Lawsuit Alleges Practicing Physicians Block New Residency Program

[nimbus]

Major props to the group for standing up to this. There is a massive conflict of interest when you have a for-profit hospital starting a training program for one of their highest earning specialties. It doesn’t take a rocket scientist to see that their long term plan is to hire their own fresh grads at lower market rates and gradually displace the established group in favor of an employed model where they will keep a larger share of the revenues down the road.

HCA is doing exactly this in anesthesia, breeding their own.


Private practice doctors are under no obligation to train residents.

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[nimbus]

Very impressive.

Sir Angus Deaton received the 2015 Nobel Prize in Economics. His wife, Anne Case, is also an accomplished economist and works alongside him in Princeton's economics department. Here's what they had to say on this matter in an article they co-wrote (emphasis mine):



If only Drs. Deaton and Case had enrolled in your undergrad econ courses. Maybe then they'd know that the concerns above are "dumb" and unworthy of our attention.

This guy’s golden parachute is more than a neurosurgeon makes in their entire career. That’s where the money is going.

Sanford pays out more than $49 millon to former CEO

In one year, Sanford Health reports it paid $65 million in one-time severance and other payments to six executives who left the organization, with more than two-thirds of it going to former CEO Kelby Krabbenhoft.

www.valleynewslive.com

 

[Osminog]

You realize physician salaries are usually just under 10% of healthcare spending right?

You have to remember that US healthcare spending is ridiculously high compared to that of other countries. If we want to speak in absolute terms, 10% of US healthcare spending is ~$380 billion, based on 2019 data. American physicians make slightly over $300K/year, on average. If American physicians were to receive the same compensation as physicians in the UK, for instance, there would be a $200 billion decrease in spending. That's an extra $600 in the pocket of every American man, woman, and child.

But sure, there is wasteful healthcare spending that goes well beyond physician salaries... administrative fees, absurd drug prices, inefficient hospital care, etc. The underlying problem is monopoly power in the healthcare industry and government mishandling of it.

 

[Matthew9Thirtyfive]

You have to remember that US healthcare spending is ridiculously high compared to that of other countries. If we want to speak in absolute terms, 10% of US healthcare spending is ~$380 billion, based on 2019 data. American physicians make slightly over $300K/year, on average. If American physicians were to receive the same compensation as physicians in the UK, for instance, there would be a $200 billion decrease in spending. That's an extra $600 in the pocket of every American man, woman, and child.

But sure, there is wasteful healthcare spending that goes well beyond physician salaries... administrative fees, absurd drug prices, inefficient hospital care, etc. The underlying problem is monopoly power in the healthcare industry and government mishandling of it.

Have you read any of the papers outlining why decreasing physician salaries would essentially do almost nothing to decrease healthcare costs?

 

[VA Hopeful Dr]

You have to remember that US healthcare spending is ridiculously high compared to that of other countries. If we want to speak in absolute terms, 10% of US healthcare spending is ~$380 billion, based on 2019 data. American physicians make slightly over $300K/year, on average. If American physicians were to receive the same compensation as physicians in the UK, for instance, there would be a $200 billion decrease in spending. That's an extra $600 in the pocket of every American man, woman, and child.

But sure, there is wasteful healthcare spending that goes well beyond physician salaries... administrative fees, absurd drug prices, inefficient hospital care, etc. The underlying problem is monopoly power in the healthcare industry and government mishandling of it.

Sure and that's not nothing, but it's a drop in the bucket compared to hospital costs and drug prices.

 

[NotAProgDirector]

Everyone points to someone else as the cause: Physicians, Pharma, Hospitals, Admin, Insurance companies, drug distributors, allied health, lawyers/malpractice, govt regulation, etc. Each of us own a slice of the cost pie. If each group owns 10% of the problem, we each can point to everything else and claim that 90% is the problem.

We all are the problem.

But every health care dollar that is waste is someone's income. Some of it is my income.

 

[ACSurgeon]

Market value is what the market will pay you for your service. The problem here is that physicians have created a cartel where foreign doctors are barred from competing on the labor market. Where we artificially limit residency positions to prop up salaries for doctors already in attendinghood.

Physician income is based on productivity not just supply and demand. Especially our current generation people value work life balance and so it’s not like we limit the number of physicians while working enough for two physicians each.

Also, physicians have little control over the political arena. So, you’re incorrect thinking the evil doctors are causing things to be as they are.

Finally, how do you know what the quality of education or standards are for students coming from international schools? Every country on earth is strict about accepting professionals from other countries. Why are US doctors evil for doing so?

