sooner or later whole world(west) is going to hire more doc at lower(not as high as it is right now) salary from East(asia). they might lower the barrier to entry. same would happen in medicine the causes are inflation, economic conditions and poor health system.
I think the system will burn down before AMA would allow any US States to import a massive amount of doctors from anywhere in the world. Which maybe is better for the rest of the world - they get to keep their doctors.
Several US states have already changed licensing rules to make it easier for foreign medical graduates and internationally trained physicians to practice medicine here. The system hasn't burned down yet.
I hear people say "we need more doctors" all the time. It would seem to me, the people deciding how many new doctors we train per year, are doctors. Their pay is proportionate to their scarcity, if we had 5x as many doctors, existing doctors would make far less.
Imagine if existing software engineers got to decide how many juniors entered our profession each year. I think things would look very, very different.
We have created a society in which the tail wags the dog. We have deferred so much control to institutions like the AMA that we have forgotten how to govern. Our politicians wring their hands and wax lyrical about the intractability of issues while they hold all the power to affect change.
I think it's time we stop allowing institutions to rule. We elect our leaders to lead. They need to start fucking leading, or people are going to start voting for some radical alternatives.
The AMA has no control over this. While they do advocate for training more doctors they don't have authority over medical school admissions or residency program funding or anything like that.
One area where we can perhaps legitimately criticize the AMA is for their lobbying state governments to limit the scope of practice for lower licensed PA/NP clinicians. While some of their concerns about care quality and patient safety might be legitimate, the reality is that we're not going to have enough primary care doctors to ensure adequate patient access. Some of that work has to be delegated down.
> The AMA has no control over this. While they do advocate for training more doctors they don't have authority over medical school admissions or residency program funding or anything like that.
I feel I made this distinction very clear in my comment, so I'm surprised to see you repeat it. I make it clear that it is our elected officials which hold the power, *but who have deferred that power to institutions like the AMA.* For example, the AMA and Association of American Medical Colleges jointly sponsor the Liaison Committee on Medical Education (LCME), which accredits US MD programmes. LCME accreditation is extremely consequential because most state licensing boards require graduation from an LCME-accredited US programme, and LCME accreditation establishes eligibility for the USMLE and ACGME residency programmes. This gives the accreditation system considerable influence over expansion. LCME standards require a school to admit only as many students as its resources can support, including faculty, facilities and clinical training capacity. Schools must also notify the LCME when class-size increases exceed specified thresholds, currently a cumulative increase of 10% or 15 students, whichever is smaller, relative to the class size at the previous full accreditation survey.
Congress decides how many doctors are trained each year. Residencies lose money so they rely on federal subsidies, Congress has limited the number of residency slots that get funded and that’s the number of doctors that get trained each year. Medical schools can’t expand without residency funding expansion.
In the SF Bay Area there's a town called Milpitas. There's a gigantic island next to it made of garbage. A government funded study has been running for over 10 years now trying to determine why Milpitas smells. They have not yet been successful. You see, succeeding means getting funding withdrawn from the study.
Is it? If I ran an organization whose members' salaries depended on my lobbying taking its time to produce as little of a result as possible - would I really want to do a good job? Or if I did - would I remain the head of said organization for very long?
If you took 30 years to deliver a project - would you still have your job? The fact that the AMA is still around means this is not one of the axes they are evaluated on. Classic misaligned incentives.
The job was to increase the number of doctors by increasing the number of residency spots. The poor folks have been lobbying for 30 years, but they are just not too good at it, gosh darn it.
So it’s not that they’re actively lobbying against more residency slots, it’s that they aren’t lobbying for it hard enough.
What you’ve done is constructed an argument where no matter what position the AMA takes, they are the bad guys.
> salaries depended on my lobbying taking its time to produce as little of a result as possible
This doesn’t make sense. How would the AMA board communicate this to their voting members when all of their communications say that they doing all they can to increase resident funding.
How about the first board to vote to change their position 30 years ago? How would the voting members know that they were planning on slow walking their new position?
Do you think they have a secret doctor only communication channel where they tell them “don’t worry guys we’re not trying that hard”. Because without that if your premise is correct all of the members would have voted them out ASAP.
Also how is the AMA (which only represents about 15% of doctors btw) preventing hospitals from effectively lobbying for an increase? They have a huge financial interest in more resident funding.
As a patient - do I really care if they have bad intentions or are simply incompetent? The results speak for themselves: there's a system that pits young residents against each other Hunger Games style and has them working 20 hour days. It allows only 5% of IMGs into residency slots. And this translates directly into mistakes and bad medical outcomes.
It's nice of you to talk to me like a child (thanks daddy!), but there's no secret comms channel needed. If an AMA official publicly came out with a platform of "let's cut your salaries in half!" they would not last long. And if there was no public announcement - their effort would be shot down behind the scenes. Simple as that.
I'm not sure about the salaries. Vocation-motivated people are already doing it. The rest needs a good reason to put their entire life, quite literally, into one single purpose. It's one of those professions that requires a complete dedication of free time, youth, health, mind, etc.
If you look across countries, you realize that a lot of the sacrifices are part of the pipeline, but not necessarily key to good outcomes. Just like the grueling hours at certain residencies.
It's like claiming that one needs to cram hours upon hours of leetcode practice to be a quality software developer. It might be necessary for some companies to hire you, but that's to meet a filter that is less and less predictive over time, not an actual performance requirement.
Education system was set up in XIX century. It's not clear how much of it is necessary in XXI century.
Back in the day religious books were copied by scribes educated in a monastic tradition. Now printers can print them in a completely godless manner but the result isn't any worse.
Nope. There is effectively infinite demand for physician services. If we had more doctors that wouldn't reduce the workload on individual doctors. The actual solution to reducing demands on their time would be through reducing the administrative workload which contributes nothing to patient care. Much of that could be automated or delegated or not done at all.
The time demands also differ widely between specialties. You can't really be a part-time neurosurgeon. But we see a lot of doctors in other specialties like pediatrics, internal medicine, radiology, and emergency care downshifting to part-time schedules after they have established careers.
Would you say that people also need to be more responsible to be healthy themselves? Reducing pressure on the system and freeing capacity. E.g. healthy lifestyle to reduce diabetes.
Of course people need to take some responsibility, but reality is most people live in a society and do as the society does. You can minimally change people with some financial intensives but the effect of that is pretty limited and its hard to implement.
You have to create a healthy system, that takes social engineering and government cooperating on a general plan. And in the US such a thing is basically not possible, even if they wanted to do it.
Ideally your transportation, agricultural, educational policies should all work together to produce healthy population. But this simply isn't the case.
But it will not 'reduce pressure' in a practical way, because such changes purely private or public take decades to work themselves threw the population.
Well let’s start with insurance actually acknowledging preventative care as a worthwhile investment. We have a system that incentivizes waiting until emergency care is necessary and that comes with massive cons.
I can’t even get basic foot stuff covered, they won’t care until my feet and knees land me under “disability,” so people like me - but unlike me they can’t afford to spend hundreds more a year on special inserts and shoes - just keep doing what they’re doing until they’re hurt.
People go to the grocery store and marketing teams are trying to sell them “vitamin water” which is neither of those things, so they have to do tons of research and pay constant attention to literally every food they buy. Then when they get hurt they can’t afford to go to a doctor and the insurance that is sucking up huge amount amounts of their annual pay doesn’t pay for it either.
Meanwhile we have a US administration that is telling everybody, a population that is incredibly predisposed to heart disease already, to go eat more red meat. Also, they have spent a decade telling people that vaccines are shady and maybe they shouldn’t get them. How much damage have we done to preventative care with that one?
I could go on and on, I’m barely covering the breadth and depth of this problem. We can’t just call it “personal responsibility” or whatever
Insurance is already required to cover preventive care services which are justified by a clear cost-benefit analysis at no cost to the patient. The list of those services should probably be expanded but in many cases we lack scientific and economic data to justify to more research is needed.
> Insurance is already required to cover preventive care services which are justified by a clear cost-benefit analysis at no cost to the patient.
I am clearly not saying they literally don’t cover any preventative care. I think most people agree that insurance companies’ idea of what is “justified” is far too narrow. What is “clear” is also often very opaque. That’s the issue I’m pointing to. US health insurance is a terrible experience.
And who cares if the analysis costs me nothing? Why is that something I should be grateful for?
Most people don't understand the system well enough to even have an informed opinion on the subject. Commercial insurance companies get a lot of criticism for denying claims or prior authorization requests, and some of that criticism is well deserved due to errors or artificial friction. But for the most part they make very few decisions about what care is justified.
At a first level the federal government publishes a set of medically unlikely edits used to deny claims when procedure codes don't align with diagnosis codes. It's used by Medicare, and most Medicaid agencies and commercial health plans have also adopted it.
At the next level most commercial health plans have adopted clinical care guidelines published by vendors like MCG. These vendors take publications from specialist medical societies and codify them to determine what's medically justified and set step therapy requirements.
At the final level, providers can appeal denials to human nurses and doctors who do case review at insurance companies (peer-to-peer). In a huge healthcare system there are always patients with unique needs who don't fit the pattern in published care guidelines. Dealing with those appeals is a major administrative burden and often badly managed on both sides of the adversarial interaction.
