When my primary care doc referred me to a dermatologist for a suspicious mole, I could not find an actual dermatologist who would see me in less than ~8 months. I ended up seeing a physician's assistant, which I'm still uneasy about since there's been a study that shows that PA's seem to have a lower success rate vs. doctors [1], and the educational requirements are very different for PAs.
As a layperson, it seems like we (patients / society) would benefit from having more doctors, i.e. opening up more residency slots and admitting more people to med school, but there's probably a lot I don't understand about the issue. Not sure if it's a lack of political willpower to do this, or if there are other reasons why the number of doctors we train is so restricted.
[1] https://pubmed.ncbi.nlm.nih.gov/29710082/ ("PAs performed more skin biopsies per case of skin cancer diagnosed and diagnosed fewer melanomas in situ, suggesting that the diagnostic accuracy of PAs may be lower than that of dermatologists")
impossiblefork 2 days ago [-]
I don't think there's necessarily much not understood.
Here in Sweden have almost 2x as many physicians you do, and we pay them about half of what you do, so we end up paying approximately the same in salaries (the average Swedish physician is paid 131k) and I think it works out completely.
We start our training of physicians right after high school, so we push them to get an MSc in Medicine, rather than treating physicians as some kind of pseudo-PhDs, with however requiring head physicians to have an actual PhD; and this system is fine. I think it's the same way in Denmark, and given the stuff they've come up with I imagine one can't complain much about their system.
a_vanderbilt 2 days ago [-]
A big driver for the high salaries of medical doctors in the U.S. is the staggering educational debt their degrees leave them with. Is it the same in Sweden? Some degree of wage depression is practically inevitable if we had more doctors, but I wonder how much that could be offset with affordable education?
atombender 2 days ago [-]
No. Universities in Sweden are free to citizens (including EU/EEA citizens). That includes highly regarded universities such as Karolinska Institute (considered one of the top medical schools in Europe), Lund University, the University of Gothenburg, and so on.
In Scandinavia, student loans are taken to cover living expenses, not the cost of tuition. Private schools exist, but are not nearly as common as in the U.S.
w10-1 1 days ago [-]
(Pretty familiar with PA's.)
Biopsy stats might differ because PA's are used in large (cough private equity) practices to do a lot of checks esp. in old-folks homes, and medicare pays. Patients per week can average 120+; no doctor does that. Plus, the PA is supposed to err on the side of caution, meaning more biopsies. DR's are more willing to ignore possible risks.
That said, most anyone (Dr. or PA) who is recently trained at a good school is often better than people with 15+ years of experience.
Also, derm exam skills are not enhanced by the depth of medical education or even much by experience (by contrast to the cardio exam). It's mostly a function of pattern recognition and patient skills.
TheNewsIsHere 1 days ago [-]
I recently had the exact same experience.
When I actually got my appointment within 30 days, due to calling and advocating for myself politely, I started wondering how much ground medical dermatology has ceded to elective and cosmetic dermatology. I am concerned that dermatology is becoming centered around the personal appearance of affluent people rather than medical need.
Try requesting appointments during December or January. A little birdie told me that appointment cancellations go through the roof at some practices during those months.
marxisttemp 2 days ago [-]
> As a layperson, it seems like we (patients / society) would benefit from having more doctors, i.e. opening up more residency slots and admitting more people to med school, but there's probably a lot I don't understand about the issue. Not sure if it's a lack of political willpower to do this, or if there are other reasons why the number of doctors we train is so restricted.
Like so many of America’s issues, it’s due to lobbying based on entrenched greed.
> In 1997, the AMA lobbied Congress to restrict the number of doctors that could be trained in the United States, claiming that, "The United States is on the verge of a serious oversupply of physicians."
freedomben 2 days ago [-]
Yep. The requirements (and cost!) to become a physician are absolutely insane, and it's entirely intentional. As a society we seem to assume that people in certain trades are altruistic and moral, simply because of their job. For some reason, everyone assumes doctors wouldn't act self-interested. Teachers are often thought of the same way. I don't want to swing the pendulum to the other side and start thinking of them as selfish (though certainly some individuals are), but I do wish as a society we would remember that people are still people. Our systems need to be structured to overcome the natural and innate tendency of people to optimize for themselves or their groups. We don't let the cigarette companies do all the science and make all the laws/rules around tobacco sales, we probably shouldn't do that with medical stuff either. We don't need antagonistic people in charge, but they should be independent.
NobleLie 1 days ago [-]
It started with the flexner report (1910). I urge you to look into it if you are interested in this topic and let me know your thoughts
And then you have the ARNP, and schools who are speedrunning people from the street into ARNPs. Oh, you need an RN? We'll have you in our "Accelerated RN" course, getting your RN in parallel with other studies.
In some places, it is possible to go from high school to ARNP within 6 years.
And while supervision requirements for PAs might vary in terms of actual oversight, ARNPs are ostensibly fully fledged independent providers.
And I'll also say that you see the same pre-hospital too. In the PNW, while there are valid criticisms that can be leveled against two of the pre-eminent paramedic programs (Harborview, and Tacoma Community), there are far, far, too many "strip mall schools" in other states that will take you from "zero to hero" in 4 or 5 months (of 6 days a week, 8 hours a day, of just class time), and dump you out on the world with just enough retained knowledge to pass your NREMT and the barest amount of ride time to meet DOT mandated minimums. It's scary, to be blunt. These people go out with no clinical experience and are now expected not just to work as a team on a 911 call, but to lead it.
f6v 2 days ago [-]
Tried getting an appointment in Denmark. “We don’t take any new patients”. A familiar story when trying to reach many specialists in European countries (Germany, Belgium). Except I doubt they’re getting 500k.
jjice 2 days ago [-]
Anecdotal, but I'm in the North East US and I called, and I'm not joking, nine primary care offices. Eight of them said they couldn't take anymore patients, and one said I could get an appointment six months later.
I hadn't needed to go to a primary care doctor in my adult life, but it was mind blowing that this was the case. Many friends of mine have had the same experience.
bookofjoe 2 days ago [-]
In mid-2023 I decided it would be good to have a primary care doctor since I was 74 years old at the time and hadn't been to a doctor in decades.
Full disclosure: I am a retired board-certified anesthesiologist.
I asked around town (Charlottesville, Virginia) and got two names from doctors I trust.
The first was not taking new patients; the second was, so I made an appointment: first available appointment was January 2025 (i.e., in 18 months). I happily took it.