Finally part 2: every profession has the right to regulate themselves and avoid oversaturation of the market. You work hard to refine your skill and should be able to find a job in your country where you trained and live. This takes priority over opening opportunities for others. Flooding the market will reduce your value but more importantly could lead to fewer jobs. It’s not like international graduates come to the US hoping to serve rural America. They come and focus on getting the most desirable jobs and cities just like anyone else.

Try again.

 

[Captain_Falcon]

Saying "we are all part of thr problem" means that everyone in Healthcare is overpaid. I don't agree with that. Administrative costs have sky rocketed over the last 2 decades as physicians on the whole have had reimbursement cut

 

[Matthew9Thirtyfive]

Everyone points to someone else as the cause: Physicians, Pharma, Hospitals, Admin, Insurance companies, drug distributors, allied health, lawyers/malpractice, govt regulation, etc. Each of us own a slice of the cost pie. If each group owns 10% of the problem, we each can point to everything else and claim that 90% is the problem.

We all are the problem.

But every health care dollar that is waste is someone's income. Some of it is my income.

I know you’re way beyond me in your career, but I just don’t agree with this. Physicians have a very necessary and rare skill that is difficult to learn, requires massive amounts of debt to get, and that puts them at high liability. That deserves high reward. If anything, some specialties are underpaid. Doctors shouldn’t have to work for free or for barely enough to pay off their student debt.

And those other countries that pay their physicians less (since other people want to bring that up)? The vast majority of them have much lower student debt. It’s easier to get paid $150k a year when you don’t owe $250k.

 

[Neopolymath]

Very impressive.

Sir Angus Deaton received the 2015 Nobel Prize in Economics. His wife, Anne Case, is also an accomplished economist and works alongside him in Princeton's economics department. Here's what they had to say on this matter in an article they co-wrote (emphasis mine):



If only Drs. Deaton and Case had enrolled in your undergrad econ courses. Maybe then they'd know that the concerns above are "dumb" and unworthy of our attention.

I'm not the one who tried to gate keep with low hanging fruit but ok? It's clear that medical prices in America aren't high due to physician salaries. You would know this if you spent any time at all looking at how the money flows and who charges what to the patient. Or spent literally 5 seconds contemplating what the thousands of admin do in a hospital besides fake "make work" jobs. Are you one of those people who think the surgeon gets even half of the money from the medical bill lol or the facility fee tacked on to the exact same care in a primary care clinic just because a hospital owns it not the private practice physician down the street? We have a million people doing nothing or even worse bloating the bill and yet I'm to believe the big bad anesthesiologist doing a Medicaid epidural is pilfering America and is who is lowering value for patients in America. Impressive.

 

[Neopolymath]

Saying "we are all part of thr problem" means that everyone in Healthcare is overpaid. I don't agree with that. Administrative costs have sky rocketed over the last 2 decades as physicians on the whole have had reimbursement cut

And we have made it to the point of the thread someone shows this graph and we don't really need to talk anymore. Bravo, sir/ma'am.

 

[7331poas]

Physician income is based on productivity not just supply and demand. Especially our current generation people value work life balance and so it’s not like we limit the number of physicians while working enough for two physicians each.

Also, physicians have little control over the political arena. So, you’re incorrect thinking the evil doctors are causing things to be as they are.

Finally, how do you know what the quality of education or standards are for students coming from international schools? Every country on earth is strict about accepting professionals from other countries. Why are US doctors evil for doing so?

Finally part 2: every profession has the right to regulate themselves and avoid oversaturation of the market. You work hard to refine your skill and should be able to find a job in your country where you trained and live. This takes priority over opening opportunities for others. Flooding the market will reduce your value but more importantly could lead to fewer jobs. It’s not like international graduates come to the US hoping to serve rural America. They come and focus on getting the most desirable jobs and cities just like anyone else.

Try again.

1. There are plenty of jobs that generate high amounts of revenue. Plenty of engineers who do more than doctors in terms of productivity yet get paid less. Either way, that point is moot since the revenue you generate has nothing to do with what you "deserve" to be paid.

2. Physicians definitely have a seat at the table. Physicians played a major role is stomping out universal healthcare. Also established the cartel with the Flexner report. the AMA continues to lobby congress to this day. Individual societies lobby at our state legislature. Know several surgical groups around here who hire lawyers for that exact purpose.

3. Easy. You could just whitelist countries that you know generate good physicians. Why cant a UK doctor practice here in the States? Is it because he has poor skills? Nope. It has to do with the fact that he gets paid 100k for his work in the UK, and would be happy to fill Gen Surg jobs for 150k here in the US.

4. Very few professions regulate themselves. Very few professions have the ability to reduce their labor force. Do you think programmers should be allowed to shut down CS programs at colleges across the US? Seems cartel-y to me.

Everything you said about flooding the market is true. It is bad for my bottom line. The problem is that American Docs have put their own pockets ahead of patients.

