Lawsuit Alleges Practicing Physicians Block New Residency Program

[Proudfather94]

The process selects for affluent applicants because it is significantly easier for them to jump through the hoops necessary to be competitive. Adcoms not purposely rejecting low SES applicants does not mean the process doesn’t select against them.

I get that but he said that admissions selects for that but that's not true. It is easier to get in with money but if you have what it takes to be a doctor you'll do whatever it takes to get in.

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[ACSurgeon]

The process selects for affluent applicants because it is significantly easier for them to jump through the hoops necessary to be competitive. Adcoms not purposely rejecting low SES applicants does not mean the process doesn’t select against them.

But with that logic all of life selects against low SES. Up until recently all the German car dealerships selected against me….

If you guys want to champion a cause, champion politicians being elected not being immediately related to money. In our era campaigns should cost close to zero dollars. Every candidate should be able to use the internet to broadcast their message and have Q/As. Yet candidates with more resources win the primary for their party, not the person most likely to represent your interests.

People with resources can afford better schools, tutors, can afford to take more risk, can afford to not work while they apply to med school several years in a row, etc. I think if anything adcoms try to factor that in and reward that from unprivileged backgrounds for their hard work and let it make up for maybe a bad semester freshman year or what have you.

But at the end of the day, alas, we don’t all have the same resources or opportunities in life. As “unfair” as America is, you still have resources and opportunities (grants, loans etc).

 

[Matthew9Thirtyfive]

But with that logic all of life selects against low SES.

Um, yes. Much of it does. Are you about to argue that it doesn’t?

 

[Matthew9Thirtyfive]

I get that but he said that admissions selects for that but that's not true. It is easier to get in with money but if you have what it takes to be a doctor you'll do whatever it takes to get in.

Admissions does. In order to be competitive, you need a great GPA and MCAT, both of which are easier to get when you don’t have to work your way through school or can afford tutors and prep classes. You have to have volunteering and shadowing and a number of ECs. All those things are way easier to get if you have money. So people with money are more likely to get in. That’s selecting for affluent applicants. Selection for or against doesn’t imply some nefarious motive.

 

[Dr G Oogle]

1. There are plenty of jobs that generate high amounts of revenue. Plenty of engineers who do more than doctors in terms of productivity yet get paid less. Either way, that point is moot since the revenue you generate has nothing to do with what you "deserve" to be paid.

2. Physicians definitely have a seat at the table. Physicians played a major role is stomping out universal healthcare. Also established the cartel with the Flexner report. the AMA continues to lobby congress to this day. Individual societies lobby at our state legislature. Know several surgical groups around here who hire lawyers for that exact purpose.

3. Easy. You could just whitelist countries that you know generate good physicians. Why cant a UK doctor practice here in the States? Is it because he has poor skills? Nope. It has to do with the fact that he gets paid 100k for his work in the UK, and would be happy to fill Gen Surg jobs for 150k here in the US.

4. Very few professions regulate themselves. Very few professions have the ability to reduce their labor force. Do you think programmers should be allowed to shut down CS programs at colleges across the US? Seems cartel-y to me.

Everything you said about flooding the market is true. It is bad for my bottom line. The problem is that American Docs have put their own pockets ahead of patients.

Why are you ok with patients waiting months for an appointment just so you can meet your RVU target?

Easy. You could just whitelist countries that you know generate good physicians. Why cant a UK doctor practice here in the States? Is it because he has poor skills? Nope. It has to do with the fact that he gets paid 100k for his work in th

The bottleneck also happens in having enough willing patients and cases. In my specialty, you can’t have a residency program unless you can guarantee an adequate number of transplants, trauma, cardiac, neuro, pediatric, and all other subspecialty cases. You shouldn’t let barely adequate graduates loose on the unsuspecting public. Not enough cases=no residency.

This is literally what is happening in gynecology; there has been residency for expansion because of a shortage, but it’s a shortage of obstetrics and office gynecologists not surgical gynecologists thats the problem. So as a result there is dilution of surgical experience among obgyn residents and they graduate with insanely low minimum surgical procedure requirements all in the name of increased access. Not saying that improving access and increasing number of docs is bad but you can’t just wave your hand and create new docs without creating minimum standards (even for cognitive specialties).

 

[ACSurgeon]

Um, yes. Much of it does. Are you about to argue that it doesn’t?

Nope. We are in agreement.

 

[Lawpy]

I’m always amazed how ingrained some of the political talking points become in our culture and how they infect discussions such as this one.

Healthcare is a right? Are you kidding me?! Quite possibly one of the stupidest things I’ve ever heard. If it’s a right then who is compelled to provide it? Sure, it’s unethical that a society with means would turn anyone away from care who needs it (and a massive chunk of my patients are Medicaid or uninsured), but arguing some innate right to healthcare seems nonsensical to me. I do it because I feel it’s the right thing to do, but someone refusing to see a patient or group of patients is not violating their human rights.

I also don’t see the problem with having SES barriers to entry in the profession. The aim of medicine is not to provide a means of social engineering for the less fortunate, so if our system means we end up with more docs from affluent backgrounds I have no issue with that. Our goal should be providing the best care we possibly can, not providing more opportunities for less fortunate students to reach their lifelong goals of becoming an orthopedic surgeon. Not everyone gets to do what they want to do. A competitive residency is not the participation trophy for medical school.

You keep saying the goal is to provide the best care possible. You know how is that possible? By having doctors able to relate to the patients and understanding their circumstances. I have no idea where you got this idea that having more affluent doctors is a good idea when it’s clear their privileged backgrounds made it significantly easier to jump through all the hoops and even luck out with not having to maximize their academic credentials for any specialty of their choice (yes this is real, a guy from Harvard can match literally anywhere he wants to even with average stats because the Harvard name and connections are powerful) This is not a meritocratic process at all, and pointing out the gross SES disparities in medicine when the profession is meant to actually serve the community they’re taking care of is not some leftist or woke or whatever political jargon talking point. It’s a real issue with real consequences

 

[Lawpy]

Do you have stats? How much weight are schools giving to kids of alumni or “well connected people”. Is it if two people with similar merit come the legacy gives you a leg up? Or are they take people with below average stats? We should not discriminate against the sons of doctors or a certain school against the alumni’s Kidd. Again, what’s your proof of real bias? Anecdotes don’t work. My anecdotes indicate there were more kids of less privileged backgrounds in my class.

