From: solman@athena.mit.edu (Jason W Solinsky)
Subject: Re: So who _should_ we train? (cf. Bleak News)
Organization: Massachusetts Institute of Technology
Date: Tue, 24 Nov 1992 05:15:19 GMT

In article <Nov.23.11.08.59.1992.9320@cadenza.rutgers.edu>, masticol@cadenza.rutgers.edu (Steve Masticola) writes:
|> Granting that there is now a vast oversupply of scientists and
|> engineers, what specialties should have priority for training support?

Let me again remind everybody that there is a vast UNDERSUPPLY of engineers. We
are talking about a VERY bad one. There is an oversupply of PhDs. These people
represent a small fraction of the jobs market. 
|
|> My contention: Medical doctors. Part of the reason for the obscene
|> costs, and the shoddy quality, of health care in the U.S. is that the
|> AMA has a death grip on the supply of doctors. They enforce a
|> permanent shortage through artificially restricting the number of
|> seats available in med schools.

This is dead wrong. There is also an oversupply of doctors. In fact, if every
doctor were to work a forty hour week, you would have large numbers of
unemployed physicians. Just compare the average number of hours of medical
care and consultation Americans need to the number of doctors per capita.
You will see that we have more than enough.

With respect to seats in medical schools, this is irrelevant due to the huge
numbers of doctors who have immigrated to the US and become certified here in
recent years. PRaticularly those from India.

|> This is done in at least two ways:
|> 
|>  - By maintaining standards that are meaninglessly tough. As we have
|> seen, they do not weed out problem doctors, and serve only to inflate
|> the price of the service.

This is not the case at all. Yes, it does increase the price of service, but it
also increases the quality of the doctors.

|>  - By requiring that years be wasted in training. It takes a med
|> student eight years in the U.S. to get the MD degree, at the end of
|> which time they may have no practical experience at all. In some
|> European countries, you can declare a medicine major as an
|> undergraduate and get through in six; as you're doing this, you're
|> working in hospitals and becoming useful.

Again, you are decreasing the quality of care. If you are willing to
trust yourself to a second rate physician, that is fine. In many
European countries you would get a nurse instead of a doctor for
many instances where doctors are clearly called for here. But Americans,
when given the choice, ALWAYS choose to take all possible medical
precautions. The health of the sick takes pecedence over everything
else. This is why our health care costs so much and this is why we have
such high standards. As a whole, we find the possiblity of trading our
health to save money unacceptable.

|> Patients see the exhorbitant profits made by doctors and have few
|> qualms about suing them for malpractice; lawyers happily join in for a
|> piece of the action. Doctors cover their a$$es by overtesting and
|> overmedicating. Actual malpractice goes unchecked because of the AMA's
|> "peer review" policy; a quack will only get their license revoked if
|> they do something egregiously rotten in public, and they can then go
|> practice in another state. Guess who gets to pay?

Quacks will quickly become uninssurable. There are also hardly any because
of all the precautions taken to make sure that American doctors are well
trained.

|> Furthermore, because supply is low, patient load per doctor is high.

This is blatantly false.

|> Doctors cease to give a damn about any individual patient and refuse
|> to discuss treatment because they're afraid of getting sued. Quality
|> of care suffers.

This is also not true. It is well known to doctors (who get free literature on
the subject rammed down their throats by drug companies) that one of the keys to
success in private practice is spending time talking to the patient. The problem
we have seen in recent years is that medical plans have been established which
sucker doctors in by paying market rates, and then slowly lower the amount that
they pay. Doctors, who by this time have several patients on these plans, make up
the difference by charging for things like phone calls. They then become very
uncooperative. This practice is extraordinarilly widespread in the Northeast. In
free market situations however, doctors are very willing to talk because the KNOW
it determines how well they do.

Jason W. Solinsky
Newsgroups: sci.research.careers