AMA is not the main culprit in supply of doctor's, that would be available spots for residents (and further downstream, available slots for sub-specialties e.g., pediatric nephrology; pulmonary critical care). You can expand med school enrollment until the cows come home, but you'll just be increasing the number of aspiring doctors who don't "match" to a program to continue their training.
Solving this is complex and complicated, in large part due to the fact that residences and many fellowship programs are funded through medicare/medicaid via congressional actions, sometimes with additional state funding.
Also keep in mind that most doctor's have high salaries and high debt load, they're not as rich as people think. There are sub-specialties though that are aboslutely rolling in cash (interventional radiology, dermatology, ortho as some).
> AMA is not the main culprit in supply of doctor's, that would be available spots for residents
The AMA has actively lobbied to lower the number of residency spots.
> In 1997, the AMA lobbied Congress to restrict the number of doctors that could be trained in the United States, claiming that, "The United States is on the verge of a serious oversupply of physicians."[12] The AMA successfully lobbied Congress to cap how much Medicare could reimburse hospitals for resident physicians
It was not my intention to defend the AMA, and organization I generally don't like (though I don't think they are villainous either).
I will note that you're referencing 30-year old legislation, which I don't think necessarily speaks to the AMA's role or position now. The AMA is not de facto against increasing slots. Please refer to this position from the president of the AMA penned last year: https://www.ama-assn.org/about/leadership/more-medicare-supp.... They have consistently asked members to support legislation increasing funding for GME positions.
But ultimately, their opinion is just that. Advanced medical education required congress to act, and expanding availability of trained professionals requires either:
1) Increasing slots for advanced training one way or the other, which will almost necessarily carry increased costs or
2) Allowing more US-trained immigrants to stay in the US after their education or
3) Creating an easier pathway for trained foreign doctors to practice in the US
Do you think there's ANY chance of #2 or #3 happening? In 2021 Congress funded 1000 new positions, the first expansion since 1997. They added 200 more spots in 2023. I imagine we'll be waiting awhile for the next expansion that the AMA actively desires.
I didn't say they needed violins of sympathy, but the majority of them are not the wealthy upper crust they are often perceived to be. This goes double for family medicine, and double-double for pediatric specialties that are paid less since Medicaid covers so much of the cost.
>I didn't say they needed violins of sympathy, but the majority of them are not the wealthy upper crust they are often perceived to be.
Sure early in their careers, just like every other well paid profession isn't "rich" early in their career. After a decade or so into their career though, they are either rich or really dumb with how they spent their money.
The worst impulse in me wants to get highly specific and detailed about how you are confidently painting with too broad of a brush, but I just don't have the energy. I'll just say two things:
1. Physicians earning story is very unique from most other professions (e.g., higher debt load; later career start; limited salary increases after starting) and doesn't correspond as well to the mental models you've constructed.
2. I'm not a physician myself, but I'm friends with several AND my professional experience includes two projects setting physician and surgeon compensation strategy across multiple geographies. I'm familiar with the macrodata and anecdata.
But I will say this: when it comes to surgeons or physicians on the "ROAD to success" (i.e., radiology [increasingly less so as the work is offshored], ophthalmology, anesthesiology, or dermatology) you are mostly right.
Another commenter already mentioned their caps. I'll add that the cost of medical school is one of the true reasons for short supply and one of claimed reasons healthcare is high. For the latter, they have to recover the cost of their expensive education.
Getting education costs down to community college levels would knock out a major source of high prices. Or they'd stop pretending it was. Whichever it actually is. :)
No, it's not. The reason for the short supply is the CAPPED number of advanced education spots after medical school. Open up 100 more med schools with class sizes of 1000 each at half the cost or typical schools and you'd still end up with pretty much the same sized cohort of doctors with advanced training.
Some states have looked into legislation allowing graduated med students to serve rural communities without having undergone a residency. I don't think this is widely available if available at all, nor do I think it's scalable.
> I don't think this is widely available if available at all
It was, a long time ago. Then states started requiring an internship (first year of residency) for a full license - which is still generally the case in the US for graduates of US medical schools (foreign school grads regardless of citizenship usually have to complete at least three years of residency before getting a permanent license). Getting privileges at a hospital will nearly always require finishing a residency. That's a matter of the hospital's medical staff bylaws, so changing them is not really in the purview of the state except to prohibit discrimination based on a protected class - and "hasn't finished residency" isn't a protected class.
It definitely would further ghetto-ize rural general practitioners. They wouldn't even be eligible to get a job outside of those rural clinics.
I think of healthcare problems in America like a watershed: the issues are not the result of any one problem but a concentration of small, medium, and large problems that all drain into the same humongous river. Things that could happen (and let's just take more socialized medicine off the table since it will never happen):
1. Increasing caps (funding) for advanced education
2. Allowing Medicare to negotiate drug prices, it's preposterous that they cannot do this
3. Increase price transparency at hospitals to enable some downward pressure on prices. This is much harder than it sounds, not that it's my problem to solve.
4. Limit hospital system monopolies that given them too much leverage in price negotiation (though have to be careful not to give insurers too much negotiating power, delicate balance)
5. Cap out of pocket expenses, though I'm not sure how.
6. Standardize and simplify billing codes across the US, with more public visibility into them. Medical billing is currently an art, it should be a science.
7. Offer loan forgiveness to medical practitioners that serve for 10 years post-advanced training in a low-healthcare access communities. For what it's worth, I'd also place income-to-debt ratio restrictions on doctors' eligibility for public service loan forgiveness as well.
8. Sadly, if we won't let immigrant trainees stay and obtain citizenship in the US after training, we should stop allocating training spots to them.
9. Increase use of mobile clinics and/or transportation services. This would almost necessarily need to be government funded.
10. Reform malpractice insurance and litigation in a way that doesn't remove physician accountability but doesn't require such high overhead to be paid by everyone down the line.
Solving this is complex and complicated, in large part due to the fact that residences and many fellowship programs are funded through medicare/medicaid via congressional actions, sometimes with additional state funding.
Also keep in mind that most doctor's have high salaries and high debt load, they're not as rich as people think. There are sub-specialties though that are aboslutely rolling in cash (interventional radiology, dermatology, ortho as some).