Doctors's simply have the strongest association/union to preserve their privilege. No wonder why they easily earn way more than your average senior software engineer, lawyer or whatever around here. After the first few years from graduation, many of them go work in private sector where there's generally less stress, and 3-4 day workweeks are pretty common too, as they can afford it. Not a bad deal at all.
Here it has got to the point where young Finns pay money to go study in poorer countries like Latvia and Romania, because it's too hard to get in medical school here.
The fact is it’s extremely expensive and time consuming to train physicians. There isn’t enough space. Third and fourth year med students are going to far-flung hospitals to have hands-on experience because staying in the larger cities means they’re competing for access to training with residents.
All of this factors in to the cost and limited space of med school classes. It’s sad, but we would have to reinvent how we train physicians to address the limitations.
The underlying fact that the AMA is directly responsible for the doctor shortage in the USA is historically accurate. 20 years ago the AMA believes we were heading towards a doctor surplus and heavily lobbied and for fewer medical schools, caps on federal funding for residencies and big cuts to the available residencies.
The AMA has reversed course and no longer supports these positions but the damage has been done, both to our supply of doctors and to their own reputation. However, even today the AMA supports many policies that keep taks that other professionals could perform the sole purview of doctors (which excacerbates the suppoy problem they helped create.)
That is indeed the AMA the talking point to justify their stance. However my problem with the AMA here isn't that they support some scope restrictions (clearly many decisions do require full training) but that they strongly support ALL scope restrictions without data to support such a rigid hardline stance. They do this even when the loosening scope restrictions would decrease cost and increase availability without any harm to patient outcomes. This absolutely exacerbates the physician supply problem that the AMA created. If the AMA actually care about the physician supply issues in the country, it would work with state and federal regulators to identify which scope restrictions can safely be loosened.
The answer to a physician supply problem is increasing the supply of physicians, not having nurses do physicians' jobs.
When an organization with a clear history of a specific agenda has a talking point, it is good to take the context of their agenda into account. I would point out that this particular agenda is one that has been largely achieved, which is why doctors in the USA make so much more than any other country and part of why our healthcare costs are so much higher.
In this case, we have a problem that the AMA deliberately worked to create for 20 years. Now that their "oversupply of doctors" myth is no longer remotely tenable, the AMA argues that the ONLY way to solve the supply problem they created is a solution that takes 10+ years to take effect.
We absolutely need to increase the number of doctors we have, but we also need to look at other ways we can safely increase patient access and decrease patient costs while we wait for new doctors to be trained.
The problem with increasing the supply of physicians it takes 10+ years for policy changes to have effects.
Yes. What’s difficult to believe about this? People respond to incentives. The incentive for every physician is to maintain a shortage of physicians, therefore improving the job security and earning potential of every physician. The only way this could be done is if the physicians formed some sort of cartel that could control how many people were allowed to become physicians. This is what the AMA is and what it verifiably does.
I don’t even know what argument you’re trying to make here? It’ll take time to solve? Yeah, obviously. That’s why we should start ASAP and given that we don’t have a time machine, that’d mean right now.
Does the federal government set the national number of teachers who can be trained each year?
Politicians "trust the experts" and the American Medical Association says...
The flaw is the AMA is just a union for doctors not a body that represents patients in any way.
> The flaw is the AMA is just a union for doctors not a body that represents patients in any way.
Ergo, AMA is not a union, hence that cannot be a flaw in the AMA. Chastising the AMA for not representing patients because it is too busy being a doctors union is a straw-man argument.
I think there is unstated subtext perhaps in your criticism. To one extent, a unions job is to care about its members. It is _not_ the unions job to care about anyone else. If the union acts in the interest of anyone other than its members, it is not doing its job. I think that criticism is more of a definition almost. The seamstress union was not created to care about the CEO and managers, but seamstresses.
It's hard to say a bit whether union benefits always do come at everyone else's expense. I'm reminded of the argument against $15 minimum wage. According to one third of business owners in 2021, it was going to cause layoffs. [1] That did not happen in Seattle where that was tried, instead the data shows: “Seattle’s minimum wage ordinance appears to have delivered higher pay to experienced workers at the cost of reduced opportunity for the inexperienced,” [2] Despite the data, there is still the claim that mass layoffs would be necessary.
I think this perhaps dovetails into the debates of trickle-down (AKA supply side economics) vs bottom-up economics. Be what it may, not everything union is good, yet you can still thank them anytime you have a weekend. [3][4][5] I'm just saying, be cautious when painting with a broad brush. The idea a union helping its members will always be at everyone else's expense strikes me as an anti-union talking point rather than something grounded in firm data. Could be true, but without citation showing that to actually be extensively true, I do not take that statement at face value.
To be sure, the _only_ claim I'm making here is that a union and professional union are not the same thing. I'm super skeptical of all these other claims/statements being made and am not really willing to accept anything on face value here without evidence, particularly broad generalizations. The points I raise I think bring some refutation to those generalization, which does not mean the inverse is true, but simply that those generalizations are neither helpful nor informative.
