Why Does the U.S. Make It So Hard to Be a Doctor?

[SurfingDoctor]

Why America Has So Few Doctors

As a matter of basic economics, fewer doctors means less care and more expensive services.

www.theatlantic.com

It's a good question without a satisfactory answer...

(I can also appreciate any article that takes a slash at the AMA)

But this article only kinda deals with the elephant in the room... the cost and time of education in this country that has very little pay off.

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[scoopdaboop]

Why America Has So Few Doctors

As a matter of basic economics, fewer doctors means less care and more expensive services.

www.theatlantic.com

It's a good question without a satisfactory answer...

(I can also appreciate any article that takes a slash at the AMA)

But this article only kinda deals with the elephant in the room... the cost and time of education in this country that has very little pay off.

idk about the little pay off... but i agree it needs revolution.

 

[Isoval]

idk about the little pay off... but i agree it needs revolution.

Comparatively, we get paid ass for the time, effort, and loans required to be a doctor.

If I had gone into engineering instead, I would likely have similar lifetime earning potential unless I had gone to do neurosurgery or some other crazy high-paying specialty. Additionally, very few would argue work-life balance of engineering is worse than being a doctor.

To be clear, we don't have tiny pay-off, but by comparison it really makes you wonder why we endure so much when other paths have similar lifetime payoff.

 

[VA Hopeful Dr]

That article was written by someone who doesn't actually know what's going on in US medical education in the last decade. Yes, all that stuff in the 90s that the AMA did was pretty shady but that was 20+ years ago.

I'm FM. When I matched, there were 2600 FM PGY-1 spots. In 2020 it was up to 4600 and 2021 was up to 4800. That's a pretty big increase that are continuing at a fair pace. I know of 2 programs in my state alone that are due to take their first class either this year or next. That's in addition to the 4 new programs that have opened in the 9 years since I finished residency. The only real concern I have with this is the fact that the FM work force is like 20% Boomers.

Length of training is more complicated. Here in the US, post-high school it takes 11 years to become a family doctor. In Australia, for comparison, it takes 11 years to be a certified GP. 6 years undergraduate medical school, 1 year internship, 1 years residency, 3 years GP Registrar. Most other specialties actually take longer than it does here in the US. In the UK it also takes 11 years to be a GP: 6 years med school, 2 Foundation Doctor years and 3 years of GP Registrar training. Now you could make the argument about shortening undergrad, but I seem to recall you complaining about the BS/MD students in the past, and you're hardly alone in that viewpoint. I had several residency attendings who felt the same way.

The biggest issue, and I feel like I say this very often, is the loan burden. It definitely shouldn't cost 350k to become a doctor when it cost 150k less than 20 years ago.

There's also something to be said for trained doctors from other countries to come here. I'd still support some reasonable stringent requirements, but not quite what it is currently.

 

[Lawpy]

Debt and the corporatization of medicine/medical training need to be urgently addressed. There’s zero reason to allow for HCA programs to exist and rapidly expand for example. There are systemic problems in the training pathway as well with the major issues occurring in residency application process

 

[Proudfather94]

What's the rate of students dropping out in other countries? I know that it's hard to get in here because they want one to prove that they can handle the rigors of medical by getting a bachelors with a good enough GPA while also getting clinical and volunteering experience. Honestly our system is the consequence of runaway competition and tuition hikes.

Off topic but I think this was the government's intentions all along. They knew that colleges would raise the bill if daddy government paid it. This means they collect more in interest from everyone's loans basically making college a career tax. High tuition isn't a bug it's a feature.

 

[SurfingDoctor]

Why America Has So Few Doctors

As a matter of basic economics, fewer doctors means less care and more expensive services.

www.theatlantic.com

It's a good question without a satisfactory answer...

(I can also appreciate any article that takes a slash at the AMA)

But this article only kinda deals with the elephant in the room... the cost and time of education in this country that has very little pay off.

Along a similar vein...

