I believe this article was written in 2013, with data as available as of that date. If I'm correct, I wish you would label your Substack communications with actual date of publication.
yes - especially because the econlib link at the bottom of the posts only link to econlib's home page and not the actual article. please add dates or actual links to the article!
What are the key regulations preventing medical schools from increasing in size or from new med schools forming? Does it run through the professional associations? Also it would be useful to see statistics on stocks as well as on flows. How has the number of MDs per capita shifted over time? Or # MDs per senior ? Aren’t those the most relevant statistics ? A quick online search found that it has actually increased from 2009 to 2019. So doctors trained abroad are filling in the gap to some degree.
The rate-limiting step is not the number of places in medical schools, but rather the number of residency positions. Doctors don't learn to be doctors in medical school--they learn to be doctors in residency. Because of funding issues, the number of residency positions is effectively limited by the government. You can increase the number of medical schools all day, but if you don't fund more accredited residency positions, you will not increase the supply of doctors. An MD or DO degree without a residency is essentially worthless. It is frustrating how difficult it is to get people to understand this.
yes second this. The link for the sentence "This is exactly what you’d expect when government imposes rigid numerical quotas" is broken for (at least for me). Curious as to what the regulations are
Great questions. I'm also curious to know if there are other non-md medical professionals that are doing the services that some MDs used to do. For example, nurse practitioners, physicians assistants, etc. licensure programs are tricky. They help protect the public from bad actors but they are also used by practitioners to create scarcity within the profession.
"Why else would the number of male doctors have fallen so far relative to demand?"
Because other opportunities have become more attractive.
Getting a lucrative tech or finance job requires much less time and money spent in college. Even getting a job in law requires less schooling than in medicine.
I don't think it explains everything. For example, the timeline for the rise in tech and finance was too late to match the stagnation of MDs. But, it is an alternate hypothesis.
So I assume that what you are (indirectly) advocating here is a world in which anybody can declare themselves a doctor, regardless That right? We had that world once. Tell us why it was, on balance, so much better. (I don't know enough to say, myself, but I have an open mind.)
Yes you do assume that, without evidence. What he complained about was rigid government qotas on training, not that peopkr can't just declare themselves doctors. We never had that worldm They're were always standards about who could call themselves doctors, even before going to a doctor was a good idea
That right? How were those "standards" enforced? Anyway I still want to know more about what Caplan thinks would replace certification and how that would work. And like I said, I have an open mind.
What does that have to do with what's being discussed? The point is that everything you said is either irrelevant or wrong, mostly both.
"Anyway I still want to know more about what Caplan thinks would replace certification and how that would work."
Why? That has nothing to do with the original post. But then nothing you've said does. What the original post was about was the restriction, by government action, of the number of doctors, not how standards are enforced. He said nothing in the post about what standards are appropriate (but the government is not good at deciding that).
"And like I said, I have an open mind."
Then why aren't you prepared to actually talk about what he said, instead of what you want to believe he said?
The title of Caplan's text is "The High Price of Doctors: A Disease of Regulation". I read this to mean that government regulation has so increased the cost of getting a medical degree in both dollars and time
that it has had the effect of limiting supply. I did not read it to mean
that government is actually setting specific numbers. Is that right? If
How do you figure that many “qualified men and women” have been denied the opportunity to practice medicine….when these folks weren’t deemed good enough to get into med school? What metric are you using for “qualified”?
Also….the physician supply is not reflected by “new MDs”….it is reflected by “total practicing MD FTEs” as there is a generational shift of “new MDs” prioritizing work-life balance and hence not always working “full time”, and especially among female MDs, and even more particularly among “new female MDs”. Furthermore, a senior in need of an MD is unlikely to care whether the MD is “new” or not, or of what gender.
"when these folks weren’t deemed good enough to get into med school?"
Except that there's no reason to believe that's a reasonable standard. If there are, as Caplan suggests, arbitrary restrictions on how many people get medical training then "not good enough to get into med school" isn't an objective standard. It's a relative standard that depends on how many want to go. This is assuming that getting into med school is the barrier (other posters suggest it's not, it's residency). If that is true then those folks were good enough to get into med school, and they still couldn't be doctors.
If “a med school determining whether an applicant is suitable to be accepted into that med school” is NOT a reasonable standard, then what qualifies as a reasonable standard?
The current “arbitrary” restriction is via entry class size. If you are accepting 200 people into your first year med school class, then it seems you would accept those whom you consider to be among the 200 best candidates. Would you propose instead that entry be open and unlimited? Should anyone who wants to become a doctor, or lawyer, or architect, or engineer, simply be accepted into the corresponding training program? Cuz as soon as you only accept X number, then you will naturally accept the top X applicants.
