[huitzitziltzin]

> I have a hard rectifying the claim that you are a health economist with the fact that you don’t appear to understand ...

Don't tell my PhD thesis adviser, I guess? He could have sworn he approved a dissertation about health economics but you've uncovered my secret, or something? (And what was I working on for all that time then? It was years of my life! Apparently nothing?!?)

> the bottleneck for increasing the supply of doctors is the number of residency slots.

No, _you_ are misunderstanding what change I want. There is no reason at all for a German, Mexican, British, etc. practicing doctor to have to do a US residency at all after they finish whatever training qualifies them to be a doctor in their home countries.

Read the article again. US medical education takes much longer than medical education almost anywhere else in the world, yet our outcomes are almost always worse along nearly any measurable dimension.

You will say: "yeah, but that's the result of many factors!" Great - I agree. But in that case it really isn't obvious that the extra years of medical education in the US do a lot for patient outcomes.

In fact, not only do I want more residency slots in the US, I want to reconsider that whole residency system, especially for doctors trained abroad.

> I think it’s pretty much universal that each country wants doctors to go through their own version of residency.

Why? That's a big part of the problem. There is literally no reason in the world for a German doctor who has been practicing there for a few years to have to come here and do a residency again. It makes no sense. You wouldn't do it for a C programmer, right?

Example: "Sorry - you learned C in Germany. If you want to program here, you'll have to get a four-year degree in CS again."

This obviously makes no sense. C is (ideally) the same language wherever it is written. And yet, while you have the same number of kidneys as a German and the same nervous system as Russian ... are you seeing the point I'm trying to make? Why require years of extra training for a doctor from one of those countries to work here? That keeps them out of our market and keeps prices high.

> A much more sensible system would to make medical school free so that the salaries don’t have to start off so high.

Let me pull out my economist card again and say: "this is not how that works." Salaries are not high because medical school is expensive. Salaries are high because supply is restricted. That's how supply and demand work.

[syki]

There is no reason at all for a German, Mexican, British, etc. practicing doctor to have to do a US residency at all after they finish whatever training qualifies them to be a doctor in their home countries.

You should have stated it this way. In your original post you referenced medical school and that gave the impression that you aren’t aware of the credentialing process to becoming a licensed physician. You had written:

There is no reason why Mexican, Canadian, British, Indian, German, ... doctors should not be allowed to come and practice in the US with more than some cursory verification that they actually attended a medical school where they are from.

There is actually a valid reason to make it hard for doctors to move from one country to another. Training doctors is time consuming and expensive. There is a moral aspect to luring doctors trained in poor countries to rich countries.

David Carr would like a word with you regarding your belief that supply/demand alone accounts for the pay of doctors. The supply would not go down if med school was free but starting salaries were x% what they currently are. The experiments have been run. Countries with mostly free higher education have lower doctor pay than the U.S.

[huitzitziltzin]

> There is actually a valid reason to make it hard for doctors to move from one country to another.

When your goal is to increase supply in the US and drive down prices, then no, there is not a valid reason to do this.

> Training doctors is time consuming and expensive. There is a moral aspect to luring doctors trained in poor countries to rich countries.

FWIW I don't completely disagree with this. But that's kind of a crappy thing to say to a Turkish doctor who wants to flee the Erdogan Sultanate, or a Sudanese doctor who wants to make more than a pittance every month.

I'm not willing to condemn some poor Pakistani doctor to a life much less comfortable than he could enjoy here AND force US citizens to pay extremely high prices for medical care to protect the incomes of US doctors. If you are, cool.

Before you get indignant with me: you yourself could train as a nurse practitioner pretty quickly and cheaply (if you are in the US) and then go practice in Sudan or 100 other countries. They'd love to have you. If you only speak English, try India, Ghana, Nigeria, ...

You would be providing a great benefit to the Sudanese. Don't want to? Then why condemn some Sudanese doctor to the same just because he was born there instead of here?

> David Carr would like a word with you...

I don't know who this is.

> regarding your belief that supply/demand alone accounts for the pay of doctors.

I will happily believe this, both on my own authority as an actual informed expert in the field AND on the basis of the research of numerous colleagues of mine, who have in the aggregate devoted several hundred years of work to understanding this topic.

> The supply would not go down if med school was free but starting salaries were x% what they currently are.

This would be a notably interesting result in economics if it were true. It is not true. Doctors salaries are not responsive to the cost of medical school.

[syki]

I said there was a moral aspect to taking medical talent from poor countries. You say that you don’t completely disagree with this. So it sounds like you too believe there is a moral aspect to this issue. Great.

I'm not willing to condemn some poor Pakistani doctor to a life much less comfortable than he could enjoy here AND force US citizens to pay extremely high prices for medical care to protect the incomes of US doctors. If you are, cool.

You assume that I’m opposed to giving licensed doctors in other countries an exemption to going through a U.S. residency program in order to practice in the U.S. You are making assumptions that are not justified by what I have written. There are at times valid reasons to restrict medical talent from easily leaving one country to another and there are times where there aren’t really any valid reasons for doing this. I was responding to your statement, “there are no valid reasons….”

Your argument here is way too black/white given the complexity of the issues involved. Thinking that “…condemning Pakistani doctors…” and “…force U.S. citizens to pay more” are the only or are necessary outcomes to not allowing Pakistani doctors to practice medicine in the U.S. without going through a U.S. residency program is not correct.

https://www.jstor.org/stable/24695058

EDIT: Modified to be less vituperative.

[vsskanth]

> There is actually a valid reason to make it hard for doctors to move from one country to another. Training doctors is time consuming and expensive. There is a moral aspect to luring doctors trained in poor countries to rich countries.

There might be a reason for the home countries to not want their trained doctors to leave considering the money spent training them. Some of them do have agreements for the trained doctors to work for a few years in return for the subsidy. That's for the home country and the student to decide.

However the main economic argument here is there's no reason the US should force them through residency again to practice, instead of just directly allowing them to practice after some vetting (USMLE whatever) and reap the benefits of fulfilling pent up demand, lowering healthcare costs and improved access.

I have point out here that "We shouldn't steal talent from poor countries" as a moral argument is a common trope amongst those pushing for immigration restrictions to limit competition to themselves. People are considered free and aren't owned by their countries. Its an understandable argument but I wouldn't pass it on as beneficial to the US or the people (it's not).