How do U.S. healthcare resources compare to other countries? - Peterson-KFF Health System Tracker

This chart collection looks at the availability of hospital resources and healthcare professionals in the United States and similarly wealthy countries. A related chart collection examines how the U.S.’s healthcare resources factor into the nation’s preparedness for the coronavirus pandemic. The...

www.healthsystemtracker.org

This always gets at the question of shortages as the shortages are really in primary care fields, but there is saturation in specialist fields. One could certainly blame student debt... but the change from primary care to specialist care occurred in the 1970s.

Where Have the Generalists Gone? They Became Specialists, Then Subspecialists

 

[Proudfather94]

Along a similar vein...

How do U.S. healthcare resources compare to other countries? - Peterson-KFF Health System Tracker

This chart collection looks at the availability of hospital resources and healthcare professionals in the United States and similarly wealthy countries. A related chart collection examines how the U.S.’s healthcare resources factor into the nation’s preparedness for the coronavirus pandemic. The...

www.healthsystemtracker.org

This always gets at the question of shortages as the shortages are really in primary care fields, but there is saturation in specialist fields. One could certainly blame student debt... but the change from primary care to specialist care occurred in the 1970s.

Where Have the Generalists Gone? They Became Specialists, Then Subspecialists

I think the competitive nature one has to have to make it to medical school contributes to the problem as well. The reputation that one is a primary care doc because they weren't good enough to specialize still exists. I think that makes people's egos get in the way and they end up picking a specialty that they're just OK with when they would have been happiest in a primary care field. Money is also a factor since it varies so wildly.

 

[SurfingDoctor]

I think the competitive nature one has to have to make it to medical school contributes to the problem as well. The reputation that one is a primary care doc because they weren't good enough to specialize still exists. I think that makes people's egos get in the way and they end up picking a specialty that they're just OK with when they would have been happiest in a primary care field. Money is also a factor since it varies so wildly.

I don't necessarily disagree. It is interesting that the solution offered by all these articles are to increase NP/PA numbers. Yet then physicians lament about that and schools can't force someone to fill in the gaps, they just get the reports that there's shortages and build new schools, which in turn, don't produce generalists.

Of course, I'm just watching from the sidelines and seeing it unfold... but it interesting how its a self-perpetuating cycle.

Also slightly surprised no one brought up Medicare expansion of the 1960s and 1970s as a catalyst for primary care shortage.

 

[Lawpy]

I don't necessarily disagree. It is interesting that the solution offered by all these articles are to increase NP/PA numbers. Yet then physicians lament about that and schools can't force someone to fill in the gaps, they just get the reports that there's shortages and build new schools, which in turn, don't produce generalists.

Of course, I'm just watching from the sidelines and seeing it unfold... but it interesting how its a self-perpetuating cycle.

Also slightly surprised no one brought up Medicare expansion of the 1960s and 1970s as a catalyst for primary care shortage.

I think we should allow IMGs to practice as assistant physicians with restricted licenses to outcompete midlevels and resolve the gaps

 

[Proudfather94]

I don't necessarily disagree. It is interesting that the solution offered by all these articles are to increase NP/PA numbers. Yet then physicians lament about that and schools can't force someone to fill in the gaps, they just get the reports that there's shortages and build new schools, which in turn, don't produce generalists.

Of course, I'm just watching from the sidelines and seeing it unfold... but it interesting how its a self-perpetuating cycle.

Also slightly surprised no one brought up Medicare expansion of the 1960s and 1970s as a catalyst for primary care shortage.

I think the best solution would be to bump up the pay of primary care doctors so that the disparity is smaller between them and specialists. This could be done by increasing reimbursements and/or offering tax breaks. With the pay closer to the average specialist the whole ego issue isn't solved but it wouldn't be as bad. Yeah a gp may not have done as well as a radiologist in medical school but if the pay gap is like 50k or less does it matter as much as it does with our market today?