[1] https://www.cnbc.com/2021/02/10/one-third-of-small-businesse...
[2] https://fox59.com/news/heres-what-happened-when-seattle-rais...
[3] https://www.politifact.com/factchecks/2015/sep/09/viral-imag...
[4] https://www.unionplus.org/blog/union-made/eight-reasons-than... (this source is very biased)
[5] https://www.pbs.org/livelyhood/workday/weekend/8hourday.html
edit fixed citation links, one was missing. Added more citations in support of claim that unions are to thank for the weekend (please correct my history if wrong, my point is that historically, in the concrete, unions have done some really good things [assuming you believe not working an average of 102 hours per week is a good thing as was the case for building tradesman in 1890 [5])
https://www.deborahgutmanmd.com/blog/new-medical-schools-upd...
The immediate bottleneck really is in residency programs. Every year, some students graduate with an MD/DO degree but are unable to practice medicine because they don't get matched to a residency program.
https://blog.petrieflom.law.harvard.edu/2022/03/15/ama-scope...
I'm seconding 'viraptor here - this isn't a good enough explanation. It doesn't stand up to scrutiny, and doesn't mesh well with day-to-day experience. Individual doctors I know seem to have very little influence over anything, and they're first in line to the protests about working conditions and pay.
1. Doctors have a lot of political influence because they are popular. This means they can get away with things that other industries mostly can't.
2. State provision of medical care corrupts the system, as I describe sidethread: https://news.ycombinator.com/item?id=40030452
One way to drive "medical costs" down is to ensure that the supply of medical care is low. This also drives prices up. This means that the incentives of the regulatory body are directly contrary to the incentives of the people supposedly benefiting from the regulation.
(And doctors and hospitals are happy with this, because such a system boils down to telling them "we want you to do less work, but for more money".)
3. (Tangentially, note that the general model of "restrict supply, subsidize demand" is incredibly common. It's popular both ways; the first part helps a small but politically active and highly motivated group, and the second part pretends to help the populace in general.)
How is this at play (from the article we are commenting on)?
The article does not mention once: "medicare", "medicaid", "regulation", "law", "government" - once.
If anything, it's the inverse. You have it bass-ackwards, the private hospital, the for-profit system is driving things like:
> I delivered my third child with my own hands because the obstetrician was stuck in a traffic jam. The following morning I went to work because if I didn’t 12 patients have to miss their surgeries, 2 anaesthetists and about 8 nurses will miss out on their day’s income. More importantly, admin would not be happy because a cancelled operating list is a huge financial loss to the hospital.
----------------
> 1. Doctors have a lot of political influence because they are popular. This means they can get away with things that other industries mostly can't.
Can you clarify how this doctor exerts any type of political influence? They have a sleeping bag in their car they sleep at their job so often and are lamenting they barely get to see their family. I don't see your point at all being illustrated in this article, at all.
---------------
> "And doctors and hospitals are happy with this, because such a system boils down to telling them "we want you to do less work, but for more money".
I get the feeling this doctor is on the verge of suicide from being over-worked. Do you think the person that wrote this article would agree with your statement?
The culprit is the AMA.
> In the 20th century, the AMA has frequently lobbied to restrict the supply of physicians, contributing to a doctor shortage in the United States.[10][11][12] The organization has also lobbied against allowing physician assistants and other health care providers to perform basic forms of health care. The organization has historically lobbied against various of government-run health insurance.
The doctors are simply wrong; the state is correct from a pernicious point of view.
Because the state is responsible for buying so much of the total supply of medical care, they generally view things from the perspective of "how much are we spending on the category 'medical care'?", rather than the perspective of how much any given treatment costs.
Increasing the number of doctors lowers the cost of all treatments and is unambiguously good.
However, it does raise the total amount of medical spending, which, in the eyes of the state, is bad.
That’s the view of the government?
Or induced demand.
That said, likely individual medical outcomes would be better.
Large scale systems tend to produce… odd behaviors.
One reason you could imagine is that the health trusts determine roughly how many student doctors they are able to train and then the government limits graduation rates based on this. But I don’t know if that’s the actual reason, and it could be a half-reason, eg the number was set a long time ago and not updated.
If I sell garden gnomes wearing knitted hats, but I only make three a year and sell to only people who drive yellow cars, I doubt I could earn a decent living off this
The sub-text is that doctors are slightly corrupt and wish to be payed more, and therefore are incetivized to reduce the total number of doctors.
After reading the travails of what this doctor is going through, that seems like a very callous take, insulting even.
