Everyone complains about the cost of healthcare and nobody asks why the AMA operates like a cartel. The number of doctors allowed to graduate hasn't changed in 40 years.
This is not to say that doctor's pay shouldn't be addressed, but the system doesn't get reformed because every discussion on fixing it gets derailed into a discussion of doctor's pay, which is literally the highest-effort lowest-payoff part of the problem. And the situation stays bad because of this dynamic.
Not on it's own, but doctor shortage can still contribute to medical costs.
Do doctors make more mistakes due to high patient loads?
Are preventable items missed because doctors can't spend enough time with patients?
Would people be less likely to abuse the ER and/or wait to address conditions if they could get a primary care appointment more easily?
If doctors had a little more slack in their schedules, might they innovate in other ways?
If we had more doctors, would it be harder for mega-hospital chains to gobble up the supply of doctors in your area, leaving more independent practices to innovate in other ways?
What if your pharmacist could do most of the practical things that matter to you about your medication, rather than requiring prescriber permission?
What if you could do X by going to a psychologist or optometrist, or some other profession that doesn't currently exist, instead of going to an MD or PA or LPN?
What if you could just buy certain things directly without a middleman?
US healthcare is over regulated in general (in many areas, even as it's arguably underregulated in others).
Right now US healthcare is very hierarchical, with physicians at the top, nurses close by. Other professions and services are subsidiary to them. You don't get to choose a provider based on skillset per se, you are forced to abide by this hierarchy.
That's the real economic cost, the restrictions in provider and service choice.
In stark contrast, the number of hospital administrators, along with their salaries has ballooned over the same time period - even at non-profit systems.
Seems like a healthy person would go to hospital only for emergencies or major projects like birth. On the other hand, I know there are entire hospital systems in southern states that cater to elderly and are basically Medicare billing factories.
That's not entirely a bad thing. It would be bad for Medicine to turn out like Law, with a huge glut of unemployable graduates after a long, expensive training program (IIRC, an intense 7 years post-college, minimum). There's a need to balance demand with the need for all (or nearly all) the graduates to be able to find a job.
Also, you're neglecting Osteopathic schools, which aren't controlled by the AMA but graduate students with the same practice rights.
> The number of doctors allowed to graduate hasn't changed in 40 years.
Do you have any data to back that claim up? The Association of American Medical Colleges says enrollment rates are increasing:
> In response to concerns that a projected doctor shortage could impact patient care, the AAMC in 2006 called on medical schools to increase first-year enrollment by 30%. That target was reached in 2018-19, when first-year matriculation reached 21,622 students. Osteopathic schools increased their enrollment by 164% during this same time period, with 8,124 first-year students enrolled. (https://www.aamc.org/news-insights/us-medical-school-enrollm...)
More people may be interested but nobody can practice until after residency, and you have a large pool of hopefuls basically in a lottery for residency slots.
You can get all the theory, but not be able to get the requisite practicum. Even if you do get a slot, you also get treated like a stevedore from what I have heard.
> More people may be interested but nobody can practice until after residency, and you have a large pool of hopefuls basically in a lottery for residency slots.
But my understanding is that residency capacity is matched to graduating class sizes, at least in the US. The selectivity is intentionally placed up front (at med school admission) so the path is clear to residency and licensure as long as the student doesn't totally fall apart (which the selectivity is supposed to guard against).
IIRC, it's foreign medical school graduates may have trouble getting a US residency.
https://www.fiercehealthcare.com/practices/more-medical-stud...
https://health.wusf.usf.edu/npr-health/2019-07-03/american-m...
The above sources indicate residency matching is decoupled from graduation from Med school, and if I recall correctly, there is actually a legal cap on the number of residency slots.
https://www.aha.org/news/headline/2019-03-14-bill-add-15000-...
So everything I've seen suggests we actually have a dysfunctional system with no up front brakes. Our Medical education system maximizes fiscal extraction from hopefuls, but the residency slots don't scale elastically or in any way matched with demand. Quite literally, it seems to take an act of Congress to change the calculus of residency slots.
I could still be wrong, and welcome the removal of the veil of mistaken impressions, but that's the gist of my current understanding.
For the data, I had done a quick search and found this (which only goes to 2010):
https://www.researchgate.net/figure/Trends-in-the-Number-of-...
However, digging more, even the AAMC is saying you need residency slots:
https://www.medicaleconomics.com/view/enrollment-rates-rise-...
Increasing first-year enrollment is a good first step, but doesn't move the needle on the number of doctors who can actually practice because the number of residencies is still limited.
Which are determined by federal government Medicare funding, btw. From your link:
> Federally supported residency training slots have been capped by Congress for more than 20 years, limiting the spots for medical school graduates to undergo additional training in a residency program before they can practice medicine.
So maybe this is more of a "call your congressman" issue.
> In March 1997, months before the Balanced Budget Act was enacted, the AMA even suggested reducing the number of US residency positions by approximately 25% from 25,000 to fewer than 19,000. “The United States is on the verge of a serious oversupply of physicians,” said the AMA and other physicians’ groups in a joint statement. Since most states require at least some residency training for medical licensure, reducing the number of residency positions would curtail the supply of doctors in the US.
> Fast forward two decades, and what once seemed like a glut now looks like a shortage. The growth in the number of residency positions—and thus the number of doctors—slowed after the passage of the Balanced Budget Act. From 1997 to 2002, the number of residents in the US increased by just 0.1%. Although the number of positions has increased since then, each year thousands of residency applicants fail to secure a position. Factor in an aging population and a projected increase in demand for health care services, and the US is now forecasted to experience a shortage of 46,900 to 121,900 physicians by 2032. Absent a meaningful response from Congress, it will be doctors—particularly residents—and their patients who pay the price.
- https://qz.com/1676207/the-us-is-on-the-verge-of-a-devastati...
Yet, only a few places currently try to convert PhDs to MDs; most places are overwhelmingly geared up for undergrads coming straight out of pre-med programs.
Politics does not do sensible, it does what is expedient.
Consider the US preaching about democracy and consent of the governed and then funding radicals to do a coup and start a civil war to oust a democratic president they don't like in a sovereign state. Why?