[End The Hypocrisy]

I respect medical doctors' abilities considerably, even if reportedly very few actually selected their profession for more than the love of money and status (which are unique to U.S. doctors). Thanks to the forces of globalization, though, increasingly well-traveled Americans are discovering what the protectionist AMA doesn't want us to: that the quality of medicine in other countries is better than they have traditionally led us to believe. I definitely don't advocate Hillary-care socialized medicine, just greater competition for the right to serve patients. Why should doctors have to spend so much to get to join the highly protected ranks of AMA-sanctioned professionals?

I don't advocate opening the medical profession to more well-meaning but incompetent quacks, either. But other countries seem to have demonstrated that the love of medicine (even when money's not guaranteed) is often enough to make adequate health care accessible. By the way, nurses here have increasingly discovered how simple most doctors' tasks actually are to perform. Do you know any with whom you could confirm this? Are all the admissions hurdles U.S. doctors are forced to surmount worth the excessive fees that we're subsequently forced to attempt to pay? Ask your expatriate or nurse acquaintances, and please share their intellectually honest reactions with us. Meanwhile, let's see how the antitrust litigation against the AMA proceeds. Since last Spring, the AMA has already reacted by easing residency requirements down to a "mere" 80 hours per week. The doctor shortage remains though... Is anyone surprised?

[End The Hypocrisy]

How about some "union-busting," for American society's sake?

[NautiNurse]

This thread is a vanity through and through. One sentence taken out of context from an editorial to promote your vanity does not make front page news.

[joesnuffy]

If you want the very best in diagnosis come to America...

If you want the very best care..go to Europe..

AMA means no competition..affirmative action in med schools and limited classes and unreal high tution certainly doesnt help matters..

Much of the family practice crisis could be obviated by Nurse Practitioners and PA (Physician Assistant) programs if restrictions were limited and tort law reformed.. (and lawyers muzzled in many cases)

A 4.0 is not necessarily a great predictor of who is going to make a better doctor...as a person carrying a 3.0 ,working a job ,supporting a wife & kids might be better suited to doctoring than some 4.0 rich kid punk...with attitude..

Fluency in english wouldnt hurt either...imo

[stubernx98]

Having experienced the healthcare systems in Canada, England, Germany, Norway, Russia(in this case I had to send a doctor with my crew), Africa, Australia(best), and Asia(God help you), I will take the US anytime. Doctors are being forced out of medicine due to over regulations, high cost of malpractice insurance(due to Trial Lawyers with the complicity of the Democrats).

Though, I agree the AMA, like other professional organizations(and unions) tend to protect their own, and make it harder to get in.

Rush is fulminating on this now. The Democrates want a single payer system so they can control you and your vote.

[Future Useless Eater]

I think it is mostly a shortage of doctors willing to
work for peanuts.

I think a doctor needs roughly 12 years of post-high-school-training at an enormous cost
... you doctors chime in and correct me if you like

The doctors have about $100,000 in loans as a resident
and get paid like janitors.

the cost of the extra schooling is a negative compared to
what they would have started earning after lets say a 4-year
science degree. (that plus they have ~no income during those
last 8 years compared to the science major that DOES
start getting an income after 4 years)

it takes a long time, maybe 15-20 years to overcome
the difference in earnings.

with Hillary/Al Gore's single payer plan, doctors would
be paid even less.
[all the while our sports entertainers
will keep getting multi-millions per year and we will
keep building for them half-billion dollar colliseums
in every major city using tax dollars]

A large chunk of todays doctors will not recommend for
their children to go into medicine because of poor
reimbursement for their talents.

[Jesse]

Your post is filled with inaccuracies.

From personal experience and from studies I've read, most doctors select their profession rather early on...many in high school or before. Money wasn't the driving issue then. As for status, I think a better word is independence. I was interested in medicine from grade school, and wanted to be in charge. As one goes on in medicine, you find that you aren't as in charge as you think.

The AMA doesn't really have a whole hell of a lot to do with the day to day practice of medicine, medical education, or medical licensing. I haven't belonged to the AMA since I was a medical student, and only about 30-40% of doctors belong to the AMA.

The residency work hours requirement was an outgrowth of state laws in New York which were enacted following the highly publicized death of a woman from meningitis, I believe. Purportedly, the resident was "too tired" to make the diagnosis. Many hospitals now use physician extenders to provide in house care. Me, I would rather have a tired doctor.