What's more, it seems that this article has triggered a reflexive anti-union stance, when it's more a hallmark of a place where capitalism does not work well. Why doesn't that hospital have more doctors? Surely, they could have found someone additional if they wanted. The hospital did not have to schedule every surgery as if they all required the average procedure time. The hospital could invest in better IT infrastructure and have software that was not a drag to use. Surely the hospital could have someone help the doctor not make 70+ calls over the course of a shift in addition to everything else they do. This blog post is not about a general scarcity of doctors; there's lots that could be done by the hospital investing in its staff and outcomes without hiring a single additional doctor.
Many hospitals are run by non profit organizations to help reduce this problem. However even they cannot run at a loss overall for long. Bankruptcy doesn’t help anyone actually provide services, after all.
Gov’t has different incentives - but then care is strongly controlled and limited by public policy, for better or worse.
And an organization that is able to optimize to produce more value than they consume (aka is more profitable) can take more risks, expand better, have more capital to invest in training, equipment, etc, be more competitive in who they hire, and have better and more comfortable facilities if they want.
And being a Dr. can be really miserable sometimes, and the training is also really hard and miserable.
Some (surgeons, esp. plastic surgery) optimize for maximum $$ for misery, usually. Others (pediatrics) optimize for maximum ‘feel goods’ for misery, usually. Most others are somewhere in between.
Either way, if they didn’t want/need the money, they’d be going to medicine sans frontiers or working in rural medicine eh?
Eg, businesses that cheat and get caught. Businesses that over consume and can no longer produce.Also, that optimization can have the opposite effect. Eg, optimize revenue by showing max ads, with max ads users start to flee. A hospital could optimize for patientoutcomes, and then do better because the patients stay around.
This overall though assumes that free market principles work in healthcare. Those principles tend to assume consumer choice.
Prestige is, of course, not a function of income alone. Plenty of software developers get paid at least as much as respected professors or top military brass. That doesn't mean they have equivalent prestige.
Further, you assume a surgeon could just become a GP. They are different fields.
https://www.quora.com/Can-a-surgeon-also-practice-as-a-prima...
"Can a surgeon become a regular doctor?"
> They can try. But they would have no idea what they are doing. But legally, they could certainly practice as a primary care doctor. They would not be board certified, and could not sit for the ABIM exam, and would not be able to pass it if they did.
> The professions are also very different, primary care is more allied to the work of a physician, whilst a surgeon is trained to do serious surgery, not the kind a primary care doctor would do. So not sure even if you could be legally certified in both specialties you wouldn't loose your surgical skills if you spend a lot of time in primary care.
> Knowing what I know about the medical world in general I would advice against such a combination, a surgical residency is such a taxing one that you wouldn't have time to do anything else beside surgery, furthermore the required mental approach to do the work well as a surgeon or a primary care physician is also quite different.
That doesn't make any sense. And not everyone has the capital or capacity to make their own business
Those bright enough go to law, IT and similar.
Speaking for my wife, she had to wade through absolutely brutal first 10 years for absolutely no good reason (she ain't no neurosurgeon, just internal medicine GP with FMH), no personal life at all at the prime of her life. 50 work week in contract (when average here is 42), reality with all required bureaucracy goes to 60-70, for everybody, consistently, unpaid (illegal here but who cares, state owns the hospital), often much more and catching up with tons of bureaucracy/billing at home.
Add night shifts, which most of us elsewhere have no experience with, that mess you up for many further days. You are a fraction of yourself, mentally and physically, for easily a week, more if you had to go through say 4-5 in a row.
These are the conditions that we put repeatedly people who have full control over life and death and health of their patients, often without further supervision, hoping they somehow magically never ever make a mistake, and when they do, folks immediately cry a murder and families sue to hell with massive dollar signs in their eyes.
You complain about that, or that you spend whole weekend being on call 48h unable to do anything really for literally 20 USD altogether (price of a canteen lunch here), including when you have to come and work 10-hour shift? You are put under pressure, shushed for being a pussy if you complain, told to toughen up since previous generations had it even tougher, and they somehow got through. Nobody mentions how horrible parents those absent folks were, how burned out they often were, quietly weeping or drinking themselves into oblivion. Well yes, those that didn't just quit, didn't go insane, didn't commit suicide, sure they got through. And now enjoy seeing young going through a bit milder version of the same. Of course there are insane amounts of money involved, but its always between insurance and hospital, doctors get less than capable IT folks for much less work. I am IT guy and consider this utterly fucked up wrong.
A good friend of ours sued the hospital (biggest public in Switzerland) for breaking basic Swiss law consistently like that, he was first but quickly gathered tons of other doctors. IIRC hospital finally caved in, a bit, but he is gone from it for good to private sector. Twice the pay, half the crap.
I could go on and on like this, a lot of doctor friends in our circles. It ain't some dream job, (at least a bit well-placed) IT job is a blessing in comparison.
/rant
It is not that IT is overpaid, it is that doctors are underpaid - at least in France.
We are the world champions of strikes and yet, somehow, doctors rarely go on strike. I do not know why.
They also know where they are going, it is not like they discover the world of medicine after 8 or 10 years.
