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]
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.
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.