You just spend more money to scale the program. Funding for the residency program has been frozen since the late 90s, the demand for doctors has not been.

You can't "just" spend more on residency training without also "just" making med school classes bigger. You can't "just" expand med school classes without "just" increasing teaching staff, who are 9 times out of 10 physicians themselves. And very few physicians are going to willingly turn down $500k/yr clinical jobs to teach for a fraction of that.

You’re describing problems that are all solved by money.

And time. You double the number of residency slots but it will take years to fill them if you increase med school size at the same time, a type of coordination that is very unlikely.

Oh okay. Guess we’ll just continue to have 1997 level supply of doctors forever.

I don’t even know what argument you’re trying to make here? It’ll take time to solve? Yeah, obviously. That’s why we should start ASAP and given that we don’t have a time machine, that’d mean right now.

30 years is a lot of time. I agree with GP. Starting back then would have been best; starting now would be second. I live in a country that has twice the number of medical school graduates per 100k population than the US, and unsurprisingly compared to the US it's easier to get general medical and specialist attention.

The supply of new doctors (and residents) should at least keep pace with population growth. For whatever reason, we spent nearly two decades keeping this number flat even as population grew by 70 million. We shouldn't have to double these numbers, they all should have organically increased at a reasonable pace. But for a variety of reasons they didn't and now we have to fix the problem.

Why do we blame this on medical lobbies when it appears to be the same issue across the board for funding state education departments?

Because it’s a different issue with different principals involved.

Does the federal government set the national number of teachers who can be trained each year?

I have no idea, but that’s not the point. The funding they put into each state’s education budget, combined with that state’s policy effectively limits hiring.

> I think you’re giving way too much credit to medical associations to rig the game in their favor. They exert enough influence over all fifty states and the various private institutions to systemically deny training to qualified candidates?

The underlying fact that the AMA is directly responsible for the doctor shortage in the USA is historically accurate. 20 years ago the AMA believes we were heading towards a doctor surplus and heavily lobbied and for fewer medical schools, caps on federal funding for residencies and big cuts to the available residencies.

The AMA has reversed course and no longer supports these positions but the damage has been done, both to our supply of doctors and to their own reputation. However, even today the AMA supports many policies that keep taks that other professionals could perform the sole purview of doctors (which excacerbates the suppoy problem they helped create.)

I am wildly in favor of expanding the number of medical schools, expanding med school class sizes, expanding residency slots and funding per resident. None of this means I want decisions now made by someone who does 4 years of college, 4 years of med school, 3-7 years of residency and potentially fellowship on top of that to instead be made by a nurse "under the supervision" of a doctor. If you're a doctor of one specialty and you want to change specialties, you have to redo residency and maybe fellowship. If you're a nurse and you want to change specialties the training is either on-the-job or measured in days/weeks.

> one of this means I want decisions now made by someone who does 4 years of college, 4 years of med school, 3-7 years of residency and potentially fellowship on top of that to instead be made by a nurse "under the supervision" of a doctor.

That is indeed the AMA the talking point to justify their stance. However my problem with the AMA here isn't that they support some scope restrictions (clearly many decisions do require full training) but that they strongly support ALL scope restrictions without data to support such a rigid hardline stance. They do this even when the loosening scope restrictions would decrease cost and increase availability without any harm to patient outcomes. This absolutely exacerbates the physician supply problem that the AMA created. If the AMA actually care about the physician supply issues in the country, it would work with state and federal regulators to identify which scope restrictions can safely be loosened.

That it may be an AMA talking point doesn't make it wrong, and as far as I am aware the AMA is in favor of increasing physician at supply at the supply point - increasing medical school class sizes, increasing the number of medical schools, and increasing federal funding for residency programs (which can increase the number of slots, pay existing residents more, or both).

The answer to a physician supply problem is increasing the supply of physicians, not having nurses do physicians' jobs.

> That it may be an AMA talking point doesn't make it wrong

When an organization with a clear history of a specific agenda has a talking point, it is good to take the context of their agenda into account. I would point out that this particular agenda is one that has been largely achieved, which is why doctors in the USA make so much more than any other country and part of why our healthcare costs are so much higher.

In this case, we have a problem that the AMA deliberately worked to create for 20 years. Now that their "oversupply of doctors" myth is no longer remotely tenable, the AMA argues that the ONLY way to solve the supply problem they created is a solution that takes 10+ years to take effect.

We absolutely need to increase the number of doctors we have, but we also need to look at other ways we can safely increase patient access and decrease patient costs while we wait for new doctors to be trained.

The problem with increasing the supply of physicians it takes 10+ years for policy changes to have effects.

> They exert enough influence over all fifty states and the various private institutions to systemically deny training to qualified candidates?

