How dermatology became the 'it' job in medicine

> 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.

I doubt that limit is an artificial one. Hospitals don't need 600 dermatologists on staff. I think this is yet another factor of capitalism: selfish interests of individual corporations being in tension with the people's interests of having affordable healthcare. Other developed countries seem to have said "yeah, we recognize that nationalizing healthcare will result in insurance companies and hospitals making less money. But that's what has to happen for the people to be able to get the care they need."

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.

There is absolutely an artificial cap on the number of residencies (across specialties, not unique to dermatology). The majority of residency slot are funded through Medicare - Congress has effectively placed an artificial cap on the number of spots.

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.

A lack of government funds is not a cap!

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.

If the government didn't fund any slots then graduate medical education programs would charge the residents themselves instead of paying them a salary. Then physicians would finish their education $1M in debt instead of $500K (or whatever) today. World that be an improvement?

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.

Out of curiosity, how were new doctors being trained before Medicare existed?

While residencies have existed since well before Medicare was passed, they were mostly something elites pursued. Overall, residency wasn't an absolutely necessary practice until the mid-late 20th century. By the 70s, with the tailwind of the baby boom, the practice became normalized.

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.

What will probably happen in most US states is that physician education will continue to require residency. But routine primary care will increasingly shift to Physician Assistants and Nurse Practitioners. Real physicians should be reserved for the more complex cases.