It's hard to justify going into primary care unless you have a wealthy family who can take care of themselves and there is a low chance that you'll need to help them. If one makes 250k a year before taxes and they have kids, a mortgage, and a spouse and then have parents who need taken care of and others who are in trouble that salary isn't looking as big at it used too. It would make sense to specialize and try to make more money to plan for this stuff so that it won't have as big of an impact on your life or retirement.

 

[SurfingDoctor]

I think the best solution would be to bump up the pay of primary care doctors so that the disparity is smaller between them and specialists. This could be done by increasing reimbursements and/or offering tax breaks. With the pay closer to the average specialist the whole ego issue isn't solved but it wouldn't be as bad. Yeah a gp may not have done as well as a radiologist in medical school but if the pay gap is like 50k or less does it matter as much as it does with our market today?

It's hard to justify going into primary care unless you have a wealthy family who can take care of themselves and there is a low chance that you'll need to help them. If one makes 250k a year before taxes and they have kids, a mortgage, and a spouse and then have parents who need taken care of and others who are in trouble that salary isn't looking as big at it used too. It would make sense to specialize and try to make more money to plan for this stuff so that it won't have as big of an impact on your life or retirement.

Sure, seems unlikely though since the trend has been decades in the making. Its far more likely to have the current trends continue, that being increasing medical schools (and spots) that produce specialists and increasing PA/NP coverage in primary care.

 

[Proudfather94]

Sure, seems unlikely though since the trend has been decades in the making. Its far more likely to have the current trends continue, that being increasing medical schools (and spots) that produce specialists and increasing PA/NP coverage in primary care.

Mid-levels tend to overtest and miss crap because their training sucks. We need a way to fix this so pts don't suffer and people don't feel financially and socially pressured into specializing. There has to be a way to show that Mid-levels are not the solution that doesn't involve doctors letting them run wild and hurt pts to prove our point.

I think doctors should lobby and advocate for independent Mid-levels to be held to the exact same standards as physicians. Call them on their bluff and go okay you think you're as good as us bye bye training wheels hello liability and accountability. After a few get eaten alive by malpractice attorneys they would fall back in line.

 

[SurfingDoctor]

Mid-levels tend to overtest and miss crap because their training sucks. We need a way to fix this so pts don't suffer and people don't feel financially and socially pressured into specializing. There has to be a way to show that Mid-levels are not the solution that doesn't involve doctors letting them run wild and hurt pts to prove our point.

I think doctors should lobby and advocate for independent Mid-levels to be held to the exact same standards as physicians. Call them on their bluff and go okay you think you're as good as us bye bye training wheels hello liability and accountability. After a few get eaten alive by malpractice attorneys they would fall back in line.

If I had to guess, I would say nothing will change until the specialist job markets force a change in the primary care market (since the speciality market is the driving force) because there will be doctors who can't practice in what they want to practice for whatever reason and market forces drive them into the primary care market. Who knows if or when that would happen... but its just a hunch.

 

[Browns99]

Mid-levels tend to overtest and miss crap because their training sucks. We need a way to fix this so pts don't suffer and people don't feel financially and socially pressured into specializing. There has to be a way to show that Mid-levels are not the solution that doesn't involve doctors letting them run wild and hurt pts to prove our point.

I think doctors should lobby and advocate for independent Mid-levels to be held to the exact same standards as physicians. Call them on their bluff and go okay you think you're as good as us bye bye training wheels hello liability and accountability. After a few get eaten alive by malpractice attorneys they would fall back in line.

I think the best solution would be to bump up the pay of primary care doctors so that the disparity is smaller between them and specialists. This could be done by increasing reimbursements and/or offering tax breaks. With the pay closer to the average specialist the whole ego issue isn't solved but it wouldn't be as bad. Yeah a gp may not have done as well as a radiologist in medical school but if the pay gap is like 50k or less does it matter as much as it does with our market today?