Most US-based HN users are on commercial self-funded group health plans sponsored by their employers. The Affordable Care Act (ACA / Obamacare) establishes a baseline for what's covered but ultimately the decisions are made by employer HR departments. Insurance companies would be happy to offer custom health plans that paid every claim at 100% with zero denials or prior authorization requirements; it would mean less work and higher profits for them. But no employer wants to pay for that so the insurance companies take measures to hold down costs.
Are you sure you can find that many more doctors? That they'll be any good?
Speaking from Romania: here medicine is prestigious. So many parents push their kids towards medicine. There's a glut of newly minted doctors every year, but rumour has it that the quality drops every year. Sure, they pass the exams and residency and what not, but... They're just not into medicine as much.
Do you want to get treated by such a person?
This year I had to go to a neurologist. I went to one locally, they dismissed me in 5 minutes, told me to take some vitamins basically. Went to another one in a much bigger city, they talked to me for an hour, ordered a ton of tests.
Would it help if we get a lot more of the first kind of doctors?
We do have qualified people to do the work of doctors, and they're called nurses. But arbitrary lines are drawn between what they can do and what doctors can do, just to maintain the existing salary structure.
If nurses are to do more of the work of physicians, nursing education needs to drastically change. Nurses are mostly taught the how of nursing and not the why of medicine. If you look at the curricula of DNP programs, which are often touted as a way to get nurses practicing with lots of autonomy in places where they are short on physicians, they're heavy on nonsense nursing theory and light on things that actually matter like pathophysiology and pharmacology.
We actually do have a better model in the form of physician assistants. They're taught the same kinds of things physicians are taught, just in less depth.
That is the kind of thing makes me wonder how much of "things that actually matter like pathophysiology and pharmacology" can be factored out into the automation land now.
AI isn't perfect, but even loosely scaffolded generalist systems show promise in the field of medicine now. And the alternative isn't some hypothetical "perfect healthcare" - the status quo is often closer to "nurses running near the limits of their competence" or "physicians stretched thin almost to the breaking point".
The fundamental problem of healthcare is that it struggles to scale. The need for well educated, well paid professionals is inescapable. Or, was inescapable? We might be at the point where this can start changing.
> That is the kind of thing makes me wonder how much of "things that actually matter like pathophysiology and pharmacology" can be factored out into the automation land now.
I would say not much. AI is still often wrong and a clinician needs to know when the LLM is saying something crazy. I think AI has the most promise for increasing the productivity of well trained professionals, not replacing them (or their training) entirely.
Human clinicians are also "often wrong", for a given definition of "often". "Get a second opinion" didn't originate with AI.
Are AIs wrong more often or less often?
Would the healthcare get better or worse if the "first opinion" was AI more often than not?
"Increasing the productivity" and "replacing them" is two sides of the same coin. If a human can do five times the work, because AI does most of the work and the human performs "exception handling"? You need less humans. And healthcare, historically, is almost always human-constrained. That's why you get insane wait times and overworked clinicians. Most other inputs scale more readily than human expertise.
Thus the impetus to figure out where "human expertise" can be substituted for that of a scalable machine system - and what would be the best ways to implement that.
I was replying to "how much of 'things that actually matter like pathophysiology and pharmacology' can be factored out into the automation land"
I'd argue they aren't being factored into automation land if they're still the responsibility of a human expert, even if there are fewer more productive human experts.
(Though I do think AI will have a role in pathophysiology and pharmacology, initially catching errors, and probably some day taking responsibility, but not soon.)
Yep. I haven’t seen an actual MD in quite some time. Instead my general care provider is a Nurse Practitioner and he’s been handling all my routine healthcare needs.
Hate to be cynical, but going by the stories a doctor in my personal circles tells me, "talked to me for an hour, ordered a ton of tests" could be more about billing the national healthcare fund for many tests, that may not be most useful, but carry best margins for the facility.
In my country, there's a big feud between cardiologists and radiologists right now, big enough to be a regular topic in national media. Inside sources tell me it has nothing to do with quality of care, and is entirely about the march of technology allowing radiologists to perform some diagnostics that previously required cardiological procedures, and those procedures happened to be the major funding source for the cardiology departments.
Which is why we need more doctors trained more cheaply who are earning less money. They have far too much labor power currently for a role that increasingly can be fulfilled by a pure “technician” style expertise.
Yes, but it's erupting now that it killed a golden goose for the "real doctors", and the problem here is not along the doctor/technician lines (radiology has doctors too), but along the specialty/hospital department divide, because those are effectively separate business units.
I'd like not to have to wait for three months to see a doctor to prescribe me the routine treatment for my routine illness, so yes, more mediocre doctors would be good for me. It would also unburden the doctors who are "really into medicine" so that they could spend their time on more difficult cases.
Earlier you just need to find a doctor and they were probably good. Now you have to take your luck with many till you find a good one (if you are still alive by then)..
I don't know why people think that they can mass produce competence..
I have the impression that some people imagine that you can produce now 10x more doctors at the same cost that you were producing one doctor 10 years ago. Mostly because some tasks (even programming) got many times "more efficient" I feel people transfer to easy to other topics.
Even worse, education expenditure is decreasing for many countries! (see some examples: <a href="https://ourworldindata.org/grapher/education-spending?tab=line&country=USA%7EROU%7ENLD%7EJPN&spending_type=gdp_share&level=all" rel="nofollow">https://ourworldindata.org/grapher/education-spending?tab=li...)
There have always been a lot of incompetent and even dangerous doctors. It's just that patients weren't aware of this and tended to trust their doctor even when the actual care quality was terrible.
Ah yes and when doctors give everyone expensive tests because the patients are a bunch of drama queens who think they know better because they have a doctorate in Google the costs go up.
This is another one of those "kids these days" thing based on nothing but vibes. <a href="https://www.science.org/doi/10.1126/sciadv.aav5916" rel="nofollow">https://www.science.org/doi/10.1126/sciadv.aav5916
I'll give you some N=1 sample on older doctors since I'm also from Romania: a lot of these older doctors haven't opened a book in a very long time and are still using older practices instead of providing their patients with the latest and most effective treatments available because they're too lazy and/or prestigious to go and learn new things. Would you say that they "into medicine"?
> Would it help if we get a lot more of the first kind of doctors?
It would certainly help hypochondriacs a lot. Ordering "a ton of tests" needs to have some basis behind it, and doing it just to make the patient "feel seen" is not a great way to do your profession. People being dismissed quickly also happens in the US quite a lot, sometimes with disastrous results though it's not incredibly common, it's typically labeled under "diagnostic error" <a href="https://qualitysafety.bmj.com/content/23/9/727.long" rel="nofollow">https://qualitysafety.bmj.com/content/23/9/727.long
You get the same problems in the US with the attitudes of doctors.
In the US, medical school is extremely expensive (like $400,000 expensive). There are many people who are excellent doctors who are just priced out of the profession. If we could make medical school less expensive (by subsidizing it and by reducing the amount of instruction), we would probably get many more excellent doctors.
Half a million in debt is scary. Especially if you have any doubts that you can match and make it through residency at the end. It's even scarier if you come from a family making $50k/yr.
Don't they have to back these gigantic loans? That might deter people from going to medical school out of fear they're not gonna have what it takes and drop out halfway with huge debt.
Loans need to be repaid. I have many physician friends who graduated from medical school with 500k-750k in student loan debt (including debt from undergrad which compounded during medical school) with a combination of federal student aid as well as private loans anywhere from 8-10%. After graduating medical school, they completed 3-5 year residency programs earning somewhere in the ballpark of $50k-$60k salary. This is in an expensive northeast US market where such a salary barely covers basic living expenses, and as such their debt continued to compound. After completing residencies, they earn $175k-$200k salary which is about average for this area as an attending physician in their specialties (primary care related specialties like Family Medicine).
You do the math: over a 10 year repayment period with compound interest, their education cost them MILLIONS and they'll be well into their 40s before they start saving a dime for retirement. The cost and scarcity of medical education is extremely punitive to doctors and prices out many would-be great physicians. Many I know who have gone through this ended up regretting it due to the enormous financial burden they are saddled with for many years after becoming an attending.
Maybe folks believe these professions should be reserved to those who inherit great amounts of generational wealth.
If "only" 30% of graduates are graduating with over $300k in debt, that means that of the 30,000 graduates that graduate from both allopathic and osteopathic programs each year [1] there are almost 9,000 physicians that are high debt graduates. At high interest rates, that debt can easily grow by hundreds of thousands of dollars while you complete a residency program.
The resident salaries that you listed are an average taken across all specialties. Family Medicine is the lowest paid specialty with 2026 PGY-1 salaries at $58,500 (representing an increase of over 15% since 2021) [2] That is simply not enough to pay the cost of living in a state like Massachusetts where the median household income is more than double that [3] and the average rent in Boston metro is almost $40,000 annually [4]. Not only can you not afford to pay down your student loan debt, you are extremely likely to accrue additional consumer debt on things like credits cards or vehicles.
My main point is that training to become a doctor carries so much financial risk that it selects against folks from poor socioeconomic backgrounds that would otherwise make great physicians. In 2018 the AAMC published a study showing that 51% of medical school matriculants were from families in the top quintile for family income [5] and if I were a betting man, I'd guess that proportion has only increased.
> At high interest rates, that debt can easily grow by hundreds of thousands of dollars while you complete a residency program.
Sure. But that’s not what you said. You said you had many fiends that graduated med school with $500k-$750k in debt. I think you were lying or your definition of many was highly exaggerated.
