
In contrast, one just need to do these in my home country to become a doctor (I know India has a very similar system to train their doctors): 1. get a high score in national standardized/matriculate exam (in my country, ~5% of top students have option to go to medical school) to get into public medical schools (there are four of them and three of them are definitely pretty good) 2. spend 5 years studying medicine (to be honest, they can cut out the first year if they want to, but it's still better than spending 4 years as undergrad in the US) 3. spend another 2 years as a rotational intern at major government hospitals (OBGYN, Surgery, Child, etc.) doing what the residents in the US system do [from what I've been told, those 2 years are certainly more demanding than the residency years in the US system] 4. take masters degree to specialize (takes ~3-4 years)
The quality of the doctors produced by these two aforementioned systems is not that different. How do I know this? My wife (foreign medical graduate) is a current medical resident at a US hospital and we have a lot of friends in the US residency programs, some of whom are foreign medical graduates. In order for them to get into these residencies as foreign graduates, they have to score on average better than their US counterparts (on top of having to work pretty hard to gain experience in the US because 99% of hospitals/medical institutions in the US don't allow volunteers/externs/interns unless one is trained from the US pipeline and is a citizen).
So the question is why is the path to becoming a doctor in the US needs to be paved with so much expenses and hurdles? Who established this path?
I'll close my long rant with what my wife recently told me after spending a year as a medical resident in the US, (I'm paraphrasing her a bit here) "I don't want to be a patient in the US hospital when I'm old. We need to go to somewhere like Singapore for treatment (she worked at a hospital in Singapore for a bit before coming to the US)."
I have two college friends who are now full-blown specialist doctors (one orthopedic from UCSD and another psychiatrist graduated from JHU). Both of them came from well-off backgrounds (in fact, both of them have at least one parent who is a doctor). Their parents helped them connect with practicing doctors in famous hospitals (e.g., children hospital of Philly) when they were in college, and both of these friends already had a handful of internship/externship experiences at credible hospitals when they graduate from college.
The psychiatrist friend even took one year off to study for USMLE step 2 before she applied to med school. Who can afford this kind of luxury? It's simply because her parents are both doctors (one psychiatrist and one anesthesiologist) and make a total of easily 600K/year back in 2009.
In comparison, while she (my friend) was studying for USMLE step 2, I was frantically looking for a job in 2009 after graduating from college (the same class year as her).
If one does a bit of research on doctors, one may likely find a positive correlation with their parents being wealthy (and also being one of their parents being a doctor). To become a doctor, one has to be born in a truly middle-class family (like parents earning at least 200K/year total with nowadays dollar kind of middle class).
But let's say, for the sake of arguments, that US adopts the requirement of having highschoolers applying straight away to medical school. Then suddenly you need a very different selection criteria. High school grades are off. SAT is jokingly too easy, so you need a much more difficult national exam (and enforce that nationwide). Students either grind in high schools for high grade or they'd rather drop that early to go for "normal" universities. And finally, you need better schools across the board to provide students with such opportunity, because if left unchecked, you'll have 10-20 percent of students from California, and only a few spots from Tennessee, thus not ensuring rural area having enough doctors.
But speaking to the Australian experience: Between 2000-2010 we went from producing 1500 new doctors to 3000.
We have a different training pathway to the US (and there are many criticisms of both) but you have to complete at least one, usually 2, generally 3-4 years of generalist or semi-generalist Training before entering your chosen speciality. This results in a much older age of graduate. However it also results in people entering the speciality that they desire. On the other upside, we exit with little Med school debt (most Americans I met left with 250-300k in debt)
The persistent bottleneck is with medical education and training.
You can not, in the course of a handful of years, massively increase the number of trainees for speciality isotopes without adequately upskilling sown the line and making sure people have jobs to go into and that the existing power structures are there to facilitate integration and adequate skill set/not be overly disenfranchised by their own hold on things that they don’t let go.
Capability is evenly distributed, opportunity is not. We must all work to improve on this
Why are people only discussing the long term changes necessary and not the fact that we need more people to treat the coronavirus now?