It's hard to justify going into primary care unless you have a wealthy family who can take care of themselves and there is a low chance that you'll need to help them. If one makes 250k a year before taxes and they have kids, a mortgage, and a spouse and then have parents who need taken care of and others who are in trouble that salary isn't looking as big at it used too. It would make sense to specialize and try to make more money to plan for this stuff so that it won't have as big of an impact on your life or retirement.

Sure, let's get pay parity between the neurosurgeon and the FM, surely the level of training is the same.....BTW, my comment is not a knock on FM in any way, it's just a response to the poster.

 

[Proudfather94]

Sure, let's get pay parity between the neurosurgeon and the FM, surely the level of training is the same.....BTW, my comment is not a knock on FM in any way, it's just a response to the poster.

I never said that FM should get near what a neurosurgeon makes you're breaking your back with that reach. I said they should make a salary that is more compared to the average specialist not the most competitive specialty with the longest residency.

"If I had to guess, I would say nothing will change until the specialist job markets force a change in the primary care market (since the speciality market is the driving force) because there will be doctors who can't practice in what they want to practice for whatever reason and market forces drive them into the primary care market. Who knows if or when that would happen... but its just a hunch."


I don't think anything will change if we continue going that route. I think there has to be more financial incentives introduced to make primary care more lucrative. We need to find a way to make sure most people that are in primary care are there because they wanted to be instead of where they just ended up.

 

[VA Hopeful Dr]

Sure, seems unlikely though since the trend has been decades in the making. Its far more likely to have the current trends continue, that being increasing medical schools (and spots) that produce specialists and increasing PA/NP coverage in primary care.

I agree the money plays a part, but I think that's not the whole of it. Part of it, as someone else mentioned, is primary care has the stigma of being the bottom of the barrel med students. Part of it is that some people just generally don't like the work. You hear around here often that many of the specialists love being able to say "I don't do that, go see your PCP". Not everyone likes being a generalist either, the whole "master of none" thing doesn't appeal to everyone.

 

[SurfingDoctor]

I agree the money plays a part, but I think that's not the whole of it. Part of it, as someone else mentioned, is primary care has the stigma of being the bottom of the barrel med students. Part of it is that some people just generally don't like the work. You hear around here often that many of the specialists love being able to say "I don't do that, go see your PCP". Not everyone likes being a generalist either, the whole "master of none" thing doesn't appeal to everyone.

Yeah, that’s always been rather perplexing to me actually. I like the idea of having solutions to a variety of answers, not only one answer to a specific question. I guess that’s why I’ve never given up my general boards and picked a subspecialty that was jack of all trades. But to each their own.

I suppose though at some point, to each their own won’t be sufficient advice and it’ll be more like either you want to be a physician who does primary care or you don’t want to be a doctor at all. Currently, market forces aren’t forcing that decision on people quite yet, but I have a hunch it’ll come faster than people anticipate and catch the system off guard.

 

[Proudfather94]

I agree the money plays a part, but I think that's not the whole of it. Part of it, as someone else mentioned, is primary care has the stigma of being the bottom of the barrel med students. Part of it is that some people just generally don't like the work. You hear around here often that many of the specialists love being able to say "I don't do that, go see your PCP". Not everyone likes being a generalist either, the whole "master of none" thing doesn't appeal to everyone.

I imagine it does sting when someone comes to you for help and you have to send them to a specialist to figure out what's wrong. I'm sure you also deal with more bs that you're more inclined to deal with as a cardiologist can decline to look at that weird groin rash as that's out of their wheelhouse.

 

[VA Hopeful Dr]

I never said that FM should get near what a neurosurgeon makes you're breaking your back with that reach. I said they should make a salary that is more compared to the average specialist not the most competitive specialty with the longest residency.

I blame medical schools for this kind of thinking. Primary care can be pretty lucrative. Will I ever make cardiologist money? Barring severe socialized medicine, no. Do I make a very good living given the hours I work (36/week), the days I work (M-F no nights, weekends, or holidays), and for having a pretty short education post-med school? Heck yes.

