[nradov]

Anyone who graduates from medical school with an MD / DO degree needs to complete several years of graduate medical education (residency) at a teaching hospital in order to become a physician legally authorized to practice medicine. Most residency slots are funded by Medicare, although some are funded by other sources. Teaching hospitals are usually run by non-profit corporations, or by state or local governments. While internal accounting is always a bit fuzzy and opaque they simply don't have the money to pay residents directly. Most residents generate less revenue than they cost to train. And hospitals don't have the freedom to raise prices to cover the cost of running residency programs. Thus the need for subsidies.

If we force prospective doctors to take on even more debt then we'll likely end up with an even worse shortage. Current levels of student debt are already unsustainable, at least for many specialties.

[lesuorac]

> Most residents generate less revenue than they cost to train.

Is this just a thresholding issue? What substantially changes about the resident from year 1 to 3? Can you chop residency up into different tiers where they don't need somebody watching them do stitches once they're no longer the lowest tier?

I find it extremely suspicious that a sector with so much money in it can't figure out how to make apprenticeships profitable but an electrician can.

[nradov]

You seem to be confusing amount of money with actual control. Electrical contractors can charge any price they want (subject to customer demand). Hospitals, especially teaching hospitals, have no such freedom. Medicare reimbursement rates are fixed by government fiat. This is not a free market.

Residencies are already chopped up into tiers. Those with more experience have more clinical and administrative autonomy. But for the most part, Medicare doesn't allow hospitals to directly bill for work done by residents. With a few limited exceptions, all of their work has to be supervised and signed off by a qualified attending physician. This training and supervision is extremely expensive.

Any major reforms will have to come at the federal government policy level. This is not a problem that medical schools and teaching hospitals can solve by themselves.

[s1artibartfast]

I think it is primarily a matter of insurance expectations and regulation of residents. It dictates what services they can bill for and the amount of redundant oversight required.

It is a self imposed problem.

[nradov]

The problem is largely imposed by Congress in terms of strict rules about what hospitals are allowed to bill Medicare for. This is not something that teaching hospitals have imposed on themselves.

[s1artibartfast]

correct, I didn't mean to imply it was by the hospitals, although the teaching hospitals may still benefit from the current arrangement.

[resource_waste]

Uh... You are talking about the highest paid profession in the US.

There is no debt problem.

I joke about how bad doctors are at math, but this is a pretty obvious case when Physicians are making 200-500k/yr and complaining about 300k of debt.

[lesuorac]

300k of debt sounds kinda low.

https://www.bls.gov/ooh/healthcare/physicians-and-surgeons.h...

> 2024 Median Pay This wage is equal to or greater than $239,200 per year or $115.00 per hour.

> Physicians and surgeons typically need a bachelor’s degree as well as a medical degree, which takes an additional 4 years to complete. Depending on their specialty, they also need 3 to 9 years in internship and residency programs. Subspecialization includes additional training in a fellowship of 1 to 3 years.

So on ~240k you pay ~50k takes just to the federal government and we'll say 12k to the state. 178k is still pretty good, knock out 80k for living expenses (better not live on the coasts) and you're left with 90k which would (naively) pay down 300k debt in 4 years. That said, you're also probably 30 with a net worth of 0$ and could've done a different career path to make ~240k per year without a decade of education.

[resource_waste]

Hahahahahaha 4 years to pay off education for the most lucrative profession in the US. (And you assumed 80k/yr for living expenses... whats the median income in the US? 50-60k? hahahahaha)

Yeah thats a steal.

You can't really paint this in a negative light.

[lesuorac]

Median household income is 80k [1].

It's really easy to paint this in a negative light. You can go study for an extra decade to be a doctor to make as much money as not studying for a decade and working in fang. Becoming a doctor over many over professions puts you literally millions of dollars behind. Doctors are not the most lucrative profession.

[1]: https://fred.stlouisfed.org/series/MEHOINUSA672N

[nradov]

You're really missing the point. There is a huge variance in physician wages based on specialty and location, to the extent that looking at averages is mostly meaningless. We already have a growing shortage of physicians, especially primary care providers in rural areas. Asking prospective doctors to fund their own residency slots will only make that problem worse.

[resource_waste]

>shortage of physicians

>Asking prospective doctors to fund their own residency slots will only make that problem worse.

Its literally the opposite.

If you have them fund their own spots, there would be potentially unlimited spots.

The limit is caused by the boogeyman of not getting government funding, not that people can't afford the temporary debt.

There was some stat that 1 in 4 qualified people become doctors. The problem is not supply. The problem is the cartel legally reducing supply to prop up wages.