
America’s aging population is leading to a doctor shortage crisis - spking
https://www.cnbc.com/2019/09/06/americas-aging-population-is-leading-to-a-doctor-shortage-crisis.html
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dantheman
The doctor shortage has to do with the American Medical Associate (AMA), a
cartel, that successfully lobbied to reduce the number of residencies
available for doctors. They also make it difficult for new medical schools to
be created -- this is intentional, since as a cartel they want to limit the
number of doctors so that they can demand hire wages.

[https://www.forbes.com/2009/08/25/american-medical-
associati...](https://www.forbes.com/2009/08/25/american-medical-association-
opinions-columnists-shikha-dalmia.html#15cc1fd42f28)

~~~
mrep
I don't work in the healthcare industry so I have no skin in the game, but in
what situations do you consider labor cartels ok because unions are exactly
that and many people here seem to advocate them. Becoming a doctor from what I
have read sounds like a horrible return on investment: You have to delay real
wages for like 8 years while you get educated, those 8 years make you
massively in debt, once you become a doctor, you have to pay off those 8 years
of debt while also paying massive insurance rates. I'm not suprised doctors
are trying to secure some wages after 8 years of investing in themselves while
going massively in debt.

~~~
wolco
The 8 years could be streamlined but it's setup to weed out many and tire out
the remaining. Many of the brightest most curious people get turned off by the
process the people that remain are the ones who could stand the beatdown. Then
they get out start working and have to see 25,000 people a year (100/day) as a
gp.

There is a huge burnout process going on. I see so many doctors try to make a
business on shark tank/dragons den work or they try to become media
personalities.

Many seem stuck because the job isn't what many would expect. They have
invested heavily time/effort in study, they have high debt and they have
increased expectations from family/community.

~~~
nmstoker
Personally I'd rather they set up a more sustainable training approach - I'm
not overly keen on having a doctor who's been "tired" out. I've seen a junior
NHS doctor treating a partner in such a state of tiredness that they had to
rely on mnemonics and tell us the number of things they'd be checking so that
he didn't forget two minutes later and miss any out.

~~~
arcticfox
Peter Attia discussed on his podcast a time when he fell asleep and fell on
top of a patient while operating on them during his residency. Pretty insanely
bad system.

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Merrill
It appears that Medicare keeps the fee for an office visit low. This causes
the doctors to schedule frequent, short exams. They also do frequent
diagnostic tests to increase revenue per visit. Less frequent, more thorough
visits would seem to be more efficient for all.

Lots of senior care is pretty elastic, since most visits result in no change
in drugs or procedures for the patient. They are simply monitoring chronic
and/or progressive conditions.

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zelon88
Well the medical debt bubble has gotta burst eventually. My guess is right
before it does the state of healthcare in the US will be so bad that women
will be giving birth in minute clinics because everyone will be priced out of
hospitals by then. We won't have a shortage of anything until we fix our
shortage of insurance providers.

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taxicabjesus
The doctor shortage would be lessened if medical resources were allocated more
intelligently. As it is, doctors have a tendency to make work for themselves.
The system needs lots of doctors simply to keep their charade going.

We all get to a point where we need less doctoring, not more. During the
'obamacare' debates some stupid politicians called this transition in the
goals of treatment "death panels" [1], but the realists on the other side of
the aisle didn't figure out how to intelligently point out that sometimes
letting people die gracefully is kinder than subjecting them to every possible
medical treatment.

My brother works with old people in Arizona. He's paid a salary, and makes a
game of trying to spend his employer's resources efficiently. On a recent
visit I noted his comment about how he's just doing palliative care. Most
doctors aren't on salary, and are paid via the standard medicare "fee-for-
service" (FFS) [2] model, which is a good way to make people profitable to
their medical providers.

[0] My earlier comment about my mom's elderly friend's predicament:
[https://news.ycombinator.com/item?id=20224523](https://news.ycombinator.com/item?id=20224523)

[1]
[https://en.wikipedia.org/wiki/Death_panel](https://en.wikipedia.org/wiki/Death_panel)

[2] [https://en.wikipedia.org/wiki/Fee-for-
service](https://en.wikipedia.org/wiki/Fee-for-service)

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pinacarlos90
Is it just me that feels like recently the word “crisis” is being overused?
not just online but by the media also

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fhsm
Shouldn’t this point to the actual report not thin reporting on its
publication?

[https://news.aamc.org/content/downloadable/209/](https://news.aamc.org/content/downloadable/209/)
[PDF, by way of CDN redirect]

Or at least the (interested sponsors) press release on the study linked in
this news article?

[https://news.aamc.org/press-
releases/article/2019-workforce-...](https://news.aamc.org/press-
releases/article/2019-workforce-projections-update/)

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NTDF9
Rural America really really needs more doctors. The amount of time it takes to
get an appointment to diagnose anything is crazy long already.

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Madmallard
Nope there's no doctor shortage. There is hospital administration greed and
crappy working conditions where patient throughput is valued above all else
leading to doctor burnout. I am angry at whomever wrote this for fueling the
wrong argument and possibly trying to detract from the real issue.

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SkyPuncher
The doctor shortage isn't really about hospitals.

It's a huge issue with family and primary care physicians, particularly in
rural areas. Paper work requirements and misguided reimbursement goals are
making it unsustainable for doctors not involved in large health systems.

