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Low, although I'll note that my exposure to the field is much more extensive than you're thinking (although I'm not inclined to provide details). I'd definitely be interested in the data you're referring to - do you have any summaries I can take a look at?
If you meant for educational quality:
We've already introduced "lower education" doctors in the U.S. for awhile now, they are called PAs and NPs. It's been researched. Tellingly, their best case (presented by the nursing lobby) is research that shows that NPs results in equal outcome with U.S. MDs without controlling for case complexity (basically the doctors got the complicated cases, the NPs get the easy cases, and they still ended up with similar outcomes).
More research has shown pretty wide outcome disparity and things like a dramatic increase in costs from the NPs (due to unneeded referrals and excess testing, the later of which is often a direct harm to the patient).
Here's an example link: https://www.ama-assn.org/practice-management/scope-practice/3-year-study-nps-ed-worse-outcomes-higher-costs?utm_campaign=Advocacy
If you meant for the bottle neck:
I'm asking you, as I generally find that posters with an opinion on this don't actually know where the bottleneck is.
Yeah, that's what I was asking. Thanks for the link.
With regard to bottleneck, residency. Schools can't plausibly increase the number of students because they won't be able to place them.
My grumpy self has to say good, because that's more knowledge than I normally see, or perhaps Ive been ranting about this here for enough years.
We have an excess supply of med students (mostly provided by the Caribbean and outside the U.S., and therefore of much lower quality but still an excess).
However it's not as simple to increase the number of residency slots as you may think. You probably know that most residency funding comes from the federal government (and good luck getting them to fund more) but some states fund slots, as do some private hospitals (most notoriously HCA), as residents are a revenue positive thing (although hospitals will claim otherwise).
In the case of HCA the residents from those programs have been notoriously underprepared and unemployable outside the HCA ecosystem, not because the candidates are bad but because the education is bad. Robust medical education is very hard and expensive and complicated and in some cases like surgery you can't create more of it no matter how much money you spend (due to case requirements).
So increasing spots varies from "eh it's doable" in some specialties to very hard to impossible in others.
A related problematic trend is that people find primary care (biggest specialty shortage) and working outside big cities undesirable. Nobody wants to increase doctor salaries so it's incredibly hard to motivate people to go into primary care (it pays half as much and has more un-fun burdens like excess charting requirements) and nobody is ever going to convince a large number of people who had to skip their 20s to move to rural Iowa as soon as they have freedom without a massive pay bump.
But yes the problem is mostly allocation as opposed to shortage.
Residency is irrelevant. Even if you make the argument that US medical training and residency is vastly superior to Canada/UK/Germany/Australia etc, the US can and should simply skim off the top 20% of those countries’ trained doctors (who are surely at or above the American standard). They don’t because of the AMA cartel.
Let's just say for a moment that we want to take the 20% of all of the countries with good educations doctors. And that they want to come.
Is that remotely ethical? All practical and cost saving measures aside it seems kinda horrifying to just steal something so important to society like that.
American citizens pay for doctors with salaries 3-5x comparable first world nations. They do so unnecessarily. I consider that to be a problem, though I don’t fault doctors like yourself for trying to preserve that unfair arrangement.
American doctors also work twice as much as most Western doctors, have longer training, and more expensive start up costs (tuition, boards, regulatory overhead, malpractice, etc.), and as discussed before you have yet to acknowledge that American doctors don't make what you think they do. The average American doctor probably has a lower net worth than the average Australian doctor.
Doctors have relatively low net worths into their 50s, here's a citation. https://www.bfadvisors.com/net-worth-by-age-for-doctors/
Decreasing doctor salaries also does nothing substantial to decrease U.S. health care costs.
And your solution seems to me to be wildly immoral and you make no effort to defend it.
This is grossly misleading. The first line of the article is literally, "When it comes to wealth-generating occupations, physicians usually make the top of the list." The graph shows that 50% of doctors ages 45-49 have a net worth of at least $1M, and that average physician comp is $350k/year. I appreciate that American doctors choose partners at Goldman Sachs as their peer cohort for compensation comparisons, but this is not based in reality.
Physician compensation is roughly 9% of U.S. health care costs per here. If you slashed physician comp 50% (so that physicians were "only" averaging $175K/year), U.S health care costs would be reduced by 4.5%, or about $250B across the U.S. per year (4.5% of $5T total annual health care spend). A few $250B here, a few $250B there . . . pretty soon we're talking about real money.
Again, Is that your true rejection? If so, would you be satisfied with importing international physicians if those physicians pledged to remit some of their American comp to their countries of origin? Because I'm sure they'd be happy to do so.
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