I figured maybe this was a way of triaging old people like myself: if we're forced to wait long enough before being seen, maybe we'll die in the meantime so slots will open up.
cafard 2 days ago [-]
We decided to look for a new primary care doctor in Washington. I was amazed when I read my wife's email to the effect that our physicals were booked for 11/25. Then I understood that this was next year, not next week.
Dracophoenix 2 days ago [-]
As a medical professional, do you think yearly checkups are useful or necessary for healthy individuals in their 20s and 30s? It seems like you've done well for yourself without the need of one due so long.
freedomben 2 days ago [-]
I'm not a medical professional, but I have a close friend who is. Most of the time, no you don't need yearly checkups. But if you develop something like diabetes, a thyroid condition, or some types of cancer, it might save your life.
If you're going to do it, I would recommend having a bunch of labs done so you can at least know how you're doing. For example might as well test A1C, Vitamin D, Iron, Thyroid, Testosterone and many other hormones and vitamin levels to get a good picture of your nutrition. If you're low/high in many of these things a simple supplementation can radically improve your life, but not if you don't know about it. A friend of mine recently found his Testosterone levels were really low, and after starting TRT he feels way, way better. It improved depression levels and many other things, with a bonus that now when he goes to the gym it's actually possible to get some results.
Worth pointing out is that you can have (most) of these labs done without a doctor. There are websites you can buy kits, and you can sometimes just go in-person to Labcorp offices and they'll run stuff for you.
Anyway, just something to consider.
doubleg72 10 hours ago [-]
My wife is a medical professional and it is in your best interest to get yearly checkups if only for a regular lab report history.
jonhohle 2 days ago [-]
At least in my area, huge medical groups or insurance companies have bought nearly all primary care practices. They’ve cut costs and raised prices and it’s virtually impossible to see an MD for an acute medical condition. All procedures need to be scheduled out months now.
It reminds me of what some Canadian friends described their healthcare system being like 20 years ago. If we’re paying more and getting the same service, I’m not sure there’s much reason not to socialize healthcare now (health care, not insurance).
While getting less service, as a marketplace insurance purchaser my premiums are doubling next year. It’s still “cheap”, but that would be a significant shock for most families.
freedomben 2 days ago [-]
Yep, with our current system we have evolved it into a monstrous and inefficient hybrid that contains most of the downsides of a socialized system with most of the downsides of a free market system. It's utterly insane what we're doing, and there seems to be very little interest in fundamental change.
cg5280 2 days ago [-]
Had the same thing in the Midwest about 8 months ago. Had to call a half dozen offices before one would take me and appointments had to be scheduled long in advance. I had not been to the doctor as an adult either and was quickly surprised by how frustrating healthcare is.
nerdponx 2 days ago [-]
This is new since Covid era. You used to be able to get an appointment for a physical just a few weeks out, and it was easy to find a new doctor if you needed to.
HeyLaughingBoy 2 days ago [-]
It regionally-dependent though. On average, if we need to see a doctor, we can get an appointment in a day or two. For a routine physical, it might be two weeks, three at most.
Projectiboga 2 days ago [-]
This has been developing for a very long time. The two major medical school systems, MDs and DOs have kept supply of medical school graduates below the demand. This has kept the market rate for fees up but has created market inefficiencies. There is an under supply of general practice doctors. And it will be hard to reverse as the internships and residencies are usually in hospitals and large medical centers and there is little room to expand the incoming DR supply.
zzbzq 2 days ago [-]
Same, had to call around a lot to find primary care, and was being given multi-month waitlist estimates for seeing an ENT specialist. I've had more luck recently as I was able to get into see an ENT in less than 30 days. It's also crazy how much everyone tries to upsell you. It' hard to tell what tests or procedures I really need.
parpfish 2 days ago [-]
I laugh to myself whenever I read some disclaimer that says “ask your doctor” because… how? I’m supposed to call the office, wait six to nine months, and then ask about a mild health concern I had that’s long past?
nerdponx 2 days ago [-]
Primary care has the opposite problem right now. Practices are closing faster than new ones are opening, and doctors are leaving the profession faster than new doctors are joining. There is an actual shortage of primary care docs.
otoburb 2 days ago [-]
Given the rise of Physican Assistants and Nurse Practitioners and their expanding scope of (even independent) practice across various states, specifically to address this growing shortage of primary care physicians (PCPs), it almost becomes a self-fulfilling prophecy that fewer potential physicians choose family medicine as that's the first specialty that seems most likely to be addressed by PAs and NPs.
Workaccount2 2 days ago [-]
I had this experience when shopping for a highly rated doctor. Luckily I was able to get in on a great doctor after a few weeks of casually calling around, and now can get appointments no problem.
When I was younger on crap insurance, I was able to quickly find one by having no standards other than "be a medical physician". And the doctor I went to was definitely lower rung.
thatfrenchguy 2 days ago [-]
This is for "new patients" though, once you're in it's generally fine. It's a back-pressure mechanism for them to not sign up too many new people.
soco 2 days ago [-]
At least in Switzerland it's like this: if you call directly the dermatologist (or just any medical specialist), they offer you a slot in 6 months. If you go over your house doctor (whatever the term is in your country) you get it in 1-2 weeks. If you are already known patient to said dermatologist, maybe even earlier. Thus: how about you try your house doctor?
shdh 2 days ago [-]
Guessing you also need a referral to see a specialist in Denmark?
In USA, with PPO insurance, you can see specialists without a referral. Direct specialist appointments without seeing your primary doctor for a referral.
paulddraper 2 days ago [-]
No, it's not a matter of referral.
It's a matter of "current patients have filled the schedule indefinitely."
Cumpiler69 2 days ago [-]
That's pretty crazy considering Denmark is touted as a socialist utopia where the taxes are high but it's worth it because the government supposedly takes care of everything for you. I'd expect them to have figured out the doctors' shortage but this problem seems endemic in every country.
nextos 2 days ago [-]
In EU, there is a severe shortage of MDs. Part of the problem is that the number of students is not sufficient to satisfy MD demand. In some countries, this is a deliberate policy imposed by MD lobbies, who act like a cartel. In other countries, the job is simply not attractive due to relatively low salaries and high workload. So students choose other degrees, or they immigrate after graduation. Furthermore, an aged population and lack of adequate policy planning does not help.
triceratops 2 days ago [-]
Sounds like it's a problem in most of the developed world.
getwiththeprog 1 days ago [-]
It sounds like it, but no evidence has been provided.
paulddraper 2 days ago [-]
A. This is exactly what is to be expected.
If high-skill jobs are compensated (relatively) less, workers are less incentivized to pursue those jobs, or they move to other markets.
