> If the US relaxed its requirements for nurses and doctors they could actually destroy the healthcare or many other countries.
Some medical professionals find the US healthcare system to be unconscionable. Some would move, some wouldn't. My doctor parents were offered jobs in the US but they refused on moral grounds - forgoing a somewhat higher salary - preferring to stay in Canada.
The best outcome would be for them to move to the US, push down salaries (salaries in the US are something like 56% of all of healthcare spending) and that normalization would then stem the flow of foreign professionals while seriously benefitting Americans.
> There is actually a valid reason to make it hard for doctors to move from one country to another.
When your goal is to increase supply in the US and drive down prices, then no, there is not a valid reason to do this.
> Training doctors is time consuming and expensive. There is a moral aspect to luring doctors trained in poor countries to rich countries.
FWIW I don't completely disagree with this. But that's kind of a crappy thing to say to a Turkish doctor who wants to flee the Erdogan Sultanate, or a Sudanese doctor who wants to make more than a pittance every month.
I'm not willing to condemn some poor Pakistani doctor to a life much less comfortable than he could enjoy here AND force US citizens to pay extremely high prices for medical care to protect the incomes of US doctors. If you are, cool.
Before you get indignant with me: you yourself could train as a nurse practitioner pretty quickly and cheaply (if you are in the US) and then go practice in Sudan or 100 other countries. They'd love to have you. If you only speak English, try India, Ghana, Nigeria, ...
You would be providing a great benefit to the Sudanese. Don't want to? Then why condemn some Sudanese doctor to the same just because he was born there instead of here?
> David Carr would like a word with you...
I don't know who this is.
> regarding your belief that supply/demand alone accounts for the pay of doctors.
I will happily believe this, both on my own authority as an actual informed expert in the field AND on the basis of the research of numerous colleagues of mine, who have in the aggregate devoted several hundred years of work to understanding this topic.
> The supply would not go down if med school was free but starting salaries were x% what they currently are.
This would be a notably interesting result in economics if it were true. It is not true. Doctors salaries are not responsive to the cost of medical school.
>The real issue is that developed countries refuse to import doctors.
That's completely ridiculous. Developed countries actively import doctors, going so far as to genuinely trying to lure them by advertising the kinds of salaries they can get.
Countries like Sweden, Norway, Germany, etc. now get significant numbers of their dcotors from abroad. Because their own population doesn't provide enough doctors. Additionally, the foreign ones tend to be cheaper (both because they're paid less but also because you don't need to put them through education).
It's so extreme that in some developing countries of Europe, half the doctors leave for the above-mentioned developed countries.
> I have a hard rectifying the claim that you are a health economist with the fact that you don’t appear to understand ...
Don't tell my PhD thesis adviser, I guess? He could have sworn he approved a dissertation about health economics but you've uncovered my secret, or something? (And what was I working on for all that time then? It was years of my life! Apparently nothing?!?)
> the bottleneck for increasing the supply of doctors is the number of residency slots.
No, _you_ are misunderstanding what change I want. There is no reason at all for a German, Mexican, British, etc. practicing doctor to have to do a US residency at all after they finish whatever training qualifies them to be a doctor in their home countries.
Read the article again. US medical education takes much longer than medical education almost anywhere else in the world, yet our outcomes are almost always worse along nearly any measurable dimension.
You will say: "yeah, but that's the result of many factors!" Great - I agree. But in that case it really isn't obvious that the extra years of medical education in the US do a lot for patient outcomes.
In fact, not only do I want more residency slots in the US, I want to reconsider that whole residency system, especially for doctors trained abroad.
> I think it’s pretty much universal that each country wants doctors to go through their own version of residency.
Why? That's a big part of the problem. There is literally no reason in the world for a German doctor who has been practicing there for a few years to have to come here and do a residency again. It makes no sense. You wouldn't do it for a C programmer, right?
Example: "Sorry - you learned C in Germany. If you want to program here, you'll have to get a four-year degree in CS again."
This obviously makes no sense. C is (ideally) the same language wherever it is written. And yet, while you have the same number of kidneys as a German and the same nervous system as Russian ... are you seeing the point I'm trying to make? Why require years of extra training for a doctor from one of those countries to work here? That keeps them out of our market and keeps prices high.
> A much more sensible system would to make medical school free so that the salaries don’t have to start off so high.
Let me pull out my economist card again and say: "this is not how that works." Salaries are not high because medical school is expensive. Salaries are high because supply is restricted. That's how supply and demand work.
> If money is no object the US healthcare system is as good as any
I don't think so. The medical personnel are way too stressed. You having money does not change that the people that will see you suffer in an inhuman system.
Even apart from money, how on earth is it possible that the people who should know more better than anyone else the effects of stress and lack of sleep let doctors work in far too long shifts? How does the existence of 24 hour shifts make any sense?
The system has a lot more problems than just money.
> I'd love to know more about this infinite pipeline of doctors and nurses you're referring to! Most coverage I've read lately has been about healthcare workers quitting in droves, so it's a relief to know that there are actually no limitations here.
I clearly state in my comment that I was not talking about the short term. In the long term we just train more and pay more, it’s not rocket science. But if you are curious about how we could have a for-all-practical-purposes infinite pipeline in the short term, that is also easy: just recognize international medical degrees and give foreign doctors work visas.
> I feel like the discussion is super explicit about this?
I don’t think it is. There is constant equivocation between medical rationing and medical triage. The mealy-mouth-ness is so ubiquitous that we take it for granted.
