Jimmy Carr home grown Drs n nurses, other medical staff.
If a student meets the standard, they get into medical school.
ralph
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Some would say it’s a continuation of an extractive empire accustomed to getting cheaper goods and labor from its former colonies for the benefit of its people. They forgot that this is harder to do with some services…
That may be a problem in UK. I don’t think its a problem in the US.
Once many students when to college as premed students often in biology or chemistry. Then they applied for medical school, and many could not get admitted.
Now you apply to med school programs before going to college and get into med school as long as you make suitable grades. A better system.
Our biggest problem is that too many doctors decide to do higher paid specialties rather than family practice. And they prefer urban areas leaving us with too few doctors in outlying areas. Getting more GPs would help.
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I don’t understand this interview….unless it’s part of a larger whole with more nuance.
Medical school places are not remaining empty because of some arbitrary quota. Quite the reverse. There aren’t enough to meet the demand of adequately qualified candidates. And remember……because this has been mentioned multiple times when discussing physician shortage….before a medical school graduate gets to become an autonomous part of the doctoring workforce, a further training period at least equal to the amount of time spent in medical school is required.
Increasing medical school places (which has always been part of some nebulous agenda dating back to when dh and I were going through the system) but without any other change just creates a bottle neck at some point.
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Actually, our biggest problem is a 1997 law that caps residency programs. You can’t become a doctor without completing a residency and this nearly 30 year old law capping it means that we will forever have a shortage. There are many many graduates of medical school that will never be a doctor in the USA because they will never get a residency. So, they turn to other professions or other countries.
As a physician-scientist and former founding dean of a medical school, I argue that the true bottleneck is not the number of medical school graduates but the insufficient number of residency training positions. Since the Balanced Budget Act of 1997, which froze the number of Medicare-funded residency slots, the United States has seen a steady increase in medical graduates, yet the availability of residency spots has stagnated. This mismatch between undergraduate medical education (UME) expansion and the lack of corresponding growth in graduate medical education (GME) is the key issue.
…
When all applicants are considered, there are only about 0.82 residency positions per applicant, meaning a significant fraction of doctors-in-training will inevitably go unmatched each year. The bottleneck thus affects not only U.S.-trained graduates but also many foreign-trained physicians eager to help address U.S. healthcare needs. In my role as a health system leader, I have seen communities desperately try to recruit physicians while an untapped pool of medical graduates sits on the sidelines due to insufficient training opportunities. This mismatch between UME and GME is at the heart of the physician workforce shortage.
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I asked ChatGPT.
{ Residency positions (the real bottleneck)
This is where limits do exist.
After med school, graduates must complete residency to practice.
Most residency slots are funded by Medicare (CMS).
Congress capped Medicare-funded residency positions in 1997 (Balanced Budget Act). }
I conclude it’s a L&Ss problem.
Cynically, I think it’s not that simple.
Who do the lobbyists, who pushed this aspect of the 1997 act, work for?
ralph
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Wasn’t this the AMA? The arguments they lobbied for were the “concern” for oversupply of doctors and the consequent oversaturation that would result in unemployment or underemployment. A rickety supposition if there ever were one and increasingly obvious as the decades pass.
Pete
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More like result in smaller paychecks. And why does Medicare even fund these things? Where’s the free market and concern for one’s own profit giving us the best and the most? Something was obviously screwed-up to begin with for teh GOv to even get involved. And before some marketeer chimes in with some government grab nonsense, the system and those in it were all for it. So even they didn’t care a flip for any free market.
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In 1996, there were concerns of oversupply - and as good politicians do, they mucked with the market by creating artificial barriers to entry.
Now there there is no longer this fear of over supply and in fact we have a shortage, nothing is being done to fix it - and of course the current government is loath to put additional funds into anything.
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Medical school seats are not the problem. Those that graduate from such programs will still be required to complete a residency program.
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That’s my understanding of the problem, too.
Who’s lobbying for the cap? The American Medical Association.
intercst
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Government started funding residency programs to cater to Medicare and Medicaid.