B. Capitalist countries like the U.S. are not completely immune to his phenomenon either.
qgin 1 days ago [-]
This is the thing, even in the US with salaries 2/3/4x those in Europe, people in much of the country can get appointments for the better part of a year.
shdh 2 days ago [-]
Are doctors in USA emigrating to other countries? Or do you mean across state lines?
paulddraper 1 days ago [-]
Sorry, I mean that USA has doctor (particularly specialists) shortages as well.
> The average dermatologist gross salary in Belgium is 215.909 € or an equivalent hourly rate of 104 €. In addition, they earn an average bonus of 13.041 €. Salary estimates based on salary survey data collected directly from employers and anonymous employees in Belgium. An entry level dermatologist (1-3 years of experience) earns an average salary of 143.218 €. On the other end, a senior level dermatologist (8+ years of experience) earns an average salary of 286.875 €.
that is... out of the box, a very very nice salary to start your career with. OMG. Top IT jobs in Belgium are at 130k or so (none management)
animal531 1 days ago [-]
I suppose that's why medical tourism has become a thing. For a few euros you could fly out here to South Africa or other places in the world and get any first world grade medical assistance immediately (as long as you can pay, of course).
Isn't this disconnected from the reality of medical school competitiveness that is, at least on paper, supposed to filter students who are not going to use their highly sought after education and resources for largely clerical jobs? What's the point of the American Medical Association restricting new medical schools and artificially constricting the number of medical students when the top of their field is to service patients with elective treatments?
nradov 2 days ago [-]
The AMA has no power to restrict new medical schools or restrict the number of medical students. They aren't an accreditation or licensing agency. Several new medical schools have opened in the past few years.
At one point the AMA did lobby Congress to restrict the number of residency slots but they long since reversed that position and now lobby for an expansion.
Doesn't the AMA administer the MCAT and facilitate the applications for not just medical schools but also residencies for Dermatology? I think excluding that while including that they're not literally the organization that does accreditation and licensing is misleading.
They're one of the largest lobbying groups in America with disastrous consequences. They have a consistent history of empty promises, including their rhetoric on expansion which hasn't been successful despite the years they've had and the political leverage during the national health emergency.
https://www.zippia.com/advice/largest-lobbyist-groups/
I hear about how wealthy and powerful the medical community is yet they shift the blame at every opportunity. I hope medical schools require students have a spine too.
nradov 1 days ago [-]
No, the AMA doesn't administer the MCAT nor does it facilitate the residency match program. Those are administered by the AAMC and NRMP, respectively.
It's always disappointing to see this kind of lazy, low-effort comment on HN. This is all public information that you could easily find if you bother to look.
s1artibartfast 2 days ago [-]
With respect to residency, there is no cap. What they lobbied for is a restriction to the number of subsidized slots.
You would think that Hospitals would be able and willing to pay for residents.
Something doesnt add up.
llamaimperative 2 days ago [-]
> You would think that Hospitals would be able and willing to pay for residents.
Why would you think that? Pay... out of their profit margins... to reduce their profit margins? Or do you mean in la-la-land where American CEOs make investments that are likely to show returns only 10+ years out in the future?
s1artibartfast 2 days ago [-]
I'm saying you think it would make money to pay doctors instead of not having doctors.
Anyways, a huge number of hospitals are non profit and still have the residency issue. There is something systemically fucked going on if a hospital can't turn a profit on a MD with "only” 8 years of postsecondary education, and needs 4-6 years more
llamaimperative 2 days ago [-]
Eh, hospitals are the practice location of last resort after they wipe out independent practices in their local areas. Doctors are totally fungible to a dominant health system. A dime a dozen.
As a hospital, they also have no incentive to treat people earlier in disease progression with less expensive care or anything. Just let the ailments fester until they have to be rescued with the most expensive interventions on the planet.
No one said anything about "not turning a profit." If you think a profit-seeking organization exists only to turn a profit, you misunderstand the enterprise.
s1artibartfast 1 days ago [-]
I think you are being intentionally combative, uncurious, and condescending.
You are not engaging with the question posed, merely listing a number of cynicisms tangential at best, or factually incorrect at worst.
Independent practices generally cant operate licensed residency programs. Similarly, your model of hospital behavior ironically requires them to forgo money could make today to cash in on expensive interventions decades in the future - exactly what you claim they are incapable of doing.
Last, you claim doctors are a dime a dozen, yet hospitals pay 4, 5, or 600k to employ them, and frequently close due to an inability to secure them at reasonable costs.
sharadov 2 days ago [-]
I had a similar experience - The dermatologist that I used to see moved to a new city and I needed to see one urgently for eczema. Primarily, I needed an RX.
For at least two months, no appointments were available with any derm in my network, so I immediately set up a telehealth appointment with one in another state, explained the condition, and got an RX on the same day.
w10-1 1 days ago [-]
Medicine has two time frames: emergency (now) and sometime. It's terrible at "concerning but no strong urgency", i.e., getting in within two weeks.
throwawaysleep 2 days ago [-]
In general, there seems to be a trend towards lifestyle jobs, i.e. jobs that fit a certain lifestyle rather than being passions.
cafard 2 days ago [-]
There is a joke going back at least fifty years, to the effect that dermatology is the ideal job: the patients never recover from their conditions and never die of them.
amluto 2 days ago [-]
> Recently, her hospital’s dermatology program received more than 600 applications for four residency slots.
Perhaps if supply of dermatologists was not so strongly limited, prices and wait times would improve.
readthenotes1 2 days ago [-]
Apparently cosmetic dermatology is not regulated so you can go through residency in some other residency program and set up your shingle selling Botox, at least where I live.
pc86 2 days ago [-]
My wife is a physician and she knows one or two otherwise very intelligent, well-respected, skilled surgeons who just do Botox because it's more lucrative.
bookofjoe 2 days ago [-]
Also: way better hours (no nights/weekends/holidays); less likelihood of malpractice lawsuits along with far lower medical malpractice insurance rates; much less stress; happier patients.
bnlxbnlx 2 days ago [-]
Sounds soul crushing to me :( I so wish people would choose what to do based on what makes sense to them based on care for the whole.
pc86 2 days ago [-]
Did you decide what to do for a living "based on care for the whole?" I suspect like most people it was mentally looking at a Venn diagram intersection of "what am I smart enough to do?", "what do I enjoy doing?", "what pays me the most, or well enough that I can do at least as well as my parents?"
How many people who get into surgery would still do it with all the same education, testing, training, and licensure requirements if it paid $100k/yr? My guess is not many. If you're in a highly litigious state in a high-risk specialty your malpractice insurance alone could be more than that.