Getting into med school absolutely is the barrier, as that is how you get your MD. Residency is at a different point in the gatekeeping process, where it determines what type of practicing doctor you will become….ie a generalist, or a specialist, etc. Some residencies are harder to get into than others. Just because you were deemed good enough to get into med school does not mean you will get into the precise field of practice that you may have wanted.
Well for a start a standard that isn’t set so that only a certain number of people can pass, regardless of the quality and size of the applicant pool.
“The current “arbitrary” restriction is via entry class size. If you are accepting 200 people into your first year med school class, then it seems you would accept those whom you consider to be among the 200 best candidates.”
So what? Why is that the cutoff? What’s wrong with the 201st through 500th best candidate? Is there any evidence at all they would not be perfectly acceptable doctors if trained?
“Would you propose instead that entry be open and unlimited?”
Why should it not be “unlimited”? Why should there be a limit on how many doctors are trained. As for “open”, yes, to anyone who can master the required skills. You seem to be setting up a strawman where you claim that I’m for anybody who turns up being given an M.D. But you know yourself that the limit is numerical not on a particular objective level of quality. You’re effectively arguing that candidates should be subjected to more strigent standards when there are a lot of smart people trying to be doctors. Why? If there were fewer people applying to be doctors and they were not generally as smart should we lower the standard? Why? Because if we’re changing the standard according to arbitrary factors then it’s not about doctor quality is it? It’s about restricting supply.
“Well for a start a standard that isn’t set so that only a certain number of people can pass,”
- so as I surmised, what you are suggesting is an open process. Anyone who wants to get into any school….med school, law school, police academy, trade school…should be allowed to, in your conception. How about just Harvard and MIT and UC Berkeley too; or Oxford and Cambridge, while we are at it. You are welcome to make that case, but definitely doesn’t fly for me. “Just cuz I want to do something “ is not a good metric for whether I would actually be suitable or half decent at doing that thing, as a profession.
“So what? Why is that the cutoff? “
— well, for starters, from the standpoint of each individual school, it could simply be logistics. A school with the resources and facilities to train 200 docs a year may not have the facilities to train 500 of them. You may then argue “well why not 201” but that’s just reductio ad absurdum.
“You seem to be setting up a strawman where you claim that I’m for anybody who turns up being given an M.D.”
—I never suggested “given”. But what I did suggest, and you’ve now confirmed, is that for you, anyone who wants to become an MD should be allowed to try (I believe we both at least agree they would, after “getting in”, still need to “pass” med school in order to actually become an MD….unless you want to complain about how evaluation and promotion of med students is also “arbitrary”).
“As for “open”, yes, to anyone who can master the required skills”
—well, that’s what med schools try to do now. They aren’t in the business of accepting students who subsequently fail to graduate. That’s why there is a gatekeeper screening process. How can it be both “open” AND “selected for those who can master it” at the same time?!? You can’t have both simultaneously.
“You’re effectively arguing that candidates should be subjected to more strigent standards when there are a lot of smart people trying to be doctors. Why?”
—because the “capacity for training doctors” is finite from a resource standpoint, as I mentioned above. And there is also a societal cost (above and beyond “tuition”)
The OP target of “new docs/capita” is wrong-headed. What Mrs. Smith cares about is “practicing doc FTE”/capita as that is where rubber meets road for patients. The other thing is it’s not necessarily “total MDs” that is the issue, as much as “total MDs in a particular field of practice”. In Canada, we have a dearth of family physicians and primary care docs. And we may be over-supplied in some specialties. So IMO, gatekeeping at the residency training level could better address (and in a more practical way) targeted shortages than simply “train more docs every year”.
“ If there were fewer people applying to be doctors and they were not generally as smart should we lower the standard? Why? “
—this for me is the only interesting question you’ve posed. If medicine became an undesirable profession that did not naturally attract high quality candidates, then it would seem that yes, the quality of output will reflect the quality of input.
"- so as I surmised, what you are suggesting is an open process. Anyone who wants to get into any school….med school, law school, police academy, trade school…should be allowed to, in your conception. "
No that's not what I said at all. What I said was that the restriction should be on an OBJECTIVE STANDARD. If you have the abilities you should be allowed to pursue the career regardless of how many other people are also doing so. Look it's a really simple concept, the restriction should be on COMPETENCE not NUMBERS. It should be on QUALITY not QUANTITY.
