[HN Gopher] How dermatology became the 'it' job in medicine
___________________________________________________________________
How dermatology became the 'it' job in medicine
Author : bookofjoe
Score : 40 points
Date : 2024-11-18 12:56 UTC (10 hours ago)
(HTM) web link (www.wsj.com)
(TXT) w3m dump (www.wsj.com)
| bookofjoe wrote:
| https://archive.ph/k14bv
| amluto wrote:
| > Recently, her hospital's dermatology program received more than
| 600 applications for four residency slots.
|
| Perhaps if supply of dermatologists was not so strongly limited,
| prices and wait times would improve.
| wyldfire wrote:
| I doubt that limit is an artificial one. Hospitals don't need
| 600 dermatologists on staff. I think this is yet another factor
| of capitalism: selfish interests of individual corporations
| being in tension with the people's interests of having
| affordable healthcare. Other developed countries seem to have
| said "yeah, we recognize that nationalizing healthcare will
| result in insurance companies and hospitals making less money.
| But that's what has to happen for the people to be able to get
| the care they need."
|
| Every time it comes up in the US, nationalized healthcare is
| demonized in some media. But it just feels like a facade
| perpetrated by the hospitals and insurance companies (and now
| private equity) who stand to lose the most. If it's good enough
| for veterans and retirees, why can't it be good enough for the
| rest of us? Maybe it's because when the government pays the
| bill, they don't just roll over and accept $EXORBITANT_FEE
| after $EXORBITANT_FEE - they negotiate and get some reasonable
| value.
| eppp wrote:
| They dont need 600 dermatologists on staff. They need
| residency slots. These people aren't asking to work for the
| hospital permanently, they just have to check the residency
| box that is artificially limited by gatekeepers.
| ninetyninenine wrote:
| It is a bit of a logistical issue shoving 600 dermatology
| interns into a hospital.
|
| Make it a law that all doctor offices need one or two
| residency slots. That should alleviate the problem in time
| due to compounding growth.
| alistairSH wrote:
| Residencies are funded via Medicare. If you want more
| doctors, you need to convince Congress to fund those
| spots. Or, convince the industry to fund the slots
| itself, without the reliance on Uncle Sam's largess.
| woooooo wrote:
| On Medicare's time horizon, losing money funding those
| residencies for 10-20 years actually could be a great
| deal if it bends the cost curve.
| nradov wrote:
| You've got to be kidding. There's no way that a regular
| doctor's office could provide adequate graduate medical
| education. Residents are taught in teaching hospitals.
| ninetyninenine wrote:
| I have no context. I'm just a layman.
|
| Maybe force every doctor office by law to be a teaching
| hospital of some sort. They get paid 500K, seems to be a
| good form of taxation on an undeserved salary.
| ninetyninenine wrote:
| Or maybe form a mentorship program. Every intern once
| they complete their training must train two other doctors
| to completion before they can genuinely practice. They
| must do this at the teaching hospital.
|
| That hospital will then have enough support staff to
| maintain a large load of interns as the compounding
| growth continues. Of course the growth has to level off
| at some point. But yeah.
| nradov wrote:
| You've got to be kidding. Physician offices don't have
| the facilities or the breadth of practice to function
| effectively as teaching hospitals. Even most hospitals
| aren't _teaching_ hospitals.
|
| And as for conscripting physicians and forcing them to
| train residents, that's a completely bizarre and
| unrealistic suggestion. Forcing someone to teach and
| mentor who doesn't want to do it will guarantee bad
| results. And many practicing physicians don't live
| anywhere near a teaching hospital.
|
| Who are you to decide how much salary someone deserves? I
| think you deserve $4 an hour. That seems fair to me. In
| the real world fairness to subjective. What actually
| matters is negotiating power. The most straightforward
| way to reduce physician negotiating power is for Congress
| to increase graduate medical education funding through
| Medicare. Income in the $500K range is already in the 35%
| tax bracket (plus any state income tax) so doctors are
| paying quite a bit; Congress just chooses to spend that
| money on other priorities.
|
| https://savegme.org/
| infecto wrote:
| Presumably a derm. resident is doing rounds related to
| dermatology. I am guessing this is similar to other
| specialized fields that don't have large volume in resident
| setting.
| Cumpiler69 wrote:
| _> Other developed countries seem to have said_
|
| The other developed countries doing this don't pay
| dermatologists 500k though.