> That is simply not enough to pay the cost of living in a state like Massachusetts
$58k is the national average. Not the average in a high cost of living area like Massachusetts.
> My main point is that training to become a doctor carries so much financial risk that it selects against folks from poor socioeconomic backgrounds that would otherwise make great physicians.
There is almost zero financial risk.
Eventual graduation rate is 96%. Eventual match rate is around 99%.
Are there doctors that could have make more money going into finance sure. Are there doctors who are financially ruined, not meaningfully.
>In 2018 the AAMC published a study showing that 51% of medical school matriculants were from families in the top quintile for family income
1. Doctors kids are more likely to become doctors.
2. High income is correlated with intelligence and intelligence is partially heritable.
3. Kids from high income families are more likely to have extended family and friends who are editors who encourage them to become doctors.
4. Med school requires college and college and children from income families are much more likely to have college degrees.
5. Medical school entrance is competitive and high income kids are much more likely to go to better colleges.
6. High income kids are much more likely to have higher grades in college because they don’t have to work.
7. High income kids are much more likely to go to better high schools which impacts what college they get into and how well they do there.
The list goes on and on. The cost of medical school is so far down that list.
I don’t think accusations of lying add anything productive to the conversation, but thanks. We have different circles of friends with different financial circumstances and that’s OK. There are plenty of stories if you would care to read more:
Residency match rates for American graduates from American MD or DO programs are more like 93%. Also worth considering that thousands of Americans go abroad for medical school due to limited seats in the US. For American IMGs the match rate is only 70%. If you dig into things a little bit further, it’s actually worse than that because the figures do not include applicants who did not submit a rank list because they did not receive any interviews.
I agree that the vast majority are able to match into a residency program, but I certainly would not consider that “almost zero financial risk”
> I don’t think accusations of lying add anything productive to the conversation, but thanks. We have different circles of friends with different financial circumstances and that’s OK.
I think it’s more likely you’re just exaggerating. How many is many? If you personally know more than 5 doctors with $500k-$750k in debt after med school I’ll eat my hat.
That reddit link only had 7 actual doctors who claimed to have graduated with more than $500k in debt. In a post about high debt with 200+ comments in a subreddit for doctors.
And the OP mentioned in the comments that he was borrowing enough to pay for his “expensive” med school and to support himself, his stay at home wife, and their baby in an expensive area.
> Residency match rates for American graduates from American MD or DO programs are more like 93%
That’s only after primary march. Match rate after SOAP is 98%. Roughly half of the unmatched 2% get marched in the next max cycle which is where I got 99%. Of the remaining 1% most of those want to eventually place somewhere.
>For American IMGs
Yeah don’t go to a factory medical school in the Caribbean. It’s a bad idea.
It’s definitely almost 0 financial risk. The only real risk is that you just hate being a a doctor. But even in that case med school unlocks tons of opportunities outside of clinical practice.
The chance of you ending up suffering financial hardship is too small to consider in your decision making.
The real out of your control risks would be severe disability that prevents you from finishing med school or working (before you can afford disability insurance). But in the case it really doesn’t matter whether you owe $50k from undergrad or $250k from med school. You’re not paying either one back and you can actually bankrupt out of student loan debt in those cases.
"Are you sure you can find that many more doctors? That they'll be any good?
Speaking from Romania: ..."
The prior post was specifically talking about the US. (I assure you, arrogant dismissive doctors are also a thing in the US)
In the US, there are a number of things that artificially increase the barriers to becoming a doctor.
1) You typically need a four year college degree to apply to medical school
2) Medical schools are accredited by the AMA, which is controlled by doctors. The AMA makes it very difficult to start a new MD-granting medical school.
3) Medical school in the US is very competitive to get in. They are likely turning away a lot of people who could complete the degree.
4) Since 1997, the federal government has a fixed number of Medicare (Medicare is a federal health insurance program for people over 65) supported residency positions. That number was basically flat for 25 years. We lost about 20% per capita of doctors being trained with support from this program. The caveat to this is that the total number of residents per capita has increased over time, particularly the past 15 years or so. My understanding is that they are less likely to be fully funded, so they spend more money getting trained, and then have higher students loans (on average graduating with debt above 200k going back to the late 2000s) that they need to pay off, so they charge more.
And you can add to this that it can be very difficult to be a doctor in another country and come to the US to practice here.
I totally dont by the "no medicare funds for training". A doctor will see you for 10min (perhaps another 10min prep) and bill $1000. If you doubt this, just check your EOB statements from the insurance company or check your deductible history.
The entire salary for the resident can be earned back in 3-4 days. You still have 360 days left to pay back admin overhead, facility overhead, supplies, etc. That is earned back in the next several weeks. After that, the next ~300 days of the year are profit.
In states with balance billing, the doctor can set any price and bill you for the remaining figure with a balance bill. In NY and NJ these can be thousands or tens of thousands. If you dont pay, it goes to collection and the provider still gets 10 to 15 cents on the dollar. So no...the $75k annual salary of a resident is not a barrier to training more doctors according to any math i'm seeing. What am I missing?
What seems more likely is that supply is artificially constrained to increase scarcity and prices.
First, private practice docs see patients with very good employer provided insurance, but residents are largely seeing patients that private practices wont see - patients who are far too medically complex to fit into a 10 minute slot and who also have particularly stingy insurance.
So as opposed to a private practice doc who is seeing 30 patients per day and billing an a average of $250 to $300 per patient (certainly not $1000 - that is unrealistic in my experience), a resident is seeing more like 10 to 15 patients per day (30 minute slots) and billing less than $100 per patient.
Second, residents have to be supervised. You have not included the salary of the physicians supervising them in your calculation.
Third, and I have mentioned this many times before on HN, training is limited by chiefly by the number of training sites that can offer quality training. For example, most hospitals will not see a single case of Guillan-Barre in a single year. Would you want to be treated by a nuerologist who trained at such a hospital? This is why neurology training is generally limited to places with a high volume of neurologic cases that would be considered rare at the average hospital, and these hospitals can only accommodate so many residents. Even for general medicine, you probably do not want to be treated by a doctor who trained at a hospital where any case that passed a certain complexity was transferred out to a bigger center.
On top of these, a few things with the training process also jump out to me from a "can we attract smart and motivated people to this work" point of view: the sheer cost of medical school that creates an imperative for high pay down the line, coupled with a real chance that you can wind up without a residency match but still owe all that money for school, and in particular the grueling nature of the residency system, currently capped at only 80 hours/week since 2003, because people were working >100 and making mistakes.
There are arguments that these are factors that filter out the people who are not sufficiently motivated, but it's hard for me to imagine there aren't a lot of bright young people who might be interested in medicine, but see one of the various paths that exist today to making doctor-level money with only an undergraduate degree and in an environment that doesn't require a working schedule that actively harms your health.
Yep, it's a huge risk. If a student enters medical school and realizes halfway through that they don't want to be a doctor then they're still stuck with a huge debt and no way to pay it off. It's not like undergraduate education where you can fairly easily switch majors from chemistry to mathematics or whatever.
> Would it help if we get a lot more of the first kind of doctors?
Depends? Did the tests actually find anything, or did they just make you feel better?
I had a talk with my GP about this at some point, and he more or less told me that he can just say "Go home, rest, come back in two weeks if it doesn't get better.", and 95% of the time that'll be exactly what is necessary. The hard part of his job is figuring out which of the visits are those 5%.
So you're saying limiting the number of doctors work better?
Speaking from Poland, we see the same outcome: doctors rushing patients out after 5 minutes. The reasons may be different, though: since COVID, many doctors here have, in my view, become more arrogant and focused on money. Over the past few months, an uproar over doctors’ pay has swept through Polish social media.
Reports have emerged of doctors billing for overlapping work under multiple contracts. In one case, a doctor’s records showed 72 hours of work in a single day!
Meanwhile, the Polish Chamber of Physicians and Dentists (NIL) continues to defend caps on medical school admissions, adding fuel to the national debate.
> Their salaries need to be lower, training needs to be cheaper and faster, and we need a lot more of them.
We need to reduce the requirements to be a doctor. I think general ability is way way way more important than the specialisation. I don't think the speciality that doctors spend money and time on add that much value..
> I think general ability is way way way more important than the specialisation. I don't think the speciality that doctors spend money and time on add that much value..
And why do you think that? I'm a doctor and I disagree completely - the medicine nowadays is so advanced, that it's impossible to keep up with advances without specialising yourself in narrow area.
Please read what I said again - it’s impossible to keep up unless you specialize. It’s really bad tactic to cut something out of context where context is literally in the same sentence.
> If the pace moves so fast that you can't keep up, it is even more reason to hire for general ability.
I can keep up with my specialized field, but I can’t keep up with entire medicine because it’s too broad. It’s clearly a case where specialization is important. I’m not the one that has problems with understanding here.
I say this as a tech person married to a physician. Hacker News is a very bad place to discuss medicine because most of the readers and writers are tech people who just don't have exposure to medicine in depth.
It would be the same as someone from Hacker News going to read a medical forum where people are discussing AI, and the takes would feel similarly juvenile and uninformed, simply due to lack of exposure.
You are right, of course… but unfortunately I don't think it's worth arguing too much here.
I don't think Dr salaries are even that high a percent of healthcare spending. Although, maybe better work life balance, lower salary escalation and less debt would help everyone.
