The planning of U.S. physician shortages (2020) • Hacker News Board

Re: The planning of U.S. physician shortages (2020)

#31

Post by 0cf8612b2e1e » Sat, Jun 03, 2023, 4:41 AM UTC

ytschfs wrote: post #24

DieBruderBauer wrote: post #5

discriminatory MCATs, brutal STEPS, insane Pre-Med curriculum, and more nonsense designed to cater to white elites who gamed the educational system and less to those who are genuinely trying to help the disenfranchised, unremembered, diverse and more. Hopefully one day, we'll make it as easy to become a doctor as it is to -- say -- become an Engineer.

Medical school and residency are incredibly hard things. So you could make getting admitted to them easier sure but you’d be setting people up to fail if they can’t pull 80 hour weeks and manage information overload when they get there.

I think what parent was referencing are the “tricks” required to get into med school. Applications are incredibly competitive, and students have every incentive to do anything they can to make the cut. Easier classes, begging for grades, leaning on connections, charity work (dependent on financial resources), etc. Leet code grinding, med school edition. Perfectly good potential doctors are passed over because they are missing X.

Re: The planning of U.S. physician shortages (2020)

#32

Post by poly_morphis » Sat, Jun 03, 2023, 4:41 AM UTC

DieBruderBauer wrote: post #5

discriminatory MCATs, brutal STEPS, insane Pre-Med curriculum, and more nonsense designed to cater to white elites who gamed the educational system and less to those who are genuinely trying to help the disenfranchised, unremembered, diverse and more. Hopefully one day, we'll make it as easy to become a doctor as it is to -- say -- become an Engineer.

I wanted to become a doctor. But I also wanted to study engineering. I didn’t want to do some relatively useless degree path like biology simply to fill all the required prerequisites for med school. And then I learned about all of this other stuff, like the MCAT, and how you essentially get abused during residency. I don’t think I’d be able to function on the sleep you’d get anyways.

It shouldn’t be easy to become a doctor, but man the bar right now is so high.

Re: The planning of U.S. physician shortages (2020)

#33

Post by the_mar » Sat, Jun 03, 2023, 4:42 AM UTC

alehlopeh wrote: post #22

whitemary wrote: post #14

Earlier quoted context omitted.

"Communist" Cuba has 64 physicians per 10K population, which is 2nd in the entire world for physicians per capita. https://en.m.wikipedia.org/wiki/List_of_countries_and_depend... During the pandemic, they were sending droves of doctors to Europe. They offered to assist in NYC but Trump turned them away as our population dwindled. Famously, when a British cruise ship with ill passengers aboard was denied by ports in F…

What’s with the scare quotes around communist? Sure they have a lot of doctors. And how many of those doctors are allowed to do business as a private practice? Or how many would be allowed to change careers if they wanted to? How many are allowed to spend their income at fancy places, where the currency they get paid in isn’t even accepted? Hate to break it to you, but “your” worldview is incredibly, laughably, misin…

I’m not a fan of communism, but your worldview about it is also misinformed. People are allowed to change careers under communism: source I was born in USSR, my mother had many careers in the 70s and 80s.

I’d give you the inability to work for a private practice, that is true, but I am not entirely convinced it’s all that beneficial to society.

Lastly, Cuba can have some things better than the US, it doesn’t necessarily mean communism is a superior type of system. It just means that even a broken clock can show the right time

Re: The planning of U.S. physician shortages (2020)

#34

Post by whitemary » Sat, Jun 03, 2023, 4:42 AM UTC

alehlopeh wrote: post #22

whitemary wrote: post #14

Earlier quoted context omitted.

"Communist" Cuba has 64 physicians per 10K population, which is 2nd in the entire world for physicians per capita. https://en.m.wikipedia.org/wiki/List_of_countries_and_depend... During the pandemic, they were sending droves of doctors to Europe. They offered to assist in NYC but Trump turned them away as our population dwindled. Famously, when a British cruise ship with ill passengers aboard was denied by ports in F…

What’s with the scare quotes around communist? Sure they have a lot of doctors. And how many of those doctors are allowed to do business as a private practice? Or how many would be allowed to change careers if they wanted to? How many are allowed to spend their income at fancy places, where the currency they get paid in isn’t even accepted? Hate to break it to you, but “your” worldview is incredibly, laughably, misin…

According to a Marxist definition of communism (classless society) neither Cuba or the Soviet Union are or were communist.

Re: The planning of U.S. physician shortages (2020)

#35

Post by scythe » Sat, Jun 03, 2023, 4:43 AM UTC

bruce511 wrote: post #6

Planning and predicting highly variable systems is hard. Long-range interventions are especially risky given the possibilities for unexpected consequences and also the long lead times in fixing the problems. Central planning on resources has been especially rife with failed examples (the USSR being the all-in poster child.) As the article points out, the concept of central planning is orthogonal to who is providing t…

>Central planning on resources has been especially rife with failed examples (the USSR being the all-in poster child.)

This assertion is greatly exaggerated. It's certainly true that the centrally planned economy of the USSR didn't grow as quickly as peer countries with similar levels of economic development. The typical contrast is the much faster growth of Japan versus the Soviet Union in the late twentieth century. (Even the computer knows the story; my phone's predictive text got the countries right!)

But the Soviet Union nonetheless grew. Its growth rate was similar to that of the United States, but starting from a lower level (missing out on catch-up growth). It was the contradiction between the government's insistence that the planned economy would outperform the West versus the reality of the situation that led to a death spiral of political dysfunction and "alternative facts".