Also like brought up before everything is easier with money. I had no connections and my “sob story” helped my admission maybe. But I hope my kids have more resources and an easier time with whatever they choose to do.

The actual admissions data is obviously confidential and not public but the AAMC surveys have already clearly documented the critical role of undergrad brand name for private med school admissions. There are also indirect effects from being from a high SES/well off backgrounds, such as having more time and resources to max out on standardized test scores (SES disparities in SAT/ACT are well documented, and the MCAT and Steps are much less g loaded than these exams and far more knowledge heavy, which aggravates the disparities by focusing on the best of the best for just sheer cramming). There’s more time and resources to travel internationally, get memorable and amazing activities and experiences without feeling the pressure of having to work to make ends meet.

I know the common view is… well that’s life. But medicine is not and should not be like careers like finance where elitist networking is supreme. Medicine is a job but it’s a very human job and it’s critical to being able to talk to and relate to patients at a personal level. Increasingly selecting for people from high SES backgrounds who have little to no experience with those from working class backgrounds makes doctors detached from patients and the community… and that’s a deep social problem.

 

[Lawpy]

Is it harder for people with low SES backgrounds to have the stats to get in? Absolutely, is it fair? He'll no, but adcoms don't purposely count out those who make it. You'll have to work harder than someone with more resources and privilege but that's life. You either outwork them or fall behind.

This is what i’m saying and i disagree that we should simply dismiss that as life. Adcoms may not intentionally select against low SES (which actually still happens because adcoms are still people susceptible to social capital and prestige bias), but the actual selection against low SES nonetheless happens because of the indirect effects of differences in resources and opportunities.

Medicine is not and should not be treated like finance where connections and brand are king.

 

[7331poas]

And why would anyone from the UK would want to come to the US to practice in underserved areas to fill gaps in our coverage?

Easy. Because they would get paid 3x higher here in the States, even in areas that aren't "underserved".

 

[7331poas]

Is there a long line of UK doctors trying to come here to practice psychiatry? I doubt it would be enough to fill the gap.

Seems a little unfair they could do medical school there for pretty much nothing, come here with no debt and make a higher income, while physicians trained here have debt burdens >300k. I can't just go to the UK whenever I feel like it. I mean theres rules for logical reasons. it seems you don't have a lot of experience in this area because you havent exactly lived it or gone through it.

Ive lived through plenty. My studentloan.gov account is proof of that.

Your rationale is not good enough to justify the cartel. Its not good enough to justify maintaining a physician shortage.

 

[Proudfather94]

Admissions does. In order to be competitive, you need a great GPA and MCAT, both of which are easier to get when you don’t have to work your way through school or can afford tutors and prep classes. You have to have volunteering and shadowing and a number of ECs. All those things are way easier to get if you have money. So people with money are more likely to get in. That’s selecting for affluent applicants. Selection for or against doesn’t imply some nefarious motive.

If you have the determination to be a doctor you can find a way to make it happen no matter what. Get a clinical job there's your clinical experience and money. Take a gap year and volunteer and study for the MCAT. If you put that you worked as one of your activities you can get away with less volunteering. I had less than 100 hours of volunteering and had a great cycle.

It's harder but you can still get through it. If having to work in school's someone's excuse for not getting in that's a cop out.

 

[Neopolymath]

As an M2, I can't believe people advocate against the best interests of their field. We see law, finance, engineering, etc pushing to increase their pie. Yet we have people in medicine being submissive to overexpansion and exploitation by admin on the predication of the lie that is "increased positive patient outcomes". They oversaturate your field and cut your pay, patients will still be paying the same prices (if not even higher prices, the suits need to pay off their new beamer!) and you'll just get paid less, econ 101.

Also, med school pushes students to develop Stockholm syndrome and it seems like we are the only field that has people walking around scarred of their own shadows. I have seen my friends in other fields and all of them are confident and cocky, and will get their piece of the pie. Not saying medicine needs to become that, but we need a MUCH stronger backbone.

That's because they still believe that any of this will improve things for the patients and not just screw things up conveniently ONLY for physicians. Unfortunately, there is a pattern here that some people don't learn about until they are adult attendings.

 

[Neopolymath]

What a loaded statement! Can I go fix some femurs in the UK? I know for a fact they have a shortage of orthopedic surgeons there. And why would anyone from the UK would want to come to the US to practice in underserved areas to fill gaps in our coverage?

Much like all NPs want to fill the gap in primary care for the poor patients and then become surgical sub or derm workers in the city.

 

[deleted1100659]

Ive lived through plenty. My studentloan.gov account is proof of that.

Your rationale is not good enough to justify the cartel. Its not good enough to justify maintaining a physician shortage.

You are obviously not an attending, I suspect not even a resident. At most a medical student, so you have no idea what the experience is for an attending physician yet you keep speaking of their motives as if you understand them, but have no experience being one.

Calling doctors the “cartel”..why don’t you lobby against the tobacco industry, alcohol, fast food, etc all the things that cause the decline of health in America and increase number of patients rather than the ones actually doing something?

 

[7331poas]

You are obviously not an attending, I suspect not even a resident. At most a medical student, so you have no idea what the experience is for an attending physician yet you keep speaking of their motives as if you understand them, but have no experience being one.

Calling doctors the “cartel”..why don’t you lobby against the tobacco industry, alcohol, fast food, etc all the things that cause the decline of health in America and increase number of patients rather than the ones actually doing something?

