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]
I don’t know what the Morgan & Morgan definition of malpractice is. For purposes of our further discussion, you should post a link to a definition of malpractice we can agree on.
I do not think a pure market is possible. I think there should simply be more market force present, to the point that only half of the qualified applicants get turned away from med school. Trump had some interesting ideas on lowering prescription costs. There are a few simple things that can be done but the AMA is definitely in the way.
One thing the AMA shoulda been doing all along is hire kickass lawyers to defend doctors. But there’s no money in it for them, so they don’t do it.
importing eager foreigners of questionable quality.
***There are plenty of homegrown Americans who can provide questionable quality.
Saba school grads
***Please define and elaborate
Then at the very least, the issue of needing more physicians would be addressed.
True that the vast majority of MD’s recognize that The AMA is a leftist organization, and want nothing to do with it.
What is never discussed is that the leftist agenda has made women the majority of medical graduates.
“The AAMC’s annual report on medical school enrollment showed that 2019 marked the first time that the majority of U.S. medical school students (50.5%) were women. As the increasing numbers of female medical students graduate, the percentage of female physicians in the workforce should rise even more.”
“Male physicians worked more hours per week (50.9 versus 43.7) and more weeks per year (47.1 versus 45.9)”
“Female physicians provided fewer clinical services than male physicians did and retired 5 years earlier.”
Mandated gender equality in medical school admissions has created, or at least exacerbated, the physician manpower shortage.
aim all for more american trained physicians. The other problem that needs to be fought is the wokeness of the medical schools. They are now for the most part preferring diversity and “ nontraditional” students over the beef and most qualified applicants. My daughter who is a beautiful classically trained ballerina who danced on scholarship through college, graduated summa cum laude from an excellent university and had outstanding MCAT scores barely got an interview at her home state med school. She ended up at a private midwestern medical school and received excellent training but at 80k/yr she now has > 200k debt on a residents salary. Quality is going to be a huge issue with the social experimentation med schools are currently engaged in
“There are plenty of homegrown Americans who can provide questionable quality”
Wait, didn’t you just say we need to get to a 2:1 acceptance ratio vs the current 8:1??
:^)
You gotta get consistent here...
Of course we have less then stellar people trying to get into the medical field at a level above their actual qualifications, but as a starter, the language difference alone is an issue that leads to problems for ordinary patients.
My own experience with actual docs in foreign lands has not been bad. My impression is that most of the best docs stay in their own country, and only the opportunists head to the US.
It’s a Caribbean med school and I’m being a bit snarky because it actually has a great graduation/residency placement rate in the US. In fact, my exposure to some of those grads is what led me to realize that a free market solution in this country was being ignored.
Excellent.
Milton Friedman warned back in 1961 that the American Medical Association was a government-sanctioned guild or trade cartel that would raise health care costs and diminish quality. Today, most economists agree with him. That’s because the costs of AMA’s aggressive tactics to keep physician wages up by, among other things, imposing onerous licensure rules, capping the number of new doctors, and harassing nurses, midwives etc. who can treat certain routine conditions more cheaply than doctors have become painfully obvious....
I don’t understand where the criticism of consistency is. I’m an AmericaFirster Trumplican, and I think having more medscchools and more doctors from America will be good for America.
The military has an expression: Quantity has a quality of its own.
Yes...I can see in context that you’re saying if we gotta have so-so docs, we don’t need to go the extent of importing them! Might as well be our guys...
So you’re being a bit cheeky too...
No need to import people when we have people here willing to do that job.
bmk
Insurance companies are SELF regulated INVESTMENT companies.
Lobbied
fair point
The bottleneck is mainly at the medical education level, including residencies. But the bottom line is that we have too few doctors. We have fewer per capita than most of the developed world. Yet we should have more given the high demand there is for healthcare in this country.
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