Here’s a snippet from Eram Alam’s (science historian) book on how the US decided to accept foreign doctors:
It all really started with the Hart-Celler Immigration and Nationality Act of 1965. Three months prior to this legislation, Medicare and Medicaid passed in the United States, and almost overnight, 20 million people had health coverage. The problem was, there weren’t enough doctors to take care of everyone. Part of this bill was designed with attention to the physician scarcity in the U.S., especially in what are called “shortage areas” across the nation. These are urban and rural communities that lack a sufficient number of healthcare workers, and where hospitals tend to be under-resourced, and a large number of patients are on Medicare and Medicaid. These aren’t usually the kinds of places that appeal to most American-trained doctors. If you have options, you might not jump at the chance to practice medicine in a small rural town in Arkansas, for example. So, immigrant physicians were and still are invited to work in these shortage areas.
interview here:How immigrant doctors fill critical gap in U.S. healthcare system — Harvard Gazette
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As I’ve explained many times before, yes, residency programs are capped. Cynically you can say to limit supply, etc., etc., but it is more to do with adequate training numbers/opportunities. Back when I was in training (early 90s) programs had to show the residents were exposed to enough types of cases to provide some semblance of proficiency. If those minimums weren’t met, the program was first put on probation and then deactivated if improvement wasn’t made. For example, I had to do so many labor epidurals, so many pediatric cases, so many X, Y, Z.
You can double the number of slots, but if you don’t double the number of cases, all you do is either produce poorly experienced doctors or you increase the years of training needed to get those numbers. Neither is a good choice.
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Makes sense, but how does the system verify this for the 25% of foreign-trained physicians currently practicing in the US?
Depending upon the specific state ed department requirements ….and the degree of post grad training the FMGs posses….a residency program may be a prerequisite.
There is an underlying student problem of mismatches. Not every medical student gets what they inititally wanted as a practice. That was normal before 1997 as well. The cap might to a degree exclude some students who would be wrong for their wished for residency.
Dad wanted to be a surgeon. He has a slight tremor in his hands. He did not follow through as a surgeon. It was not entirely his decision. Also when doing rounds as a student he was awful at dermatology. He passed that up gratefully.
There are some folks who should not be doctors even after graduating medical school. There are lawyers who are not good. You can not expect everyone who graduates school to get what they want.
No, the AMA supports removal of the cap because of the severe and growing shortage of er docs in rural areas: https://www.ama-assn.org/education/gme-funding/congress-revives-bill-add-14000-gme-slots-over-seven-years
I do not know a lot about the topic, but I know a little because my son-in-law is an er doc in a rural area. His hospital was already struggling to attract er docs from higher paying urban areas when COVID hit and swamped the er’s with so many sick and dying covid patients that there was no room nor personnel for critical care. He gutted it out, but some of the docs and nurses did not. They moved on to other practices, places or professions.
Recently one of his skilled, well-liked colleagues did not get his visa renewed under recent anti-immigrant policies.
I also know that a nearby desperately underserved rural hospital offered him an insane amount of money to work for them one weekend a month to cover their severe shortage, but he was already working too many all night shifts and sleeping too little.
So apparently Medicare/medicaid are needed to fund these rural hospital residencies, the AMA and a majority in congress want it to serve the rural communities. But that will cost tax money and is apparently less important billionaire tax cuts.
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The shortage of professional staff isn’t confined to the seemingly less desirable, rural areas. The impact of “travel “ docs, nurses etc. was a new phenom to me when we moved here to Colorado just over 9 years ago. It seems to have become worse….i.e. more prevalent….since Covid. Even the University hospital setup had a significant number of travel nurses involved with my husband’s post op care (fortunately no one involved in the hands-on part of “putting him to sleep” and waking him up again in good shape).
So, in addition to the numbers of medical staff retiring early or leaving clinical medicine for other fields, there’s a bit of a shift in the commitment to the traditional career path among the younger crowd entering healthcare (possibly other fields too) In chatting with the travel nurses involved with dh’s care, this mountain location is very desirable for the outdoorsy type…winter and summer….and working a gig where they could pull the level of compensation that allows a two week on, two week off agenda (bedside or mountains) it preferable to the traditional model.
Nice work if you can get it, as the saying goes…..but an unsustainable long term prospect on the delivery side, it seems to me. Hospital groups offering higher and higher stipends (oftentimes via locum companies that add a level of “skim” to the ensuing cost) for fewer work hours “on the job”. Not even going to touch on the topic of continuity of care.
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The US has reciprocity with a few countries: Canada, UK, Australia, and New Zealand come to mind. They can come here and we can go there to practice after verification. It is definitely more one sided in favor of me going there. But I’m sure things have changed since the last time I looked.
Most often, if they’ve graduated from a recognized medical school, they would need to come here and do a residency training program.
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