I can walk and chew gum at the same time.

You dont need to be an attending to see what happens at the state legislature. Do you think the only people who are able to voice valid criticisms of physicians are attendings? Nobel prize winning economists agree with my stance.

We had surprise billing reforms passed in our state. Those bills were actively being lobbied against by surgeons because they wanted to pad their bottom line with that sweet out-of-network billing fees. Our trauma surgeons dont even accept insurance for those reasons. Dont need to be an attending to see that doctors aren't descendants of angels.

 

[VA Hopeful Dr]

Easy. You could just whitelist countries that you know generate good physicians. Why cant a UK doctor practice here in the States? Is it because he has poor skills? Nope. It has to do with the fact that he gets paid 100k for his work in th


This is literally what is happening in gynecology; there has been residency for expansion because of a shortage, but it’s a shortage of obstetrics and office gynecologists not surgical gynecologists thats the problem. So as a result there is dilution of surgical experience among obgyn residents and they graduate with insanely low minimum surgical procedure requirements all in the name of increased access. Not saying that improving access and increasing number of docs is bad but you can’t just wave your hand and create new docs without creating minimum standards (even for cognitive specialties).

You realize UK doctors can come work here, right?

I am Currently Certified in a Country Outside the United States | ABFM | American Board of Family Medicine

If you have received training and certification in Australia, Canada, Great Britain or New Zealand you may be eligible to receive initial board certification through ABFM if:

www.theabfm.org

 

[Proudfather94]

Why do people keep calling physicians a cartel? Do you think a physician will behead you with a machete for opening a practice too close to theirs?

 

[VA Hopeful Dr]

I have a fun thought experiment. The number of practicing emergency physicians has been increasing sharply the last 5 to 6 years or so. As a consequence, the money that they can make has gone down quite a bit.

Has anyone noticed a decrease in emergency department bills?

 

[jstwannagraduaaate!!!]

Much like all NPs want to fill the gap in primary care for the poor patients and then become surgical sub or derm workers in the city.

Or all the cries to expand residency spots, meanwhile theres tons of IM and FM spots easily accessible for people to SOAP into.

 

[Dr G Oogle]

You realize UK doctors can come work here, right?

I am Currently Certified in a Country Outside the United States | ABFM | American Board of Family Medicine

If you have received training and certification in Australia, Canada, Great Britain or New Zealand you may be eligible to receive initial board certification through ABFM if:

www.theabfm.org

You realize UK doctors can come work here, right?

I am Currently Certified in a Country Outside the United States | ABFM | American Board of Family Medicine

If you have received training and certification in Australia, Canada, Great Britain or New Zealand you may be eligible to receive initial board certification through ABFM if:

www.theabfm.org

Sorry I was quoting another poster with regard to UK doctors and trying to make your same point as you and I can’t use the button correctly I guess 🤦‍♂️ Also nobody talks about that docs there can make bank if/when they opt out of the NHS

 

[jstwannagraduaaate!!!]

I can walk and chew gum at the same time.

You dont need to be an attending to see what happens at the state legislature. Do you think the only people who are able to voice valid criticisms of physicians are attendings? Nobel prize winning economists agree with my stance.

We had surprise billing reforms passed in our state. Those bills were actively being lobbied against by surgeons because they wanted to pad their bottom line with that sweet out-of-network billing fees. Our trauma surgeons dont even accept insurance for those reasons. Dont need to be an attending to see that doctors aren't descendants of angels.

No one says they are. The point of this thread is protecting the profession. Doctors are people too. I don't know about you but I hope to have a solid paying secure job after residency/fellowship one day. If you are appalled at the salary that you are going to earn, you are more than welcome to donate it or open a free clinic; just don't force your beliefs on the rest of the profession

 

[Neopolymath]

I can walk and chew gum at the same time.

You dont need to be an attending to see what happens at the state legislature. Do you think the only people who are able to voice valid criticisms of physicians are attendings? Nobel prize winning economists agree with my stance.

We had surprise billing reforms passed in our state. Those bills were actively being lobbied against by surgeons because they wanted to pad their bottom line with that sweet out-of-network billing fees. Our trauma surgeons dont even accept insurance for those reasons. Dont need to be an attending to see that doctors aren't descendants of angels.

If you don't understand why some doctors, even and often ethically sound doctors, are against the surprise billing legislation then you need to spend some time in the anesthesia forum. It's more complicated than "surprise billing bad" unfortunately. It's not just jerks being out of network out of greed or surgical first assistants charging a **** ton of money on unsuspecting people.

That's the headline but the truth is the only reason insurance companies want to do this is to screw the little guy by giving him nothing to negotiate against. I would explain further but it sounds like it would be pointless. Just read the anesthesia subforum if you are interested in learning more.

 

[Dr G Oogle]

I have a fun thought experiment. The number of practicing emergency physicians has been increasing sharply the last 5 to 6 years or so. As a consequence, the money that they can make has gone down quite a bit.

Has anyone noticed a decrease in emergency department bills?

I haven’t; but I’ve noticed quite a few free standing private equity firms opening up over that same time period employing mid levels to “improve access”, I’ve also not noticed improved outcomes and population health metrics despite this increased access

 

[UnoMas]

I can walk and chew gum at the same time.

You dont need to be an attending to see what happens at the state legislature. Do you think the only people who are able to voice valid criticisms of physicians are attendings? Nobel prize winning economists agree with my stance.

We had surprise billing reforms passed in our state. Those bills were actively being lobbied against by surgeons because they wanted to pad their bottom line with that sweet out-of-network billing fees. Our trauma surgeons dont even accept insurance for those reasons. Dont need to be an attending to see that doctors aren't descendants of angels.

Or you know, they just want to retain their ability to negotiate a fair rate with the insurance companies instead of being told by UnitedHealthcare that their lap choles are now $125 a pop without any recourse and the patients still pay out of their buttholes for the premium

How do trauma surgeons cherry-pick insurance??? They would turn away trauma patients with a GSW to the chest/belly if they have bad insurance? lol. Elective trauma is a thing?

