
Hospitals are suddenly short of young doctors because of visa ban - elorant
https://www.propublica.org/article/hospitals-are-suddenly-short-of-young-doctors-because-of-trumps-visa-ban
======
flowerlad
Part of the problem is the unnecessarily long path to becoming a doctor in the
US. It takes 4 years longer in the US, compared to UK, to become a doctor.

In the US medical school is a graduate program, which means students must
obtain a bachelor’s degree before going on to medical school. The subjects US
students study vary: earning a “pre-med” degree is not necessarily required to
qualify for medical school. In fact, medical students can and do major in
everything from mathematics to physics, even music!

Becoming a doctor in the US takes a minimum of 11 years: 4 years to obtain an
undergraduate degree, followed by 4 years to complete medical school then 3
years of residency.

Compare that to UK: There the study of medicine starts at the undergraduate
level. After spending between 5 years in medical school, students earn their
bachelor’s degree and enter the workforce as junior doctors. They then spend 2
years in the “foundation programme,” which is intended to reinforce what they
have learned at the university in a professional environment. That's a total
of 7 years to become a doctor in the UK.

The difference is the 4 years US students spend obtaining an undergraduate
degree before starting medical school. This seems wasteful. Eliminating this
requirement will reduce the amount of debt medical students accumulate, and
encourage more people to become doctors.

~~~
koheripbal
> _4 years US students spend obtaining an undergraduate degree before starting
> medical school. This seems wasteful._

While it's not required, the majority of students DO follow a pre-med program
that allows them to take Biology, Organic chem, Chemistry, Physics,
Psychology, etc...

These aren't wasted years, for the _majority_ of medical students.

I think the solution is more about having more medical schools and reinforcing
STEM for younger students so that the supply can keep up with demand.

One of the reasons so many foreign students go into medicine is because they
come from countries with very strong culture of STEM education at a young age
- something that's not done in the majority of US school districts.

~~~
arcticbull
> These aren't wasted years, for the majority of medical students.

They aren't _wasted_ but they're not necessary either, and I think that was
the point. Let's say I wanted to become a general contractor, but for some
reason that's a graduate program. I spend 4 years taking civil engineering.
Did I waste my time learning about concrete... no, probably not, but it is
necessary to do my job? Also no.

It's also hard to equate your "stronger early focus on STEM" with a pre-med
program. If all it takes is teaching biology and math a little earlier, is
that 4 years really the best use of time?

~~~
senortumnus
I place enormous value on my undergrad training in chemistry before going on
to med school. Impossible to prove but I do think the deeper your foundation
in life sciences the better your ability to adapt to new medicines,
procedures, & other advances in medicine. Speaking as a urologist.

Edit: the pre med prereqs are a good start. But I value the skills & concepts
from the senior level bio/chem classes that I wouldn’t have gotten with a 6 yr
track. Something also to be said for the emotional maturity that comes with 4
yrs prior to med school.

~~~
asapatient
"Impossible to prove..." sure, but that's tautology outside some very
constrained problem domains like mathematics.

The salient question is cost/benefit. What is the cost in terms of lives and
resources of those extra years? Do sufficient benefits obtain?

The US is globally known as a great place to get treated for cancers,
especially. 5 year survival rates are relatively high - but of course only a
fraction of Americans actually have access to the kind of diagnostics and
treatments that deliver these outcomes, and only a smaller fraction of those
with said access actually pass on significant assets to their heirs. For most,
the medical- and death-industrial complex fulfills its primary extractive
purpose.

I find it deeply ironic that your literally academic perspective ("Something
also to be said for the emotional maturity that comes with 4 yrs prior to med
school") is so utterly subjective - i.e. about your feelings, NOT data around
outcomes. In the OECD, people live longer, on average, in places where less
time and money is spent educating physicians. Yes, there are confounding
factors - but this is true even controlling for the big ones like obesity

------
bnchrch
Maybe open up more med schools and drop the excessive volunteering
requirements. It only serves to filter out the talented with a poor economic
background.

~~~
adsljfl3
As the other poster mentioned, med schools aren't actually the barrier to
increasing the physician workforce. In order to be a practicing physician you
need to go through residency training. However the number of residency spots
has stayed fixed for the last 3 decades and is controlled by government
funding.

If you want more doctors, lobby your government to increase residency training
funding.

