[casenmgreen]

We do not need all doctors to be uber doctors.

We need a range of doctors, who range in price according to quality.

That way for simple stuff, which anyone can get right, we go to a cheap, reasonable doctor.

A similar example would be if we only had uber software engineers. Each one had to have a PhD. There were no cheap and okay developers who could do say web-sites but not write a programming language from scratch.

[nradov]

That is not even remotely viable. There is little or no correlation between price and quality in healthcare. There are no reliable ways to accurately measure quality of individual doctors across the full spectrum of services that they deliver. In particular, it doesn't make sense to just look at outcomes because the doctors who take on more difficult cases will always look worse in the metrics regardless of the quality of care that they deliver.

Your example doesn't even make sense. Having a PhD doesn't make software engineers more productive on average. PhD programs train researchers. Research skills have very little correlation with practical software engineering.

What could actually work is to train more physician assistants and nurse practitioners, then have them deliver the bulk of simple primary care services under the supervision of physicians. This is more cost effective and usually works well enough, although there may be some degradation in service quality for edge cases.

[anjel]

Like air transport, in America Healthcare has its First Class, Business and Steerage tiers of medical care.

ACA (Obamacare)HMOs may have opened healthcare up to a lot of people who until then were going without. But its a faaaar cry from from Employer PPOs. And the ACA PPOs somewhere in between.

An don't forget the Trumpcare policies, with major policy exclusions.

[nradov]

You appear to be mixing up a number of unrelated issues. Employers often offer both HMO and PPO plans. The differences are typically in provider networks and deductibles/co-pays/co-insurance. Employer sponsored PPO plans don't necessarily make it easier to access higher quality providers — especially because most of the metrics for measuring provider quality are unreliable or even misleading. And in practice there is very little difference in networks between most health plans; the majority of major provider organizations accept all the major plans.

If you really want "First Class" health care then you'll have to pay out of pocket for concierge medicine. That isn't directly covered by most insurance plans, although they will reimburse for certain services delivered through concierge medicine practices.

[mindslight]

I've heard this before, but I still can't figure out where this first class medical care is hiding. For the regional medical system I'm familiar with, there are two major hospitals, each with a set of associated providers. They both take most "insurances", because they effectively have to. I'm mostly familiar with the "better" one, and my experiences there have not been good. Are they checking the class of a patient's "insurance" plan behind the scenes, and sending different doctors based on that? Do I need to travel to a major 1M+ city (somehow even during an emergency)? Or what else gives? Where are these engaged doctors, who actually give you more than a 10-20 minute slice of their time, actually hiding? Ones who don't simply pass the buck to a different place (often booking many months out), recursively? Because from what I've gathered, I suspect that most people are just not very good at judging the competence of professionals, and are absolutely unable to judge the constructive incompetence of systems.

[starluz]

Well what we are learning is that we don’t need doctors for the simple stuff. The doctors cap honestly make sense. We have a surplus of generalists who still do not understand the body systematically, so the demand is not there

[casenmgreen]

If the demand is not there, why is a cap required?

If the demand is there, why is a cap imposed?

[seadan83]

Seems it comes down to: "budget-minded politicians in Congress"

According to 'studentdoctor.net' from 2017 - there is a cap because there are not enough residencies for graduating med students. The government is the primary payer for residencies: "It was because of the cost of GME funding that this program came under the fire of budget-minded politicians in Congress. This resulted in curbing of funding for residencies under the Balanced Budget Act (BBA) of both 1997 and 1999:" [1]

> The limitation in funding has essentially put a cap on the number of residencies that can take place in the United States – and since a doctor cannot go into practice without a residency, this is essentially a cap on the number of new, American-trained physicians who are allowed to practice in this country. The American Medical Association, in its AMA wire, blames this cap for the record number of students in 2015 who were not matched with a residency program at the end of their four years in medical school: of the 18,025 allopathic seniors and 3,000 osteopathic seniors who participated in the Main Residency Match, the two groups matched at rates of 93.9% and 79.3% respectively, leaving the highest percentage ever unmatched – and also unable to practice on their own.

> There are proponents for keeping the current cap in place, however. This is mostly among budget-minded members of Congress who are wanting to cut spending, but even the Obama administration proposed reducing Medicare expenditure on GME, even halving support for children’s hospitals, which have their own separate sources of funding. People on this side of this issue tend to decry the seriousness of the physician shortage, pointing out that the increase of physician’s assistants and advanced nurse practitioners has helped to mitigate this problem, even with the cap still in place.

The resource [1] is a bit dated. "Congress recently took steps to support several programs supporting GME funding by fixing technical issues that left some rural programs with an inadvertently low cap, expanding eligibility for rural training track funding, and adding 1000 new Medicare-funded positions for the first time since 1997. " [2]

[1] https://www.studentdoctor.net/2017/01/24/medical-students-kn...

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8370355/

[selimthegrim]

> We have a surplus of generalists who still do not understand the body systematically

How is this synonymous with not specializing?

[Wowfunhappy]

I think you're possibly describing nurse practitioners?

[senortumnus]

Yes they are describing NPs and PAs. MDs are the PhDs of the medical world. Don’t get me started on “DNPs”

[Scoundreller]

Or maybe more of a "doctor minus" rather than a "nurse plus" system.

[smugma]

A Physician’s Assistant (PA) is exactly that.

[cqqxo4zV46cp]

Lol. Vary by price? This screams USA. Cost, even of labour, is very much disconnected from patient outcomes.

[casenmgreen]

I would say to you that in the normal case, in general, across all fields - bicycles, clothing, tables, chocolate, holidays, houses, butlers, what-have-you - cost is related to outcome, and this is what would be expected.

In the normal case, I would then think that cost in medicine and medical services would be related to outcome.

To the extent this generalization is true, then when cost is not related to outcome, this is not a normal situation, and then the question would be "why?" - what's going on to make a situation which on the face of it is not normal.