[tptacek]

There is a reason that doctors in the US make multiples of what doctors in Europe makes: the AMA lobbied the US CMS, back in the 1990s, to limit the number of residencies opened up every year, to avoid a "glut" of doctors. We have artificial scarcity of doctors.

[s1artibartfast]

>We have artificial scarcity of doctors.

What is artifical when talking about a program that subsidizes residency?

Focus on limited federal residency funding seems to be a red herring. Most modern economic analyses seems to show residency programs are net profitable before federal subsidies.

IMO the problem is largely structural, around how these are positions and services are handeled by regulation and insurance.

[tptacek]

The number is deliberately set to avoid a glut of doctors. We have the opposite problem.

[s1artibartfast]

This seems to missing the point. Why is the number of doctors so so dependent on federal residency funding (or is it?).

I suspect people overweight it for reasons above. Underweight factors would the long US education path to become a doctor being twice that of many countries, and extremely high cost and high accreditation of medical schools.

[tptacek]

Because Medicare funds residency slots. I don't really understand what you're getting at here.

[s1artibartfast]

Im asking if or how much that actually matters. Im asking if it must matter.

By way of hypothetical, if we doubled residency funding. Would new doctors double, go up 10%, or stay the same?

If education time and obscene school costs are the bottle neck, it might not matter much. Some 25% of residents are already paid out of pocket by hospitals because residents make hospitals money.

If we cut it entirely, what would happen?

[tptacek]

The scaling limit on the number of doctors we have is residencies, not medical school slots, and further, medical school slots can't usefully be scaled up because of the residency cap.

[cogman10]

That's part of the problem, but we also have a problem with limited medical schools in general and with those schools charging through the nose because of that scarcity.

I have a nephew training to be a doctor now. He's looking at $500k in student loan debt by the end. That's a major problem.

[sssilver]

When my surgeon charged $250,000 for my hand reconstruction surgery, how much of it did he personally pocket, and how much of that went towards that $500,000 debt vs. his brand new S-class Mercedes?

[cogman10]

Depends entirely on how he's employed.

If it's his own private practice then yeah, he pockets a lot of that 250k. If he's working for a hospital, then he has basically no influence on the price he's not payed per surgery.

[troosevelt]

That's why I have ahrd time getting mad at doctors. What else are they supposed to do besides charge absurd rates?