"— well, for starters, from the standpoint of each individual school, it could simply be logistics. A school with the resources and facilities to train 200 docs a year may not have the facilities to train 500 of them. You may then argue “well why not 201” but that’s just reductio ad absurdum."
Then why not simply provide more resources so you can provide more services, like any other service that's in demand? The limitation is not resources, it's deliberate restrictions by the AMA and other interested parties. Now you might not believe that, but it is the whole point of the article. So if you want to dispute it, do so. Stop making up lies about my positions.
"But what I did suggest, and you’ve now confirmed, is that for you, anyone who wants to become an MD should be allowed to try"
Umm... no I didn't say that at all. There are numerous reasons why someone should be denied the opportunity to be in a senstive position like healthcare provider, such as for instance certain criminal offenses.
" (I believe we both at least agree they would, after “getting in”, still need to “pass” med school in order to actually become an MD….unless you want to complain about how evaluation and promotion of med students is also “arbitrary”)."
If the standard is based on a certain number being trained, rather than a certain quality, yes it is.
"“You’re effectively arguing that candidates should be subjected to more strigent standards when there are a lot of smart people trying to be doctors. Why?”
—because the “capacity for training doctors” is finite from a resource standpoint, as I mentioned above. And there is also a societal cost (above and beyond “tuition”)"
Except it's not being limited by resources, that's the point you're dishonestly trying to avoid.
"The OP target of “new docs/capita” is wrong-headed. What Mrs. Smith cares about is “practicing doc FTE”/capita as that is where rubber meets road for patients. "
And you don't think how many new doctors are trained affects this? You really don't have an honest argument do you?
"—this for me is the only interesting question you’ve posed. If medicine became an undesirable profession that did not naturally attract high quality candidates, then it would seem that yes, the quality of output will reflect the quality of input."
But it should not affect the quantity of input? Why not train less doctors if there are less applicants that achieve a suitable standard? Again, clearly if you prefer less competent doctors, as long as you have the present number, you don't care about standards. Look it's simple, why aren't you for objective standards in M.D.s and instead in favor of supply restrictions?
“COMPETENCE not NUMBERS. It should be on QUALITY not QUANTITY. “
—-that already IS the restriction. They are trying to take the best X number, within the practical fiscal limit of how many can be trained by any one school at any one time. What “objective standard” do you propose? Currently, pre-requisites are objective and serve as the floor. How do you plan for “we’ll take as many as meets our floor”? Also, you want “quality not quantity”….yet would place no limit on quantity. How does that work? In your dream world, perhaps?
So, anyone who meets the floor for police academy should get in? So there would be no point in any interview process then? How do you assess interpersonal skills on a piece of paper or computer printout?
“The limitation is not resources”
—as I said, it costs $ to train doctors. Who pays that to train all comers (who meet your supposed but unstated “objective standards”)?
“Except it's not being limited by resources, that's the point you're dishonestly trying to avoid.”
—not sure how I’m avoiding it. I provided a link that attempts to price out the cost to train a doctor. Does society have unlimited resources to fund this? Or is there, in fact, maybe a “limit”? If you assert it’s the AMA (or some other imaginary bogeyman), burden is on you to prove it.
“And you don't think how many new doctors are trained affects this? You really don't have an honest argument do you?”
—yes, the number of new docs factors into that. But as I said, patients don’t care about whether a doc is new or not; they care whether there is one or not. Hence the key is actual total working physician numbers. Not that complicated, if you endeavour to think about it.
“But it should not affect the quantity of input? “
—-you asked if we “should lower the standard”. I merely stated that lower quality input will lower the quality of output. But yes, reducing quantity works as well. Interestingly, you are still stony-silent on how one comes up with “objective standards “. What might those be, pray tell.
“why aren't you for objective standards in M.D.s and instead in favor of supply restrictions?”
—cuz you’ve yet to tell me what those “objective standards” look like, in contrast to the current admissions process. Just some magical black box, insofar as I can tell.
Wouldn’t the disparity between males and females indicate it is NOT due to regulation (since regulations are not gender specific)?!? Can you connect the dots a bit more for me here? Do you also argue that the low numbers of females in computer science are due to regulation?
Not only have women taken over the medical profession, but also women tend to work fewer hours and/or tend to retire early. This exacerbates the workforce problem. Young men have been discouraged from pursuing higher education by accusing them of general worthlessness and responsibility for all the problems of society. Medicine is no longer a well-paying profession, but rather a middle class job. Why would a bright young man give up his twenties, which is what you have to do to be a doctor, and incur many thousands of dollars in educational debt, when he could become a successful tradesman or business owner?