 

[Dr G Oogle]

I can walk and chew gum at the same time.

You dont need to be an attending to see what happens at the state legislature. Do you think the only people who are able to voice valid criticisms of physicians are attendings? Nobel prize winning economists agree with my stance.

We had surprise billing reforms passed in our state. Those bills were actively being lobbied against by surgeons because they wanted to pad their bottom line with that sweet out-of-network billing fees. Our trauma surgeons dont even accept insurance for those reasons. Dont need to be an attending to see that doctors aren't descendants of angels.

Dollars to donuts they surgeons other docs weren’t lobbying against surprise billing to pad their pockets but because if a patient sees an out of network surgeon for an emergency they have to treat that patient. And if you’re a trauma surgeon or ER doc not employed by a hospital system or academic center that’s a big chunk of your patients. And if they don’t bill they don’t get paid and nobody wants to work for free, especially at 3 in the morning. Blame the insurance companies for not covering out of network emergency care which is borderline line evil, not the doc who wants to get paid for their work.


You don’t need to be an attending to discuss this kind of stuff but it sure helps to be able to understand and speak intelligently about these topics if you’ve had more than an undergrad and med school education.

Also, Nobel prize winners can be idiots too, especially if they are discussing things that they have no idea about. Applying labor economic principles to Medicine is a fools errand, and many fools have and will go on this errand. Medicine cannot be a free market because it is not a commodity, people don’t want the best for their buck they want the best, period. When you shop around for doctors, you’re not shopping for the best price, you’re shopping for the best results. The people who become the best doctors (the ones willing to grind, put in extra effort, see just one more patient) will simply stop going into medicine if they cannot be reimbursed fairly for their time.

 

[nimbus]

You keep saying the goal is to provide the best care possible. You know how is that possible? By having doctors able to relate to the patients and understanding their circumstances. I have no idea where you got this idea that having more affluent doctors is a good idea when it’s clear their privileged backgrounds made it significantly easier to jump through all the hoops and even luck out with not having to maximize their academic credentials for any specialty of their choice (yes this is real, a guy from Harvard can match literally anywhere he wants to even with average stats because the Harvard name and connections are powerful) This is not a meritocratic process at all, and pointing out the gross SES disparities in medicine when the profession is meant to actually serve the community they’re taking care of is not some leftist or woke or whatever political jargon talking point. It’s a real issue with real consequences

Have you considered that the average Harvard med school class is full of 520+ MCAT, 4.0 gpa, multiple publication, multiple leadership positions, got their s*** together beasts? Is that easier to do when you have rich supportive parents? Yes. They still did it.

 

[nimbus]

I can walk and chew gum at the same time.

You dont need to be an attending to see what happens at the state legislature. Do you think the only people who are able to voice valid criticisms of physicians are attendings? Nobel prize winning economists agree with my stance.

We had surprise billing reforms passed in our state. Those bills were actively being lobbied against by surgeons because they wanted to pad their bottom line with that sweet out-of-network billing fees. Our trauma surgeons dont even accept insurance for those reasons. Dont need to be an attending to see that doctors aren't descendants of angels.

You’re missing the actual reason why we oppose surprise billing legislation. No doctor wants to be out of network. It’s a pain in the a**. The reason we lobby against surprise billing legislation is because they remove all negotiating leverage to get decent in network rates from insurance companies.

UnitedHealth Group Reports Third Quarter 2021 Performance

Consistent, well-balanced growth continued across UnitedHealth Group (NYSE: UNH) in the third quarter 2021. “Our positive growth and operating results

www.businesswire.com

Anesthesiologists allege BCBS of North Carolina using 'strongarm tactics' ahead of No Surprises Act rollout

The American Society of Anesthesiologists issued a statement condemning BlueCross BlueShield of North Carolina's alleged abuse of the No Surprises Act to

www.beckershospitalreview.com

 

[Wordead]

I can walk and chew gum at the same time.

You dont need to be an attending to see what happens at the state legislature. Do you think the only people who are able to voice valid criticisms of physicians are attendings? Nobel prize winning economists agree with my stance.

We had surprise billing reforms passed in our state. Those bills were actively being lobbied against by surgeons because they wanted to pad their bottom line with that sweet out-of-network billing fees. Our trauma surgeons dont even accept insurance for those reasons. Dont need to be an attending to see that doctors aren't descendants of angels.

If everyone in the profession is on one side of the argument, and you the med student are the lone voice on the other, is it more likely that you're the only person who sees the truth or that you have no idea what you're talking about?

 

[operaman]

You keep saying the goal is to provide the best care possible. You know how is that possible? By having doctors able to relate to the patients and understanding their circumstances. I have no idea where you got this idea that having more affluent doctors is a good idea when it’s clear their privileged backgrounds made it significantly easier to jump through all the hoops and even luck out with not having to maximize their academic credentials for any specialty of their choice (yes this is real, a guy from Harvard can match literally anywhere he wants to even with average stats because the Harvard name and connections are powerful) This is not a meritocratic process at all, and pointing out the gross SES disparities in medicine when the profession is meant to actually serve the community they’re taking care of is not some leftist or woke or whatever political jargon talking point. It’s a real issue with real consequences

Sorry but I fail to see how I would be any better or more compassionate a physician had I grown up poor in a crap hole. I’m sure there’s a level of affluence where someone would be woefully out of touch, but that Simply isn’t the case for most docs and even if it is, it’s fairly easy to overcome with a modicum of intelligence.

I would argue that the Harvard name isn’t quite the golden ticket you suggest since I’ve seen more than one Harvard grad DNR’d in rank meetings, but yes it definitely helps. I don’t mind that though - if accomplished motivated affluent young people have some additional advantages because of a school name, that’s fine with me.

