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tptacekyesterday at 8:46 PM1 replyview on HN

The AMA orchestrated the capping of residency slots through CMS/Medicare, which is the primary structural impediment to increased supply. Doctors in the US make integer multiples of what they do in Europe in part as a result of this.

I have to say: you can go either way on the AMA, I guess, but it's a weird hill to die on, isn't it? They're a trade group, not a public health organization. They exist for the benefit of their members.


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bonsai_spoolyesterday at 9:55 PM

I really would love to see the sources you have on this. As someone who has been in medicine for decades now, I have never hears this. This may be the result of a game of telephone but I'll comment as I can:

> The AMA orchestrated the capping of residency slots through CMS/Medicare,

This has very little to do with the AMA, though it is true that in 1997 the AMA was predicting an oversupply of physicians. CMS funding is the role of Congress and the AMA has supported increases in residency seats since the prediction of oversupply was found incorrect.

If there's a problem with an advisory group suggesting that the US not overspend, then I think we'll not agree on much.

I take their 1997 position as one in good faith; the graduate training component of medicine is very resource-intensive (and honestly dangerous!) so it should not be expanded without good reason.

> Doctors in the US make integer multiples of what they do in Europe in part as a result of this.

Doctors in the US make mulitples of what they do in Europe because we do not have a single-payer. You even say this earlier in the thread!

> They're a trade group, not a public health organization. They exist for the benefit of their members.

I assure you, no physician feels their needs are reflected by the AMA. It's an odd duck that probably made sense in the era of PCPs owning their own firms. The AMA has several structural roles in medical training (they administer application programs, primarily) so they're not going away any time soon, no matter what I may wish.

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