~~~
qwerty456127
Or to lower the requirements. Doctors with no experience but a medical school
are still much better than no doctors. I don't need a doctor with a fancy
license, I need a doctor who has a scientifically adequate (and up-to-date)
idea of how does a human body work and what has a good chance to be a
reasonable way to cure my sickness.

~~~
lotsofpulp
I agree with this comment. US medicine has setup a long and tortuous road,
which might result in extremely well qualified people (or might not), but
other developed countries seem to do just fine without the hazing ritual the
US required doctors to go through.

Why would you ever choose to be a doctor over an employee at a FAANG? It would
be worse for your mental and physical health, and now the pay isn’t even much
higher for doctors.

~~~
asdfasgasdgasdg
I would guess the average pay is not higher at all. Even if you don't account
for opportunity cost and the time value of money, I think it may be that top
tech cos pay better for someone with similar levels of experience. Certainly I
don't think many of my doctor friends my age are making as much as I do, and I
was also earning for almost a decade before most of them were able to become
attending physicians. And many of them went into family practice or other
solidly middle class specialties, which certainly pay a good deal less. This
is not even accounting for the fact I work like 36h a week with zero on call
time (at least on the current project), and few doctors can swing that.

~~~
waxachasee
I left FANG for medicine. I think this is not a good argument for 2 main
reasons.

1) People tend to compare FANG to family medicine. It wouldn't be more apt to
compare the average tech worker making 100-200k to family medicine, or compare
to some of the more competitive specialties.

2) Salaries are underestimated by many people. The best source is the MGMA is
is often used to negotiate salaries by the hiring side. Unfortunately the data
is expensive to access so few have it - there's an older screenshot someone
took [1]. Further, these are biased lower since academic medicine and part
time researchers tend to make less. You can also tailor you're career with
more flexibility. Want to make $1M? Go for it. Want to work 2 weeks a year and
still bring in 2-300k? Go for it.

Now if you want to live in NY or SF tech will pay more as medicine pays more
as you get more rural.

[1] : [https://imgur.com/gallery/ZQo6aKo](https://imgur.com/gallery/ZQo6aKo)

~~~
lotsofpulp
I think the last 40 years were golden years for doctors in the US. They made
great money, but now the jig is up and there are 2 options for the next
generation:

1) if US goes with taxpayer funded healthcare, expect pay to go down similar
to other developed countries with taxpayer funded healthcare. Because there
will be no negotiating power.

2) with the ACA framework, it’s a race for insurers, hospitals, and physicians
groups to get as big as they can do they can gain as much negotiating power as
they can. I can see it with all the M&A in the hospital and provider space,
and the rule of thumb is “the closer you are to the money, the more you make”.
In this case, insurers will hold the money, so it will be at their mercy that
they approve or deny payments for certain procedures.

The American people themselves don’t have enough money to continue paying for
this gravy train, and the government was picking up the slack, but I think
that’s going to be over soon.

The CVS/Aetna vertical integration model is interesting too, as they are
talking about adding doctors to their stores to make it a one stop shop.
Insurance, provider, medicine all in one, similar to Kaiser.

And then there’s doctor groups who are able to pump out more work from one
doctor by using physician assistances and nurse practitioners to actually see
patients “supervised” by one doctor, but the doctor never actually sees the
patient.

~~~
waxachasee
Pay may go down a bit. I don't have a source off hand but a huge portion of
medical expense are due to administrator bloat, doc pay is much smaller.
Ideally the regulations and billing gets simpler cutting that bloat.
Regardless many docs advocate for better healthcare despite lower pay. I don't
have data to say most, but my experience has been that in a conservative part
of the US.

The NP/PA practice is also a growing concern amongst doctors. Those groups are
advocating for independent practice despite reduced training.

I'll admit, I'm a fairly stereotypical introvert tech guy and tend to judge
people more than I should. Talking to patients has a way of shifting your
views. I used (and I suppose still do a bit) to judge alcoholics, drug users,
and other preventable conditions. But you realize how they really are a result
of social or medical circumstance and I think for that reason many doctors are
willing to sacrifice some pay. Hell I went into medicine for the security and
money (mostly, plus more academic stimulation than software), as taboo as that
is, and I'd be ok with it.

That said I think specialty medicine pay is fairly safe. Fact is supply is
limited, right thing or not.

------
heavyset_go
It's almost as if the AMA shouldn't heavily limit residencies such that only a
constrained amount of young people are able to enter the ranks and become
doctors.

