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Why Does the US make it so hard to be a doctor?

theatlantic.com

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Re: Why Does the US make it so hard to be a doctor?

#21

Post by huitzitziltzin »

syki wrote: post #19
vsskanth wrote: post #18

Earlier quoted context omitted.

I don't agree the cost of university is driving the salaries here. It's all about how many doctors are available to meet demand. If there are less, it's going to drive up salaries. There are other countries where the cost of getting a degree in a certain specialty is very low due to state subsidies but the salaries are very high once they graduate since they are scarce.

In countries with mostly free higher education doctor’s salaries are less on average than in the U.S. You really think having several hundred thousand dollars in student loans doesn’t in any way affect salaries?

There are important differences in most of those countries including (importantly!) direct government regulation of prices, including salaries in the medical market.

British doctors, for example, work under a contract negotiated between a British version of the AMA and the British government. The government and the providers both have leverage, but the British government is the primary purchaser of services in that country. Salaries are lower since the government exerts pressure on them, as they are paid for out of direct taxation.

I understand that you feel very strongly that student debt for doctors is unjustifiable or too high or something. Student debt is not the main driver (or even a driver) of high salaries among US doctors. The level of their student debt is a completely separate topic.

Re: Why Does the US make it so hard to be a doctor?

#22

Post by strikelaserclaw »

thfuran wrote: post #14
strikelaserclaw wrote: post #10

Earlier quoted context omitted.

To be perfectly honest, i have found primary care doctors pretty useless in the last 5 - 10 years, not only did i find that their answers were things i could easily find on google, i also noticed that most of them didn't actually care about patient well being. It seems like most doctors these days are only in it for the money, which is fine if they are actually providing a valuable service, but low level doctors are…

A doctor in it for the money is pretty unlikely to go into primary care.

They usually set up their own clinic and rake it in, tons of primary care doctors i know did this.

Re: Why Does the US make it so hard to be a doctor?

#23

Post by commandlinefan »

huitzitziltzin wrote: post #2

Health economist here. This is a great piece top to bottom. There is no credible objection I'm aware of to any of the deregulation proposals included herein. The American Medical Association will object, because they don't want the competition because it will have a negative effect on its members' incomes. If you think health care is too expensive in the US, the changes proposed herein are Job 1. There is no reason w…

> doctors are consistently among the very highest paid people in American society

Isn't that at least in part because there's so little competition though?

Re: Why Does the US make it so hard to be a doctor?

#24

Post by namelessoracle »

strikelaserclaw wrote: post #10
syki wrote: post #6

Earlier quoted context omitted.

I have a hard time rectifying the claim that you are a health economist with the fact that you don’t appear to understand that the bottleneck for increasing the supply of doctors is the number of residency slots. Foreign medical school certifications are largely accepted at face value but graduating a foreign residency program largely is not. I think it’s pretty much universal that each country wants doctors to go th…

To be perfectly honest, i have found primary care doctors pretty useless in the last 5 - 10 years, not only did i find that their answers were things i could easily find on google, i also noticed that most of them didn't actually care about patient well being. It seems like most doctors these days are only in it for the money, which is fine if they are actually providing a valuable service, but low level doctors are…

This is sadly true.

There is basically no value in a general medicine doctor that i can see. General health issues can be handled by a nurse practitioner, they can see if you have an ear infection, are sick with the flu, and proscribe you the antibiotics, or other controlled medicines just fine. They could easily switch to a model where the General Medicine doctor acts as like the staff engineer over the senior devs, and just does a quick plus one on their results and makes sure no mistakes were made. (this is how most doctors visits play out anyways)

When there IS something seriously wrong, they almost always send you to a specialist who can actually treat your specific issue. Have a really bad ear infection / something is lodged in your ear? Here is the ENT referral! Pay me for telling you to go see the ear doctor when you had ear problems.

Re: Why Does the US make it so hard to be a doctor?

#25

Post by maxerickson »

syki wrote: post #19
vsskanth wrote: post #18

Earlier quoted context omitted.

I don't agree the cost of university is driving the salaries here. It's all about how many doctors are available to meet demand. If there are less, it's going to drive up salaries. There are other countries where the cost of getting a degree in a certain specialty is very low due to state subsidies but the salaries are very high once they graduate since they are scarce.

In countries with mostly free higher education doctor’s salaries are less on average than in the U.S. You really think having several hundred thousand dollars in student loans doesn’t in any way affect salaries?

If it has any effect it is much less than the regulatory bottlenecks imposed on the number of doctors.

Re: Why Does the US make it so hard to be a doctor?

#26

Post by ChrisLomont »

syki wrote: post #19
vsskanth wrote: post #18

Earlier quoted context omitted.

I don't agree the cost of university is driving the salaries here. It's all about how many doctors are available to meet demand. If there are less, it's going to drive up salaries. There are other countries where the cost of getting a degree in a certain specialty is very low due to state subsidies but the salaries are very high once they graduate since they are scarce.

In countries with mostly free higher education doctor’s salaries are less on average than in the U.S. You really think having several hundred thousand dollars in student loans doesn’t in any way affect salaries?

In almost every country professional salaries are much lower, so looking only at doctors and thinking your argument is unique to them is flawed.

And no, debt does not affect salaries. It's the other way around - with the potential to make a lot more income, one is willing to get more debt to reach that goal. Higher salaries people cause more demand, and so prices go up.

If debt affected salaries, you'd expect your claim to play out on all fields, which it does not. Higher paying undergrad salaries don't correlate to more debt, for example.

Re: Why Does the US make it so hard to be a doctor?