Agree - one sensible start would be to at least hybridize the European model where students are a whole lot closer to getting there medical degree as an undergraduate.
In most countries that do this training is longer which that total training time is only 1-2 years shorter.
So you’re doing a few things.
1. Moving more training from cheaper colleges to more expensive medical schools.
2. Moving the filter from undergrad to medical school
3. There is no national curriculum in US high schools, so essentially the first 2 years is getting everyone on the same footing. Removing this without changing high school, puts students at poor high schools at an even greater disadvantage.
Many of the programs you listed don’t cut any time off. They’re just a special pipeline program that can help you get into med school.
Of the ones that do save time, most cut 1 year off not 2. And they do it by having students take more than a full time load during undergrad.
It’s essentially the same thing as taking an extra class or 2 every semester so you can finish undergrad in 3 years instead of 4.
I randomly sample 15 of the programs listed there and 14 were 8 year programs. Only 1 had an optional 7 year program (if you were willing to take more than full time load or go to school in summmer). And there were no 6 year programs.
While you're at it why not no crime so there's no police. Nothing dangerous so no firemen. Nobody throws anything away, so no need for factories. Peace on earth, so no soldiers.
I think you’re not sufficiently taking into account the demographic trajectory of age distribution [0], and the lag induced by the length of the human lifespan on health improvements. For the next few decades, more doctors will be needed.
That is a good analogy. Let us consider that there is a growing number of fire events in the recent years. Instead of finding out what is causing it, and fixing it we are asking for more firemen....
> The reality is we need more doctors. A lot more.
I think building a better prevention layer is more important.
Don't get me wrong, I agree that we need more doctors (and nurses, and physios, and dietetists, and ...), but it is much easier to scale a good prevention system than the number of workers in healthcare.
Prevention is not about age related diseases, but early onset cancer, diabetes, high blood pressure caused by alcohol and tobacco use, unhealthy diet, and sedentary lifestyle.
A significant amount of cases could be prevented before they need medical intervention (and put burden on the medical system). There are several researches about this, the number of people with type 2 diabetes doubled in the past decades.
This is why some healthcare systems reward for example doing 10.000 steps a day with lower insurance fees. They recognized they save a huge amount of money if they get people to move.
Widespread use of GLP-1 agonist drugs will prove to be the most effective prevention layer. I absolutely support people living healthier lifestyles in order to delay the onset of the chronic diseases that drive the majority of medical care demand. But on a population basis, attempts at lifestyle interventions have been broadly ineffective. A lot of the chronic disease burden including type-2 diabetes, hypertension, heart failure, MSK, etc is downstream of obesity so if GLP-1 drugs can cause a lot of people to lose weight then we might see some real improvements within a decade.
To be clear I'm not suggesting that everyone should be on GLP-1 drugs, and it's obviously better to maintain a healthy lifestyle and body composition without those drugs. But for people who can't or won't do that on their own the drugs seem to work pretty well. There's also promising evidence that they cause reduction in alcoholism and other substance abuse disorders.
I think one issue is that the admissions for medicine are getting harder and harder. In many places you practically need a 4.0.GPA, volunteer work, great mcat scores, research experience, sometimes a post grad degree like an MSc and PhD etc. This selects for highly competitive and intense personalities that are not always suited for every medicine specialty. Most of them don't want to go into family medicine and pediatrics because it's more work, less money, less prestige etc. The friends I had who wanted to go into family medicine couldn't because of the admission requirements. Their only alternative was to have family money to pay for medical school in places like Ireland.
Edit: I should have mentioned that pediatrics and family medicine represent a large proportion of available residency spots each year and are rarely full.
General practitioners make something like 150k on average in the US. Specialists tend to make a lot more (upwards of double) and also tend to skew perceptions of doctors’ pay.
You could argue specialists should make less but considering how long it takes to become a doctor, how much work it takes to get there, how long you’re putting off real earning potential, school debt, etc., I do not consider 150k overpaid.
From a more practical angle, I don’t know how you could possibly find more doctors by lowering their earning potential.
Other countries have double, even triple the number of physicians per capita. They also pay them a lot less. Are they all less competent? Are US filtering requirements actually all that predictive of future performance? Can we, say, see that MCAT scores really line up well with clinical performance? Because it's easy to be selective, but not so easy for the selectivity to be predictive of actual quality, especially when you are being selective before training starts.
They can make a lot more than 250K in less attractive places as well. But I believe the current cohorts of med students are more 'worldly' and in it for the money than in the past. They'll take getting paid 100K less so they can stay in a nice city and take another 50K less to work part time.
The author:
"Doctors are caught in a web of business, no longer a noble vocation. The altruism of young doctors have been replaced by the shackles of efficiency, productivity and key performance indicators."
The answer: here's some key performance indicator we can improve.
Speculating, but it could be a spiral where the shortage places more responsibilities on existing doctors, making the field less appealing to potential doctors. For too many people no amount of income compensates for a difficult lifestyle (we see this with air traffic control). If this were the case it would be productive to redesign medical systems to unburden doctors, but the current for-profit, scarcity-oriented system (in the US anyway) seems calibrated to squeeze everyone.
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.”
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.
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.
Then you end up with students from places like Nepal and Pakistan, where cheating is so rampant that you can't really evaluate the quality of your medical student or applicant. Even standardized exams like the USMLE/STEP series have been gamed. You also end up with significant cultural mismatch. I don't believe this is a good solution.
anecdote alert: had a family member treated by a foreign doctor last year, and received advice from that doc that was both 1) highly dangerous, 2) bare minimum 20 years out of date.
Inconceivable that a domestically-trained doc would have made the same mistake.
Probably better solution is to upskill nurses + AI to do handle all the simpler tasks like prescribing standard treatments, etc. There's already a concept of mid-level practitioner which can be expanded.
There's basically no need for GP to be a doctor.
This is so hilariously false and completely inverted that it shocks me that people not in medicine can believe it.
Out of respect for you as a fellow intelligent HN commenter — you are deeply misinformed, and I would urge you to reconsider your perspectives on this.
Every study shows that utilization of APPs and nurse practitioners Leads to decreased quality of care and a significant increase in utilization of other healthcare resources, like the emergency department and imaging, that better-trained physicians don't need.
Less-trained providers misdiagnose cancers, refer patients to the wrong specialists, overprescribe antibiotics, and generally cost the system significantly more in overall health load than if we had better-paid general practitioners.
There is an argument that not enough physicians go into general practice, which is true, but it's because subspecialties are in such high demand that they're generally better paid. The unfortunate fix is that we need to find a way to better compensate primary care, even though Medicare physician reimbursement rates continually decline and our health insurance system is not well structured to support this kind of primary care model.
I've left a few links below if you'd like to read them:
General burden of NPs higher than physicians even with lower appointment cost: <a href="https://static1.squarespace.com/static/615326dd2c363f1e2a5c8fc8/t/65fb41dcfee3eb7db180e3d1/1710965212680/Hattiesburg%2Bstudy_MiACCT_web_update.pdf" rel="nofollow">https://static1.squarespace.com/static/615326dd2c363f1e2a5c8...
Skin cancer misdiagnosis: <a href="https://www.ovid.com/journals/jaderm/abstract/10.1001/jamadermatol.2018.0212~accuracy-of-skin-cancer-diagnosis-by-physician-assistants?redirectionsource=fulltextview" rel="nofollow">https://www.ovid.com/journals/jaderm/abstract/10.1001/jamade...
There are several papers demonstrating AI is at least as good at diagnostics as fully qualified doctors. So why would NP + AI be worse? AI should compensate for the lack of knowledge.
And I'm not saying NP + ChatGPT - it should be properly calibrated system which would defer to a 'proper doctor' in more complex cases.
> AI is at least as good at diagnostics as fully qualified doctors
If the prompt is an expert-written board question! Not so with inferior prompts [0]. Critically, you need deep medical knowledge to interact correctly with the agent.
What you're asking is basically: "If we take someone out of a three month dev bootcamp, and have them prompt Claude, why can't they be as good as a four year CS grad?"
I doubt that you would feel similarly about expertise in your own field.
There have been a huge progress in AI reasoning in the past 2 years. GPT-4o mentioned in the article would struggle with high-school math problems, OTOH GPT-6 can solve problems beyond capability of professional mathematicians.
I'd wager GPT-6 would not depend on high-quality prompts, although it might still be good to get a trained person to enter information and do a sanity check.
Yes, point taken. I am well aware of the intelligence explosion and I am very AI pilled.
But the core problem still exists based on the clarity of the prompt and the prompter.
Seeing my wife's depth of intuition and expertise as a physician, compared to my comparatively caveman-like prompts when asking for health advice, there's a massive delta in accuracy.
Have you ever had a significant health issue and tried to get help from a model? Even something like GPT 6 Pro? The firehose and confusion you will generate trying to figure out answers are far less helpful than having directed interaction with a physician.
Following up on this because I've been thinking about why this is. I believe a big part of it is just that the intuitive parts of medicine are learned essentially by internship and therefore are not well encoded into the models. Unlike software, where you can have deterministic output that the models can train on, medical outputs are very fluid and dynamic. What works well in a paper, even though we claim to do evidence-based medicine, may be very far from what a "good" physician does in practice.
The issue is that the AI is at best what's in papers and medical records, which often forgoes the core thing that might lead a physician to uncover something or take a different approach with the patient.
