Why Does the US make it so hard to be a doctor? • Hacker News Board

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

#41

Post by vsskanth » Mon, Feb 14, 2022, 9:49 PM UTC

syki wrote: post #30

huitzitziltzin wrote: post #20

Earlier quoted context omitted.

> 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…

> There is actually a valid reason to make it hard for doctors to move from one country to another. Training doctors is time consuming and expensive. There is a moral aspect to luring doctors trained in poor countries to rich countries.

There might be a reason for the home countries to not want their trained doctors to leave considering the money spent training them. Some of them do have agreements for the trained doctors to work for a few years in return for the subsidy. That's for the home country and the student to decide.

However the main economic argument here is there's no reason the US should force them through residency again to practice, instead of just directly allowing them to practice after some vetting (USMLE whatever) and reap the benefits of fulfilling pent up demand, lowering healthcare costs and improved access.

I have point out here that "We shouldn't steal talent from poor countries" as a moral argument is a common trope amongst those pushing for immigration restrictions to limit competition to themselves. People are considered free and aren't owned by their countries. Its an understandable argument but I wouldn't pass it on as beneficial to the US or the people (it's not).

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

#42

Post by syki » Mon, Feb 14, 2022, 10:23 PM UTC

ChrisLomont wrote: post #39

syki wrote: post #29

Earlier quoted context omitted.

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 uniqu…

The paper calls into question the existence of a supply/demand curve and as such is relevant to all of your points. Supply/demand is not sufficient to describe elasticity of labor in all cases. For example, in the quoted article:

“…concludes that 'wage elasticity is unresponsive (or inelastic) and that very large increases in wages would be needed to induce even moderate increases in nurse labour supply', adding that the 'weak role of wage increases in promoting nurse supply is also supported by recent qualitative studies..”

I misread your original comment regarding uniqueness. I now understand what you meant. The situation for doctors in the U.S.:

It’s a field that requires highly motivated, highly intelligent people to go through the process. There is a high opportunity costs involved due to the 10 - 12 years of required training at little or no pay. A massive debt is incurred to become a doctor. The people entering the field have the talent and ability to do something else that has high pay or is otherwise rewarding.

As such, attracting people into the field must take into account the ability to service the debt. Suppose starting next year all graduating med students were forevermore saddled with a $1 million med school tax upon graduation in form of a debt to the Treasury at 5% interest. Salaries for incoming doctors would eventually have to rise to take this into account in order to attract talent. Clearly the large debt incurred in order to become a doctor has some effect on the salary necessary to attract talent.

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.

It’s the case that this model of how things work is too simplistic. There’s a dance between the different forces at play. Each of the forces involved evolves over time and they all adjust over time to each other. That is the proper modeling of such things.

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

#43

Post by syki » Mon, Feb 14, 2022, 10:26 PM UTC

s1artibartfast wrote: post #36

syki wrote: post #32

Earlier quoted context omitted.

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…

If doctors already make more than enough to pay off their medical debt, what would change to make them start accepting lower salaries..

If med school were free then salary required to live at the required standard would go down since the need to service the debt would no longer be there.

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

#44

Post by lupire » Mon, Feb 14, 2022, 10:40 PM UTC

allcentury wrote: post #8

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…

The limit of residency slots is in the article. > A much more sensible system would to make medical school free so that the salaries don’t have to start off so high. That's not how any labor market works. Your salary isn't determined by how much debt you rack up. Doctor's salary's are high because the supply of doctor's is so low (especially primary care). The article covers all the points you're debating (much bette…

Primary care is a low paying job because nurses and PAs can provide primary care.

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

#45

Post by s1artibartfast » Mon, Feb 14, 2022, 10:42 PM UTC

syki wrote: post #43

s1artibartfast wrote: post #36

Earlier quoted context omitted.

>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…

If doctors already make more than enough to pay off their medical debt, what would change to make them start accepting lower salaries.. If med school were free then salary required to live at the required standard would go down since the need to service the debt would no longer be there.

I think that is the point. What is the "required standard" where doctors refuse more money? I don't think there is one. If doctor can live on 100k a year, they can also live on 500k a year. If you were a doctor, which job would you pick? Hospitals will always compete on salary because there aren't enough doctors to go around, and they don't want to be the one without a doctor.

Sure, some people might settle for a low-ball salary for personal reasons if they don't have debt, but I think the vast majority would follow the salary.

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

#46

Post by s1artibartfast » Mon, Feb 14, 2022, 11:47 PM UTC

syki wrote: post #42

ChrisLomont wrote: post #39

Earlier quoted context omitted.

>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 uniqu…

The paper calls into question the existence of a supply/demand curve and as such is relevant to all of your points. Supply/demand is not sufficient to describe elasticity of labor in all cases. For example, in the quoted article: “ …concludes that 'wage elasticity is unresponsive (or inelastic) and that very large increases in wages would be needed to induce even moderate increases in nurse labour supply', adding tha…

>As such, attracting people into the field must take into account the ability to service the debt. Suppose starting next year all graduating med students were forevermore saddled with a $1 million med school tax upon graduation in form of a debt to the Treasury at 5% interest. Salaries for incoming doctors would eventually have to rise to take this into account in order to attract talent.

The easy way to conceptualize this is the waiting list for medschool. Today the line is out the door and around the corner. As tuition goes up, the line will start shrinking. Only after the line is gone and fewer doctors are graduating will salaries start rising.

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

#47

Post by CogitoCogito » Tue, Feb 15, 2022, 1:25 PM UTC

syki wrote: post #15

allcentury wrote: post #8

Earlier quoted context omitted.

The limit of residency slots is in the article. > A much more sensible system would to make medical school free so that the salaries don’t have to start off so high. That's not how any labor market works. Your salary isn't determined by how much debt you rack up. Doctor's salary's are high because the supply of doctor's is so low (especially primary care). The article covers all the points you're debating (much bette…

My response was about the claim that OP is a health economist while not understanding where the bottleneck in the supply for doctors comes from. I believe you are incorrect as it pertains to doctor salaries. Demand is high and supply relatively low. That is true but this isn’t the only factor that goes into determining pay. That’s an overly simplistic view of things. Supply/demand does not account for everything in t…

I believe you have it backwards. The high salaries increase the levels of debt potential doctors consider acceptable.

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

#48

Post by namelessoracle » Tue, Feb 15, 2022, 9:36 PM UTC

kashunstva wrote: post #37

namelessoracle wrote: post #24

Earlier quoted context omitted.

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 su…

What you are talking about is ideal state. My experience is literally its always "here's the referal" if i talk about anything specific and the standard host of anti biotics and standard z pac style medicines dont clear it up. Always.

Now my view might be biased because i have been given Kaiser as my provider and i know they have incentives in their system that arent the norm. But its always a specialist referral. Ear problems that the anti biotic didnt solve? ENT referral! (the ENT laughed and said the general medicine doctor made the problem actively worse with the multiple types of anti biotics proscribed sense it was a fungal infection in the ears). Skin issue? Here's the dermatologist referral! Shortness of breath after working out? Here's the pulmonology referal if you want it. Your knee hurts? Here's the rheumatology referral.

I am legit curious what medical service the doctor would provide. You mention "multi-systemic disorders that most mid-level practitioners would never recognize" do you have an example of that?