When you have nothing new to add, repeat what you’ve already said. Fair enough.
How can you shop for the best price at a hospital? The rates are negotiated with insurance companies and they are not available to the insured.
The reason we don’t have enough doctors in the US is because of population growth and US medical schools not increasing the numbers admitted to medical school.
Every seat in every medical school is full. There is no shortage of students wanting to go to med school. It has absolutely nothing to do with failures of Stem curriculum in the US.
“Med School Acceptance Rates
In 2016–2017, 22,031 applicants were accepted to allopathic (MD) medical schools out of the 53,042 who applied, for an overall acceptance rate of 41%. You can find acceptance rates for particular schools you are considering in our medical school profiles.”
There is no shortage of applicants. There is a shortage of seats in medical schools.
And then the left demonize them and blame them for the high cost of healthcare and want to cut their pay.
The economist who wrote the Op-Ed piece below agrees with you, (mostly).
He state that
- Americans pay too much for doctors,
And doesn’t say it’s related to our poor schools (my guess) nor because a medical education is hard, expensive and time consuming, (@SottoVoce).
He compares doctors’ professional organizations to a cartel
when economists like me look at medicine in America – whether we lean left or right politically – we see something that looks an awful lot like a cartel. . . .
. . . In recent years, the number of medical residents has become so restricted that even the American Medical Association is pushing to have the number of slots increased. The major obstacle at this point is funding. It costs a teaching hospital roughly $150,000 a year for a residency slot. Most of the money comes from Medicare, with a lesser amount from Medicaid and other government sources. The number of slots supported by Medicare has been frozen for two decades after Congress lowered it in 1997 at the request of the American Medical Association and other doctors’ organizations. . . .
The article also states
U.S. doctors receive higher pay, and like anyone in a position to exploit a cartel, they also get patients to buy services (i.e., from specialists) that they don’t really need . . .
. . . The other reason that our physicians earn so much more is that roughly two-thirds are specialists. This contrasts with the situation in other countries, where roughly two-thirds of doctors are general practitioners. This means we are paying specialists’ wages for many tasks that elsewhere are performed by general practitioners. Since there is little evidence of systematically better outcomes in the United States, the increased use of specialists does not appear to be driven by medical necessity. . .
https://www.politico.com/agenda/story/2017/10/25/doctors-salaries-pay-disparities-000557
The OECD also hints at supply and demand causes for the price that doctors and hospitals charge.
In the US supply is limited by a lack doctors and lack of hospital beds. Demand for healthcare is increased, in part because we are an obese nation.
(In the US), the number of doctors per person are relatively low (2.6 per 1 000 people compared to an OECD average of 3.4), as are numbers of hospital beds (2.8 versus 4.7 beds per 1 000).
and
The United States has the highest prevalence of obesity in the OECD (38% of adults, compared with an OECD
average of 19.4%), and second highest overall share of population overweight or obese (70%).
Higher utilization. Aging population. Increasing medical complexity. More chronic disease at younger ages. Longer lifespans with chronic disease. More commonly used expensive advanced drugs. Higher reliance on specialists.
Take your pick.
The more hospital beds available, the more likely they are to be filled. That drives up cost.
So the US has only 2.6 doctors per 1,000 ppl, vs 3.4 per 1,000 OECD average (76%).
The US has only 59% as many hospital beds as the OECD average.
AND
The US has twice the OECD occurrence of obesity.
Less supply and more demand. Means higher prices for doctors and hospitals. When you combine our higher Dr. salaries and our comparative overuse of specialists we pay our doctors twice what our OECD countetparts do.
an unavoidable part of the high cost of U.S. health care is how much we pay doctors — twice as much on average as physicians in other wealthy countries. Because our doctors are paid, on average, more than $250,000 a year (even after malpractice insurance and other expenses), and more than 900,000 doctors in the country, that means we pay an extra $100 billion a year in doctor salaries. That works out to more than $700 per U.S. household per year.
Emphasis mine.
Cartel? Give me a break.
Ok, fine. Let’s say that tomorrow we drop the salary of a US physician to the median world salary that you gave in a chart earlier. $80,000. Now doctors all make $80,000. We haven’t changed anything else.
