[chimeracoder]

> Then who decides how many residency spots are available?

Well... Congress, essentially, by determining how much funding Medicare gets, a portion of which is allocated to funding residency programs.

Contrary to popular belief, residency programs are by and large not money-making operations (or even self-sustaining ones). If they were, hospitals would expand them! But because they lose money, the government has to subsidize them in order to encourage hospitals to run them at their current levels.

[TuringNYC]

I've heard this simple explanation many times and it never makes sense. Review the EOB (Explanation of Benefits) after going to a hospital and getting examined by a resident, the bill is ~250$ for the 5min visit. Assume there is some work behind the scenes (writing scripts, reviewing charts) and one might think ~10min. That is effectively a million+ revenue center for the hospital for a resident making sub six figures, even considering 50% or more in charge-offs.

Why would the hospital restrict residency spots because of funding? Residents are wildly profitable, so that wouldnt make sense.

The explanation I'm told makes sense is this: US medical boards are unwilling to train more doctors because that would increase supply and reduce overall MD earnings. So they have a small number of openings each year, and blame the "shortage" on Congress.

[chimeracoder]

> The explanation I'm told makes sense is this: US medical boards are unwilling to train more doctors because that would increase supply and reduce overall MD earnings. So they have a small number of openings each year,

That "explanation" might be plausible if "medical boards" were in control of the size of residency programs or hospitals' decisions to run them. Except, they're not.

> Why would the hospital restrict residency spots because of funding? Residents are wildly profitable, so that wouldnt make sense.

This is an example of a logical fallacy known as begging the question[0]. You are assuming that "residents are wildly profitable", and then trying to use that to disprove the statement that "residency programs are not profitable".

A better way to reason about this is by contradiction. Assume that hospitals are greedy and avaricious profit-seeking entities who will do anything that increases their bottom line. If residency programs were profitable, these greedy profit-seeking entities would open them (the hospitals that don't currently run programs) or expand them (the hospitals that do). Except, they choose not to. That provides a contradiction between the logical conclusion of the assumptions and actual reality.

It's much simpler to resolve that contradiction by rejecting the premise "residency programs are profitable" than by resorting to contorted explanations that hinge on objectively counterfactual assumptions (such as "medical boards control residency programs' decisions", which is objectively incorrect).

(Your explanation also falls flat when you realize that your logic actually provides US doctors and medical boards with a strong incentive to increase the number of medical school slots, because that would actually preserve earnings for domestic doctors. But that's a subtler point, and the topic at hand is residency programs.)

[0] https://en.wikipedia.org/wiki/Begging_the_question

[TuringNYC]

> If residency programs were profitable, these greedy profit-seeking entities would open them (the hospitals that don't currently run programs) or expand them (the hospitals that do). Except, they choose not to. That provides a contradiction between the logical conclusion of the assumptions and actual reality.

This seems to be the logical fallacy. Hospitals neither get to confer medical degrees nor award board certifications. They cannot just magically create residents out of thin air, they are restricted by supply. No amount of Matrix Architect speak makes them do so.

https://youtu.be/ZKpFFD7aX3c?t=81

[chimeracoder]

> This seems to be the logical fallacy. Hospitals neither get to confer medical degrees nor award board certifications. They cannot just magically create residents out of thin air, they are restricted by supply. No amount of Matrix Architect speak makes them do so.

You seem confused about the question at hand. As has been explained multiple times, including in the original article, there are more medical degrees granted every year than there are residency slots available at hospitals.

The whole question is why hospitals don't take advantage of the excess supply of of medical graduates by creating more residency positions.

[908B64B197]

> But because they lose money, the government has to subsidize them in order to encourage hospitals to run them at their current levels.

I have no doubts they are capable of losing money, on paper at least, especially when spending more means they can get a subsidy from the government.