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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.
Ugh I bring this up every time and it gets ignored every time by people with axes to grind.
To further explain - common surgeries still happen (duh) but you have things like:
-Needing to experience complications, which happen less because we are better at stuff now.
-Stuff that used to be always or often a surgery being managed more conservatively leading to less cases.
-Changes to how surgeries work to be less invasive but more complicated to learn. Might take 100 open cases to be proficient and a 1000 robot cases or whatever.
-Duty hour restrictions. We used to work 100% of the fucking time. Now we get to sleep, but that means stuff happens without us.
This is pretty surgery specific but a number of other types of specialities have similar issues where you can't maintain training quality with increased residents.
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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.
I think the problem here is that you often don't know what you're dealing with until you're already knee deep.
If we're keeping with the baseball analogy, the specialist is the guy you call when you already know you're up against the absolute best knuckleballers. The generalists are still out there dealing with most pitchers, who aren't the best at it but do mix in knuckleballs among fasts and curves. I guess the analogy I should have used is:
"If I'm betting my life on a baseball team, I want most of their batters to have at least gone up against a lot of knuckleballs in their life instead of a bunch of guys who've mostly only hit against fasts/curves and are going to be out there winging it for the first time if it turns out the opponent team has many solid knuckleball pitchers." (Sorry if this is bad baseball, I don't actually follow baseball)
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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.
This is plausible. But the real world data is that P is very high compared to R. So Rs are being subsidized with not-Rs in the post-R environment. All indicia point to X>C
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