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Comment by mikeyouse | Hacker News Reader

There is no limit by rule -- just by funding. We've had really nice increases in medical school graduates since the ACA, but predictably, one of the two major parties is staunchly against spending more dollars on residency slots so they torpedo the legislation every time when it's proposed (the vast majority of residency funding is provided via Medicare). The most recent bill:

https://www.congress.gov/bill/117th-congress/house-bill/2256... https://www.congress.gov/bill/117th-congress/senate-bill/834...

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The issue isn't a shortage of residency slots, it's that we don't allow doctors with foreign residencies to practice in the United States.

The physicians in Spain and South Korea and Costa Rica are really good. Arguably better than American doctors based on health outcomes. Many would jump at the chance to earn high American wages. There's no reason a South Korean doctor with ten years of experience in the world leading hospitals of Seoul shouldn't be allowed to practice medicine in the US just because he didn't do a residency in rural Alabama

I mean, that's one solution to a similar problem - but we also have a fixed number of residency slots and an increasing number of med school graduates, including overseas ones who could come to the US and complete their training in US Residency programs.

https://www.aamc.org/news-insights/medical-school-enrollment...

Ah. The good ol’ “steal the good workers from the poor countries to serve my wealthy country that doesn’t want to invest in training its own workers” argument. What happens when those workers are tapped and/or the cost/benefit for them is not attractive? Back to square one.

There's 1.1 million physicians in the US, and about 12.8 million worldwide. Almost all of whom are making substantially lower salaries than their American counterparts. Many more than 50% lower. Even if 10% were willing to immigrate for a huge wage boost we could replace every doctor in America multiple times over.

Huge wage boost erased by increased supply and much higher living costs. Also, I am not convinced quality is the same and language barrier results in poor communication with patients. Let other countries have their doctors and train doctors in your own country is the proper and moral solution.

There are numerous physicians who have immigrated to the US already and are stuck working menial jobs instead of providing people with care when they are fully qualified to do so. There’s absolutely no good reason for this.

Do hospitals lose money on medical residents without federal funding? I'd figure residents provide a lot of labor for the hospitals.

Yeah, residency programs are extremely expensive to run -- most of the work they do is duplicative, especially for 1st & 2nd year students. You're essentially paying multiple doctors a little money to follow doctors who make a lot of money around. They do cover overnight shifts, but they still need to be supervised by 'real' physicians so there aren't really any savings. Vox did a good summary of the whole situation last year;

https://www.vox.com/22989930/residency-match-physician-docto...

I would say it's not so clear, and it's open for debate until hospitals open up their books.

Yes residents need to be supervised, but one doctor can supervise many residents seeing many more patients than they could alone. If hospitals didn't have residents they would have to hire more doctors.

Also consider that a resident costs less to employ than a nurse and that the hospital bills for all the work residents do.

Finally, doctors in teaching hospitals tend to be payed less than doctors in non-teaching hospitals.

Right, exactly - I'd skeptical of the claim that residents cause hospitals to lose money.

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