Not "we all want", but especially doctors themselves want less competition (even when they say they are overworked).

There were multiple similar stories on that, e.g. "Thousands of doctors in South Korea took to the streets of Seoul on Sunday to protest the government's plans to increase medical school admissions." from 2024. Similar stories from Nepal and Bangladesh.

The most interesting part of that is that population typically sides with the doctors, not the government, for some reason.

My understanding is that in many countries the biggest blocker to increasing number of doctors is the fact that there aren't enough doctors to teach. Unlike CS where we can simply increase the number of seats in. A course with medical school there are real bottlenecks on things like cadavers and mentors.

There aren't enough spots in medical schools. I was a 4.1/4.3 GPA in Canada and I didn't get in med school. My sister got in with a 4.24/4.3 GPA (one single A, all A+).

Doctors in control regularly shut down any attempts at increasing this limit.

While true, it's also true that scaling medical school is not like a CS situation. My school quadrupled the number of CS seats to meet demands over 4 years. I can't see this happening with medical schools. My brother who is currently in a medical school regularly says how hard it is for the faculty to find teachers simply because there aren't enough. To add to it there are bottlenecks like not having enough cadavers.

Medical education is very hands on unlike engineering where we just throw people in the deep end at work. This is with good reason.

I'm absolutely for having more doctors and medical school seats but I think it's important to acknowledge that it maynot be as simple as increasing seats. There needs to be more fundamental reforms. That being said yes there are completely pricks of doctors who enter politics.

And intelligence combined with ability to deal with people and enough grit, memory and sleep deprivation resistance to pass medical school.

Maybe medical school itself needs to change to make the role easier and split the functions into easier ones that more people can do.

Right. Medical school in other countries is certainly not a walk in the park. But nor is it the hellacious endeavor it can be in the US, especially then as an early resident.

Yes!

After I finished grad school (electrophysiology and imaging in large animal models, so seemingly relevant experience), I thought about becoming a clinician. However, I wasn't even eligible to apply to med school because it had been 5 years since I took an introductory biology or physics class (with lab!). It seems I was qualified enough to teach in a medical school but not to be a student.

A faster scientist -> practitioner pathway would be such an obvious win-win: it'd help with the overcrowded academic job market AND relieve clinical shortages, but most of the emphasis seems to be on getting MDs into research instead.

But reducing the number of admissions is not going to fix it, it will only exacerbate it.

If we increase number of admissions, then long-term doctors should become less overworked. That's a path to fix it.

Doctors and medical professionals are somehow immune from allegations of gatekeeping when in fact that is what they do all the time under the guise of different noble reasons

> doctors themselves want less competition

Which is entirely rational. A medical degree is expensive and doctors want a return on their investment. In that sense, doctors are very similar to real estate investors (and to a certain extent labor unions); they all want a return on investment (don't we all!) at the detriment of society. Because damn, competition kinda sucks compared to coasting along, especially as you get older.

There are countries where university education is free and there are exactly the same problems.

Doesn't really matter. Doctors spend a huge amount of time in education. There's a massive opportunity cost, and they want to be paid.

"If I'm going to study into my 30s I want a huge bag."

Understandable, though not necessarily defensible.

So it doesn't really matter because other occupations also have the same opportunity cost and want to be paid and are not getting top of the field salaries straight out of university but have to take shitty internships and maybe get decent pay past 30yo.

If people in those fields could use laws to limit competition, they would do so as well.

Happened in France too. It was put in place in the late 70s, and ended in 2020. Called the «numerus clausus» (closed number, in latin) and it restricted the number of medicine students allowed in the country every year.

The number of students fell by 50% between 1980 and the mid 90s: 8500 new students/year in 1972, 3500 in 1993.

Of course, now the number of doctors in France is far from enough for an aging population, in every specialty and it will take at least a decade to improve. It's not uncommon to have 1-year waitlists for ophthalmology appointments, and several weeks or even months for dermatology.

Not sure if it is valid for France. But there is paid healthcare system in Germany. No wait time and newest treatment methods are used if you bring your own cash. Same doctor has appointment next day if you tell that you‘re paying by yourself. If you come as normally public insured patient… well… come in a month or better in a year please.

> The most interesting part of that is that population typically sides with the doctors, not the government, for some reason.

I wish.

