Posted on 08/01/2021 6:29:06 PM PDT by Kevmo
Does the AMA limit the number of doctors to increase current doctors' salaries?
Asked 10 years, 1 month ago Active 11 months ago Viewed 21k times
45
7 A suggested reason why doctors get paid so much more in the US as opposed to other developed countries is that the American Medical Association (AMA) artificially limits the physician supply in order to drive up salaries. I found this article which blames the AMA, but gives as its only source Milton Friedman's book from 1962.
A more recent article dates from 1986. Lew Rockwell also blames the AMA, but he also doesn't cite too many sources nor go into specifics.
So, does the AMA limit doctor certifications in order to increase salaries?
EDIT: At Cos's suggestion, I would like to remark that it is unlikely that you will find an interview with the head of the AMA saying "we want to screw over new doctors so existing ones get paid more." So the standard of evidence is something like:
Has the AMA (since 1962) had policies (or taken action) to restrict the expansion of existing medical schools or discourage the creation of new medical schools? Are doctors in short supply? If so, can this be explained independently of the AMA policies? medical-science economics united-states Share Improve this question Follow edited Aug 20 '20 at 16:10
Nat 4,05122 gold badges2424 silver badges3636 bronze badges asked Jun 13 '11 at 17:37
Xodarap 1,01711 gold badge77 silver badges1313 bronze badges Add a comment 3 Answers
34
This USA today article from 2005 confirms that the AMA and other organizations were indeed actively seeking to limit the number of new physicians being trained to prevent a projected surplus.
For the past quarter-century, the American Medical Association and other industry groups have predicted a glut of doctors and worked to limit the number of new physicians. In 1994, the Journal of the American Medical Association predicted a surplus of 165,000 doctors by 2000.
However once the looming shortage became apparent, these efforts were reversed. For example the American Association of Medical Colleges (AAMC) set the goal of increasing medical school enrollment by 30% from 2002 levels by 2015. Unfortunately they are already behind on this goal.
More importantly, medical school itself is not the rate-limiting step in training new physicians. As a recent, excellent article in the Seattle Times points out,
In order to become practicing physicians, graduates must complete at least three years of residency training, usually in large teaching hospitals. Without more residency slots, the number of physicians entering the workforce cannot increase. (If the number of U.S. medical school graduates increased, but the cap were left in place, graduates of U.S. medical schools, who have preference for residency slots, would replace graduates of foreign schools, but that would have no net impact on total physician supply.)
The article goes on:
The logjam in residency openings stems from the 1997 Balanced Budget Act. At that time, the number of residency slots funded by Medicare (the principal source of residency funding) was capped at around 100,000, and that cap has remained in place ever since.
The article also includes a fairly in-depth account of the mid-00's reversal of fears from surplus to shortage which I won't bother to blockquote here. It's worth reading if you're really interested.
In summary, while this claim may have had some truth in the past, it is certainly not true now as the major professional organizations are actively lobbying to expand medical education. Unfortunately at the moment the major limiting factor in that expansion is federal health spending, which in the current political environment is a hard sell even for the powerful AMA lobby.
Share Improve this answer Follow answered Jun 18 '11 at 3:26
NonSequitur 1,17999 silver badges1111 bronze badges 3 Why do "graduates must complete at least three years of residency training"? Did the AMA have anything to do with imposing such requirements? – Jayson Virissimo Aug 7 '16 at 23:12 1 @jaysonvirissimo because attending lectures and passing tests is not enough. You have to do the things you're supposed to be able to do, and there are such a variety of things in that list, three years is probably not even enough to get them all checked for every doctor. Just long enough for most to do most, and the important stuff. – Nij Aug 14 '16 at 3:33 5 Makes sense @Nij, but some countries have more/less required residency than the US does. Do countries that require 1 or 2 years residency have unqualified doctors practicing medicine? – Jayson Virissimo Aug 14 '16 at 20:20 1 @jaysonvirissimo Depends on what else they do, and to what extent they cover it. It's a lot easier to have experienced something when there are 2 chances for 2 people, than it is with 10 chances for 12 people, for example. – Nij Aug 14 '16 at 21:18 Add a comment
6
Given the dearth of answers, I tried to do some more research. I found the following suggestive statistic:
In 2002, there was a baseline of 16,488 annual admissions to LCME medical schools; by 2009, the number of medical students enrolled had increased by 11.6 percent to 18,393... From 2002 to 2009 there was a 62.2 percent increase in annual enrollment [of osteopathic schools] - CGME 20th report
Given that allopathic and osteopathic degrees are legally equivalent, we might expect demand to be equivalent. So it is suggestive that AMA-accredited schools have much smaller growth in enrollment than non-AMA-accredited schools.
In fact, from 2002-2013, there will be 3k more DOs (an increase of 99%) and 3.5k more MDs (an increase of 30%). So again, unless there is just a huge shift in preference for DO vs. MD, it seems unlikely that this is the result of a free market.