#27

Post by zozbot234 »

pfranz wrote: post #5
huitzitziltzin wrote: post #2

Health economist here. This is a great piece top to bottom. There is no credible objection I'm aware of to any of the deregulation proposals included herein. The American Medical Association will object, because they don't want the competition because it will have a negative effect on its members' incomes. If you think health care is too expensive in the US, the changes proposed herein are Job 1. There is no reason w…

> they don't want the competition because it will have a negative effect on its members' incomes. Is it the perception that increased competition will have negative effects on members' incomes or is that actually true? I swear I remember a story, study, allegory about a second doctor moving to town and both incomes went up.

In theory, it could go the other way. More supply, better specialization among doctors, higher productivity at the margin, more income. The final effect is ambiguous. What is true is that patients would benefit, even if doctors were to earn more after all.

Re: Why Does the US make it so hard to be a doctor?

#28

Post by syki »

huitzitziltzin wrote: post #21
syki wrote: post #19

Earlier quoted context omitted.

In countries with mostly free higher education doctor’s salaries are less on average than in the U.S. You really think having several hundred thousand dollars in student loans doesn’t in any way affect salaries?

There are important differences in most of those countries including (importantly!) direct government regulation of prices , including salaries in the medical market. British doctors, for example, work under a contract negotiated between a British version of the AMA and the British government. The government and the providers both have leverage, but the British government is the primary purchaser of services in that…

There are private doctors in Canada and the UK and they don’t make as much as their American counterparts.

Anecdotal evidence. My wife has $400,000 in med school debt. She needs a $300,000 salary to afford paying that debt off whilst also maintaining a “good” lifestyle. Med school, residency, etc. were hard and sacrifices were made to go through them. It would not be worth it to go through that without a reasonably high salary.

She’d gladly have gone through the process for a $200,000 a year job. It is certainly the case that highly motivated, highly intelligent people take into account the ability to service med school debt when deciding to become a doctor vs. another going into another field. It is obvious that high med school debt has an effect on the salary needed to attract talent.

David Carr won the Nobel Prize in part for his work questioning the traditional supply/demand view of labor economics. Here is a link to an interesting (to me) paper.

https://www.jstor.org/stable/24695058

Re: Why Does the US make it so hard to be a doctor?

#29

Post by syki »

ChrisLomont wrote: post #26
syki wrote: post #19

Earlier quoted context omitted.

In countries with mostly free higher education doctor’s salaries are less on average than in the U.S. You really think having several hundred thousand dollars in student loans doesn’t in any way affect salaries?

In almost every country professional salaries are much lower, so looking only at doctors and thinking your argument is unique to them is flawed. And no, debt does not affect salaries. It's the other way around - with the potential to make a lot more income, one is willing to get more debt to reach that goal. Higher salaries people cause more demand, and so prices go up. If debt affected salaries, you'd expect your cl…

I made no claims about uniqueness so I don’t understand your first paragraph.

If debt affected salaries, you'd expect your claim to play out on all fields, which it does not.

This is very much wrong! All fields are not equal. No one should expect motivations, forces at a play in one field to necessarily apply to all fields.

Do you think highly intelligent, highly motivated people would take on hundreds of thousands dollars of student loan debt without an expectation of a high enough salary to service that debt while maintaining a good lifestyle? We are talking about people who could go into just about any field. To be able to attract the talent the salaries need to be high enough to service the debt. Without the debt the salary needed to attract that talent would go down.

My wife’s med school debt is $400,000. She needs the $300,000 salary she has to service this debt while living a good lifestyle. That high salary will last the rest of her life and not just for the few years it takes to pay off her debt. If she had no debt the she’d be able to live the same lifestyle making $225,000 per year.

Personally I think it’s naive to think that the debt level doesn’t come into play when determining the salary needed to attract the labor of highly intelligent, highly motivated people. You really think that in the alternate world where the U.S. had free med school and all else was the same that salaries would be the same?

https://www.jstor.org/stable/24695058

Re: Why Does the US make it so hard to be a doctor?

#30

Post by syki »

huitzitziltzin wrote: post #20
syki wrote: post #17

Earlier quoted context omitted.

There is no reason at all for a German, Mexican, British, etc. practicing doctor to have to do a US residency at all after they finish whatever training qualifies them to be a doctor in their home countries. You should have stated it this way. In your original post you referenced medical school and that gave the impression that you aren’t aware of the credentialing process to becoming a licensed physician. You had wr…

> There is actually a valid reason to make it hard for doctors to move from one country to another. When your goal is to increase supply in the US and drive down prices, then no, there is not a valid reason to do this. > Training doctors is time consuming and expensive. There is a moral aspect to luring doctors trained in poor countries to rich countries. FWIW I don't completely disagree with this. But that's kind of…

I said there was a moral aspect to taking medical talent from poor countries. You say that you don’t completely disagree with this. So it sounds like you too believe there is a moral aspect to this issue. Great.

I'm not willing to condemn some poor Pakistani doctor to a life much less comfortable than he could enjoy here AND force US citizens to pay extremely high prices for medical care to protect the incomes of US doctors. If you are, cool.

You assume that I’m opposed to giving licensed doctors in other countries an exemption to going through a U.S. residency program in order to practice in the U.S. You are making assumptions that are not justified by what I have written. There are at times valid reasons to restrict medical talent from easily leaving one country to another and there are times where there aren’t really any valid reasons for doing this. I was responding to your statement, “there are no valid reasons….”

Your argument here is way too black/white given the complexity of the issues involved. Thinking that “…condemning Pakistani doctors…” and “…force U.S. citizens to pay more” are the only or are necessary outcomes to not allowing Pakistani doctors to practice medicine in the U.S. without going through a U.S. residency program is not correct.

https://www.jstor.org/stable/24695058

EDIT: Modified to be less vituperative.

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