The government is a convenient scapegoat to protect a system that restricts the supply of doctors to maintain their wages.
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.
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.
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.