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Notes -
I would love to know why you don't think it wouldn't help with the shortage. I figure that, having a shortage of doctors willing to work in VA, combined with doctors from other countries who are willing to work at VA because it will gain them the higher US pay + a path to US citizenship, would indeed alleviate shortage of doctors at VA. However, I am not a medical doctor, so what am I missing?
Coming in way too hot.
The VA has had hiring freezes for the last two years, to my understanding. So no traditional shortage there.
Hiring extra VA physicians does nothing for the general problems we have in any case (which isn't a traditional shortage).
VA had a hiring spree last year, in large part because of the expanding benefits from the PACT Act.
Your impression of a hiring freeze remains partly correct, because VA has budget shortfalls and plans to lay off staff:
I suspect that VA tends to paint a bleak picture to Congress as a standard operating procedure, in hopes of getting more funding. Though my nephew assures me from his VA experience that more funding would not go amiss.
So back to my off-the-cuff idea of importing doctors: my point is that any VA hospital that finds it challenging to attract a decent US doctor ought to be able to do what the private sector does. Right now, the VA follows AMA's standards, which require any non-US-trained doctor to do 3+ years of residency (plus other things) before they can practice medicine in US. Residency slots are, apparently, the bottleneck for US doctor supply in the first place.
My question is: just how crucial is it for someone already practicing as a doctor in a French or German hospital to do 3+ years of residency in US?
I've never met a foreign trained doctor who came to the U.S. with Medical School and Residency training in Western Europe. We might actually have reciprocity agreements for those countries, I don't know, I've never encountered one. Scott did his Medical School in Ireland IIRC, which is note quite the same. The vast majority of foreign doctors I've met are from Asia (mostly India) and do absolutely need retraining and will generally admit as such, however frustrating it is.
Every time this comes up I have to drag out a few facts.
-There is actually a surplus of residency spots. Yes you heard me.
-We do have something of a shortage of some specialties, but this can't adequately be solved by increasing spots without decreasing training quality.
-Nobody wants to go into primary care because it pays significantly less, is one of the harder jobs, and has been made less attractive by regulatory burden and other factors.
-Most jobs are in primary care anyway, aka most doctors work in primary care.
-Even within primary care we have more of an allocation problem than a shortage. Doctors train very hard and start their adult life late. They want to be in desirable locations so Iowa has a shortage but NYC does not.
-NPs and PAs were meant to fix this but make it worse - they still want to go into specialties (and can since they have no specialty training, they can just do what they want) and they still hang around the same urban areas.
-You could hypothetically fix this by importing a ton of foreign doctors but you'd have to enslave them and force them to work in the undesirable locations long term or they would just leave immediately when given the option.
-You can fix this using the resources we have by raising salaries to what incentivizes the behavior you want. Nobody wants to do this, they just want to continue giving doctors the pay cuts they've been getting for the last 20-30 years, even though doctors are not a high percentage of healthcare costs.
Thanks for taking the time to share your experience with me.
Here's a citation re: open residency spots
https://www.nrmp.org/match-data/2024/06/results-and-data-2024-main-residency-match/
Table 1A - pretty normal for about 5-10% of offered spots to be unfilled.
Figures 1, 3, and Table 5 might tell a different story to some folks. 5-10% unfilled can easily be chalked up to various frictions (see also discussions of things like the general unemployment rate), and one could think that the percentage unfilled would remain approximately constant if the number of slots were increased within some range.
Some complicating factors include the fact that not all spots are funded by the federal government which means we can in fact increase the number of spots. Not all spots are desirable, and a good number are bad enough that American grads will give up or try again next year instead of being willing to take them.
As to if the international applicants are so bad that the places won't take them or the spots are so bad they won't go to them, I do not know.
Ah yes, the classic restrict supply, subsidize demand model. Once someone has given in to restricting supply, the only way out is to subsidize demand. So they say in every industry that sucks because of this exact phenomenon.
But I'm not sure one needs to get into the details of which frictions cause the 5-10% of unfilled slots to have a sense that perhaps that data at least doesn't cleanly support the claim that there is a "surplus" of residency spots. It's at least messy.
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