More Subsidization, More Doctors?


(NB: Please excuse the haste and possible inconsistencies of this post. I can honestly say this is the first time I've posted to T&B when I've been exceedingly annoyed.)

I just turned on the radio -- NPR, my usual when it's not C-SPAN -- to hear a report by Patricia Neighmond on a study about a potential shortage of doctors. (I've not located the full study yet. I'll have to listen to the report again.)

Essentially, the problem is this: while the population grows and thus the demand for health care, the US is graduating only about enough doctors to replace the ones that are retiring. Population and demand will soon outstrip supply. In the course of the interview, Neighmond lets the guest opine on how the country might confront such a problem. And how does the man respond?

"It's the right time to spend more money on training more doctors." (A paraphrase, but a close one.) And it went by the Neighmond with nary a comment.

In a world of skyrocketing malpractice premiums, higher insurance bills for patients, and ballooning court awards to winners of court trials (see first item), are we sure that it's the cost of the education that is the problem here? Why might it not be, oh, I don't know...the fact that the strong financial incentives to incur the debt in the first place are being eroded through massive regulation by the AMA, FDA, the federal government and more? With all the technique and expertise it takes to be a doctor in the world's most advanced health care industry, are we really certain making it easier for more people to go to school is the best idea? Wouldn't we expect to draw more of the wrong kind of people to medical school if we make entrance easier? Might we not see such a surge in demand for attending medical school that schools might start to accept more people in order to capture more of the funds (perfectly acceptable to me on the part of the hospitals -- but why should I be on the hook for the income of a university because someone's gotten some of this "training money"?). Oh, certainly there might be some dedicated folks that such a policy would draw, much the same as there really are good people working for the government (there are, I promise, I've worked with them). But at the margin, why should we make the temporary price of education lower when we could allow the future profit stream to rise and thus induce a lot more people to become doctors?

This strikes me as similar to the problem with the supply of teachers. In order to get more teachers, states frequently drop the requirements for becoming one. This allows in more people, but they are not necessarily the ones best qualified to become a teacher. As a result, we have more people getting little to no better results from the education system. It seems to me that the requirements are moving in precisely the wrong direction. Harder qualifications to enter the profession could limit the pool, allow wages to rise and begin to draw the people who either have the innate ability or the willingness to work hard in order to achieve the financial and emotional rewards of becoming a teacher. Meanwhile, better trained teachers might better handle the larger class size that will result from the short-run reduction in supply of teachers.

Why is the default position -- "clearly the government needs to spend more money to fix the problem" -- accepted so blindly by some reporters? There are good reasons we don't have doctors sitting on the Council of Economic Advisers, and why we don't have economists doing brain surgery. Why not take a moment to realize that a good person to comment on economic incentives might be someone who actually studies the issue to some extent? Was a phone call to a local college really too time consuming for Neighmond?

After all, do we want more doctors? Or do we want more good doctors?


How does the fact that the AMA controls the medical schools fit into all this? Doctors themselves control how many new doctors graduate every year. Do you think that they have an incentive to control graduation rates to maintain income?

Part of the recruitment issue is lifestyle. Not a lot of Americans want to go through 12+ years of training, then work 60-80 hour weeks, especially when all costs are accounted for, they're really not getting paid all that much. Related to the lifestyle issue is that over 50% of the entrants are female, and they tend to do less demanding disciplines (eg dermatology, family practice) and not the high-end things like neurosurgery. So yes, we don't just need more doctors, we need more good doctors, and more of the right kinds of doctors.

I have no problem with some kind of "medical school ROTC" program - i.e. the government pays for your training, and in return you must work in a salaried position for a given period of time in a government-run hospital.

Buzzcut, I highly doubt the medical schools are holding down the number of graduates to keep up everyone's pay.