~~~
tryptophan
It's almost as if they don't.

There are more residency slots than there are American med school grads.

~~~
heavyset_go
Maybe there would be more American grads if their prospects were better and
the foreign competition wasn't so fierce.

~~~
sjg007
The AMA regulates medical school admissions.

------
invalidOrTaken
Boo effing hoo, my brother is ~300K in debt and making 60K a year at 31, and
now is considering leaving medicine. I don't see why I'm supposed to feel
sorry for hospitals here.

~~~
vikramkr
You look at how much McKinsey will pay you and look at how much money
corporate pays, and it becomes a tough deal to stay in medicine if you're even
a bit financially motivated. Schools like NYUs new free med school and
adaptations like nurse practitioners for primary care are the only way this
field will survive.

~~~
3pt14159
This is really surprising to me as a Canadian. I was told that doctors in the
States earn way more than doctors here.

~~~
vikramkr
Way more debt + years of residency to let that debt pile on makes earning more
in the end irrelevant. And you can only really be financially free in a few
specialties that pay you enough. If you become a primary care doctor, you're
only making 160k a year. You can make more in areas where doctors are in short
supply. That's not enough to pay off 300k in debt compounding at 7-8% a year
for years before you can start paying into it, especially when you also have
to pay 7500+ a year in malpractice insurance costs. You've also spent so long
getting tot hat point that you're probably around 31 years old, meaning you
might be starting a young family around then and cant fit everyone in a cheap
studio apartment anymore.

~~~
BeetleB
> If you become a primary care doctor, you're only making 160k a year.

There are many more lucrative choices than PCP that don't require
specialization. A friend of mine was making $250-350K/yr as a hospitalist - no
specialization needed. Just the usual 3 years of residency.

The _real_ issue is that doctors don't want to live where the work is
lucrative (rural areas in Midwest, etc).

------
epmaybe
I am a medical resident. I'd be very surprised if the ban affected a
significant number of foreign educated residents, as most programs require
their incoming residents to be there for orientation before July 1. Our
orientation was mid June. I doubt you'd move last minute, as it does take a
few days to settle down.

Also, if your program doesn't understand and help you get to this county after
matching you to their program, it's now a problem that encompasses the program
as well as the politics of the visa ban.

Ninja edit: I will however note some personal anecdotes of some resident
friends impacted by the h4 dependent visa, that are having trouble renewing
due to the virus, and have to put their training on hold for the time being.

~~~
caseysoftware
Shh... don't let facts harm the narrative.

~~~
epmaybe
I mean, I still think that the immigration guidelines were pretty poorly
implemented and caused a lot of unnecessary stress/confusion. I just don't
think a ton of residents are actually in a precarious position right now.

------
bawana
We could make more doctors if medical school tuition was lower and new doctors
were paid more than a garbage man. But The cabal that is the hospital and
pharma lobby won’t allow it

~~~
newacct583
Median residency salary for a doctor in the US is something like $65k
(probably about twice what sanitation workers make, though I'm too lazy to
look it up). That's somewhat low relative to other jobs requiring the same
education, but not particularly out of range. Lawyers do better at that stage
of their careers for sure, but we have plenty of post-docs making far less. I
don't see that this is much of an argument in context.

~~~
claudeganon
What’s the average monthly debt payment for a typical resident? That will tell
you a lot more about what their actual income looks like.

~~~
tsco77
$200/300\. Everyone uses income based repayment plans. It's literally
impossible to make standard payment plan monthly payments on a residents
salary (assuming a average debt).

Those payments don't even reach the principle though, so it's more just
kicking the can down the road.

------
brentis
It's become a horrible profession in US. Radiologists used to have bit of
cachet now are required to review 300+ MRIs/x-rays a Day. No wonder they need
insurance to cover the error rate.

