Actually understaffing isn’t so much because the AMA or a restrictive providers pipelines. Most understaffing is due to Private Equity owners who are squeezing every dollar they can out of healthcare systems.
For example, at one hospital where my daughter works, the nurses demanded an increase in hourly pay due to both inflation/cost of living adjustment and to reflect their increased workload in Covid times. The PE healthcare system that owned the hospital refused and instead fired most of its nursing staff, replacing them with temporary traveling nurses who a) were paid significantly higher wages than the increase the nursing staff had asked for; and b) were unfamiliar with hospital procedures and EHR which caused them to be much less productive than the fired staff.
Productivity went down, costs went up so the solution–hire fewer nurses and increase the workload of the remaining nurses, leading to more burnout, more medical errors and more staff turnover. Morale is terrible. Patient satisfaction is poor, but since it’s a hospital in a low resource area (read: poor) and there aren’t any close by alternatives–no one cares.
This situation is in the process of repeating itself at another hospital she works at. PE management decided that costs were too high so the contract they offer the physician group gave them a choice–accept below the going reimbursement rate for their service or cut their work hours by 1-2 days/month. The doctors voted to work less but keep their current reimbursement rates. (Most of them can easily moonlight at other hospitals to make up any lost income.) So there are fewer doctors in the ER than there were before. Wait times have exploded and patient satisfaction has declined. It’s entirely possible that people will die because their access to healthcare has been reduced. But again, it’s a hospital without any close by alternatives in a low resource area so no one cares.
The US has substantially fewer doctors per 1k population, at 2.8, than most European countries which are in the 4.0 to 5.8 range. That is a deliberate decision-plenty of foreign doctors wish to work here and plenty of American kids wish to be doctors. Poor management likely contributes to the problem, but any shortage is the natural and predictable consequence of decisions to restrict the supply.
Of course, they are also trying to pay off their educational debt.
Primary care specialties are also competing with other higher paid specialties for medical students choosing which specialties to apply for residency to. Debt pressure probably influences these choices.
Earns $224K only after accruing an average of $400K (at 7.5% APR) in education debt and delaying starting retirement saving until their mid-thirties or later.
Also as independent contractors, they have no benefits, so factor in the cost of health insurance, life insurance and disability insurance. Plus tail insurance on their malpractice. No parental leave or sick leave. No PTO at all.
Consider the health and well being tolls of having chronic sleep dysrhythmia from working a different shift every day together with very high stress job that usually doesn’t allow the physician to eat or go to the bathroom for 8-12 hours at time…
And that $224K/ year isn’t quite as outrageously high as you seem to suggest.
No surprise that things go bad for employees facing a monopsony and patients facing a monopoly, and that those who do care have neither choice nor power to do anything about it.
Those who choose contractor status versus W2 status have many negative side effects. This is neither unique nor mandatory in medicine. Both law school and graduate buiness school may have equally high graduate tuitions with less certain returns on investment, and far less job security. Not all medical specialties face high stress or uncertain hours and most pay double or triple the above salaries for pcp/ER work.
Without a doubt the profession has become more demanding, but much of that is due to the medical lobby itself. Those doctors burdened by insurance oversight could support a single payor system. Those burdened by work could permit np and pa to help with the vast majority of routine cases. There are answers, but they cant be implemented without the support of the supposedly burdened doctors.
And private equity companies own these “staffing agencies.” Terrible for health care. What’s the goal of PE? Is it to deliver best-in-class, compassionate health care? Never.