Men don't want to be educated in any field dominated by women. The minute women enter a field the value in that field goes down, the income standard decreases and men don't wanna anymore. Men. Are. Pigs.
I have read that indeed residency slots are the limiting factor, that some MS grads can't get slots, and that the limits are "enforced" by the AMA. (Wonder why they would do that.) Also most degree-demanding occupations are seeing drastic shifts in favor of females.
One thing we still manufacture, produce and export as a nation tethered to serving our imperial oligarchs: Manufactured Scarcity. Or, as I like to feature it in the movies of my mind: SCARE CITY.
SCARE CITY is the lubricant of this age as it was of my grade school through high school through draft for a South Asian War benefiting only Daddy Warbucks. My Civil Bomb Shelter drilling youth in the Empire City of the Empire State. After weapons, SCARE CITY is mostly what we've produced in abundance and boy has it done its job on INFLATION. Keep HOUSING SCARCE and even a poorly maintained dump upon badly laid foundation will cost a king's effin' ransom.
Manufactured and manipulated Markets are the Hall of Mirrors of Gog and Magog. Yes we need planned markets. Nope, never was any such thing as FREE MARKETS in any working social order we can locate. We're way past the time of those old service-able Propaganda Points of our bi-polar if well-spent yoot. Growing up comes next....that requires social forces and not anti-social forces of exploitation by the Cleverly Selfish.
Lay-Low Studios, Ore-Wa (Refuge of Atonement Seekers)
Media Discussion List\Looksee
PS - If you've got some walking to do, keep these psalms scribbled down by Hamilton Camp in yer mind as I got them via email from James Don BlueWolf earlier this clearing morn:
Pride Of Man (By Hamilton Camp, Performed by Quicksilver Messenger Service) Audio/Lyrics
Hamilton's Bible-based lyrics seem particularly appropriate for these times, even for non-christians...and Quicksilver were a fixture of our youth
James Don BlueWolf
Dec 21
READ IN APP
Listen to post · 4:07
Turn around go back down
Back the way you came
Can't you see that flash of fire
Ten times brighter than the day
And behold a mighty city
Broken in the dust again
Oh, God, pride of man
Broken in the dust again
Turn around, go back down
Back the way you came
Babylon is laid to waste
Egypt's buried in her shame
Their mighty men are all beaten down
Their kings are all fallen in the ways
Oh God, pride of man
Broken in the dust again
Turn around, go back down
Back the way you came
Terror is on ever side
Though our leaders are dismayed
For those who place their faith in fire
In fire their fate shall be repayed
Oh God, pride of man
Broken in the dust again
Turn around, go back down
Back the way you came
And shout a warning to the nations
That the sword of God is raised
Yet Babylon, that mighty city
Rich in treasure, wide in fame
Oh God, pride of man
Broken in the dust again
And it shall cause your tower to fall
Make of you a pyre of flame
Oh you who dwell on many waters
Rich in treasures, wide in fame
You bow unto your, your god of gold
Your pride of might shall be a shame
For only God can lead his people
Back unto the earth again
Oh God, pride of man
Broken in the dust again
Thy holy mounatin be restored
Have mercy on the people
The Alien anthropologists admitted they were still perplexed, but on eliminating every other reason for Our sad demise, they logged the only explanation left—this Species has amused itself to Death! (Pink Floyd) (via Neil Postman....)
Hamilton Camp served as one of the links between the Woody Guthrie and Pete Seeger folk music of the '40s and the singer/songwriter school of Bob Dylan, Tom Paxton, and Phil Ochs in the '60s. [Apple Music]
Camp is probably best known as the author of the song "Pride of Man", which was recorded by a number of artists, notably Quicksilver Messenger Service, Gram Parsons, and Gordon Lightfoot, who included it as one of three songs by other songwriters on his first record. Camp died of a heart attack on October 2, 2005, four weeks before his 71st birthday. He was survived by his six children and thirteen grandchildren. [Wiki]
I believe this article was written in 2013, with data as available as of that date. If I'm correct, I wish you would label your Substack communications with actual date of publication.
yes - especially because the econlib link at the bottom of the posts only link to econlib's home page and not the actual article. please add dates or actual links to the article!
What are the key regulations preventing medical schools from increasing in size or from new med schools forming? Does it run through the professional associations? Also it would be useful to see statistics on stocks as well as on flows. How has the number of MDs per capita shifted over time? Or # MDs per senior ? Aren’t those the most relevant statistics ? A quick online search found that it has actually increased from 2009 to 2019. So doctors trained abroad are filling in the gap to some degree.