It's not surprising to see smart people leave risky positions with pretty objectively bad work-life balance for more money, less stress, and better WLB.
jmcgough 2 days ago [-]
Many people go into medicine wanting to do good, but then after a couple years of working 100 hours a week for a gen surg residency you realize that this isn't sustainable, especially if you want to start a family.
red-iron-pine 2 days ago [-]
seems like that's been the trend -- a lot of those set up around here, it seems. like, I can think of three off the top of my head, and I don't recall seeing em 3+ years ago.
quantumwoke 2 days ago [-]
The problem is not limited supply but rather the ability to train sufficient supply in a reasonable timeframe which necessitates attending pay cuts (because they can't do as much work) and creation of funded structured training programs with good teachers and case mix. Source: my wife is a doctor
scld 2 days ago [-]
Increasing the time and cost of the training is how the supply is limited.
quantumwoke 2 days ago [-]
Can you expand on this? I don't think this is the whole story. Perhaps a concrete example would help.
wyldfire 2 days ago [-]
I doubt that limit is an artificial one. Hospitals don't need 600 dermatologists on staff. I think this is yet another factor of capitalism: selfish interests of individual corporations being in tension with the people's interests of having affordable healthcare. Other developed countries seem to have said "yeah, we recognize that nationalizing healthcare will result in insurance companies and hospitals making less money. But that's what has to happen for the people to be able to get the care they need."
Every time it comes up in the US, nationalized healthcare is demonized in some media. But it just feels like a facade perpetrated by the hospitals and insurance companies (and now private equity) who stand to lose the most. If it's good enough for veterans and retirees, why can't it be good enough for the rest of us? Maybe it's because when the government pays the bill, they don't just roll over and accept $EXORBITANT_FEE after $EXORBITANT_FEE - they negotiate and get some reasonable value.
alistairSH 2 days ago [-]
There is absolutely an artificial cap on the number of residencies (across specialties, not unique to dermatology). The majority of residency slot are funded through Medicare - Congress has effectively placed an artificial cap on the number of spots.
From what I gather, Congress set the current low limit due to lobbying from the AMA something like 30 years ago. The AMA has since changed its tune and wants more slots to alleviate shortages in some regions and specialties, but the funding has not materialized.
maxerickson 2 days ago [-]
A lack of government funds is not a cap!
What would they do if the government didn't fund any slots, just shrug and decide they didn't need doctors?
Note that I'm not opposed to the government funding lots more slots, I am objecting to the presumption that government funding is the only possible way to make a doctor.
nradov 2 days ago [-]
If the government didn't fund any slots then graduate medical education programs would charge the residents themselves instead of paying them a salary. Then physicians would finish their education $1M in debt instead of $500K (or whatever) today. World that be an improvement?
There are a small number of residency slots funded by non-profit foundations but those are a drop in the bucket. None of the other major players in the national healthcare system have an incentive to pay for this stuff.
wl 2 days ago [-]
There are also residency slots not funded by Medicare or any foundation. They pay the same as the funded slots. These slots exist because it's usually profitable to pay a resident physician to deliver care at a fraction of the salary of an attending physician.
jmcgough 2 days ago [-]
Running surgical residents ragged for 80-100 hours per week for several years and only paying them $70k/yr seems extremely lucrative.
triceratops 2 days ago [-]
> Then physicians would finish their education $1M in debt instead of $500K (or whatever) today. World that be an improvement?
Maybe the graduate medical education programs would have to compete on price as well as quality and reputation?
otterley 2 days ago [-]
Out of curiosity, how were new doctors being trained before Medicare existed?
bryanlarsen 2 days ago [-]
AFAICT, way back in the day hospitals and clinics did residencies out of a desire for free/cheap labor, the same reason that some firms provide internships in other fields today. Nowadays the costs and obligations of providing a residency far exceed the benefits of the lower cost labor.
phil21 2 days ago [-]
I really don’t understand how the average resident could be a cost center for a hospital. At least over the course of their 4-6+ years.
There are some hospitals you will go to (big names!) where you will never actually see an attending physician most of the time. Your entire care team are residents.
How a hospital can’t turn a profit off $60k/yr “junior doctors” doing all the actual work is beyond me. I’m sure there are costs I am not considering, but my immediate gut reaction is that it’s nearly all creative accounting to pretend residents cost more than they bring in - to keep that sweet government subsidy coming in as well as limiting the number of slots.
Some programs of course this makes sense, but on the whole it doesn’t seem to pass a smell test to me.
alistairSH 2 days ago [-]
I've always wondered the same.
For the math to work, the fully qualified attending would have to be ~10x more efficient than the residents ($600k salary vs $60k salary - very rough, obv).
The current state seems to be "a single attending is more efficient practicing solo than the same attending overseeing five residents"
nradov 2 days ago [-]
Some of this is an internal accounting problem. The net income (or loss) from operating a residency program depends on how you allocate associated revenues and fixed costs to it. But empirically the fact that teaching hospitals aren't all rushing to expand their residency programs indicates that they probably aren't profitable.
The value of residents varies a lot by experience and specialty. Like a 1st-year neurosurgery resident might be worse than useless and a huge burden to everyone around them. Whereas a 3rd-year family medicine resident can do a lot with minimal supervision.
otterley 2 days ago [-]
Perhaps, then, those who have graduated into practice and who are now earning big bucks ought to absorb part of the cost. For example, training residents at some reasonable frequency could become a requirement of license renewal.
nradov 2 days ago [-]
Not all physicians live and work near a teaching hospital where residents are trained. This isn't something that can be done just anywhere. And not everyone makes a good teacher; forcing people to teach who don't want to do it will guarantee bad results.
jmoak 2 days ago [-]
While residencies have existed since well before Medicare was passed, they were mostly something elites pursued. Overall, residency wasn't an absolutely necessary practice until the mid-late 20th century. By the 70s, with the tailwind of the baby boom, the practice became normalized.
Our demographic makeup means we have more elderly in need of care and fewer to care for them, which means we will need to revert our requirements. The UK is already discussing/planning-for this in their healthcare system: https://www.independent.co.uk/news/health/nurses-doctors-deg...
I understand that it's scary that care quality may be lower, but that argument is similar to demanding that every road worker and civil engineer have a PhD. Our bridges and roads would likely be better if all participants were so educated and qualified, at least for the horrifically expensive and few roads/bridges we would be able to build.
nradov 2 days ago [-]
What will probably happen in most US states is that physician education will continue to require residency. But routine primary care will increasingly shift to Physician Assistants and Nurse Practitioners. Real physicians should be reserved for the more complex cases.
jmoak 2 days ago [-]
I agree with this as a possibility for general doctor visits.
