Healthcare cost and few doctors?

25 comments

1. Those 2 things are not related…

   Healthcare cost- we see the itemized bill, not what’s actually covered

   Doctors- med school takes a dickload of time and commitment

2. Medical school is expensive and high pressure, places with shortages of doctors tend to be more rural, and a large number of people in medical schools go into specialties instead of becoming general practitioners because there’s more money in it.

3. It depends on where you are. Unfortunately rural communities are very underserved; for example many rural counties don’t have a hospital where someone can deliver a baby. Cities and other high population areas do not typically have this issue.

4. Becoming a doctor is quite difficult, time consuming and expensive. It’s also competitive given the limited residency spots. Few want to go through all that without getting a significant return on their investment.

   The areas with sharp shortages are almost always low-income and very often rural where it’s a long trip to a centralized location for a large facility like a hospital.

   Aside from earning potential, people don’t like to uproot their lives and the residency spots are mostly where the hospitals and practice hubs are. In other words, big cities that can support them and usually relatively affluent areas thereof.

   Nursing is also seeing a lot of shortages and…frankly for the effort required to get the qualification there are often much lower stress, more stable and often better paying careers to pursue.

5. Its also not unique to the US, many countries are facing shortages of physicians, including Canada, the UK, Australia and Germany. So its probably more complicated.

6. Becoming a doctor in the US takes 4 years of undergrad followed by 4 years of med school that costs an average of $250K. Then you have to complete 3-7 years of residency training where you work around the clock and get paid like $60K.

   So, 11-15 years of your life and hundreds of thousands in debt on average before you actually get to launch your career and make a full doctor salary.

   Plus, there’s a shortage of residency programs right now. Many med school graduates have to try multiple times to get a placement right now.

7. I had no problem finding a primary care doc recently. Depends where you are. Edit: to be clear, found without any wait time too.

8. Primary care doctors don’t make as much as other specialties

9. I don’t think this is the whole problem, but I work at a medical school and the logistics of medical education sort of create a bottleneck. We need more doctors than we have and we have more people who want to be doctors and would probably make good ones than we have spots in schools. But medical training is super resource intensive. Students have to take tons of standardized tests which you need to pay for and need staff and space to proctor. You have to have all sorts of expensive supplies and trainings which again take staff and space. And then you need medical professionals willing to train your students, usually for free. Which again requires a ton of staff resources, relationships with hospitals and so many legal, medical and admin resources to get those agreements into place and to get students into training. And that’s all before even talking about residency. It’s truly mind boggling looking at how many salaries have to be paid, how many supplies have to be bought, how much upkeep has to happen and how lucky you have to get to find enough doctors who actually have the space, time and skills to train the next generation.

10. I’ve never experienced a doctor shortage. I can usually get in to see a doctor within a day or two

11. We haven’t been importing as many as we used to.

12. Partially because besides just pay (which is low for primary care to begin with), fewer and fewer people want to live in the rural areas. Even with increased pay, many people don’t want to, because they are rural, lack a lot of resources, and lack a lot of things to do (theaters, theatres, festivals, food options, bars, etc etc)

13. I recently learned there was some sort of rule in place that prohibited new medical schools from getting accreditation and also from allowing current schools from expanding class sizes. I cannot remember if it was an actual law/rule in place or just a handshake sort of deal. If I remember correctly, it was also just for MD type education. Schools got around this by offering DO degrees. And as far as I know, this rule is no longer in place as there have been new schools opened in the 2000s.

    [Here](https://journals.lww.com/academicmedicine/Fulltext/2020/03000/The_Development_of_New_MD_Granting_Medical_Schools.16.aspx) is a paper that discusses some of it (I only read the first few lines of the abstract).

14. the healthcare industry in the US is overregulated basically

    being a bona fide doctor and not some assistant or non-rn nurse is impossible

15. Cuz insurance.

    Doctors need to spend outrageous amounts of money to be insured against malpractice lawsuits and insurance companies pay Pennies for services( lab work, x rays, diagnostic tools, etc).

16. The shortage of doctors overall is deliberate – the AMA limits the number of doctors in order to keep profits up.

    The shortage of doctors in many places is likely due to those places being undesirable to live or practice medicine.

17. Many of the shortages are in rural areas that are seeing population drain in general. Politics and struggling economies are a major factor. Once you’ve left your rural community and found success elsewhere it can be very challenging to want to go back. This is especially true if your experience with rural living included poverty, bigotry or stiffling social expectations.

18. The cost of medical school has skyrocketed. The gap in pay between being a general doctor in a small town vs a specialist in the big city has widened considerably. Medical schools are putting out fewer doctors per capita than decades ago. Immigrant doctors are filling the gaps, but they often don’t want to live in small towns.

19. Primary care physicians don’t really make that much money.

20. The doctor profession in the US is a closed guild. They make it as hard as possible to get admitted. There is such a limited number of residency placements that even if you manage to get admitted to one of the few medical schools, and finish school, there is no guarantee you will ever be allowed to practice medicine. 10% those who graduate don’t get placed. This is done to keep salaries high, and has the side effect creating the doctor shortage.

21. In addition to what others have said – Most of that money goes to insurance companies and hospital systems or private equity firms that own medical practices. Not to the doctors themselves. Yes, some of them earn high salaries (although it differs A LOT by specialty) but it’s not like my whole $30k labor and delivery bill gets deposited into my OBGYN’s account.

22. Not worth the BS even after you finish like a decade of expensive school then another few years of doing underpaid bitch work

23. I have lived in 8 states. In small towns (less than 600 residents) and in mid sized cities (1,000,000 people) I have never lived anywhere without a doctor. The town of 600 people was in a county of 23,000, we had a hospital. There were 3 additional hospitals between that town and the nearest major metropolitan area. Never lacked for health care. When I lived in the swamps of Lafourche Parish I was only 35 minutes from a hospital. I lived on Harpswell Neck in Maine, went over to Orrs Island for the doctor of my choice, bypassing other doctors that were closer. In a small coastal town I had a choice of doctors. I have had to travel distances for specialists but still did not lack medical care.

    Costs on the other hand can be extremely expensive without insurance. For instance if I paid out of pocket for one of my asthma maintenance medications, a months supply would cost $275-$300. With my insurance I pay $10 a month. I have very good insurance coverage through my employer but not everyone does. That being said when I was a young adult that was hospitalized for 10 days with asthma complications I was without insurance at that time but there was never a suggestion that I would not receive care at the hospital. I did receive the benefit of a religious group’s help in paying my hospital bills, again not everyone benefits like that. But in most towns I’ve lived in there were nonprofit nongovernmental organizations that provided health care services to people that did not have insurance.

24. They don’t pay the staff doctors properly here and expected them to actually take a pay cut. It’s because they pay out the ass for all the travelers.

25. High healthcare cost doesn’t necessarily translate into high salaries, especially when you factor in how much they have to borrow to get their MD.