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

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

#31

Post by kbelder »

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?

It's mostly the other way around. Because of demand, doctor's salaries are high, and so the cost of education increases because new doctors can absorb the high loan payments.

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

#32

Post by syki »

kbelder wrote: post #31
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?

It's mostly the other way around. Because of demand, doctor's salaries are high, and so the cost of education increases because new doctors can absorb the high loan payments.

I believe there is a dance between these various quantities. Overall, my claim is that large med school debt does play a role in high doctor salaries. I don’t claim it is the only factor but just that it is a factor. I further claim that if med school was free them doctor salaries wouldn’t have to be quite as high as they are. That is, the same number of people would be aspire to be doctors with med school being free but doctor’s salaries being x% lower.

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

#33

Post by huitzitziltzin »

syki wrote: post #28
huitzitziltzin wrote: post #21

Earlier quoted context omitted.

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 h…

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

Great example. These doctors face competition from a low- or no-cost private sector. This keeps prices down since every consumer can use the state sector. This is true in many countries w/ state health sectors.

> David Carr won the Nobel Prize in part for his work questioning the traditional supply/demand view of labor economics.

Could you mean David CARD?

https://davidcard.berkeley.edu/

His work of course I know. It is related to the economics of minimum wages. I would not say it questions the traditional supply and demand framework (nor would he say that, I bet), though he does point out an empirical observation which doesn't fit well within that framework.

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

#34

Post by throwaway4220 »

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…

> This is not the population which is deserving of student debt relief.

Residents don’t need debt relief but they also don’t need hostility.

look up FAANG salaries and TC I will bet you undergrad education will get debt relief

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

#35

Post by syki »

huitzitziltzin wrote: post #33
syki wrote: post #28

Earlier quoted context omitted.

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 h…

> There are private doctors in Canada and the UK and they don’t make as much as their American counterparts. Great example. These doctors face competition from a low- or no-cost private sector. This keeps prices down since every consumer can use the state sector. This is true in many countries w/ state health sectors. > David Carr won the Nobel Prize in part for his work questioning the traditional supply/demand view…

Sorry. Yes, Card. Clearly I’m not an economist but I believe within the field is an emerging movement question the traditional iron clad belief in supply/demand being the explanation in labor economics.

One cannot always use the state system. For example, some elective surgeries can’t be done in the state system fast enough for the upper class and then there are those who want vanity cosmetic surgery. I don’t know what the data says but I’d be surprised if private cosmetic plastic surgeons make as much in France as they do in the U.S.

For the record I believe licensed doctors in, say, the EU should be able to practice medicine here without having to do a residency. Though there is a moral consideration in terms of draining the medical talent from countries like Greece, Romania, etc. I believe that med school in the U.S. should be free and that doctor’s salaries could correspondingly go down without decreasing the supply of people wanting to become doctors. It seems obvious to me that having $x in student loan debt is a factor in determining the required starting salary to attract enough talent. I don’t see how anyone can think otherwise. If the debt can’t be serviced easily enough while having a good enough standard of living then these talented people will do something else.

Of course, I could be wrong about everything. There are lots of “obvious” things that aren’t true.

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

#36

Post by s1artibartfast »

syki wrote: post #32
kbelder wrote: post #31

Earlier quoted context omitted.

It's mostly the other way around. Because of demand, doctor's salaries are high, and so the cost of education increases because new doctors can absorb the high loan payments.

I believe there is a dance between these various quantities. Overall, my claim is that large med school debt does play a role in high doctor salaries. I don’t claim it is the only factor but just that it is a factor. I further claim that if med school was free them doctor salaries wouldn’t have to be quite as high as they are. That is, the same number of people would be aspire to be doctors with med school being free…

>That is, the same number of people would be aspire to be doctors with med school being free but doctor’s salaries being x% lower.

I think the point others are making is that there is already a surplus of people that want to be doctors and a fixed number of a medical degrees in both scenarios.