"Nurses have discovered how simple most doctors tasks are to perform." Huh?

There is not a global physician shortage. However, their are regional shortages and specialty shortages. Training more physicians does not automatically translate into lowered costs or charges, and in some cases it is probably not possible to increase the number of specialists, because the costs of the training programs are so prohibitive.

BTW, the federal government has a lot more to do with the numbers of physicians in training than the AMA...Medicare pays for physician training, and it pays for only so many slots in so many specialties.


I've been in this business for over 20 years, and one thing I have learned is that there are a lot of people who think what we do is "simple". You don't know what you are talking about.

[LibWhacker]

Doctors are like everyone else. They go where the jobs are (forget starting up your own private practice . . . The insurance will kill you before you even see one patient) and where the money is; i.e., large metropolitan areas. In many of these areas there's actually a glut of doctors, not a shortage.

One of the things I'd like to see is a drastic relaxation of the requirement that a person have a prescription before being able to buy his medications. You shouldn't have to shell out a bazillion bucks to a doctor every time you need some naproxyn, for example.

[WilliamWallace1999]

Total disinformation. The AMA doesn't have anything to do with medical school or residency admissions. Less than half of U.S. physicians even belong. Protectionist, gimme a frikken break dude. Medical school slots and residency slots are going UNUSED in this country because everyone wants to be a lawyer. If you think today's graduates are gonna get rich, you don't know a thing about recent cuts in doctor pay. Sure there are a few getting rich, but the majority of us have seen nothing but falling pay for the same work over the last ten years. Expenses have kept climbing while the pay is falling, you do the math and see how long that will last. As for your altruistic foriegn medical graduates, what have you been smoking? They are consumed with greed and can't wait to grab the golden ring as fast as they can. Ethics doesn't seem to have the same meaning for someone from a country where they breed suicide bombers.
Your statements about the length of medical education in foriegn countries also is full of half-truths. In places like Russia, doctors are no better trained than EMT's in the U.S., so yes they get out quicker. In England, Canada, India, Pakistan, Mexico, the Carribean, and South America; medical education is a post graduate process that follows the university experience.

Mindless AMA bashing is most unbecoming.

NO, I am not a member. Just a piss-ant country doc with an attitude.

[RLK]

Did you know that in nearly all OTHER countries, medicine is a highly focused UNDERgraduate degree?

------------------------

I don't think that's a good idea.

[anoldafvet]

My son is a second year medical student at Indiana University School of Medicine. After he completes AT LEAST 10 years of schooling, he will be at least $125,000 in debt. That means at current tax rates he will have to earn upwards of $250,000 just to pay off his loans.
He spends about 6 hours per day sleeping, the rest of the time he studies. I can tell you that he is not in medicine for the money but because he loves it! He has a B.S. degree in Electrical Engineering, a 4.0 average, and could write his own ticket with any number of companies (even in these tough times), yet he still wants to be a doctor. I know that may be hard to believe, but all of his friends feel the same way. The day he started on the road to becoming a doctor, the dean of the medical school told all the students that if they were in it for the money, they were in the wrong profession. Don't kid yourself that ANYONE can be a doctor or that we can "cut corners" and still get quality medical care, it won't happen. The main reason for the high cost of medical care today is the Trial Lawyers and the RATS. The lawyers sue everyone in sight and the RATS pass legislation to improve HMO's by MANDATING everything under the sun. There's no free lunch anywhere and if you think things are better overseas, try getting sick over there.

[RJCogburn]

Your post is disingenuous, inaccurate, and displays an amazing ignorance of the facts and issues. While one can discuss and argue the merits of the subject, your comments and post are so over the edge as to make any reasonable discussion unlikely.

[keats5]

I'm a nurse, although not actively practicing since children have come along. I deeply respect most of the physicians I've worked with in the past. They work harder than many know, and many would not go into medicine again had they understood what they were getting into. They love the patients, but the insurers simply require too much paperwork. Their decisions are often scrutinized and reversed by insurers not willing to pay for treatment.

Dont' ask the nurses to do the doctors' jobs. They are not the same. Doctors cure. Nurses offer care for recuperation. Besides, nurses already have a frighteneing shortage of their own. I get job enticements mailed to my home almost daily. Frankly, even if I would go back to work, I'd be afraid to enter such a needy field right now. I don't need the manditory overtime- been there, done that.