 

[VA Hopeful Dr]

Yeah, that’s always been rather perplexing to me actually. I like the idea of having solutions to a variety of answers, not only one answer to a specific question. I guess that’s why I’ve never given up my general boards and picked a subspecialty that was jack of all trades. But to each their own.

I suppose though at some point, to each their own won’t be sufficient advice and it’ll be more like either you want to be a physician who does primary care or you don’t want to be a doctor at all. Currently, market forces aren’t forcing that decision on people quite yet, but I have a hunch it’ll come faster than people anticipate and catch the system off guard.

That was a big draw for me, I like the fact that a week almost never goes by that I don't use almost every part of my medical education. I also like being the first stop for health issues.

 

[VA Hopeful Dr]

I imagine it does sting when someone comes to you for help and you have to send them to a specialist to figure out what's wrong. I'm sure you also deal with more bs that you're more inclined to deal with as a cardiologist can decline to look at that weird groin rash as that's out of their wheelhouse.

Not at all, although that doesn't happen all that often either. I usually have a pretty good idea why I'm referring someone.

 

[Proudfather94]

I blame medical schools for this kind of thinking. Primary care can be pretty lucrative. Will I ever make cardiologist money? Barring severe socialized medicine, no. Do I make a very good living given the hours I work (36/week), the days I work (M-F no nights, weekends, or holidays), and for having a pretty short education post-med school? Heck yes.

That's good I do think more incentives need to be introduced to encourage people to go into the speciality with the mindset of helping underserved areas. If they offered enough in tax breaks and other things (maybe government matched pension or something?) That it rose the average to be closer to non surgical specialties that would really help out.

 

[Wordead]

I never said that FM should get near what a neurosurgeon makes you're breaking your back with that reach. I said they should make a salary that is more compared to the average specialist not the most competitive specialty with the longest residency.

"If I had to guess, I would say nothing will change until the specialist job markets force a change in the primary care market (since the speciality market is the driving force) because there will be doctors who can't practice in what they want to practice for whatever reason and market forces drive them into the primary care market. Who knows if or when that would happen... but its just a hunch."


I don't think anything will change if we continue going that route. I think there has to be more financial incentives introduced to make primary care more lucrative. We need to find a way to make sure most people that are in primary care are there because they wanted to be instead of where they just ended up.

Where is this money going to come from? You going to up taxes to pay doctors more? Take it from specialists?

 

[Lawpy]

Where is this money going to come from? You going to up taxes to pay doctors more? Take it from specialists?

Med school endowments

 

[Proudfather94]

Where is this money going to come from? You going to up taxes to pay doctors more? Take it from specialists?

Maybe the government could adjust the budget a little to allocate money to it. I'm sure the health of the country is more important than some things we waste money on as a country. It shouldn't come from specialists though. Primary care needs get risen up rather than specialties being torn down.

 

[VA Hopeful Dr]

That's good I do think more incentives need to be introduced to encourage people to go into the speciality with the mindset of helping underserved areas. If they offered enough in tax breaks and other things (maybe government matched pension or something?) That it rose the average to be closer to non surgical specialties that would really help out.

Its already there in many places.

 

[notretired]

Its already there in many places.

Do you have examples of this? Not being snarky at all but genuinely curious as I've heard of a few state programs that have tuition forgiveness, but relatively small number of spots and relatively hard to get (need to be from the area etc).

 

[VA Hopeful Dr]

Do you have examples of this? Not being snarky at all but genuinely curious as I've heard of a few state programs that have tuition forgiveness, but relatively small number of spots and relatively hard to get (need to be from the area etc).

Well any nonprofit can do PSLF. Most hospitals and I think a goodly number of FQHCs offer loan repayment.

But I was more going for the fact that we can make a good amount of money to begin with. For instance, pretty much every full time PCP in my network whose not brand new or old and slowing down broke 300k last year. About a quarter of us broke 400.

