[Puffer Fish]

There are signs that it's getting harder for Americans to find a doctor.

Why it's getting so hard to find a new doctor, and what to do if you end up looking for one , MarketWatch, Sally Benford, May 10, 2023

This is due to at least two main factors.

Not enough new doctors are being trained, there are not enough residency slots for every applicant applying who graduated from medical school.

This article goes into more detail, explaining that there are more residency slots than the number of persons graduating from U.S. schools, but after also factoring in people who trained at medical schools outside the country (some of whom are U.S. citizens and some not) there exist 0.85 positions per applicant.

Match Day 2023 a reminder of the real cause of the physician shortage: not enough residency positions, Rebekah Bernard, M.D., MedicalEconomics.com, March 15, 2023

Training doctors is expensive and requires a big investment of resources.

The other problem is the government has set up a price-fixing scheme, when it comes to the Medicare and Medicaid programs, and there is an increasing lag between what government has set the price at and the going price set by doctors.

It's a basic principle of economics that price fixing tends to cause shortages.

Under the Medicare program, a doctor is not allowed to charge the patient 15% more than the amount the government has set to pay for that procedure. If a doctor is caught charging more than that, they can face fines or ultimately lose eligibility to be reimbursed by Medicare.
In the U.S. there is a 2.9% payroll tax to pay for Medicare (half paid by the employee and half paid by the employer). Once a person reaches 65 years of age, they have access to Medicare. It's typically after around this age that a person starts requiring a lot more medical care, statistically.

This is going to end up having consequences for the American healthcare system and the population's access to healthcare.

[late]

The Boomers are at the age where they consume a lot of healthcare. Over the several years I've been retired, I've had cancer, a stroke, got diabetes from the cancer treatment, and tons of therapy of differing sorts. I'm in PT right now.

But that's just the surface, the health care system has a ton of problems. There is a shortage of highly skilled nurses. These were people, many had advanced degrees, that didn't enjoy being treated like slave labor during Covid. So they left. It's actually a dramatic, hair raising problem that no one talks about.

There's lots of other problems, like supply shortages.

The solutions aren't generally complicated, but the politics are a nightmare, mostly due to corruption.

[Puffer Fish]

The Boomers are at the age where they consume a lot of healthcare.

The median age of the U.S. population began to level off after about 2003. It is continuing to increase but very slowly. Probably much of that is due to immigration; the white segment of the population is continuing to age.
So that would get us thinking that demographic aging is a factor but perhaps not the largest factor going on here.

I do also wonder if perhaps the system wasn't able to cope with the population increase from immigration. When population increased, added investments should have been made, but it looks like those investments were not made.

related thread: the problem with bringing in foreign workers to take care of the old

[late]

The median age of the U.S. population began to level off after about 2003. It is continuing to increase but very slowly. Probably much of that is due to immigration; the white segment of the population is continuing to age.
So that would get us thinking that demographic aging is a factor but perhaps not the largest factor going on here.

I do also wonder if perhaps the system wasn't able to cope with the population increase from immigration. When population increased, added investments should have been made, but it looks like those investments were not made.

related thread: the problem with bringing in foreign workers to take care of the old

Immigration has helped, esp. with healthcare.

[Puffer Fish]

Immigration has helped, esp. with healthcare.

Why would you say that?

Are you claiming that immigrants have more money or are more likely to be a doctor than the average American? Because I think both of those are not true.
If there are not enough doctors, why do you think adding more people would help?

If you're arguing this has to do with demographic aging, then as I pointed out, isn't the country going to eventually be left with an even bigger problem once all of those newer people grow old?

(Never mind speculation that exists that immigration might be part of the reason pushing down American birthrates, due to increased level of competition in housing and labour markets)

[late]

Why would you say that?

It's true.

I know what I am talking about, seize the opportunity to learn something.

I lack the time and the interest to teach you everything, for the love of an imaginary deity, go f**king learn.

[Potemkin]

It's true.

I know what I am talking about, seize the opportunity to learn something.

I lack the time and the interest to teach you everything, for the love of an imaginary deity, go f**king learn.

Quoted for truth. @Puffer Fish Who does all the grunt work that native-born Americans don’t want to do for shit wages? Forget doctors, healthcare depends on nurses, porters, and people willing to wipe the asses of strangers for minimum wage or less. Without immigrants, legal or otherwise, the American healthcare system would have collapsed decades ago. That goes for the UK as well.

