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Interesting. I need to look into this. Perhaps my model of the world is wrong or out of date. I was under the impression that the AMA severely restricts the number of medical schools and the number of spots within those schools - such that the typical new doctor graduates with hundreds of thousands of student loan debt. Any links as to what drives healthcare costs?
The bottleneck in producing new doctors in America isn't the schools, it's the residencies. After graduation, all doctors go to some teaching hospital somewhere and serve a 4 year residency to learn how to actually practice medicine. This training program costs the teaching hospitals money, which is reimbursed by CMS. So in practice, the number of available residencies is determined by CMS; hospitals won't spend money out of their own pocket to train new doctors above and beyond what CMS reimburses.
The impact this has on healthcare costs, I don't know. I'm sure it's something, but is it a major component, or a drop in the bucket compared to other factors? I don't know.
"We won't train doctors to the regulatory standard unless taxpayers give us bundles of money to do so," is an obvious confluence of terrible interests in the private sector and government, especially when the industry has achieved significant amounts of regulatory capture. Surely, there is a better way.
Imagine this in other industries. Grocery stores get the government to set up a licencing requirement to stock shelves, with some boilerplate reasoning about food safety or something. The thing is, the only way to get licensed is to get a grocery store to give you the mandatory years of experience. And, of course, they refuse to have such positions unless the government pays them for it. I would predict that there would be fewer grocery store employees, their pay would be higher, industry profits would be higher, government outlays would be higher, prices to the consumer would be higher, and service quality would decrease.
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Everyone points fingers at a variety of things but physician salaries are under ten percent of spending. A massive drop in doctor salary only gets you 3-4 percent less expensive healthcare.
The AMA historically was engaged in what you are talking about but then spent multiple decades lobbying for increased role for midlevel providers which is a de facto supply increase. It's finally moving away from that in the last few years but has yet to find a new passion lol.
Historically the limiting factor on doctor production has been residency spots which are mostly funded by the government, however plenty of states and private corporations will fund those spots because the labor is dirt cheap and they actually make a ton of money.
Additionally ability to increase spots in the higher paying/lower number specialties is limited because you need enough work to adequately train and all kinds of things have caused problems with that (ex: a reduction in surgical frequency secondary to an increase in medical technology meaning not enough cases). Lower paying specialties like FM and Peds have more room to grow but nobody wants to do them because of the poor (relatively speaking) pay.
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