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We're no stranger to the immigration hot button here; we all want some way to filter for attractive women and investment dollars where we live and less competition for labor, but the want for those things proves weaker than the iron laws of supply and demand for both. However, here's a problem in the immigration debate that I don't think has come up in discussion before: ladies and gentlemen and undecideds of the Motte: how do we fix the doctor shortage?
And I mean globally. The solution many places settled on after it became clear that it was difficult to impossible to train more doctors locally is to import them, but this simply moves the problem around and causes brain drain as market efficiencies mean doctors move where they can get paid more.
Accounting for inflation, apparently physician pay growth is lagging although I'm not sure if anyone has more up to date information on whether this is still the case.
The easy low effort swipe is to make it easier to qualify as a doctor, but doing so without lowering medical standards and/or quality of care seems more difficult. There's also the simple calculus where people are less willing to take on, in the US, large amounts of student debt and to commit to the many years of study it takes to become a qualified doctor. After which you can look forward to high stress, long hours, dealing with patients, and potential lawsuits. It's no surprise that people would rather hustle sneakers or crypto or streaming when the effort to do so is significantly less.
Previously, governments would subsidize medical training as they saw medical professionals as a necessary function. Now, why bother? If there are opportunities and more money to be made elsewhere, they'd just move elsewhere after being trained, which would be happy to take them. Is there a low effort politically achievable band-aid fix, like making mandatory provision of medical care within the country a necessary precondition of qualification? But that'd make the profession even less popular - if you're a Kenyan doctor, fuck staying in Kenya if you can get paid multiples of that elsewhere.
Disclaimer: I'm asking for entirely selfish reasons. Working on a new investment thesis after the last one turned out spot on although with limited rewards so far for being right. I foresee this problem getting much, much worse as doctors retire, populations trend upwards in age and require increased medical care.
Isn’t the doctor shortage almost entirely because the AMA restricts medical school class sizes? I know of at least one quite smart and motivated guy who did not get into medical school when he totally should have. People are doing insane resume padding things like working in hospitals for a few years before medical school. The doctors have a midevil guild and they are restricting the supply of labor, patients be damned.
This is exactly it, but anyone with fancy letters next to their name will kvetch and contort their words all over to avoid taking responsibility. No one with a medical degree should be in charge of deciding who else can get that degree. There's no clearer modern racket to me.
Quickest way out is probably just to pass legislature allowing PAs (and maybe NPs, but I'm more skeptical of their training) to perform without an MD above them - but of course every time this comes up, the AMA lobbyists come out in full force.
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This an outdated meme, wrote a bit more about it elsewhere in the thread.
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The evil seems more than just mid, honestly
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According to Scott, the real bottleneck is residency slots, not med school. He himself spent a year without practicing because he could not find a residency after graduation. Residency is expensive for the hospital, so it depends on government subsidies, and the government doesn't subsidize enough residency slots to keep up with demand.
As I understand it, one common workaround has been to give more power to nurses and other assistants, while having the actual doctors simply look over and sign their names after the fact, effectively turning them into managers. For example, whenever I go to the local community health center, the person who sees me and prescribes my medicines is always an APRN or a PA, never an MD.
Of course, would be easier to abolish residency.
If you'd like to deep dive into the causes I recommend sheriff of sodium on YouTube.
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Nurse Practitioners and PAs aren't really Nurse or assistants as such. The are medical providers who study medicine albeit in a shorter program then doctors. They are whole new category of "midlevels" not normal nurses or medical assistants. PAs probably fit the role designed better. Nurse practitioners have more variety in the standards of their training programs and can operate totally independently in many states which seems to be going to far to me.
It's worth noting that PAs do get a somewhat condensed version of the physician curriculum, but NPs do not actually learn regular medicine.
That sounds ridiculous and it is. It should also stress you out and if it does, good.
It doesn't. I would much rather have half a doctor than no doctor. Specially when I am not legally allowed to buy any useful medicine without a prescription.
The day when MDs and PAs are so numerous that they are working for minimum wage and you can find one on every street corner is the day when I agree that NPs should be held to a higher standard. Until then, I am in favor of anything that increases the supply of healthcare.
This sounds good until you create more work by being incompetent. Psychiatric NPs are famous for doing this by putting patients on unsafe medication regimens that increase total burden to the system.
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Exactly. It seems pretty implausible that the current medical hiring split is the one that's maximally recruiting those with the capability to be good medical professionals, especially when there's a ton of random carveouts for affirmative action identities
I will absolutely complain about affirmative action in medicine but the problem is a bit more complicated - for instance we've decided to push away the autists in favor of socially minded types. This is both good and bad.
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