[restuijs]

The tasks of physicians don't require unique skills, in the sense that there is no other route to obtaining those skills. What they do requires skill, but often they are skills that could be and are acquired by different means, but are prevented from use by the arbitrary educational structure required by regulation. Physicians too benefit from the artificial benefits of rent seeking.

[JoeAltmaier]

Permitting physicians to practice without certification has historically been a mess. That's why the rules are there. To filter quacks and con men.

[GFischer]

Agreed, but it definitely could be argued that the pendulum has swung way to the other side, and that many diagnoses and procedures that could be performed by someone with 1 or 2 years of education are performed at a substantially higher cost and inconvenience by doctors.

Maybe an equivalent to the lawyer's "bar exam" without the degree requirement?

http://www.slate.com/blogs/business_insider/2014/08/02/state...

[0xcde4c3db]

I'm having trouble finding a source for this (I'm pretty sure I initially read it ~12 years ago, which puts it pretty close to the current linkrot horizon), but it's been claimed that many bar exams are somehow rigged to control the supply of lawyers as well. The evidence was something like the derivative of the pass rate being inversely correlated to the derivative of the number of practicing lawyers in the jurisdiction.

[TheOtherHobbes]

It could be argued, but that argument would be incorrect, because leaving diagnosis to untrained individuals unrealistically favours "obvious" - but wrong - shallow diagnoses over less obvious deeper diagnoses.

You could argue that doctors aren't great at deep diagnoses either, and unfortunately that seems to be true. But they're still likely to better than someone who lacks the experience or knowledge to understand why a shallow diagnosis may be misleading or limited.

Law is a different problem. Lawyers are paid to be persuasive, using some knowledge of law as a foundation for rhetoric. Specialist lawyers are likely to have access to useful domain-specific professional networks. But a lot of law is relatively menial (but expensive) form-filling. The very specific and self-contained skills used to handle routine property transfers, wills and probate, and so on, can easily be handled by paralegals.

Medicine doesn't have those nice clean silos. If someone has abdominal pain, the range of possible causes is huge, and often very dependent on an extended medical history.

[GFischer]

I'm not saying to exclude doctors :) , I'm saying that primary care and triage could be done by individuals with less extensive studies.

Having more medical services does drive the cost down and I live in a country with firsthand experience.

Here in Uruguay, we have several tiers of care, the first one being an equivalent to a walk-in clinic plus doctor-to-home services. If your child has a fever, or you're feeling unwell for some reason, or you have a rash, you go to those and get immediate service. Here they're manned by actual doctors because we have a lot of them (4 per 1000 inhabitants, highest in the world).

These doctors usually only did the standard training (which is 6 years) and not the specializations (which are 4 more years).

These services are not free but they're available with a ridiculously cheap subscription (about 35 dollars/month) which includes free ambulance services in case of heart attack or similar.

These are the ones I'd man with nurses or equivalents in the U.S. They know better than to treat complicated cases - if they triage and understand your diagnosis might be more serious (let's say they suspect the abdominal pain is an appendicitis), they immediately transfer you to your primary care center.

As mentioned, if your injury or symptoms are more serious, then you can go to your primary health provider. These are under a "mutualism system", which is basically equivalent to being a state-provided healthcare system. Those are paid from your paycheck (4.5% to 6% of gross salary) and free for those under some sort of state subsidy or pension or equivalent.

Here you have access to all specialists, if you're on a standard service, you'll have to be referred by a general practitioner or have a wait time of a few months. There are also private insurance companies that provide a service on top of this, which for an extra monthly premium (200 dollars in my case) you can get same-day appointments to any specialist.

Many doctors here are among the 1%, but a lot of them (those in the primary care centers I mentioned) don't make much above a standard wage.