Why are you ok with patients waiting months for an appointment just so you can meet your RVU target?

 

[DarkHorizon]

1. There are plenty of jobs that generate high amounts of revenue. Plenty of engineers who do more than doctors in terms of productivity yet get paid less. Either way, that point is moot since the revenue you generate has nothing to do with what you "deserve" to be paid.

If an engineer generates millions of dollars, they are paid accordingly, show me an engineer who generates as much as a surgeon, I bet he/she is paid just as much, if not more than a surgeon. In my health system, orthopedic service line generated $2 Billion in downstream revenue in 2019 with 72 surgeons, for reference.

2. Physicians definitely have a seat at the table. Physicians played a major role is stomping out universal healthcare. Also established the cartel with the Flexner report. the AMA continues to lobby congress to this day. Individual societies lobby at our state legislature. Know several surgical groups around here who hire lawyers for that exact purpose.

The influence physicians have compared to hospital lobby and administrators is minuscule at best, and laughable at worst. You’re just a number in corporate medicine, very disposable. You will learn that once you’re actually in practice.

3. Easy. You could just whitelist countries that you know generate good physicians. Why cant a UK doctor practice here in the States? Is it because he has poor skills? Nope. It has to do with the fact that he gets paid 100k for his work in the UK, and would be happy to fill Gen Surg jobs for 150k here in the US.

Sure, are they going to let me fix femurs in UK or Canada for that matter? No they will not, so why should we? Also, Canada and UK have worse shortage of orthopods, for reference. Why do you think that is?

4. Very few professions regulate themselves. Very few professions have the ability to reduce their labor force. Do you think programmers should be allowed to shut down CS programs at colleges across the US? Seems cartel-y to me.

Any licensed profession regulates itself. The barrier to entry is high, as it should be. Why should there be more doctors than needed? TAkes 11-16 years post high school to become a physician, you don’t even need a degree to be a coder or programmer.

Everything you said about flooding the market is true. It is bad for my bottom line. The problem is that American Docs have put their own pockets ahead of patients.

Why are you ok with patients waiting months for an appointment just so you can meet your RVU target?

Why don’t you look up the wait time for elective joint replacement in Canada/UK/Scandinavia/ and New Zealand, and get back to us, since you think US physicians are the only ones creating a protectionist environment. While you’re at it, also look up the percentage of foreign trained and educated practicing physicians and compare them to the US.

 

[VA Hopeful Dr]

1. There are plenty of jobs that generate high amounts of revenue. Plenty of engineers who do more than doctors in terms of productivity yet get paid less. Either way, that point is moot since the revenue you generate has nothing to do with what you "deserve" to be paid.

2. Physicians definitely have a seat at the table. Physicians played a major role is stomping out universal healthcare. Also established the cartel with the Flexner report. the AMA continues to lobby congress to this day. Individual societies lobby at our state legislature. Know several surgical groups around here who hire lawyers for that exact purpose.

3. Easy. You could just whitelist countries that you know generate good physicians. Why cant a UK doctor practice here in the States? Is it because he has poor skills? Nope. It has to do with the fact that he gets paid 100k for his work in the UK, and would be happy to fill Gen Surg jobs for 150k here in the US.

4. Very few professions regulate themselves. Very few professions have the ability to reduce their labor force. Do you think programmers should be allowed to shut down CS programs at colleges across the US? Seems cartel-y to me.

Everything you said about flooding the market is true. It is bad for my bottom line. The problem is that American Docs have put their own pockets ahead of patients.

Why are you ok with patients waiting months for an appointment just so you can meet your RVU target?

1. Do those same engineers bill for the same amount of money we do? I'm a family doctor which is one of the lower paid specialties in medicine. In the last 12 months I have probably build somewhere in the neighborhood of 1.5 million dollars. That is just for my direct labor.

2. The flexner report was actually about quality of medical education. It established standards that you had to meet. If you can meet those standards you can open your own medical school. Happens all the time. And even those standards are more lax if you're opening a do school. You can't really accuse physicians of stifling numbers when the osteopathic section of this message board is full of new schools opening all the time.

3. First, lots of countries are whitelisted to come practice here. Primarily the English-speaking former British dominions, and the United Kingdom. It's not so much protection against people coming to work for less, because doctors that moved to American know they're going to make a lot more money. It's about a combination of language skills and training that we are familiar with. Same reason I could go to New Zealand or Australia pretty easily but would have to go through significantly more hoops to go to Germany.

4. Lots of professions regulate themselves to the same extent we do. Pretty much any licensed occupation can set whatever rules they want for licensure.