[late]

Quoted for truth. @Puffer Fish Who does all the grunt work that native-born Americans don’t want to do for shit wages? Forget doctors, healthcare depends on nurses, porters, and people willing to wipe the asses of strangers for minimum wage or less. Without immigrants, legal or otherwise, the American healthcare system would have collapsed decades ago. That goes for the UK as well.

You are talking about a guy that regularly uses goofballs for sources.

There are a number of issues going on here. Income Inequality may be at the top of the list. Boomers hitting retirement is also Boomers needing lots and lots of health care.

Docs have been chasing money. They might like that, but as a national policy it's shooting yourself in the nuts.

There's more..

[Puffer Fish]

@Puffer Fish Who does all the grunt work that native-born Americans don’t want to do for shit wages? Forget doctors, healthcare depends on nurses, porters, and people willing to wipe the asses of strangers for minimum wage or less. Without immigrants, legal or otherwise, the American healthcare system would have collapsed decades ago. That goes for the UK as well.

You are correct, but as I explained in this thread, > the problem with bringing in foreign workers to take care of the old < , there is a huge inherent problem with that reasoning.
Although it seems to be solving the problem now, it's setting up a huge ticking time bomb for the future. It should also raise alarm bells when a country as big as the U.S. or U.K. (or Germany) has to bring in workers from outside countries to do the critical work. Something is not right in the system.

Some might even try to argue the importation of medical workers into higher income countries could be creating a "brain drain" and further exacerbating the problem of medical access in other countries. For those who care about "inequality", do you really want your country taking nurses from another country like India which has an even much lower ratio of nurses relative to the population than your country does?

[late]

You are correct, but as I explained in this thread, > the problem with bringing in foreign workers to take care of the old < , there is a huge inherent problem with that reasoning.
Although it seems to be solving the problem now, it's setting up a huge ticking time bomb for the future. It should also raise alarm bells when a country as big as the U.S. or U.K. (or Germany) has to bring in workers from outside countries to do the critical work. Something is not right in the system.

Some might even try to argue the importation of medical workers into higher income countries could be creating a "brain drain" and further exacerbating the problem of medical access in other countries. For those who care about "inequality", do you really want your country taking nurses from another country like India which has an even much lower ratio of nurses relative to the population than your country does?

America has had waves of immigrants for centuries.

They are not a ticking time bomb. There are always problems with assimilation, but with the exception of the former slaves, they eventually get assimilated.

I'm guessing you are getting your fairy tale from some dumbass Right wing site. Most of those people couldn't find their butt if their life depended on it.

Btw, there is always something wrong. Some people think you can have stability. That's nonsense, what you have is periods of stability interrupted by crisis. Before WW1 there was an economic crisis, before WW2 there was an economic crisis.

What we are slowly learning how to do is adapt to changing circumstances. To be honest, we suck at it, but we are learning (if Republicans ever stop their radicalism and do their damn job).

[Puffer Fish]

America has had waves of immigrants for centuries.
They are not a ticking time bomb.

I meant demographically. Potemkin wanted to bring up the issue of lower paid health workers.
If we're going to bring in a poorer group of people to take care of the old generation, how is the country planning to deal with taking care of the healthcare of that new group of people when they eventually become old, 25 to 30 years from now?

That's the question I was trying to get you to focus on.

It just doesn't seem like a really well thought out solution, and is going to kick the can down the road (proverbially speaking).

If there's not enough doctors, you think adding more population is going to make the problem better?

You don't seem to understand that if more people are brought in, there needs to be more infrastructure investment, and that includes the training of more doctors, something that is expensive and consumes a lot of resources. Otherwise living standards in the country and healthcare access is eventually going to go down.

[late]

I meant demographically. Potemkin wanted to bring up the issue of lower paid health workers.
If we're going to bring in a poorer group of people to take care of the old generation, how is the country planning to deal with taking care of the healthcare of that new group of people when they eventually become old, 25 to 30 years from now?

That's the question I was trying to get you to focus on.

It just doesn't seem like a really well thought out solution, and is going to kick the can down the road (proverbially speaking).

If there's not enough doctors, you think adding more population is going to make the problem better?

You don't seem to understand that if more people are brought in, there needs to be more infrastructure investment, and that includes the training of more doctors, something that is expensive and consumes a lot of resources. Otherwise living standards in the country and healthcare access is eventually going to go down.

We have a demographic problem now, not enough skilled workers...

My Doc was a Doc when he came here...

Living standards started going down a long time ago, you need to learn about income inequality...

[Puffer Fish]

Interesting article on how the U.S. is not prioritizing medical residencies for American doctors, leaving thousands of them unable to practice medicine.