I am happy that they are people who want to help others, but they also need to eat, sleep and party. Nobody will give them that if they do not protest.
Regarding doctors strikes, I asked the question to multiple ones and the few explanations I got are : - they are deeply regulated and organized, they rely more on acting behind the scenes (lobbying) than going public in the streets - they still have a comfortable situation that they chose ; unlike blue-collar workers who can barely afford food/housing and have to take what job and salary is offered to them ; a GP can move to a private hospital if they want more money and less hours - even though they are organized, they have much more individualistic views of their job than labor workers ; after all they mostly are their own company
EDIT: I just looked up some numbers and you are right, MDs get about 5000€ net pour month in average, which is higher than IT
Poland chiming in. Nobody will give them that even when they go out and protest.
When talking about public healthcare, strikes mean little. State won't care unless the strike is massive enough to attract media attention. Hospitals can't close down, a "safe" minimum of workers must care for patients so not a big problem for the state generally.
The doctors in Nicaragua, the neighboring country, is as described in your comment, except the economy of the whole country is in shambles, and they also have to "voluntarily" participate in "government" political activities. Oh, and since the country is poor there are no immigrants waiting in line to fulfill those positions.
https://www.oecd-ilibrary.org/sites/f8ac5867-en/index.html?i...
So high wait times there doesn't sound entirely perfect either.
Cost of medical treatment and holidays included still cheaper than America?
Fits perfectly for non-emergencies.
Hard disagree here. I don't feel I need to state the reasons. If much of a business relies upon technology that the IT people ensure is up and running for the non-IT folk, I would say that is not overpaid.
This is such a shallow opinion with no forethought into the domino effect. I won't try to make a commentary on doctors, because I am not a doctor and don't pretend to say that "doctors are ridiculously overpaid" because I know it would be a wasteful opinion that does nothing for the conversation.
This is happening across society, and I consider it a tragedy the people focused on race and sex have taken all the oxygen out of the room for a much needed discussion on class.
I’d even go so far as to say it’s encouraged (eg, BlockRock ESG) as part of a “divide and conquer” strategy by the capital class.
If "anti-imperialist" Westerners truly care so much about brain drain negatively affecting other countries, they should go live in those countries themselves and provide their services there for the sake of greater good. But very few actually do so, and even fewer are willing to do it on any kind of non-temporary basis.
PS. I didn't say that people calling this imperialism are from west.
> too much suffering and risk for relatively little reward.
A lot of what you say is true for doctors in their first 5-10 years into their career, when employed in a hospital.
This not true for doctors which reached a certain level like „oberarzt“ and above.
This is especially not true for doctors with their own „office“ (business).
Yeah people may cry, but normally it is very hard to bring a doctor to justice even when there are quite obvious mistakes or misconduct. They are very well protected, suing a doctor not seldom takes 10 years from start to verdict, with a lot of legal costs involved.
And last but not least, it is a very secure profession. You must be really really stupid to end up jobless. So you have 5-10 years with a „ok“ salary compared to the power you invest. And 20-30 Years with a very good to exceptional salary, especially when compared to the broader population.
My sense is that the field developed in the era of independent/private practice, where the grueling hours worked was justified by high pay and minimal bureaucratic/administrative burden. Add decades of stagnant/falling pay plus death by a thousand administrative cuts and the profession no longer justifies the difficult working conditions as convincingly. Some practices are still good, others terrible. Look at the rate of physician turnover to see which is which.
Oh and the “provider” discussion is worth paying attention to. Your doctor has this calculus worked out - years & energy invested, work environment & income expected, then the only viable option in your city is to be employed by a large hospital system (because hospitals get paid at least double for the same work, outcome is as expected.) But wait there’s more: you are now called “provider” by your large hospital employer who hires 2x NP employees to do the “same” work as you and pay half. Guess what direction the pricing pressure is going. In the future expect few MDs to stay in primary care because the system does not support that path. Specialty training is the future for MDs who invest time, energy, & money to excel in their field.
Its trivial to sue a doctor, my wife, on her effin' first night shift in the country here got involved death of a patient and got into court case that took 6 months of court hearings to resolve. Not her fault, wasn't her patient even, but she still had to spent ridiculous amount of time for it outside work to get finally cleared.
Her colleague at this moment is getting sued, almost immediately after situation, for overlooking a cancer, when markers from test twice were non-conclusive (I don't/can't go into details, its a very complex case). Suing is very common here, its just that in case error can't be proved on their side, they have cca decent (and expensive) legal insurance. If they don't, license revocation, life-destroying fines, or even jail are on the table. Cases like this are common. This is very common for GPs with their own practice too, since they see more patients than some specialists.
Also not sure why you degrade other's people mental issues when under semi-constant decades of pressure from all sides. "Yeah people may cry" - this ain't how mental issues and burnout should be acknowledged. Please show some respect they properly deserve, you clearly are an outsider to profession and I sense some envy in between your lines. If its that bad with your life, go and start medicine studies, schools are open for anybody of any age and public schools here are free.
