you could solve a lot of problems just by doubling the number of places at medical schools, breaking the cartel of artificial scarcity that has left the US with one of the worst doctor-patient ratios in the developed world - ThreadSky

beijingpalmer.bsky.social • 1 day ago

you could solve a lot of problems just by doubling the number of places at medical schools, breaking the cartel of artificial scarcity that has left the US with one of the worst doctor-patient ratios in the developed world

Reposted from Anonymous WPA Bureaucrat

I always thought it was an underrated problem that the M4A debates and proposals were not seriously engaging with how the culture of doctors in this country is rancid, and it starts in their education and training

Comments

lessdismalsci.bsky.social•23 hours ago

You also have to double the number of residency slots, which is not trivial either. But yeah, med schools could take way more students with no appreciable drop in admissions quality.

severaxe.bsky.social•23 hours ago

That’s easy - just ask doctors to work 40 hours a week during residency, doubling the number of slots…

conjurial.bsky.social•22 hours ago

what's the practical limit from how many patients there are to treat? you couldn't train, say, 100 million doctors because they wouldn't have enough patients to learn what they're doing, but is it...2x the current number? 3x? 10x?

parisdog.bsky.social•22 hours ago

maybe with more residents they could work fewer hours/wk without having to 'find' more patients?

conjurial.bsky.social•22 hours ago

well, right, they totally could but at some point there aren't enough patients per doctor to learn how to be a good doctor. I'd think that point is far enough away from where we are now to not be worth worrying about, but it's an interesting question

conjurial.bsky.social•22 hours ago

in the abstract

subtlefire.bsky.social•20 hours ago

you also need adultier doctors to supervise them. that's sure to be the worse bottleneck, enough places with enough people who will take on that teaching role *and* are suited to doing it

jlindy.bsky.social•23 hours ago

Even if the quality drops it's still a net improvement to society.

joestieb.bsky.social•7 hours ago

People are calling it Abundance

effjayem.bsky.social•14 hours ago

Same in the UK with dentistry.

annepaulson.bsky.social•22 hours ago

Isn't it residencies that are the bottleneck?

vidarej.bsky.social•23 hours ago

i think sometimes about how easily we could bring back a world where the "make money then retire early" profession is medicine instead of finance

nowhere.bsky.social•6 hours ago

My cancer-suppressant drug runs out in 1 day. I can't get in to see a new pcp until November lol.

Teledoc will prescribe 1 month at a time, but the last telefuck refused a bridge without seeing new labs (my dosage has not changed in 20 years). Labs won't even be done before I run out. Absurd.

nichayyay.bsky.social•21 hours ago

Don’t know how related this is but I am a nurse and I was just today at a doc appointment and the provider brought that nurses aren’t very smart and NPs are evil and dumb while I’m describing my symptoms. This is every appt for me! It’s so mean!

subtlefire.bsky.social•20 hours ago

wow, that person must really be intimated by NPs. I'm guessing people started preferring their (or someone else's) NP to doc's "helpful" thoughts

flame89.bsky.social•15 hours ago

I tend to think any institution that is admitting less than two percent of applicants (which is the case with multiple medical schools) is just doing it for rankings purposes.

jamesleahy.bsky.social•1 day ago

Definitely a sign the system is broken when the hardest part of medical school is getting in

johngordon.bsky.social•14 hours ago

Have medical schools changed that much? They were very far from easy for most in the 80s. (I know people who said it was easy. They had magical memories and were also fibbing.)

datadrivenfp.bsky.social•11 hours ago

You're looking at a symptom, not the cause.
The shortage of primary care physicians (and their replacement by less trained practitioners) is bc of insurance maximizing profits(% of total cost) by increasing costs.
They spend more on hospital care, & they get a cut.
https://pubmed.ncbi.nlm.nih.gov/15769797/

datadrivenfp.bsky.social•11 hours ago

See fig 8
Social Services spending reduces spending on health care.
You're looking at the wrong part of the picture/elephant.
http://www.commonwealthfund.org/~/media/files/publications/issue-brief/2015/oct/1819_squires_us_hlt_care_global_perspective_oecd_intl_brief_v3.pdf

datadrivenfp.bsky.social•11 hours ago

Countries w GOV insurance & GOV health care (UK) have the lowest costs, highest quality.
Countries w PRIVATE insurance & health care have highest costs, lowest quality.
Social services $ reduce HC $.
https://www.commonwealthfund.org/publications/fund-reports/2024/sep/mirror-mirror-2024

datadrivenfp.bsky.social•11 hours ago

US healthcare is $$$ because FOR-PROFIT insurance MUST increase profits every year. Profits are just a small % of total cost, but insurance sets payment policy. Total costs MUST increase. UCR sets fees https://www.experts.com/articles/usual-customary-reasonable-charges-healthcare-services-by-rpc
US MCR run by PRIVATE ins co's. https://www.cms.gov/medicare/coding-billing/medicare-administrative-contractors-macs

skiddius.bsky.social•23 hours ago

You could double the number of med school spots twice over. It's still not going to produce more residents or convince someone to go into a low paid specialty after not matching surgery or something.

