Hacker News Reader

Comment by alephnerd | Hacker News Reader

> they didn't want more competition

It isn't because of that alone. In PH and Korea, senior doctors are expected to oversee junior or trainee doctors. These senior doctors are already overloaded with both giving care and training junior doctors.

Adding more MDs won't change anything because the residency/training bottleneck still exists and there is no way to change that.

This is why my SO left Vietnam for the US - getting paid $1-2k a year to train 6 juniors and work 60 hour shifts providing care is hellish.

The same is happening in Korea as well, with senior doctors leaving for Japan and the US now.

View on HN

So the solution is to get more doctors who can then unload the burden. If you look at the cap on medical school enrollment in the US, it’s very much an artificial supply restriction to keep wages high.

> So the solution is to get more doctors

How? You need a residency to actually learn how to do stuff.

Just getting an MD is not enough to make someone ready to be a practicing physician.

Graduating more MDs doesn't automatically create more specialists tomorrow.

There must be short term pain - in 15 years you can have a lot more doctors, but we have to get them through school and residency first, and everyone already in the industry needs to work even harder to do that.

> There must be short term pain

This is medicine. That short term pain means more people die than would have before.

When specialists quit, who replaces them? You need to be trained - just book learning and shadowing during an MD is not enough.

> everyone already in the industry needs to work even harder to do that

Everyone in the industry is already working hard.

The average physician works around a 50 hour weeks but 25% work 61-80 hour weeks [0].

It's already teetering on the brink due to burnout.

[0] - https://www.ama-assn.org/practice-management/physician-healt...

Demand for healthcare is super high and supply of doctors is low. And you're arguing _against_ increasing the supply? The status quo isn't a valid answer -- if doctors are already at the point of burnout, something has to be done to fix the long-term problem that has brought us to this point.

Interesting! I didn't know this ... however, getting an MD is necessary to make someone ready to be a practising physician. In Ireland we seem to be drastically undersupplied with doctors - I had a couple of years recently where I was in my local ER quite a lot, and there were typically 2 doctors on duty, covering a catchment area of half a million people. Training more MDs seems like an important first step in increasing the supply

Residency programs are hot bullshit, it's just more gatekeeping. There's no reason that a recent medical grad couldn't do the same shit they're having nurse practitioners do instead of doctors at 95% of all care facilities now. Currently we cram the entirety of someone's medical training in 5 really awful years, then call them "finished" and let them do whatever the fuck they want with limited oversight in a lot of cases. If other trades ran like that, the world would be literally falling apart.

Or what if we trained more nurse practitioners and PAs so we needed fewer doctors (proportional to the population)?

Residences are crucial for actual clinical learning, it's more developmental than medical school which is a broad base for understanding physiology. Most doctors at teaching programs will tell you: even 3rd-year med students barely know a thing. Could they likely do the same tasks as first-year NPs who went straight from RN to NP school without any clinical experience? Yes, probably, but they almost certainly would have the same vulnerability NPs do: they don't have anywhere close to the same understanding of the physiology critical for decision-making outside of typical cases or considering interactions of different indicators.

That said, I do think there's probably more of a role for some graduating med students than we use now. I don't think they need a 3-year residency to enable them for many general practitioner duties particularly in rural settings where the patient load is less, the pay is likely less, but the cases are more homogenous.

Where do all the trained doctors go though?

If 1 person trains 6, then in a few years you now have 7 trained doctors who could either train 42 more or, if given half the workload, could train 21 more.

If the training doctors are always oversubscribed then there's a deeper problem in the system that's creating this bottleneck.

How did your SO from Viet Nam get a working visa to practice medicine is the US? Surely we don't have the full story here.

If you have skills getting a VISA is much easier - not all of them are random lotteries.

Plus SO often implies OP was a citizen and then SO comes in on a priority VISA program. They do check to ensure you really are romantically involved. There are a number of poor who decide nearly any American is a better life than they could have at home and so will sign up for a blind marriage to anyone. A doctor likely has means to do some verification of a potential mate before committing, but if they find life bad enough back home they can have low standards. (from what I can tell it mostly works out for those doing this - some get abused, but most seem to have a good life)

The bit about romantically involved was part of my point. If that person was a man, forget it, he will be staying home with low wages.

Also, we are definitely missing a large part of the story. There are very few medical schools outside US that will qualify you to practice is the US. Getting recertified in the US is extremely difficult, especially from a developing country with much worse healthcare standards.

So what's the solution? To have less doctors so they will have even less time to oversee junior or trainees?

Reply on news.ycombinator.com