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Comment by scheme271 | Hacker News Reader

There's also a bunch of organizations that are desperate and can't pay. E.g. a lot of rural and VA hospitals are staffed by H1B physicians. A rural hospital in the middle of Idaho won't attract a cardiologist through salary (i.e. the 500k/yr they can make in cities) and probably won't be able to afford a 100k application fee to get one. Also for lots of researchers and post-docs, 100k is more than their annual salary.

This fee is a great way to ensure that there's very little medical services available to rural populations and to help kill science in the US among other things.

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The MD shortage is entirely artificial - limited by the number of taxpayer-funded residency slots, itself a result of federal congressional action (or inaction). You may ask, why is the taxpayer on the hook for resident training, when there already oceans worth of government and citizen money flowing into healthcare? Because the healthcare industry lobbied for it.

> E.g. a lot of rural and VA hospitals are staffed by H1B physicians.

Doctors, pilots and other genuinely essential professions are well covered by a number of other visa categories, such as EB-2.

I don't think the EB-2 is an alternative. If the applicant is outside the US, the process takes ~3 years to get the applicant into the US and up to 4-12 years if the applicant is Chinese or Indian.

I don't think the EB-2 process allows the applicant to stay within the US while waiting for the priority date to become current so staying in the US and working during that 3-12 year period won't work without another visa type.

H1B is not a solution for shortages in rural hospitals. If visa is terminated it actually can force government to look for a better more permanent solution to the problem.

There are plenty of first-rate medical schools in the US, it's very possible to increase the supply of qualified doctors to re-balance. Yes it will probably mean a similar scenario where doctors are paid somewhat less than they have been previously, but hey, look how bad engineering has gotten these past 20-something years relative to where it once was as a comparable profession to medicine.

Exactly. The difference is doctors were able to cap the number of doctors graduated, and now we have a shortage. Welp, I know the solution to that.

The cost of becoming an MD is astronomical. I have a nephew currently studying for it and he's looking at $500,000 in student loans. For a school in idaho of all places.

Part of the shortage is also because very few people can afford to become doctors.

There are no empty slots for med school in America. We turn qualified kids away.

Except for the DOE student loan programs just capped loans for med school to 200k lifetime so unless students are fairly wealthy, they're going to find it hard to become a doctor.

> it's very possible to increase the supply of qualified doctors to re-balance.

In many cases, the rebalancing that is needed is from subspecialties to community based primary care in rural and other underserved areas. Some new medical schools appeared in the 1970’s to address the need for more family medicine docs. What happened was completely predictable… more subspecialists. Graduates follow the money trail when choosing residencies and fellowships.

> Also for lots of researchers and post-docs, 100k is more than their annual salary.

Don't post docs usually come over on J-1s (if they aren't using practical training)?

I just read a thread earlier today in the medical-professionals /r/medicine group of reddit that had a lot of participation from medical people:

"My rural patients are so much more insufferable than my urban ones"

https://old.reddit.com/r/medicine/comments/1nkb8f9/my_rural_...

It seems that the reasons for missing doctors are... complex.

> My rural patients are so much more insufferable than my urban ones…

I retired from medicine, having spent my career at a well-known institution in the upper midwest of the U.S. Over the course of my tenure there, I took care of patients from all parts of the world, all walks of life. Some of my most cherished patients hailed from rural farm communities. Whatever that commenter’s issues might be, this doesn’t line up with my experience at all. The work of the physician is to tailor their work to meet the needs of the patient by understanding their needs in ways that may be difficult to discern through ways other than empathic understanding.

It is not about that one commenter, I would not have posted it for a single anecdote. I read through most of the comments. While there are voices like yours, the many people having similar things to say as the OP, and what exactly they say, DO make it sound like they have something interesting to say. Given the quality of many of the comments there, I don't think simply ignoring it with a counter-example is correct.

Reddit and internet forums have a bias for negative anecdotes.

Do you have any proof or even just actual argument whatsoever that the very specific thread I linked to has any such alleged problems? Did you actually even bother to read the many comments there? Unlike your single-phrase blanket statement they are actually quite thoughtful. You could learn a thing or to on Internet discussions from that thread.

There was no prediction or conclusion made whatsoever, it was a number of for the Internet quite high quality personal observations. If you are unable or unwilling to accept the personal observations of those people, here doctors, then the issue is on your side.

We also know that there indeed is a significant difference in culture, we can see that in elections and elsewhere. That too is a "known bias", which you also ignore.

For example:

https://www.aspeninstitute.org/blog-posts/the-electoral-coll...

https://www.sciencedirect.com/science/article/abs/pii/S07430...

https://en.wikipedia.org/wiki/Urban%E2%80%93rural_political_...

So differences in general are real, and you cannot simply dismiss any anecdotes as "bias", especially since there never was a claim for that thread to be anything more than that.

This divide is also not the same all over the globe, the US may be more extreme (example: https://www.uva.nl/shared-content/uva/en/news/news/2024/03/t... -- "Compared to the US, UK and Canada, overall levels of urban-rural electoral divides are still substantially lower in most European countries, due to centrist parties attracting support from both urban and rural areas."). That too has some interesting comments showing this in that thread, with the bad anecdotes coming mostly from US doctors.

You should read the comment guidelines for this forum: https://news.ycombinator.com/newsguidelines.html

I counted through all the top-level comments with at least 5 upvotes which state a personal opinion on the topic, and there seem to be 15 medical professionals who feel negatively about working in rural areas and 13 who feel positive.

So, if we're using the reddit thread you yourself have presented as evidence of the general sentiment on this topic, I think the parent commenter is correct in arguing that there is no particular universal trend here. These experiences probably have more to do with the simple randomness of where you work and what kind of personality you have.

I'm from Idaho and grew up in rural Idaho. My mother was a nurse for such a hospital.

Rural hospitals are lucky to have any doctor on staff let alone a cardiologist. They are mostly staffed by nurses for quick patch-up work and life flights to major medical centers.

H1B doesn't solve the problem of poor communities getting poor healthcare. Frankly, it costs too much to become a doctor which limits where doctors can be employed. Plenty would like to work rural, but not with $500,000 in student loans. And no, that's no joke. I have a nephew going to medical school in Idaho and that's what his loans are.

The question to ask is why it costs so much to become a doctor in the USA vs other countries and then work to address that.

A serious problem should not be treated with a band-aid and if you think a band-aid is ok do not be surprised the problem gets worse.

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