[TuringNYC]

In the US, the average resident makes ~57k USD these days. If you're familiar with medical bill rates in the US, a week of billings covers the entire annual salary. For specialists (e.g., derm, radiology, etc) a day of billing can cover the entire annual salary for the resident. Even if you assume not all bills are collected, or that many are negotiated down by insurers, the profit margin on residents is off the charts.

Given billing rates, "we dont have money" is a very convenient answer for why there arent more residents (and hence more future supply of doctors.) Heck, given the wild profit of a resident, I'd personally fund their annual salary for a share of the annual billings.

The real answer is...current doctors, specifically specialty boards must actually be willing to train a resident, however they are funded (medicare, by hospitals, by me, etc.) -- and specialty boards do not. It would increase supply and decrease their future wages. Openings are very carefully throttled to create artificial scarcity.

Medical specialty boards are essentially cartels.

This is hard to imagine as a technologist because we largely operate in a free market. Anyone can enter the market and opt to work for less money than you. A foreign worker can try to do your job for less. The job can be off-shored.

[nradov]

You don't understand how it works. Specialty boards don't control funding for residency programs.

[felix_nagaand]

Then explain how these things work instead of just giving a glib "you're wrong. Why? Because I said so. "

[nradov]

Have you read the link I posted in my grandparent comment above? It's all right there.

[TuringNYC]

@nradov - i'd love to understand your point more, but all you've shown is that there is some funding gap for residency programs. Funding gaps exist for unprofitable things where you dont get back immediate money for each dollar you put in. There is a funding gap for the arts, for urban preservation, etc.

Medical resident positions are wildly profitable entities, so "funding gap" sounds like a boogieman excuse.

Medical resident positions are so wildly profitable, that if any medical board was willing to train residents/fellows, i'm certain I can get VC/PE/HF funding to fund those spots and no one would have to worry about funding gaps. Who wouldn't want to fund a position that produces 10x revenues?!

I'd be willing to bet that for many residencies (cosmetic derm, spinal surgery, ortho, radioiology) residents would be willing to work for absolutely free given the massive windfall they expect in 5yrs time.

"Medicare funding gaps" are boogieman excuses provided by the AMA and medical specialty boards to not train doctors, especially specialists and sub-specialists and create artificial scarcity and increase their own wages.

[nradov]

Medical boards don't train residents at all. And board certification isn't even required to practice medicine; it's entirely optional. You're complaining about the wrong problem.

Residents are trained in teaching hospitals, most of which are non-profit. So VC/PE/HF funding isn't applicable. The federal government provides the majority of funding for residency slots and there is a hard cap.

Teaching hospitals certainly could fund more resident slots themselves but they generally choose to spend their money on other priorities like new MRI machines or free care for indigent patients or shiny new buildings named for major donors. Hospital budgeting decisions are made by business executives and BoD members just like any enterprise; they aren't controlled by the AMA or medical boards.

Training residents isn't as profitable as you think; there are huge overhead expenses for supervision, insurance, equipment, and support staff. But if you don't believe me then feel free to get VC funding, found a new for-profit teaching hospital, obtain AGCME accreditation, and hire a thousand residents. I expect you'll find the economics don't work but maybe you'll disrupt the industry and make a fortune?

[WhompingWindows]

Do technologists truly operate in a free market? There are rampant anti-competitive practices across tech, I think it's a SV libertarian fantasy that they are in a free market, a fantasy they tell themselves to paper over their squashing of rivals.

[AnthonyMouse]

The job market is very competitive. You don't need anyone's permission to enter it, all you have to do is do good work. Salaries are high due to a combination of massive demand and the fact that it takes a long time to get good at it. Even their stupid collusion attempts are basically fruitless, because the tech market isn't just four colluding companies, there are thousands. You don't have to go from Google to Apple, you can go to Amazon or Red Hat or numerous others, or create your own startup. That number of companies could never secretly collude -- they couldn't even get away with four. Which is why salaries are still high.

The true threat is companies crushing smaller rivals, because that's how in the long term you end up in a situation where there aren't thousands of tech companies because no one can compete without the assent of one of the major ones, and they prefer to destroy you or compete with you or buy you out than let you grow independently. And that's how salaries could fall in the long-term. But you tell people that supporting walled gardens and closed proprietary services could lower their long-term salary and they don't hear you, because they're after the quick buck today.

[scarejunba]

We’re on this forum because we, as little guys, can often beat the big guys at things. It’s more of a free market than most things. Though nothing is a completely unregulated market.