The AMA doesn’t have to set enrollment numbers. Who do you think accredits said medical schools? The AMA does, and if a school enlarges enrollment too much the AMA will threaten their accreditation, without which their students can’t get a medical license. The Bar Association engages in similar tactics at law schools.

Next time you’re in the Doc’s office see if you have to sign a new privacy form! I’ve done dozens and I’m pretty healthy. Now multiply that in every area. Electrical equipment has to be tested (lamps included), staff audited, continual retraining and training….

Cut even a small amount of this deadweight and the effects will be astounding.

In any case, the AMA now represents less than 20% of physicians – I don’t belong, and I’ve never missed it.

Increasing med school enrollment as a solution is quick, attractive, makes a good sound bite – and is completely wrong!

There are any number of reasons for physician shortages:
1. Early retirement
2. MDs can’t make enough to pay staff, rent, overhead, etc. and still take home enough to make the whole thing worth it – I can remember as a resident (years ago) hearing from one of my mentors that the taxi driver bringing his patient to his office would make more than he did!
3. A much higher percentage of women as physicians, who work fewer hours than men at all comparable stages of practice, with the possible exception of late in their careers (this is from AAMC demographic data)
4. Changing demographics – the population gets older, and utilization of all medical services increases
5. No matter how hard payers bang on MDs to become more “productive,” there’s a limit on how many patients you can see, how many procedures can be done; and switching to EMRs compounds the problem, because most EMRs are horrible and timeconsuming, rather than time-saving
6. It’s just not particularly fulfilling anymore, and the attractions of getting up in the middle of the night to fix some drunk in the ER begin to wane.

I have three kids, and none of them will be physicians if I have anything to do with it….

I know of an MD-PhD student (almost through her schooling) who refuses medicine for her pronounced OCD because it would interfere with her studying!

Incorrect. In the US there are physician’s assistants and nurse practitioners. They both are masters degree programs. The types of clinical tasks they can perform independently varies by state. Most PAs and NPs work under the supervision of a physician, and they can handle most things that a family practitioner would deal with. They can bill independently for their services.

Some physicians dislike the idea of PAs and NPs practicing even low-level medicine, but most physicians like them. The PAs and NPs can handle simple problems and leave the physicians more time to handle the tougher problems. Some physicians also use the PAs and NPs for routine counselling on diet, exercise, or medication use and side effects.

I should be able to verify somebody’s training / certifcation in 30 seconds on my iPhone. I’d trust an independent organization far more than I’d trust the government. Various organizations would get better / worse reputations based on experience, and better training / certification would become more valuable.

Why do so many physicians want to become specialists? Because medicine is so vast that it is nearly impossible to be a good “GP” today. Family Practice is a total joke. Today’s family practitioners have a broad but extremely shallow knowledge base. They can do routine exams, simple procedures, and common diagnoses, but they have to refer for diagnosis almost anything else. My wife and daughter both have chronic diseases that are somewhat rare. Family practice physicians refuse to care for them even though their diseases are stable.

The market is quite adept at “regulating” specialties. For example, dermatology and dermatopathology specialties are booming because more people are moving south, people are living longer, and there are more skin lesions and skin cancers. Other specialties have undergone relative declines such as orthopedics (safer cars and fewer smashed bones). It takes some work, but physicians can change specialties. My pathology program recently acquired a urologist and a surgeon for retraining.

The feds should butt out. Not much chance of that now, and there will be no chance of the feds butting out if some form of national health insurance or (worse) nationalized medical care gets enacted.

On the other hand, b/c this is all on my insurance, I really have no idea whether I’m paying any less to see the PA than those people who insist on having the MD do their exam are paying.