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.

You're correct - a hospital could indeed find alternate funding for residency slots. Medicare funds something like 70% of them today, the rest are funded by state/local government or non-profits.

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.

Perhaps we could consider making it less burdensome?

It's bizarre that these discussions seem to start from the assumption that we got here intentionally by only making good decisions.