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Notes -
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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