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I have many friends in medicine with whom I talk about these issues fairly often. My understanding based on these conversations is that you can't just go out and increase residency positions because the whole point of residency is to get sufficient exposure to cases. A surgical resident needs to do X gallbladder surgeries, Y appendix surgeries, etc. to reach competence and be able to perform independently. There are only so many patients who actually need those surgeries per year. Also, there are only so many teaching surgeons willing to supervise residents (teaching is almost universally a pay cut in medicine). Freeing the cap on residencies would mean a lot of doctors-in-training who waste time sitting on their hands and come out underprepared.
This can’t be right. The number of doctors needed for any given discipline X should scale linearly with the number of cases in discipline X. If there are not enough cases to train doctors, then there is no doctor shortage.
Suppose surgery X is only needed by P patients per year per hospital, but surgical residents on average need to do at least C cases under supervision to reach competency. If residency is Y years long and you have R residency spots per hospital, then R is limited to C > Y P R.
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This is the problem, but not for the reason you suggest, at least in the US. The issue is funding - training residents costs hospitals money, which is covered by CMS. Technically, I guess hospitals could fund residencies above and beyond their CMS allocations, but then they are spending money to train a future doctor that may or may not work for them. The financial incentives aren't there for hospitals to fund residencies themselves, so we end up with the number of residencies CMS is willing to fund. That number was mostly static for over 20 years, until Covid made stark how lacking in medical personnel the US is. So they've slowly been increasing the allocations over the last few years, but of course, at a much lower rate than general population growth.
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Quick Google search suggests that there's something like half a million gallbladder removals per year in the USA. I'll leave it as a simple exercise for the reader to estimate how many residents per year could be trained to do gallbladder surgeries at such a rare.
You'd have to do this exercise for every type of surgery that a competent surgeon should know. Gallbladder is one of the most common (hence, one of the first to come off the top of my head), but you still need your local surgeon to be able to do the less known things as well. If I'm betting my life on a baseball player hitting a home run off a knuckleball pitcher, I want him to have at least gone up against a lot of knuckleballs in his life instead of a guy who's mostly only hit against fastball and curveballs and is going to be out there winging it for the first time.
Isn't that what specialists are for, though? If you need a guy who knows what to do with a knuckleball, you go to that guy, who specialized in it. But if you're dealing with fastballs and curveballs, then your local guy is good enough.
There's a death of generalists in medicine underlying a lot of this, in part because everyone wants the guy who's good with knuckleballs. But not everyone is going to face a knuckleball, and you don't need to go to the specialist otherwise.
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This would be a problem if every hospital was already a teaching hospital, but that is not the case.
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If what you are saying was truly the real problem then the easy solution would be to allow foreign doctors trained in European countries/Australia/NZ etc. to come and work in the US without needing to redo their residency. Medical standards in these countries are no lower than the US in aggregate and may well be higher. Sure you can ask for equivalency exams (like how the UK does for foreign doctors) but there's no valid argument that the 90th percentile British doctor is worse than the 10th percentile American doctor, so why block the former from working in the US?
That we don't see this is Bayesian evidence that this is not the true objection for why the US medical cartel wants so few licenced doctors.
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If that were true it would be self-fixing. You'd have the number of surgical residents that are needed to do surgeries going forward. Or at least, current demand. But instead all these positions are basically people working more hours than is healthy a day, making a paltry salary, and then once freed from the artificially contained program immediately making 4-10x they were.
Suppose surgery X is only needed by P patients per year per hospital, but surgical residents require C cases to reach competency. If residency is Y years long and you have R residency spots per hospital, then R is limited to C > Y P R.
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