It’s called physicians assistants and nurse practitioners. They are essentially exactly what’s you’re talking about. They make less and they have less training.
For a lot of specialties, we just don't have enough caseload to train doctors well enough. There is this meme that there's a cap on residency positions, which is the main limiter, but caseload is a significant limiter as well, especially for anything procedural or less knowledge-based.
> (speaking from US): The reality is we need more doctors. A lot more.
[Doctors only spend around 18% of their time with patients in the U.S.](<a href="https://pubmed.ncbi.nlm.nih.gov/40500897/" rel="nofollow">https://pubmed.ncbi.nlm.nih.gov/40500897/) The rest is spent on administration. I respectfully contend that the bigger issue is not the number of doctors per patient (though I admit that it could be a contributing factors), but rather that successive bureaucracy and compliance and laws and insurance requirements and policies have resulted in a system which forces doctors away from patients and towards ass covering. Remove the bureaucracy and you instantly have 5x as many doctors, effectively. Add more doctors to the machine and the machine will only find more creative ways to waste their time and talents.
Re-engineer the entire US system or train more doctors…
> Remove the bureaucracy and you instantly have 5x as many doctors, effectively. Add more doctors to the machine and the machine will only find more creative ways to waste their time and talents.
That’s a huge leap and not at all evidenced by your comment.
I’m all for simplifying all these administrative stuff. But no, that will not solve the fact that we have way more people who are way sicker and fewer doctors for them.
Yes, that's true to an extent. Some administrative tasks can really only be done by the attending physician. Ultimately they're the ones taking legal accountability. But other tasks can be automated or shifted to cheaper employees or not done at all. The problem is that many health system managers and administrators treat physician time as an unlimited free resource and impose all sorts of extra burdens on them. This is one of the factors driving physicians to burn out and leave the profession, further exacerbating the shortage.
True, but the other side of that is a lot of primary care will be taken over by lower licensed PA/NP. We can't possibly train enough new physicians to meet the demand imposed by an aging population. It doesn't take a real doctor to deal with routine scrapes and sniffles.
estearum · · focus · HN ↗
There's no solution other than training a lot, lot, lot, lot more doctors.
Their salaries need to be lower, training needs to be cheaper and faster, and we need a lot more of them.
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<a href="https://www.fsmb.org/siteassets/advocacy/policies/states-with-enacted-and-proposed-additional-img-licensure-pathways-key-issue-chart.pdf" rel="nofollow">https://www.fsmb.org/siteassets/advocacy/policies/states-wit...
joenot443 · · focus · HN ↗
I hear people say "we need more doctors" all the time. It would seem to me, the people deciding how many new doctors we train per year, are doctors. Their pay is proportionate to their scarcity, if we had 5x as many doctors, existing doctors would make far less.
Imagine if existing software engineers got to decide how many juniors entered our profession each year. I think things would look very, very different.
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Gareth321 · · focus · HN ↗
I think it's time we stop allowing institutions to rule. We elect our leaders to lead. They need to start fucking leading, or people are going to start voting for some radical alternatives.
nradov · · focus · HN ↗
<a href="https://savegme.org/" rel="nofollow">https://savegme.org/
One area where we can perhaps legitimately criticize the AMA is for their lobbying state governments to limit the scope of practice for lower licensed PA/NP clinicians. While some of their concerns about care quality and patient safety might be legitimate, the reality is that we're not going to have enough primary care doctors to ensure adequate patient access. Some of that work has to be delegated down.
Gareth321 · · focus · HN ↗
I feel I made this distinction very clear in my comment, so I'm surprised to see you repeat it. I make it clear that it is our elected officials which hold the power, *but who have deferred that power to institutions like the AMA.* For example, the AMA and Association of American Medical Colleges jointly sponsor the Liaison Committee on Medical Education (LCME), which accredits US MD programmes. LCME accreditation is extremely consequential because most state licensing boards require graduation from an LCME-accredited US programme, and LCME accreditation establishes eligibility for the USMLE and ACGME residency programmes. This gives the accreditation system considerable influence over expansion. LCME standards require a school to admit only as many students as its resources can support, including faculty, facilities and clinical training capacity. Schools must also notify the LCME when class-size increases exceed specified thresholds, currently a cumulative increase of 10% or 15 students, whichever is smaller, relative to the class size at the previous full accreditation survey.
estearum · · focus · HN ↗
Congress decides how many slots get funded and they have been way too slow to fund them.
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RussianBot9580 · · focus · HN ↗
estearum · · focus · HN ↗
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estearum · · focus · HN ↗
The AMA has been lobbying for MORE residency slots for decades.
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estearum · · focus · HN ↗
Or you’re saying they failed at the made-up goal you wish they had, and therefore failed?
RussianBot9580 · · focus · HN ↗
The job was to increase the number of doctors by increasing the number of residency spots. The poor folks have been lobbying for 30 years, but they are just not too good at it, gosh darn it.
sarchertech · · focus · HN ↗
What you’ve done is constructed an argument where no matter what position the AMA takes, they are the bad guys.
> salaries depended on my lobbying taking its time to produce as little of a result as possible
This doesn’t make sense. How would the AMA board communicate this to their voting members when all of their communications say that they doing all they can to increase resident funding.
How about the first board to vote to change their position 30 years ago? How would the voting members know that they were planning on slow walking their new position?
Do you think they have a secret doctor only communication channel where they tell them “don’t worry guys we’re not trying that hard”. Because without that if your premise is correct all of the members would have voted them out ASAP.
Also how is the AMA (which only represents about 15% of doctors btw) preventing hospitals from effectively lobbying for an increase? They have a huge financial interest in more resident funding.
RussianBot9580 · · focus · HN ↗
It's nice of you to talk to me like a child (thanks daddy!), but there's no secret comms channel needed. If an AMA official publicly came out with a platform of "let's cut your salaries in half!" they would not last long. And if there was no public announcement - their effort would be shot down behind the scenes. Simple as that.
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It's like claiming that one needs to cram hours upon hours of leetcode practice to be a quality software developer. It might be necessary for some companies to hire you, but that's to meet a filter that is less and less predictive over time, not an actual performance requirement.
killerstorm · · focus · HN ↗
Back in the day religious books were copied by scribes educated in a monastic tradition. Now printers can print them in a completely godless manner but the result isn't any worse.
nradov · · focus · HN ↗
The time demands also differ widely between specialties. You can't really be a part-time neurosurgeon. But we see a lot of doctors in other specialties like pediatrics, internal medicine, radiology, and emergency care downshifting to part-time schedules after they have established careers.
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panick21_ · · focus · HN ↗
You have to create a healthy system, that takes social engineering and government cooperating on a general plan. And in the US such a thing is basically not possible, even if they wanted to do it.
Ideally your transportation, agricultural, educational policies should all work together to produce healthy population. But this simply isn't the case.
But it will not 'reduce pressure' in a practical way, because such changes purely private or public take decades to work themselves threw the population.
Forgeties79 · · focus · HN ↗
I can’t even get basic foot stuff covered, they won’t care until my feet and knees land me under “disability,” so people like me - but unlike me they can’t afford to spend hundreds more a year on special inserts and shoes - just keep doing what they’re doing until they’re hurt.
People go to the grocery store and marketing teams are trying to sell them “vitamin water” which is neither of those things, so they have to do tons of research and pay constant attention to literally every food they buy. Then when they get hurt they can’t afford to go to a doctor and the insurance that is sucking up huge amount amounts of their annual pay doesn’t pay for it either.
Meanwhile we have a US administration that is telling everybody, a population that is incredibly predisposed to heart disease already, to go eat more red meat. Also, they have spent a decade telling people that vaccines are shady and maybe they shouldn’t get them. How much damage have we done to preventative care with that one?
I could go on and on, I’m barely covering the breadth and depth of this problem. We can’t just call it “personal responsibility” or whatever
nradov · · focus · HN ↗
<a href="https://www.healthcare.gov/coverage/preventive-care-benefits/" rel="nofollow">https://www.healthcare.gov/coverage/preventive-care-benefits...
Forgeties79 · · focus · HN ↗
I am clearly not saying they literally don’t cover any preventative care. I think most people agree that insurance companies’ idea of what is “justified” is far too narrow. What is “clear” is also often very opaque. That’s the issue I’m pointing to. US health insurance is a terrible experience.
And who cares if the analysis costs me nothing? Why is that something I should be grateful for?
nradov · · focus · HN ↗
At a first level the federal government publishes a set of medically unlikely edits used to deny claims when procedure codes don't align with diagnosis codes. It's used by Medicare, and most Medicaid agencies and commercial health plans have also adopted it.
<a href="https://www.cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncci-edits/medicare-ncci-medically-unlikely-edits-mues" rel="nofollow">https://www.cms.gov/medicare/coding-billing/national-correct...
At the next level most commercial health plans have adopted clinical care guidelines published by vendors like MCG. These vendors take publications from specialist medical societies and codify them to determine what's medically justified and set step therapy requirements.
<a href="https://www.mcg.com/solutions/care-guidelines/" rel="nofollow">https://www.mcg.com/solutions/care-guidelines/
At the final level, providers can appeal denials to human nurses and doctors who do case review at insurance companies (peer-to-peer). In a huge healthcare system there are always patients with unique needs who don't fit the pattern in published care guidelines. Dealing with those appeals is a major administrative burden and often badly managed on both sides of the adversarial interaction.