The rate-limiting step is not the number of places in medical schools, but rather the number of residency positions. Doctors don't learn to be doctors in medical school--they learn to be doctors in residency. Because of funding issues, the number of residency positions is effectively limited by the government. You can increase the number of medical schools all day, but if you don't fund more accredited residency positions, you will not increase the supply of doctors. An MD or DO degree without a residency is essentially worthless. It is frustrating how difficult it is to get people to understand this.
yes second this. The link for the sentence "This is exactly what you’d expect when government imposes rigid numerical quotas" is broken for (at least for me). Curious as to what the regulations are
Great questions. I'm also curious to know if there are other non-md medical professionals that are doing the services that some MDs used to do. For example, nurse practitioners, physicians assistants, etc. licensure programs are tricky. They help protect the public from bad actors but they are also used by practitioners to create scarcity within the profession.
"Why else would the number of male doctors have fallen so far relative to demand?"
Because other opportunities have become more attractive.
Getting a lucrative tech or finance job requires much less time and money spent in college. Even getting a job in law requires less schooling than in medicine.
I don't think it explains everything. For example, the timeline for the rise in tech and finance was too late to match the stagnation of MDs. But, it is an alternate hypothesis.
So I assume that what you are (indirectly) advocating here is a world in which anybody can declare themselves a doctor, regardless That right? We had that world once. Tell us why it was, on balance, so much better. (I don't know enough to say, myself, but I have an open mind.)
Yes you do assume that, without evidence. What he complained about was rigid government qotas on training, not that peopkr can't just declare themselves doctors. We never had that worldm They're were always standards about who could call themselves doctors, even before going to a doctor was a good idea
That right? How were those "standards" enforced? Anyway I still want to know more about what Caplan thinks would replace certification and how that would work. And like I said, I have an open mind.
"How were those "standards" enforced?"
What does that have to do with what's being discussed? The point is that everything you said is either irrelevant or wrong, mostly both.
"Anyway I still want to know more about what Caplan thinks would replace certification and how that would work."
Why? That has nothing to do with the original post. But then nothing you've said does. What the original post was about was the restriction, by government action, of the number of doctors, not how standards are enforced. He said nothing in the post about what standards are appropriate (but the government is not good at deciding that).
"And like I said, I have an open mind."
Then why aren't you prepared to actually talk about what he said, instead of what you want to believe he said?
The title of Caplan's text is "The High Price of Doctors: A Disease of Regulation". I read this to mean that government regulation has so increased the cost of getting a medical degree in both dollars and time
that it has had the effect of limiting supply. I did not read it to mean
that government is actually setting specific numbers. Is that right? If
not, please tell me what you think he means.
"If not, please tell me what you think he means."
So you only read the title? And yet you presume to waste my time debating? That is not the act of a decent person.
Would have been useful to comment on the nature of barriers.
The table(s) DO NOT SHOW "the total number of new MDs," nor any total numbers at all. They show ratios only.
How do you figure that many “qualified men and women” have been denied the opportunity to practice medicine….when these folks weren’t deemed good enough to get into med school? What metric are you using for “qualified”?
Also….the physician supply is not reflected by “new MDs”….it is reflected by “total practicing MD FTEs” as there is a generational shift of “new MDs” prioritizing work-life balance and hence not always working “full time”, and especially among female MDs, and even more particularly among “new female MDs”. Furthermore, a senior in need of an MD is unlikely to care whether the MD is “new” or not, or of what gender.
"when these folks weren’t deemed good enough to get into med school?"
Except that there's no reason to believe that's a reasonable standard. If there are, as Caplan suggests, arbitrary restrictions on how many people get medical training then "not good enough to get into med school" isn't an objective standard. It's a relative standard that depends on how many want to go. This is assuming that getting into med school is the barrier (other posters suggest it's not, it's residency). If that is true then those folks were good enough to get into med school, and they still couldn't be doctors.
If “a med school determining whether an applicant is suitable to be accepted into that med school” is NOT a reasonable standard, then what qualifies as a reasonable standard?
The current “arbitrary” restriction is via entry class size. If you are accepting 200 people into your first year med school class, then it seems you would accept those whom you consider to be among the 200 best candidates. Would you propose instead that entry be open and unlimited? Should anyone who wants to become a doctor, or lawyer, or architect, or engineer, simply be accepted into the corresponding training program? Cuz as soon as you only accept X number, then you will naturally accept the top X applicants.