[monday]

"Did you know that in nearly all OTHER countries, medicine is a highly focused UNDERgraduate degree? "

Of course if you are in a life threatening situation who would you rather have treating you? I admit it might be nice to have a choice. Go to the diploma by mail guy for a hangnail and to a real doctor if you really need help.

". Meanwhile, medical services overseas are better than the AMA would have us believe."

Depends on the country. Some are quite good others suck. Depends on many factors, including who pays. If you want a real shortage of doctors and helthcare professionals then go to a country with socialized medicine. The US has the best healthcare in the world. Its the most expensive as well.

It could be made cheaper by lowering the standards, or it could be made cheaper by tort reform and halting government funding for medicade etc.. Penalizing lawyers for filing frivilous lawsuits and getting the governmentout of healthcare would go a long way towards decreasing healthcare costs.

Getting rid of the AMA wouldn't hurt either, but then don't complain if your doctor turns out to be a quack. Heck he might be a quack anyway, but your odds are better that he won't be with the AMA then without.

The high cost of mal-practice insurance are causing doctors to relocate or retire early. I guess it is up to people to decide which is more important to them, rich lawyers, or quality medical care. I think that many, like you, don't really understand what the choices are.

[monday]

One other observation. The doctor shortage is also due to there being very few competent people who want to become doctors. Only fools would go into medicine while the politicians argue over whither or not to socialize the profession. Who wants to spend 1000's of dollars for an education where you can't pay it back because you are paid whatever the government feels like.

In case you aren't aware, the government is famous for screwing over doctors, hospitials, and anyone else who provides medical care under government programs.

[Prodigal Son]

I'm not going to argue with you. I'll just present some of the facts as I know and experience them.

I haven't lived in the States in damn near 12 years, so I won't profess to know what the state of affairs is like there. I've lived in Germany, France, Northern Ireland, England and currently Scotland (I lived in S Africa as well but we'll keep the comparison to European Health Care). My wife is German and is a doctor.

My wife didn't finish her medical education until she was 27. For a German, this is normal. British Med Students seem to get finished a few years earlier. 24 seems to be the average age and my wife has encountered one as young as 22.

For my wife's practical year of her education- she chose to go to South Africa to get hands on experience. In Soweto, she was allowed to do things she never would have been allowed to do in Europe or the States- unsupervised often. They'd just hand her a Central Line, explain how it went in and leave her to it. This experience paid off- she's dealt with more gunshot wounds than many of the consultants with whom she works here.

She chose not to ever practice medicine in Germany. The reason is purely economics. In 1999, when she became a first yr- the Germans were paying 1400 DM per month. That's about $700 US (or was at the time). This would have been for well over 80 hours a week. That's not even minimum wage. And that's if she found a spot. She could've spent the next 10 yrs of her career being allowed to do nothing more than hold hooks during an operation.

At any rate, she chose Britain- financially the much more attractive option. As a first yr here she was making about 1400 pounds sterling- roughly three times as much. But she still put in over 80 hours per week. She is now getting ready to take a registrar position- which is two rungs up the ladder from first yr (Junior House Officer JHO, Senior House Officer SHO- Registrar, Specialist Reg, Consultant). She has doctors under her. She is required to give teaching to them and medical students once a week and she gets to perform many surgeries on her own. She has to fight to be allowed to do bigger things under supervision- but fair enough, she expects that. An 80 hour work week is still normal. In fact, her on calls this week will see her logging 82 hours and she figures this is a slow week.

She makes about 30,000 quid a year. To put this in perspective- this is what the firefighters here are going on strike to get. That's right- if they get their way, an average firefighter will make the same base salary as my wife who has 22 yrs of total schooling and performs hip replacements/appendectomies etc. My wife and a firefighter are considered equivalent here.

The nurses here do not put in IV lines. They do not draw blood. Phlebotomists are in short supply so my wife spends much time doing work that is frankly beneath a doctor. In the Army Privates put in IV lines and drew blood. Here you need an 8 yr degree. The nurses here get guaranteed tea time. When their break comes- they're off to the lounge. Not so for a doctor. The surgery theater schedule is built around the nurses tea time- I sh!t you not.

