[HN Gopher] The Moratorium on US Medical School Enrollment from ...
___________________________________________________________________
The Moratorium on US Medical School Enrollment from 1980 to 2005
(2008)
Author : consumer451
Score : 61 points
Date : 2022-12-30 21:41 UTC (1 hours ago)
(HTM) web link (www.amjmed.com)
(TXT) w3m dump (www.amjmed.com)
| SuperNinKenDo wrote:
| Any time a professional class decides that there needs to be an
| urgent restriction of supply for their skillset, it should be
| treated with a kind of skepticism touching on scorn.
|
| I don't accept the mea culpa for stuff like this. The author even
| acknowledges that there were obvious signs that they were wrong,
| and yet they persisted for over 20 years.
|
| Who can imagine what incentive structure possibly led them to
| make this mistake? I guess it'll be one of life's persisting
| mysteries.
| bjornsing wrote:
| It's a mystery indeed. Interestingly Swedish physicians made a
| very similar mistake in the same time period. The consequences
| for those who made it was of course very positive.
| ibeckermayer wrote:
| Bingo. The fact that the law even allows for such a protection
| racket is an indictment of the law.
| dsfyu404ed wrote:
| Well of course they don't call it a protection racket or
| sandbagging supply when they're pitching it.
|
| They make vague statements about quality of work, safety,
| keeping "bad guys" out, etc. and YouPeople(TM) eat it up
| without the slightest thought about the tradeoffs because you
| like the face value of what you here.
| SuperNinKenDo wrote:
| Same arguments that any trade guild makes, but most guilds
| were working- and middle-class affairs. The powers that be
| only seem to accept these arguments when they're made by
| the upper-crust of society. Like favours like and all that
| I suppose.
| mistrial9 wrote:
| at least when the Doctors were really needed, the AMA Doctors
| were "safe and effective"
| betaby wrote:
| Same in Canada. Most of provinces keep enrollment well below of
| the speed of the population growth.
| trynewideas wrote:
| "In retrospect, we should have recognized that as the US
| population increases the number of US medical graduates should
| increase" is an all-timer.
| ssklash wrote:
| I think the problem is not that they didn't recognize this
| fact, but that they intentionally ignored it in order to
| maintain an artificial scarcity of physicians, thereby ensuring
| higher wages.
| downrightmike wrote:
| That there are thousands of graduated doctors that can't get
| residencies because they went to school in the Caribbean,
| needs to be resolved. Get them in residencies and we will be
| on an accelerated resolution path.
| maxerickson wrote:
| The way to do this is a modest hospital tax.
|
| That way the funding is scaled to the size of the industry
| without reevaluating it year to year.
| wolverine876 wrote:
| Did it say that in the article? I didn't see it. Is there
| evidence of that?
| darth_avocado wrote:
| Is there another reason why having a surplus of doctors a
| problem?
| mbg721 wrote:
| Isn't "the existing doctors would be displeased" reason
| enough?
| orhmeh09 wrote:
| No?
| mbg721 wrote:
| Well, that's pretty much what the current protectionism
| is doing.
| orhmeh09 wrote:
| That's unfortunately true. "The purpose of a system is
| what it does."
| avmich wrote:
| Why doctors would be displeased? They could offload some
| ungodly load to their peers, while enjoying less
| desperate patients. BTW patients significantly outnumber
| doctors, and they would probably be pleased, no?
|
| /s
| noyoudumbdolt wrote:
| It's pretty obvious why the doctor's guild would prevent
| more medical school spots from being available.
| lazide wrote:
| I would hope they'd be smart enough to not write it down if
| they did.
| strawhatguy wrote:
| It didn't no, but that's the effect, and why it was so slow
| to change: the existing members benefited.
| avmich wrote:
| It would be interesting to predict a surplus of software
| engineers and sharply raise the requirements for applicants
| to engineering departments.
|
| At least the prediction of surplus of VCs in all other
| countries except US seems to be working well.
|
| /s
| passwordoops wrote:
| This is a case where the act itself is evidence of the
| intent.
|
| I know how insulting this is, but asking this question
| implies either the one asking shouldn't participate in
| discussions of any kind, or is involved in the corruption
| avmich wrote:
| Interesting that while US population increased over the last
| century, at least the percentage of agricultural workers
| actually sharply decreased.
|
| Somehow productivity among medical professionals - also taking
| into account increased demand - didn't increase fast enough to
| get to similar decreases of doctors per capita.
| Eisenstein wrote:
| A more efficient plow can increase agricultural yields and a
| machine that can automatically core apples will remove the
| need for people to core the apples -- is there an equivalent
| for medical diagnostics?
