<p>Well, of course there are "surpluses" of physicians in the sense that there are many areas where physicians would prefer to have less competition.</p>
<p>What you're describing may well be a shortage of insurers rather than a surplus of physicians, too.</p>
<p>But to my way of thinking about economics, you're not getting a surplus until there's so many that they're actually choosing to get up and leave rather than take the opportunities that exist there.</p>
<p>It's the way a union would describe a surplus of labor: their workers aren't getting paid enough and their conditions are unpleasant. To my way of thinking economically, as long as there is still space for more workers -- that is, as long as workers can still move to the area and find employment which is good enough that they are willing to stay -- there is no surplus.</p>
<p>There might, of course, be a shortage of employers. (A "monopsony" in the labor market.)</p>
<p>"The problem at this point is simply that there isn't enough funding to train all the kids who want to be doctors. There's no shortage of kids who want to be doctors, so you don't need to worry about the long years of studying or the financial arrangements involved. The problem is that there's a bottleneck in the training arrangement."</p>
<p>Medical students paying 50k a year in tuition and not enough funding?? It's kind of extreme in my opinion.</p>
<p>If I remember correctly, tuition finances less than 10% of the cost of educating a medical student. Now add residency into the mix, where residents are being paid but still cost a great deal to train.</p>
<p>Look up a faculty to student ratio at a top-flight medical school. You'll begin to see why it's so expensive.</p>
<p>While the US do have a great medical care, other european countries also have top-notch doctors without having to oblige doctors to bear hundred thousand dollars of burden after graduation. This seems to me a failure in the administration and medical system, not financial situation of the US itself (it doesn't make sense to me that the richest country on earth who touts its top-notch medical field can't supply for the demand of medical care of its citizens, nor supply enough doctors because of financial reasons_while obliging medical students to pay gargantuan and ridiculous tuition prices)</p>
<p>Other countries have higher taxes, which have varying economic implications. That's almost certainly how they fund medical education -- at least, I'd be surprised if it were otherwise.</p>
<p>In the end, most neoclassical economists will agree that having doctors pay their own way will lead to less deadweight loss for social welfare... but I suppose that doesn't make ME feel any better.</p>
<p>Higher taxes? I am rather skeptic about this. According to one of your own post where you estimated how indebted a neurologist will be, you stated that he would gain 208k a year but lose 92k in taxes. That's almost 50% of his income in taxes. That's what I call heavy taxes.</p>
<p>Besides, heavy debts makes doctors motivated to specialize, making a shortage of primary care physicians in the US (That's not my own inference, but I read it in a health magazine) I also believe that some unethical behaviors stem from such need for money, originating the heavy debt burden.</p>
<p>Sorry for my lack of eloquence, but I meant that since doctors in the US (and citizens in the US in general) make so much money, the government has more occasions to tax more often heavily, thus gaining money. We don't hear so much about european doctors making more than 150k a year.</p>
<p>I never meant that taxing a lot is good. I said that the US is a rich country, meaning to me that its citizens produce and gain more money, so that the government gains more money by taxing it citizens. Thus the government should have a plethora of money to provide for health care, medical education for the well being of its citizens. Something in the intermediary steps of this process is going awry, and I would argue that it is the administrative system of health care in the US (simple speculation by process of elimination)</p>
<p>1.) Heavy debt prompts doctors to go into fields where there's more money. The fact that specialties have more money than primary care is the core problem -- not remotely related to the cost of medical education. Come on, this should have been obvious to you.</p>
<p>2.)
[quote]
That's almost 50% of his income in taxes. That's what I call heavy taxes.
[/quote]
If you were living in Europe, that's what you would call gloriously low taxes. Especially if you were in the upper brackets. For that matter, if you lived in pre-Kennedy America (or so I've been told).</p>
<p>3.) Process of elimination is a horrible way to make an argument.</p>
<p>4.) A reminder. High tuition is not remotely related to the shortage of physicians. It almost certainly has no effect, and probably actually increases the supply slightly.</p>
<p>The US is also a federal government, and taxation works very differently in each state. There are very few blanket solutions for funding in a country that has so much power devolved to administrative units.</p>
<p>"Heavy debt prompts doctors to go into fields where there's more money. The fact that specialties have more money than primary care is the core problem -- not remotely related to the cost of medical education. Come on, this should have been obvious to you." Sorry to disagree, but if the debts weren't so high, a doctor would be more motivated to work in a specialty that he likes most, without taking into account the financial situation it would entail. Thus the balance between choice for specialization or primary care would be re-established.</p>
<p>Dude, just think about it. The core problem is that primary care is underpaid relative to the services they provide. Fix that, and it doesn't matter how much debt your doctors are in.</p>
<p>Hah -- there are definitely advantages both ways. I'd actually suggest that the core problem here is too much centralization. In theory -- and you have to make all kinds of assumptions which may or may not hold -- patients will tend to pay a certain amount of money to stay healthy. Either a doctor prevents a disease, or a doctor fixes it. Theoretically, the preventer should get paid more, right? Of course, you have lots of problems with this model -- patients lacking information, among others. But let's set these aside for later.</p>
<p>Now you introduce government into the mix, and it has to make its own judgments and is quite likely to get them wrong, not least because special interest advocacies don't always reflect social interests.</p>
<p>For a primary care physician to get paid more than the specialist in our example, he simply has to get most of his patients to agree that he provides more valuable services (which he does). In theory, that shouldn't be too hard. For him to get paid more in the real world, he has to go lobby Congress, which may or may not pay him correctly -- and in our world, it doesn't.</p>
<p>Theoretically, a more decentralized system based on competition would allow better allocation of resources. Of course this model is very problematic and would need to be significantly tweaked for lack of patient information and all that, and in fact it's probably best to have insurers around for at least this part of the model, and of course we'd want a government safety net of some kind involved -- and now all of a sudden we're talking about... well, the system we (sort of) have now.</p>
<p>So I've just talked myself in a very large circle. Wonderful.</p>
<p>Summary: The problem with centralized states is that your centralized state has to get it right. At least in decentralized situations, if somebody gets it wrong, he doesn't mess up health care for everybody.</p>
<p>Returning to the main point of this thread, I would like to sum up a bit of what I have absorbed.
There is a lack of (good) physicians in the US, considering population growth and senescence, but the financial situation does not make the prospect for future doctors and premeds bright. For one thing, medical education involves tremendous debt, but the main problem lies in other dilemmas (which still don't seem clear to me). </p>
<p>Although physicians will be needed, premeds will face a tough competion<em>if not tougher competion</em> because the facilities aren't present to graduate more doctors. On the other hand, doctors will have to work longer hours with the present demand (because of their altruism for patients as well as the competition), while witnessing a rise in malpractice costs...</p>
<ol>
<li><p>Is that right?</p></li>
<li><p>Also, collegekid said this: "I do not want to have to deal with legal battles for malpractice claims. There are plenty of reasons why people do not want to become physicians."
There are plenty of reasons, but it does not justify the dearth of physicians since they are so many premeds aspiring to be doctors.</p></li>
</ol>
<p>"I think nurse practitioners and physician's assistants will end up handling primary care patients with increasing frequency, and physicians will handle the specialties more and more. I would not be surprised to learn that physicians make less money 15 years from now than they do now, adjusted for inflation. I think our nation is headed towards nationalized medicine, and that will lead to lower salaries for physicians along with increased use of mid-level practitioners."</p>
<ol>
<li>Can someone assess the veracity of this assertion?</li>
</ol>