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Licensing is one thing, but self-selection signaling is another.
If I graduate from the American Samoa school of Law (that's a Better Call Saul reference) I can handle wills and whatnot, but no real going business concern is going to hire me for complex corporate litigation. If I, this hypothetical business owner, enjoy spending my weekends enjoying recreational Columbia narcotics, I'm going to hire the lawyer who is ex-DA's office and knows all the judges, instead of the one man libertarian law firm who will passionately argue about decriminalizing all drugs.
Basically, we're talking about signaling-credentialism. If a Lawyer went to Yale Law and now works at Latham & Watkins, he or she is probably quite good. If a banker went to Harvard and is now at Goldman Sachs, likewise*. For doctors, we don't quite have the same gradations. If you're an attending in any major metro hospital, you're roughly interchangeable outside of specialties.
I think what OP is saying is he'd like to see more doctors, even those who are the equivalents of Saul Goodman - they can write a prescription for some antibiotics, but you're not going to them for your hip replacement. I could be wrong tho (not op)
I would say right now that there is in fact broad variation in competence in the medical profession. You can see from the average medical licensing exam scores of different specialties that the best MDs tend to go into opthalmology, dermatology, and neurosurgery, whereas the worst ones go into family medicine and psychiatry.
About a year ago I had a rather severe case of mononucleosis, and was sick for about a month. I went to my primary care provider after having a 102F fever for about five days straight, but all the tests they ordered were negative, including the test for Epstein-Barr (though that particular test has like a 30% false negative rate), and they weren't able to give me a diagnosis. After the fever dragged on for ten days I went to the ER, where the resident suspected a cyst in my liver due to elevated enzymes and ordered a CT, along with a huge number of other tests. The next day I was seen by an infectious disease specialist, who suspected mono. Eventually a more accurate blood test confirmed the diagnosis. My health insurance covered everything, but in total my ER visit and 1 night stay in the hospital cost the insurance company about $18,000. There was no intervention except to rest, so I chose to go home. The fever went away like two days later.
Hilariously, my friend who's an anesthesiologist and medical school professor gave me the correct diagnosis before I went to the hospital. He advised me to go to the ER just to be safe but suspected mono, despite the initial negative test result. We've collaborated on research and I know him to be exceedingly competent, but this episode just reinforces in my mind that there are significant differences in the competence of physicians.
There definitely need to be more residency openings to keep up with demand, but part of that problem is that Americans are just so unhealthy compared to other developed countries. Japan has an older population, about 3/4 as many doctors per capita, yet they seem to be doing somewhat better.
Couldn't agree more. If you strip away chronic maladies that are directly due to poor lifestyle choices, you get rid of 50% of medical spend annually right there. If you then also exclude last two years of life care, you're at something like 90% of medical spend annually. And these two things interact. Getting old sucks, but it shouldn't be particularly painful or burdensome - but it is because people are getting obese first, then developing metabolic syndrome, and then getting old. Modern medicine and ethics keeps them alive, albeit with drastically reduced quality of life, pretty much up until the whole body just gives out.
Eventually, social security, medicare, and medicaid are going to run out of money. And, as this thread discusses, we're playing with the idea of a fundamental medical care shortage a la the NHS in Britain. If we don't grow our way out of this / come up with some seriously amazing medical technology innovations, I have two predictions:
The cohabitation with an elderly parent will become ubiquitous in American society outside of the top 5%. For the top 5%, assisted living and retirement communities will become even more opulent and lavish then they are now. The wealthy elderly will become bizarrely hedonistic.
There will be a large scale campaign for legalization of assisted suicide. It's already happening as a movement in the USA and they're already doing it in Canada.
I hate both of these things, personally. But I still believe they will happen. Getting wealthy in the next 50 years will be as simple as staying healthy, getting and staying married, staying employed (at pretty much any wage level that isn't working poverty), and caring about your children and family. Individualism will claim at least a third of society, perhaps more.
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Yes there are general differences in competency and knowledge within the field, but this is mostly the system functioning as designed, if you go to the ED (which most doctors will recommend if their is any concern, because they don't want to get sued), and then the ED whose job it is to make sure you aren't dying will pan scan the hell out of you to make sure you aren't dying (because they don't want to get sued).
In another country they'd probably just send you home or admit you for observation and not do much.
Whether anyone in the ED actually suspected a less typical Mono presentation is very orthogonal to what they actually do.
In any case we already have a surplus of residency spots, posted about that elsewhere.
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