And every time, I've explained that there aren't "extreme returns" to becoming a doctor. After accounting for all the expenses that physicians are required to pay out-of-pocket (which are not tax-deductible, due to AMT), the expected take-home pay is lower than what a mid-career engineer at Google or Microsoft makes, And the debt load is already high enough that it's discouraging people from entering the field[0][1][2], due to both the size and the risk..
Making medicine an even riskier bet (by taking on an even larger debt load with a longer time horizon) isn't going to solve any of that; it'll just lower the overall quality. At that point, it's more efficient to talk about NPs and PAs than piling on more debt to physicians.
[0] https://news.ycombinator.com/item?id=15758833
Also, the returns aren't simply monetary, but the fact that you have much higher social status in general that outweighs a lower net salary, even if it got to that point.
>Making medicine an even riskier bet (by taking on an even larger debt load with a longer time horizon) isn't going to solve any of that; it'll just lower the overall quality.
They still have to meet the med school and residency requirements.
>the expected take-home pay is lower than what a mid-career engineer at Google
The typical doctor would not qualify to work at Google.
>At that point, it's more efficient to talk about NPs and PAs than piling on more debt to physicians.
Or, as I said before, lifting the pointless requirement to have an unrelated four year degree. Or applying a whole host of QA feedback loops to the process. That doesn't change the fact that Medicare funding cannot reasonably be called the bottleneck here, for the same reason a subsidy can never be called a bottleneck when there is excess demand.
[1] marginal in the economic sense; not saying they are rare just that they're not common enough to affect the logic
The top ones absolutely would. In fact, math and statistics (which includes CS, in their categorization) is the second-highest performing undergraduate major for medical school matriculants.
You're kidding yourself if you think that the top students aren't making career decisions between medical school or finance and STEM and factoring in the massive difference in both risk and reward in the process.
> Or, as I said before, lifting the pointless requirement to have an unrelated four year degree.
There is no requirement to have an unrelated four-year degree - or any degree at all. Medical schools could accept someone straight out of high school. Except they don't, because the top-performing matriculants are those with a degree in the humanities, followed by those with a degree in the social sciences. Pre-med, amusingly, comes in dead last.
> the fact that you have much higher social status in general that outweighs a lower net salary
This may be the funniest thing I've read in this thread. No, compared to the other options available for a bright, qualified college student, going into medicine is probably the worst option if you want to optimize for either wealth or social status.
But sure, if you want to propose an incredibly convoluted process for filtering away the top prospective doctors (incentivizing them towards finance and STEM instead, for the better pay and respect), replacing them instead with less-qualified, middle-of-the-pack, independently-wealthy people who are willing to take on an extremely large and risky debt load because they can afford to and they don't have any other well-paying options... fine, go ahead, I won't stop you. If you think that that's the answer, then that means there's no policy solution needed. Nothing's stopping you from finding those people and going to them and encouraging them to take on that debt load themselves and apply to medical school today. They can take out those loans themselves, or use their own money to pay their own way.
But then please stop derailing these conversations by talking about lifting non-existent requirements, or making rather pedantic quibbles about terminology. When we're talking institutional policy, it's perfectly fine to say that an existing subsidy is "the bottleneck", in the sense that, ceteris paribus, increasing it would alleviate the problem and decreasing it would exacerbate it.
>The top ones absolutely would.
I was referring to the typical one.
>Medical schools could accept someone straight out of high school. Except they don't, because the top-performing matriculants are those with a degree in the humanities, followed by those with a degree in the social sciences. Pre-med, amusingly, comes in dead last.
But they're not even considering those without a four-year -- that's another cause of low supply.
>This may be the funniest thing I've read in this thread. No, compared to the other options available for a bright, qualified college student, going into medicine is probably the worst option if you want to optimize for either wealth or social status.
You're saying the typical doctor has lower social status than the typical CS job or finance?
>But sure, if you want to propose an incredibly convoluted process for filtering away the top prospective doctors (incentivizing them towards finance and STEM instead, for the better pay and respect), replacing them instead with less-qualified, middle-of-the-pack, independently-wealthy people who are willing to take on an extremely large and risky debt load because they can afford to and they don't have any other well-paying options...
That's a strawman -- the comparison was to doing e.g. 10% more residencies by having them 10% less funded. Still no requirement for independent wealth.
>But then please stop derailing these conversations by talking about lifting non-existent requirements, or making rather pedantic quibbles about terminology. When we're talking institutional policy, it's perfectly fine to say that an existing subsidy is "the bottleneck", in the sense that, ceteris paribus, increasing it would alleviate the problem and decreasing it would exacerbate it.
When you talk about "the bottleneck", has a precise meaning: "this is the limiting factor that must be relaxed for any growth". If that criterion doesn't hold, it's just one of many factors and one of many options to consider.
When you say that Medicare subsides are "the" bottleneck, you're claiming it's literally impossible to have more doctors unless a government agency spends more tax money on it. That's every bit as false as the equivalent claim about Hamilton in LA and the TSA: if the private market is already willing to pay, and to be paid, enough for it to happen, the problem can't be insufficient subsidies, but a refusal to implement well-trod solutions (or the regulations that prevent that well-trod solution).
That is definitely not a pedantic quibble, but the difference between "this needs more money" and "this only needs more money because they're adhering to harmful practices" (like rejecting qualified students who don't yet have a four year degree, which they're apparently doing even if not required).
If there are more aspiring doctors than can fill the subsidized slots (there are), you can balance demand and supply by passing some of the costs on to the resident[1]; many will still gladly accept this because of the extreme returns to becoming a doctor.
The fact that they don't allow that happen is not a funding issue.
You can further massively increase the supply at little cost to doctor quality by getting rid of the pointless four-year degree pre-requisite. (vindicating the blame placed on the AMA)
More generally, if demand vastly exceeds supply (as it does here), subsidies can't be the bottleneck. To reiterate the analogy (from the past copies of this exchange), it would be like saying the musical Hamilton can't come to LA because the TSA won't pay for the plane tickets to get the cast down there. No: there is enough demand to cover the cost of airfare. And there is enough demand to cover the shortfalls in resident subsides.
[1] Concretely: instead of funding 100,000 slots at 100%, fund 120,000 at 80% or something like that.