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.
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.
ossicones · · focus · HN ↗
askari01 · · focus · HN ↗
dh2022 · · focus · HN ↗
nradov · · focus · HN ↗
<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.
sebastiansm7 · · focus · HN ↗
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.
HDThoreaun · · focus · HN ↗
sarchertech · · focus · HN ↗
RussianBot9580 · · focus · HN ↗
estearum · · focus · HN ↗
RussianBot9580 · · focus · HN ↗
estearum · · focus · HN ↗
The AMA has been lobbying for MORE residency slots for decades.
RussianBot9580 · · focus · HN ↗
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.
khriss · · focus · HN ↗
RussianBot9580 · · focus · HN ↗