I see zero benefit in making everything more equitable across the board. I’ve yet to meet two people I thought were equal in any way, much less entire groups of people sorted by SES or race or nationality. Some people are smarter and more gifted and simply better than others, and I have no problem if they end up doing better than the less fortunate. It’s absolutely a meritocratic process but the dumb fact is that some people are simply better than others. Sometimes those advantages correlate with wealth. Doesn’t make them less real.

The medical profession can and does serve the community just fine and we don’t need to dumb things down or open crap community Ortho programs in the same of equitable outcomes for snowflakes who just know they’re special enough to be an orthopedic surgeon. You don’t need to grow up poor to understand poverty. The system favors the best among us, and I say let them distinguish themselves and rise to the challenge.

 

[Matthew9Thirtyfive]

Sorry but I fail to see how I would be any better or more compassionate a physician had I grown up poor in a crap hole. I’m sure there’s a level of affluence where someone would be woefully out of touch, but that Simply isn’t the case for most docs and even if it is, it’s fairly easy to overcome with a modicum of intelligence.

I would argue that the Harvard name isn’t quite the golden ticket you suggest since I’ve seen more than one Harvard grad DNR’d in rank meetings, but yes it definitely helps. I don’t mind that though - if accomplished motivated affluent young people have some additional advantages because of a school name, that’s fine with me.

I see zero benefit in making everything more equitable across the board. I’ve yet to meet two people I thought were equal in any way, much less entire groups of people sorted by SES or race or nationality. Some people are smarter and more gifted and simply better than others, and I have no problem if they end up doing better than the less fortunate. It’s absolutely a meritocratic process but the dumb fact is that some people are simply better than others. Sometimes those advantages correlate with wealth. Doesn’t make them less real.

The medical profession can and does serve the community just fine and we don’t need to dumb things down or open crap community Ortho programs in the same of equitable outcomes for snowflakes who just know they’re special enough to be an orthopedic surgeon. You don’t need to grow up poor to understand poverty. The system favors the best among us, and I say let them distinguish themselves and rise to the challenge.

Wow. This is a bad look. Honestly was not expecting something this ignorant from you.

 

[VA Hopeful Dr]

Wow. This is a bad look. Honestly was not expecting something this ignorant from you.

Care to expound on that?

 

[Lawpy]

Have you considered that the average Harvard med school class is full of 520+ MCAT, 4.0 gpa, multiple publication, multiple leadership positions, got their s*** together beasts? Is that easier to do when you have rich supportive parents? Yes. They still did it.

Not full. They accept people below median stats and favors legacies too. Multiple leaderships can be achieved very easily by knowing the right people which is easy for them. Same thing for multiple papers, research/academia suffer badly from nepotism too. The real winners are those who got into such schools without that privilege or advantage

 

[Obnoxious Dad]

No one says they are. The point of this thread is protecting the profession. Doctors are people too. I don't know about you but I hope to have a solid paying secure job after residency/fellowship one day. If you are appalled at the salary that you are going to earn, you are more than welcome to donate it or open a free clinic; just don't force your beliefs on the rest of the profession

Did you voice these sentiments at your med school interviews?

 

[Obnoxious Dad]

Why do people keep calling physicians a cartel? Do you think a physician will behead you with a machete for opening a practice too close to theirs?

OECD Statistics

OECD.Stat enables users to search for and extract data from across OECD’s many databases.

stats.oecd.org

"A cartel is a formal agreement among firms in an oligopolistic industry. Cartel members may agree on such matters as prices, total industry output, market shares, allocation of customers, allocation of territories, bid-rigging, establishment of common sales agencies, and the division of profits or combination of these."

 

[Matthew9Thirtyfive]

Care to expound on that?

On why it’s ignorant to heavily implying that lower SES folks are not as smart as affluent folks or why it’s ignorant to say it doesn’t matter if lower SES populations aren’t represented in medicine despite that meaning minorities will disproportionately be less represented?

 

[Obnoxious Dad]

Anybody who thinks medicine isn't a cartel needs to see this video.

Where Do Your Med School Tuition Dollars Go?

'Our debt is an amount of money that schools might not actually need'

www.medpagetoday.com

 

[deleted1100659]

OECD Statistics

OECD.Stat enables users to search for and extract data from across OECD’s many databases.

stats.oecd.org

"A cartel is a formal agreement among firms in an oligopolistic industry. Cartel members may agree on such matters as prices, total industry output, market shares, allocation of customers, allocation of territories, bid-rigging, establishment of common sales agencies, and the division of profits or combination of these."

you think most physicians have this kind of power? Hospital CEOs and medical school administrators may have some influence over this but the average physician has zero influence over it.

You guys still havent explained to me what a "fair" salary for a physician is. What are our services worth???

 

[VA Hopeful Dr]

OECD Statistics

OECD.Stat enables users to search for and extract data from across OECD’s many databases.

stats.oecd.org

"A cartel is a formal agreement among firms in an oligopolistic industry. Cartel members may agree on such matters as prices, total industry output, market shares, allocation of customers, allocation of territories, bid-rigging, establishment of common sales agencies, and the division of profits or combination of these."

So you do realize that every single aspect of medicine is controlled by a different group and most of them don't work that well together right?

Let's start with our first rate limiting step which is medical school. Enrollment has been going up sharply in recent years. I'm matriculated in 2005. They were right at 17,000 first year medical students at that time across the country. In 2020 that number was up to approximately 22,000. That's almost a 25% increase.

Next let's look at residency positions. My first year residency there were according to match statistics just under 23,000 residency positions available. For 2020 there were just over 34,000 positions. That's a 33% increase in 10 years.

Those numbers sure do sound awfully cartal-y to me.

The last rate living step is actually licensure. As long as you meet the criteria, you get a license. Those criteria are controlled in most states by the state legislature, certainly with input from physicians, but if we tried to become too restrictive about who gets a license you had better believe we'd get smacked down for it and rightfully so.

