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Comment by NavinF | Hacker News Reader

The article whines about doctors having to read patient's charts and use crappy software while ignoring the elephant in the room. The average doctor makes $350k and specialists make even more. As salaries increase, the number of doctors does not increase (the way it would in any other industry) because there is a fixed number of doctors in the US each year. It's capped by law: https://www.advisory.com/daily-briefing/2022/02/16/physician...

Note that other healthcare (generic drugs, telehealth, DEXA scans, etc) is dirt cheap in the US and has no waitlists. There is no cap on the number of Nurse Practitioners or DEXA techs.

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I glanced at your article and didn't see where it says the number of doctors each year is capped by law. What law is it that does this?

In a roundabout way, the law that allow you to practice medicine only if you're a licensed doctor. The organizations that run the MD and DO programs in the US limit the number of students and residents added to the system every year, and unless you go through the whole program, you can't practice medicine legally.

> The organizations that run the MD and DO programs in the US limit the number of students and residents added to the system every year.

The argument that a licensing requirement constitutes a legal cap is silly, otherwise you have to say every licensed profession is capped.

It sounds like those organizations are capping it, not the law. And they could presumably change that decision without any change to the law.

I was being a bit reductionist since it's really the interaction of multiple laws and policies, but largely they all boil down to money and licensing requirements for practicing medicine. Other responses to your parent comment explain it in a bit more detail, so you should take a look at those. The residency bottleneck is a real thing that I've had the mispleasure of hearing about from multiple friends and family members pursuing a medical degree.

Doctors must do three years of residency. More for specialists.

The number of resident slots is limited because the gov't must pay a fixed amount to the hospital for each resident and that funding is capped. This is an intentional construction. More on that here: https://www.openhealthpolicy.com/p/medical-residency-slots-c...

If that's what you mean then "there is a fixed number of doctors in the US each year. It's capped by law" seems like an incredibly misleading description of it. Why not just say "the US government underfunds residency programs"? Couldn't some other entity ostensibly fund these programs?

The gov't forces itself to pay for residency programs. The intent of the law is to cap the number of new doctors each year. Other replies have answered your question in more detail

I've read the answers and I still don't see what legally prevents (for example) state governments from funding these. Is there a law that prohibits them from taking money from anybody other than the federal government?

The number of residency slots (a legal requirement to be a doctor) is limited because it's funded by Medicare and only Congress can increase it. AMA (American Medical Association) has lobbied to keep it that way.

Is there some legal obstacle to some entity other than Medicare funding it?

not really, but private funding is generally pretty controversial with weird incentives (e.g. a company may only fund for positions that will create demand for their products--like a skincare company only funding dermatologists) [1]

don't think many other entities besides the federal government have a ton of incentive to fund residency. and the federal government does have caps on residency slots

[1] https://slate.com/technology/2005/06/private-funding-for-res...

What about state governments?

States do fund residency. This site says that state matching of federal Medicaid funds is ~12% of the total funding: https://mostpolicyinitiative.org/science-note/state-supporte....

Interesting related thread: https://www.reddit.com/r/Residency/comments/a01cfr/funding_y...

they contribute already, but it's more challenging than federal. many residents do not stick around in the state they train in, so states have less incentive to fund this

My understanding is the balanced budget act of 1997 limits how many residency slots there can be, and then medical schools can also prevent new schools from being created through the LCME and ACGME. So schools will only graduate enough students for federal funding, and existing schools will keep other schools from being formed which might compete against them in new ways.

Edit: this comment must have made a lot of people mad, because three other people responded within 5 minutes lol

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