| Shatnerz wrote:
| Perhaps this is because supply isn't being artificially
| restricted?
| Cumpiler69 wrote:
| Doctors' profession have artificial barriers to entry and
| keep the supply limited, in many other countries, but
| even with those, they won't dream to earn anywhere near
| 500k.
| quantumwoke wrote:
| This is not true, and you should look at private practice
| in Canada, Australia, and to a lesser extent U.K.
| Cumpiler69 wrote:
| It's 100% true where I'm from in Europe. The government
| opens up only a fixed number of residencies positions
| every year regardless of how many more students graduate
| (cartel behavior from the national Doctors' association).
|
| My cousin graduated med-school last year and is still
| unemployed because no hospital had a place for her.
| Private practices don't fix that issue since they're not
| designed to be part of the medical teaching cycle. So a
| lot of young doctors have to emigrate to other EU
| countries where they can find spots to practice.
| quantumwoke wrote:
| This is orthogonal to your GP point which was about
| salary. There are a lot of issues with the teaching
| pipeline AFAIUI so it is difficult to comment on n=1
| examples.
| quantumwoke wrote:
| Some of them do e.g. Australia
| Cumpiler69 wrote:
| Care to exemplify?
| infecto wrote:
| I am not sure how you connect the first part of your idea to
| the last.
|
| Would this not also be a problem in single payer systems? The
| article does not do a great job of it but it would be
| interesting to see the billings split between cosmetic and
| medical. The article is already on how the field is booming
| because of cosmetics, one of the interviewed doctors does not
| even accept insurance. This has nothing to do with capitalism
| vs socialized healthcare and all to do with cosmetic
| procedures which would mostly not be covered under a single
| payer style system anyway.
| alistairSH wrote:
| There is absolutely an artificial cap on the number of
| residencies (across specialties, not unique to dermatology).
| The majority of residency slot are funded through Medicare -
| Congress has effectively placed an artificial cap on the
| number of spots.
|
| From what I gather, Congress set the current low limit due to
| lobbying from the AMA something like 30 years ago. The AMA
| has since changed its tune and wants more slots to alleviate
| shortages in some regions and specialties, but the funding
| has not materialized.
| maxerickson wrote:
| A lack of government funds is not a cap!
|
| What would they do if the government didn't fund any slots,
| just shrug and decide they didn't need doctors?
|
| Note that I'm not opposed to the government funding lots
| more slots, I am objecting to the presumption that
| government funding is the only possible way to make a
| doctor.
| nradov wrote:
| If the government didn't fund any slots then graduate
| medical education programs would charge the residents
| themselves instead of paying them a salary. Then
| physicians would finish their education $1M in debt
| instead of $500K (or whatever) today. World that be an
| improvement?
|
| There are a small number of residency slots funded by
| non-profit foundations but those are a drop in the
| bucket. None of the other major players in the national
| healthcare system have an incentive to pay for this
| stuff.
| indymike wrote:
| > World that be an improvement?
|
| Unpopular opinion: if the student will be able to pay
| that loan off in 10-20 years and maintain a good standard
| of living while doing so, then it is probably fine.
|
| > None of the other major players in the national
| healthcare system have an incentive to pay for this
| stuff.
|
| I'm pretty sure the entire system's revenue model breaks
| without physicians, so there are plenty of businesses
| (hospitals, labs, practices, etc...) with an incentive to
| have more billing capacity.
| otterley wrote:
| Out of curiosity, how were new doctors being trained
| before Medicare existed?
| bryanlarsen wrote:
| AFAICT, way back in the day hospitals and clinics did
| residencies out of a desire for free/cheap labor, the
| same reason that some firms provide internships in other
| fields today. Nowadays the costs and obligations of
| providing a residency far exceed the benefits of the
| lower cost labor.
| otterley wrote:
| Perhaps, then, those who have graduated into practice and
| who are now earning big bucks ought to absorb part of the
| cost. For example, training residents at some reasonable
| frequency could become a requirement of license renewal.
| nradov wrote:
| Not all physicians live and work near a teaching hospital
| where residents are trained. This isn't something that
| can be done just anywhere. And not everyone makes a good
| teacher; forcing people to teach who don't want to do it
| will guarantee bad results.