EDIT: As far as I can tell, DO and MD are quite similar:
Osteopathic physicians, known as DOs, are licensed to practice medicine and surgery in all 50 states and have full scope of medical practice in over 50 countries... “We now find ourselves living at a time when osteopathic and allopathic graduates are both sought after by many of the same residency programs; are in most instances both licensed by the same licensing boards; are both privileged by many of the same hospitals; and are found in appreciable numbers on the faculties of each other's medical schools." - wikipedia
DOs are allowed to prescribe meds, do surgeries etc. the same as MDs. Further certifications (e.g. anesthesiology) are open to them just as if they were MDs. I don't think that DO is exactly equivalent to MD, but they seem similar enough that we would expect demand to be approximately the same.
The LCME accredits allopathic schools; it's made up of the AMA and the AAMC.
EDIT 2: this paper is more recent (from 2003) and claims that the AMA engages in rent-seeking behavior. It also gives as one of the reasons for the shortage a minimum wage requirement for residents:
The ACGME historically has required that teaching hospitals pay residents a reasonable wage and pay residents in all specialties the same amount. However, the wage that clears the market for residents in pediatrics or family practice may be too high to clear the market for surgical residents... I estimate that medical students would be willing to pay teaching hospitals for residency training in dermatology, general surgery, orthopedic surgery, and radiology. [As opposed to the hospitals paying residents]
This subject came up between Regulator and me. https://freerepublic.com/focus/news/3981142/posts?page=50#50
Regulator to Kevmo
Oh sure, but I really only have the one data point.
My search link was
https://search.brave.com/search?q=ama+future+MD+requirement+totals&source=desktop
There’s a lot of other hits.
It’s a long discussion, and I had at least two more paragraphs that I deleted in my original reply to you.
The bottom line is that a supply side approach to MDs in this country would solve major cost issues, and that an enormous number of perfectly capable people were denied entry to medical school in the last 50 years because of the system being gamed by not just the AMA but a lot of other people. What surprises me is that the customers - the INSURANCE companies - went along with it.
FYI
I’m not sure if there are any pertinent ping lists
I’ve never known of an unemployed doctor, other than a retired one.
Keeping doctor’s salaries high was the original, stated, explicit purpose of the AMA. That’s what licensing is all about: a barrier to entry to the marketplace, which those charged with keeping the barrier have a vested interest in maintaining.
The information I have is rather old:
Only about 10% of licensed doctors choose to join the AMA because the 90% feel that it is a corrupt organization which only wants the dues money and does little else.
I do bet you know good ones and bad ones though
The AMA is not a regulatory board — it is an association and a rather liberal one at that. I cannot stand that AMA — they are a bunch of idiots and I am not a member as neither are any of my colleagues.
The number of residencies are set by the federal government which determines the number of physicians.
Its disgusting.
We don’t need any more Dr. Fauxcys...
If we had 5x as many doctors our medical costs would probably be about 4x lower.
Spot on. Thank you.
I would rather spend $600 for a pizza than to send dues to the AMA.
Insurance companies are highly regulated. As I recall, and I can be corrected, Insurance companies are allowed a profit of essentially cost plus a "reasonable percentage". Thus, insurance companies have an incentive of increasing medical costs. As medical costs increase, what they can charge and how much they can profit can increase.
“Many FR”??? Some kind of typo?
The AMA and the ABA. Two entities fully positioned and endowed with authority to bamboozle the common man.
The medical field is a powerful and well protected lobby. In the military they are virtually their own chain of command like JaG or Chaplains.
You can be a PhD in physics and the military will treat you as a private and see little interest in you. But a mere nurse can get red carpet treatment and be an officer just like that with all kinds of waivers, age does not matter.
I think this issue has existed long before the AMA was set up to highjack this lobby for its niche own benefits. Eg. The American Heart Association is also a licensing mafia for CPR certification, but even AHA certified people have a hard time accessing the technical knowledge needed to do a good job, they thus learn on the job and with other 3rd party material to get current.
The result I suppose is few people get certified and they make a lot of money training restaurant owners and even doctors, however the overall scheme to realize is that it really is a pyramidal scheme where you make money certifying other instructors who will then certify other people etc. To save the planet from heart attacks.... Or, rather, get $$$
Seems like they’re doing a good job of keeping up that barrier and keeping doctors’ salaries high.
Now is the time to address the issue that this is not healthy for America.
Personally I think the number of medical schools should be set at the number of QUALIFIED students who are rejected by med schools. Right now it’s sumthin like 8:1 qualified applicants are rejected. When we have sumthin like 2:1 rejection rate of QUALIFIED [I know I’m gonna have to repeat this in the future for someone: Q.U.A.L.I.F.I.E.D.] applicants, that is when we can stabilize the number of medical schools.
Not all of us need to see the highest bestest doctor in the world just because we got a tummy ache. When it really is diagnosed as pancreatic cancer, that’s when we need them superduper docs.
Add to this the Chamber of Commerce republicrat orgs like the American Heart Association. It is a virtual racket to save people’s lives with researched “standards”
ABA = American Bar Association? There seem to be plenty of lawyers.
The number of annual new MD slots in the USA is a federal program .Sadly , too many foreigners are stealing these slots .
Foreign DRs can take the apply to practice in the US too .
Watch that crowd mostly questionable medical schools grads .
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