Last part - yes unemployment isn't generally high among doctors willing to work, but ie check canton Geneve now - no new GP licenses are granted (as = 0), and old folks are retiring fast. People are desperate to get a GP, I have colleagues begging me to find somebody via my wife for them, new doctors need to travel 2-3h every day to other cantons to find work, and some are properly desperate. As IT guy, I don't know a single capable colleague who has even similar employment issues, companies are always hiring good seniors, and there are tons of companies needing good IT folks left and right.
Then it's just semi-official hazing. It's still something that should be fixed.
This is unlikely to be true.
And does the (my impression) widespread support for oh-so-rigorous qualifications for doctors reflect any real-world data about actual resulting quality of patient care? Or is it a way for prospective patients to vocalize a bunch of anxieties and emotions about medical care, plus a way for the doctors who've had to endure such treatment to say "all the noobs should have to suffer as much as I did"?
We need a range of doctors, who range in price according to quality.
That way for simple stuff, which anyone can get right, we go to a cheap, reasonable doctor.
A similar example would be if we only had uber software engineers. Each one had to have a PhD. There were no cheap and okay developers who could do say web-sites but not write a programming language from scratch.
Your example doesn't even make sense. Having a PhD doesn't make software engineers more productive on average. PhD programs train researchers. Research skills have very little correlation with practical software engineering.
What could actually work is to train more physician assistants and nurse practitioners, then have them deliver the bulk of simple primary care services under the supervision of physicians. This is more cost effective and usually works well enough, although there may be some degradation in service quality for edge cases.
ACA (Obamacare)HMOs may have opened healthcare up to a lot of people who until then were going without. But its a faaaar cry from from Employer PPOs. And the ACA PPOs somewhere in between.
An don't forget the Trumpcare policies, with major policy exclusions.
If you really want "First Class" health care then you'll have to pay out of pocket for concierge medicine. That isn't directly covered by most insurance plans, although they will reimburse for certain services delivered through concierge medicine practices.
If the demand is there, why is a cap imposed?
According to 'studentdoctor.net' from 2017 - there is a cap because there are not enough residencies for graduating med students. The government is the primary payer for residencies: "It was because of the cost of GME funding that this program came under the fire of budget-minded politicians in Congress. This resulted in curbing of funding for residencies under the Balanced Budget Act (BBA) of both 1997 and 1999:" [1]
> The limitation in funding has essentially put a cap on the number of residencies that can take place in the United States – and since a doctor cannot go into practice without a residency, this is essentially a cap on the number of new, American-trained physicians who are allowed to practice in this country. The American Medical Association, in its AMA wire, blames this cap for the record number of students in 2015 who were not matched with a residency program at the end of their four years in medical school: of the 18,025 allopathic seniors and 3,000 osteopathic seniors who participated in the Main Residency Match, the two groups matched at rates of 93.9% and 79.3% respectively, leaving the highest percentage ever unmatched – and also unable to practice on their own.
> There are proponents for keeping the current cap in place, however. This is mostly among budget-minded members of Congress who are wanting to cut spending, but even the Obama administration proposed reducing Medicare expenditure on GME, even halving support for children’s hospitals, which have their own separate sources of funding. People on this side of this issue tend to decry the seriousness of the physician shortage, pointing out that the increase of physician’s assistants and advanced nurse practitioners has helped to mitigate this problem, even with the cap still in place.
The resource [1] is a bit dated. "Congress recently took steps to support several programs supporting GME funding by fixing technical issues that left some rural programs with an inadvertently low cap, expanding eligibility for rural training track funding, and adding 1000 new Medicare-funded positions for the first time since 1997. " [2]
[1] https://www.studentdoctor.net/2017/01/24/medical-students-kn...
How is this synonymous with not specializing?
In the normal case, I would then think that cost in medicine and medical services would be related to outcome.
To the extent this generalization is true, then when cost is not related to outcome, this is not a normal situation, and then the question would be "why?" - what's going on to make a situation which on the face of it is not normal.
Having a doctor available to treat you at all is still much better than having your very high standards and then not having a doctor available period.
We need doctors who are available to treat simple conditions and refer to a more qualified doctor for the complex ones. Such a job doesn't require being a genius, just people who are not complete idiots, and the qualifications required here are genius-level, not idiotproof-level.
> We need doctors who are available to treat simple conditions and refer to a more qualified doctor for the complex ones.
It people can't see a doctor, or can't get decent care because doctors are overworked, they will go to the "pseudo doctors". "pseudo doctors" are usually much less regulated, because they don't really practice medicine, can't make prescriptions, are not covered by healthcare subsidies, etc... but they are available, and actually caring, because there is no shortage of them.
This is actually good for the patients, sometimes, all you need to get better is someone who listens to you and points you to a healthier lifestyle something, something that "pseudo doctors" can do well. The problem is when they bring their pseudoscience to "treat" actual medical problems that can't just be solved by eating vegetables and getting some rest.