| phil21 wrote:
| I really don't understand how the average resident could
| be a cost center for a hospital. At least over the course
| of their 4-6+ years.
|
| There are some hospitals you will go to (big names!)
| where you will never actually see an attending physician
| most of the time. Your entire care team are residents.
|
| How a hospital can't turn a profit off $60k/yr "junior
| doctors" doing all the actual work is beyond me. I'm sure
| there are costs I am not considering, but my immediate
| gut reaction is that it's nearly all creative accounting
| to pretend residents cost more than they bring in - to
| keep that sweet government subsidy coming in as well as
| limiting the number of slots.
|
| Some programs of course this makes sense, but on the
| whole it doesn't seem to pass a smell test to me.
| alistairSH wrote:
| I've always wondered the same.
|
| For the math to work, the fully qualified attending would
| have to be ~10x more efficient than the residents ($600k
| salary vs $60k salary - very rough, obv).
|
| The current state seems to be "a single attending is more
| efficient practicing solo than the same attending
| overseeing five residents"
| nradov wrote:
| Some of this is an internal accounting problem. The net
| income (or loss) from operating a residency program
| depends on how you allocate associated revenues and fixed
| costs to it. But empirically the fact that teaching
| hospitals aren't all rushing to expand their residency
| programs indicates that they probably aren't profitable.
|
| The value of residents varies a lot by experience and
| specialty. Like a 1st-year neurosurgery resident might be
| worse than useless and a huge burden to everyone around
| them. Whereas a 3rd-year family medicine resident can do
| a lot with minimal supervision.
| jmoak wrote:
| While residencies have existed since well before Medicare
| was passed, they were mostly something elites pursued.
| Overall, residency wasn't an absolutely necessary
| practice until the mid-late 20th century. By the 70s,
| with the tailwind of the baby boom, the practice became
| normalized.
|
| https://en.wikipedia.org/wiki/Residency_(medicine)#:~:tex
| t=B...
|
| Our demographic makeup means we have more elderly in need
| of care and fewer to care for them, which means we will
| need to revert our requirements. The UK is already
| discussing/planning-for this in their healthcare system:
| https://www.independent.co.uk/news/health/nurses-doctors-
| deg...
|
| I understand that it's scary that care quality may be
| lower, but that argument is similar to demanding that
| every road worker and civil engineer have a PhD. Our
| bridges and roads would likely be better if all
| participants were so educated and qualified, at least for
| the horrifically expensive and few roads/bridges we would
| be able to build.
| nradov wrote:
| What will probably happen in most US states is that
| physician education will continue to require residency.
| But routine primary care will increasingly shift to
| Physician Assistants and Nurse Practitioners. Real
| physicians should be reserved for the more complex cases.
| jmoak wrote:
| I agree with this as a possibility for general doctor
| visits.
|
| I already mostly see NPs for my checkups. If they aren't
| sure, then I can jump through the hoops to get a
| Physician.
|
| It works well and I get plenty of time to discuss things
| during my appointments.
|
| EDIT: I still think my original point may stand for
| specialists however, we'll have to see how it shakes out
| and what healthcare systems under more stress than ours
| decide to do in the near future.
| s1artibartfast wrote:
| Exactly. If you create a regulatory system so strict that
| you cant make doctors, you end up with a shortage, and
| creating a new class of professionals that do what
| doctors did before.
|
| I think there are parallels to nursing as well, with
| increasing credentialism and then creation of new
| classes. 30 years ago nurses entered the workforce with a
| 2 year associates from a junior college. Heck, my
| _highschool_ had a nursing occupational program.
| maxerickson wrote:
| Presumably the government could at least try to change
| the incentives that they are already heavily involved in
| shaping.
| wl wrote:
| There are also residency slots not funded by Medicare or
| any foundation. They pay the same as the funded slots.
| These slots exist because it's usually profitable to pay
| a resident physician to deliver care at a fraction of the
| salary of an attending physician.
| triceratops wrote:
| > Then physicians would finish their education $1M in
| debt instead of $500K (or whatever) today. World that be
| an improvement?
|
| Maybe the graduate medical education programs would have
| to compete on price as well as quality and reputation?
| alistairSH wrote:
| You're correct - a hospital could indeed find alternate
| funding for residency slots. Medicare funds something
| like 70% of them today, the rest are funded by
| state/local government or non-profits.
