[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.

[triceratops]

> [you] are essentially making a hand-waving argument

I'm not the only one.

"In Elisabeth Rosenthal’s excellent book, An American Sickness, she notes:

'The median cost to a hospital for each full-time resident in 2013 was $134,803. That includes a salary of between $50,000 and $80,000. Federal support translates into about $100,000 per resident per year. Researchers have calculated that the value of the work each resident performs annually is $232,726. Even without any subsidy, having residents is a better than break-even deal.' "

And

"In the old days, hospitals paid for resident training by building those costs into the bills they sent patients. But in 1965, Congress acknowledged resident medical training as a public good deserving of public investment, and firmly established federal funding for graduate medical education costs with the Medicare Act.

(What’s interesting is that Congress intended for the public funding to be temporary, with language in both the House and Senate reports noting that the funds were intended to last only “until the community undertakes to bear such educational costs in some other way.” Unsurprisingly, once governmental funds became available, hospitals have had little interest in undertaking how to bear these costs any other way.)"

https://thesheriffofsodium.com/2022/02/04/how-much-are-resid...

> they generally have to be directly supervised by an attending physician, which is expensive

The blog post argues that they also free up attending physicians to focus on the highest-compensated doctoring activities.