Newsgroups: alt.politics.marrou,alt.politics.elections
Date: Thu, 30 Jul 1992 11:38:37 -0400 
From: Conrad Poelman <cp2w+@andrew.cmu.edu>
Subject: Re: Andre Marrou on Larry King
	<15887@pitt.UUCP>

Excerpts from netnews.alt.politics.elections: 29-Jul-92 Re: Andre Marrou
on Larry King gordon e. banks@dsl.pitt (2589)

> In article <8eR=E7200h5y9Cn25K@andrew.cmu.edu> cp2w+@andrew.cmu.edu
> (Conrad Poelman) writes:

> >government to benefit themselves.  The AMA regulates how many of what
> >sort of doctors get licensed, in some states directly (i.e. the state
> >*gives* the AMA that power) and in some states indirectly (the state
> >accredidation board basically rubber-stamps AMA decisions).  They are
> >supposed to determine how many of what specialists they think the state
> >or country will need, and only allow that many into medical schools. 

> You know, it would be really nice if people knew something about
> what they were talking about instead of just spouting this nonsense.
> The AMA has nothing to say about how many of each specialty goes to
> what state.  Licensure is handled by state licensing boards, not
> the AMA.  Licensure is obtained right after internship and before
> specialty training is taken.  Before the student enters medical
> school, how the hell is the AMA going to know what kind of specialist
> he is eventually going to become anyhow?  The AMA also has nothing
> to do with the requirements for specialty board certification (not
> licensure).  No specialty board takes geographical considerations
> into account in setting up its board requirements.  Anyone who
> completes an approved residency and passes the exam will be
> board certified without regard to anything else.

Ok, you are obviously more knowledgeable on this topic than I.  My
information is based on recollection of a television new show of at
least a year ago.  I evidently mistook the point at which the specialty
considerations are made - of course those considerations must be made
after medical school but before specialty training - no big deal.  I aso
said "state or country" when evidently it's only "country" (since you
said no geographic considerations are made) - no big deal.  Your
criticisms of my errors on those points are certainly valid, but try to
keep in mind the original points I was addressing.  First, the
government does largely regulate medicine, from drugs to medical
practices. (I don't think anyone will contest that.)  Second, I was
responding to a post that suggested that there was some evil conspiracy
by the AMA and drug makers to manipulate regulations to their own
benefit.  I claimed that there did not need to be any "conspiracy", but
simply individual members of the medical profession acting to manipulate
government regulation and licensure to their own advantage.  In fact,
your clarification that the legal power of the AMA is less than I had
heard only further supports the "no conspiracy" conclusion.

So let's forget about the AMA.  Who sits on the state or federal or
whatever board which determines how many podiatrists get accepted for
residency, or how many students a particular podiatry school is allowed
to accept, or how many podiatrists get licensed, however it works? 
(Please feel free to make a post clarifying this process - if specialty
certifications are based solely on passing a test, how are their numbers
regulated?  Do they make the test harder or easier depending on how many
podiatrists they need?  To be an approved school, can you only accept a
certain number of students?  Or is there no regulation at all?)  I
suspect that the board has a large number of podiatrists.  I'm sure most
of them try to honestly determine how many podiatrists are needed, but
are they more likely to err on the side of too many or too few?  If they
allow too few, people will have to wait longer and possibly pay higher
prices for podiatrist services, and podiatrists will be assured of
getting as much business as they want.  If they allow too many,
podiatrists may sit around in empty offices waiting for referrals. 
Hmmm...  If I were a podiatrist, I think I'd play it safe...

If you claim that there are no such regulations or requirements for
determining the number of any particular specialty, then I KNOW that the
above argument applies to medical schools in general.  I KNOW I remember
that several schools risked losing their accredidation simply because
they accepted too many students.  There are usually flimsy
justifications for this, such as "if you have that many students, you
can't educate them well" but the board presented no evidence to this
effect, they just claimed that the school accepted "too many" students.

> >After all, the AMA specifically deems it "unethical" for doctors to
> >complete on the basis of price, and can censure its members that do,
> >possibly forcing them to lose their license.  

> The AMA has no way of determining my prices nor of telling me whether
> they are too low.  AMA censure can have no effect on non-members,
> and can have no effect on the state license.

> The AMA is a political lobbying group.  They also develop positions
> on various issues and have a high visibility in this regard.

I don't expect that they survery prices.  When I said "compete" I mean
things like running advertisements that they have low prices or offering
to reduce their fee in order to get more business or get business from
other doctors.  Also, I understand that they have no "legal" power, but
as I said, my understanding is (was?) that many state boards essentially
rubber stamp AMA decisions, especially regarding school accredidation. 
And if a doctor is censured by the AMA for "unethical practices", I
suspect s'he is likely to be investigated by the state licensure board
as well.

> Most MDs do not belong to the AMA anymore.

That's intersting!

Anyway, I'm sorry if I made some mistakes regarding the licensure
process and the influence of the AMA, and thanks for pointing out my
errors.  Please post any corrections/clarifications to things I've
stated in this post as well.  However, my central argument really had
nothing to do with the AMA or even with medicine.  It's that you don't
need "conspiracy theories" or even to suggest that people are evil or
completely selfish in order to explain how groups or individuals
manipulate government regulation, generally adopted under the pretense
of "public safety", to their own advantage.

--Conrad
Newsgroups: alt.politics.marrou,alt.politics.elections