[throwaway13337]

Agreed.

Entrenched institutions are the general problem with America. It's the police unions protecting bad policing, the restricting of doctor supply via the residency bottleneck, and local governments preventing new building for burgeoning populations.

They're all the same problem really. Beneficial to the incumbent group at the expense of those they service. It's kind of amazing.

[mycologos]

> the restricting of doctor supply via the residency bottleneck

Assuming that you're referring to the AMA here, their role is pretty unclear to me. They appear to have played a lobbying role to get Congress to freeze residency funding in 1997 to avoid having lots of doctors [1], but for several years now, the AMA has at least publicly claimed that they've been lobbying congress to increase funding for residency slots [2]. Maybe they're lying? But I for one don't actually know who is keeping residency funding low.

[1] https://qz.com/1676207/the-us-is-on-the-verge-of-a-devastati...

[2] https://www.ama-assn.org/press-center/press-releases/ama-bui...

[smooth_remmy]

AMA is a bad actor. They refuse to allow junior doctors (doctors who are MD school graduates but who have not completed residency) to practice medicine in ANY capacity.

Common sense says that junior doctors should have the same practice rights as physician assistants - but the AMA refuses to let that happen. They are a medical cartel.

A few states have allowed junior doctors to start practicing medicine in a limited capacity, because every other doctor so damn expensive. But the AMA does not support those states' decision.

[jac241]

Does the AMA want that or is that the purview of state medical boards? AMA doesn't set practice laws. The people who lobby against new grad MDs having the same practice rights as NPs/PAs are NPs and PAs (more NPs). NPs lobby against assistant-physician laws because why would you want someone who has had 500 hours of clinical shadowing while completing their part-time online, direct-entry, 100% acceptance, diploma-mill school (NP) vs. a new-grad physician who's had 2 years of physiology, anatomy, and pharmacology and 2 years with 5000 clinical hours where there's actually an expectation that you contribute treatment plans and care to the team. The fact that the AMA has been asleep at the wheel and unable to stop NPs from getting independent practice in 20+ states show that they don't have any real influence on who practices where.

[someguydave]

The AMA also argues against prescription rights for other health professionals like pharmacists (who often have much more in-depth education on drugs)

[jac241]

What do you have to do before you prescribe a drug? Make a diagnosis, which is what is taught in medical school and not in pharmacy school. Pharmacists are frequently embedded in care teams in hospitals and primary care clinics where they make medication recommendations and know how to get drugs approved by insurance companies (sad that this has to happen...).

[Smithalicious]

It's totally possible to have one party diagnose and another prescribe.

[someguydave]

you are correct, doctors should stay in their lane and diagnose and leave treatments to others

[maxerickson]

Is there any reason the slots can't be privately funded?

Like, could minting more doctors drive down costs for hospitals (that need doctors for services)?

[mbg721]

Institutional trust is certainly a huge problem right now.