No one’s promising you can keep your doctor anymore

Increasingly politicians funded by Private Equity want lower cost nurses to do more. There’s also a hope that widespread use of AI in healthcare can goose excessive Executive Compensation. Tweaking the algorithm to send more patients to hospice care rather than more expensive rehabilitation services would be a big winner.



…except for the “JCs”. They will get whatever they want, at the corporation’s expense, because their care and feeding is the only priority.



“If you like your plan, you can keep your plan.”



@DrBob2 the opposition did everything it could to destroy medical care for as many people as possible. Congrats on your quote. sarcasm It is like purposely seeing to the deaths of 30k people a year because they are uninsured or underinsured. Marvelous to win that way.

In the same vein, we have sent abroad most of our factories until 2020 with such winning gusto. Amazing just win after win and third-rate blame. Third-rate blaming is called lies by some.


Demographics. More and more older MDs are retiring (including me and DW) and the generations behind us are not going into the career. I’ve predicted for many years now that NPs (nurse practitioners) and PAs (physician assistants) will supplant MDs for the majority of “routine care”. They can be produced quicker and cheaper than an MD.

AI is an interesting twist, but I only trust it within the data set it was trained upon. My BIL who helps build/design supercomputers at Oak Ridge National Labs (yes, Manhattan Project), gave an example of AI having issues between pics of chihauhaus and blue berry muffins (among other things).

He said he wouldn’t trust it beyond the tested and known data set.


The kids I know say medical school admission is extremely competitive and all spots get filled.

I’m sure there are many takes on this. Here’s one from the Atlantic.

" Imagine you were planning a conspiracy to limit the number of doctors in America. Certainly, you’d make sure to have a costly, lengthy credentialing system. You would also tell politicians that America has too many doctors already. That way, you could purposefully constrain the number of medical-school students. You might freeze or slash funding for residencies and medical scholarships. You’d fight proposals to allow nurses to do the work of physicians. And because none of this would stop foreign-trained doctors from slipping into the country and committing the crime of helping sick people get better, you’d throw in some rules that made it onerous for immigrant doctors, especially from neighboring countries Mexico and Canada, to do their job.

Okay, I think you’ve caught on by this point. America has already done all of this."


The dynamics and lengthiness of becoming an MD are well beyond what is needed. Experience in the job is more important.

Same with being an EMT. The book in the last ten years in CT weighed three times what the two books weighed in the 1990s.

There is overkill on the academic side.

Meanwhile, the best and the brightest over the last twenty years decided to cheat on Wall Street instead. At least from what I have seen parents had plenty of input into that decision.

Got a friend who used to be a nurse over 10 years ago. His career took him into Pharma research, and then an even bigger side track later (that still involved the medical field, think of things like computerizing medical records, research results, etc.). He’s now out of work. Problem is, no one will hire him as a nurse any longer because of how long it has been since he has touched a patient. This despite the fact he gets calls from head-hunters for contract nursing jobs in hard-hit areas. (amazing how much those jobs can be worth).

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My PCP’s bio lists him as the chief of technology on the billing side with insurance companies for something like a decade. Talk about not marketing yourself well. He is the best doctor I have had in a while. He is sharp like computer coding demands with experience. Closing in on 65 he has plenty of longer term experience which is what a patient really wants. He does not quote his textbooks directly because he is so good at seeing the patient fit into the materials for a diagnosis.

I do not think his schedule is full. He either sees people so quickly and well I must say or he comes across differently from any other doctor. He is not attracting a lot of people who need him.

But that’s precisely what makes a medical education so lengthy…the experience gained under supervision during residency, fellowship and more. That’s what equips a licensed physician to continue to gain experience over subsequent years which hanging a shingle up the day after graduating medical school probably would not.

This might have more traction as an idea if other countries weren’t suffering from a similar situation…physicians retiring early, younger generations wanting shorter hours/more circumscribed duties/better quality of life etc.

A couple of years ago whilst we were back on a visit to the UK, one news story was a warning of an even greater manpower crunch with physicians. Especially at primary care level. One reason being given was an unwillingness to work the number of hours usually demanded (needed) to make NHS contracts work. One suggestion I heard discussed was to limit the number of places for women applying to medical school…as this is the demographic that’s most likely to work part time from choice or necessity as the Usual Suspects when it comes to taking care of family (oftentimes children and elderly parents)

That’s only part of it. Much of the physician shortage in the US is regional. I suspect there is no shortage in places like Boston, Denver, SF, NYC and San Diego. MDs having already given up years in extra education and dollars in student loans are not willing to sacrifice more to live in underserved areas where people with money don’t want to live. in addition, being highly educated they are unlikely to want to live in states that restrict abortion, persecute LGBTQs, and ban books.

Can’t say I blame them.

If rural areas and red states want to play the culture war game, then they will have to pay more to get doctors to practice.

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How is it an Irish student can do five years of undergrad as a medical student? That is three years less than the US student and one extra year of medical training. To become a doctor in the US add three years. That is a pain.

More aptly I mean how rigorous something is should not be measured in paperwork. Two-year degrees often skip the principles and just add work. A better four-year degree derives principles. Of course, medical degrees derive principles but the degree of work has gone up endlessly. I will never forget my Dad ten years ago discussing how he would not make it through medical school today if he was just starting out. In his 50s he was the top doctor in his specialty in the region. There were no flies on the man. There is a point where competent people are locked out by overwork. You can go to Wall Street an entire failure with great Ivy League grades and way underperform for an entire career. The pay will be better.

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The main problem with that line of thinking, they don’t take into consideration the amount of training/patients seen into account.

I’m sure you’ve heard the old rule that to become proficient at anything takes 10,000 hours. To become a proficient physician, you have to see/treat so many patients. You could double or triple the number of medical school graduates tomorrow but if in residency training you don’t have the patient volume/cases to properly train these new physicians, you produce a much inferior and dangerous product. And this would be on top of less patients for medical students to see because there are now more medical students to divide among. So beginning residents would be even further behind in experience.

As far as immigrant doctors, the US has reciprocal medical school licensing with some countries, but they would still have to sit and take national licensing exam. It was the FLEX back in my day but now the NMBE. Some countries they have to go to medical school here. Bottom line, you set a standard and keep it.

Without reading more than the excerpt from the link, the Atlantic article garbage.

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Additionally, no matter the reciprocal agreements and what a FMG does to satisfy the equivalency requirements to match a graduating US medical student, the residency and fellowship etc requirements are still going to be there.

There’s a reason for this…and it seems very obvious to me…regardless of the value of say 30 years experience in a physician or dentist etc, there is a period in every experienced doctor’s career when they don’t have that experience. Used to be (especially within dentistry) that a new graduate could just hang up their shingle and get started. Not no more. So, I’m going to suggest that anyone looking for competence in a provider for any health condition of importance, they better hope and pray that, if they’re even remotely close to the start of their independent careers, those docs got lots of opportunity to practice and learn from any errors they made by virtue of a wealth of patients and years of post grad/residency/fellowship training.