In my country, the government blames everything on doctors despite displaying truly sovietic levels of corruption and inefficiency. Doctors working for the government in poor areas might not even be provided with a functioning sink to wash their hands with, yet society still expects them to provide the highest standard of care.

Entire media campaigns have been launched against the "mercenary" doctors who put profit over the well being of the poor patients. Now doctors manning ERs routinely suffer physical violence. 15 minute waits are enough to provoke literal vandalism in the ERs. I know of one case where murder charges were pressed against a couple of stable flu patients who after sitting around for less than 15 minutes decided they had waited enough due to the laziness of the doctors, invaded restricted areas of the hospital, vandalized them and disrupted a team managing a myocardial infarction, obviously leading to the patient's death.

> If doctors don't have enough time, then there aren't enough doctors.

It's not until around 1950 that medicine becomes a virtually guaranteed path to being in the top 1-2%. It's not until the late 70s that it's viable for anyone almost anyone (people without already wealthy parents). It's not until the late 90s that the average person who cares about nothing but money has figured out that medicine is a virtually guaranteed ticket to being "rich".

I think the problem stems from there being too many people in the profession that care about almost nothing but having a lot of money - which isn't any different from most professions where you can make a ton of money.

I do believe that the vast majority of doctors, especially older ones, AT THE VERY LEAST have decent intentions.

But even a very small percentage of wildly greedy people can damage a system severely.

I'm not sure how you put Pandora back in the box here.

At the end of the day, good doctors are providing a service of almost unlimited value.

Modern medicine is basically a miracle if you're literally about to die.

I disagree with most of the argument in the parent

> I think the problem stems from there being too many people in the profession that care about almost nothing

IMO you need to substantiate this claim.

> even a very small percentage of wildly greedy people can damage a system severely

This is medicine you're talking about. If the doctor doesn't have contact with patients, they aren't affecting them. I just cannot follow the claim that a greedy doctor can have an outsized effect. What is the mechanism?

(Half a joke, to make my point:) Greedy doctors aren't like greedy venture capitalists... It seems like they can only suck $500k out of the system every year.

There are amplifiers that increase the suck. One is physician ownership of diagnostic clinic(s). A strong tendency to order tests can be remarkably enriching, way more than a paltry $500K.

Isn't that a Stark law violation?

It's complicated. Physicians can own imaging equipment, for example, but they can't require you to use it for the radiology tests that they order. There are weird carve-outs for in-office ancillary services (e.g. you're an orthopedic surgeon who uses x-rays in your office, which is common and arguably necessary).

There's also rules regarding things like percentage ownership of physician owned facilities and the percentage of referrals to that equipment that come from the physician owners.

Urine drug screens in an in-office "lab" are another big source of revenue for certain specialties that involve referring patients to your own tests, or doing your own pathology on biopsies as a dermatologist or whatever. My understanding is that most of those things, and many like them, are not Stark law violations.

Can you provide any proof of this?

It's no longer a guaranteed path to being rich, for the record. Since the 1990s, the average income of physicians has grown at less than the rate of inflation (Median physician compensation was ~$140k in 2000 and is ~$240k today). It's gone from being maybe a top 2% income to being a top 10% income.

Not to say it's not still remunerative, or anyone is going to go poor choosing to become a doctor, but there are other paths to a good wage that don't require 8 years of schooling or nearly as much student debt.

240k as an individual is a lot higher than top 10% of American incomes.

It's around the 5th percentile but obviously half of physicians make less than that

Inflation has jacked up salaries and rates. There’s a big disparity now depending on whether salaries have been adjusted.

Name another "standard" profession that makes a median of 240k per year.

Airline pilots make about $230K

Doctors, especially young doctors, are not the wildly greedy people you paint them to be. There are dozens of easier paths to riches these days than medicine and we all know it. My medical school is "cheap" and tuition + cost of living is ~$90k/year. Then, we have 3-7 years of residency before we start making the real money which is less than any generation of doctors in 100 years. I could become a senior software engineer at a Fortune 50 company in less time than it takes to graduate medical school and be better off financially than most doctors. Ask me how I know.

"But even a very small percentage of wildly greedy people can damage a system severely."

You are close to placing the blame in the correct place. My emergency department was just bought by a private equity group. There were 28 doctors. Most of whom worked there because they could spend adequate time with patients and work a reasonable schedule. After the PE company bought us, they mandated less of EVERY position from CNA to MD. The MD headcount is now 11, and the 17 physicians who are looking for jobs are having a tough time (relatively) because most other emergency departments in the area are also owned by PE firms who care about money over health outcomes. Those are the greedy people damaging the system you are looking for.