I already mostly see NPs for my checkups. If they aren't sure, then I can jump through the hoops to get a Physician.
It works well and I get plenty of time to discuss things during my appointments.
EDIT: I still think my original point may stand for specialists however, we'll have to see how it shakes out and what healthcare systems under more stress than ours decide to do in the near future.
s1artibartfast 2 days ago [-]
Exactly. If you create a regulatory system so strict that you cant make doctors, you end up with a shortage, and creating a new class of professionals that do what doctors did before.
I think there are parallels to nursing as well, with increasing credentialism and then creation of new classes. 30 years ago nurses entered the workforce with a 2 year associates from a junior college. Heck, my highschool had a nursing occupational program.
indymike 2 days ago [-]
> World that be an improvement?
Unpopular opinion: if the student will be able to pay that loan off in 10-20 years and maintain a good standard of living while doing so, then it is probably fine.
> None of the other major players in the national healthcare system have an incentive to pay for this stuff.
I'm pretty sure the entire system's revenue model breaks without physicians, so there are plenty of businesses (hospitals, labs, practices, etc...) with an incentive to have more billing capacity.
maxerickson 2 days ago [-]
Presumably the government could at least try to change the incentives that they are already heavily involved in shaping.
alistairSH 2 days ago [-]
You're correct - a hospital could indeed find alternate funding for residency slots. Medicare funds something like 70% of them today, the rest are funded by state/local government or non-profits.
But, the fact that hospitals don't fund their own seems to prove the underlying assumption - that offering a residency is a net loss to the hospital. If that weren't true, they'd fund the slots on their own.
triceratops 2 days ago [-]
The status quo might be more profitable for hospitals though.
The lack of doctors allows hospitals to charge more money for access to the ones they have. And right now the government foots the bill for training new doctors.
If they funded new residency slots they'd simultaneously increase their expenses, and reduce long-term revenues. Even if the resident's work is profitable by itself - in the sense of generating more in billings than the costs in salary, benefits, and teaching time - it could be bad for the hospital in a decade or two.
If the government simply ended the practice of funding residencies then hospitals and the rest of the medical establishment would be forced to come up with a new approach. Until then they're content to ride the gravy train.
maxerickson 2 days ago [-]
Perhaps we could consider making it less burdensome?
It's bizarre that these discussions seem to start from the assumption that we got here intentionally by only making good decisions.
s1artibartfast 2 days ago [-]
The people have "decided" that they prefer extremely high quality and cost doctors to a high supply of doctors.
Regulation, left unchecked, favors constant indirect damage from shortage to more visible direct harms.
This is why it takes 3000 hours of training to cut someone's hair.
eppp 2 days ago [-]
They dont need 600 dermatologists on staff. They need residency slots. These people aren't asking to work for the hospital permanently, they just have to check the residency box that is artificially limited by gatekeepers.
ninetyninenine 2 days ago [-]
It is a bit of a logistical issue shoving 600 dermatology interns into a hospital.
Make it a law that all doctor offices need one or two residency slots. That should alleviate the problem in time due to compounding growth.
alistairSH 2 days ago [-]
Residencies are funded via Medicare. If you want more doctors, you need to convince Congress to fund those spots. Or, convince the industry to fund the slots itself, without the reliance on Uncle Sam's largess.
woooooo 2 days ago [-]
On Medicare's time horizon, losing money funding those residencies for 10-20 years actually could be a great deal if it bends the cost curve.
nradov 2 days ago [-]
You've got to be kidding. There's no way that a regular doctor's office could provide adequate graduate medical education. Residents are taught in teaching hospitals.
ninetyninenine 2 days ago [-]
I have no context. I’m just a layman.
Maybe force every doctor office by law to be a teaching hospital of some sort. They get paid 500K, seems to be a good form of taxation on an undeserved salary.
ninetyninenine 2 days ago [-]
Or maybe form a mentorship program. Every intern once they complete their training must train two other doctors to completion before they can genuinely practice. They must do this at the teaching hospital.
That hospital will then have enough support staff to maintain a large load of interns as the compounding growth continues. Of course the growth has to level off at some point. But yeah.
nradov 2 days ago [-]
You've got to be kidding. Physician offices don't have the facilities or the breadth of practice to function effectively as teaching hospitals. Even most hospitals aren't teaching hospitals.
And as for conscripting physicians and forcing them to train residents, that's a completely bizarre and unrealistic suggestion. Forcing someone to teach and mentor who doesn't want to do it will guarantee bad results. And many practicing physicians don't live anywhere near a teaching hospital.
Who are you to decide how much salary someone deserves? I think you deserve $4 an hour. That seems fair to me. In the real world fairness to subjective. What actually matters is negotiating power. The most straightforward way to reduce physician negotiating power is for Congress to increase graduate medical education funding through Medicare. Income in the $500K range is already in the 35% tax bracket (plus any state income tax) so doctors are paying quite a bit; Congress just chooses to spend that money on other priorities.
It’s already unrealistic to get paid 500k. You want to become a doctor and earn that much? You need to actually take part of that 500k and turn your fucking office into a teaching facility.
I think it’s fucking disgusting the amount doctors get paid. It’s revolting and evil the way health is held hostage for money.
I don’t care if it’s a 35 percent tax bracket I have very little respect or appreciation for doctors who want to coast and get paid 500k while I have to pay 1000 just to get some uvb shined on my fucking skin. Like seriously some of these treatments are outta this world expensive and doctors charge an arm and leg just to have a goddamn intern shine a light on my skin.
Who am I to decide how much someone deserves? How about when all your patients are disgusted by you and your fucking money making tendencies then come talk to me about being entitled. The only reason why I’m not shining that light on myself is because the law forms a cartel and allows you to literally steal money from me. The AMA lobbies congress to limit the amount of residency spots. It’s a cartel. Don’t blame the government. Blame the business interests that limit the government.
People used to respect doctors. Now the majority of people I know fucking hate them. Your comment really pissed me off. I don’t think you’re aware at how much people in the US hate doctors. It’s like their life is in your hands so they don’t tell you first hand what they hate about you.
How about you cut your pay to 100k and increase the supply of doctors 10x so you have an easier time and can be more affective? Do you actually think what you do is so professional that only you can do it? The whole md degree is a gate keeping tool.
infecto 2 days ago [-]
Presumably a derm. resident is doing rounds related to dermatology. I am guessing this is similar to other specialized fields that don't have large volume in resident setting.