Most US-based HN users are on commercial self-funded group health plans sponsored by their employers. The Affordable Care Act (ACA / Obamacare) establishes a baseline for what's covered but ultimately the decisions are made by employer HR departments. Insurance companies would be happy to offer custom health plans that paid every claim at 100% with zero denials or prior authorization requirements; it would mean less work and higher profits for them. But no employer wants to pay for that so the insurance companies take measures to hold down costs.
rolisz · · focus · HN ↗
Speaking from Romania: here medicine is prestigious. So many parents push their kids towards medicine. There's a glut of newly minted doctors every year, but rumour has it that the quality drops every year. Sure, they pass the exams and residency and what not, but... They're just not into medicine as much.
Do you want to get treated by such a person?
This year I had to go to a neurologist. I went to one locally, they dismissed me in 5 minutes, told me to take some vitamins basically. Went to another one in a much bigger city, they talked to me for an hour, ordered a ton of tests.
Would it help if we get a lot more of the first kind of doctors?
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wl · · focus · HN ↗
We actually do have a better model in the form of physician assistants. They're taught the same kinds of things physicians are taught, just in less depth.
ACCount39 · · focus · HN ↗
AI isn't perfect, but even loosely scaffolded generalist systems show promise in the field of medicine now. And the alternative isn't some hypothetical "perfect healthcare" - the status quo is often closer to "nurses running near the limits of their competence" or "physicians stretched thin almost to the breaking point".
The fundamental problem of healthcare is that it struggles to scale. The need for well educated, well paid professionals is inescapable. Or, was inescapable? We might be at the point where this can start changing.
leereeves · · focus · HN ↗
I would say not much. AI is still often wrong and a clinician needs to know when the LLM is saying something crazy. I think AI has the most promise for increasing the productivity of well trained professionals, not replacing them (or their training) entirely.
ACCount39 · · focus · HN ↗
Are AIs wrong more often or less often?
Would the healthcare get better or worse if the "first opinion" was AI more often than not?
"Increasing the productivity" and "replacing them" is two sides of the same coin. If a human can do five times the work, because AI does most of the work and the human performs "exception handling"? You need less humans. And healthcare, historically, is almost always human-constrained. That's why you get insane wait times and overworked clinicians. Most other inputs scale more readily than human expertise.
Thus the impetus to figure out where "human expertise" can be substituted for that of a scalable machine system - and what would be the best ways to implement that.
leereeves · · focus · HN ↗
I'd argue they aren't being factored into automation land if they're still the responsibility of a human expert, even if there are fewer more productive human experts.
(Though I do think AI will have a role in pathophysiology and pharmacology, initially catching errors, and probably some day taking responsibility, but not soon.)
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TeMPOraL · · focus · HN ↗
In my country, there's a big feud between cardiologists and radiologists right now, big enough to be a regular topic in national media. Inside sources tell me it has nothing to do with quality of care, and is entirely about the march of technology allowing radiologists to perform some diagnostics that previously required cardiological procedures, and those procedures happened to be the major funding source for the cardiology departments.
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lolakutty · · focus · HN ↗
Earlier you just need to find a doctor and they were probably good. Now you have to take your luck with many till you find a good one (if you are still alive by then)..
I don't know why people think that they can mass produce competence..
vladms · · focus · HN ↗
I have the impression that some people imagine that you can produce now 10x more doctors at the same cost that you were producing one doctor 10 years ago. Mostly because some tasks (even programming) got many times "more efficient" I feel people transfer to easy to other topics.
Even worse, education expenditure is decreasing for many countries! (see some examples: <a href="https://ourworldindata.org/grapher/education-spending?tab=line&country=USA%7EROU%7ENLD%7EJPN&spending_type=gdp_share&level=all" rel="nofollow">https://ourworldindata.org/grapher/education-spending?tab=li...)
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cbg0 · · focus · HN ↗
I'll give you some N=1 sample on older doctors since I'm also from Romania: a lot of these older doctors haven't opened a book in a very long time and are still using older practices instead of providing their patients with the latest and most effective treatments available because they're too lazy and/or prestigious to go and learn new things. Would you say that they "into medicine"?
> Would it help if we get a lot more of the first kind of doctors?
It would certainly help hypochondriacs a lot. Ordering "a ton of tests" needs to have some basis behind it, and doing it just to make the patient "feel seen" is not a great way to do your profession. People being dismissed quickly also happens in the US quite a lot, sometimes with disastrous results though it's not incredibly common, it's typically labeled under "diagnostic error" <a href="https://qualitysafety.bmj.com/content/23/9/727.long" rel="nofollow">https://qualitysafety.bmj.com/content/23/9/727.long
account42 · · focus · HN ↗
Hard to tell when you don't let us know which of those doctors ended up solving the issues that made you seek a doctor.
Dismissive doctors are bad but so are those that waste your time and risk complications from unnecessary invasive tests.
elil17 · · focus · HN ↗
In the US, medical school is extremely expensive (like $400,000 expensive). There are many people who are excellent doctors who are just priced out of the profession. If we could make medical school less expensive (by subsidizing it and by reducing the amount of instruction), we would probably get many more excellent doctors.
sarchertech · · focus · HN ↗
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sarchertech · · focus · HN ↗
The average med school debt is half that and only 30% of borrowers end up owning $300k or more.
Fewer than 1% of us med school graduates never find a slot. And that includes people who start families, move into industry etc and voluntarily leave.
The bottleneck is residency slots not med school slots.
elil17 · · focus · HN ↗
Right, because they are paying for it out of pocket
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sarchertech · · focus · HN ↗
Also the bottleneck is residency slots, so even if this is the case, it wouldn’t change anything.
tossstone · · focus · HN ↗
You do the math: over a 10 year repayment period with compound interest, their education cost them MILLIONS and they'll be well into their 40s before they start saving a dime for retirement. The cost and scarcity of medical education is extremely punitive to doctors and prices out many would-be great physicians. Many I know who have gone through this ended up regretting it due to the enormous financial burden they are saddled with for many years after becoming an attending.
Maybe folks believe these professions should be reserved to those who inherit great amounts of generational wealth.
sarchertech · · focus · HN ↗
The average debt is a little over $200k. Only 30% of graduates have over $300k in debt and they are considered high debt graduates.
Family Medicine salaries are above $200k in every state in the nation for full time doctors.
None of the doctors I know come from families with generational wealth.
Here is the nationwide average for resident salaries by year and its higher in higher cost of living areas.
Program year 1—$68,166.
Program year 2—$70,499.
Program year 3—$73,301.
Program year 4—$77,593.
Program year 5—$81,807.
Program year 6—$84,744.
Program year 7—$89,187.
Program year 8—$94,215.
Your entire picture is inaccurate.
tossstone · · focus · HN ↗
The resident salaries that you listed are an average taken across all specialties. Family Medicine is the lowest paid specialty with 2026 PGY-1 salaries at $58,500 (representing an increase of over 15% since 2021) [2] That is simply not enough to pay the cost of living in a state like Massachusetts where the median household income is more than double that [3] and the average rent in Boston metro is almost $40,000 annually [4]. Not only can you not afford to pay down your student loan debt, you are extremely likely to accrue additional consumer debt on things like credits cards or vehicles.
My main point is that training to become a doctor carries so much financial risk that it selects against folks from poor socioeconomic backgrounds that would otherwise make great physicians. In 2018 the AAMC published a study showing that 51% of medical school matriculants were from families in the top quintile for family income [5] and if I were a betting man, I'd guess that proportion has only increased.
1. <a href="https://www.kff.org/state-health-policy-data/state-indicator/total-medical-school-graduates/" rel="nofollow">https://www.kff.org/state-health-policy-data/state-indicator...
2. <a href="https://www.inspiraadvantage.com/blog/how-much-do-medical-residents-get-paid" rel="nofollow">https://www.inspiraadvantage.com/blog/how-much-do-medical-re...
3. <a href="https://fred.stlouisfed.org/series/MEHOINUSMAA672N" rel="nofollow">https://fred.stlouisfed.org/series/MEHOINUSMAA672N
4. <a href="https://www.zillow.com/rental-manager/market-trends/boston-ma/" rel="nofollow">https://www.zillow.com/rental-manager/market-trends/boston-m...
5. <a href="https://www.aamc.org/media/9596/download" rel="nofollow">https://www.aamc.org/media/9596/download
sarchertech · · focus · HN ↗
Sure. But that’s not what you said. You said you had many fiends that graduated med school with $500k-$750k in debt. I think you were lying or your definition of many was highly exaggerated.
> That is simply not enough to pay the cost of living in a state like Massachusetts
$58k is the national average. Not the average in a high cost of living area like Massachusetts.
> My main point is that training to become a doctor carries so much financial risk that it selects against folks from poor socioeconomic backgrounds that would otherwise make great physicians.
There is almost zero financial risk.
Eventual graduation rate is 96%. Eventual match rate is around 99%.
Are there doctors that could have make more money going into finance sure. Are there doctors who are financially ruined, not meaningfully.
>In 2018 the AAMC published a study showing that 51% of medical school matriculants were from families in the top quintile for family income
1. Doctors kids are more likely to become doctors.
2. High income is correlated with intelligence and intelligence is partially heritable.
3. Kids from high income families are more likely to have extended family and friends who are editors who encourage them to become doctors.
4. Med school requires college and college and children from income families are much more likely to have college degrees.
