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Thread: Why doesn't the US train more doctors?

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    Shrieking Violet Sprockey's Avatar
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    Why doesn't the US train more doctors?

    Health experts warn that recent health careand immigration policies could worsen an ongoing doctor shortage, raising the question of why the federal government doesn't train more doctors in the first place.

    Some physicians' groups continue to call for an increase in the federal funding of medical residency programs, the training that doctors get after medical school in specialties like surgery and pediatrics. These funds, which were capped by the 1997 Balanced Budget Act, are predominantly financed by Medicare in the vicinity of $10 billion.
    "Everyone always thought that that cap was going to be lifted," said Dr. Janis Orlowski, chief health care officer of the Association of American Medical Colleges. "Twenty years later, that cap is in place."



    To train residents at teaching hospitals, the federal government budgeted over $10 billion of mandatory funds in 2016, about 90% of which came from Medicare and the rest from Medicaid, according to the Congressional Budget Office. Additional voluntary funding may come from private sources and other government agencies, such as the Department of Veterans Affairs.
    Orloski said teaching hospitals also contribute to cost of residents, especially when they exceed the number of residents allotted by the cap.
    Medical school enrollment jumped 27% between 2002 and 2016, according to the association. But due to the cap, this did not result in 27% more doctors being trained in the US; instead, the number of international doctors entering US programs went down, and the number of US graduates who were not accepted went up, said Orlowski. Attempts at passing legislation to remove the cap have been unsuccessful.



    A new analysis commissioned by the Association of American Medical Colleges predicted a doctor deficit of 40,800 to 104,900 by 2030.

    Spots to fill



    Even with the increase in American medical students, there are fewer of them than there are residency spots.
    Last year, just over 18,000 graduating MDs vied for nearly 28,000 first-year residency slots, with a much smaller number of osteopathic students submitting applications, according to the National Resident Matching Program. This year's numbers will be announced on Friday, when the next batch of medical school graduates will find out where they are headed.
    The rest of the positions are filled largely by foreign doctors and US citizens who have studied abroad, many in Caribbean medical schools. Just over 50% of each group who applied to American programs matched into one.



    Many foreign doctors practice in rural, underserved and primary care settings, where medical care is often lacking, according to the Association of American Medical Colleges. This is due in part to programs like the Conrad 30 J-1 Visa Waiver, which recruits foreign doctors to work in rural and medically underserved areas that may be less desirable to many American-educated doctors.
    A number of health care organizations also expect nurse practitioners and physician assistants to take on some of this workload, but a shortage of primary care doctors will persist, Orlowski said.
    http://www.cnn.com/2017/03/13/health/train-more-doctors-residency/index.html

    Should the US do more about training doctors?

  2. #2
    Sponsor GiftOfFlavor's Avatar
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    I've been saying this for years.
    1. Student loans.
    As a GP you can't make ends meet when you owe 500k on student loan debt and get Medicaid reimbursement.
    I would literally go broke trying to pay my student loans if I accepted Medicaid. Literally. The numbers just don't add up and I would not be able to provide the same quality of care and materials that I do now.

    Fix the rediculously elevated cost cost of a medical education and more smart folks will want to become a doctor. Right now there's lots of other professions to be with less debt, paperwork and bullshit to deal with.

    2. Medical malpractice reform
    There are real reasons that so many obgyn will not actually deliver in the hospital and they're all lawsuits. I seriously considered being an anesthesiologist. But I didn't for one reason - unbelievable cost for liability insurance. Anesthesiologists get sued constantly. So do most medical practitioners. I had a guy bring a lawsuit against me trying to get paid out because a filling fell out. Turns out it was a filling placed over 4 years prior and I wasn't even the doctor who placed it! But I had to call my malpractice insurance and file a claim and go through the whole ringamarole and stress coz that guy saw me as a piggy bank. If there's a lawyer to take the case they'll take it all the way!