Lastly, there are a literal handful of specialties in my area, which is a fairly small town in South carolina, that take more than 2 to 4 weeks to get in with new patients. Basically it's derm, endocrinology, and rheumatology.

 

[nimbus]

1. There are plenty of jobs that generate high amounts of revenue. Plenty of engineers who do more than doctors in terms of productivity yet get paid less. Either way, that point is moot since the revenue you generate has nothing to do with what you "deserve" to be paid.

2. Physicians definitely have a seat at the table. Physicians played a major role is stomping out universal healthcare. Also established the cartel with the Flexner report. the AMA continues to lobby congress to this day. Individual societies lobby at our state legislature. Know several surgical groups around here who hire lawyers for that exact purpose.

3. Easy. You could just whitelist countries that you know generate good physicians. Why cant a UK doctor practice here in the States? Is it because he has poor skills? Nope. It has to do with the fact that he gets paid 100k for his work in the UK, and would be happy to fill Gen Surg jobs for 150k here in the US.

4. Very few professions regulate themselves. Very few professions have the ability to reduce their labor force. Do you think programmers should be allowed to shut down CS programs at colleges across the US? Seems cartel-y to me.

Everything you said about flooding the market is true. It is bad for my bottom line. The problem is that American Docs have put their own pockets ahead of patients.

Why are you ok with patients waiting months for an appointment just so you can meet your RVU target?

Fine, we’ll all be Amazon warehouse workers which is exactly how companies like HCA would like to treat us. For profit corporations like HCA are the apex predators of American society. Their singular mission is to maximize profit for their shareholders. The actual delivery of healthcare is merely a means to that end goal.

 

[Proudfather94]

Honestly if there is not crazy wait times in that area I don't see the problem with preventing an overabundance of a specialty. That would just bring the pay of everyone down due to competition. They should pick a place that has more need of training physicians.

 

[7331poas]

Fine, we’ll all be Amazon warehouse workers which is exactly how companies like HCA would like to treat us. For profit corporations like HCA are the apex predators of American society. Their singular mission is to maximize profit for their shareholders. The actual delivery of healthcare is merely a means to that end goal.

How does that have anything to do with HCA? I dont care about HCA whatsoever.

If physicians want to form a cartel to fight private equity thats fine, but call it what it is.

 

[Dr G Oogle]

Thats because rich people can afford to enter medical school due to barriers of entry. If you polled poor people today there would be plenty lining up to accept an admission.

Probably because they believe doctors make good living. I sincerely doubt anyone would want to give up their 20s and mid-30s work 30 hour days and see 30 patients in clinic in addition to fielding phone calls for $100k pretax. My plumber makes more than that.

I work my butt off for my patients, squeeze them in for surgery and see between 25-35 patients in clinic which always runs 2 hours behind; and I give many of them my cell number (which is crazy but is not abused by them). I am in academics but get paid a pretty good amount (would be way more if I was in PP) and am also fairly reimbursed for this extra work. Believe me if i was paid what people perceive as market value, id be available between 9 and 3, 4 days a week, see 15 patients per week and maybe do 5 surgeries per week. I am not alone in this. A lot of people expect doctors to be bleeding heart saints willing to help the masses for free, and I wholly agree that healthcare is a right and everyone should have access to it, but doc salaries ain’t the problem. And any sort of drive on anyone’s part to make salaries even lower will similarly result in subpar care and less than capable people going into medicine.

 

[Lawpy]

On the topic of the Flexner report, that model needs to be replaced with a much better model. I’ll argue much of the deep, systemic problems in med education arose directly because of the severe problems of Flexner report (and the bigoted, outdated views of Flexner himself). So i’ll agree with criticisms of Flexner report but for different reasons

 

[deleted1100659]

Im flattered that all of these medical students (?) have this conspiracy notion that us attending physicians have a secret organization, or cartel if you will as thrown around by a few here, that secretly drives up healthcare costs and allows us to set prices effortlessly. You see, once you graduate medical school, you get your honorary Ferrari (they used to do aston martins but they didnt want us to feel too entitlted) and then your biggest problem becomes deciding between a mansion in miami or beverly hills. We also hold meetings where we have $100 bill fights.

In all seriousness, I pay about $50,000 a year towards my medical school loans (all my loans are literally from medical school). We could always lower physician salaries to 100k a year. Then that way, after taxes and loan repayment, ill make even less than I did in residency, except with 2,000x more responsibility.

American physicians deserve high salaries. Its not entitlement, its simple fact. We take on huge debt, work long hours, and have huge risks. If the risk isnt even somewhat equal to the reward, eventually people wont want to do it. Passion is great and definitely a requirement but no human can undergo the stress of this job without financial compensation that makes up for it. You will burn out in less than a year, this field will chew you up and spit you out.