Private Equity is probably responsible for a lot of the ills that are harming society in general, it goes way past their involvement in healthcare imo

Other industries benefit as well from the lack of credientialing pathway for foreign MDs, because they end up taking under market salary roles in things like pharmacovigilance, sales, clindev, med affairs and other roles in biotech and pharma. I have a Bulgarian MD doing a vendor manager role for central lab and he is criminally underpaid for how overqualified he is. One time at a client dinner I asked him if he misses using his MD and he was like, "It's better than nothing and doing this contract PM role is still 10x more than I would be making being an actual doctor in Bulgaria."

There are nurses that can write prescriptions now. That seems to be how we are addressing the issue.

The internet asserts that there are pathways from NP to MD, but I’m not close enough to the problem to make heads or tails of how realistic the path is. Is it legitimate or a sop?

> The internet asserts that there are pathways from NP to MD, but I’m not close enough to the problem to make heads or tails of how realistic the path is.

The path (at least in the US, YMMV elsewhere) is "go to medical school".

I hope not. As with everything, YMMV. As an experienced paramedic, I have not any issue with experienced nurses going the route of NP.

But there are also zero-to-hero schools that will take you out of high school and have you as an NP in 5 years, able to prescribe medications (in many states, without any physician supervision).

There's a happy medium. I have the same feeling about zero-to-hero paramedic strip mall schools that will turn you out in under a year and 1,000 hours whereas others will require you to have 2,000+ patient contacts as an EMT before they'll even admit you to a 1,800 hour course.

It's really tiring how the medical profession can't do what engineering does with jr engineers and pay them a living wage as they gain experience and still do economically valuable work.

What do you think voters should do? How do we increase the number of doctors?

The current doctor workforce is limited by a congressional cap on Medicare-funded educational slots. Apparently it was established in 1997 to prevent a surplus.

Of course, the opposite happened because of demographics and increased lifespans.

> Apparently it was established in 1997 to prevent a surplus.

Perish the thought that we have slightly too many doctors. That can never be allowed!

I can't believe they passed that shit with a straight face.

I'll repeat what I've said before: no other profession in America requires a literal act of Congress to fund the training of new members. What's so special about doctors? Let anyone open a medical school if they meet standards. Give anyone an MD if they pass the exams and do the residencies, like lawyers.

And while they're at it let doctors go to medical school straight out of high school like they do in every other country in the world (other than Canada, I think). You'll give every new doctor an additional 2 years in their career they would've spent in undegrad doing a useless "pre-med" degree.

There already are 6 yr programs. A school in Ohio has a 6 yr program where you graduate with a BS and MD.

You're missing the point. Anyone already can open a medical school if they meet standards. In fact, several new medical schools have opened in recent years. But that doesn't do anything to address the primary bottleneck, which is lack of residency slots. If you graduate from medical school with an MD you still can't practice medicine until you complete a residency program.

Some schools do have accelerated combined BS/MD programs which can cut 1-2 years off the required total education.

I'm aware and I thought it was implied in my comment that Medicare funding shouldn't be a limiting factor on residency slots, when I said "Every other profession manages to train new members without Congress". I guess that wasn't clear enough. I'd go so far as to pull all Medicare funding for residencies. Let each program figure it out themselves.

Accelerated programs aren't the norm. They should be.

If we pull Medicare funding for residency programs then the system will collapse. Most teaching hospitals are run by local governments or non-profit foundations. They simply don't have the resources to subsidize graduate medical education. The money has to come from somewhere.

(And let's not have any stupid comments suggesting that residents should pay for it themselves. They're already tapped out in terms of student debt.)

If Medicare funding disappeared tomorrow the healthcare industry would figure out how to fund residents. The alternative is no new doctors. Nobody wants that.

I'm not advocating pulling the plug overnight without planning an alternative. That would guarantee a collapse as you said. But announcing an expiration of the program would heavily incentivize all participants to figure something out.

Residents make like $70k a year plus benefits. I'm sure the hospital bills their work for a lot more than that, even accounting for the time of attending physicians. Right now that profit margin probably subsidizes other loss-making activities in the hospital.

