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Comment by michelb | Hacker News Reader

Why aren't there enough doctors or specialists? Especially in America it seems like a very profitable profession. Is it artificially limited?

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4 years college taking some of the toughest courses there are to be ready for 4 years of medical school. After that 8 years of schooling then you have to go through the hazing ritual they call "residency". Residency varies depending on your specialty, from 3 to 7 more years[1] - during which time you're working 60-80 hour weeks [2].

So baseline if you're smart and hard working, you need to take the hardest college track from ages 18-22, medical school (22-26). Then work two jobs worth of hours as a trainee making well under 100k starting at age 27 and into your early 30s [3] so you can't save or pay down any of your debt from getting here.

So if you choose to be a doctor, you have to: (a) dedicate to working your ass off at 18, (b) keep at it until you're in your early 30s, (c) start with massive debt

I think it's actually pretty amazing that we have as many doctors as we do.

[1] https://medschoolinsiders.com/medical-student/how-long-is-re... [2] https://www.ama-assn.org/medical-students/preparing-residenc... [3] https://www.inspiraadvantage.com/blog/how-much-do-medical-re...

But what's the actual rate limiting factor? I remember liking at University entrance requirements in my country and the minimum requirements were low compared to what you actually needed because of the insane competition.

Why not just expand the amount of spots and train more doctors? Surely they don't take everyone that applies and then filter them out (even CS doesn't do that).

The limiting factor, as I understand it, is residency slots. Residency slots are, for some reason, principally funded by Medicare, so they are funded by Congress, which has for the past several decades not increased that allocation. Apparently that's starting to change?

In my opinion though, I can't see why the number of doctors should be something that is principally controlled by congress at all, and ideally some other method should come about.

Until that happens though, it's up to Congress to fix this.

I've read about it and came upon the same answer as you just gave, but I'm not satisfied with it.

Looking around the world, it seems to me that most developed countries (if not all) suffer from the same problem of lack of doctors. Some mask it by pulling doctors from poorer countries (including poorer developed countries), but it seems like there's a lack of doctors everywhere. If that's the case then Congress can't really be the only limiting factor.

Why are there no developed countries that have far too many doctors? The only countries that I can think of that export doctors are Cuba and third world countries.

You need to be smart, hard working, dedicated, and interested in medicine. That’s going to be a limiting factor. Add in high tuition and a public that hates you, and it’s hard to motivate.

Becoming a medical professional is very expensive; tuition often going into the six-figures. Becoming a physician takes a good decade or more of your life. The entry process is very competitive and limited, with majority of applicants being rejected. IIRC the acceptance rates are below 50%. Once a person clears those hurdles however, they are now faced with a torrential abuse of corruption, racism, fraud, elitism, favoritism, etc. that they must overcome.

Much of the medical field is like this unfortunately, it's not just doctors. Take for example this article about Duke's Nursing School and racism: https://archive.is/DIJ98. From what I've heard through third-party, corruption at Duke is at an all-time high. This is just the stuff we hear about too, so I'm sure these problems affect all of the top-tier colleges that nobody reports so they don't get ejected from these programs.

Complete destruction of price signals due to the symbiotic relationship between "providers" and "insurance" cooperating to defraud patients. This is backed up by whatever corrupt laws allow "providers" to send arbitrary post-facto bills and even presumably enforce such nonsense "debts", rather than getting prosecuted for said fraud.

Unfortunately most people taking notice of how broken the system is end up get fixated on the large figures on those fraudulent bills, and think single payer can do something to fix at least part of the system. But systematically, at best single payer would be tying the garbage bag off for tidy disposal, when what we actually need is for the sheer majority of medical care to have a functioning market that allows for patient agency.

Yes, by the guild of doctors.

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