Something really needs to be done about current crony capitalistic US medical industry.
I have a few physicians in my extended family and this mirrors what I've seen from them; I don't know how you'd get board certified neurosurgeons to take q3 trauma call in more rural areas for years on end other than ''here's a boatload of money''. It's masochistic work.
Capitalism, especially our current flavor of it, has plenty of problems, but I think it's important to separate the core principals (mostly free markets, pursuit of self interest) from the pollutants (loopholes, cronyism and special interests).
Citation required. I'd venture the US is more accurately described as a hybrid socialist / mercantilist regime than a capitalist regime.
If there were twice as many doctors, the existing doctors probably wouldn't need to work 80 hours a week, and could likely cut down to 40 hours.
The other problem might be that doctors are paid extremely well in the U.S. compared to the rest of the world, and even compared to other rich first-world countries.
Proposals to expand residency run into the problem that it costs the government money. Residencies are funded at the federal level; teaching hospitals get a certain amount of money per resident to compensate for the effort required to train them. And the number of residencies funded per year has (I think?) been maintained at a pretty constant level compared for a long time, with so many new doctors per year per million people.
One option, I suppose, would be to allow self-funded residencies. Why should only the government's money be good enough? But that would probably be an option only for wealthy students, or those who are willing to go even further into debt.
Another option would be to replace residencies with something more like conventional apprenticeship. Is there any reason a new doctor has to learn the practical details of her trade at a hospital, rather than working under the supervision of an experienced doctor in private practice?
Of course, nothing like this is likely to happen. The whole medical industry is extensively regulated; those regulatory barriers are wide moats that ensure fat incomes and profits, which in turn create strong interest in keeping things as they are. Barring utter crisis, nothing is going to change.
PAs provide an instructive example, but there are many others of different sorts. Often, PA schools have stricter prerequisite experience requirements, and PA students often take the bulk of their courses with the MD students, and have maybe a semester less of courses, before clinical training. So the end effect is that a PA's actual experience is often the comparable to an MD's after a couple of years of practice. Hospitals and health care systems know this, and have been gradually replacing MDs in many areas with PAs because they're cheaper but provide similar care.
We can't afford to maintain this fiction that the only way to have something skillfully done is by the MD training model.