|
| But, the fact that hospitals don't fund their own seems
| to prove the underlying assumption - that offering a
| residency is a net loss to the hospital. If that weren't
| true, they'd fund the slots on their own.
| maxerickson wrote:
| Perhaps we could consider making it less burdensome?
|
| It's bizarre that these discussions seem to start from
| the assumption that we got here intentionally by only
| making good decisions.
| s1artibartfast wrote:
| The people have "decided" that they prefer extremely high
| quality and cost doctors to a high supply of doctors.
|
| Regulation, left unchecked, favors constant indirect
| damage from shortage to more visible direct harms.
|
| This is why it takes 3000 hours of training to cut
| someone's hair.
| triceratops wrote:
| The status quo might be more profitable for hospitals
| though.
|
| The lack of doctors allows hospitals to charge more money
| for access to the ones they have. And right now the
| government foots the bill for training new doctors.
|
| If they funded new residency slots they'd simultaneously
| increase their expenses, and reduce long-term revenues.
| Even if the resident's work is profitable by itself - in
| the sense of generating more in billings than the costs
| in salary, benefits, and teaching time - it could be bad
| for the hospital in a decade or two.
|
| If the government simply ended the practice of funding
| residencies then hospitals and the rest of the medical
| establishment would be forced to come up with a new
| approach. Until then they're content to ride the gravy
| train.
| paulddraper wrote:
| > Hospitals don't need 600 dermatologists on staff.
|
| But imagine how available and inexpensive dermatologists
| would be.
|
| (Okay, let's not say 600, but let's say 2x or 4x the current
| #)
| readthenotes1 wrote:
| Apparently cosmetic dermatology is not regulated so you can go
| through residency in some other residency program and set up
| your shingle selling Botox, at least where I live.
| pc86 wrote:
| My wife is a physician and she knows one or two otherwise
| very intelligent, well-respected, skilled _surgeons_ who just
| do Botox because it 's more lucrative.
| bookofjoe wrote:
| Also: way better hours (no nights/weekends/holidays); less
| likelihood of malpractice lawsuits along with far lower
| medical malpractice insurance rates; much less stress;
| happier patients.
| bnlxbnlx wrote:
| Sounds soul crushing to me :( I so wish people would choose
| what to do based on what makes sense to them based on care
| for the whole.
| pc86 wrote:
| Did you decide what to do for a living "based on care for
| the whole?" I suspect like most people it was mentally
| looking at a Venn diagram intersection of "what am I
| smart enough to do?", "what do I enjoy doing?", "what
| pays me the most, or well enough that I can do at least
| as well as my parents?"
|
| How many people who get into surgery would still do it
| with all the same education, testing, training, and
| licensure requirements if it paid $100k/yr? My guess is
| not many. If you're in a highly litigious state in a
| high-risk specialty your malpractice insurance alone
| could be more than that.
|
| It's not surprising to see smart people leave risky
| positions with pretty objectively bad work-life balance
| for more money, less stress, and better WLB.
| red-iron-pine wrote:
| seems like that's been the trend -- a lot of those set up
| around here, it seems. like, I can think of three off the top
| of my head, and I don't recall seeing em 3+ years ago.
| quantumwoke wrote:
| The problem is not limited supply but rather the ability to
| train sufficient supply in a reasonable timeframe which
| necessitates attending pay cuts (because they can't do as much
| work) and creation of funded structured training programs with
| good teachers and case mix. Source: my wife is a doctor
| scld wrote:
| Increasing the time and cost of the training is how the
| supply is limited.
| quantumwoke wrote:
| Can you expand on this? I don't think this is the whole
| story. Perhaps a concrete example would help.
| f6v wrote:
| Tried getting an appointment in Denmark. "We don't take any new
| patients". A familiar story when trying to reach many specialists
| in European countries (Germany, Belgium). Except I doubt they're
| getting 500k.
| shdh wrote:
| Guessing you also need a referral to see a specialist in
| Denmark?
|
| In USA, with PPO insurance, you can see specialists without a
| referral. Direct specialist appointments without seeing your
| primary doctor for a referral.
| paulddraper wrote:
| No, it's not a matter of referral.
|
| It's a matter of "current patients have filled the schedule
| indefinitely."