Now imagine an actual doctor who is available and caring, giving you all the benefits of the "pseudo doctor", but in addition, can actually practice medicine. Maybe not to the highest level, but he would have attended an actual medical school and knows enough not to treat cancer with fruits.
The problem now in many places is that it is not just hard to become a doctor, it is hard to access medical studies.
For what it's worth, I do agree we should train more doctors, but I think it's a complicated problem.
This happens already, today. There are dozens of reasonable questions you can raise based on this fact - but I don't think it's obvious that the failures at the end of training can majoritarily be identified by pre-training metrics.
Some countries allow any student to take the first two years of medical courses, and then impose restrictions on the following years. This seems a relatively fair system; you can imagine someone persevering over many years to attain the requisite knowledge - but this person would not have had the opportunity if there were a pre-medical school filter
This isn't true of the AAMC position in the US today, and when it was true in the 90s, there were many articles about an upcoming oversupply of physicians.
First, US medical school graduating classes are smaller in number than the number of available residency positions. So every year, the US is importing physicians trained in other countries.
Next, residency positions (required to practice in the US) are funded by the US government. You could readily contact your US representatives about the problem you perceive - if this a legitimate concern for you.
Additionally, US residency positions don't need to be funded by any government body, at all! Hospitals need 'simply' show that there is enough patient volume to support educating additional residents. This is another avenue where you can intervene, if this is indeed something you care about.
Lastly, 'advanced practice providers' are filling in large amounts of the deficits in physicians in primary care providers. So focusing on the number of physicians is to ignore the huge growth of NPs and PAs - some of whom can function without a physician in some parts of their practice.
I see many people blame 'the AAMC' for healthcare problems, but worry that not many appreciate the lack of a role the AAMC plays in the number of providers in America.
That's because the artificial restriction is placed on entrants to study, not qualified post-study graduates.
And it really is a purely artificial restriction: in the 90s, in SA, when affirmative action was implemented (where a C student from a particular background would get placed before an A student from a different background) didn't result in any measurable difference to the resulting quality of doctors.
We literally have a small experiment showing that allowing C students into med school doesn't affect the outcomes, and yet there is still a very limited intake into medical schools, and this is purely an artificial limitation.
A google search for '1990s physician oversupply' will give you many articles, like this one:
It's fairly trivial to analyse population vs. medical student places and see where the problem lies - there was an expansion in training places a few years ago, but it's a pipeline problem, and doesn't get fixed overnight. If somebody really wanted to fix things, there would probably need to be some kind of accelerated training of doctors and nurses for a few years.
> Expanding the cap on medical and dental school places is complicated by the cost of training, current university and clinical placement capacity, and the current number of clinically qualified academic staff who design and deliver courses.
Furthermore, the NHS actually needs the funds to hire staff.
The core problem is that people are getting older with more complex health care requirements, that more and more conditions become treatable, that healthcare is often expensive, and that no one wants to pay for it.
lolno. Aside from the fact that AI is nowhere near good enough, we can't really build robots anywhere close to the dexterity required to do many of the physical actions. Also people like having human contact.
"Economies of scale" only works well for things like manufacture, and is much more limited for many other things. It certainly doesn't reduce the cost of actually paying a yearly salary to these people, or ensuring you have enough places (hospitals) for the to work at, which isn't cheap either. There are some small advantages one can take here on there, but in general, it scales fairly linearly. This is not just me saying that, your own link, again, says that.
Training 10 junior devs really is about 10 times as much work as training 1. Maybe slightly less because you can group some things, but not too much. And training 20 junior devs is about twice as much work as training 10.
It really is just a funding issue – which is what everyone has been saying for years. Labour wants to increase spots by abolishing non-doms – we'll see if that works when they win the election.
Otherwise feel free to stand for election and propose the n% tax hike required for all of this and see how well that goes.
Not only Computer Aided Medicine would be a god send (it could help to duagnoze the entroprything above the MD forgot about, but would also help to leave the time for people actually sick with something an MD can help with
But it is undeniable that doctors are paid considerably more than most other jobs. This is why.
What's the evidence for your position? Researchers who study this question have shown that the cost of medical education is significantly higher than the price assessed to students.
In other words, having more medical students would cost schools money.
What actually happened was cartel shit.
https://www.washingtonpost.com/archive/politics/1997/03/09/r...
And of course, residents super overworked. I think it speaks for itself that making medicine 2x - 3x more people per year would help the problem. Yes, there's a "sweet spot" where quality of doctors would drop, but there's also a sweet spot where services rendered drop due to overwork, and we're on the far side of that one
in portugal, public workers are one of the biggest lobbies
medicine
- can't be taught at (non public) private universities
- there's limited growth in class sizes/etc
- it's nearly impossible to get into due to grade inflation at high school, which means only the richer paying for private high school pass it (requires grade 19.x/20 at least)
At the same time, there's 100s of nursing schools (can't be too different can it?), there's way too many nurses and way too few doctors.