Cumpiler69 2 days ago [-]
>Other developed countries seem to have said
The other developed countries doing this don't pay dermatologists 500k though.
Shatnerz 2 days ago [-]
Perhaps this is because supply isn't being artificially restricted?
Cumpiler69 2 days ago [-]
Doctors' profession have artificial barriers to entry and keep the supply limited, in many other countries, but even with those, they won't dream to earn anywhere near 500k.
quantumwoke 2 days ago [-]
This is not true, and you should look at private practice in Canada, Australia, and to a lesser extent U.K.
Cumpiler69 2 days ago [-]
It's 100% true where I'm from in Europe. The government opens up only a fixed number of residencies positions every year regardless of how many more students graduate (cartel behavior from the national Doctors' association).
My cousin graduated med-school last year and is still unemployed because no hospital had a place for her. Private practices don't fix that issue since they're not designed to be part of the medical teaching cycle. So a lot of young doctors have to emigrate to other EU countries where they can find spots to practice.
quantumwoke 2 days ago [-]
This is orthogonal to your GP point which was about salary. There are a lot of issues with the teaching pipeline AFAIUI so it is difficult to comment on n=1 examples.
quantumwoke 2 days ago [-]
Some of them do e.g. Australia
Cumpiler69 2 days ago [-]
Care to exemplify?
2 days ago [-]
infecto 2 days ago [-]
I am not sure how you connect the first part of your idea to the last.
Would this not also be a problem in single payer systems? The article does not do a great job of it but it would be interesting to see the billings split between cosmetic and medical. The article is already on how the field is booming because of cosmetics, one of the interviewed doctors does not even accept insurance. This has nothing to do with capitalism vs socialized healthcare and all to do with cosmetic procedures which would mostly not be covered under a single payer style system anyway.
paulddraper 2 days ago [-]
> Hospitals don't need 600 dermatologists on staff.
But imagine how available and inexpensive dermatologists would be.
(Okay, let's not say 600, but let's say 2x or 4x the current #)
iluvcommunism 2 days ago [-]
I did microneedling a couple times. If anything my scars are worse. I’d rather just get laser skin treatment in Thailand and save money. Or do the lower % acidic peels myself.
ProllyInfamous 24 hours ago [-]
Decades ago, I interviewed at five US medical schools. For each, two separate physician interviews contributed to my "candidate score." Ultimately I was accepted to my 2nd choice school, which I left after the first year.
One of those ten interviewers was a dermatologist: arrived late; bitchy attitude; chip-on-her-shoulder; challenged an easily-verifiable fact about my candidacy (she even rolled her eyes when I tried to change the subject!)... tl;dr: her undeserved apathy turned me off from her program, entirely.
The first few years after leaving medical school I felt bad about having "wasted a spot." After years of reflection (and an alternate career), I am now able to better-empathize with physicians — mainly for all the sacrifices they have made just for (most) patients to ignore their professional advice.
You cannot pay a US physician enough money to counteract all they've given up (life/balance/youth).
lupire 2 days ago [-]
Seinfeld did an episode about this issue in the 1990s. ("Skin cancer, eesh"
Cumpiler69 2 days ago [-]
[flagged]
Rendered at 14:34:19 GMT+0000 (Coordinated Universal Time) with Vercel.
As a layperson, it seems like we (patients / society) would benefit from having more doctors, i.e. opening up more residency slots and admitting more people to med school, but there's probably a lot I don't understand about the issue. Not sure if it's a lack of political willpower to do this, or if there are other reasons why the number of doctors we train is so restricted.
[1] https://pubmed.ncbi.nlm.nih.gov/29710082/ ("PAs performed more skin biopsies per case of skin cancer diagnosed and diagnosed fewer melanomas in situ, suggesting that the diagnostic accuracy of PAs may be lower than that of dermatologists")
Here in Sweden have almost 2x as many physicians you do, and we pay them about half of what you do, so we end up paying approximately the same in salaries (the average Swedish physician is paid 131k) and I think it works out completely.
We start our training of physicians right after high school, so we push them to get an MSc in Medicine, rather than treating physicians as some kind of pseudo-PhDs, with however requiring head physicians to have an actual PhD; and this system is fine. I think it's the same way in Denmark, and given the stuff they've come up with I imagine one can't complain much about their system.
In Scandinavia, student loans are taken to cover living expenses, not the cost of tuition. Private schools exist, but are not nearly as common as in the U.S.
Biopsy stats might differ because PA's are used in large (cough private equity) practices to do a lot of checks esp. in old-folks homes, and medicare pays. Patients per week can average 120+; no doctor does that. Plus, the PA is supposed to err on the side of caution, meaning more biopsies. DR's are more willing to ignore possible risks.
That said, most anyone (Dr. or PA) who is recently trained at a good school is often better than people with 15+ years of experience.
Also, derm exam skills are not enhanced by the depth of medical education or even much by experience (by contrast to the cardio exam). It's mostly a function of pattern recognition and patient skills.
When I actually got my appointment within 30 days, due to calling and advocating for myself politely, I started wondering how much ground medical dermatology has ceded to elective and cosmetic dermatology. I am concerned that dermatology is becoming centered around the personal appearance of affluent people rather than medical need.
Try requesting appointments during December or January. A little birdie told me that appointment cancellations go through the roof at some practices during those months.
Like so many of America’s issues, it’s due to lobbying based on entrenched greed.
> In 1997, the AMA lobbied Congress to restrict the number of doctors that could be trained in the United States, claiming that, "The United States is on the verge of a serious oversupply of physicians."
https://en.m.wikipedia.org/wiki/Flexner_Report
In some places, it is possible to go from high school to ARNP within 6 years.
And while supervision requirements for PAs might vary in terms of actual oversight, ARNPs are ostensibly fully fledged independent providers.
And I'll also say that you see the same pre-hospital too. In the PNW, while there are valid criticisms that can be leveled against two of the pre-eminent paramedic programs (Harborview, and Tacoma Community), there are far, far, too many "strip mall schools" in other states that will take you from "zero to hero" in 4 or 5 months (of 6 days a week, 8 hours a day, of just class time), and dump you out on the world with just enough retained knowledge to pass your NREMT and the barest amount of ride time to meet DOT mandated minimums. It's scary, to be blunt. These people go out with no clinical experience and are now expected not just to work as a team on a 911 call, but to lead it.
I hadn't needed to go to a primary care doctor in my adult life, but it was mind blowing that this was the case. Many friends of mine have had the same experience.