Getting into med school absolutely is the barrier, as that is how you get your MD. Residency is at a different point in the gatekeeping process, where it determines what type of practicing doctor you will become….ie a generalist, or a specialist, etc. Some residencies are harder to get into than others. Just because you were deemed good enough to get into med school does not mean you will get into the precise field of practice that you may have wanted.
Well for a start a standard that isn’t set so that only a certain number of people can pass, regardless of the quality and size of the applicant pool.
“The current “arbitrary” restriction is via entry class size. If you are accepting 200 people into your first year med school class, then it seems you would accept those whom you consider to be among the 200 best candidates.”
So what? Why is that the cutoff? What’s wrong with the 201st through 500th best candidate? Is there any evidence at all they would not be perfectly acceptable doctors if trained?
“Would you propose instead that entry be open and unlimited?”
Why should it not be “unlimited”? Why should there be a limit on how many doctors are trained. As for “open”, yes, to anyone who can master the required skills. You seem to be setting up a strawman where you claim that I’m for anybody who turns up being given an M.D. But you know yourself that the limit is numerical not on a particular objective level of quality. You’re effectively arguing that candidates should be subjected to more strigent standards when there are a lot of smart people trying to be doctors. Why? If there were fewer people applying to be doctors and they were not generally as smart should we lower the standard? Why? Because if we’re changing the standard according to arbitrary factors then it’s not about doctor quality is it? It’s about restricting supply.
“Well for a start a standard that isn’t set so that only a certain number of people can pass,”
- so as I surmised, what you are suggesting is an open process. Anyone who wants to get into any school….med school, law school, police academy, trade school…should be allowed to, in your conception. How about just Harvard and MIT and UC Berkeley too; or Oxford and Cambridge, while we are at it. You are welcome to make that case, but definitely doesn’t fly for me. “Just cuz I want to do something “ is not a good metric for whether I would actually be suitable or half decent at doing that thing, as a profession.
“So what? Why is that the cutoff? “
— well, for starters, from the standpoint of each individual school, it could simply be logistics. A school with the resources and facilities to train 200 docs a year may not have the facilities to train 500 of them. You may then argue “well why not 201” but that’s just reductio ad absurdum.
“You seem to be setting up a strawman where you claim that I’m for anybody who turns up being given an M.D.”
—I never suggested “given”. But what I did suggest, and you’ve now confirmed, is that for you, anyone who wants to become an MD should be allowed to try (I believe we both at least agree they would, after “getting in”, still need to “pass” med school in order to actually become an MD….unless you want to complain about how evaluation and promotion of med students is also “arbitrary”).
“As for “open”, yes, to anyone who can master the required skills”
—well, that’s what med schools try to do now. They aren’t in the business of accepting students who subsequently fail to graduate. That’s why there is a gatekeeper screening process. How can it be both “open” AND “selected for those who can master it” at the same time?!? You can’t have both simultaneously.
“You’re effectively arguing that candidates should be subjected to more strigent standards when there are a lot of smart people trying to be doctors. Why?”
—because the “capacity for training doctors” is finite from a resource standpoint, as I mentioned above. And there is also a societal cost (above and beyond “tuition”)
https://pubmed.ncbi.nlm.nih.gov/9075424/
The OP target of “new docs/capita” is wrong-headed. What Mrs. Smith cares about is “practicing doc FTE”/capita as that is where rubber meets road for patients. The other thing is it’s not necessarily “total MDs” that is the issue, as much as “total MDs in a particular field of practice”. In Canada, we have a dearth of family physicians and primary care docs. And we may be over-supplied in some specialties. So IMO, gatekeeping at the residency training level could better address (and in a more practical way) targeted shortages than simply “train more docs every year”.
“ If there were fewer people applying to be doctors and they were not generally as smart should we lower the standard? Why? “
—this for me is the only interesting question you’ve posed. If medicine became an undesirable profession that did not naturally attract high quality candidates, then it would seem that yes, the quality of output will reflect the quality of input.
"- so as I surmised, what you are suggesting is an open process. Anyone who wants to get into any school….med school, law school, police academy, trade school…should be allowed to, in your conception. "
No that's not what I said at all. What I said was that the restriction should be on an OBJECTIVE STANDARD. If you have the abilities you should be allowed to pursue the career regardless of how many other people are also doing so. Look it's a really simple concept, the restriction should be on COMPETENCE not NUMBERS. It should be on QUALITY not QUANTITY.
"— well, for starters, from the standpoint of each individual school, it could simply be logistics. A school with the resources and facilities to train 200 docs a year may not have the facilities to train 500 of them. You may then argue “well why not 201” but that’s just reductio ad absurdum."