~~~
PhantomGremlin
One would have to be crazy to want to become a radiologist in the US.

In addition to what you mentioned, remote radiology has been here for quite a
while. Jobs are being outsourced to to "scabs" in low wage countries. A
definite race to the bottom.

~~~
brentis
True. On top of all that Watson / etc are supposedly more accurate for several
cancers already. Given IBM, probably still have a few decades before they can
effectively get to market. ;)

------
throwawy061820
It's idiotic the US would bar skilled workers of any category, but the story
is even worse than blocking foreign medical students from (already far too
limited) residency slots. Even if they were able to come here to train, there
likely wouldn't be jobs waiting for them on the other side.

My wife is a chief resident at a top-ranked program in Emergency Medicine
(Level I hospital with volume of 100k+ pts annually, multiple sites, etc.).
Perfect USMLE scores, etc. She's good at what she does. A few years ago we
considered her career fortunate because it is stable and portable: the demand
for emergency medical care is inelastic and perpetual, and she could likely
get a job almost anywhere paying a salary high enough to live comfortably.

She is finishing her training this year and just started looking for a job,
only to discover a horrifying truth: almost no hospitals are hiring physicians
specialized in emergency medicine. Let that sink in. In the middle of a global
pandemic, when the medical system is overwhelmed by undifferentiated patients,
hospitals are not trying to expand the number of doctors on the front-line.
It's bananas. The reason for this is entirely financial; high-reimbursement
procedures are not being carried out in adequate volume, and treating patients
with COVID-19 is not revenue generating when a plurality are uninsured/under-
insured and treated by mandate due to EMTALA. Medicaid/medicare payments
barely keep the lights on, and there simply aren't enough insured patients
transiting the hospital to support staffing up to respond to pandemic
conditions. It's maddening. Universal healthcare would go a long way to
solving the problem, but sacrifices will need to be made on the hospital side
as well, with lower salaries for providers and (largely ossified and inept)
administrators. The pandemic pushed hospital financials into the red.
Physician groups in myriad specialties across the country have taken voluntary
or required salary cuts to help the system stay afloat, but something has to
give at a societal level. If we had better national leadership, this crisis
would be an opportunity to rethink how we pay for and deliver healthcare in
this country, but we don't, so it it's all a giant slow-speed car crash. The
future is not bright unless we get the pandemic under control, but that too
looks like a dumpster fire thanks to politicization of life-saving control
measures.

If I were a foreign medical grad, I'd be smart to complete my training in any
country _other than_ the US—at least for the foreseeable future.

(and other countries, if you're listening: this is a great time to make it
easy for high-skill workers from the US to obtain work visas and citizenship)

~~~
ikiris
this guy gets it. unlike most of the upvoted drek in here.

The real problem is the finances of hospitals and their associated clinic
networks is much different than most people think. And as is typical with
America, not having a clue how something works is not a barrier to people
opining on whats wrong with it or trying to change it.

~~~
invalidOrTaken
On the contrary, labor oversupply is the painkiller that lets hospitals and
the associated system kick the can down the road. Anything that pressures that
system is a good thing in my book.

It's not doctors that need to get their house in order here.

------
KoftaBob
This is an artificially created shortage. The number of doctors entering the
system every year is limited by the number of residency spots.

Because resident salaries are paid for by the CMS Medicaid fund, the number of
residency spots are therefore limited by how many spots the American Medical
Association is able to negotiate with Congress.

Congress needs to increase funding to residencies so they can do a better job
of keeping up with demand for doctors.

Thankfully, this is being worked on:

"The number of residency positions has increased only 1% a year, far lower
than the 52% growth in medical school spots since 2002, the AAMC said.
Federally supported residency training slots have been capped by Congress for
more than 20 years, limiting the spots for medical school graduates to undergo
additional training in a residency program before they can practice medicine.

To increase the supply of doctors in the U.S., the AAMC supports a
multipronged approach, including passage of legislation by Congress that would
provide a modest but critical increase in the number of federally supported
graduate medical education positions.

A bill, the Resident Physician Shortage Reduction Act of 2019, is awaiting
action in both the Senate and the House of Representatives. It would gradually
provide 15,000 Medicare-supported residency positions over a five-year period
starting in 2021."

------
samfisher83
We have people people with 3.7 gpas and 31 on their MCAT that can't get into
medschool. I don't think it's an issue of not having enough people trying to
be doctors.