Like, why are we even talking about nurse shortages in this thread? If we were discussing whether it’s worth it to pay for an extra floor on our expensive houses, people wouldn't keep bringing up how we have to consider last year’s lumber shortage and how the US has too few skilled craftsmen because it doesn’t properly support trade schools (which is ofc true). We would just say “having another floor is nice, but it’s not worth an extra $100k”).
> Is the long-run alternative that future medicines like that are available for $0.50/month worldwide or not available at all?
Not if the government nationalizes the pharmaceutical industry and treats it like NASA, which it should have done a LONG time ago.
> If the reduction in current value of their lifetime pay is greater than the value of their education debts, why wouldn’t they be incensed? I would be as well, as would most people.
Hospitals are overworking medical staff. The average nursing shift is 12 hours long. Most surgeons are putting in 60+ hours a week. The number of medical staff needs to increase and their work hours need to be normalized as much as possible. We've allowed medical associations to artificially gatekeep the populations of staff for no damned good reason.
>have to earn very high pay to cover the (insane) cost of medical school and insurance.
Also opportunity cost for people capable to become physicians in the US have other options with competitive pay to quality of life at work ratio. Lots of ways to not spend one’s 20s memorizing stuff for step exams and then spend 26 to 30 being a slave during residency, and then maybe a fellowship or getting board certified, and at the end, you still have to deal with patients.
Alternatively, they could go for a job where they sit behind a computer and not deal with the general public and get to work from home when shit hits the fan.
> How do you feel about the fact that doctors from foreign countries need to requalify in the US [...]
I have zero problem with this. If I was a doctor on the US and moved outside of it I'd expect to requalify there. Different areas have different levels required and just because you've met the levels required in one area doesn't mean you've met them in another.
> They don’t just need to re-do the testing; they need to waste six years and another $300k of tuition to learn things they already know, before anyone will be willing to test them.
That's your actual concern. I don't think you want to get rid of requalification, just make the process quicker and less expensive. Advocate for this, then.
> Ultimately we need more doctors and less hospital administrators.
I guess I tend to agree but you can't just conjure them up. You can set policies to encourage physicians to emigrate to the US and make it easier for students to pay for med school, but in the end only so many people are going to want to become doctors.
> You need a decade to actually functionally increase the supply of nurses and specialists.
Similar things were said for the vaccine.
There is so much gatekeeping in the medical community that is not totally necessary. A doctor or nurse that immigrates to the US from a different country which has better health care than we do cannot practice were without jumping through tons of hoops. That is a pretty straightforward way the government – in a state of national emergency mind you! – could instantly and functionally increase the supply of nurses and specialists.
> There is actually a valid reason to make it hard for doctors to move from one country to another. Training doctors is time consuming and expensive. There is a moral aspect to luring doctors trained in poor countries to rich countries.
There might be a reason for the home countries to not want their trained doctors to leave considering the money spent training them. Some of them do have agreements for the trained doctors to work for a few years in return for the subsidy. That's for the home country and the student to decide.
However the main economic argument here is there's no reason the US should force them through residency again to practice, instead of just directly allowing them to practice after some vetting (USMLE whatever) and reap the benefits of fulfilling pent up demand, lowering healthcare costs and improved access.
I have point out here that "We shouldn't steal talent from poor countries" as a moral argument is a common trope amongst those pushing for immigration restrictions to limit competition to themselves. People are considered free and aren't owned by their countries. Its an understandable argument but I wouldn't pass it on as beneficial to the US or the people (it's not).
> Doctors in the US are unionized, for the economical sense of the word,
No they are not, for any sense of the word.
> and it is one of the reasons of high cost of health care and under-supply.
No, they are not. Aside from the fact that doctors collectively have about zero control over the total supply, physician earnings account for about 7% of healthcare expenditures. That's a drop in the bucket, even if you reduced that to zero.
> Otherwise, the U.S. would bar foreigners from practicing software engineering, and limit the amount of people that can have a software license.
This much is completely true, and you can look to the incredibly long and xenophobic history of labor unions for evidence of that.
> Doctors don’t enforce shortages. No one is stopping new medical schools from being created, it’s just not a trivial thing to do.
USA could do like they do in tech and import already educated people. In tech we welcome that, in medicine that process requires the immigrant doctors to take additional years of study since medical doctors in USA have a post grad degree for no good reason.
>I suppose that importing doctors and lawyers would not help lower the costs much. Doctors in the US are expensive not (only) because clueful, experienced people are rare, but because the supply is (or was) limited.
What exactly do you think would happen to the price if supply increased?
Doctors are also expensive because of malpractice insurance. Finance gets a big cut.
> AMA licensing, etc. never mind that every country has those, and probably more restrictive versions.
How can they be more restrictive when they are licensing way more doctors? USA is at the bottom of the developed world in number of physicians per capita but also pay the most. The only plausible way that can be true is if USA is the most restrictive in the developed world, like requiring way more years of schooling than necessary or limiting residency spots or limiting how many schools are allowed to educate doctors or making it hard for immigrants to become doctors etc.
Japan has less doctors, but they are also among the healthiest in the world so maybe they don't require as many for that reason. But USA is at the other end of the healthiness spectrum so you can't use that explanation there.
Some medical professionals find the US healthcare system to be unconscionable. Some would move, some wouldn't. My doctor parents were offered jobs in the US but they refused on moral grounds - forgoing a somewhat higher salary - preferring to stay in Canada.
The best outcome would be for them to move to the US, push down salaries (salaries in the US are something like 56% of all of healthcare spending) and that normalization would then stem the flow of foreign professionals while seriously benefitting Americans.
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