 

[Proudfather94]

Well any nonprofit can do PSLF. Most hospitals and I think a goodly number of FQHCs offer loan repayment.

But I was more going for the fact that we can make a good amount of money to begin with. For instance, pretty much every full time PCP in my network whose not brand new or old and slowing down broke 300k last year. About a quarter of us broke 400.

That's pretty much the average nonsurgical specialty pay. Is that going to have to be in really rural areas or just out of major cities?

 

[VA Hopeful Dr]

That's pretty much the average nonsurgical specialty pay. Is that going to have to be in really rural areas or just out of major cities?

I'm in a smallish SC town but that's not unusual for Columbia or Greenville. So not major cities but not middle of nowhere either.

 

[Redpancreas]

If we put average Americans under the right circumstances and motivation, an overwhelming majority would be able to (eventually) matriculate into medical school and eventually become physicians.

The issue is the amount of redundancy it takes to get there. It starts with the American education system. First we have middle school where we learn things foreigners are learning in 3rd grade. In high school, there's so much variability that some high schoolers graduate knowing more science/math and write better than other college graduates...whereas others come out not even knowing basic concepts like mass and density. Therefore, we all are put through 4 years of general studies unless you're lucky to get into a BS/MD program that shaves off years. Then, there's an admissions test that doesn't even test the primary competencies of being a physician, but it creates another bottleneck in the system.

Then, you come into medical school and have to memorize a ton of irrelevant information which had nothing to do with what you previously learned and frankly has little to do with our future, but oh well... Most of us are in our mid-20s before we actually start seeing patients and getting assessed. You don't like it or you suck? Kind of late to switch... The clinical education in medical "school" is so variable with no real standards across schools aside from board exams that don't represent real medicine and most medical schools graduate with critical deficiencies because of inadequate assessment and supervision. The residency part is good because at that point, there is a need to take some accountability for patient care...but after that though, no one trusts us to make any decisions because the U.S. medicolegal interplay is set up in such a way where specialist consultation is incentivized for every little thing despite our entire training system teaching us it's not indicated...creating a positive feedback cycle for unneeded specialist involvement.

Meanwhile, an alternative field comes in and creates a shortcut and everyone's confused. Are they fake doctors? Why are some of them kind of legit tho?

The entire system just lacks direction and is getting more chaotic each year. Ultimately anyone going through this knows what I'm talking about, but the money making industries who have the power to fix this stuff don't do it because they're not committed to the education of physicians or care about long term well-being, but rather want to make sure if a patient develops XYZ medical problem, they can provide the care that is indicated often in the form of an overpriced hospitalization that comes onto the taxpayers and patient.
.

 

[7331poas]

Its hard to become a doctor because doctors intentionally limit the supply of graduates in order to increase their salaries.

 

[Lawpy]

Its hard to become a doctor because doctors intentionally limit the supply of graduates in order to increase their salaries.

How do EM and radonc physicians react?

 

[jstwannagraduaaate!!!]

A thing that is overlooked is ownership of a practice, its more difficult to do now but from what I've been told, fm and medicine subspecialists can make this happen provided they put in the work. I see people on this site get so caught up in X specialty makes X compared to X field; hypothetically, do you really believe the high earning GI doc or allergist who owns their own clinic is going to participate in these surveys? No. Sure nsgy makes a lot of money, but a lot of neurosurgery jobs are employed and dependent on hospitals (unless you do spine in pp). So while the salary looks great, its more of a tax burden filling out a W2 making 800k rather than a 1099 making 500k (and you can "pay" yourself less, put the extra $ into an LLC etc).

And yes as an m2 I see students all the time cringe when the words family medicine are spoken, meanwhile here in the SE they make 350-400k which isn't bad if you ask me (again pretty solid if you own the practice). But a major problem is the threat of nps, if they didn't exist you would see more med students being fine with being a pcp. Personally, I think equating mid levels to docs is like saying the flight attendant can fly the plane, the two aren't equal and its a joke how much they have grown. Also these nps do not go into rural areas like their lobby said they would lol, they just flock to the cities and pretend to play doctor.