Now let's talk payment. 99% of us receive payment from insurance companies. Outside of large hospital systems, Most physicians are stuck with whatever the insurance companies offer. There can sometimes be a slight increase in their initial offer but it's almost never significant. Large hospital systems are a different beast but physicians have little/no say in most of those. We're employees and rarely more.

The only territorial aspects of medicine to which I'm aware are the non-compete clauses that are hardly unique to medicine.

The only division of profit we typically have is again those of us who are employed. Private practice groups almost never enter into any kind of bargaining with other practices or any kind of profit sharing.

 

[2021Doctor]

If there really was a cartel, it would have to be called the most ineffective cartel ever.

CSA - MEDICARE REIMBURSEMENT FOR COMMON GENERAL SURGERY PROCEDURES HAS DECLINED OVER THE LAST DECADE

centralsurg.org

Surgeons tend to pay at least $30000 to $50000 per year in malpractice. So the surgeon has do 50-70 cholecystectomies just to pay the malpractice premium. Nevermind office rent, utilities, office staff. You can't see the patient for surgery follow-up in a parking lot.
In addition, Major surgery allocates a 90-day global period in which the surgeon is responsible for all related surgical care one day before surgery through 90 postoperative days with no additional charge.

For example, Medicare reimbursement for coronary artery bypass grafting (CABG) has dropped by almost 50% since the late 1980s (Figure 1).
Given the pressures already impacting our specialty, Medicare payment cuts of this magnitude could cripple a surgical workforce already succumbing to financial pressures.

DEFINE_ME

In addition, Major surgery allocates a 90-day global period in which the surgeon is responsible for all related surgical care one day before surgery through 90 postoperative days with no additional charge.

Average Student Loan Debt for Medical School for 2023 | Credible

Medical school students graduate with an average of $215,900 in debt. Learn more about the average medical school debt and how to manage it here.

www.credible.com

P.S.: I should add that these calculations were done with the hopes that every patient ends in a full payment. Many insurance companies will not pay you on time, in full, or at all. There is a very real chance that you might have to work extra days to make up for lost income from deadbeat billings.

The economics of medicine: solo practice

I am concluding this miniseries on the economics of medicine by examining the cost of doing business as a solo practitioner. Earlier, we saw that living a decent lifestyle requires an annual salary…

halfmd.wordpress.com

 

[VA Hopeful Dr]

On why it’s ignorant to heavily implying that lower SES folks are not as smart as affluent folks or why it’s ignorant to say it doesn’t matter if lower SES populations aren’t represented in medicine despite that meaning minorities will disproportionately be less represented?

I didn't get either of those from that post.

 

[Dr G Oogle]

Sorry but I fail to see how I would be any better or more compassionate a physician had I grown up poor in a crap hole. I’m sure there’s a level of affluence where someone would be woefully out of touch, but that Simply isn’t the case for most docs and even if it is, it’s fairly easy to overcome with a modicum of intelligence.

I would argue that the Harvard name isn’t quite the golden ticket you suggest since I’ve seen more than one Harvard grad DNR’d in rank meetings, but yes it definitely helps. I don’t mind that though - if accomplished motivated affluent young people have some additional advantages because of a school name, that’s fine with me.

I see zero benefit in making everything more equitable across the board. I’ve yet to meet two people I thought were equal in any way, much less entire groups of people sorted by SES or race or nationality. Some people are smarter and more gifted and simply better than others, and I have no problem if they end up doing better than the less fortunate. It’s absolutely a meritocratic process but the dumb fact is that some people are simply better than others. Sometimes those advantages correlate with wealth. Doesn’t make them less real.

The medical profession can and does serve the community just fine and we don’t need to dumb things down or open crap community Ortho programs in the same of equitable outcomes for snowflakes who just know they’re special enough to be an orthopedic surgeon. You don’t need to grow up poor to understand poverty. The system favors the best among us, and I say let them distinguish themselves and rise to the challenge.

I don’t know about all this. You most definitely need to be impoverished to understand what it means to be poor. I’m sure many people understand that poor=bad but not what that actually means. When I worked at the county hospital I had well meaning colleagues complain that the no show rate was high. But it wasn’t high because patients were jerks but because they couldn’t afford to get the bus that day, or have a babysitter, or pay the $3 parking fee. I’ve had patients who didn’t have a phone and people were at a loss as to how to deal with this. I grew up pretty poor and had my own experience of how I dealt with all of the above specifically from a perspective getting to medical appts. It was easier for me to come up with a solution for the patients simply by thinking of how my family dealt with it. I’m sure my colleagues from more affluent backgrounds would have eventually come to similar conclusions but it wasn’t natural for them.

Things are not equitable in medicine if we only look at “merit”. A kid with a background full of adversity and slightly lower mcat scores and less extracurricular then a kid from a more affluent, even middle class background is for sure the better applicant because they have resilience and given similar opportunities would perform better than the other kid. Similar to an engineering major who comes in with a lower gpa than a bio or chem major. Engineering is just harder and a life full of adversity is just harder, and you want the person who’s faced challenges, because medicine in challenging. And a life of adversity allows for introspection that frankly many affluent people lack.

I don’t agree with blanket favoritism of minorities and lower SES people over affluent people because being poor or a minority are not adequate qualifications, and some of this is happening, now more than ever. And I think that’s where your frustration is coming from and I’m very frustrated by that also. But to say that the system is set up to favor the best of us is categorically untrue.

 

[Matthew9Thirtyfive]

I didn't get either of those from that post.

How else do you read these?

You don’t need to grow up poor to understand poverty. The system favors the best among us, and I say let them distinguish themselves and rise to the challenge.

I see zero benefit in making everything more equitable across the board. I’ve yet to meet two people I thought were equal in any way, much less entire groups of people sorted by SES or race or nationality.

Some people are smarter and more gifted and simply better than others, and I have no problem if they end up doing better than the less fortunate. It’s absolutely a meritocratic process but the dumb fact is that some people are simply better than others. Sometimes those advantages correlate with wealth. Doesn’t make them less real.

