[isubkhankulov]

The current doctor workforce is limited by a congressional cap on Medicare-funded educational slots. Apparently it was established in 1997 to prevent a surplus.

Of course, the opposite happened because of demographics and increased lifespans.

[triceratops]

> Apparently it was established in 1997 to prevent a surplus.

Perish the thought that we have slightly too many doctors. That can never be allowed!

I can't believe they passed that shit with a straight face.

I'll repeat what I've said before: no other profession in America requires a literal act of Congress to fund the training of new members. What's so special about doctors? Let anyone open a medical school if they meet standards. Give anyone an MD if they pass the exams and do the residencies, like lawyers.

And while they're at it let doctors go to medical school straight out of high school like they do in every other country in the world (other than Canada, I think). You'll give every new doctor an additional 2 years in their career they would've spent in undergrad doing a useless "pre-med" degree (assuming medical school becomes 6 years of study after high school instead of 4 years after an undergrad degree).

[wombatpm]

There already are 6 yr programs. A school in Ohio has a 6 yr program where you graduate with a BS and MD.

[nradov]

You're missing the point. Anyone already can open a medical school if they meet standards. In fact, several new medical schools have opened in recent years. But that doesn't do anything to address the primary bottleneck, which is lack of residency slots. If you graduate from medical school with an MD you still can't practice medicine until you complete a residency program.

Some schools do have accelerated combined BS/MD programs which can cut 1-2 years off the required total education.

[triceratops]

I'm aware and I thought it was implied in my comment that Medicare funding shouldn't be a limiting factor on residency slots, when I said "Every other profession manages to train new members without Congress". I guess that wasn't clear enough. I'd go so far as to pull all Medicare funding for residencies. Let each program figure it out themselves.

Accelerated programs aren't the norm. They should be.

[nradov]

If we pull Medicare funding for residency programs then the system will collapse. Most teaching hospitals are run by local governments or non-profit foundations. They simply don't have the resources to subsidize graduate medical education. The money has to come from somewhere.

(And let's not have any stupid comments suggesting that residents should pay for it themselves. They're already tapped out in terms of student debt.)

[triceratops]

If Medicare funding disappeared tomorrow the healthcare industry would figure out how to fund residents. The alternative is no new doctors. Nobody wants that.

I'm not advocating pulling the plug overnight without planning an alternative. That would guarantee a collapse as you said. But announcing an expiration of the program would heavily incentivize all participants to figure something out.

Residents make like $70k a year plus benefits. I'm sure the hospital bills their work for a lot more than that, even accounting for the time of attending physicians. Right now that profit margin probably subsidizes other loss-making activities in the hospital.

[nradov]

Nonsense. No other major participants in the healthcare system have the financial incentives or resources to subsidize residencies on the scale needed. Hospital cost accounting is somewhat fuzzy but overall graduate medical education is a money loser. Hospitals have very limited ability to bill for procedures performed by residents: they generally have to be directly supervised by an attending physician, which is expensive. And reimbursement rates are largely fixed by Medicare: hospitals can't just raise prices to make up the difference.

You have no clue what you're talking about here and are essentially making a hand-waving argument without any facts to back it up.

[dpkirchner]

And as for what should voters do: they should choose people that are the most likely to improve the state of government.