 

[jstwannagraduaaate!!!]

Its hard to become a doctor because doctors intentionally limit the supply of graduates in order to increase their salaries.

Expanding fields is how you "kill" fields, see em and rad onc.

Basic economics really needs to be taught in med schools, the concept of supply and demand is not difficult to grasp.

 

[7331poas]

Expanding fields is how you "kill" fields, see em and rad onc.

Basic economics really needs to be taught in med schools, the concept of supply and demand is not difficult to grasp.

Not sure what the point of your comment is. I clearly stated that limiting the supply will increase the demand for an individual physician. What is incorrect there?

 

[Goro]

Why America Has So Few Doctors

As a matter of basic economics, fewer doctors means less care and more expensive services.

www.theatlantic.com

It's a good question without a satisfactory answer...

(I can also appreciate any article that takes a slash at the AMA)

But this article only kinda deals with the elephant in the room... the cost and time of education in this country that has very little pay off.

 

[Goro]

I don't know, maybe because there's a finite pool of people who are smart enough and competent enough to be doctors in the United States?

And if we recruit them from overseas than we are robbing the pool of people who are competent enough and smart enough to be doctors in their home countries?

It's not that we make it hard to be doctors in the United States, we want to make sure that doctors don't kill patients in the United States.

If it's hard for people to find doctors in Jonesboro Arkansas, Skagit Alaska, or Kalispell Montana, maybe they should be paid more,? Just a thought.

 

[Goro]

I blame medical schools for this kind of thinking. Primary care can be pretty lucrative. Will I ever make cardiologist money? Barring severe socialized medicine, no. Do I make a very good living given the hours I work (36/week), the days I work (M-F no nights, weekends, or holidays), and for having a pretty short education post-med school? Heck yes.

Even back in 1994, when I was a postdoc at a major medical school in the Midwest, I remember an MD PhD student telling me that a Family Care doc was just a "traffic cop", ie, sending people to specialists. So that pernicious mindset has been around for quite a while!

 

[SurfingDoctor]

Even back in 1994, when I was a postdoc at a major medical school in the Midwest, I remember an MD PhD student telling me that a Family Care doc was just a "traffic cop", ie, sending people to specialists. So that pernicious mindset has been around for quite a while!

I actually thoroughly enjoyed my family medicine rotation in medical school. Much better than half the other rotations I had.

 

[Osminog]

I don't know, maybe because there's a finite pool of people who are smart enough and competent enough to be doctors in the United States?

And if we recruit them from overseas than we are robbing the pool of people who are competent enough and smart enough to be doctors in their home countries?

It's not that we make it hard to be doctors in the United States, we want to make sure that doctors don't kill patients in the United States.

If it's hard for people to find doctors in Jonesboro Arkansas, Skagit Alaska, or Kalispell Montana, maybe they should be paid more,? Just a thought.

We have fewer physicians per capita than many developed Western counties, despite having a much less healthy population than all of them.

It’s not that we don’t have enough smart, competent people. I haven’t seen any evidence that America has a smaller proportion of intelligent people compared to, say, Italy or Spain. The real issue is that the American system of medical education has uniquely unpleasant barriers to entry—ones that push many smart, talented people away from medicine and toward other career paths.

 

[Goro]

We have fewer physicians per capita than many developed Western counties, despite having a much less healthy population than all of them.

View attachment 350197

It’s not that we don’t have enough smart, competent people. I haven’t seen any evidence that America has a smaller proportion of intelligent people compared to, say, Italy or Spain. The real issue is that the American system of medical education has uniquely unpleasant barriers to entry—ones that push many smart, talented people away from medicine and toward other career paths.

With all the Tiger Parents we have???????

I'm amazed!

 

[VA Hopeful Dr]

We have fewer physicians per capita than many developed Western counties, despite having a much less healthy population than all of them.