I'd tend to agree with Buzz on the AMA issue. If they do exert pressure on reducing the number of people that enter, it's most likely through things like helping define a common set of minimum requirements for entrance, helping write the GMAT, that sort of thing. Most of which, I think, is more out of a sense of trying to keep certification uniform. (Though, I've heard decent arguments about the supply-limiting nature of certficiation itself. Despite my other libertarian leanings, the information communicated in having a degree from a recognizable university seems like a small burden when we consider just how specialized the medical field is. How in the world would I otherwise know to trust the qualifications of someone who deals exclusively, say, with the respiratory ailments of the elderly?)

I'm not sure I see much difference between the ROTC program and a school loan. If I were to return to medical school, I'd most likely have to take a loan to cover living expenses, maybe some books, etc. And being in medical school, I'd be willing to bet a few banks would be very interested in lending to me. But that means when I get out, I'm going to be searching for work that will allow me to pay back my loans, or a program that helps by giving debt repayment/forgiveness, etc. In either case, the choice is for less up-front costs in return for lower income after the education. I don't see it inspiring the numbers of people we are apparently going to need to be doctors soon.

To get back to an old saw of mine -- the problem is going to get worse if this country continues to choose to have government lower the price of insurance that people face. The medical industry just won't be able to respond adequately to the demand for health care by increasing wages. We'll start to look like Canada; everyone's covered, but you have to schedule your colds far enough in advance to make sure you can see the one doctor in your town in time.

Agreed on doctors, not so sure about doctors. I have friends that were teachers out of school. They seem to last 2 or 3 years, then find something else to do. All of them quit because they didn't like dealing with parents and the lack of control over their own classroom. Often times, the parents blame the teacher for any problems, or the system, or whatever. It is extremely difficult to maintain any kind of control over the child. Little time is spent on teaching and learning. After a couple of years of frustration, the find a new vacation.

I'm afraid the problem is beyond simple economics, it's cultural. Just like doctors are quitting because it's difficult to be a doctor (my understanding is that lawsuits, etc. has made the doctor/patient relationship more adversarial), it's similarly more difficult to be a teacher.

oops, should have previewed. sorry about the typos

That's it CB, no more posting. We don't permit any typos on this cite.


I hear much the same about teachers myself. Of course, doctors are a bit more locked into their profession since their skills are so specific to the industry. But I do know that a lot of doctors move away from high-population areas to work in smaller practices where they get more ability to set their own schedule. So, in general I agree that the culture has a lot to do with it. But I prefer not to set policy based on the hopes of changing culture. I think if the economic incentives were stronger, we'd see more people who would be inclined to live with the prevailing culture, provided they feel adequately compensated for it.

I contrast medical school to engineering school or law. All professional programs are generally difficult, as evidenced by, say, low graduation rates.

But engineering schools are open to everyone who wants to give them a try. It is safe to say that there is a law school willing to take almost any college grad.

Medical schools are not like that. The require BS like "showing a lifelong interest in medicine" through nonsense like candystriping and other volunteer work.

It isn't enough to have a high GPA and GRE (or whatever) score to get into medical school. There are lots of other, non-academic requirements. It seems to me that these other requirements are evidence that the AMA is artifically.

Need more evidence? Is there a "baby doc" law school? Engineering school? Why do people go to Haiti to become doctors?

You guys are so wrong ! First of all doctors get an awesome salary ! Most specialists get paid 250,000 to 300,000$ for certain, and if you've got the right business skills, millions. And they have the ultimate job security. Only the best of the best lawyers get paid even close to that, and there's horrible job security in law.

Anyone can become a lawyer, but only people who are at least somewhat smart can become doctors, because there are no super-easy med schools to get into in the US. Contrast the GPA average of the average US law school of 3.3 vs. 3.6 for med school, not to mention med students have take the MCAT and have to take hard premed classes, versus the easy garbage pre-law people take like psychology, poli sci, whatever....

Since doctors make SOOO MUCH MONEY, there's no need to subsidize them. Who cares how much med school costs, when you're going to be filty rich when you're older.



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