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Comment by resource_waste | Hacker News Reader

For some reason we only focus on the names of corporations when it comes to corruption in Medical.

There is almost no criticism of Physicians in all of this. They are a top 4 lobbying group with a half a billion dollars in bribes. They use their private, unelected group ACGME to reduce supply of workers... and on-topic: the billing of insurance maximum rates seems wrong.

Yes things get 'adjusted', but it creates a culture where you cannot pay out of pocket and there is no competition for reduced rates.

I don't even mean to pick on Physicians here. If you look at the top lobbyists, pharma, pharmacists, pharmacies, insurance companies, and hospitals all make top 10.

I cannot see the path to reform, there is too much non-partisan money here. The electorate is divided on solutions, so there is little appetite by serious politicians to make this a major campaign plan.

Maybe there are historical examples of how to reform. Tragedy?

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ACGME reducing supply hasn't been true for at least 10 years. Medical schools and residency positions are exploding and quality of training is decreasing. Medical schools are now finding it hard just to place their students into adequate clinical rotations because hospitals are saturated with learners. Despite that, we even have to bring in more than 5,000 international physicians every year just to fill the available residency positions because there literally aren't enough American graduates. Meanwhile, reimbursements keep getting cut and physician liability increases.

You’re confusing me here. The hospitals are overloaded with learners but there aren’t enough graduates?

Both can be true at the same time. Just some rough numbers.

There are approximately 30,000 American medical graduates each year. There are about 40,000 residency spots per incoming class each year. Both of these numbers continue to go up at least several hundred per year, it's just that always residency spots > American graduates. That answers the "not enough graduates" question.

Each year, that 10,000 resident surplus is filled with approximately 4,000 US citizens who went to international schools and 6,000 non-US citizens who went to international schools.

Now for hospitals being saturated with learners. There are at least 162,000 residents and fellows and 60,000 medical students (3rd and 4th year students) in total in the hospitals, not counting students in other disciplines such as nursing, physician assistant, etc. That means there are at least 222,000 residents/fellows/medical students in the hospitals. I am saying that to accommodate 222,000 learners getting enough exposure to all the nuances of medicine is extremely difficult and, as medical schools continue to grow, many schools are finding it hard to place students into environments with adequate opportunities to learn.

I'm a doctor. When I was in medical school, I literally had to call and send applications begging other physicians to take me as a student, otherwise the school threatens to dismiss you for not meeting graduation requirements. Many students don't have that problem, however many do and the number is increasing. It is just very hard to scale massively complex infrastructure while maintaining quality.

Spouse of an oncology trainee here. This is an accurate statement. But whenever you mention similar thing on public forums like HN or Reddit, you get downvoted. I have a feeling that a lot of pre-meds, current medical residents and doctors (and their families) hang out in those forums and downvote everything that is stating the truth.

My wife is going to make $400K+ minimum (if she does more than one day per week on-call, she will make easily $500K/year; on-call for oncology aren't difficult btw) when she's done with the fellowship. We both came from Burma (Myanmar), and she told me how unnecessarily expensive everything with medicine in the US is (including the number of years required to train to become a generic/internal medicine doctor in the US).

She is also unhappy with the fact that doctors are acting as unnecessary gatekeeper for a lot of medicines that are fairly safe to use (and are available for over-the-counter purchase in other countries like India and Burma). We have a lot of doctor friends in the US, so we know the "industry" very well. Doctors (along with pharma and insurance companies) are at least somewhat complicit in the ever-increasing prices in the US. AMA (American Medical Association) spent $24M+ in 2024 for lobbying [ https://www.opensecrets.org/federal-lobbying/clients/summary... ] while pharma spent 30-40x more in lobbying [ https://www.opensecrets.org/news/reports/layers-of-lobbying ].

Side note: yesterday, my wife's department (a fairly large hospital in LA metro area) was treated with steaks by pharma reps from cancer medicine company. A lot of doctors, residents and fellows were delighted with that meal to say the least. I have been to expensive (Wagyu-beef expensive) hot pot dinner hosted by another pharmacy company when my wife was just an intern at a private clinic.

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