American residencies limiting FMGs...im confused where that is going..its not exactly easy for me to just go to another country and practice medicine? Thats a whole different can of worms though.

The people that think physicians are the problem, are part of the actual problem itself, which is fueled by ignorance and foolishness without experience and factual data.

 

[7331poas]

Im flattered that all of these medical students (?) have this conspiracy notion that us attending physicians have a secret organization, or cartel if you will as thrown around by a few here, that secretly drives up healthcare costs and allows us to set prices effortlessly.

Its not secret. its call the ACGME. It lowers your competition on the job market.

Can you really argue that is not true?

 

[Lawpy]

If we’re going to criticize physicians, can we condemn the practice of legacy admissions? Why are med school admissions increasingly selecting for kids of physicians, especially kids of the schools’ alumni?

 

[deleted1100659]

Its not secret. its call the ACGME. It lowers your competition on the job market.

Can you really argue that is not true?

How do you propose that the ACGME is lowering my competition?

What do you feel a psychiatrist should be paid? Hm?

 

[Dr G Oogle]

Very impressive.

Sir Angus Deaton received the 2015 Nobel Prize in Economics. His wife, Anne Case, is also an accomplished economist and works alongside him in Princeton's economics department. Here's what they had to say on this matter in an article they co-wrote (emphasis mine):



If only Drs. Deaton and Case had enrolled in your undergrad econ courses. Maybe then they'd know that the concerns above are "dumb" and unworthy of our attention.

Do they go on to talk about the accumulation of debt among America’s doctors compared to other countries? And that in other countries medical education is subsidized and most docs don’t start their practices in crippling debt? Do they talk about the fact that in most other countries med school starts right after high school and does not require as much time to acquire a medical degree? Do they talk about the fact that in many such countries there is a separate healthcare system where doctors charge whatever they want and that’s the only reason they tolerate the lower salaries?

I’d be more than happy to accept a lower salary if everything else that is done in those countries to allow a lower salary is also put in place.

 

[Proudfather94]

Everything you said about flooding the market is true. It is bad for my bottom line. The problem is that American Docs have put their own pockets ahead of patients.
[/QUOTE]
Since when is expecting a good living putting ones pockets ahead of patients? In the United States one has to obtain a 4 year degree while competing tooth and nail with other students to get into medical school to fight tooth and nail to get into a residency if it's competitive. Then you make barley enough money to survive for 3 or more years working nonstop in residency. To say someone is being greedy to the patients for wanting to be paid for having the intelligence and work ethic to deal with all of that for more than 10 years is absurd. If someone is going to achieve that much then they deserve to be in at least the top 5% point blank. This is a capitalistic society and the quality of life for you and your family are directly tied to your income. To expect that to not be important to someone because they take of patients is also absurd.

People who fight this hard to get to where they are will fight to keep the rewards that they earn for getting there. Preventing ones wage from getting cut due to oversupply makes perfect sense. Look at what happened to pharmacology and law their markets are wrecked. Supply needs to match demand or the whole balance gets thrown off.

When do you hold the patient as being responsible for their decisions anyway? If the wait is too long in one area nothing is stopping you from scheduling an appointment somewhere less busy and traveling there.

 

[deleted1100659]

The people that are advocating for a paycut to physicians should set a good example for me by donating half their salary to a worthy cause.

 

[Matthew9Thirtyfive]

Very impressive.

Sir Angus Deaton received the 2015 Nobel Prize in Economics. His wife, Anne Case, is also an accomplished economist and works alongside him in Princeton's economics department. Here's what they had to say on this matter in an article they co-wrote (emphasis mine):



If only Drs. Deaton and Case had enrolled in your undergrad econ courses. Maybe then they'd know that the concerns above are "dumb" and unworthy of our attention.

Then this would be the first time in history that two educated people were wrong about something, I guess.

 

[ACSurgeon]

The people here arguing against the tide are really not interested in a logical discussion and are clearly not trying to exchange information or knowledge. They are just interested in pushing their misinformed opinions and clearly a waste of time for anyone to try and counter.

Of note, most professions are allowed to have unions but physicians are not. Why are we calling the organizations that set standards for medical education or (poorly) represent physician interests as having a cartel?

I wonder if bitterness of the poster(s) is because they are IMG with low chances to match and practice in US. Sure, I can totally understand why someone with a useless degree from the Caribbean would argue that we should allow every “doctor” to work for 150k a year rather than fairly paying physicians and avoiding flooding the market with more physicians than we need. After all, 150k for an IMG is much more than zero, so I understand that logic.

This discussion has run its course. For me anyways.

 

[Lawpy]

The people here arguing against the tide are really not interested in a logical discussion and are clearly not trying to exchange information or knowledge. They are just interested in pushing their misinformed opinions and clearly a waste of time for anyone to try and counter.

