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Comment by chromatin | Hacker News Reader

> Their salaries need to be lower, training needs to be cheaper and faster, and we need a lot more of them.

The quality of the average physician is already so low I am not sure what you are hoping to accomplish with lower salaries and faster training.

Doctoring isn't a matter of more warm bodies

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Most countries get good results with shorter training and much lower salaries. And, just like most other US university degrees, the majority of the filtering is done on entrance, not on training. So it's not that we are evaluating the best doctor, but the best diligent people that get great scores in the MCAT. Whether that actually lines up well with being a good doctor is not all that clear.

Here’s an excerpt from a study of more than 1m physicians:

> “Better examination performance was linked to improved adherence to mammography screening recommendations, appropriate prescribing practices, improved care of patients with diabetes, lower patient morbidity and mortality, fewer complaints to regulatory bodies, and lower malpractice payments. The association was observed across examination formats and medical specialties.”

https://academic.oup.com/academicmedicine/article-abstract/1...

Unfortunately, it’s very clear.

It's low because there's no competition. MDs are like medieval guild: once you're in, you're set for life. Restrictive regulations are lobbied by MD associations, which limit competition.

It's an old joke:

Q: What do you call the worst student to be admitted to medical school?

A: Doctor.

Ha ha, but the joke is kind of wrong. While anyone with an MD degree is entitled to the honorific "doctor" that doesn't mean they can legally practice medicine. Becoming a licensed physician generally requires completing a residency program, and the worst students sometimes fail to get matched to the limited number of residency slots.

Yes it's a joke, but to quote some numbers in the US: something like 93% of the US graduates matched to a residency program [1], although the numbers were a lot lower for international students applying for US residency. So if you're talking about US medical students, you have to be in the bottom 10% to flunk out.

The attrition for lawyers is higher, neither has anything on PhDs where the number of "practicing" doctors drops off constantly during and after the degree, and only really levels off when O(10%) of them land faculty jobs.

[1]: https://www.ama-assn.org/medical-students/preparing-residenc...

I can think of at least one person who failed out of my medical school class

An alternative hypothesis is that it's low because our most talented kids know they can make a ton more in finance and tech

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