Posted on 08/01/2021 6:29:06 PM PDT by Kevmo
Congress needs to fund more residencies. Then Med Schools can expand enrollment.
It seems we are importing them by leaps and bounds. My poor sister can’t understand a word her doc says, but he’s the only GP covered by her insurance within any kind of reasonable distance.
Hogwash. Including most of the reply posts. I won’t dignify it any further than that.
You’re so full of bluster that your writing lacks clarity. Take a writing class. Before you do, identify what it is you are labelling ‘hogwash’.
To my mind, that is strong evidence of a failed policy because that could have been an American born & raised doctor she was talking to. It is an artificial barrier raised by the AMA and now they are importing foreigners to do the work Americans want but can’t get.
Congress is corrupt. They only really respond to bribes paid.
Unfortunately this is not the case — the problem with health care costs are not the lack of competition driving up the cost of medicine, it is the regulatory burden. In. system where 18 cents on the dollar translate to patient care (and that includes professional component such was physician fees) the issue is not tubers of physicians. Tort reform would be the thing that puts the biggest dent into medical costs. Passing meaningful tort reform with loser pays and caps on awards would probably drive down the cost of medicine 60% overnight.
The AMA is a liberal lobbying group. They have nothing to do with setting the number of residency spots available
Feel free to bring us up to speed on who DOES set the number of residency spots available and how we can get that multiplied by 5x so we can lower medical costs to reasonable levels.
See my above post — it is the federal government that establishes number of residencies. Also see that 5x doctors will not significantly dent the cost of health Care. The cost of regulation is what is driving the cost of medicine. In most cases physicians salaries are loosely capped by CMS reimbursement.
You think the solution is tort reform? Malpractice insurance wouldn’t be so high if there wasn’t so much malpractice.
But to your point, a free market where a person makes an informed choice about their doctor is the best approach. And that informed choice would include how much insurance they carry and how far along the scale on qualifications the doctor is.
A new doctor with few quals and low insurance is gonna be cheaper. Market forces start contributing to the balance.
And even if you have 5x the number of residency spots you would need to increase the number of medical school spots by the same number to fill them
Please refrain from acronyms because those are only for people in the know. Assume you’re dealing with ordinary people.
The FACT that physician salaries are capped is something that market forces could correct. Competition is a good thing. I just don’t need to see a superduper specialist with 3 weeks waiting time just to get a prescription for my foot infection. There has to be some friggen common sense applied.
That is what I am advocating.
Go for it. I do not think it would accomplish what you think it would. Physician reimbursement is a very small percentage of healthcare cost and compared to other professionals we do not make an inordinate amount. I make about 1/3 hourly if the lawyer i recently hired for some estate planning issues. But we clearly need more physicians as there are t enough to go around now.
There is not a lot of malpractice — there are a lot of scum sucking bottom dwelling attorneys that take flimsy cases on a contingency basis. When it cost nearly $250,000 to try a malpractice case, when an insurance company gets a cost of defense settlement offer for say $100k, they consider themselves 150k ahead and control their costs
The attorney takes 33% -> essentially 33,000 for a few nasty letters and the plaintiff takes $67,000.
The fact of the matter is that this the largest contribution cost to modern medicine as there is so much defensive medicine that drives the costs of healthcare up.
There is nothing that is market forced in this medical system — the government has assured that. I happen to agree with you that a purely free market system should exist that includes torts should be paid for by plaintiff. If a plaintiff had to shell out a retainer of $50,000 for a complaint and summons you would see an immediate drop in malpractice litigation.
Obviously you have bought into the Morgan and Morgan definition of malpractice, not the actual legal definition.
Thanks. Good comments here that throw light on the reality of the problem.
It’s obvious that the tangled web of interleaving constraints has led to absurd results: high prices for substandard docs, i.e. Foreigners.
The superdocs who had to accomplish two moon landings with 1600 SATs sensibly find the highest paying specialty program they can get into because it’s the only thing that made sense for the gauntlet they ran. This leaves a patchwork of PAs, LPNs, foreign docs, Saba school grads and other misfortunates to take up the slack in the GP space, least as far as I can tell.
Would the country be better served with more native born MDs from expanded or new US med schools? I think to a large degree, yes. Certainly it would level the competency across the board, and maybe free up the technician level people to spend more time doing a higher quality job.
But this thread appears to have good insight from actual medicos so I’ll leave it to them to comment.
Since you are in the field - is it true that residencies are funded from Medicare or Medicade, not sure which one, which effectively caps the number available.
Had a friend who kid was working to get into medical school, and I asked why, if we need so many more docs, don’t they just add more open slots in medical schools.
His response was they could - though that’s not easy either, but even if they did, the number of available residencies is out of their control and controlled by federal funding. If they added more class there would just be a bottle neck at the residency stage after expensive medical school instead of before…
Thank you in advance if you have time to respond.
Yes, CMS (Center for medicare services) funds residencies and CMS is funded ever year by congress at the federal level. Interestingly Medicaid, though a state service, also receives block grants from the federal government.
Each resident has a budget far greater than an attending physician blocked to the hospitals because the are “learning” and will generally order more tests / procedures etc which are reimbursed. Residents are actual a profit to the medical center that has a residency.
The way the federal government controls healthcare is disgusting. Consider this — what most people get promoted for in business ends a doc in an orange jump suit. Getting trial lawyers and the federal government out of the way would create a far superior system.
I have heard the exact comment you made here from a good friend (well, my closest friend...met in kindergarten while our parents attended Republican party meetings in the Eisenhower era...) who is currently in a managerial role for a large hospital operating group.
His comment was that with the high cost of even one mistake, the actual costs would stay high since SOMEONE is going to make a mistake and probably one a day across the national system, leading to massive risk exposure on a daily basis.
Not that the general quality of docs was bad, just that with the sheer number of opportunities to have something go south, something would. And the resulting cost would be astronomical.
But I think the solution is two fold, and it’s based on my own rather unpleasant experience: have seen actual mistakes made by a foreign doc - he got wire brushed by the State Medical board after I referred him, and after a few other similar complaints, I think he’s relaxing in a condo near a beach somewhere, without the opportunity to drop the ball on another case - and in another instance (my father’s last days on planet Earth), a foreign doc who was not incompetent, but not particularly brilliant either, and got pushed by a Chief Resident to take the path of least resistance because it was expedient.
And thus the two points...
1 - Tort reform as you point out; much medical time/expense is now devoted to layers of CYA review/testing etc to produce a paper trail that can’t be assailed (but will be anyway in court)
2 - A larger group of MDs and concomitant residency slots who should be able to produce overall better results at a lower cost since Item 1 will free up available cash for them, not tests, lawyers, and awards.
An emotional and patriotic benefit would be that more homegrown docs would be involved due to Item 2; it’s ridiculous that the current game appears to be artificially limiting the number of docs in this country with the assumption that any shortfall can be cheaply made up by importing eager foreigners of questionable quality.
My viewpoint may be simplistic and certainly one from the consumer side, but I’ve seen examples of both situations and experienced their side effects.
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