Full disclosure: I am a retired board-certified anesthesiologist.
I asked around town (Charlottesville, Virginia) and got two names from doctors I trust.
The first was not taking new patients; the second was, so I made an appointment: first available appointment was January 2025 (i.e., in 18 months). I happily took it.
I figured maybe this was a way of triaging old people like myself: if we're forced to wait long enough before being seen, maybe we'll die in the meantime so slots will open up.
If you're going to do it, I would recommend having a bunch of labs done so you can at least know how you're doing. For example might as well test A1C, Vitamin D, Iron, Thyroid, Testosterone and many other hormones and vitamin levels to get a good picture of your nutrition. If you're low/high in many of these things a simple supplementation can radically improve your life, but not if you don't know about it. A friend of mine recently found his Testosterone levels were really low, and after starting TRT he feels way, way better. It improved depression levels and many other things, with a bonus that now when he goes to the gym it's actually possible to get some results.
Worth pointing out is that you can have (most) of these labs done without a doctor. There are websites you can buy kits, and you can sometimes just go in-person to Labcorp offices and they'll run stuff for you.
Anyway, just something to consider.
It reminds me of what some Canadian friends described their healthcare system being like 20 years ago. If we’re paying more and getting the same service, I’m not sure there’s much reason not to socialize healthcare now (health care, not insurance).
While getting less service, as a marketplace insurance purchaser my premiums are doubling next year. It’s still “cheap”, but that would be a significant shock for most families.
When I was younger on crap insurance, I was able to quickly find one by having no standards other than "be a medical physician". And the doctor I went to was definitely lower rung.
In USA, with PPO insurance, you can see specialists without a referral. Direct specialist appointments without seeing your primary doctor for a referral.
It's a matter of "current patients have filled the schedule indefinitely."
If high-skill jobs are compensated (relatively) less, workers are less incentivized to pursue those jobs, or they move to other markets.
B. Capitalist countries like the U.S. are not completely immune to his phenomenon either.
https://www.salaryexpert.com/salary/job/dermatologist/belgiu...
> The average dermatologist gross salary in Belgium is 215.909 € or an equivalent hourly rate of 104 €. In addition, they earn an average bonus of 13.041 €. Salary estimates based on salary survey data collected directly from employers and anonymous employees in Belgium. An entry level dermatologist (1-3 years of experience) earns an average salary of 143.218 €. On the other end, a senior level dermatologist (8+ years of experience) earns an average salary of 286.875 €.
that is... out of the box, a very very nice salary to start your career with. OMG. Top IT jobs in Belgium are at 130k or so (none management)
https://lcme.org/directory/accredited-u-s-programs/
At one point the AMA did lobby Congress to restrict the number of residency slots but they long since reversed that position and now lobby for an expansion.
https://savegme.org/
They're one of the largest lobbying groups in America with disastrous consequences. They have a consistent history of empty promises, including their rhetoric on expansion which hasn't been successful despite the years they've had and the political leverage during the national health emergency. https://www.zippia.com/advice/largest-lobbyist-groups/
Here's a differing opinion from yours where "The American Medical Association (AMA) bears substantial responsibility for the policies that led to physician shortages". https://blog.petrieflom.law.harvard.edu/2022/03/15/ama-scope...
I hear about how wealthy and powerful the medical community is yet they shift the blame at every opportunity. I hope medical schools require students have a spine too.
It's always disappointing to see this kind of lazy, low-effort comment on HN. This is all public information that you could easily find if you bother to look.
You would think that Hospitals would be able and willing to pay for residents.
Something doesnt add up.
Why would you think that? Pay... out of their profit margins... to reduce their profit margins? Or do you mean in la-la-land where American CEOs make investments that are likely to show returns only 10+ years out in the future?
Anyways, a huge number of hospitals are non profit and still have the residency issue. There is something systemically fucked going on if a hospital can't turn a profit on a MD with "only” 8 years of postsecondary education, and needs 4-6 years more
As a hospital, they also have no incentive to treat people earlier in disease progression with less expensive care or anything. Just let the ailments fester until they have to be rescued with the most expensive interventions on the planet.
No one said anything about "not turning a profit." If you think a profit-seeking organization exists only to turn a profit, you misunderstand the enterprise.
You are not engaging with the question posed, merely listing a number of cynicisms tangential at best, or factually incorrect at worst.
Independent practices generally cant operate licensed residency programs. Similarly, your model of hospital behavior ironically requires them to forgo money could make today to cash in on expensive interventions decades in the future - exactly what you claim they are incapable of doing.
Last, you claim doctors are a dime a dozen, yet hospitals pay 4, 5, or 600k to employ them, and frequently close due to an inability to secure them at reasonable costs.
For at least two months, no appointments were available with any derm in my network, so I immediately set up a telehealth appointment with one in another state, explained the condition, and got an RX on the same day.
Perhaps if supply of dermatologists was not so strongly limited, prices and wait times would improve.
How many people who get into surgery would still do it with all the same education, testing, training, and licensure requirements if it paid $100k/yr? My guess is not many. If you're in a highly litigious state in a high-risk specialty your malpractice insurance alone could be more than that.
It's not surprising to see smart people leave risky positions with pretty objectively bad work-life balance for more money, less stress, and better WLB.
Every time it comes up in the US, nationalized healthcare is demonized in some media. But it just feels like a facade perpetrated by the hospitals and insurance companies (and now private equity) who stand to lose the most. If it's good enough for veterans and retirees, why can't it be good enough for the rest of us? Maybe it's because when the government pays the bill, they don't just roll over and accept $EXORBITANT_FEE after $EXORBITANT_FEE - they negotiate and get some reasonable value.
From what I gather, Congress set the current low limit due to lobbying from the AMA something like 30 years ago. The AMA has since changed its tune and wants more slots to alleviate shortages in some regions and specialties, but the funding has not materialized.
What would they do if the government didn't fund any slots, just shrug and decide they didn't need doctors?
Note that I'm not opposed to the government funding lots more slots, I am objecting to the presumption that government funding is the only possible way to make a doctor.
There are a small number of residency slots funded by non-profit foundations but those are a drop in the bucket. None of the other major players in the national healthcare system have an incentive to pay for this stuff.
Maybe the graduate medical education programs would have to compete on price as well as quality and reputation?
There are some hospitals you will go to (big names!) where you will never actually see an attending physician most of the time. Your entire care team are residents.
How a hospital can’t turn a profit off $60k/yr “junior doctors” doing all the actual work is beyond me. I’m sure there are costs I am not considering, but my immediate gut reaction is that it’s nearly all creative accounting to pretend residents cost more than they bring in - to keep that sweet government subsidy coming in as well as limiting the number of slots.