There Are Limited Spots for Doctors in Medical Schools - and We're Giving Them Away to Foreigners - Opinion

" There's only one profession in which students who graduate from an advanced learning program and who pass all the required exams are barred from employment due to bureaucratic red tape and predatory immigration policies. That profession is medical doctor.

Under the current system, in order to practice medicine, a medical school graduate must match to a residency position at a U.S. teaching hospital. If they don't match and complete their residency, they cannot practice medicine.

Decades ago, earning an MD degree practically guaranteed one could practice medicine. That's less and less the case, as nearly 5,000 doctors heard last week from the National Resident Matching Program (NRMP) that they went unmatched. That number includes 2,364 doctors graduating from U.S. medical schools in 2023 or earlier and 2,590 U.S. citizens graduating from international medical schools in 2023 or earlier. "

There Are Limited Spots for Doctors in Medical Schools - and We're Giving Them Away to Foreigners | Opinion
Newsweek, by Kevin Lynn - Executive Director, The Institute for Sound Public Policy; Founder, U.S. Tech Workers, March 22, 2023

[late]

I meant demographically. Potemkin wanted to bring up the issue of lower paid health workers.

If we're going to bring in a poorer group of people to take care of the old generation, how is the country planning to deal with taking care of the healthcare of that new group of people when they eventually become old, 25 to 30 years from now?

That's the question I was trying to get you to focus on.

It just doesn't seem like a really well thought out solution, and is going to kick the can down the road (proverbially speaking).

If there's not enough doctors, you think adding more population is going to make the problem better?

You don't seem to understand that if more people are brought in, there needs to be more infrastructure investment, and that includes the training of more doctors, something that is expensive and consumes a lot of resources. Otherwise living standards in the country and healthcare access is eventually going to go down.

It's not just doctors, we've been importing health care workers for a long time.

There are a couple things going on here. One is that Docs limit the number of people becoming doctors to keep their income high. We'll just keep importing Docs.

We need to have a national conversation about the cost of health care, but that's going to have to wait until the opposition party becomes sane, or gets replaced by a new party.

[Rancid]

Quoted for truth. @Puffer Fish Who does all the grunt work that native-born Americans don’t want to do for shit wages? Forget doctors, healthcare depends on nurses, porters, and people willing to wipe the asses of strangers for minimum wage or less. Without immigrants, legal or otherwise, the American healthcare system would have collapsed decades ago. That goes for the UK as well.

Indeed.

@Puffer Fish doesn't understand the world. He fears it.

[Tainari88]

Quoted for truth. @Puffer Fish Who does all the grunt work that native-born Americans don’t want to do for shit wages? Forget doctors, healthcare depends on nurses, porters, and people willing to wipe the asses of strangers for minimum wage or less. Without immigrants, legal or otherwise, the American healthcare system would have collapsed decades ago. That goes for the UK as well.

I wonder why the English, Scottish and Welsh, and Northern Irish do not like wiping the asses of old people for minimum wages? Isn't the minimum wage enough to do well in these lands of opportunity? Or are the Tories now in power lying again?



https://uk.indeed.com/career/healthcare ... t/salaries

You make a lot more in the USA for a comparable position. But? It also is an expensive cost of living Potemkin.

In general you UK market folks are CHEAPSKATES with salaries.

https://www.indeed.com/career/medical-a ... Denver--CO

[Puffer Fish]

Indeed.

Puffer Fish doesn't understand the world. He fears it.

Rather I suspect that it is people like you who do not fear the rest of the world because you do not understand it.

You do not know what it would actually be like to live in many of these other countries.

When most people from developed countries travel, they either travel to other developed (usually white/European) countries, or they mostly only stay in the tourist areas of other countries, not seeing the poverty and how things are like in most of the other parts of that country.

[Rancid]

Immigrants Immigrants Immigrants
Blacks Blacks Blacks

[late]

Rather I suspect that it is people like you who do not fear the rest of the world because you do not understand it.

You do not know what it would actually be like to live in many of these other countries.

When most people from developed countries travel, they either travel to other developed (usually white/European) countries, or they mostly only stay in the tourist areas of other countries, not seeing the poverty and how things are like in most of the other parts of that country.

Immigrants routinely oppose immigration. It could depress their income.

I don't mean that in a mean way, to some degree you have to take care of your interests.

Btw, one of the problems of success: Urban people move out of the city, and then want some of what they had back in the city. Which makes the locals complain about the newcomers driving up property values and their taxes, and driving them out.

Zeihan likes to say we've never had a competent government because we don't have to have one. Like the Brits in the old British empire, we muddle along.