    3. Science education/our fucked up education system
    It's gonna be hard to attract students to medicine if we can't even decide as a population if science is real. Medicine is evidence based. Decisions practitioners make are based on published literature.
    There's a decent size portion of the population that thinks vaccines cause autism.
    (They DONT. And even if they did, which they don't, its better to be autistic than die of polio, but I digress)
    People are either not being taught what science is properly, or are too stupid to understand it, or both. It's hard to attract individuals smart enough to get through med school when they don't understand basic scientific concepts. You can't be an evidence based practitioner if you don't understand what true evidence is.

    Those are the ones that pop into my head... I'm sure more will.

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    Full Sponsor TapToTalk's Avatar
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    It's hard to attract people to med schools if they think they're going to be government employees after all that hard work and loans.

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    I'm just here for the lulz. Sarsparilla's Avatar
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    Quote Originally Posted by TapToTalk View Post
    It's hard to attract people to med schools if they think they're going to be government employees after all that hard work and loans.
    My niece with a master's degree in public health went on to get a medical degree. She graduated with high honors, then went on to do an extra year of residency in a special program for high achievers. She is a doctor at the VA in Portland, OR. On purpose. By choice. With other more lucrative offers, she chose to be a government employee. Maybe part of the problem is there's apparently some kind of shame or dissatisfaction associated with being a government doctor in the US.
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    Premier Sponsor Inky's Avatar
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    Quote Originally Posted by TapToTalk View Post
    It's hard to attract people to med schools if they think they're going to be government employees after all that hard work and loans.
    I don't know - our doctors seem to be managing quite well.

    I know that Canada does have the same problem as the U.S. however, as far as the # of doctors being trained. For a while there was a push on to accept more foreign trained doctors but they had to meet certain criteria as far as training goes, and a lot didn't make the cut. Sometimes for good reason, sometimes not.
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  6. #6
    Full Sponsor TapToTalk's Avatar
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    Quote Originally Posted by Sarsparilla View Post
    My niece with a master's degree in public health went on to get a medical degree. She graduated with high honors, then went on to do an extra year of residency in a special program for high achievers. She is a doctor at the VA in Portland, OR. On purpose. By choice.
    By choice is the operative phrase. Some want to be in private practice. Some want to be in a group. Some want to work for a hospital. I'm pro-choice ;)

    I also didn't mean to imply shame for being a doctor working for a government agency. Sorry if it came out that way.

  7. #7
    I flunked typing coachgrrl's Avatar
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    So many are going into employment with large groups/medical centers that can better negotiate with insurance companies while dealing with overhead, I really don't know what the difference is. I work for a state university hospital, all of the MDs that practice there also work for the state. We have good state benefits including a great retirement plan. More importantly they do not have to deal with anything other than seeing pts, teaching and documentation. They have a vast medical system that takes care of all of their overhead.

    We have an amazing group of docs...I not only work with them, but have been treated by them throughout my cancer stuff. None of them seem to hate working for the state.

    I have one friend from CT who was a solo practitioner in his own internal medicine (BUSY) private practice. He finally through in the towel 2 years ago and went to work for the hospital system. He does the same work without any of the overhead/hiring/firing/keeping up with state/govt regs. He was sad to do it, but is now very happy.

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    Chronically sleep deprived RN_mom's Avatar
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    I also think that article about residency spots is a bit skewed. It doesn't mention residency for what? For specialties there are very limited spots and all fill up. That leaves gen med residencies and not a lot of folks are interested in that. There's no money in it and when you're drowning in debt, you look for what's going to make you money.

    It also doesn't mention that not all residency programs are created equal. Some of those not filling spots aren't the desirable residency programs or hospitals.

    I think it comes down to cost, for one. And limited program sized for two.

    We are seeing similar issues with the nursing shortage.

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    Nihongo dame desu villanelle's Avatar
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    It seems like there is an opportunity to expand student loan forgiveness for those going in to certain specialties, accepting medicare/caid, and/or working in government positions.

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    Full Sponsor RealCranky's Avatar
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    There's not a shortage of people applying to medical school, there's a shortage of slots to fill, and I think that's deliberate.

    Plus, it's hard to get people to go into primary care and then live in the areas that actually need primary care doctors. The local medical school offers all sorts of incentives for that, and still can't get people to go into general medicine.
    nesha ;-)


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