We're importing doctors from cuba and other countries to fill the gap.
Some people decide to study abroad (within EU) because yay, you study medicine in eastern europe, you may come back to work in Portugal because EU, and again only the richer people could afford this
I do know that limiting the number of doctors is one of many mechanisms to limit healthcare spending. A doctor can only see so many patients in one day.
Instead, we have a dire shortage of doctors and people in government employed full time trying to recruit the limited supply.
Doctors can’t move to the next hospital for more pay, but they can move to the next province, or to the US.
How do you suggest we limit the demand for healthcare?
The way to decrease demand For complicated and expensive interventions to preventable problems is to increase access to preventative care.
https://www.healthcare.gov/coverage/preventive-care-benefits...
But demand is increasingly driven by chronic medical conditions caused by lifestyle issues and local environments: obesity, substance abuse, sedentary lifestyles, toxin exposure, excess stress, lack of sunlight, etc. Those issues will have to be addressed through social policy rather than the healthcare system.
In New Zealand "poor" might be a synonym for uninsured? However my peer group is middle aged professionals (not poor) with as variety of healthcare issues. Only a very few would preventative care help. Prevention would help many of my friends. A friend with a cancer scare that keeps smoking. A friend with gout that doesn't change habits. Multiple friends with issues from drugs that continue to take drugs. All my friends and me that are unfit and eat poor diets. I've given up drinking recently but I'm most definitely an outlier.
Prevention is often the cure.
Assuming you mean prevention when you say preventative care?
https://www.healthcare.gov/coverage/preventive-care-benefits...
But prevention is largely outside the scope of medical care. For issues like diet, exercise, and avoidance of substance abuse patients may be able to get help from a variety of other sources including public health agencies, therapists, social workers, dieticians, personal trainers, etc.
At the hospital, they just classify your symptoms as “not critical”, refuse to admit you and kick you back to your GP, who then refuses to refer you for any investigations, I imagine because there is a gun to their head over targets etc
If your levels are high, you’re told oh it’s not severe. If it’s severe, you’re told oh it’s not critical etc
We have a system where everyone just gaslights you that you’re in fact not sick because you aren’t 3 seconds from death
I'm in New Zealand: not a heap better than you describe. Here GPs are overworked and getting an appointment is difficult. The health system has waitlists to control access to a limited number of procedures performed in each specialty. You need to be healthy enough to pass the access requirements and for acute surgery you need to live long enough to get to the front of the queue.
Some people absolutely don't bother seeking care because they know they'll be denied care without a huge battle
But I was wondering if more physician assistants would help the doctors. Maybe they could take care of the paperwork and all those things as well.
Lastly, the gov finally acknowledged the problem and tried to suppress the "numerus closus" (limiting the number of medecine students) but the problem is now that... there's
- not enough teachers and not enough room in universities
- not enough position in hospital for "internship" (not sure if it's the right word) because theses interns have to be managed by experienced medics
- it takes a loooooong time to make a doctor
- "young" doctors don't want to spend countless hours without personal life like previous generation did... so more doctors are needed !
And the problem is even more pregnant for out-of-hospital doctors (particularily outside of cities)
Right now, the gov strategy is to try to give more and more power for nurses, pharmacists to limit load on doctors (and cost for social services)... but sometimes doctors may spot specific symptoms where others may not
Hospitals cost absurdly large amounts of money, especially in the UK where there are consultancies and layers of subcontracting for everything. So the infrastructure costs of adding even a few hundred student places is astronomical.
Due to strategic underinvestment (or ideological sabotage, or governance incompetence, depending on outlook) there is now a self-reinforcing problem: not enough hospitals and staff to train doctors to beef up existing hospital staffing or work in hypothetical new hospitals even if a money firehose was turned on.
Rather than having a tall glass of concrete and doing the hard thing, which will still take decades to manifest, what the government is currently doing is a rerun of Healthcare Assistants where more care is delegated to much cheaper-to-train staff. Plus quite a bit of noise about "AI" bring used to allow them to sweat the asset of the staff they do have by, for example having one radiologist verifying AI findings rather than a pair-based system.
Which will all work "kinda ok" and let them punt the problems at least into the next government's domain when they lose the next election and can spend 5 years screaming from the Opposition benches about the mess. But you cannot do it forever (or the hail-Mary works, there's an AI revolution and you can actually run a hospital with an app, 2 agency nurses, a few smart plugs and an AWS instance).