Even though the system was not efficient, it wasn't disastrous by itself, only suboptimal. It's a standard prediction of economic theory that lower risk tolerance comes at the cost of some expected return. But in the case of fields like education and medicine, we might have a lower risk tolerance and be willing to tolerate lower growth to achieve it.

In this case, the government stopped subsidizing medical schools. That would seem like what the libertarians want, but the outcomes were not good. Blaming central planning per se doesn't seem like the answer.

Re: The planning of U.S. physician shortages (2020)

#36

Post by rcme » Sat, Jun 03, 2023, 4:44 AM UTC

lotsofpulp wrote: post #26

nemonemo wrote: post #23

I doubt US would be able to see a level of medical accessibility on par with many European countries. The medical education system has a perverse incentive to reduce the yearly graduates -- the less graduates there are, the more profits and prestiges each of the current members can garner (with arguably better trained graduates) -- and as shown in the article, they seem to have monopolistic capability for the throttl…

There already has been. The solution was to pump out physician assistants (PAs) and nurse practitioners (NPs) that require a fraction of the training of a doctor to get licensed, and then have them practice medicine under the “supervision” of a doctor. Some states even went as far as giving people with no medical training the right to prescribe, such as naturopaths, whatever that means. So it is up to each person now…

Hospitals have regional monopolies are are being consolidated by private equity companies. The doctors have way more leverage with the hospitals.

Re: The planning of U.S. physician shortages (2020)

#37

Post by HyperSane » Sat, Jun 03, 2023, 4:46 AM UTC

trustingtrust wrote: post #13

DieBruderBauer wrote: post #5

discriminatory MCATs, brutal STEPS, insane Pre-Med curriculum, and more nonsense designed to cater to white elites who gamed the educational system and less to those who are genuinely trying to help the disenfranchised, unremembered, diverse and more. Hopefully one day, we'll make it as easy to become a doctor as it is to -- say -- become an Engineer.

I hope it’s not as easy to make a doctor as it is to make an engineer. I am an engineer dating a surgical resident who has to go through so much training that an engineer would never even come close to an engineer. The room for error is quite small. If it was as easy to make a doctor as an engineer I would lose faith in the medical system and would never want such a doctor opening me up.

If being a doctor is so incredibly hard then why are they allowed to practice after not sleeping for so long?

Re: The planning of U.S. physician shortages (2020)

#38

Post by bruce511 » Sat, Jun 03, 2023, 4:49 AM UTC

alehlopeh wrote: post #22

whitemary wrote: post #14

Earlier quoted context omitted.

"Communist" Cuba has 64 physicians per 10K population, which is 2nd in the entire world for physicians per capita. https://en.m.wikipedia.org/wiki/List_of_countries_and_depend... During the pandemic, they were sending droves of doctors to Europe. They offered to assist in NYC but Trump turned them away as our population dwindled. Famously, when a British cruise ship with ill passengers aboard was denied by ports in F…

What’s with the scare quotes around communist? Sure they have a lot of doctors. And how many of those doctors are allowed to do business as a private practice? Or how many would be allowed to change careers if they wanted to? How many are allowed to spend their income at fancy places, where the currency they get paid in isn’t even accepted? Hate to break it to you, but “your” worldview is incredibly, laughably, misin…

Again, it's best not to align planning to political methodologies. Cuba has success stories. That isn't a vote for communism.

Equally, another "communist" state (China) is doing very well and while there is a lot of planning there, there is also a lot of free-market. Again, not a vote for communism.

I use communist in quotes here because Chinese communism is different to communism as practiced in the USSR. Just like capitalism is different in the US compared to say Switzerland.

There are (literally) hundreds of political systems, and we find it helpful to lump them together under broad names, but that can lead to a misunderstanding of the actual system.

Incidentally some planning is necessary- but it remains hard.

Cuba planned for, and got, a fantastic heath system built around primary health care. Cuban doctors are well respected, and are exported all over the world.

Cuba also got a lot wrong, and saying they got something right is not an endorsement of all ideas Cuban.

Re: The planning of U.S. physician shortages (2020)

#39

Post by hammock » Sat, Jun 03, 2023, 4:50 AM UTC

DieBruderBauer wrote: post #5

discriminatory MCATs, brutal STEPS, insane Pre-Med curriculum, and more nonsense designed to cater to white elites who gamed the educational system and less to those who are genuinely trying to help the disenfranchised, unremembered, diverse and more. Hopefully one day, we'll make it as easy to become a doctor as it is to -- say -- become an Engineer.

Too many white doctors? Have you been to a doctor in the last 15 years?

Re: The planning of U.S. physician shortages (2020)

#40

Post by nemonemo » Sat, Jun 03, 2023, 4:52 AM UTC

lotsofpulp wrote: post #26

nemonemo wrote: post #23

I doubt US would be able to see a level of medical accessibility on par with many European countries. The medical education system has a perverse incentive to reduce the yearly graduates -- the less graduates there are, the more profits and prestiges each of the current members can garner (with arguably better trained graduates) -- and as shown in the article, they seem to have monopolistic capability for the throttl…

There already has been. The solution was to pump out physician assistants (PAs) and nurse practitioners (NPs) that require a fraction of the training of a doctor to get licensed, and then have them practice medicine under the “supervision” of a doctor. Some states even went as far as giving people with no medical training the right to prescribe, such as naturopaths, whatever that means. So it is up to each person now…

My experience with PAs and NPs have been mixed. I would still prefer MD doctors if I have a choice.

Now that there are many reasonably good medical education systems outside US, why doesn't US just open more to those international MDs? I would prefer those MDs to NPs or PAs. Maybe doctors' golden years have been passed, but I don't think that necessarily means more accessibility to quality cares.