Some programs of course this makes sense, but on the whole it doesn’t seem to pass a smell test to me.
For the math to work, the fully qualified attending would have to be ~10x more efficient than the residents ($600k salary vs $60k salary - very rough, obv).
The current state seems to be "a single attending is more efficient practicing solo than the same attending overseeing five residents"
The value of residents varies a lot by experience and specialty. Like a 1st-year neurosurgery resident might be worse than useless and a huge burden to everyone around them. Whereas a 3rd-year family medicine resident can do a lot with minimal supervision.
https://en.wikipedia.org/wiki/Residency_(medicine)#:~:text=B...
Our demographic makeup means we have more elderly in need of care and fewer to care for them, which means we will need to revert our requirements. The UK is already discussing/planning-for this in their healthcare system: https://www.independent.co.uk/news/health/nurses-doctors-deg...
I understand that it's scary that care quality may be lower, but that argument is similar to demanding that every road worker and civil engineer have a PhD. Our bridges and roads would likely be better if all participants were so educated and qualified, at least for the horrifically expensive and few roads/bridges we would be able to build.
I already mostly see NPs for my checkups. If they aren't sure, then I can jump through the hoops to get a Physician.
It works well and I get plenty of time to discuss things during my appointments.
EDIT: I still think my original point may stand for specialists however, we'll have to see how it shakes out and what healthcare systems under more stress than ours decide to do in the near future.
I think there are parallels to nursing as well, with increasing credentialism and then creation of new classes. 30 years ago nurses entered the workforce with a 2 year associates from a junior college. Heck, my highschool had a nursing occupational program.
Unpopular opinion: if the student will be able to pay that loan off in 10-20 years and maintain a good standard of living while doing so, then it is probably fine.
> None of the other major players in the national healthcare system have an incentive to pay for this stuff.
I'm pretty sure the entire system's revenue model breaks without physicians, so there are plenty of businesses (hospitals, labs, practices, etc...) with an incentive to have more billing capacity.
But, the fact that hospitals don't fund their own seems to prove the underlying assumption - that offering a residency is a net loss to the hospital. If that weren't true, they'd fund the slots on their own.
The lack of doctors allows hospitals to charge more money for access to the ones they have. And right now the government foots the bill for training new doctors.
If they funded new residency slots they'd simultaneously increase their expenses, and reduce long-term revenues. Even if the resident's work is profitable by itself - in the sense of generating more in billings than the costs in salary, benefits, and teaching time - it could be bad for the hospital in a decade or two.
If the government simply ended the practice of funding residencies then hospitals and the rest of the medical establishment would be forced to come up with a new approach. Until then they're content to ride the gravy train.
It's bizarre that these discussions seem to start from the assumption that we got here intentionally by only making good decisions.
Regulation, left unchecked, favors constant indirect damage from shortage to more visible direct harms.
This is why it takes 3000 hours of training to cut someone's hair.
Make it a law that all doctor offices need one or two residency slots. That should alleviate the problem in time due to compounding growth.
Maybe force every doctor office by law to be a teaching hospital of some sort. They get paid 500K, seems to be a good form of taxation on an undeserved salary.
That hospital will then have enough support staff to maintain a large load of interns as the compounding growth continues. Of course the growth has to level off at some point. But yeah.
And as for conscripting physicians and forcing them to train residents, that's a completely bizarre and unrealistic suggestion. Forcing someone to teach and mentor who doesn't want to do it will guarantee bad results. And many practicing physicians don't live anywhere near a teaching hospital.
Who are you to decide how much salary someone deserves? I think you deserve $4 an hour. That seems fair to me. In the real world fairness to subjective. What actually matters is negotiating power. The most straightforward way to reduce physician negotiating power is for Congress to increase graduate medical education funding through Medicare. Income in the $500K range is already in the 35% tax bracket (plus any state income tax) so doctors are paying quite a bit; Congress just chooses to spend that money on other priorities.
https://savegme.org/
I think it’s fucking disgusting the amount doctors get paid. It’s revolting and evil the way health is held hostage for money.
I don’t care if it’s a 35 percent tax bracket I have very little respect or appreciation for doctors who want to coast and get paid 500k while I have to pay 1000 just to get some uvb shined on my fucking skin. Like seriously some of these treatments are outta this world expensive and doctors charge an arm and leg just to have a goddamn intern shine a light on my skin.
Who am I to decide how much someone deserves? How about when all your patients are disgusted by you and your fucking money making tendencies then come talk to me about being entitled. The only reason why I’m not shining that light on myself is because the law forms a cartel and allows you to literally steal money from me. The AMA lobbies congress to limit the amount of residency spots. It’s a cartel. Don’t blame the government. Blame the business interests that limit the government.
People used to respect doctors. Now the majority of people I know fucking hate them. Your comment really pissed me off. I don’t think you’re aware at how much people in the US hate doctors. It’s like their life is in your hands so they don’t tell you first hand what they hate about you.
How about you cut your pay to 100k and increase the supply of doctors 10x so you have an easier time and can be more affective? Do you actually think what you do is so professional that only you can do it? The whole md degree is a gate keeping tool.
The other developed countries doing this don't pay dermatologists 500k though.
My cousin graduated med-school last year and is still unemployed because no hospital had a place for her. Private practices don't fix that issue since they're not designed to be part of the medical teaching cycle. So a lot of young doctors have to emigrate to other EU countries where they can find spots to practice.
Would this not also be a problem in single payer systems? The article does not do a great job of it but it would be interesting to see the billings split between cosmetic and medical. The article is already on how the field is booming because of cosmetics, one of the interviewed doctors does not even accept insurance. This has nothing to do with capitalism vs socialized healthcare and all to do with cosmetic procedures which would mostly not be covered under a single payer style system anyway.
But imagine how available and inexpensive dermatologists would be.
(Okay, let's not say 600, but let's say 2x or 4x the current #)
One of those ten interviewers was a dermatologist: arrived late; bitchy attitude; chip-on-her-shoulder; challenged an easily-verifiable fact about my candidacy (she even rolled her eyes when I tried to change the subject!)... tl;dr: her undeserved apathy turned me off from her program, entirely.
The first few years after leaving medical school I felt bad about having "wasted a spot." After years of reflection (and an alternate career), I am now able to better-empathize with physicians — mainly for all the sacrifices they have made just for (most) patients to ignore their professional advice.
You cannot pay a US physician enough money to counteract all they've given up (life/balance/youth).