[76543210]

Just an idea (that would never happen)-

Why not make it like Engineering?

You do your 4 year undergrad and at your first job, no one trusts you. Your supervisor/senior engineer checks Everything you do. You are reserved for paperwork and unskilled manual labor which is also checked. After a few years (4) you get some Freedom, but still checked by your seniors. Anything important, even when you are a senior engineer goes through your Managers and directors.

I don't see why this system wouldn't work in medical. We build airbags and bridges. Both safety critical.

I would even say having 1 physician is more dangerous than having a team of Engineers with less Schooling.

[adrianN]

The medical system works pretty much like this. After studying medicine you have a long practical education where nobody trusts you.

[MiroF]

Yes, but we also have the “fellowship bottleneck” and limited med school seating we use to keep doctor salaries artificially high.

In addition to training new doctors, we should also just loosen restrictions for doctors to enter the US and use their medical expertise.

[wahern]

When choosing a primary physician at one of the San Francisco Kaiser Permanente campuses, I noticed that a substantial number of doctors had overseas medical training. Which was fine by me--I'm an enthusiastic Kaiser member and support their cost management strategies--but I found it interesting.

Kaiser also recently opened their own medical school: https://en.wikipedia.org/wiki/Kaiser_Permanente_Bernard_J._T...

So they're now using a mixed strategy of both out-sourcing and in-sourcing medical training to address high costs.

[MiroF]

> So they're now using a mixed strategy of both out-sourcing and in-sourcing medical training to address high costs.

Not as much as they could though - there are still federal caps on the number of fellowship seats available as well as pretty strong restrictions for physicians coming from overseas (although if I recall correctly, California has less stringent restrictions than most)

We discuss insurance as a big part of the cost problem, but regulatory capture on the supply end is another huge (and unnecessary) factor.

[snowwrestler]

You don't need full MDs for respiratory therapy, or for many medical treatments. PAs and RNs can do a lot, and it's far easier and less expensive to attain those certifications than full MD.

[MiroF]

For sure and we should also expand the jobs that PAs and RNs are allowed to do.

[colinmhayes]

Doctors wouldn't let either of those things happen because it would lower their salary. The AMA is a powerful lobbying association, no way any law that lowers doctor salary would pass.

[MiroF]

Lobbying power can be confronted by other considerable lobbying interests. Large healthcare conglomerates would seem to have considerable interest in reducing labor costs.

A crisis like this would be the perfect opportunity to fix some of these supply side issues. Lobbying is less effective when voters are paying attention and the government is in crisis-response mode.

[stephencanon]

How do you think medical education works? Because it's basically exactly this.

[76543210]

No. there is an extra 4+ years of classes.

[stephencanon]

There are two extra years of classes for med students, at which point they begin doing rotations through all the different specialties. During rotations, they are essentially “reserved for paperwork and unskilled labor which is also checked.”

This process continues in intern year and residency, during which time they gradually build competency and trust.

Much of medicine in the US is delivered by nurses, who have a training regime even more similar to what you suggest.

[JoeAltmaier]

Categorically false for modern medical school. My daughter started rotations almost immediately, alternating with classes every couple of months throughout. She rarely did 'paperwork' (computers), had close patient contact immediately and was doing procedures almost from the start, under close supervision. Her final rotations had her in the operating room, handling her own patients from triage to discharge, doing night shifts etc along with a resident.

Things have changed rapidly in medical education. At least some places.