| Cumpiler69 wrote:
| That's pretty crazy considering Denmark is touted as a
| socialist utopia where the taxes are high but it's worth it
| because the government supposedly takes care of everything
| for you. I'd expect them to have figured out the doctors'
| shortage but this problem seems endemic in every country.
| nextos wrote:
| In EU, there is a severe shortage of MDs. Part of the
| problem is that the number of students is not sufficient
| to satisfy MD demand. In some countries, this is a
| deliberate policy imposed by MD lobbies, who act like a
| cartel. In other countries, the job is simply not
| attractive due to relatively low salaries and high
| workload. So students choose other degrees, or they
| immigrate after graduation. Furthermore, an aged
| population and lack of adequate policy planning does not
| help.
| triceratops wrote:
| Sounds like it's a problem in most of the developed
| world.
| paulddraper wrote:
| A. This is exactly what is to be expected.
|
| If high-skill jobs are compensated (relatively) less,
| workers are less incentivized to pursue those jobs, or
| they move to other markets.
|
| B. Capitalist countries like the U.S. are not completely
| immune to his phenomenon either.
| shdh wrote:
| Are doctors in USA emigrating to other countries? Or do
| you mean across state lines?
| mcfist wrote:
| https://www.sundhed.dk/borger/guides/find-behandler/ tells you
| waiting times at specialist doctors
| soco wrote:
| At least in Switzerland it's like this: if you call directly
| the dermatologist (or just any medical specialist), they offer
| you a slot in 6 months. If you go over your house doctor
| (whatever the term is in your country) you get it in 1-2 weeks.
| If you are already known patient to said dermatologist, maybe
| even earlier. Thus: how about you try your house doctor?
| jjice wrote:
| Anecdotal, but I'm in the North East US and I called, and I'm
| not joking, nine primary care offices. Eight of them said they
| couldn't take anymore patients, and one said I could get an
| appointment six months later.
|
| I hadn't needed to go to a primary care doctor in my adult
| life, but it was mind blowing that this was the case. Many
| friends of mine have had the same experience.
| cg5280 wrote:
| Had the same thing in the Midwest about 8 months ago. Had to
| call a half dozen offices before one would take me and
| appointments had to be scheduled long in advance. I had not
| been to the doctor as an adult either and was quickly
| surprised by how frustrating healthcare is.
| zzbzq wrote:
| Same, had to call around a lot to find primary care, and
| was being given multi-month waitlist estimates for seeing
| an ENT specialist. I've had more luck recently as I was
| able to get into see an ENT in less than 30 days. It's also
| crazy how much everyone tries to upsell you. It' hard to
| tell what tests or procedures I really need.
| nerdponx wrote:
| This is new since Covid era. You used to be able to get an
| appointment for a physical just a few weeks out, and it was
| easy to find a new doctor if you needed to.
| HeyLaughingBoy wrote:
| It regionally-dependent though. On average, if we need to
| see a doctor, we can get an appointment in a day or two.
| For a routine physical, it might be two weeks, three at
| most.
| Projectiboga wrote:
| This has been developing for a very long time. The two
| major medical school systems, MDs and DOs have kept supply
| of medical school graduates below the demand. This has kept
| the market rate for fees up but has created market
| inefficiencies. There is an under supply of general
| practice doctors. And it will be hard to reverse as the
| internships and residencies are usually in hospitals and
| large medical centers and there is little room to expand
| the incoming DR supply.
| Workaccount2 wrote:
| I had this experience when shopping for a highly rated
| doctor. Luckily I was able to get in on a great doctor after
| a few weeks of casually calling around, and now can get
| appointments no problem.
|
| When I was younger on crap insurance, I was able to quickly
| find one by having no standards other than "be a medical
| physician". And the doctor I went to was definitely lower
| rung.
| parpfish wrote:
| I laugh to myself whenever I read some disclaimer that says
| "ask your doctor" because... how? I'm supposed to call the
| office, wait six to nine months, and then ask about a mild
| health concern I had that's long past?
| bookofjoe wrote:
| In mid-2023 I decided it would be good to have a primary care
| doctor since I was 74 years old at the time and hadn't been
| to a doctor in decades.
|
| Full disclosure: I am a retired board-certified
| anesthesiologist.
|
| I asked around town (Charlottesville, Virginia) and got two
| names from doctors I trust.