If doctors already make more than enough to pay off their medical debt, what would change to make them start accepting lower salaries? It seems that the salary is driven by competition between hospitals (demand ) opposed to what doctors are willing to take. I guess it is possible that doctors without school debt would less actively chase higher salaries, so perhaps there is some small impact there.

That said, it seems by far the best solution is still more doctors, with or without school debt.

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

#37

Post by kashunstva »

namelessoracle wrote: post #24
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…

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,…

Former general internist here. I obviously have opinions about the assertion that generalists provide no incremental value. The model you posit, wherein a generalist oversees a panel of NP’s and PA’s is already common. Many primary care problems can be handled in this way. No disagreement. But there is a host of multi-systemic disorders that most mid-level practitioners would never recognize. And do you think most subspecialists are interested, aside from the occasional rheumatologist, in comprehensive management of the protean manifestations of most of these types of disorders. This coordination of care for complex disorders has to be done by someone. And for the sake of the patient I hope it’s someone with a solid command of pathology, physiology, pharmacology and so forth. And maybe someone with the time and empathy to talk to actual humans. If you think coordination of care is handing out referrals, that’s a massively reductionist view.

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

#38

Post by react_burger38 »

One interesting thing to note is that Medicare (US gov't paid healthcare for the elderly) pays hospitals DOUBLE the price for the same procedures that an MD can do in her own clinic. They pay this supposedly so that hospitals can take in patients who can't afford to pay in the emergency room, etc.

But to me this is another one of those cases where poor government policy boosts prices. Hospitals already have an incentive to buy up small practices to reduce competition, but if hospitals are paid double the price for the same procedure compared to an ambulatory clinic, the government is just incentivizing concentration in the market.

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

#39

Post by ChrisLomont »

syki wrote: post #29
ChrisLomont wrote: post #26

Earlier quoted context omitted.

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 d…

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

You responded to a point from a previous poster with "In countries with mostly free higher education doctor’s salaries are less on average than in the U.S." as if those doctor low salaries were the result of less debt (which is your argument throughout this thread - that debt makes salaries higher), and I pointed out that this is not unique to doctors, and the costs across all fields don't seem to have debt/salary correlation. Your evidence for your thesis does not hold up outside doctors, and then only for US doctors, so it's hard to believe there is some mystical economic law working only for that sub-case.

>the debt level doesn’t come into play when determining the salary needed to attract the labor of highly intelligent

It does. However your claim is "You really think having several hundred thousand dollars in student loans doesn’t in any way affect salaries?" as if the debt forces employers to pay more. It nearly certainly works the other way - if you are going for a job that pays a lot, you are willing to take on more debt to obtain it. Thus those teaching students how to make so much money are able to charge more for teaching that skill.

This is the exact same causal direction of pretty much any asset. Something is more valued, so people will pay more to obtain it. You're implying the other direction.

>To be able to attract the talent the salaries need to be high enough to service the debt

This again makes little sense as to direction. Quants could get PhDs in STEM (mine is in math, and I have a lto of quant friends) and they make vastly more than all but the highest doctors, yet they don't have all the debt. As the quant field matures (and if it lasts), the cost to obtain training will likely rise.

Not sure what your paper shows, except that which I already claimed: doctors are rare, skilled, and take a long time to make. As such they will get paid a lot because their skills are in demand. This has zero to do with debt - this is exactly supply and demand.

Next, again because of supply and demand, those able to teach people to become doctors realize those doctors will make a lot of money, so they, like all free market actors, will charge what the market will bear. Thus the causation is opposite what you claim - each step in the chain absorbs what the market will bear.

It's not like schools decided to charge far beyond what anyone would pay, and later the wages rose to pay for that debt beyond what people could previously pay. It's more that as wages rose, due to demand, school increased prices to capture what the market would bear to provide those skills.

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

#40

Post by react_burger38 »

Another thing the US could do to reduce prices is to give people the option for certain expensive procedures (hip transplants, knee replacements, etc.) to be done outside the US by qualified doctors. Then the patient could get a discount on their insurance every month or get an incentive from medicare that splits the savings with the patient.
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