Hacker News new | past | comments | ask | show | jobs | submit login

> It's not an accident; medical societies have blocked medical school expansion for decades until recently as the population grew.

Sort of. There are a lot of very common misconceptions around this.

The AAMC (not AMA!) limited the number of medical school students until about ten years ago, at which point they announced an explicit goal of expanding the number of graduates from medical school.

However, this doesn't mean anything in practice[0], because the bottleneck isn't the medical school graduates - it's the residency programs. As a medical school graduate, you have an MD, but you are not actually qualified to practice medicine. That requires usually four years of training (minimum), plus several more for various specialties.

These programs are costly to run, and so hospitals that offer residency programs are funded by the federal government to do so (through Medicare). The only way to expand the number of practicing physicians in the US is to skimp on quality during training (which nobody wants to do), or to increase funding through Medicare (which nobody wants to do.

> US doctors are fewer and have more responsibilities and thus must be paid extraordinarily to work very long hours and not retire at the usual ages

They also have to be paid a hefty amount to pay off massive debt. If you see an attending physician in his 30s (or even 40s), even if he's making a respectable amount of money, there's a good chance he still has a negative net worth. The level of debt of course varies by location, specialty, and quality of education, but it's rather misleading to look at an e.g. $200K/year income for a physician and compare that to the equivalent amount in the tech industry.

[0] pun not intended, but very a propos!




Thank you for adding detail.

In this case, the bureaucracy eventually overcame institutional resistance of the wealthiest professional Americans to reform of a system that limited doctors and thus vastly expanded their incomes. I expect that same government and institutional bureaucracy to eventually increase significantly the residencies, but it will move in that typical slow motion of bureaucracy eventually doing good.

When it eventually adds to our production of new doctors, it will have a bigger impact than ten Obamacares or single payer plans or HIPAAs.

The debit of American medical students is as legendary as the vast incomes of doctors, both wildly out of proportion to the rest of the first world. Hazing practices during residency are also still crazy, though much reduced after glacial bureaucratic reforms.

I don't know if there's any better idea there than to hire and appoint good administrators to plan better. A violent revolution like the one in Cuba that built a better health care system seems too extreme.




Consider applying for YC's W25 batch! Applications are open till Nov 12.

Guidelines | FAQ | Lists | API | Security | Legal | Apply to YC | Contact

Search: