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.
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.
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
"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.
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.
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.)
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?
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.
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.
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
"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.
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.
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.)
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?
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
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....)
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]
**
There's been an increase in the number of nurse practitioners. Is there data on that? How much do you think that could offset the lack of new doctors?