5. Medical school entrance is competitive and high income kids are much more likely to go to better colleges.
6. High income kids are much more likely to have higher grades in college because they don’t have to work.
7. High income kids are much more likely to go to better high schools which impacts what college they get into and how well they do there.
The list goes on and on. The cost of medical school is so far down that list.
tossstone · · focus · HN ↗
<a href="https://www.reddit.com/r/whitecoatinvestor/comments/1jayeai/are_med_students_really_in_this_much_debt/" rel="nofollow">https://www.reddit.com/r/whitecoatinvestor/comments/1jayeai/...
Residency match rates for American graduates from American MD or DO programs are more like 93%. Also worth considering that thousands of Americans go abroad for medical school due to limited seats in the US. For American IMGs the match rate is only 70%. If you dig into things a little bit further, it’s actually worse than that because the figures do not include applicants who did not submit a rank list because they did not receive any interviews.
I agree that the vast majority are able to match into a residency program, but I certainly would not consider that “almost zero financial risk”
<a href="https://www.nrmp.org/about/news/2026/03/nrmp-releases-results-of-the-2026-main-residency-match-for-more-than-38000-future-residents/" rel="nofollow">https://www.nrmp.org/about/news/2026/03/nrmp-releases-result...
sarchertech · · focus · HN ↗
I think it’s more likely you’re just exaggerating. How many is many? If you personally know more than 5 doctors with $500k-$750k in debt after med school I’ll eat my hat.
That reddit link only had 7 actual doctors who claimed to have graduated with more than $500k in debt. In a post about high debt with 200+ comments in a subreddit for doctors.
And the OP mentioned in the comments that he was borrowing enough to pay for his “expensive” med school and to support himself, his stay at home wife, and their baby in an expensive area.
> Residency match rates for American graduates from American MD or DO programs are more like 93%
That’s only after primary march. Match rate after SOAP is 98%. Roughly half of the unmatched 2% get marched in the next max cycle which is where I got 99%. Of the remaining 1% most of those want to eventually place somewhere.
>For American IMGs
Yeah don’t go to a factory medical school in the Caribbean. It’s a bad idea.
It’s definitely almost 0 financial risk. The only real risk is that you just hate being a a doctor. But even in that case med school unlocks tons of opportunities outside of clinical practice.
The chance of you ending up suffering financial hardship is too small to consider in your decision making.
The real out of your control risks would be severe disability that prevents you from finishing med school or working (before you can afford disability insurance). But in the case it really doesn’t matter whether you owe $50k from undergrad or $250k from med school. You’re not paying either one back and you can actually bankrupt out of student loan debt in those cases.
fusslo · · focus · HN ↗
We have the Public Service Loan Forgiveness program where qualifying public servants pay 10 years of their loans and the rest is forgiven tax free.
Removing financial stress from doctors seems like a public good most people could get behind
nradov · · focus · HN ↗
nradov · · focus · HN ↗
<a href="https://students-residents.aamc.org/medical-school-admission-requirements/medical-schools-offering-combined-baccalaureate-md-programs-state-and-program-length-2025-2026" rel="nofollow">https://students-residents.aamc.org/medical-school-admission...
bookofjoe · · focus · HN ↗
juujian · · focus · HN ↗
1980phipsi · · focus · HN ↗
The prior post was specifically talking about the US. (I assure you, arrogant dismissive doctors are also a thing in the US)
In the US, there are a number of things that artificially increase the barriers to becoming a doctor.
1) You typically need a four year college degree to apply to medical school
2) Medical schools are accredited by the AMA, which is controlled by doctors. The AMA makes it very difficult to start a new MD-granting medical school.
3) Medical school in the US is very competitive to get in. They are likely turning away a lot of people who could complete the degree.
4) Since 1997, the federal government has a fixed number of Medicare (Medicare is a federal health insurance program for people over 65) supported residency positions. That number was basically flat for 25 years. We lost about 20% per capita of doctors being trained with support from this program. The caveat to this is that the total number of residents per capita has increased over time, particularly the past 15 years or so. My understanding is that they are less likely to be fully funded, so they spend more money getting trained, and then have higher students loans (on average graduating with debt above 200k going back to the late 2000s) that they need to pay off, so they charge more.
And you can add to this that it can be very difficult to be a doctor in another country and come to the US to practice here.
TuringNYC · · focus · HN ↗
The entire salary for the resident can be earned back in 3-4 days. You still have 360 days left to pay back admin overhead, facility overhead, supplies, etc. That is earned back in the next several weeks. After that, the next ~300 days of the year are profit.
In states with balance billing, the doctor can set any price and bill you for the remaining figure with a balance bill. In NY and NJ these can be thousands or tens of thousands. If you dont pay, it goes to collection and the provider still gets 10 to 15 cents on the dollar. So no...the $75k annual salary of a resident is not a barrier to training more doctors according to any math i'm seeing. What am I missing?
What seems more likely is that supply is artificially constrained to increase scarcity and prices.
b38484848 · · focus · HN ↗
Anyone here should be familiar with the ""sAfEtY"" argument at this point.
Calavar · · focus · HN ↗
Several things.
First, private practice docs see patients with very good employer provided insurance, but residents are largely seeing patients that private practices wont see - patients who are far too medically complex to fit into a 10 minute slot and who also have particularly stingy insurance.
So as opposed to a private practice doc who is seeing 30 patients per day and billing an a average of $250 to $300 per patient (certainly not $1000 - that is unrealistic in my experience), a resident is seeing more like 10 to 15 patients per day (30 minute slots) and billing less than $100 per patient.
Second, residents have to be supervised. You have not included the salary of the physicians supervising them in your calculation.
Third, and I have mentioned this many times before on HN, training is limited by chiefly by the number of training sites that can offer quality training. For example, most hospitals will not see a single case of Guillan-Barre in a single year. Would you want to be treated by a nuerologist who trained at such a hospital? This is why neurology training is generally limited to places with a high volume of neurologic cases that would be considered rare at the average hospital, and these hospitals can only accommodate so many residents. Even for general medicine, you probably do not want to be treated by a doctor who trained at a hospital where any case that passed a certain complexity was transferred out to a bigger center.
[deleted] · · focus · HN ↗
[deleted]
macNchz · · focus · HN ↗
There are arguments that these are factors that filter out the people who are not sufficiently motivated, but it's hard for me to imagine there aren't a lot of bright young people who might be interested in medicine, but see one of the various paths that exist today to making doctor-level money with only an undergraduate degree and in an environment that doesn't require a working schedule that actively harms your health.
nradov · · focus · HN ↗
nradov · · focus · HN ↗
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Aeolun · · focus · HN ↗
Depends? Did the tests actually find anything, or did they just make you feel better?
I had a talk with my GP about this at some point, and he more or less told me that he can just say "Go home, rest, come back in two weeks if it doesn't get better.", and 95% of the time that'll be exactly what is necessary. The hard part of his job is figuring out which of the visits are those 5%.
rudolftheone · · focus · HN ↗
Speaking from Poland, we see the same outcome: doctors rushing patients out after 5 minutes. The reasons may be different, though: since COVID, many doctors here have, in my view, become more arrogant and focused on money. Over the past few months, an uproar over doctors’ pay has swept through Polish social media.
Reports have emerged of doctors billing for overlapping work under multiple contracts. In one case, a doctor’s records showed 72 hours of work in a single day!
Meanwhile, the Polish Chamber of Physicians and Dentists (NIL) continues to defend caps on medical school admissions, adding fuel to the national debate.
M95D · · focus · HN ↗
simianwords · · focus · HN ↗
We need to reduce the requirements to be a doctor. I think general ability is way way way more important than the specialisation. I don't think the speciality that doctors spend money and time on add that much value..
azan_ · · focus · HN ↗
And why do you think that? I'm a doctor and I disagree completely - the medicine nowadays is so advanced, that it's impossible to keep up with advances without specialising yourself in narrow area.
simianwords · · focus · HN ↗
azan_ · · focus · HN ↗
simianwords · · focus · HN ↗
What made you think that "things are moving really fast" is an argument for hiring specialists? Doctors smh..
Please at least show an attempt to understand what is said.
azan_ · · focus · HN ↗
I can keep up with my specialized field, but I can’t keep up with entire medicine because it’s too broad. It’s clearly a case where specialization is important. I’m not the one that has problems with understanding here.
joeatiris · · focus · HN ↗
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sebmellen · · focus · HN ↗
It would be the same as someone from Hacker News going to read a medical forum where people are discussing AI, and the takes would feel similarly juvenile and uninformed, simply due to lack of exposure.
You are right, of course… but unfortunately I don't think it's worth arguing too much here.
jeuue · · focus · HN ↗
He’s polluting this damn place.
Many of his posts tend to be down voted for a reason.
7952 · · focus · HN ↗
sarchertech · · focus · HN ↗
estearum · · focus · HN ↗
balderdash · · focus · HN ↗
sarchertech · · focus · HN ↗
So you’re doing a few things.
1. Moving more training from cheaper colleges to more expensive medical schools.
2. Moving the filter from undergrad to medical school
3. There is no national curriculum in US high schools, so essentially the first 2 years is getting everyone on the same footing. Removing this without changing high school, puts students at poor high schools at an even greater disadvantage.
nradov · · focus · HN ↗
<a href="https://students-residents.aamc.org/medical-school-admission-requirements/medical-schools-offering-combined-baccalaureate-md-programs-state-and-program-length-2025-2026" rel="nofollow">https://students-residents.aamc.org/medical-school-admission...
sarchertech · · focus · HN ↗
Of the ones that do save time, most cut 1 year off not 2. And they do it by having students take more than a full time load during undergrad.