~~~
PhantomGremlin
This is not a new problem.

I knew US citizens that went to foreign medical schools (think Spain) 50 years
ago because it was so hard to get into US schools.

The beauty then (don't know if it's true now) is it was simple to get US
residency on return. Just go work for a trauma center in a run-down area in
Brooklyn. Shootings galore on a daily basis. You never run out of new
patients.

------
mountainboot
As has been pointed out here, the shortage is because of the AMA, not because
of the visa situation.

------
jacquesm
Good. That way other countries can hold on to their most needed doctors.

~~~
logicchains
> Good. That way other countries can hold on to their most needed doctors.

And those doctors don't get a say in where they want to live?

~~~
ballenf
Brain drain is a huge problem for countries on the cusp -- countries where
taxpayers foot the bill for most education. Forced labor isn't the answer, but
taking away some of the incentives to leave will certainly help.

~~~
bzb3
Maybe they should pay their doctors better so they don't leave.

~~~
woopwoop
I usually agree that "brain drain" arguments are nonsense, but the United
States really badly overpays for medical care because of our horribly
dysfunctional system, so I'm a bit more sympathetic to them in this particular
case.

------
drocer88
Employers are complaining about a "labor shortage"? Just raise wages. That
will send the proper signal to labor to train for the job. This is the same
for any other product or service in the economy.

~~~
dicomdan
US doctors make 3 times as much as doctors in France. It's not a salary
problem, but artificial limits on supply on all levels of the pipelines.

[https://www.medscape.com/slideshow/2019-international-
compen...](https://www.medscape.com/slideshow/2019-international-compensation-
report-6011814)

~~~
heavenlyblue
How much do French doctors owe their government after graduation vs US
doctors?

~~~
programmertote
Say you owe 300K in med school loan. On average, a doctor in the US makes
~230-250K (even if the doctor does not have a speciality). If one lives in Los
Angeles, CA with 250K/year income (in CA metropolitan areas, generalist
doctors usually make more than 250K/year; it's more like 280K/year minimum),
the take home pay would be ~160K. How long do you think it would take for
someone to pay back the 300K loan? If one is financially responsible, it would
take at most 5 years to pay it back.

So by the time one becomes a full-blown doctor at age 32 (usually in the US,
it only takes ~12 years to become a generalist doctor, who specializes in
Internal Medicine, from the time s/he graduates from high school), s/he is
making 250K. I wish I could make something like that as a programmer, but we
know that that kind of salary is reserved for people who work for FAANG and/or
are at the top of their game in the software field. For doctors, that is just
the starting salary.

This is all to say that I disagree that the medical debt is much of a concern
for US doctors __once they become one __. It is the unnecessarily convoluted
path, which they have to take to become a doctor, that is more of the problem.

~~~
kyawzazaw
I think you should also include in undergrad debt.

Are you factoring in opportunity cost during the years of not getting paid as
much?

And not all doctors get paid that much; instead of average, a median would be
better for comparison since some speciality get paid a lot, and some barely.