View attachment 350197

It’s not that we don’t have enough smart, competent people. I haven’t seen any evidence that America has a smaller proportion of intelligent people compared to, say, Italy or Spain. The real issue is that the American system of medical education has uniquely unpleasant barriers to entry—ones that push many smart, talented people away from medicine and toward other career paths.

No, the real issue is that we've only recently really started expanding med schools and residencies after years of small changes at best. I also wonder if our population is growing faster than those European countries.

If the barriers to entry were the problem then you would see medical school seats going unfilled.

 

[7331poas]

No, the real issue is that we've only recently really started expanding med schools and residencies after years of small changes at best. I also wonder if our population is growing faster than those European countries.

If the barriers to entry were the problem then you would see medical school seats going unfilled.

This is incorrect. Because we also have barriers of entry along our borders. Is there something about UK or Germanic doctors that makes them so unqualified to practice here in the States?

 

[VA Hopeful Dr]

This is incorrect. Because we also have barriers of entry along our borders. Is there something about UK or Germanic doctors that makes them so unqualified to practice here in the States?

That was not a point you made in your original post. Your original point, the one I was addressing with my post, was this:

We have fewer physicians per capita than many developed Western counties, despite having a much less healthy population than all of them.

View attachment 350197

It’s not that we don’t have enough smart, competent people. I haven’t seen any evidence that America has a smaller proportion of intelligent people compared to, say, Italy or Spain. The real issue is that the American system of medical education has uniquely unpleasant barriers to entry—ones that push many smart, talented people away from medicine and toward other career paths.

That doesn't mention anything about foreign doctors coming here. But since you mentioned it now, I already addressed that in a prior post:

There's also something to be said for trained doctors from other countries to come here. I'd still support some reasonably stringent requirements, but not quite what it is currently.

 

[Proudfather94]

We have fewer physicians per capita than many developed Western counties, despite having a much less healthy population than all of them.

View attachment 350197

It’s not that we don’t have enough smart, competent people. I haven’t seen any evidence that America has a smaller proportion of intelligent people compared to, say, Italy or Spain. The real issue is that the American system of medical education has uniquely unpleasant barriers to entry—ones that push many smart, talented people away from medicine and toward other career paths.

The current system is set up to attract the best of the best. It takes some intelligence but alot more commitment and perseverance to become a doctor here. If the bar gets dropped to get in you will have people who are either less intelligent or less committed to becoming a doctor. That would make patients suffer.

Looking at only one variable like amount of doctors per person is leaving info out that's important. I bet alot more people in the United States have vehicles and driver licenses than most of those countries. If one has to take public transportation to see a doctor it makes sense that the country would want a higher density of doctors. It doesn’t make it worse to have less doctors here if people have the means to get to them if it's like a 20 minute drive.

 

[7331poas]

The current system is set up to attract the best of the best. It takes some intelligence but alot more commitment and perseverance to become a doctor here. If the bar gets dropped to get in you will have people who are either less intelligent or less committed to becoming a doctor. That would make patients suffer.

Looking at only one variable like amount of doctors per person is leaving info out that's important. I bet alot more people in the United States have vehicles and driver licenses than most of those countries. If one has to take public transportation to see a doctor it makes sense that the country would want a higher density of doctors. It doesn’t make it worse to have less doctors here if people have the means to get to them if it's like a 20 minute drive.

Do you think American doctors are more dedicated than those in the UK?

 

[Proudfather94]

Do you think American doctors are more dedicated than those in the UK?

I'm not that familiar with how hard it is to get into medical school in the UK. I do know that they are having retention issues with keeping their physicians there and seen people on here talk about how Mid-levels over there are doing more stuff because there's not enough doctors in some specialities to meet the patient demand.

 

[Ho0v-man]

We don’t really make it hard to be a doctor compared to anywhere else. We make it expensive though. It’s very risky to take on that level of debt only to not get in if you don’t have rich parents.