 

[deleted1100659]

The actual medical school debt is much higher than the data leads you to believe. They include people that go to med school for free because of military or some other agreement and that skews it downward. Medical tuition has gotten to be around 40-50k a year. Living expenses are at least 25-50k depending on where you live. And your loan accumulates interest day 1 of medical school. Its very common to be way over 300k when you hit residency

 

[Obnoxious Dad]

So you do realize that every single aspect of medicine is controlled by a different group and most of them don't work that well together right?

Let's start with our first rate limiting step which is medical school. Enrollment has been going up sharply in recent years. I'm matriculated in 2005. They were right at 17,000 first year medical students at that time across the country. In 2020 that number was up to approximately 22,000. That's almost a 25% increase.

Next let's look at residency positions. My first year residency there were according to match statistics just under 23,000 residency positions available. For 2020 there were just over 34,000 positions. That's a 33% increase in 10 years.

Those numbers sure do sound awfully cartal-y to me.

The last rate living step is actually licensure. As long as you meet the criteria, you get a license. Those criteria are controlled in most states by the state legislature, certainly with input from physicians, but if we tried to become too restrictive about who gets a license you had better believe we'd get smacked down for it and rightfully so.

Now let's talk payment. 99% of us receive payment from insurance companies. Outside of large hospital systems, Most physicians are stuck with whatever the insurance companies offer. There can sometimes be a slight increase in their initial offer but it's almost never significant. Large hospital systems are a different beast but physicians have little/no say in most of those. We're employees and rarely more.

The only territorial aspects of medicine to which I'm aware are the non-compete clauses that are hardly unique to medicine.

The only division of profit we typically have is again those of us who are employed. Private practice groups almost never enter into any kind of bargaining with other practices or any kind of profit sharing.

Yes, I realize that the American Medical Association and the American Nurses Association are distinct entities. However, their anticompetitive practices are very similar

It is true that we have seen a significant increase in the number of medical students. If you throw in osteopathic students, the number of first year medical students actually exceeds 30,000. However, the number of medical school applicants who have the talent to succeed in medical school vastly exceeds 30,000. This is demonstrated by the low rates of acceptance of med school applicants from states that don't invest in medical education. Furthermore, the price of medical school is vastly greater than its underlying costs. See this interview:

Why Doctors Are Drowning in Medical School Debt

A resident physician investigates the causes of skyrocketing tuition

blogs.scientificamerican.com

Furthermore, the number of medical residency slots is artificially low. There are 900,000 hospital beds in the U.S. and approximately 30,000 new graduates annually begin residency programs leading to board certification which leaves a ratio of one new resident for every 30 beds. In the Henry Ford System in southeastern Michigan, there are 230 new residents every year in a system with 2,300 beds. That's one new resident for every 10 beds. If every U.S. hospital system had the same ratio of beds to residents that Henry Ford has, we'd have 90,000 new residents per year. Why does Henry Ford have so many slots? It's cheaper to train a resident than hiring an NP. A note by Chandra, Khullar, and Wilensky in the June 19, 2014 edition of The New England Journal of Medicine addressed the growth of residency slots. The three authors made a solid case that the number of residents has grown in spite of the 1997 budget deal because medical residents pay for their own training by the delivery of services to patients.

The salary you are paid is a reflection of the market. You aren't a slave. You can always go someplace else to get a better deal.

 

[Thesimplelifeofamyloid]

Yes, I realize that the American Medical Association and the American Nurses Association are distinct entities. However, their anticompetitive practices are very similar

It is true that we have seen a significant increase in the number of medical students. If you throw in osteopathic students, the number of first year medical students actually exceeds 30,000. However, the number of medical school applicants who have the talent to succeed in medical school vastly exceeds 30,000. This is demonstrated by the low rates of acceptance of med school applicants from states that don't invest in medical education. Furthermore, the price of medical school is vastly greater than its underlying costs. See this interview:

Why Doctors Are Drowning in Medical School Debt

A resident physician investigates the causes of skyrocketing tuition

blogs.scientificamerican.com

Furthermore, the number of medical residency slots is artificially low. There are 900,000 hospital beds in the U.S. and approximately 30,000 new graduates annually begin residency programs leading to board certification which leaves a ratio of one new resident for every 30 beds. In the Henry Ford System in southeastern Michigan, there are 230 new residents every year in a system with 2,300 beds. That's one new resident for every 10 beds. If every U.S. hospital system had the same ratio of beds to residents that Henry Ford has, we'd have 90,000 new residents per year. Why does Henry Ford have so many slots? It's cheaper to train a resident than hiring an NP. A note by Chandra, Khullar, and Wilensky in the June 19, 2014 edition of The New England Journal of Medicine addressed the growth of residency slots. The three authors made a solid case that the number of residents has grown in spite of the 1997 budget deal because medical residents pay for their own training by the delivery of services to patients.

The salary you are paid is a reflection of the market. You aren't a slave. You can always go someplace else to get a better deal.

Every industry has some form of artificial inflation competition. It's not unique to medicine. You really think being an actor in a Marvel film making 7 is based in any sort of meritocracy? There's thousands that can do an equal job. But what they do is prevent people from even entering the reading room other than the well-connected top picks with an agent

 

[VA Hopeful Dr]

Yes, I realize that the American Medical Association and the American Nurses Association are distinct entities. However, their anticompetitive practices are very similar

It is true that we have seen a significant increase in the number of medical students. If you throw in osteopathic students, the number of first year medical students actually exceeds 30,000. However, the number of medical school applicants who have the talent to succeed in medical school vastly exceeds 30,000. This is demonstrated by the low rates of acceptance of med school applicants from states that don't invest in medical education. Furthermore, the price of medical school is vastly greater than its underlying costs. See this interview:

Why Doctors Are Drowning in Medical School Debt

A resident physician investigates the causes of skyrocketing tuition

blogs.scientificamerican.com

Furthermore, the number of medical residency slots is artificially low. There are 900,000 hospital beds in the U.S. and approximately 30,000 new graduates annually begin residency programs leading to board certification which leaves a ratio of one new resident for every 30 beds. In the Henry Ford System in southeastern Michigan, there are 230 new residents every year in a system with 2,300 beds. That's one new resident for every 10 beds. If every U.S. hospital system had the same ratio of beds to residents that Henry Ford has, we'd have 90,000 new residents per year. Why does Henry Ford have so many slots? It's cheaper to train a resident than hiring an NP. A note by Chandra, Khullar, and Wilensky in the June 19, 2014 edition of The New England Journal of Medicine addressed the growth of residency slots. The three authors made a solid case that the number of residents has grown in spite of the 1997 budget deal because medical residents pay for their own training by the delivery of services to patients.