Then why not simply provide more resources so you can provide more services, like any other service that's in demand? The limitation is not resources, it's deliberate restrictions by the AMA and other interested parties. Now you might not believe that, but it is the whole point of the article. So if you want to dispute it, do so. Stop making up lies about my positions.
"But what I did suggest, and you’ve now confirmed, is that for you, anyone who wants to become an MD should be allowed to try"
Umm... no I didn't say that at all. There are numerous reasons why someone should be denied the opportunity to be in a senstive position like healthcare provider, such as for instance certain criminal offenses.
" (I believe we both at least agree they would, after “getting in”, still need to “pass” med school in order to actually become an MD….unless you want to complain about how evaluation and promotion of med students is also “arbitrary”)."
If the standard is based on a certain number being trained, rather than a certain quality, yes it is.
"“You’re effectively arguing that candidates should be subjected to more strigent standards when there are a lot of smart people trying to be doctors. Why?”
—because the “capacity for training doctors” is finite from a resource standpoint, as I mentioned above. And there is also a societal cost (above and beyond “tuition”)"
Except it's not being limited by resources, that's the point you're dishonestly trying to avoid.
"The OP target of “new docs/capita” is wrong-headed. What Mrs. Smith cares about is “practicing doc FTE”/capita as that is where rubber meets road for patients. "
And you don't think how many new doctors are trained affects this? You really don't have an honest argument do you?
"—this for me is the only interesting question you’ve posed. If medicine became an undesirable profession that did not naturally attract high quality candidates, then it would seem that yes, the quality of output will reflect the quality of input."
But it should not affect the quantity of input? Why not train less doctors if there are less applicants that achieve a suitable standard? Again, clearly if you prefer less competent doctors, as long as you have the present number, you don't care about standards. Look it's simple, why aren't you for objective standards in M.D.s and instead in favor of supply restrictions?
“COMPETENCE not NUMBERS. It should be on QUALITY not QUANTITY. “
—-that already IS the restriction. They are trying to take the best X number, within the practical fiscal limit of how many can be trained by any one school at any one time. What “objective standard” do you propose? Currently, pre-requisites are objective and serve as the floor. How do you plan for “we’ll take as many as meets our floor”? Also, you want “quality not quantity”….yet would place no limit on quantity. How does that work? In your dream world, perhaps?
So, anyone who meets the floor for police academy should get in? So there would be no point in any interview process then? How do you assess interpersonal skills on a piece of paper or computer printout?
“The limitation is not resources”
—as I said, it costs $ to train doctors. Who pays that to train all comers (who meet your supposed but unstated “objective standards”)?
“Except it's not being limited by resources, that's the point you're dishonestly trying to avoid.”
—not sure how I’m avoiding it. I provided a link that attempts to price out the cost to train a doctor. Does society have unlimited resources to fund this? Or is there, in fact, maybe a “limit”? If you assert it’s the AMA (or some other imaginary bogeyman), burden is on you to prove it.
“And you don't think how many new doctors are trained affects this? You really don't have an honest argument do you?”
—yes, the number of new docs factors into that. But as I said, patients don’t care about whether a doc is new or not; they care whether there is one or not. Hence the key is actual total working physician numbers. Not that complicated, if you endeavour to think about it.
“But it should not affect the quantity of input? “
—-you asked if we “should lower the standard”. I merely stated that lower quality input will lower the quality of output. But yes, reducing quantity works as well. Interestingly, you are still stony-silent on how one comes up with “objective standards “. What might those be, pray tell.
“why aren't you for objective standards in M.D.s and instead in favor of supply restrictions?”
—cuz you’ve yet to tell me what those “objective standards” look like, in contrast to the current admissions process. Just some magical black box, insofar as I can tell.
Wouldn’t the disparity between males and females indicate it is NOT due to regulation (since regulations are not gender specific)?!? Can you connect the dots a bit more for me here? Do you also argue that the low numbers of females in computer science are due to regulation?
Not only have women taken over the medical profession, but also women tend to work fewer hours and/or tend to retire early. This exacerbates the workforce problem. Young men have been discouraged from pursuing higher education by accusing them of general worthlessness and responsibility for all the problems of society. Medicine is no longer a well-paying profession, but rather a middle class job. Why would a bright young man give up his twenties, which is what you have to do to be a doctor, and incur many thousands of dollars in educational debt, when he could become a successful tradesman or business owner?
Men don't want to be educated in any field dominated by women. The minute women enter a field the value in that field goes down, the income standard decreases and men don't wanna anymore. Men. Are. Pigs.