Also, at age 32, you already have 10 years of experience as a SWE and have
been getting paid a lot, with chance to invest (same assumptions of
financially responsible person for a doctor as you mentioned)

~~~
programmertote
Most people who went to undergrad (at least the ones in the US) have college
loans, so the undergrad debt is unfortunately unavoidable for most (unless
they have well-off parents who decided to foot their college bills) regardless
of whether you are a med student or not. Actually, it's because of the
undergrad loans that only relatively well-off students can afford to go to med
school in the US (I wrote another comment related to that in this thread).

For the opportunity cost part, I have to agree with you to an extent. But let
me present my rough calculation. I can probably make ~70-120K/year for 10
years before I reach the age of 32 (assuming I don't get laid off in the
meantime and assuming I'm not lucky enough to be employed by FAANG). To make
it simple, let's assume make an average of 95K/year (average of 70K+120K) for
10 years starting from when I graduate from college. So my take home pay in
Los Angeles would be 65K/year. Suppose I can live relatively frugal in LA and
save ~30K/year for those 10 years, my investments would have probably grown to
about 415K in 10 years (assuming there is no recession and the returns for my
investment averages 7%/year; [https://www.investor.gov/financial-tools-
calculators/calcula...](https://www.investor.gov/financial-tools-
calculators/calculators/compound-interest-calculator)). That is NOT a lot of
head-start for those who chose to do programming (or cannot afford to go to
med school).

Remember that programmers are actually one of the better-paid professionals
among those who graduate from college every year. Also you have to keep in
mind that a lot professions have issues keeping their jobs when they get older
(e.g., old programmers tend to have a difficult time finding programming jobs
while maintaining their senior salaries unless they are really good at what
they do; employers will prefer find young, fresh programmers who are willing
to be paid less and can spend a lot more time at work than older programmers,
but that's for another discussion). Doctors don't have that problem (at least
for now because the supply of doctors is artificially limited in the US).

Also, if you are really hard-working (and greedy) as a doctor, you can take
two jobs (as a hospitalist or attending) at once. I know two doctors (from my
country), who live in CA suburb and make ~500K+ by working at two hospitals
(of course, they have to work 6 days a week, alternating 3 days at each
hospital). Alternatively, you can run your own practice (either as primary
income or just a side hustle on weekends). My wife used to volunteer at
several private clinics in NY metro area. Most of the generalist doctors (i.e.
Internal Medicine) she volunteered for see ~30-40 patients a day (actually one
doctor sees 70-80 patients a day!). They make ~$80 net (that is assuming the
patients uses medicaid/medicare, which is actually at the lower end of the pay
per visit) from each patient (because my wife enters the code and helps with
miscellaneous things around the clinic for them). These clinicians are making
each year ~$80 _30 patients_ 20 days per month * 12 months a year =
$576K/year. All of these doctors she volunteered are above 60+ years old. I am
not exaggerating about that. Of course, this is in NY-like metro area where
population is diverse and dense. Some rural area doctors wouldn't have such
opportunity to make that much money, but what I'm saying is that generalist
doctors sure have opportunity to make significantly more than 250K/yr average.

All in all, I'm not buying that the opportunity cost of becoming a doctor is a
sacrifice one mad. It is (in my opinion) part of the trade-off one have to
make to get a steady and pretty good income for the remaining 30 years of your
working life (assuming one retires at 62, but if you are a generalist doctor--
i.e. not related to ICU or surgery--you can work until 65+ just like the
anesthesiologist from my host family. With 250K/year income
([https://www.kaptest.com/study/mcat/doctor-salaries-by-
specia...](https://www.kaptest.com/study/mcat/doctor-salaries-by-specialty/)),
you can easily catch up for the missed opportunity cost in a reasonable time
frame.

~~~
heavenlyblue
It’s a really long post but in the first paragraph you’re already making a
mistake of not adding any undergraduate fees because in the US other
undergraduate degrees would also have those; however we are making a
comparison with France, not other degrees in the US.

------
basicplus2
Maybe just maybe new young doctors should be treated (like not be worked to
death) and paid properly then there would be plenty of people willing to take
up the profession and there would not be a shortaage

~~~
golem14
Agreed that working conditions are atrocious and have been for years. But
getting new doctors domestically from scratch will take years, and the article
argues that there’s just not enough time for that.

~~~
Feolkin
The problem with that line of thinking is how it creates systems like the H1-B
and doesn't really solve the problem of "we aren't educating enough doctors".
Instead of thinking both long-term and short-term, the solution that's chosen
_now_ to solve the problem becomes the permanent solution going forward, and
the solution for _now_ is attracting foreign doctors instead of fixing medical
education locally.

------
tehjoker
The US has a doctor shortage because the entire system is designed to make it
expensive and difficult to become one in order to legitimize high salaries.
The US has arcane rules like only allowing US residencies to practice in the
US unlike basically every other country.