The salary you are paid is a reflection of the market. You aren't a slave. You can always go someplace else to get a better deal.

I always find it fun that people outside of medicine think the AMA has that much power regarding this sort of thing.

You can't use beds as a proxy for residents. There's a rural hospital connected with my hospital system that has 30 beds. By your reasoning they can support a resident, but they only see very basic pathology there. No peds, no ob, no ICU. There is no way that they could support a resident or any kind. This is actually what I was getting at with my very first post in this thread. Just because the hospital can open a program doesn't mean it has sufficient patient numbers or complexity to actually train a good quality resident.

 

[Proudfather94]

Yes, I realize that the American Medical Association and the American Nurses Association are distinct entities. However, their anticompetitive practices are very similar

It is true that we have seen a significant increase in the number of medical students. If you throw in osteopathic students, the number of first year medical students actually exceeds 30,000. However, the number of medical school applicants who have the talent to succeed in medical school vastly exceeds 30,000. This is demonstrated by the low rates of acceptance of med school applicants from states that don't invest in medical education. Furthermore, the price of medical school is vastly greater than its underlying costs. See this interview:

Why Doctors Are Drowning in Medical School Debt

A resident physician investigates the causes of skyrocketing tuition

blogs.scientificamerican.com

Furthermore, the number of medical residency slots is artificially low. There are 900,000 hospital beds in the U.S. and approximately 30,000 new graduates annually begin residency programs leading to board certification which leaves a ratio of one new resident for every 30 beds. In the Henry Ford System in southeastern Michigan, there are 230 new residents every year in a system with 2,300 beds. That's one new resident for every 10 beds. If every U.S. hospital system had the same ratio of beds to residents that Henry Ford has, we'd have 90,000 new residents per year. Why does Henry Ford have so many slots? It's cheaper to train a resident than hiring an NP. A note by Chandra, Khullar, and Wilensky in the June 19, 2014 edition of The New England Journal of Medicine addressed the growth of residency slots. The three authors made a solid case that the number of residents has grown in spite of the 1997 budget deal because medical residents pay for their own training by the delivery of services to patients.

The salary you are paid is a reflection of the market. You aren't a slave. You can always go someplace else to get a better deal.

I agree that you're paid based on the markets value of you. That is why physicians want to prevent flooding the field and driving their wages down. If people were waiting a year to see the doctor because the US was cranking out 10 doctor a year and the average salary of a US doctor was 10 million a year I would agree with you. Right now supply and demand is set up to where the salary of physicians is closer to what most physicians think is fair for their work and education.

Why don't we focus on the responsibilities that fall on the patient? If they don't want to wait to see a specialist they can make an appointment somewhere else and travel there. If you move to the middle of nowhere you should expect to have to travel to see doctors. Why should the market get flooded and ruined so that people aren't responsible for their choices in life?

 

[Neopolymath]

I always find it fun that people outside of medicine think the AMA has that much power regarding this sort of thing.

You can't use beds as a proxy for residents. There's a rural hospital connected with my hospital system that has 30 beds. By your reasoning they can support a resident, but they only see very basic pathology there. No peds, no ob, no ICU. There is no way that they could support a resident or any kind. This is actually what I was getting at with my very first post in this thread. Just because the hospital can open a program doesn't mean it has sufficient patient numbers or complexity to actually train a good quality resident.

"There are like 330 million people in the USA (or something like that) so there are 330 million sinuses to learn ENT on. Just go open 5000 more ENT slots. What's the big deal if we lower the quality of training even more when it's barely adequate in some fields?"

Basically the argument.

 

[deleted1100659]

Yes, I realize that the American Medical Association and the American Nurses Association are distinct entities. However, their anticompetitive practices are very similar

It is true that we have seen a significant increase in the number of medical students. If you throw in osteopathic students, the number of first year medical students actually exceeds 30,000. However, the number of medical school applicants who have the talent to succeed in medical school vastly exceeds 30,000. This is demonstrated by the low rates of acceptance of med school applicants from states that don't invest in medical education. Furthermore, the price of medical school is vastly greater than its underlying costs. See this interview:

Why Doctors Are Drowning in Medical School Debt

A resident physician investigates the causes of skyrocketing tuition

blogs.scientificamerican.com

Well that is the one thing I agree with you about; the the cost of medical school is absurd and is one of the reasons we have to have a good salary, otherwise we would be in debt for the rest of our lives. But its not a barrier to entry; federal loans are widely accessible and few people who want to be a doctor give up on that idea because of the cost, they just go into massive debt like half of the attendings on SDN.

If anything, DO schools over recruit. The attrition at a fair number of DO schools is much higher then you know. In my class out of 150 around 25 people couldnt survive how rigorous it was and had to leave/be dismissed, and they left with a sizeable loan burden. If anything DO schools are often too generous.

We need to be if anything, more rigorous with who gets accepted. Medical school is no joke, its quite hard, and it only gets harder after that. If you don't make it you end up with six figure debt and nothing to show for it. Thats a huge a price to pay for a dream that didnt pan out. Not as many people are as qualified as you think.