Of note, most professions are allowed to have unions but physicians are not. Why are we calling the organizations that set standards for medical education or (poorly) represent physician interests as having a cartel?

I wonder if bitterness of the poster(s) is because they are IMG with low chances to match and practice in US. Sure, I can totally understand why someone with a useless degree from the Caribbean would argue that we should allow every “doctor” to work for 150k a year rather than fairly paying physicians and avoiding flooding the market with more physicians than we need. After all, 150k for an IMG is much more than zero, so I understand that logic.

This discussion has run its course. For me anyways.

They’re US med students. The cartel phenomenon is real but i don’t agree with their focus on physician salaries. The real villain is legacy admissions and the excessive support and advocacy for people from high SES backgrounds

 

[deleted1100659]

The whole cartel thing can easily be countered by the fact that the government funds residency positions, and the match rate is >90% for US physicians, so its not like half the people in the USA that graduate cant find residency/become a doctor. Most who make it through a medical school in the USA go on to match and be a practicing physician. Not to mention were continuously opening new medical schools, and there has been an increase in residency slots, albeit maybe not proportional but this is hard with the consistent increase in DO schools.

I mean come on, there has to be some bar that is set to becoming a physician. I would feel much better knowing the man/woman in charge of my life was the best of the best

 

[nimbus]

How does that have anything to do with HCA? I dont care about HCA whatsoever.

If physicians want to form a cartel to fight private equity thats fine, but call it what it is.

Did you read the article? HCA owns Grand Strand and is trying to start the new ortho residency. And HCA is a publicly traded, for profit corporation, not PE.

 

[Lawpy]

The whole cartel thing can easily be countered by the fact that the government funds residency positions, and the match rate is >90% for US physicians, so its not like half the people in the USA that graduate cant find residency/become a doctor. Most who make it through a medical school in the USA go on to match and be a practicing physician. Not to mention were continuously opening new medical schools, and there has been an increase in residency slots, albeit maybe not proportional but this is hard with the consistent increase in DO schools.

I mean come on, there has to be some bar that is set to becoming a physician. I would feel much better knowing the man/woman in charge of my life was the best of the best

Except it’s not truly best of the best, and there’s a lot of prestige addiction and rampant nepotism in the elite places. Who you know matters far more than board scores and grades especially down the line

 

[Lawpy]

Also posts defending HCA make no sense. HCA suffers a lot of problems and is a massive disturbing symptom of the corporatization of medicine. People are right to slam CEOs, lawyers, senior executives, administrators and private equity managers for making far more than doctors while contributing little of value.

 

[deleted1100659]

Except it’s not truly best of the best, and there’s a lot of prestige addiction and rampant nepotism in the elite places. Who you know matters far more than board scores and grades especially down the line

I look at that as more of a wider issue where money buys power, rather than healthcare specific issue though. I think fixing that would be pretty hard. I don't disagree that things of that nature happen but I do believe the majority who make it this far are hard working/dedicating individuals. Theres always some bad apples in each batch though, no matter what field/sector it is.

Another point of irony, the ones saying we make too much while were in the middle of a pandemic, and many of us were there when it started, sometimes without adequate PPE.

 

[Wordead]

They’re US med students. The cartel phenomenon is real but i don’t agree with their focus on physician salaries. The real villain is legacy admissions and the excessive support and advocacy for people from high SES backgrounds

Not sure why all the medical students see it through the lens of a cartel rather than maintaining quality control and not turning out crappy doctors (which is already happening). You can't train an unlimited number of people to the same level.

 

[7331poas]

How do you propose that the ACGME is lowering my competition?

What do you feel a psychiatrist should be paid? Hm?

They restrict the number of graduating psychiatrists each year. Do they not?

 

[Lawpy]

I look at that as more of a wider issue where money buys power, rather than healthcare specific issue though. I think fixing that would be pretty hard. I don't disagree that things of that nature happen but I do believe the majority who make it this far are hard working/dedicating individuals. Theres always some bad apples in each batch though, no matter what field/sector it is.

Another point of irony, the ones saying we make too much while were in the middle of a pandemic, and many of us were there when it started, sometimes without adequate PPE.

The problem is it has real negative effects that start clearly from the bottom up (so med school admissions actively selecting against people from low SES backgrounds who couldn’t do much because they had to work to pay bills in favor of people from high SES backgrounds with amazing travel and humanitarian experiences because they don’t have to worry about the bills). This isolates the profession from society and gives admins the excuse to keep raising debt under the grounds that people will be able to pay it off

So with increasing debt comes with other increasing pains in the medical training process and that results in frustrated newly mint doctors wanting to defend their earnings and job security. And with that comes nepotism and connections to help each other and isolate themselves even more from those who weren’t privileged to be well off in the first place

People like to rail on COCA for the DO expansion but honestly, it’s looking like DO schools are becoming more meritocratic (where connections, alumni network play a less role) since it gives a chance for those from middle and low SES backgrounds to become a doctor even despite poor circumstances and make $200K/year working in FM, IM, peds etc.