|
| The first was not taking new patients; the second was, so I
| made an appointment: first available appointment was January
| 2025 (i.e., in 18 months). I happily took it.
|
| I figured maybe this was a way of triaging old people like
| myself: if we're forced to wait long enough before being
| seen, maybe we'll die in the meantime so slots will open up.
| Dracophoenix wrote:
| As a medical professional, do you think yearly checkups are
| useful or necessary for healthy individuals in their 20s
| and 30s? It seems like you've done well for yourself
| without the need of one due so long.
| freedomben wrote:
| I'm not a medical professional, but I have a close friend
| who is. Most of the time, no you don't need yearly
| checkups. But if you develop something like diabetes, a
| thyroid condition, or some types of cancer, it might save
| your life.
|
| If you're going to do it, I would recommend having a
| bunch of labs done so you can at least know how you're
| doing. For example might as well test A1C, Vitamin D,
| Iron, Thyroid, Testosterone and many other hormones and
| vitamin levels to get a good picture of your nutrition.
| If you're low/high in many of these things a simple
| supplementation can radically improve your life, but not
| if you don't know about it. A friend of mine recently
| found his Testosterone levels were really low, and after
| starting TRT he feels way, way better. It improved
| depression levels and many other things, with a bonus
| that now when he goes to the gym it's actually possible
| to get some results.
|
| Worth pointing out is that you can have (most) of these
| labs done without a doctor. There are websites you can
| buy kits, and you can sometimes just go in-person to
| Labcorp offices and they'll run stuff for you.
|
| Anyway, just something to consider.
| jonhohle wrote:
| At least in my area, huge medical groups or insurance
| companies have bought nearly all primary care practices.
| They've cut costs and raised prices and it's virtually
| impossible to see an MD for an acute medical condition. All
| procedures need to be scheduled out months now.
|
| It reminds me of what some Canadian friends described their
| healthcare system being like 20 years ago. If we're paying
| more and getting the same service, I'm not sure there's much
| reason not to socialize healthcare now (health care, not
| insurance).
|
| While getting less service, as a marketplace insurance
| purchaser my premiums are doubling next year. It's still
| "cheap", but that would be a significant shock for most
| families.
| freedomben wrote:
| Yep, with our current system we have evolved it into a
| monstrous and inefficient hybrid that contains most of the
| downsides of a socialized system with most of the downsides
| of a free market system. It's utterly insane what we're
| doing, and there seems to be very little interest in
| fundamental change.
| nerdponx wrote:
| Primary care has the opposite problem right now. Practices
| are closing faster than new ones are opening, and doctors are
| leaving the profession faster than new doctors are joining.
| There is an actual shortage of primary care docs.
| otoburb wrote:
| Given the rise of Physican Assistants and Nurse
| Practitioners and their expanding scope of (even
| independent) practice across various states, specifically
| to address this growing shortage of primary care physicians
| (PCPs), it almost becomes a self-fulfilling prophecy that
| fewer potential physicians choose family medicine as that's
| the first specialty that seems most likely to be addressed
| by PAs and NPs.
| thatfrenchguy wrote:
| This is for "new patients" though, once you're in it's
| generally fine. It's a back-pressure mechanism for them to
| not sign up too many new people.
| throwawaysleep wrote:
| In general, there seems to be a trend towards lifestyle jobs,
| i.e. jobs that fit a certain lifestyle rather than being
| passions.
| kittikitti wrote:
| Isn't this disconnected from the reality of medical school
| competitiveness that is, at least on paper, supposed to filter
| students who are not going to use their highly sought after
| education and resources for largely clerical jobs? What's the
| point of the American Medical Association restricting new medical
| schools and artificially constricting the number of medical
| students when the top of their field is to service patients with
| elective treatments?
| nradov wrote:
| The AMA has no power to restrict new medical schools or
| restrict the number of medical students. They aren't an
| accreditation or licensing agency. Several new medical schools
| have opened in the past few years.
|
| https://lcme.org/directory/accredited-u-s-programs/
|
| At one point the AMA did lobby Congress to restrict the number
| of residency slots but they long since reversed that position
| and now lobby for an expansion.
|
| https://savegme.org/
| s1artibartfast wrote:
| With respect to residency, there is no cap. What they lobbied
| for is a restriction to the number of subsidized slots.
|
| You would think that Hospitals would be able and willing to
| pay for residents.