Of course "doing the hard thing" would be easy to say if it was just the NHS, but there's the same structural degradation in everything. So you also need to spend billions on education. That's the same general problem - shortage of facilities and not enough existing staff to train new staff and the ones you do train quit. Schools are currently one something like a near-500-year replacement rate (50 per year, 24000 total) and that's without considering population growth or even the hundreds of schools that need rebuilding because they're made of RAAC. Then roads need billions to repair the accumulating damage. The railways need huge investment and staffing. Energy is the same - virtually no supply of domestic nuclear design engineers mean they get absolutely rinsed on even squinting in the direction of a drawing of reactor (though Hinkley Point C cost spiral is currently EDF's problem, not the taxpayer and green energy is actually a rare success story). Defence is similar (e.g. ships being retired because they need the staff elsewhere). At least some water networks are collapsing into a multi-billion hole after private dividend extraction. So that money firehose has a lot of work to do, even if they would turn it on. Which is ideological poison apparently.
All easily solvable:
1. * You also need a hospital (and GP surgeries etc) to be attached as well as enough senior staff to train them when they are there. *
Only for the final 2 years of a total of 7 years of study, which means if we ramp up entrants for 2025, the extra new facilities need to be ready only in 2032.
2. * That training is very intensive on trainer:trainee ratios and the senior staff are also in critically short supply *
Not a problem for a career which is regulated with a national body - simply enforce a minimum number of hours of teaching/mentorship per year to renew mambership of that body. Since the full capacity will only be needed by 2032, this can be done progressively over 7 years.
3. * are retiring by the thousands and many newer junior doctors quit or emigrate as a result of their experiences up to that point.*
Simple: you currently don't get to qualify as a practicing doctor simply by passing exams, so withhold certification until a minimum time has been spent in mentorship/public health services.
To keep salaries high.
I'm brazilian. In recent years, brazilian medical schools have been "democratized", so to speak. The number of medical schools has exploded and acceptance of doctors from neighboring south american countries has been facilitated. About 50 thousand new doctors enter the market every year.
Result? Pathetic salaries. Actual unemployment. Doctors fighting each other over the shittiest jobs with the worst working conditions. Doctors becoming Uber drivers. Complete loss of the prestige the profession once enjoyed. Rampant charlatanism and unethical conduct. Badly educated doctors who kill their patients. Dishonest doctors promising miracle cures on Instagram because that's what gets them engagement and therefore patients.
There is no reason whatsoever to become a doctor under these conditions. Too much responsibility, too little reward. You're better off doing literally anything else.
Society needs to carefully consider the needs of those who will be responsible for other people's lives. When responsibility does not equal reward, it's pointless. My society chose to treat those people with absolute contempt. The results are plain to see.
I’m from Ireland and have the same experience as most of the rest of the commentators on this thread, i.e., we have a chronic shortage of doctors – and nurses – in our health system. This has been the case for as long as I’ve been alive but it’s got much worse in the last decade or so.
It’s interesting to see how universal this problem is – aside from the odd country like Brazil where the pendulum seems to have swung too far in the opposite direction. It’d be nice to know if any country has found a happy medium.
Just imagine how bad it's going to be once the "you're set for life if you go to medical school" meme dies. It's still very much alive here in Brazil but people are already being forcibly woken up to face reality before they've even graduated. Won't be long before the new generation of students realizes that medical school is a bad choice.
The bitter truth is nobody is really going to put the "care" in health care if they're not getting paid ridiculous sums of money for it. Would you really want to slave your life away in some hospital for shitty pay? I mean that literally, medical residency is analogous to indentured servitude. Would you want to spend the best decade of your youth studying and training and working 14 hours a day only to end up poor? I've seen doctors actually kill themselves over lesser failures than that.
Very few people are that selfless and altruistic, even those who affect such a demeanor in public are likely secretly hoping it will come back to them in some way in the future. They will be bitterly disappointed when it doesn't. Even fewer are rich enough that they can sustain such caring activities out of love. Those who try discover that they are just individuals, that they don't scale, they don't form a health care system. They don't make much difference in the grand scheme of things.
Today I saw an interesting post from an older doctor. He just straight up quit medicine. Took his money, bought a bunch of trucks and now he's managing a logistics company and making several times as much money as he used to while caring for people. This is an older doctor who reaped the profits of the golden age, he had the capital to create his business. New doctors arrive at the market with 100kUSD+ debt only to find that they get paid about 10 dollars a consult if they're lucky. The only winners here are the owners of the medical schools.
The end result is that the health practice degrades overall, and social inequality strenghtens. I think nobody is happy with the former reason.
I’ve come across quite a few medical doctors who seem to lack the ability to listen to their patients – or the interest in investigating the cause of problems. I got the impression that they came from wealthy backgrounds and are the type of people who do well in exams and became doctors purely for the monetary return and social prestige. It’s disappointing to realise that I, as a system administrator, put more effort into investigating and solving IT problems for co-workers than some doctors put into investigating serious medical and health problems.
On the other hand, I’ve met a few intelligent, gifted and empathetic people who really wanted to be doctors or nurses but weren’t so good at rote memorisation. As a result, they didn’t obtain the necessary “points” to get one of the very limited places in medical courses.