[eyphka]

The reason for the scarcity of talent/ doctors is due to a regulation change in 1983/1996 that wasn't adjusted until last year that was restricting the number of residency spots for doctors in the US.

See a vox piece from 2022 on this topic: https://www.vox.com/22989930/residency-match-day-physician-d...

*Also note this has been slightly fixed with an increase of residency spots, but still puts the US in position to have fewer doctors per person than almost all other developed countries.

** Also see this piece published in medical economics for further reading on the subject of physician shortage: https://www.medicaleconomics.com/view/match-day-2023-a-remin...

[freddie_mercury]

That may explain the overall lack of doctors in the US but seems irrelevant to this thread about rural healthcare.

All you have to do is look at other countries and see the same issue playing out. Germany, Vietnam, and Australia are all very different from the US, and from one another, and all have issues with rural health care.

The reality is that low populations make it hard to provide any service and most of the "first world infrastructure" they do have is provided by federal or state/provincial government (i.e. not their own tax base). They aren't attractive places to live for many professionals, who usually trained in bigger cities and are used to small comforts like being able to eat a variety of cuisines or seeing live events (sports, music, drama) or having good schools for their children. The cost structure and (relatively) low demand affect the financial side of the equation. Etc etc.

Many countries allow "foreign doctors" provided they do some kind of provincial work (think of the old comedy series Northern Exposure) but that hasn't exactly proven to be a panacea.

[bradleyjg]

Why does the federal government need to pay for every single residency? Ok, maybe they messed up in 1983/96—no other entity in the entire nation was capable of picking up any of the slack?

[eyphka]

This is beyond the scope of my knowledge, but what I can say is that the original issue in the 90s arose from a fear of too many doctors coupled with too much spending on said doctors which resulted in multiple regulatory changes to prevent this outcome.

[tyoma]

I never got this either. Residents, from my understanding, are paid poorly. Hospitals charge immense amounts of money. Surely they can squeeze a few residents in there without begging the government for money.

[nradov]

Residents are poorly paid, but residency programs are expensive to operate and expand. The non-profit and public sector teaching hospitals which operate most such programs are generally doing better than small rural hospitals but they're still in a precarious state. They take losses treating a lot of uninsured and Medicare/Medicaid patients.

[HDThoreaun]

Residencies lose money. The doctors that teach in them generally do not enjoy it(source my father who is a doctor and chairs a residency) and need to be paid extra to participate. There would be close to none without the federal subsidies.

[bradleyjg]

I get that they cost money.

The federal government has a lot of money. So does the California government. So does the San Francisco government. So does the Bill and Melinda Gates Foundation. So does Harvard University. So does Amazon. So does UnitedHealth Group. So does NY Presbyterian.

I reiterate: Why does the federal government need to pay for every single residency?

[HDThoreaun]

Because no one else will... I encourage you to go ahead and start funding them or lobbying others to though.

[bradleyjg]

I’m not the one whining about insufficient residency slots.

[Sakos]

Because of Moloch https://slatestarcodex.com/2014/07/30/meditations-on-moloch/

Or rather, misaligned incentives. If they aren't paying for residencies today, there's no reason to believe they'll magically do so tomorrow. Also, if a state decides to do so, that still leaves every other state with insufficient funding for residencies.

[bradleyjg]

There’s a bunch of people that think the federal government should fund more residencies. Some of them raised money, hired lobbyists, made slick websites etc. Others are on websites like this talking up the issue.

They don’t seem to be getting anywhere. Looking at the current state of Congress and the trend line I’m not super optimistic they will pass any sort of “common sense” laws in any area anytime soon.

What I’m suggesting then, is perhaps all these advocates should find some other trees to bark up. Maybe they’ll get no where, maybe they’ll be pleasantly surprised.

Or they can just keep doing what they are doing. I don’t especially care.

[nradov]

Which other entity would you suggest? Residency programs mostly run in non-profit or state government teaching hospitals. They are already financially struggling.

[bradleyjg]

The “non-profit” hospital systems* by me are neither non-profit, nor struggling. They are distributing their large profits to their de facto owners—the executives.

* Systems not hospitals. These groups are gobbling up the entire industry. Hospitals are only a part of their diversified portfolio of businesses.

—-

What about the universities with the medical schools? How many of them are sitting on giant endowments?

[failuser]

It does not restrict the number of residencies, but the number of federally-funded ones. And for some propaganda reason that is always presented as a cap on residencies, not on their funding. With for-profit healthcare why can’t private market step in? I guess it’s not profitable. Who could have guessed.