Nonsense. No other major participants in the healthcare system have the financial incentives or resources to subsidize residencies on the scale needed. Hospital cost accounting is somewhat fuzzy but overall graduate medical education is a money loser. Hospitals have very limited ability to bill for procedures performed by residents: they generally have to be directly supervised by an attending physician, which is expensive. And reimbursement rates are largely fixed by Medicare: hospitals can't just raise prices to make up the difference.

You have no clue what you're talking about here and are essentially making a hand-waving argument without any facts to back it up.

> [you] are essentially making a hand-waving argument

I'm not the only one.

"In Elisabeth Rosenthal’s excellent book, An American Sickness, she notes:

'The median cost to a hospital for each full-time resident in 2013 was $134,803. That includes a salary of between $50,000 and $80,000. Federal support translates into about $100,000 per resident per year. Researchers have calculated that the value of the work each resident performs annually is $232,726. Even without any subsidy, having residents is a better than break-even deal.' "

And

"In the old days, hospitals paid for resident training by building those costs into the bills they sent patients. But in 1965, Congress acknowledged resident medical training as a public good deserving of public investment, and firmly established federal funding for graduate medical education costs with the Medicare Act.

(What’s interesting is that Congress intended for the public funding to be temporary, with language in both the House and Senate reports noting that the funds were intended to last only “until the community undertakes to bear such educational costs in some other way.” Unsurprisingly, once governmental funds became available, hospitals have had little interest in undertaking how to bear these costs any other way.)"

https://thesheriffofsodium.com/2022/02/04/how-much-are-resid...

> they generally have to be directly supervised by an attending physician, which is expensive

The blog post argues that they also free up attending physicians to focus on the highest-compensated doctoring activities.

And as for what should voters do: they should choose people that are the most likely to improve the state of government.

Our society will continue to feel the civilizational tax of not having enough kids unless AI doctor becomes a thing.

So, do your part. Make babies! It's fun and rewarding.

In my opinion, we need to increase the number of admitted MDs and the number of residency spots. But more importantly, we need to also stop thinking of MDs as being necessary for a procedure or set of procedures, and focus instead on actual skill and experience for the procedure or service, and how one might get there.

I guess what I'm suggesting is that the solution is not "increasing the number of doctors" but rather "increasing the number and types of providers". Some of those could be more MDs, but some of them could be other types of providers. We need to create alternate paths to MDs, and also increase the number of degree endpoints that result in similar kinds of independent practice authority within a given medical field. Let other types of providers provide a wider range of services — maybe with increased scrutiny over training pre and post degree, like MDs have.

A good analogy might be dentists - are there other spices of the medical profession that could be turned into more focused specialties with less total schooling?

Ophthalmology? Maybe dermatology. Or at least you could lose part of the training for them. Probably need still a few specialized people with full schooling. But could lot be done there with less?

I'm most familiar with pharmacy and psychology as examples, although I think there are probably many other fields as well, maybe diagnostic radiology for example. I'm also aware of research on surgical specialists in areas of the world where physicians are scarce, focused on relatively minor surgeries, showing that these procedures can be done with the same outcomes if the providers have the right training.

My guess is there is probably a way to encourage fields to come up with ideas that any given person out there outside the field wouldn't think of.

To prove your point, I believe the last time I went to an ENT to get my nose cauterized for bloody noses cost my insurance around $500 or so. That's for a 5 minute "procedure" I could easily do at home with the right equipment.

Yeah one of the benefits of the NHS, even with its problems, is that you can just roll up to a doctor/dentist whatever and if its something simple that requires slight medical intervention, or a cheap prescription for instance, there's no drama around insurance billing or bureaucracy. Now, on the other hand, you need to go to the ER, you need actual surgery?

Stop charging $300k for the medical degree.

We should factor medical tasks into a larger number of specialized roles akin to phlebotomists and dental techs.

These roles should perform highly in-demand, relatively straightforward and repetitive tasks that don’t require complex medical decision-making, where training can be efficiently scaled up.

An example that currently doesn’t exist would be a specialist who can prescribe short term courses of drugs like methodone for opioid addiction as a bridge to longer term care by a doctor. This would enable us to have bridges to treatment readily available all over cities whenever an addict walks in ready, perhaps only for that moment in time, to start treatment.

You're absolutely right. However that salary is 1) not adjusting with inflation and 2) I'd argue is required to offset medical school debts and deferred employment

Well, in the US doctors are rich. Something completely different to most of the rest of the world.