It’s essentially the same thing as taking an extra class or 2 every semester so you can finish undergrad in 3 years instead of 4.
I randomly sample 15 of the programs listed there and 14 were 8 year programs. Only 1 had an optional 7 year program (if you were willing to take more than full time load or go to school in summmer). And there were no 6 year programs.
mococa · · focus · HN ↗
lolakutty · · focus · HN ↗
No, the reality is we should be more healthy, so we need less doctors.
killingtime74 · · focus · HN ↗
layer8 · · focus · HN ↗
[0] <a href="https://www.calculatedriskblog.com/2013/08/us-population-distribution-by-age-1900.html" rel="nofollow">https://www.calculatedriskblog.com/2013/08/us-population-dis...
victorbjorklund · · focus · HN ↗
lolakutty · · focus · HN ↗
zsoltkacsandi · · focus · HN ↗
I think building a better prevention layer is more important.
Don't get me wrong, I agree that we need more doctors (and nurses, and physios, and dietetists, and ...), but it is much easier to scale a good prevention system than the number of workers in healthcare.
lotsofpulp · · focus · HN ↗
zsoltkacsandi · · focus · HN ↗
A significant amount of cases could be prevented before they need medical intervention (and put burden on the medical system). There are several researches about this, the number of people with type 2 diabetes doubled in the past decades.
This is why some healthcare systems reward for example doing 10.000 steps a day with lower insurance fees. They recognized they save a huge amount of money if they get people to move.
nradov · · focus · HN ↗
To be clear I'm not suggesting that everyone should be on GLP-1 drugs, and it's obviously better to maintain a healthy lifestyle and body composition without those drugs. But for people who can't or won't do that on their own the drugs seem to work pretty well. There's also promising evidence that they cause reduction in alcoholism and other substance abuse disorders.
gww · · focus · HN ↗
Edit: I should have mentioned that pediatrics and family medicine represent a large proportion of available residency spots each year and are rarely full.
Forgeties79 · · focus · HN ↗
You could argue specialists should make less but considering how long it takes to become a doctor, how much work it takes to get there, how long you’re putting off real earning potential, school debt, etc., I do not consider 150k overpaid.
From a more practical angle, I don’t know how you could possibly find more doctors by lowering their earning potential.
chromatin · · focus · HN ↗
You certainly could if you were willing to accept people who are terrible at being a physician.
The notion that you can just throw more warm bodies at the problem is ludicrous
hibikir · · focus · HN ↗
victorbjorklund · · focus · HN ↗
folkrav · · focus · HN ↗
Calavar · · focus · HN ↗
boelboel · · focus · HN ↗
Palomides · · focus · HN ↗
sucks but that's incentives for ya
torben-friis · · focus · HN ↗
The answer: here's some key performance indicator we can improve.
Sigh.
baxtr · · focus · HN ↗
I have no idea what this might be.
mzmzmzm · · focus · HN ↗
chromatin · · focus · HN ↗
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
hibikir · · focus · HN ↗
sebmellen · · focus · HN ↗
> “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.”
<a href="https://academic.oup.com/academicmedicine/article-abstract/101/8/1012/8537997" rel="nofollow">https://academic.oup.com/academicmedicine/article-abstract/1...
Unfortunately, it’s very clear.
killerstorm · · focus · HN ↗
dguest · · focus · HN ↗
Q: What do you call the worst student to be admitted to medical school?
A: Doctor.
nradov · · focus · HN ↗
dguest · · focus · HN ↗
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]: <a href="https://www.ama-assn.org/medical-students/preparing-residency/largest-match-day-record-dive-2026-numbers" rel="nofollow">https://www.ama-assn.org/medical-students/preparing-residenc...
chromatin · · focus · HN ↗
chromatin · · focus · HN ↗
meken · · focus · HN ↗
Seems like having doctors emigrate from other countries would work as well.
layer8 · · focus · HN ↗
sebmellen · · focus · HN ↗
slices · · focus · HN ↗
Inconceivable that a domestically-trained doc would have made the same mistake.
killerstorm · · focus · HN ↗
There's basically no need for GP to be a doctor.
sebmellen · · focus · HN ↗
Out of respect for you as a fellow intelligent HN commenter — you are deeply misinformed, and I would urge you to reconsider your perspectives on this.
Every study shows that utilization of APPs and nurse practitioners Leads to decreased quality of care and a significant increase in utilization of other healthcare resources, like the emergency department and imaging, that better-trained physicians don't need.
Less-trained providers misdiagnose cancers, refer patients to the wrong specialists, overprescribe antibiotics, and generally cost the system significantly more in overall health load than if we had better-paid general practitioners.
There is an argument that not enough physicians go into general practice, which is true, but it's because subspecialties are in such high demand that they're generally better paid. The unfortunate fix is that we need to find a way to better compensate primary care, even though Medicare physician reimbursement rates continually decline and our health insurance system is not well structured to support this kind of primary care model.
I've left a few links below if you'd like to read them:
General burden of NPs higher than physicians even with lower appointment cost: <a href="https://static1.squarespace.com/static/615326dd2c363f1e2a5c8fc8/t/65fb41dcfee3eb7db180e3d1/1710965212680/Hattiesburg%2Bstudy_MiACCT_web_update.pdf" rel="nofollow">https://static1.squarespace.com/static/615326dd2c363f1e2a5c8...
Skin cancer misdiagnosis: <a href="https://www.ovid.com/journals/jaderm/abstract/10.1001/jamadermatol.2018.0212~accuracy-of-skin-cancer-diagnosis-by-physician-assistants?redirectionsource=fulltextview" rel="nofollow">https://www.ovid.com/journals/jaderm/abstract/10.1001/jamade...
Antibiotics overprescribed: <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC5047413/" rel="nofollow">https://pmc.ncbi.nlm.nih.gov/articles/PMC5047413/
killerstorm · · focus · HN ↗
And I'm not saying NP + ChatGPT - it should be properly calibrated system which would defer to a 'proper doctor' in more complex cases.
sebmellen · · focus · HN ↗
If the prompt is an expert-written board question! Not so with inferior prompts [0]. Critically, you need deep medical knowledge to interact correctly with the agent.
What you're asking is basically: "If we take someone out of a three month dev bootcamp, and have them prompt Claude, why can't they be as good as a four year CS grad?"
I doubt that you would feel similarly about expertise in your own field.
[0]: <a href="https://www.nature.com/articles/s41746-026-02428-5.pdf" rel="nofollow">https://www.nature.com/articles/s41746-026-02428-5.pdf
killerstorm · · focus · HN ↗
I'd wager GPT-6 would not depend on high-quality prompts, although it might still be good to get a trained person to enter information and do a sanity check.
sebmellen · · focus · HN ↗
But the core problem still exists based on the clarity of the prompt and the prompter.
Seeing my wife's depth of intuition and expertise as a physician, compared to my comparatively caveman-like prompts when asking for health advice, there's a massive delta in accuracy.
Have you ever had a significant health issue and tried to get help from a model? Even something like GPT 6 Pro? The firehose and confusion you will generate trying to figure out answers are far less helpful than having directed interaction with a physician.
sebmellen · · focus · HN ↗
The issue is that the AI is at best what's in papers and medical records, which often forgoes the core thing that might lead a physician to uncover something or take a different approach with the patient.
SirFatty · · focus · HN ↗
Not true.. according to most around here, it will be AI and robots all the way.
sleepyguy · · focus · HN ↗
sarchertech · · focus · HN ↗
It’s called physicians assistants and nurse practitioners. They are essentially exactly what’s you’re talking about. They make less and they have less training.
xadhominemx · · focus · HN ↗
halJordan · · focus · HN ↗
sarchertech · · focus · HN ↗
qmmmur · · focus · HN ↗
sebmellen · · focus · HN ↗
Gareth321 · · focus · HN ↗
[Doctors only spend around 18% of their time with patients in the U.S.](<a href="https://pubmed.ncbi.nlm.nih.gov/40500897/" rel="nofollow">https://pubmed.ncbi.nlm.nih.gov/40500897/) The rest is spent on administration. I respectfully contend that the bigger issue is not the number of doctors per patient (though I admit that it could be a contributing factors), but rather that successive bureaucracy and compliance and laws and insurance requirements and policies have resulted in a system which forces doctors away from patients and towards ass covering. Remove the bureaucracy and you instantly have 5x as many doctors, effectively. Add more doctors to the machine and the machine will only find more creative ways to waste their time and talents.
estearum · · focus · HN ↗
> Remove the bureaucracy and you instantly have 5x as many doctors, effectively. Add more doctors to the machine and the machine will only find more creative ways to waste their time and talents.
That’s a huge leap and not at all evidenced by your comment.
I’m all for simplifying all these administrative stuff. But no, that will not solve the fact that we have way more people who are way sicker and fewer doctors for them.
nradov · · focus · HN ↗
nradov · · focus · HN ↗
matheusmoreira · · focus · HN ↗
yilomap · · focus · HN ↗
strideashort · · focus · HN ↗
At least as first line docs.
But what the author describes - fuck no, this is absolute unsustainable madness. Race to the bottom. I’d rather fix plumbing at my own pace.