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Comment by amkkma | Hacker News Reader

Why have residency spots shrunk per capita? Why do unmatched grads have to work at mcdonalds but NP's and PA's can practice with more latitude than some residents?

(serious questions)

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ACR for radiology is going on in Washington DC. Current staffing throughout the country is poor - over utilization of imaging and not enough radiologists. So we are lobbying for an increase in Medicare funding for residency positions (they are paid by Medicare). Also trying to get more J1 visas but that’s kind of dubious as we are taking physicians from another country who likely also needs physicians.

I have no idea why unmatched graduates are working at McDonald’s as you say. There’s always primary care positions open for the scramble last I checked. If they can’t get a spot there’s likely a real issue in their education or themselves. It’s a normal distribution of a population, MD or not.

I can’t speak to what NP and PA’s do - they have their own PACs and organizations. I know they want to increase their scope of practice and keep their liability low.

>So we are lobbying for an increase in Medicare funding for residency positions (they are paid by Medicare).

Hey taxpayers, can you pay for my grad degree too? Wait its worse, I actually profit during this period.

Don't worry that I'm the highest paid profession upon graduation.

You think you’ll be able to recruit more people into medicine by reducing compensation, keeping education costs the same, and also keeping medicolegal liability on the physician?

Residency as “profit” is a stretch. You tread water for 5 years. If you would like those apprenticeship years to go unpaid then I’m not sure how it increases the number of people who want to go into medicine.

>You think you’ll be able to recruit more people into medicine by reducing compensation

You don't need to recruit more, there is an abundant supply of people who want it.

>Residency as “profit” is a stretch.

Physicians are funny, a fantastic wage for the lower-middle class is considered 'treading water'. And its for education. Something every other degree pays for.

>I’m not sure how it increases the number of people who want to go into medicine.

This is not an issue, there are plenty of people who want degrees that don't involve math. The issue is number of licenses, not number of people who are capable of doing the job and want to.

Residents should absolutely be paid. Years of often times reaching 80 hours/week, treating patients, performing procedures, writing notes - all is valuable labor.

It is like saying we won't pay you for the first several years of your first dev job because it is primarily a ramp up / educational period.

What is true:

The labor isnt valuable thus cannot be billed and needs to be taken via taxes. It also means that whatever people are doing in residency, they don't need residency for. Licensure bullshit.

The labor is valuable and doesnt need to be taken via taxes.

You can't legally practice as a primary care physician without one year of internship, after which you get unrestricted licensed. If you're unmatched, no internship. Is that not correct?

Yea that’s right. You can scramble separately into 1 year internships. Those are really easy to get - but the unfilled spots are not in happy places. They’re usually more rural and surgical.

But like you said if you have a year under your belt you can work in an urgent care or the like.

I didn't realize they had that option. In general, I still find absurdity in what an NP can do vs an unmatched doctor. That's entirely incoherent.

Also, it's laudable what rads is doing, but didn't the AMA lobby for less residency spots?

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