US doctors are not that good compared with a German or French doctor, they could be as bad as bad doctors in other countries.

The best doctors in the US are more often than not also the best in the world. The US disproportionately attracts from abroad and produces domestically the MDs that are at the forefront of medicine.

The good and the okay doctors, i.e. the vast majority, are also very good. Probably a wash with most large Western nations.

America's actual problem, and failure, is prevention and uniform access to primary care. No surprises here.

> US doctors are not that good compared with a German or French doctor

Any evidence to back this up?

Granted, I’ve had some bad docs in the U.S., but the trick is to get good recommendations from people that work with the better doctors.

Just anecdotal, but I visited Shanghai this summer and toured a top clinic - from my perspective, their standard of care is on par with, if not better, than many large (and quite good) groups like Sutter Health or Straub. The doctors there were educated in the U.S. and Germany (Massachusetts and Munich if memory serves).

Plus, if you can wait, treatment is nearly free, but you can get same day service for many procedures, like overnight ecg, for say $100 -$200.

Chinese public hospitals, at least ten years ago, didn’t provide nursing assistant care, so families would be responsible for cleaning and feeding someone in the hospital. Private hospitals are another matter, and when I lived in Beijing, I would go private even for ER services. And the private hospitals were pretty affordable, most of the doctors were foreign or foreign trained, most Chinese med students go to the public hospitals for residencies and after they graduate (my wife has a cousin in Shanghai finishing up her Med degree now). The program is different, it’s a 5 year degree plus residency, though you can go for a masters or PhD also (many doctors do), I think the American system of medical school is the odd one out.

Private health insurance had a cap (~$100k/year) for some reason. I thought that was risky.

If anyone has a friend or family member in the hospital, the best thing you can do is spend a few hours with them every day until they get out, or arange a schedule with other friends and family members.

Patients need advocates (and someone to help them from getting lonely, which also helps their recovery).

Ya, but bedpan duty is something else.

Some US doctors are rich. With a strong bias toward certain medical specialties, where you can bill X thousand dollars for a "procedure". And do a lot of those procedures every week.

Vs. merely billing by the hour - then having to pay your office rent, utilities, medical school loans, nurse's salary, receptionist's wages, etc. etc. out of that. I've read quite a few accounts of that sort of doctor going bankrupt...unless they were being supported by the specialists, to whom they were referring patients who needed procedures or other expensive care.

Not all doctors are - infectious diseases, for example, is fairly poorly compensated. As is pediatrics.

Voters voted to close rural hospitals, which Ironically means they get no healthcare themselves and cities will have more doctors. Stupid is as stupid does.

And voters 4 years ago voted for an open border which filled emergency rooms and denied American Citizens from recieving treatment in American Hospitals. The emergency room wait times have been dropping since January of this year

Troll

See how those numbers go when premiums spike due to expiring ACA funding & Medicaid cuts.

> emergency room wait times have been dropping since January of this year

Source?

That is a backwards and likely self-serving perspective. You want to not only deprive foreign countries and populations of their doctors so that they can come serve American interests from having mismanaged the supply and the demand for doctors, all while having imported around 60 million foreign nationals in the last 25 years alone, which has only contributed to extra pressures and taxation of the medical field and has contributed to driving up costs for medical services in America.

So again, where do you want to get these doctors from that are in excess in their own countries, in order to bring them to the USA in order to serve American interests, while harming the communities you want to deprive them of?

Or alternatively foreign countries don't value their doctors enough for them to stick around and so they don't... Are you saying someone is suggesting forcing them to come to the west or should people not be allowed to move where they want and can contribute? The US needs more doctors and if there are foreign trained qualified doctors they should be able to practice, healthcare is a free market system or so I am told, labor goes where it gets paid.

Also given the much higher wages in the west, sending a portion to relatives back home often does quite a bit to alleviate suffering and stimulate some economic activity.

On top of all of that the US govt could step in an increase supply of doctors in various ways, the medical industry could stop artificially keeping supply low to drive wages up, the medical industry could totally opt out of a free market model and operate like a public service. I am sure there are plenty of different solutions I am leaving off.

There is no limit on the number of medical school seats. The primary bottleneck for producing new practicing physicians is actually the number of residency program slots. Every year, some students graduate from medical school but are unable to practice medicine because they don't get matched. (Some of them do get matched the following year.)

https://savegme.org/

And who exactly, historically lobbied for that low limit to limit doctor supply? Why the AMA and other similar organizations!

