Strong disagree: they’re the main entity responsible for limiting the available quantity of doctors/medical practitioners available,
and, well, they’re frankly not spending enough time with each patient per appointment.
Not something to glance over - it’s a complete mishandling of the only formula that matters to the patient.
A snippet:
> CMS residency funding was capped beginning in 1997 at 1996 levels, and has only been raised once since then in Section 126 of the Consolidated Appropriations Act of 2021. From 1987 to 1997 the number of residents grew by 20.6%, while from 1997 to 2007 the growth in residencies was only 8%. The 2021 law attempts to address several issues by slowly increasing residencies in specific underserved situations such as rural areas. This officially just began with 200 new residencies nationwide this year, climbing to 1,000 additional residencies per year in five years. It is only a drop in the bucket compared to the 140,000 resident doctors in the US in 2020, the majority of whom were federally funded. Using a rough estimate from Census population data for 2000 and 2020, there are at least 50 million, or 18%, more people in the nation today than when the law was passed, making the current change a rather small effort.
> This growth in population without a corresponding growth in the doctors we train each year leads to higher salaries for doctors and higher costs for patients. More people are demanding the time of a similar number of doctors, driving up the price of doctor’s time, even before accounting for the US’ aging population.
I'm not defending their profession.
I'm drawing a parallel in rights.
And limiting entry is great for wages.
Flooding your profession with people lowers wages.
A drivers union would do the same if they could: create and raise standards.
I can't even draw an "imagine if we limited... " comparison because limiting access to doctors is already close to the worst case, obviously destructive thing to do. Maybe food? If instead of subsidizing farming to ensure we always overgrow and don't have famines, we capped farming, ensuring famines?
What’s the opposite of flooding?
…because that’s what their mandate has been since the 90s.
from colleagues in the UK: their headline demand is “pay restoration,” but the underlying grievances are much broader: when understaffing becomes normal operating procedure, every absence is a freaking emergency. nights and on-call work are intense enough already; broken sleep and persistent overload should not be normal too.
The AMA has taken protectionist positions before, including opposing expansion—fair criticism. But opposing expansion can also mean opposing inadequately funded or structured training. And, as the other commenter said—thank you—don’t physicians deserve to pool bargaining power like other workers?
My point is: it has more and more directly to do with patients than it may seem - being able to do the work properly, with enough time and capacity for the clinical judgement we've been trained for to be fully deployed... leads to better patient outcomes and safety.
From the first week of school, you are all taught that the good doctor is the one that can stay awake and autopilot paperwork for 48+ hours.
That’s a nonstarter - it’s simply broken from the beginning.
> to be fully deployed... leads to better patient outcomes and safety.
Respectfully: no.
There is no other human resource-planning concept on the planet that says using 100% of resources all of the time, or running to failure, is the safest method for the customer (patient).
You guys messed up; your members are noticing, but instead of spending time cleaning up your own house, you want to educate the public?
No: get your stumbling behemoth of an “organization” under control, please.
Regarding "the good doctor" and accepting a near-constant state of fatigue... this is not a personal choice, and it shouldn't be treated as such (wrapped into the box of "the price of this qualification/profession" type of stories). From my experience and I don't claim to be the authority on understanding all aspects of this problem, it's 1. part structural - not enough people (AMA's anti-expansion positions really didn't help here, true) and high demand... and 2. part cultural: medicine has normalised "heroic" endurance which makes it convenient to focus on economics and not see fatigue for what it is - safety risk. The cultural narrative isn't exclusive to medicine.
anyway, I hope community appreciates a perspective from the other side of that organisation, I was hoping to illustrate we ultimately share the same goal - better patient outcomes and safety.
Not trying to personally attack - it’s a question I’d like to gently ask anyone who empathizes from within.
Unfortunately there’s only so much individuals can do - we must lean on each other to really review.
Nope. If allowing sufficient staff to graduate such that hospitals are staffed isn’t on your todo list as an organization, then there had better be money allocated to ensure you can pay people to show up.
Chronic (decades) understaffing while profits remain at record highs means you kept too much money. It doesn’t take an accountant to do that math.
I have an idea of where to get the money, too: the ever-increasing revenue streams, ever-increasing admin pay, and ever-increasing shareholder payout,
again, at minimum until the organization is operating at a bare minimum for a first-world country, able to do basic things like childbirth better than nations with comparatively no money...
For the same reason Americans don’t care much about the (often very valid) complaints of Congresspeople,
you’ll want to start ensuring better service before you start asking for us to care and make noise for you.
Many doctors would agree with you. They're under enormous pressure to work faster from both non-medical administrators and non-medical reimbursement decision makers.
You have a personal responsibility to demand the appropriate amount of time to be seen by your provider - or walk.
(Any ideas that have gained traction in other pleasant countries to live in?)
People (especially conservatives) repeat this, but AMA was lobbying for more residencies for years and conservative party was always against.
The AMA’s public-facing stance seems to be shifting since the 90s and 00s where they obviously wanted limits.
They’re on paper as supporting expansions on 2021 and 2023.
Decades are long.
The AMA lobbies for more _subsidized_ residencies while downplaying that unsubsidized residencies also exist and could expand without waiting on more taxpayer funding