Students go in expecting to do good in the world, are put through a grinder,
and come out thinking fuck everything at least I get paid. The system self-
perpetuates instead of increasing the number of physicians, reducing pay to
the mere low hundreds of thousands, making medical school not only free but
paid, and reducing work load and redundant overlaps to increase patient safety
(as turn over between shifts is one of the most dangerous times of day).

The AMA until very recently also was a key opponent of Medicare for All, so
there's that lovely bubble of reaction sitting there too.

------
vsskanth
Since residency spots have to be funded through Medicare, I was under the
impression that they are very competitive essentially making them a zero sum
game. If less get through on a visa, the spots will just be filled up by
natives.

Or is it that there just aren't enough native applicants (like grad school) ?

~~~
tryptophan
There are not enough usa grads to fill all the training spots.

However, some usa grads do not match to a spot, around 1%, which makes lots of
US educated doctors (rightfully) really mad. You get random foreign doctors
going to state sponsored schools with openly nepotistic admissions sometimes
getting spots over people who trained here.

Imo the solution is more us medical schools opening, which is slowly
happening. It is however not so easy to do so due to the (rightfully imo) high
requirements.

~~~
vsskanth
Interesting, I wasn't aware 1% don't get matched. Is it because of some
minimum score needed in medical school exams ?

~~~
tryptophan
The application process is highly convoluted and not very well designed. Some
people just fall through the cracks.

But yes, also a small number of people just don't have the intellectual
ability to handle it, although schools do a lot of screening to minimize this.
Graduation rates at schools are typically 100%, with maybe 1 person every
other year failing out.

~~~
vsskanth
Thanks for the insight.

------
JoshTko
Interesting how most of this thread pretty much exclusively focuses on
problems with AMA vs the Visa ban itself.

~~~
vsskanth
There's quite a bit of anti-work-visa sentiment in HN, primarily because they
assume it increases supply and reduces pay.

So, It's implicitly assumed that the visa ban is not the cause behind the
doctor shortage - its expensive medical school, low resident pay and a limit
on residency spots (blamed on AMA lobbying).

The hypothesis here (I don't necessarily fully agree with this) is if the path
to becoming a doctor is expanded with removing limits on residency slots, more
pay and less debt, more natives will choose to become doctors.

------
42droids
The country which haven’t figured out yet that it needs immigration is bound
to fail. Reality doesn’t care much about your political ideology.

------
IknowIamRight
This is good. The developed world should stop pulling high skilled workers
like doctors from the 3rd world.

The 3rd world needs them if they are ever to develop.

The developed world should figure out how to create more doctors from their
own countries

~~~
koheripbal
Doctors are a service industry. So the way to afford to pay them more is to
develop 3rd world economies.

------
xbar
<large, systemic problem> Because of <recent, specific reason>

Is free market residency a better long term solution for that market, rather
than expanding imported skilled labor?

~~~
oblio
For medical stuff free market anything is a recipe for disaster. You want a
bit of free market with solid government oversight.

Letting the market self correct in 10-20-80 years works for making chewing gum
or PCs or toilet paper, but not for human lives.

------
oblio
Why doesn't the US have a points based immigration system?

~~~
kyawzazaw
The faux selling point of American Dream.

Experienced a lot of this sentiment in questions on the subreddit.

------
persaspiration
US citizens can start med school right after graduating high school at an
English program in Poland. Understandably this is out of the realm of reality
for many people but for those who are adventurous the ROI is simply
astounding. I've met people who have done so and had no issues starting
residency when people they went to high school with are already in massive
debt and just starting med school in the US.

------
rcpt
If you're interested in the dynamics of the residency match Brian Carmody has
a good blog

[https://thesheriffofsodium.com/2019/03/02/the-etiology-of-
ap...](https://thesheriffofsodium.com/2019/03/02/the-etiology-of-application-
fever/)

------
tomohawk
The problem is that H1-B exists. Instead of that, expand green cards to people
who want to immigrate and have desirable skills.

H1-B is mostly used to offshore jobs anyway. It allows offshoring companies to
bring in captive workers to learn the skills/jobs to be offshored, and then to
send them back. That is not a benefit to the US, and taxpayers should not be
footing the bill for it.