| greggarious wrote:
| > "In retrospect, we should have recognized that as the US
| population increases the number of US medical graduates should
| increase" is an all-timer.
|
| Meanwhile, there's no cap on law admissions, leading to
| malignant narcissists who couldn't make it in the humanities
| doubling down on chasing losses and feeling entitled to grift
| the vulerable at the barrel of a gun because they made they are
| too ornery to get good tips if they work customer service and
| can't figure out a terminal prompt to save their life.
| Eisenstein wrote:
| Those curious, as I was, about what 'allopathic' and
| 'osteopathic' medicine are may benefit from this article:
|
| * https://en.wikipedia.org/wiki/Comparison_of_MD_and_DO_in_the...
|
| My takeaway is that they are essentially the same today, but
| there was a much larger difference decades ago, centering around
| the patient as a focus of medicine vs the treatment of illnesses.
| Corrections and clarifications welcome.
| maxerickson wrote:
| This failure is 100% on the government. Regulators should expect
| the guild to act in their own interests.
|
| Ultimately, it's the government that makes it difficult to
| practice medicine without the correct credentials, for more or
| less good reason, which means that the government better make
| damn sure they don't screw it up.
|
| It's probably not particularly possible to force one of the
| private entities to do anything. It should be plenty possible to
| empower an additional private entity (or substitute a public
| one).
| giantg2 wrote:
| Wouldn't the government failure be on the thing they fail to
| mention - funding for residencies?
| dsfyu404ed wrote:
| The failure is on the people who don't harass their politicians
| and make noise when the politicians cave to the guilds' lobby.
|
| Seriously, try arguing against time consuming and expensive
| professional license requirements, let alone for relaxation of
| current requirements around here and see where it gets you.
| Your comments will be unwelcome if applied to any trade other
| than software. People very much buy into the various trade
| organization's marketing.
| manholio wrote:
| I always wondered: ok, the US medical system is atrociously
| expensive and inaccessible, but where does all that money go?
| Surely a surgery cannot _really_ cost half a million dollars, can
| it?
|
| Well, when a large number of patients are effectively outbidding
| each other over an insufficient pool of medical professionals,
| then yes, it _really can_ cost that much, not necessarily by
| making doctors absurdly rich (probably some of that too), but in
| the sense that price gouging structures will surely emerge to
| capture that surplus.
| analog31 wrote:
| Everybody accuses somebody else of gouging us. That's a sure
| sign that they're all gouging us. I wonder if benefit of a
| government system is just that it's possible to figure out
| where the money is going.
| kneebonian wrote:
| Don't forget a large chunk of it is going to three or four
| layers of middlemen for everything that happens that need to
| get their cut.
| pixelmonkey wrote:
| Most doctors aren't getting "absurdly rich" in medicine, at
| least not anymore, and certainly not by tech industry
| standards. (Source: I am a medspouse who works in tech outside
| of SV.)
|
| Most of the money is going to private insurance companies and
| their non-med staff, as well as hospital administrators.
| jbullock35 wrote:
| > Most doctors aren't getting "absurdly rich" in medicine, at
| least not anymore, and certainly not by tech industry
| standards. (Source: I am a medspouse.)
|
| "Absurdly rich" is too vague to be meaningful. But on
| average, in the United States, doctors are better-paid than
| those in the tech industry. And it is not a close call. See
| https://news.ycombinator.com/item?id=30047116 for links to
| tables from the Bureau of Labor Statistics.
|
| At Hacker News, we may overestimate tech salaries (thinking
| too much of FAANG salaries, for example). And like most
| Americans, we may underestimate doctors' wages.
| throwaway6734 wrote:
| Not to mention that doctors are paid in cash and not stock
| hanniabu wrote:
| As the parent mentioned, you need to consider their
| malpractice insurance and overhead, which isn't
| insignificant
| pixelmonkey wrote:
| You are not considering the cost of graduate school and the
| opportunity cost of medical school + residency + fellowship
| (7-12 years), as well as malpractice insurance costs, long
| working hours, and on-call burden.
| sxg wrote:
| You can't overlook the fact that doctors also work about
| 1.5-2x standard work hours. About 60 hrs/week is on par for
| most doctors. Many surgeons will be putting in 80 hrs/week
| or else take a pay cut. Adjusting for that in addition to
| cost of medical school and time spent in school and
| residency (4-11 years after college), I don't think the
| salary is really that substantially different.
| Retric wrote:
| The majority of people in Tech are making under 100k and most
| cap out under 150k.
|
| The SV numbers tossed around roughly compare to the
| percentage of doctors making over 1 million per year which is
| very real, but again small percentage of the total.
| chromatin wrote:
| The money by-and-large isn't going to the surgeon; it's going
| to the insurance company's layers of bureaucracy, and to the
| hospitals' fattened administrative staffs.