But the higher the prestige ladder goes, the more critical these connections become and that can end up having real negative consequences down the line. This effectively feeds the cartel phenomenon but for very different reasons from what others are arguing. The issue is not physician salaries (if anything, reimbursements should go up). The issue is the overwhelming emphasis of social capital and high SES in the profession. Unless the problem changes from the ground up (so with physicians themselves in admissions and resident selection committees), the gatekeeping will only worsen

Not sure why all the medical students see it through the lens of a cartel rather than maintaining quality control and not turning out crappy doctors (which is already happening). You can't train an unlimited number of people to the same level.

The quality control unfairly punishes too many good candidates who either slipped through the cracks, lacked the connections from being handicapped by their school, SES status etc. Too many poor candidates and those with massive red flags get through only to end up being expelled, fired, or worse, graduating and killing people down the line

 

[DarkHorizon]

They restrict the number of graduating psychiatrists each year. Do they not?

So the premise of your argument is they we should train unlimited number of psychiatrists? Not sure if you’re purposely being disingenuous.

 

[nimbus]

So the premise of your argument is they we should train unlimited number of psychiatrists? Not sure if you’re purposely being disingenuous.

The bottleneck also happens in having enough willing patients and cases. In my specialty, you can’t have a residency program unless you can guarantee an adequate number of transplants, trauma, cardiac, neuro, pediatric, and all other subspecialty cases. You shouldn’t let barely adequate graduates loose on the unsuspecting public. Not enough cases=no residency.

 

[7331poas]

Not sure why all the medical students see it through the lens of a cartel rather than maintaining quality control and not turning out crappy doctors (which is already happening). You can't train an unlimited number of people to the same level.

You're right. Wouldnt want crappy doctors from the UK to enter into the midst of the superior American Physician.

 

[operaman]

I’m always amazed how ingrained some of the political talking points become in our culture and how they infect discussions such as this one.

Healthcare is a right? Are you kidding me?! Quite possibly one of the stupidest things I’ve ever heard. If it’s a right then who is compelled to provide it? Sure, it’s unethical that a society with means would turn anyone away from care who needs it (and a massive chunk of my patients are Medicaid or uninsured), but arguing some innate right to healthcare seems nonsensical to me. I do it because I feel it’s the right thing to do, but someone refusing to see a patient or group of patients is not violating their human rights.

I also don’t see the problem with having SES barriers to entry in the profession. The aim of medicine is not to provide a means of social engineering for the less fortunate, so if our system means we end up with more docs from affluent backgrounds I have no issue with that. Our goal should be providing the best care we possibly can, not providing more opportunities for less fortunate students to reach their lifelong goals of becoming an orthopedic surgeon. Not everyone gets to do what they want to do. A competitive residency is not the participation trophy for medical school.

So, if we chose to view this OrthoSC group through the lens of leftism, then they’re just greedy docs trying to stamp out competition and preventing more Med students from becoming orthopedic surgeons while also restricting access to Ortho care in their area. But when viewed through a more realistic and pragmatic lens, they are fighting to maintain the high standard of care in their region while preventing the proliferation of underpaid employed positions by a for profit entity that is not even hiding its intention to push the private group out of the local market. They are preventing yet another crap community program from opening and churning out poorly trained surgeons whose best job coming out of training will be an HCA employed position.

 

[deleted1100659]

You're right. Wouldnt want crappy doctors from the UK to enter into the midst of the superior American Physician.

Is there a long line of UK doctors trying to come here to practice psychiatry? I doubt it would be enough to fill the gap.

Seems a little unfair they could do medical school there for pretty much nothing, come here with no debt and make a higher income, while physicians trained here have debt burdens >300k. I can't just go to the UK whenever I feel like it. I mean theres rules for logical reasons. it seems you don't have a lot of experience in this area because you havent exactly lived it or gone through it.

 

[deleted1100659]

The problem is it has real negative effects that start clearly from the bottom up (so med school admissions actively selecting against people from low SES backgrounds who couldn’t do much because they had to work to pay bills in favor of people from high SES backgrounds with amazing travel and humanitarian experiences because they don’t have to worry about the bills). This isolates the profession from society and gives admins the excuse to keep raising debt under the grounds that people will be able to pay it off

Have to respectfully disagree with that, as a first generation college student who paid for his own college and medical school, and worked my entire life. Nothing was handed to me and I made it. I worked a full time job, no one in my family had even graduated college. So its def possible to work hard. Some people have more advantages than others but hard work can overcome many things.

