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Comment by chongli | Hacker News Reader

We need more doctors.

Yes, unfortunately we've made doctors the gatekeepers and they don't want more doctors because that will eat into their income. This happens with every single licensed occupation where the license body is run by members of the occupation, with the possible exception of bar associations.

My theory on that one is that the more lawyers you have in society the more lawyers you need because lawyers do a great job creating work for one another (both through litigation but also through legal documentation which needs to be read and interpreted by other lawyers).

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The vast majority of doctors support increasing the number of doctors. Most doctors are not members of the AMA and many disagree with their positions on many subjects. The main issue with the shortage is the lack of funding for residencies that is mostly paid for by Medicare and grants. Medical schools don't want to increase the number of students if they won't have slots to finish their training to become doctors. The limits you're talking about are comparatively minor issues as the limits imposed on MDs have led to more DOs. And what nobody wants to talk about are the thousands of slots that go to international medical students, the majority of which do not stay after training.

They currently have a senate bill to increase funding and incentivize the most needed specialties (GP and psych). We'll see how that goes. At this point, it feels like interest in being a doctor has diminished - there's too much training, many specialties don't pay well enough to justify the delayed earnings and costs, the hours can be miserable, and it's a nightmare to deal with all the regulations and legal aspects.

The main issue with the shortage is the lack of funding for residencies

No, that’s the proximate issue. The main issue is the requirement of residencies for all doctors in the first place. In particular, I’m referring to doctors from other countries who may have years or even decades of experience practicing medicine being required to compete for residency spots. These doctors infamously end up driving for Uber instead of practicing medicine.

My mom was one of those lucky few doctors that was able to redo internship and residency after moving to the US. When she first arrived she cleaned houses and worked as a waitress while awaiting entrance into a program. This was the early 80s. Of her friends, she's one of the few who was able to go through the gauntlet and become a doctor in the US. Most became other types of medical workers, including my father who became a respiratory therapist.

Contrast that to my cousin who moved to Australia and was quickly accepted as a practicing physician.

If I trained at a community hospital in Nepal, am I going to need US residency standards? We don’t know. That’s why we have standard board exams and admission pathways that all US physicians need to follow. We should not compromise on that.

We can expand US MD and US DO schools and fill our thousands of unfilled Family Medicine, Internal Medicine, and Pediatric Subspecialty residency slots first!

Board exams are fine. You can sit thousands of candidates for those. The issue is residency slots which are the main bottleneck. Why should a surgeon with 20 years of experience working in Mumbai be forced to become a resident alongside fresh-faced med school grads in the US? It’s a huge problem when it’s cheaper and safer to fly to India for surgery than to get the same surgery in the US (from a less experienced surgeon).

It’s the tyranny of the status quo. Milton Friedman was complaining about this more than 50 years ago.

[1] https://youtu.be/UmVrfbfKBIk

"Why should a surgeon with 20 years of experience working in Mumbai be forced to become a resident alongside fresh-faced med school grads in the US?"

Perhaps you could have them in some accelerated program, but i think it makes a lot of sense to require doctors to train or prove themselves in the specific country/region using the standard practices, tools, etc customary there. I wouldn't want a US doctor operating on me in India since they're likely to make assumptions and recommendations for treatment that overlook local practices, resources, etc.

I think this is a fundamental disagreement, not tyranny of the status quo. We have a functional medical training pipeline already that produces (arguably) the best physician population in the world. Let’s invest there.

The surgeon from Mumbai can come in and prove their worth through a surgical residency. That’s completely fair.

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