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Notes -
Most European countries have 6 years of combined med school and undergrad (see: Germany) vs. 4 years of undergrad + 4 years of med school in the U.S. these days 1-2 gap years is also common, with 3-5 being uncommon but not rare (for things like PHD, MPH, MBA).
The amount of debt is important because it is relevant to the level of pushback you get for changes, and the fact that if you cut salaries by half and allow limitless importing of doctors then you will have pretty much zero people applying to med school in the U.S. overnight (and that would be the rational response). People still interested will do PA/NP school instead.
Do also keep in mind the quality difference which is real but is frequently not acknowledged.
The 4 years of undergrad could be in a variety of subjects and aren’t really comparable to the first few years of training in countries where med school begins at 18.
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We have 6 years of combined med school and undergrad here in the UK (3 years undergrad + 3 years clinical training), but that doesn't mean that when you're done with those 6 years you can start working as a doctor. After those 6 years you have to do another 2 years "foundation training" which brings it up to 8 years. Even than that's not enough, becuase after those 8 years you have to do mandatory "specialist training" which is 3 years for GPs and 5-8 years if you want to do a speciality (and are good enough to get in).
At a minimum to become a fully qualified and independent doctor it takes 11 years and at the most it takes 16 years. That's not dissimilar to the US.
Do keep in mind that the UK does its own thing and doesn't map well to the process in the U.S. (or other western countries).
At an extreme example if you want to be an electrophysiologist in the U.S. you'll be doing a minimum of 16-18 years of training after high school, with many looking at 22 years. During 8 of those years you will be working 60-80 hours a week with some programs closer to 100 hours a week. Even if the years are the same you are doing twice* as much work during each year (is that sane? No. But it is).
All the while you are dealing with an average student loan debt of around 250k, with that number not counting interest or all the rich kids (who are admittedly a fair chunk) with zero debt.
If you want anybody in the U.S. at all to do that you need to offer them a pretty big carrot. And you do want them to do that - we've seen the outcome disparity between U.S. MDs and other populations (most notably of late, midlevels).
AND.
Lower quality doctors (or doctor replacement) increase overall healthcare cost due to increased unnecessary testing. Very well documented at this point.
You need to change the regulatory and malpractice environment first if you want any of this to work, which nobody seems to be interested in doing, and if you did things would cost less without coming for MD salaries at all.
*these days 1.5 times the work is much more common and realistic but that's still a fuck huge disparity.
I think you’re discussing a few separate issues:
“Debt loads are too high to pay less.” Agree in part, the solution is to subsidize medical school costs such that medical students pay no more than the average STEM degree haver who goes on to a well-but-not-exceptionally-highly paid job.
“No talent will go into the profession”. Plenty of smart people are going to continue to want to be doctors for a salary of $120-300k a year. Are you going to get the 99.9th percentile people who want a guaranteed path to being moderately rich? No, but the question here is ‘do we need them?’. Is it really so bad if doctors are 95th percentile people instead of 99th percentile? I don’t think so, I think there are plenty of moderately smart people happy to do this job for $200k a year if trained. And healing people is high status vs. sales or finance or other professions people consider a little dirty. That boosts demand to be a doctor too, in the same way that many smart people want to be journalists or diplomats even though they get paid badly.
“Residency sucks”. Again, completely agreed. Doctors shouldn’t have to work 100 hour weeks during training. That’s an issue for hospitals and people who manage residency programs to solve, ideally with the help of residents. On the other hand, a lot of doctors have a ladder-pulling mentality and think that because they went through it, the kids of today have to do so too.
“Midlevels are taking our jerbs”. Again, I agree that this is a problem and I sympathize with doctors who see poorly-trained midlevels hurt patients and waste time and money. But they don’t seem to understand that mid levels are a consequence of desperation on the part of other elements of the healthcare system (ie the hospital managers who have to try and balance budgets) because doctors are paid so much money. In other systems, doctors might be paid 60-80% more than nurses. In the US (excluding rare examples of temp/travel nurses etc), specialist doctors and surgeons often make 300% more than baseline unspecialized nurses; this naturally leads to the creation and proliferation of midlevel roles. If doctor pay was halved and there were many more doctors in the US, hospitals would obviously hire them instead of CRNAs and specialized NPs etc.
Actually, if the AMA really cared about solving the midlevel problem, they’d provide a simplified pathway for CRNAs and NPs to become physicians, with guaranteed residency at their current hospital (if they pass whatever assessment required) and negotiate some kind of federal support for any dependants during the study process.
Right now it takes like 10-12 years for a competent CRNA to become an anesthesiologist, even if they can already do much of the job. Surely you can see how ridiculous it is - do you REALLY think it takes 10+ years to teach a good CRNA to do an anesthesiologist’s job?
On 1), don’t multiple other countries subsidize medical school, and all of those countries have in common medical school working very differently from the US? Specifically, things like a shorter overall path, strictly meritocratic admissions with no fudge factors at all, etc, etc.
Obviously if the US declared medschool free for anyone who could get in, there’d be all sorts of problems. For one, medical schools would admit thousands of people who spend immense amounts of money to never graduate(or graduate into incompetence). No doubt right wing Twitter would find someone literally named Shaniqua who’s getting paid to take organic chemistry again after failing it three times, but the problem is actually deeper than that- students who never graduate are now a money printer for medical schools. Currently there’s some incentive but actually doing this pretty much requires the federal government to pay for every medical student’s books and classes and also give them all living stipends. That changes things.
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That's all stuff which is much amenable to discussion and debate (even if we disagree) but these are unrelated to my problem with your post which was the gross factual inaccuracies.
It's several orders of magnitude more common for a doctor to start making 250K a year at age 32 with a half million dollars in debt than it is for a doctor to be making over 750k a year, which nearly zero are doing through clinical duties alone.
Your comment, much as I loathe to use this term, is misinformation.
"What is the right amount of money for a doctor to make" is a reasonable question but it's functionally entirely unrelated to healthcare costs in America.
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