So now you finish training, at age 30, and are $200,000 in debt. If you wanted to pay that off in 10 years, assuming no interest, you’d pay a quarter of your salary (pre-tax) to student loans. Now you’re making $60K pre-tax. Let’s say you decide to spread it out and pay it over 20 years. Now you’re making $70K.
You’re telling me that smart, qualified people (that you want taking care of you and your loved ones) will continue to want to be doctors when it requires 11-15 years of education after high school, leaves you hundreds of thousands of dollars in debt, is a high stress field, and now makes as much or less than many other professions that don’t have all the disadvantages?
I’m sure that’s true to some extent. My family and I have a handful of anecdotes in which overnight stays were decio by such factors as insurance coverage vs. “do we need the bed.”
The hospital staff, professional as they were, made no attempts to deceive us into thinking “patient need” was the primary factor in decision making.
If your “it’s too haaaaard” or “it’s too expensive” whine were the reason for our relative shortage of doctors then med schools wouldn’t be turning candidates away and foreigners wouldn’t be coming here.
So, why do you think our system is so over inflated?
Well one person suggests ir’d because our doctors work haaaaasard and any other system (like Canadas) means I want a dummy for my family doctor.
The rest of us are not hyperventilating and have seen that we have (only) 75% as many doctors, because of a lack of residency slots (supply) and because our obese population places greater denand on our limited pool of doctors.
You’re looking at two separate issues.
People should want to go into medicine because they want to help people and they love it. The job is stressful and takes a lot of time and money to get there, however. Even if you absolutely love what you do, and I don’t care what it is, if there is no economic or lifestyle advantage to doing it, you’re going to do something else. If there is no benefit to becoming a doctor, or worse, it becomes unattractive, people will do something else.
Right now, there is still a “payoff” in becoming a doctor. It isn’t what it was 20 or 30 years ago, but it’s still there. That’s why people still go into medicine and that’s why it’s still competitive. Whether or not we should train more doctors is a different issue than keeping the incentives to become a doctor in the first place.
Well, throughout the OECD doctors are paid less and yet Canada, the UK, Germany etc. still seem to have good doctors.
It’s true that that the public can negotiate a lower rate.
However, Not all insurance companies have the same reimbursment rates or reimburment methodology with each probider. Rates vary considerably depending on the negotiating power of the insurance company.
It’s the same with nursing. The program will only take so ma applicants a year no matter how many people are actually trying to go through the program. You may have 150 people trying to get a nursing degree but the nursing program will only accept 55 a year.
How the heck does that help with any shortage they may have?
I moved a few years ago.
Prior to that I had a neighbor who is from Nigeria. He is a nurse here in the US. Same deal his wife. He insists there is a shortage of nurses in the US and thst hiring foreign nurses is the only way to fix it.
See:
About 8 percent of U.S. registered nurses (RNs), numbering around 219,000, are estimated to be foreign educated. Eighty percent are from lower-income countries. The Philippines is the major source country, accounting for more than 30 percent of U.S. foreign-educated nurses. Nurse immigration to the United States has tripled since 1994, to close to 15,000 entrants annually.
Well, let’s look at Canada.
First, the salaries you gave for Canadian doctors are either wrong or woefully outdated. I don’t know the source, but it claims $161K for specialists and $101K for GPs.
Here’s data from the Canadian Institute for Health Information, 2016 report.
The “average” Canadian doctor made C$339K or $261K. You can see all the different specialties on page 20. People are stuck on pre-2004 Canadian doctor salaries, I guess to make a point.
Second, although Canadian medical school debt is significant, they have access to loans as low as 2.7%, whereas US loans range from 5.84 to 7%.
Next, Canadian doctors provide a single care level and don’t have the administrative overhead that US physicians have. There is no ICD/CPT system no pre-authorization.
Lastly, Canadian doctors are overall happier than their American counterparts. In 2009, 75% of Canadian doctors were satisfied or very satisfied with their job, compared to 64% of American doctors (2009 Commonweath Fund Survey).
So, to answer your question, at least when it comes to Canada - as of today they are paid at the same rates, and at times more, than their American counterparts, with better student loan options, less administrative overhead, and overall greater job satisfaction. Canadian doctors are doing just fine.
