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Comment by telotortium | Hacker News Reader

"Opinion"

Seems like the primary issues are poor compensation and lack of respect.

The primary issue is that there aren't enough residencies so we don't train enough doctors. There are literally millions of competent Americans who would love to become primary care doctors but can't.

I think requiring 11 years of post high school education (undergrad + medical school + residency) is a pretty big reason why we don’t have enough primary care doctors.

It’s such a huge investment of time and money, that it’s very hard to convince anyone to get into the field.

We have this immutable education track, seemingly because that’s the way we’ve always done it in the US. But I’d be very curious if we actually achieve better outcomes than countries with shorter medical educations.

The article mentions that NPs and PAs also favor higher lying specialties - but it seems much easier to solve that supply and demand problem than paying the cost for more MDs

There are far more med school applicants than spots every year. They can't expand because of residency constraints, sure all that stuff would lead to more people wanting to become doctors, but the people who want to be doctors now largely can't. That problem would only be worse with less education.

Actually the issue is not residency; basically everyone who graduates med school gets a residency.

The filter is on entering med school.

No. Med schools desperately want to expand because they make a ton of money, there are not enough residency slots for them to expand without competent graduates going unmatched.

While there are more residency spots that graduating medical students in the us every year, they do have to compete with foreign grads, of which there are more than enough. So the us grads can’t be completely and openly incompetent. So some of them do fail to even graduate, and obviously not get residency spots.

> We have this immutable education track, seemingly because that’s the way we’ve always done it in the US.

It's not: it's only been that way since the nineteenth century. There used to be a Bachelor of Medicine degree that represented six years or so of study and was sufficient to practice medicine.

It's just like the housing issue. It's not that we don't want to build more housing stock. The system is broken and artificially limited the supply

We don't want to allow people to utilize the resources we have. There are more houses than housed and unhoused people but we keep building more and pricing out the poors. The poors grow in number every year. We just don't care. We like our society this way. This is what we want.

This is a ridiculous argument. There are 143 million housing units in the US and 600k homeless. That means that a vacancy rate of 0.4%, or 1.5 days per year is enough to make that true. Vacancy just due to people moving will greatly exceed that number.

You're proving my point while disagreeing with me? I'd like for that to be a new one.

We want this. This is us.

I don't know how accurate it was, but I read that 27% of Canadians were fine with MAID (medical assistance in dying - i.e. euthanasia) for those whose only affliction was "poverty".

https://nationalpost.com/news/canada/canada-maid-assisted-su...

I've been thinking about that a lot recently. You're right: this is who, at least a large group of us, are.

That's very much the worst possible spin on people's feelings with a framed poll and National Post reporting though.

It could equally be argued that 27% of Canadians do not agree that MAID should be restricted, the poll question was preambled:

    At this point, only an adult with a grievous and irremediable medical condition can seek medical assistance in dying in Canada ...

and went to list other conditions (povety, homelessness, disability, etc).

One extreme interpretation is that all those replies indicate support for culling the weak.

The other extreme interpretation is that all those replies support the self determined right to seek assisted suicide regardless of conditions.

People love to take these statistics and make them something they are not and complain about how terrible our society is. It makes them feel morally superior.

This is intentional, to keep salaries high. Only in USA do you have to get a random degree before you can go to a medical school. The only purpose served here is to reduce the number of doctors.

This isn't true for primary care. There are tons of open spots every year that are filled by International graduates or aren't filled at all. The problem is nobody wants to do this job.

"filled by International graduates or aren't filled at all."

Do you have a source for that?

The stuff I saw says that a certain number of slots are reserved for international students, which further constrains the supply.

The following document seems to be the definitive source, supports the larger point of speciality dependent results, and was my first google result: https://www.nrmp.org/wp-content/uploads/2023/04/Advance-Data...

Thanks! Yeah, looks like there are some openings. Also looks like that is one specialty that has increased its slots by over 25% in the past 5 years. Progress

Sure. Here you go:

https://www.nrmp.org/wp-content/uploads/2023/03/Match-Rates-...

Note: lack of respect for primary care physicians by government and insurance companies. Not by patients or the general public.

Of course, the end result of all the short-term cost saving, is that care is switching to emergency only, which is a lot more expensive for everyone.

The lack of respect by insurance companies is startling. Insurance companies effectively govern what care people receive, rather than doctors. I paid almost $1000 last year for a sleep study to diagnose sleep apnea, because my insurance company wouldn't cover it -- I wasn't high-enough risk. Turns out, I have severe obstructive sleep apnea. I'm just glad I was in a financial position to pay for the study myself.

Also lack of respect from the medical profession. Hanging out with pre-meds at elite universities, it was considered a bit of a disappointment to only get a GP or internal medicine residency - good students try to get speciality residency. This is of course downstream of the lack of compensation from government or insurers - specialties earn more, unless you're willing to become a physician in a rural hospital.

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