| colechristensen wrote:
| When the price of an end product (in this case medical care)
| goes up, all of the suppliers prices go up as well. When you
| charge a lot for something you tend to justify it by
| expanding your headcount, and to give them something to do
| you make things more complicated.
|
| The money goes all over the place, everybody gets their cut,
| prices are almost never lowered because competition doesn't
| properly exist, and things get more expensive.
|
| Most of it doesn't need to exist but almost nobody's
| interests are aligned properly to want to lower prices and
| raise efficiency.
| Robotbeat wrote:
| We should import massive numbers of doctors from overseas with a
| streamlined short-term training program to get them up to speed
| with how things are done in the US. If existing graduates get mad
| about the recent surge of workers in their field pulling wages
| down, some student loan forgiveness can be done for recent
| graduates most affected and most indebted.
|
| Solve the problem with abundance.
| funstuff007 wrote:
| > In retrospect, we should have recognized that as the US
| population increases the number of US medical graduates should
| increase.
|
| I suspect the same problem exists among elite-tier university
| enrollment sizes.
| giantg2 wrote:
| Did I miss it or did this article not talk about the real issue -
| residency funding.
|
| Who cares if MDs are restricted if you can still graduate DOs?
| The bigger issue would be funding for residency and the new
| competition (if you can call it that when a % are earmarked for
| foreign students) of foreign students for the already tight
| budget.
| lr4444lr wrote:
| Unbelievable that in this country we effectively let the medical
| union entirely gatekeep the qualifications to practice. It's a
| legally sanctioned cartel, and should be taken to task on RICO
| grounds.
| giantg2 wrote:
| How does your argument apply to DOs? My understanding is that
| this is only talking about MDs.
| xyst wrote:
| https://www.popehat.com/2016/06/14/lawsplainer-its-not-rico-...
| classichasclass wrote:
| Took me three years to get in. Great MCATs (if I do say so
| myself) but screwed around my freshman year in undergrad and paid
| dearly for it on my GPA. In the end it was a professor I was
| doing research work for who knew the dean of admissions at the
| school that I eventually matriculated at, and put in a good word
| for me.
| greggarious wrote:
| Fun fact: Ted Bundy also compensated for GPA with
| recommendations.
| Eisenstein wrote:
| Is that a joke? If it is I don't get it. If it isn't I don't
| understand what the relevance is, since Ted Bundy was never
| to my knowledge in medical school.
| lostlogin wrote:
| Why does osteopathy get a mention in this at all? Does anyone use
| them interchangeably?
| tialaramex wrote:
| In the US it's more or less normal for Osteopaths to be general
| doctors yes. The modern degree for an Osteopath in the US, DO,
| would cover roughly the same ground as MD (a conventional
| doctor) except from a different angle.
|
| https://en.wikipedia.org/wiki/Osteopathic_medicine_in_the_Un...
|
| Historically these were very different approaches to medicine.
| In some countries osteopathy shrank and essentially went away,
| in the US instead it morphed until it's not different.
| yodsanklai wrote:
| In France, Osteopathy is entirely different from conventional
| medicine and isn't taught in medical schools as it is
| considered to be unscientific. Also, osteopaths can't
| prescribe drugs. That being said, it's extremely popular
| among people who don't trust conventional doctors, or suffer
| from troubles that conventional medicine is unable to solve.
|
| I don't know about the US medical system, but I'm a bit
| surprised about comments saying an osteopath is roughly the
| same thing an MD.
|
| Edit: there's a dedicated page on wikipedia https://en.wikipe
| dia.org/wiki/Osteopathic_medicine_in_the_Un...
|
| > US DO graduates have historically applied for medical
| licensure in 87 countries outside of the United States, 85 of
| which provided them with the full scope of medical and
| surgical practice. The field is distinct from osteopathic
| practices offered in nations outside of the U.S., whose
| practitioners are generally not considered part of core
| medical staff nor of medicine itself.
| repiret wrote:
| The training, and resulting skills and privileges are nearly
| identical between DOs and MDs. I don't know about
| interchangeable - every DO and MD I know would be offended if
| you put the wrong two letters after their name, but DO and MD
| schools are not significantly different paths to producing
| physicians.
| lr4444lr wrote:
| I keep hearing this claimed, but I have never met a physician
| in my life who would honestly say that, given acceptance to
| both an MD and DO program, he would pick the DO. It is widely
| viewed as an alternative path to becoming a physician if you
| cannot get accepted by an MD program and do not want to go
| overseas.
| pixelmonkey wrote:
| This Wikipedia page will answer your question. It's specific to
| the US medical system:
|
| https://en.wikipedia.org/wiki/Comparison_of_MD_and_DO_in_the...