 

[jstwannagraduaaate!!!]

As an M2, I can't believe people advocate against the best interests of their field. We see law, finance, engineering, etc pushing to increase their pie. Yet we have people in medicine being submissive to overexpansion and exploitation by admin on the predication of the lie that is "increased positive patient outcomes". They oversaturate your field and cut your pay, patients will still be paying the same prices (if not even higher prices, the suits need to pay off their new beamer!) and you'll just get paid less, econ 101.

Also, med school pushes students to develop Stockholm syndrome and it seems like we are the only field that has people walking around scarred of their own shadows. I have seen my friends in other fields and all of them are confident and cocky, and will get their piece of the pie. Not saying medicine needs to become that, but we need a MUCH stronger backbone.

 

[DarkHorizon]

You're right. Wouldnt want crappy doctors from the UK to enter into the midst of the superior American Physician.

What a loaded statement! Can I go fix some femurs in the UK? I know for a fact they have a shortage of orthopedic surgeons there. And why would anyone from the UK would want to come to the US to practice in underserved areas to fill gaps in our coverage?

 

[Lawpy]

Have to respectfully disagree with that, as a first generation college student who paid for his own college and medical school, and worked my entire life. Nothing was handed to me and I made it. I worked a full time job, no one in my family had even graduated college. So its def possible to work hard. Some people have more advantages than others but hard work can overcome many things.

It’s not impossible but it’s much harder. The privileged have an easier time in medicine and the system from med admissions onwards actively encourages that

 

[ACSurgeon]

It’s not impossible but it’s much harder. The privileged have an easier time in medicine and the system from med admissions onwards actively encourages that

Do you have stats? How much weight are schools giving to kids of alumni or “well connected people”. Is it if two people with similar merit come the legacy gives you a leg up? Or are they take people with below average stats? We should not discriminate against the sons of doctors or a certain school against the alumni’s Kidd. Again, what’s your proof of real bias? Anecdotes don’t work. My anecdotes indicate there were more kids of less privileged backgrounds in my class.

Also like brought up before everything is easier with money. I had no connections and my “sob story” helped my admission maybe. But I hope my kids have more resources and an easier time with whatever they choose to do.

 

[Proudfather94]

The problem is it has real negative effects that start clearly from the bottom up (so med school admissions actively selecting against people from low SES backgrounds who couldn’t do much because they had to work to pay bills in favor of people from high SES backgrounds with amazing travel and humanitarian experiences because they don’t have to worry about the bills). This isolates the profession from society and gives admins the excuse to keep raising debt under the grounds that people will be able to pay it off

I disagree with people from low SES statuses being selected against. My entire family is blue collar I'm the only one with a STEM degree. I worked weekends through undergrad and worked full time in the hospital on night shift while studying for the MCAT. It took me a little longer to get in somewhere than I planned but I made it. The school I got into saw all of this and commended me on my perseverance and I think that is what got me accepted. I bet if I came from a wealthy family and had no work experience it would have less likely I would have gotten in so my experience is the exact opposite of what you're saying.

Is it harder for people with low SES backgrounds to have the stats to get in? Absolutely, is it fair? He'll no, but adcoms don't purposely count out those who make it. You'll have to work harder than someone with more resources and privilege but that's life. You either outwork them or fall behind.

 

[Matthew9Thirtyfive]

I disagree with people from low SES statuses being selected against. My entire family is blue collar I'm the only one with a STEM degree. I worked weekends through undergrad and worked full time in the hospital on night shift while studying for the MCAT. It took me a little longer to get in somewhere than I planned but I made it. The school I got into saw all of this and commended me on my perseverance and I think that is what got me accepted. I bet if I came from a wealthy family and had no work experience it would have less likely I would have gotten in so my experience is the exact opposite of what you're saying.

Is it harder for people with low SES backgrounds to have the stats to get in? Absolutely, is it fair? He'll no, but adcoms don't purposely count out those who make it. You'll have to work harder than someone with more resources and privilege but that's life. You either outwork them or fall behind.

The process selects for affluent applicants because it is significantly easier for them to jump through the hoops necessary to be competitive. Adcoms not purposely rejecting low SES applicants does not mean the process doesn’t select against them.

 

[DarkHorizon]

The process selects for affluent applicants because it is significantly easier for them to jump through the hoops necessary to be competitive. Adcoms not purposely rejecting low SES applicants does not mean the process doesn’t select against them.

Agree with this. Came from a working class immigrant family with income of 20k. Lucky to be here but it was not easy.