tft.io•14 hours ago

Also ease the accreditation of overseas trained doctors.

nocleverhandle.bsky.social•7 hours ago

The bottleneck is at the residency stage (there are more med school graduates than residency slots), and IIRC the total number of residency slots in the US is set by Congress.

stomachtax.bsky.social•18 hours ago

But they might have to drive a lesser Mercedes!

mrbtx.bsky.social•1 day ago

yeah my current doctor is Fine I think partly because she went to a Caribbean school

df1.bsky.social•23 hours ago

An Interstate Highway System-level program to build federal medical colleges/hospitals in underserved areas. Train the locals to be doctors, nurses and pharmacists for a modest tuition, and forgive that if they work in the community for a few years after graduation.

werealldoodshey.bsky.social•23 hours ago

DO schools are doing this to an extent

maggiemarbles.bsky.social•1 day ago

Subsidize the training so they don't start out in massive debt. And make a lot more primary care doctors, or rather make it financially reasonable for them to go into primary care.

jlindy.bsky.social•23 hours ago

Primary care doctors are still rich.

maggiemarbles.bsky.social•23 hours ago

Perhaps eventually, and if they got trained in previous decades. But we want a lot more new people to go into the field. And we also want the price to go down so basic health care becomes more affordable. Which means we want to reduce the incentive for future doctors to chase money.

jtsdmpk.bsky.social•20 hours ago

We're near the end of a generational shift in primary care docs generally not owning their own practices anymore, so the incentive structure has changed pretty rapidly and the current gen is less likely to make bank on the actual infrastructure side too.

hammbear2024.bsky.social•23 hours ago

It’s still usually reasonable, it’s just they are cultured not to.

cocktailchem.bsky.social•1 day ago

I remember one proposal that med school would be free, but you’d have to pay for the extra training to become a specialist.

elucida.bsky.social•23 hours ago

Make ALL training free, and pay students' living expenses - as in Scandinavia.

johngordon.bsky.social•14 hours ago

That would produce very privileged specialists.

jjinandtonic.bsky.social•23 hours ago

medical schools, despite their limited numbers, aren’t actually the biggest bottleneck: its residencies/funding for residencies (funded via Medicare and hobbled by a push for balanced budgets, incidentally)

Not all med school grads get placed into residency, even if otherwise qualified

mirandapitcher.bsky.social•22 hours ago

Came here to say this. Plus there are a lot of very qualified immigrant doctors (trained abroad) who pass the USMLE but can't get matched for a residency because there aren't enough slots.

parisdog.bsky.social•21 hours ago

there are unfilled slots in some specialties. family medicine generally has a hard time filling all slots. of course there is a reason for that. some just don't match into their desired area

https://www.nrmp.org/wp-content/uploads/2025/02/SMS_Results_and_Data_2025.pdf

shamiltonrowe.bsky.social•21 hours ago

Family Medicine docs have a higher administrative burden for about half the salary, and you don’t get to be the hero nearly as often as a specialist.

parisdog.bsky.social•21 hours ago

yep

jotates.bsky.social•1 day ago

Make it free too.

jotates.bsky.social•1 day ago

You want to spend the rest of your life saving others, you get schooled for free

agtmadcat.bsky.social•1 day ago

We have that with a condition that you put your first several years into somewhere with a series shortage. I forget the name of the program, but I think it's not uncommon?

jlindy.bsky.social•23 hours ago

The Northern Exposure program

masmith78.bsky.social•23 hours ago

*residency spots

That’s the bottleneck.

theloaraxe.bsky.social•23 hours ago

And additionally, resource hospitals to the point where "our doctors get plenty of sleep and make fewer errors" doesn't get defeated by "the fewer staff changes, the lower mortality, therefore our doctors all have insane sleep deprivation."

nothingsmonstrd.bsky.social•23 hours ago

This would do a lot for the health of junior doctors and their unfortunate patients. It's not good for either doctor or patient when people are trying to do work on zero sleep.

snootacamund.bsky.social•23 hours ago

Favorite med-school hack was someone who bought a cheap lot in a Western US state, which allowed them to be considered a resident for admissions, which got them a state resident slot in the med-school and later resident subsidized tuition rate. Just a very dumb system.

drakesmitha12.bsky.social•20 hours ago

That's genius.

A WWAMI state?

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