And these kinds of issues seem more global than not.

True, but the AMA reversed its position some years ago and has been lobbying Congress for increased Medicare residency program funding. However, Congress hasn't acted due to budget concerns.

The last time the AMA lobbied for capping residency slots was almost 30 years ago. The vast majority of doctors practicing today weren’t even in the field back then.

That may be true, but insurers continue to lobby for capping, and in the US most large employers are "insurers" in the sense that although they might outsource the administration of the health plans of their employees, they basically pay the entire cost of the care.

Although doctor pay is only a small fraction of the total cost of health care, limiting doctor availability is an effective way to limit total cost because most expensive health care goods and services require a doctor to order or prescribe the good or service. I.e, until the patient gets enough time with the doctor for the doctor to realize that the good or service is necessary, the insurer does not need to pay for the good or service.

Stop lying. No major commercial insurer is currently lobbying Congress for limiting the number of physicians. In fact, some insurers have even voluntarily donated to support residency programs (although the amounts are small relative to Medicare funding).

OK, I now tend to believe that when the ACA capped the profit margins of insurers, their previous incentive to reduce cost of care (so they could keep the savings as profit) ended, so they stopped lobbying for restrictions on the supply of doctors. Unless I see evidence to the contrary, I will continue to tend to believe that large employers (not subject to any cap on their own profit margins) continue to lobby for restrictions.

I tend to believe this because of how strong the correlation has been in my own "career" as a patient between my ease of access to doctors' time and how much my insurance plan ends up paying for tests and treatments.

How would restrictions on the supply of doctors help insurance companies reduce cost of care?

Limiting doctor availability is an effective way to limit total cost because most expensive health care goods and services require a doctor to order or prescribe the good or service. I.e, until the patient gets enough time with a doctor for the doctor to realize that the good or service is necessary (then prescribe or order it) the insurer does not need to pay for the good or service.

Limiting the supply of doctors will increase costs in the long run because it reduces access to preventive care. Residency caps disproportionately impact PCPs.

It might reduce the costs they pay for preventive care or non-urgent care, but serious issues will progress.

You might not have to pay for metformin to treat diabetes, but you’ll eventually end up paying for a hospital stay and amputation.

You don't have to convince me that limiting the supply of doctors is not in the interests of anyone of median income or lower. I am aware.

Your proposed incentive for insurance companies to want to restrict the supply of doctors (prior to the ACA) doesn’t make sense, and that’s what I’m trying to convince you of.

Ah, I see now. Sorry for not getting it right away.

Nope, there are no major self-funded employers lobbying for physician caps either. But hey, don't let facts get in the way of your ridiculous, uninformed beliefs.

I’ve never heard of insurers lobbying for capping residency slots. Do you have any sources?

Regardless I was responding to the claim about doctors lobbying for caps.

> there aren't enough doctors

Be very careful with what you're suggesting and to what degree.

I live in a country that has taken "we need more doctors" to the max and opened hundreds of new medical schools backed by student loans. As a result, the medical profession has become a shadow of its former self. It used to be that only the best students would be selected for medical school. Nowadays any moron can become a doctor.

Pay is nosediving since about 40 thousand new doctors enter the market every year or so. Emergency rooms are supposed to attract the most experienced, most cold blooded doctors in the field. Here they have turned into total shit jobs that only attract the heavily indebted and quite possibly incompetent newly minted doctors.

Do you know how much damage a stupid indebted inexperienced doctor can cause? People are going to fucking die. I'm actually afraid of getting sick.

> If there are more doctors, they will need to need to spread further into regions where they're in demand.

Yeah, that's essentially my country's strategy. Squeeze doctors so much they'll have no choice but to relocate to the literal Amazon jungle in search for jobs.

Would you like to live in the jungle? Raise a family there? I sure as hell wouldn't. There's a reason the doctors are all concentrated in the capital. Same reason why people migrate to the capital. No one actually wants to live in some undeveloped shithole.

"They will need" betrays the fact you think you're qualified to dictate the careers and life paths of an entire category of people. That borders on magical thinking: if you squeeze them, then they'll do what you want the way you want it. No such deal exists. People have any number of options laid out for them. They can just as easily give up on medicine altogether, take their capital and start a business instead. I've actually seen a few do just that. Buy trucks and start a goddamn logistics business because medicine wasn't cutting it anymore.