| lostlogin wrote:
| That was my first go to, followed by a search for evidence it
| ever works. The TLDR was that it's showing promise that it
| might work for musculoskeletal pain.
|
| https://www.bmj.com/company/newsroom/promising-evidence-
| that...
| carbocation wrote:
| Right, but what most DOs actually do is just practice
| regular medicine, not osteopathy. (At least, the ones I
| interact with at major medical centers.) Like, unless you
| looked at the degree, you wouldn't notice.
| chromatin wrote:
| Well, if you read the article, osteopathic schools did not
| participate in the moratorium. SO, it seems like a pretty
| crucial distinction in the context of this article.
| lostlogin wrote:
| > Well, if you read the article
|
| That's how I knew they were mentioned.
|
| I have never know anyone who has been treated by an osteopath
| rather than a medical doctor (or whatever you call the
| conventional training). They are not equivalent in any of the
| medical systems I have been involved with.
| maxerickson wrote:
| They are equivalent in the US.
|
| https://en.wikipedia.org/wiki/Osteopathic_medicine_in_the_U
| n...
| daveaiello wrote:
| One thing that appears to be unmentioned in this journal article
| is the explosion of nurse practitioners, physician assistants,
| and other medical professionals with "different" educational and
| training standards.
|
| The impact that these people have had on primary and specialty
| care disciplines in the United States is huge, with both good and
| bad implications for cost control and quality of care.
|
| One could argue that the explosion of nurse practitioners has had
| a greater recent impact in these fields than the near tripling of
| osteopathic medicine graduates over the 25 years covered in the
| article.
| darth_avocado wrote:
| The cost aspect is overblown. NPs and the other alphabet soup
| of primary care providers charge almost the same as an MD. And
| the quality of care isn't the same. You end up getting the
| general "pop a Tylenol" or "I'll give you a referral to a
| specialist" for the money you pay, which either makes the
| problems worse and/or expensive anyway.
| giantg2 wrote:
| I generally agree. There are some scenarios where NPs or PAs
| are useful. Some may even be good. My personal experience has
| found them lacking... multiple times. And the charge has been
| the same since the practice is the one billing and charges
| the same whether you see a doctor or other provider.
| kneebonian wrote:
| That's something interesting I've found over my much time
| sitting in hospitals. It seems like NPs are just Drs lite
| edition. But I question if we need all the training we
| currently have for doctors I remember reading a SSC article
| about how they don't require undergrad degrees in many
| countries and their drs. perform at the same levels.
|
| Seems like in the US we just brought in NPs to fill the gaps
| instead.
| AtlasBarfed wrote:
| There are four pigs at the trough of US healthcare. Insurance
| companies, drug/medical device makers, lawyers, and doctors/AMA.
|
| Here we have the AMA / profession of doctor restricting the
| supply for absolutely no good reason. Complicit in this? How many
| of the medical schools are state universities and receive federal
| funding for education AND via payment for services? Outrageous.
|
| I've personally worked for an insurance company, a device maker,
| and had a roommate that was a specialist doctor, so I have some
| familiarity of each of those three pigs.
|
| Insurance companies present low profitability to the stock
| market, but have GIGANTIC executive classes and executive
| compensation. The MBA class controls the profits there.
|
| Medical device/drug makers have both a gigantic MBA vampire
| caste, and device monopolies via patents and other tricks that
| produce their huge profitability and cost. Many of those
| companies were started by pure engineer/bioscience people in the
| beginning but long have been taken over by the MBA finance people
| and basically perform rent seeking and cartel economics.
|
| Medical providers in the US are so strongly incentivized towards
| specialization. Would you rather make 100,000$ as a vanilla doc,
| or 500-700,000 a year as a specialist? Yeah.
|
| The fourth, trial lawyers, seem to be the most hated, but I
| suspect it is the smallest of the four, but it is the one I have
| the least direct experience with.
|
| Of course, who's fault is the high cost of medical care? Point at
| the other three pigs at the trough.
|
| The only good news, and this is true of almost all policy in the
| US, is that there is opposition between the insurance providers
| to control costs, and the providers/drug companies to increase
| revenue.
|
| But insurance companies are on the forefront of denial of service
| to its customers (DEATH PANELS!!!!), as well as monopolization of
| local hospitals/facilities to increase their margins as well.
| dsfyu404ed wrote:
| Regulators are the fifth pig. The amount of resources that flow
| and careers that exist to make sure all the paperwork involved
| in this bloated mess is filled out properly probably counts for
| at least as much as the lawyers.
___________________________________________________________________
(page generated 2022-12-30 23:01 UTC)