[nradov]

Medicare reimbursement levels are sufficient to support most medical practices. They charge more because they can, not because they have to. If reimbursement levels are cut then they'll find ways to improve efficiency, and then cut salaries.

Is there a reason that US doctors should get paid significantly more than their peers in other developed countries?

https://www.medscape.com/slideshow/2019-international-compen...

[OrvalWintermute]

> Medicare reimbursement levels are sufficient to support most medical practices.

Big Nope.

Most practices have fairly fixed costs:

Medical malpractice

Facilities rent, or mortgage

Front office

IT & EMR

Privileging/Credentialing

Practice

CME/required education

The only highly variable cost is physician compensation, and considering the limited availability, this will merely cause the retirements and limited access to specialists.

Perhaps you have some evidence to support your extraordinary claim?

I'll provide evidence to the contrary, based on Hospitals and practices refusing to accepting Medicaid [1] patients, or, not accepting/limiting medicare patients[2], [3], [4]

The simple fact is, there is a limited supply of physicians, and many of them don't want to practice the higher volume, 5 minutes per patient, 5 minutes for notes x 12 hours a day type of practice. Not only is the higher volume more dangerous for the patient, it is also more risky for the medical provider, both in terms of quality of life, and also, the risk of an error, or inadequate information exchange.

[1] https://www.reliasmedia.com/articles/147019-when-hospitals-r...

[2] https://www.investopedia.com/articles/personal-finance/10021...

[3] https://www.verywellhealth.com/doctors-accept-medicare-insur...

[4] https://www.hlc.org/news/more-physicians-no-longer-seeing-me...

[toomuchtodo]

> there is a limited supply of physicians

If the AMA isn't going to fix the physician and residency pipeline, could we not offer visas to physician immigrants who meet first world medical credentialing standards to deepen the supply and therefore support demand? If supply is the issue, we should fix the supple, not destroy necessary demand.

[nradov]

The AMA isn't responsible for the bottleneck in residency slots. We should be asking Congress to increase funding.

https://www.ama-assn.org/press-center/press-releases/ama-fun...

[toomuchtodo]

I stand corrected. Thank you for pointing out my mistake.

[OrvalWintermute]

> could we not offer visas to physician immigrants who meet first world medical credentialing standards

Basically, you are saying American trained doctors only then, as American doctors are much better trained.

Because my experience is that a physician immigrant has to do the following:

Receive ECFMG verification

Complete missing medical education requirements

Study a boatload!

Pass US medical licensing exams 1 & 2

Find a residency (matching)

Go through Residency again

Obtain certification from ECFMG

start practicing, or

Complete Fellowship, then start practicing

[toomuchtodo]

> Basically, you are saying American trained doctors only then, as American doctors are much better trained.

Considering how much healthcare costs in the US and the quality of care received [1], I assert American doctors are not better trained, simply that they are more expensive and there are less of them per capita than other OECD countries [2] [3] [4]. I'm suggesting bypassing the undersized US doctor development pipeline until it is fully funded to produce enough doctors to meet demand and drive down costs.

https://www.ajmc.com/view/the-quality-of-us-healthcare-compa... ("A 2014 report from the Commonwealth Fund revealed continued trends that were along the same lines—despite the implementation of the Affordable Care Act (ACA) in the interim. In the report, the US “ranked last overall among 11 industrialized countries on measures of health system quality, efficiency, access to care, equity and healthy lives.” Significantly, the US was noted to have the highest costs while also displaying the lowest performance.")

[2] https://data.worldbank.org/indicator/SH.MED.PHYS.ZS?most_rec...

[3] https://www.fiercehealthcare.com/practices/how-u-s-stacks-up... ("When it comes to practicing physicians, there are only two physicians for every 1,000 Americans, nearly half the ratio of countries with nationalized public healthcare. Countries with nationalized systems saw the greatest increase in the number of physicians relative to their population.")

[4] https://www.medicaresupplement.com/content/global-healthcare...