[PymnImmen]

Cheating insurance companies.

[bug_user]

Originally posted by Oerdin
Cheating insurance companies. Capitalism at work

[ceagstuntee]

Having lived under both systems, I'll stick take the NHS anyday.

[Breilopmil]

Regulation is the gov't's job, not the market's.

[Unoloknovagog]

Originally posted by Oerdin
Cheating insurance companies. Always worried about the big companies there aren't you? I'm sure they are gratefull to you.

[avitalporatova]

Certainly, I think that market forces would provide cheaper, better services. If that's what you mean.

[DoctorNiCYDEn]

Originally posted by DanS
Certainly, I think that market forces would provide cheaper, better services. If that's what you mean. Yep, because poor people would get any treatment.

[Pheddytrourry]

Okay, that's a given, but do you have any realistic suggestions, given that the MD training process is highly unlikely to change any time soon?

[mikeyyuiok]

Originally posted by snoopy369
Okay, that's a given, but do you have any realistic suggestions, given that the MD training process is highly unlikely to change any time soon? I know that you didn't mean it, but the dismissiveness of this comment is pretty insulting.

If you aren't going to fix this, then no manner of combinations of solutions will do any good.

[Nigeopire]

If that's your attitude, then we might as well throw up our hands and fork over however much money is demanded of us. This is the crux of the supply bottleneck. This training regime is by far the most laborious of any profession. Getting a Ph.D. is much easier (and yes, TAs do get paid). There's no law of nature that requires this process.

There are market mechanisms that you can insert into the process that could circumvent this. Flooding the market with physician's assistants could be a start.

In any event, I think you were paid more in your starting job per hour. Residents get paid about minimum wage and the working conditions are harsh.

[Pdarassenko]

Originally posted by DanS
Overall, you have to allow supply to meet demand. So that people can get more botox? One problem is that there's all kinds of medical treatment to get now that rich people can afford to get. Supply and demand isn't working again.

[espenijij]

Originally posted by DanS
If that's your attitude, then we might as well throw up our hands and fork over however much money is demanded of us. This is the crux of the supply bottleneck. This training regime is by far the most laborious of any profession. Getting a Ph.D. is much easier (and yes, TAs do get paid). There's no law of nature that requires this process.

There are market mechanisms that you can insert into the process that could circumvent this. Flooding the market with physician's assistants could be a start.

In any event, I think you were paid more in your starting job per hour. Residents get paid about minimum wage and the working conditions are harsh. 1. Mean resident salary for a 3 year residency is $46,000/yr for a 3 year resident, and higher for a more experienced resident (see this table) with cost-of-living adjustments in some areas. Even at 80 hours a week - now the legal limit for residents - this is well over minimum wage (around $11.50/hr). Add in free health insurance (another $1-2k a year) plus other perks as well (free food while working, which is ~70% of your meals; significant time off - often 4-5 weeks paid vacation time - and free parking/etc. while at work) and it's $12-13 an hour all told.

Compare that to what my GF makes, who is indeed a Ph.D. student in immunology, who works side by side with residents and full doctors; they get paid half that - around $23.5k a year - and work between 60 and 70 hours a week on average, including over the course of a year around 30 days working over 24 hours consecutively (on a long experiment) after year 2. Yes, about every other week. (Some students probably have experiments that can be delayed across several days, but they end up putting in the same hours, just more spread out.)

The program lasts about 7 years- which is roughly equivalent to a MD program for a basic doctor with no specialty - and then leads to a post-doctorate where you make a whopping $37k a year on average, for around the same amount of work (maybe slightly less, 50-60 hr/week). That lasts 2 to 5 years, depending on your skill level, or more (some stay at the post-doctorate level for a long time). You can also leave for industry after the 7 year span, in which case you presumably make more money, but that is basically a dead end (you have a much, much lower ceiling of money and importance). After the postdoctorate, you can again go into industry at a higher level, or become a Professor and P.I. (Primary Investigator), in which case you finally make the big bucks ... maybe $80k a year, unless and until you are a significant success.

Oh yeah, those T.A.s you talked about? $1000 per quarter at the U of C (11 weeks of 3hr/week classes). Most biology Ph.D. students T.A. maybe 2 or 3 classes in their entire 7 years (again, at the U of C at least).

(I'm not a big fan of the residency system either, and think anyone who would do this is totally mad; but it's not nearly as bad as you make it out to be.)

What is the driving factor in limiting doctors is med school, not residency or other elements (although that certainly delays the entry into the system, that effect is not felt in the total # of doctors). There are more medical school applications than positions.

Incidentally, do you know how many doctors there are per capita in the US? 2.4/1000, which is higher than the U.K. (2.2) and Canada (2.1). (OECD stats) Most European have around 3-3.5, which is somewhat higher certainly, and I'd certainly rather have around that number; but I don't know that this is the major sticky factor.

Also, look up residency details - most European countries have just as long of residencies as the US's average (Cardiac physicians and neurologists are the bleeding edge that way; most US end up with 5-6 years.) For example, [url=http://www.valuemd.com/residency-match-forum/132238-residency-iin-europe.htmlthis site[/url] and the database it links to.

I certainly agree that the AMA's power over selecting physicians is well beyond the power it should be, and is in part responsible for our exceedingly high health care costs. I don't, however, think it is the largest driver in that cost; and I think there are lots of things that can be done much more realistically. What those things are I am not entirely sure; and I'm not sure that true market forces will ever be able to take effect. Health insurers will always have a very substantial degree of control over the costs (through their reimbursement levels). I'm not even sure it's a good thing for market forces to govern health care - it's not necessarily a good thing that richer people gain better care, and there's been little evidence that market forces have improved physician health care (as opposed to drug development, which they certainly have improved). Physician health care does not significantly innovate - and in fact innovation is generally discouraged - and this is where the market is supposed to be the strongest.

I am not willing to give up on the market yet- I'm a conservative in the Adam Smith model after all - but I'm no longer sure that the current system has any chance of succeeding without actual governmental action. I don't care for any of the major health plans that are out there now (Clinton, Obama, Edwards - they're worse than what we have now - but I'm not sure that there isn't a good plan to be had, just not something that candidates for president are willing to state (for fear of causing insurers, doctors, and numerous others from turning on them).

[peakyesno]

She pays no tuition, but neither does a resident. Costs for public school medical employment is around $75,000 in tuition/fees, and about $120,000 for private(3 years $25k public $40k private) ... a pretty small amount given that can be paid back at around $3500 a year until residency is over (on the lowest payment level for public school), or probably even less (It wouldn't surprise me to see lenders allow a deferment until after residency - a med school loan is basically 99.5% safe money, and the more interest the better...)

[ecosportpol_ru]

Originally posted by DanS
By way of illustration, my friend S spent about... 4 years undergrad, 4 years medical school, 1 year internship, 2 years internal medicine residency, 3 years cardiology residency, 1 year invasive cardiology fellowship, 1 year electrocardiology fellowship. By the time he was done with those 16 years of training at 80+ hours a week of work, he was able to insert pacemakers under his own name.

Hmmm... My timeline is off somewhere. I think he was only in 15 years. Happy to hear he succeeded with his studies.