|
| Something doesnt add up.
| llamaimperative wrote:
| > You would think that Hospitals would be able and willing
| to pay for residents.
|
| Why would you think that? Pay... _out of their profit
| margins_... to reduce their profit margins? Or do you mean
| in la-la-land where American CEOs make investments that are
| likely to show returns only 10+ years out in the future?
| NameError wrote:
| When my primary care doc referred me to a dermatologist for a
| suspicious mole, I could not find an actual dermatologist who
| would see me in less than ~8 months. I ended up seeing a
| physician's assistant, which I'm still uneasy about since there's
| been a study that shows that PA's seem to have a lower success
| rate vs. doctors [1], and the educational requirements are very
| different for PAs.
|
| As a layperson, it seems like we (patients / society) would
| benefit from having more doctors, i.e. opening up more residency
| slots and admitting more people to med school, but there's
| probably a lot I don't understand about the issue. Not sure if
| it's a lack of political willpower to do this, or if there are
| other reasons why the number of doctors we train is so
| restricted.
|
| [1] https://pubmed.ncbi.nlm.nih.gov/29710082/ ("PAs performed
| more skin biopsies per case of skin cancer diagnosed and
| diagnosed fewer melanomas in situ, suggesting that the diagnostic
| accuracy of PAs may be lower than that of dermatologists")
| marxisttemp wrote:
| > As a layperson, it seems like we (patients / society) would
| benefit from having more doctors, i.e. opening up more
| residency slots and admitting more people to med school, but
| there's probably a lot I don't understand about the issue. Not
| sure if it's a lack of political willpower to do this, or if
| there are other reasons why the number of doctors we train is
| so restricted.
|
| Like so many of America's issues, it's due to lobbying based on
| entrenched greed.
|
| > In 1997, the AMA lobbied Congress to restrict the number of
| doctors that could be trained in the United States, claiming
| that, "The United States is on the verge of a serious
| oversupply of physicians."
| freedomben wrote:
| Yep. The requirements (and cost!) to become a physician are
| absolutely insane, and it's entirely intentional. As a
| society we seem to assume that people in certain trades are
| altruistic and moral, simply because of their job. For some
| reason, everyone assumes doctors wouldn't act self-
| interested. Teachers are often thought of the same way. I
| don't want to swing the pendulum to the other side and start
| thinking of them as selfish (though certainly some
| individuals are), but I do wish as a society we would
| remember that people are still people. Our systems need to be
| structured to overcome the natural and innate tendency of
| people to optimize for themselves or their groups. We don't
| let the cigarette companies do all the science and make all
| the laws/rules around tobacco sales, we probably shouldn't do
| that with medical stuff either. We don't need antagonistic
| people in charge, but they should be independent.
| impossiblefork wrote:
| I don't think there's necessarily much not understood.
|
| Here in Sweden have almost 2x as many physicians you do, and we
| pay them about half of what you do, so we end up paying
| approximately the same in salaries (the average Swedish
| physician is paid 131k) and I think it works out completely.
|
| We start our training of physicians right after high school, so
| we push them to get an MSc in Medicine, rather than treating
| physicians as some kind of pseudo-PhDs, with however requiring
| head physicians to have an actual PhD; and this system is fine.
| I think it's the same way in Denmark, and given the stuff
| they've come up with I imagine one can't complain much about
| their system.
| a_vanderbilt wrote:
| A big driver for the high salaries of medical doctors in the
| U.S. is the staggering educational debt their degrees leave
| them with. Is it the same in Sweden? Some degree of wage
| depression is practically inevitable if we had more doctors,
| but I wonder how much that could be offset with affordable
| education?
| sharadov wrote:
| I had a similar experience - The dermatologist that I used to see
| moved to a new city and I needed to see one urgently for eczema.
| Primarily, I needed an RX.
|
| For at least two months, no appointments were available with any
| derm in my network, so I immediately set up a telehealth
| appointment with one in another state, explained the condition,
| and got an RX on the same day.
| iluvcommunism wrote:
| I did microneedling a couple times. If anything my scars are
| worse. I'd rather just get laser skin treatment in Thailand and
| save money. Or do the lower % acidic peels myself.
| lupire wrote:
| Seinfeld did an episode about this issue in the 1990s. ("Skin
| cancer, eesh"
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