The standards to become a medical doctor in the 70s-90s compared to the 2000s and the 2010s are vast. There is a lot of extra bullshit now required to become a doctor like volunteering in africa and a person with A average GPA failing to get in, while if they were in the 80s, did not require to do that. Start with getting rid of the absolutely stupid barriers.

> volunteering in africa

What the hell? Volunteer work is a requirement to get into medical school? Yeah, maybe some calibration is warranted.

Just be very careful about it.

It's not required - you just need to be a promising and interesting student. Most of the students I send to medical school get there by doing undergraduate research.

Not to dismiss your claims but the profession is tightly regulated in every developed country in the world. So even if there was an oversupply of doctors in your country, the high bar to getting licensed ( med school and afterwards specialist training) is still the same for everyone.

> the high bar to getting licensed ( med school and afterwards specialist training) is still the same for everyone

Oversupplying doctors will lower that bar one way or another. Medical schools are a bottleneck? Race them to the bottom. Fund hundreds of them so that it's always possible for any student to find one that'll accept them. Problem solved. Now the medical licensing process has become the bottleneck. Millions will be spent on lobbying in order to subvert it via whatever means. Once that's done, medical specialization will turn into the bottleneck. Repeat.

No system retains its integrity when you inject billions into it via loans. And that's just financial interests. Factor in the fact reelections of politicians might very well ride on their providence of more doctors to the population. Just look at the post I replied to:

> This is a problem that we as voters should start to act upon.

That's the sort of populism that could very well decide elections. Politicians do not give a shit about anything other than reelection, least of all the quality of the doctors their voters are getting. They will always be able to afford the best care.

Realize that it's against my interests to warn citizens of developed nations about this. If I were a socipathic person, I would be praising their openness since it could facilitate my own immigration into their countries. I genuinely don't want to watch other people suffer the same fate.

Then what you have is a large group of unemployed indebted people. Are we sure that there are even enough competent people that we trust to do medicine in the first place? Maybe the reality is such that we simply don't have that many potential and qualified people in the first place.

This assumes that having more doctors will fix the problems and I can tell you it won’t. I’ve unfortunately had to experience what’s described in the article multiple times in recent years, with the only silver lining that I’m not dead yet.

Majority of doctors simply do not go beyond the textbook definition of “standard of care”. You tell them this doesn’t feel like flu? Nope go back with Tylenol and come back if gets worse. Still not getting better 10 days later and you tell them your sinuses are clogged and hurting? Let’s get you Flonase and send you back. Finally you’re half conscious and in the ER almost 3 weeks in? Ohh my bad, should’ve started antibiotics a while ago.

Get transferred to a new urgent care because the one that sent you back with a Tylenol yesterday can’t take you in today because you got worse? Let’s start from scratch and tell you exactly what you heard yesterday and refuse to do more tests.

Most doctors I’ve had to interact with are laughably clueless when it comes to even slightly non standard illnesses. They are highly opinionated and refuse to do things differently. And surprisingly the only good doctors that I’ve encountered are the older ones, sometimes closer to retirement. Maybe something went horribly wrong in the past 50 years but the new ones are terrible. No wonder people lose their lives when they get sent back home with NyQuil and Tylenol.

Similar experiences, (though not as bad). I still assume more doctors means they can give more attention and actually listen to the patients.

There was a shift in attitude to where physicians are managing livestock instead of caring for people. It's not great when some of the livestock die, but that's what livestock does... oh well. The psychology of that shift is complicated, multiple factors that are difficult to tease out. But the bad news is that the shift is likely irreversible, it's lasted long enough that the current doctors teach it to the new incoming residents.

The problem at the root is the financialization of everything.

Public hospitals are one thing, there incentive structures revolve around saving money - yeeting patients out of the door far faster than you'd have don in the past, to a large degree made possible by new operation technologies (minimally invasive surgeries).

But private run hospitals? They see you as a cash cow, extract as much money as possible from you. And yes, often enough that includes outright billing fraud.

>Public hospitals are one thing, there incentive structures revolve around saving money - yeeting patients out of the door f

That's a popular narrative, but doesn't much explain many of the variations of this phenomena at all. Women have complained forever that doctors don't listen to them when it comes to their treatment... even prior to the "financialization of everything". It is a popular narrative that it's the moneygrubbers or something like that which causes all the problems in healthcare, but it's not a very explanatory narrative, just a popular one.