> Recently, her hospital’s dermatology program received more than 600 applications for four residency slots.
Perhaps if supply of dermatologists was not so strongly limited, prices and wait times would improve.
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Perhaps if supply of dermatologists was not so strongly limited, prices and wait times would improve.
Every time it comes up in the US, nationalized healthcare is demonized in some media. But it just feels like a facade perpetrated by the hospitals and insurance companies (and now private equity) who stand to lose the most. If it's good enough for veterans and retirees, why can't it be good enough for the rest of us? Maybe it's because when the government pays the bill, they don't just roll over and accept $EXORBITANT_FEE after $EXORBITANT_FEE - they negotiate and get some reasonable value.
From what I gather, Congress set the current low limit due to lobbying from the AMA something like 30 years ago. The AMA has since changed its tune and wants more slots to alleviate shortages in some regions and specialties, but the funding has not materialized.
What would they do if the government didn't fund any slots, just shrug and decide they didn't need doctors?
Note that I'm not opposed to the government funding lots more slots, I am objecting to the presumption that government funding is the only possible way to make a doctor.
There are a small number of residency slots funded by non-profit foundations but those are a drop in the bucket. None of the other major players in the national healthcare system have an incentive to pay for this stuff.
Unpopular opinion: if the student will be able to pay that loan off in 10-20 years and maintain a good standard of living while doing so, then it is probably fine.
> None of the other major players in the national healthcare system have an incentive to pay for this stuff.
I'm pretty sure the entire system's revenue model breaks without physicians, so there are plenty of businesses (hospitals, labs, practices, etc...) with an incentive to have more billing capacity.
https://en.wikipedia.org/wiki/Residency_(medicine)#:~:text=B...
Our demographic makeup means we have more elderly in need of care and fewer to care for them, which means we will need to revert our requirements. The UK is already discussing/planning-for this in their healthcare system: https://www.independent.co.uk/news/health/nurses-doctors-deg...
I understand that it's scary that care quality may be lower, but that argument is similar to demanding that every road worker and civil engineer have a PhD. Our bridges and roads would likely be better if all participants were so educated and qualified, at least for the horrifically expensive and few roads/bridges we would be able to build.
But, the fact that hospitals don't fund their own seems to prove the underlying assumption - that offering a residency is a net loss to the hospital. If that weren't true, they'd fund the slots on their own.
It's bizarre that these discussions seem to start from the assumption that we got here intentionally by only making good decisions.
There are some hospitals you will go to (big names!) where you will never actually see an attending physician most of the time. Your entire care team are residents.
How a hospital can’t turn a profit off $60k/yr “junior doctors” doing all the actual work is beyond me. I’m sure there are costs I am not considering, but my immediate gut reaction is that it’s nearly all creative accounting to pretend residents cost more than they bring in - to keep that sweet government subsidy coming in as well as limiting the number of slots.
Some programs of course this makes sense, but on the whole it doesn’t seem to pass a smell test to me.
For the math to work, the fully qualified attending would have to be ~10x more efficient than the residents ($600k salary vs $60k salary - very rough, obv).
The current state seems to be "a single attending is more efficient practicing solo than the same attending overseeing five residents"
The value of residents varies a lot by experience and specialty. Like a 1st-year neurosurgery resident might be worse than useless and a huge burden to everyone around them. Whereas a 3rd-year family medicine resident can do a lot with minimal supervision.
I already mostly see NPs for my checkups. If they aren't sure, then I can jump through the hoops to get a Physician.
It works well and I get plenty of time to discuss things during my appointments.
EDIT: I still think my original point may stand for specialists however, we'll have to see how it shakes out and what healthcare systems under more stress than ours decide to do in the near future.
The lack of doctors allows hospitals to charge more money for access to the ones they have. And right now the government foots the bill for training new doctors.
If they funded new residency slots they'd simultaneously increase their expenses, and reduce long-term revenues. Even if the resident's work is profitable by itself - in the sense of generating more in billings than the costs in salary, benefits, and teaching time - it could be bad for the hospital in a decade or two.
If the government simply ended the practice of funding residencies then hospitals and the rest of the medical establishment would be forced to come up with a new approach. Until then they're content to ride the gravy train.
Maybe the graduate medical education programs would have to compete on price as well as quality and reputation?
I think there are parallels to nursing as well, with increasing credentialism and then creation of new classes. 30 years ago nurses entered the workforce with a 2 year associates from a junior college. Heck, my highschool had a nursing occupational program.
Regulation, left unchecked, favors constant indirect damage from shortage to more visible direct harms.
This is why it takes 3000 hours of training to cut someone's hair.