The waiting lists here are atrocious. If you're in need of a hip replacement- you are in pain. Your daily life is a living hell. The waiting time for that operation is up to a yr. You need an MRI? Ha ha! In Germany, the waiting time for an MRI is a few minutes in some hospitals. Here they don't even bother asking for one because by the time they get it- the patient is often pushing up daisies. There are many heart patients who are paying out of their own pockets to fly to South Africa to get needed treatment. The medical system here in the UK is the source of one of the biggest debates in the country. It's scandalous. It is only getting worse and they don't have enough British Doctors to fill the positions. The Rosters here are made up of Egyptians, Sudanese, Zimbaweans, Pakistanis, Indians and Germans ;-). Too many Brits realize medicine is a financial dead end or they play it smart and head to America.

You brought up another interesting point about rigid rules in America for foreign students/doctors. Good point. The language test should be required (they are thinking of requiring it here as well) but $1200 is expensive and it is absurd to have it only in Philadelphia. There should be alternatives in Britain, Canada and Australia at the very least IMHO (perhaps in South Africa as well).

Then there's the American Medical Exam. My wife would have to take this exam- which is equivalent to resitting her finals. She would have to take a yr off and do nothing but study again for 16 hours a day. I understand its necessity, but it makes coming to the States unnacttractive.

She plans to make it into the Royal College of Surgeons as a fellow and then she can move with relative impunity around the Commonwealth. We plan on moving to Australia or New Zealand. If we're not happy there, we'll either move to South America or she'll give up medicine because the financial payoff just isn't good enough outside the States. She likes helping people, but she likes to get paid for her expertise, and that's just not happening here or anywhere else it seems.

The biggest single worry she has about practicing in the States is everybody is litigation crazy. What if she puts out all that cash, all that time to study and makes a mistake and winds up in jail or in debt for the rest of her life? She always wanted to emigrate to the States- but sadly, she'll do so as something different than a doctor if she does.

I don't think the doctors in Europe are anywhere near as altruistic as you imagine and while you seem to rave about the care here- I would have to be bleeding to death before I would go to the hospital. My wife has told me too many stories of the incompetence and complacency that comes with Social Medicine. I think most doctors pratice in their home country because it's their home and they'd like be better paid but they also want to live in their homeland, speak their own language and be close to the people and things that they love.

One last thing- if you think nurses and doctors are equivalent- well, you've got another think coming. Nurses can do many things for sure. But who do I want a nurse replacing my hip? Who do I want one sorting out my General Anesthesia? What about a valve job on my heart? No, nurses have their place but there is no way they are equivalent to doctors- no way. I think the nurses in the States are probably superior to the ones here but even then- no way are they the same.

[Hostage]

It costs alot to educate and train doctors, to staff residency programs. Medicare pays for most of it. There is a tradeoff in the churning out of providers vis-a-vis the cost of producing them.

Besides, most expenses in the medical field today come not from Doctor's salaries but from administration. If you advocate more doctors but keep the level of paperwork per provider the same, you create more expense in medicare and medicaid.

It isn't just doctors that are produced but a whole industry around them that gets created around them.

So your question is more accurately posed as
"If there is a shortage of medical clinics, why not let more Americans start medical clinics?".

Lastly, a doctor in today's legal environment is liable for a great many things and in order for insurance companies to cover these liabilities, they must charge premiums that range from 25% to 100% of a doctor's personal income. Thus extrapolating to a greater pool of doctors, you have greater liability coverage, hence greater premiums. At some point a doctor's salary would be on par with a career requiring only a bachelor's degree, hence medical school enrollments would decline.

The legal environment surrounding malpractice has already created a negative view of attending medical school. More and more doctors are telling their sons and daughters to find another career.

[krb]

Great post. I expect this to be a great thread. But be careful; doctors (and their spouses who also benifit from the pelf, and their co-conspirators in the nursing field) will jump all over you and declare that you aren't allowed to point out that doctors in this country have abused their monopoly.

Oh yeah, and don't fall for it when they distract you by asking you if everyone should be allowed to prescribe pills, given you are criticizing doctors...

[Sonny M]

Personally, my solution, would be for the AMA to remove many of the caps that are listed on number of students admitted to medical schools, also serious tort reform, to protect doctors, making medice an undergrad major, and making any immigrant doctor that wishes to practise here in states, to take a 3 or 4 year residency. A big problem never the less is the AMA's anti-trust style of behaving.

[nightdriver]

"According to the American Medical Association, 12 states face serious dangers of doctor shortages due to spiraling insurance costs."

I dunno, this may be true. The little town I grew up in had 3 doctors while I was there. I read a couple of years ago in Parade magazine that they had to do a nation-wide search to try to persuade a GP to come and open an office there.

Something's amiss, for sure.