Yes. What’s difficult to believe about this? People respond to incentives. The incentive for every physician is to maintain a shortage of physicians, therefore improving the job security and earning potential of every physician. The only way this could be done is if the physicians formed some sort of cartel that could control how many people were allowed to become physicians. This is what the AMA is and what it verifiably does.

> They exert enough influence over all fifty states and the various private institutions to systemically deny training to qualified candidates?

Politicians "trust the experts" and the American Medical Association says...

The flaw is the AMA is just a union for doctors not a body that represents patients in any way.

The American Medical Association says ... we need more doctors and Congress should increase Medicare funding for residency programs.

https://savegme.org/

Which is pointless without also increasing the number of medical student slots.

The AMA doesn't control the number of medical student slots either. They have no regulatory or accreditation authority. Medical schools are free to add more students, and several entire new medical schools have opened in the past few years.

https://www.deborahgutmanmd.com/blog/new-medical-schools-upd...

The immediate bottleneck really is in residency programs. Every year, some students graduate with an MD/DO degree but are unable to practice medicine because they don't get matched to a residency program.

In the late 1990s, the AMA lobbied to reduce available residency positions and residency funding.

https://blog.petrieflom.law.harvard.edu/2022/03/15/ama-scope...

Exactly: I want to see more/newer data on residency programs and placement rates per resident (MD, DO, IMG), because last I checked, residency spots (and the bottleneck created by limited Medicare funding, which I find interesting considering the profit created by residents) were the primary bottleneck; medical schools have every incentive to open new spots as quickly as humanly possible considering the ludicrous pricing they charge. We're firmly into 'money printer' territory for medical schools and their cost of operation.

AMA is not a union, it's an association, akin to the National Association of Realtors, or even the "National Association of Photoshop Professionals." There are big differences between a professional association and a union. For starters, a Union would likely demand required overtime pay for the on-call shift, a cap of max hours worked, likely plenty more. I'm not in a position to judge whether those kinds of demands would be a positive or a negative, but it's a big example of a difference between a union and a professional association.

> The flaw is the AMA is just a union for doctors not a body that represents patients in any way.

Ergo, AMA is not a union, hence that cannot be a flaw in the AMA. Chastising the AMA for not representing patients because it is too busy being a doctors union is a straw-man argument.

One thing that a generic union has in common with the AMA specifically is that both only care about its members, not anyone else, and will vehemently argue in favor of things that enrich its members at the direct expense of everyone else.

The overlap of commonality does not mean a lot, a professional association is not a union, a union is not a professional association.

I think there is unstated subtext perhaps in your criticism. To one extent, a unions job is to care about its members. It is _not_ the unions job to care about anyone else. If the union acts in the interest of anyone other than its members, it is not doing its job. I think that criticism is more of a definition almost. The seamstress union was not created to care about the CEO and managers, but seamstresses.

It's hard to say a bit whether union benefits always do come at everyone else's expense. I'm reminded of the argument against $15 minimum wage. According to one third of business owners in 2021, it was going to cause layoffs. [1] That did not happen in Seattle where that was tried, instead the data shows: “Seattle’s minimum wage ordinance appears to have delivered higher pay to experienced workers at the cost of reduced opportunity for the inexperienced,” [2] Despite the data, there is still the claim that mass layoffs would be necessary.

I think this perhaps dovetails into the debates of trickle-down (AKA supply side economics) vs bottom-up economics. Be what it may, not everything union is good, yet you can still thank them anytime you have a weekend. [3][4][5] I'm just saying, be cautious when painting with a broad brush. The idea a union helping its members will always be at everyone else's expense strikes me as an anti-union talking point rather than something grounded in firm data. Could be true, but without citation showing that to actually be extensively true, I do not take that statement at face value.

To be sure, the _only_ claim I'm making here is that a union and professional union are not the same thing. I'm super skeptical of all these other claims/statements being made and am not really willing to accept anything on face value here without evidence, particularly broad generalizations. The points I raise I think bring some refutation to those generalization, which does not mean the inverse is true, but simply that those generalizations are neither helpful nor informative.

[1] https://www.cnbc.com/2021/02/10/one-third-of-small-businesse...

[2] https://fox59.com/news/heres-what-happened-when-seattle-rais...

[3] https://www.politifact.com/factchecks/2015/sep/09/viral-imag...

[4] https://www.unionplus.org/blog/union-made/eight-reasons-than... (this source is very biased)

[5] https://www.pbs.org/livelyhood/workday/weekend/8hourday.html

edit fixed citation links, one was missing. Added more citations in support of claim that unions are to thank for the weekend (please correct my history if wrong, my point is that historically, in the concrete, unions have done some really good things [assuming you believe not working an average of 102 hours per week is a good thing as was the case for building tradesman in 1890 [5])