I have read that indeed residency slots are the limiting factor, that some MS grads can't get slots, and that the limits are "enforced" by the AMA. (Wonder why they would do that.) Also most degree-demanding occupations are seeing drastic shifts in favor of females.
Residency should actually be cost saving for the government, given that intern do actual work but are very underpaid.
So... what are the regulations exactly?
Not my favorite piece.
America has around 36 doctors per 100k
Seemingly in with most other first world countries
If so, wouldn't that imply that lack of doctors is a relatively minor reason healthcare is so expensive in the us
I would love to see an estimate of how much each person pays more due to these specific regulations
2013!!!?
One thing we still manufacture, produce and export as a nation tethered to serving our imperial oligarchs: Manufactured Scarcity. Or, as I like to feature it in the movies of my mind: SCARE CITY.
SCARE CITY is the lubricant of this age as it was of my grade school through high school through draft for a South Asian War benefiting only Daddy Warbucks. My Civil Bomb Shelter drilling youth in the Empire City of the Empire State. After weapons, SCARE CITY is mostly what we've produced in abundance and boy has it done its job on INFLATION. Keep HOUSING SCARCE and even a poorly maintained dump upon badly laid foundation will cost a king's effin' ransom.
Manufactured and manipulated Markets are the Hall of Mirrors of Gog and Magog. Yes we need planned markets. Nope, never was any such thing as FREE MARKETS in any working social order we can locate. We're way past the time of those old service-able Propaganda Points of our bi-polar if well-spent yoot. Growing up comes next....that requires social forces and not anti-social forces of exploitation by the Cleverly Selfish.
Tio Mitchito
Mitch Ritter\Paradigm Sifters, Code Shifters, PsalmSong Chasers
Lay-Low Studios, Ore-Wa (Refuge of Atonement Seekers)
Media Discussion List\Looksee
PS - If you've got some walking to do, keep these psalms scribbled down by Hamilton Camp in yer mind as I got them via email from James Don BlueWolf earlier this clearing morn:
https://www.youtube.com/watch?v=uq7HPwRsDKg
Pride Of Man (By Hamilton Camp, Performed by Quicksilver Messenger Service) Audio/Lyrics
Hamilton's Bible-based lyrics seem particularly appropriate for these times, even for non-christians...and Quicksilver were a fixture of our youth
James Don BlueWolf
Dec 21
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Listen to post · 4:07
Turn around go back down
Back the way you came
Can't you see that flash of fire
Ten times brighter than the day
And behold a mighty city
Broken in the dust again
Oh, God, pride of man
Broken in the dust again
Turn around, go back down
Back the way you came
Babylon is laid to waste
Egypt's buried in her shame
Their mighty men are all beaten down
Their kings are all fallen in the ways
Oh God, pride of man
Broken in the dust again
Turn around, go back down
Back the way you came
Terror is on ever side
Though our leaders are dismayed
For those who place their faith in fire
In fire their fate shall be repayed
Oh God, pride of man
Broken in the dust again
Turn around, go back down
Back the way you came
And shout a warning to the nations
That the sword of God is raised
Yet Babylon, that mighty city
Rich in treasure, wide in fame
Oh God, pride of man
Broken in the dust again
And it shall cause your tower to fall
Make of you a pyre of flame
Oh you who dwell on many waters
Rich in treasures, wide in fame
You bow unto your, your god of gold
Your pride of might shall be a shame
For only God can lead his people
Back unto the earth again
Oh God, pride of man
Broken in the dust again
Thy holy mounatin be restored
Have mercy on the people
The Alien anthropologists admitted they were still perplexed, but on eliminating every other reason for Our sad demise, they logged the only explanation left—this Species has amused itself to Death! (Pink Floyd) (via Neil Postman....)
https://www.youtube.com/watch?v=uq7HPwRsDKg
Hamilton Camp : Pride Of Man
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Hamilton Camp performs on Art Fein's Poker Party
Hamilton Camp served as one of the links between the Woody Guthrie and Pete Seeger folk music of the '40s and the singer/songwriter school of Bob Dylan, Tom Paxton, and Phil Ochs in the '60s. [Apple Music]
Camp is probably best known as the author of the song "Pride of Man", which was recorded by a number of artists, notably Quicksilver Messenger Service, Gram Parsons, and Gordon Lightfoot, who included it as one of three songs by other songwriters on his first record. Camp died of a heart attack on October 2, 2005, four weeks before his 71st birthday. He was survived by his six children and thirteen grandchildren. [Wiki]
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