And does the (my impression) widespread support for oh-so-rigorous qualifications for doctors reflect any real-world data about actual resulting quality of patient care? Or is it a way for prospective patients to vocalize a bunch of anxieties and emotions about medical care, plus a way for the doctors who've had to endure such treatment to say "all the noobs should have to suffer as much as I did"?
We need a range of doctors, who range in price according to quality.
That way for simple stuff, which anyone can get right, we go to a cheap, reasonable doctor.
A similar example would be if we only had uber software engineers. Each one had to have a PhD. There were no cheap and okay developers who could do say web-sites but not write a programming language from scratch.
Your example doesn't even make sense. Having a PhD doesn't make software engineers more productive on average. PhD programs train researchers. Research skills have very little correlation with practical software engineering.
What could actually work is to train more physician assistants and nurse practitioners, then have them deliver the bulk of simple primary care services under the supervision of physicians. This is more cost effective and usually works well enough, although there may be some degradation in service quality for edge cases.
ACA (Obamacare)HMOs may have opened healthcare up to a lot of people who until then were going without. But its a faaaar cry from from Employer PPOs. And the ACA PPOs somewhere in between.
An don't forget the Trumpcare policies, with major policy exclusions.
If you really want "First Class" health care then you'll have to pay out of pocket for concierge medicine. That isn't directly covered by most insurance plans, although they will reimburse for certain services delivered through concierge medicine practices.
If the demand is there, why is a cap imposed?
According to 'studentdoctor.net' from 2017 - there is a cap because there are not enough residencies for graduating med students. The government is the primary payer for residencies: "It was because of the cost of GME funding that this program came under the fire of budget-minded politicians in Congress. This resulted in curbing of funding for residencies under the Balanced Budget Act (BBA) of both 1997 and 1999:" [1]
> The limitation in funding has essentially put a cap on the number of residencies that can take place in the United States – and since a doctor cannot go into practice without a residency, this is essentially a cap on the number of new, American-trained physicians who are allowed to practice in this country. The American Medical Association, in its AMA wire, blames this cap for the record number of students in 2015 who were not matched with a residency program at the end of their four years in medical school: of the 18,025 allopathic seniors and 3,000 osteopathic seniors who participated in the Main Residency Match, the two groups matched at rates of 93.9% and 79.3% respectively, leaving the highest percentage ever unmatched – and also unable to practice on their own.
> There are proponents for keeping the current cap in place, however. This is mostly among budget-minded members of Congress who are wanting to cut spending, but even the Obama administration proposed reducing Medicare expenditure on GME, even halving support for children’s hospitals, which have their own separate sources of funding. People on this side of this issue tend to decry the seriousness of the physician shortage, pointing out that the increase of physician’s assistants and advanced nurse practitioners has helped to mitigate this problem, even with the cap still in place.
The resource [1] is a bit dated. "Congress recently took steps to support several programs supporting GME funding by fixing technical issues that left some rural programs with an inadvertently low cap, expanding eligibility for rural training track funding, and adding 1000 new Medicare-funded positions for the first time since 1997. " [2]
[1] https://www.studentdoctor.net/2017/01/24/medical-students-kn...
How is this synonymous with not specializing?
In the normal case, I would then think that cost in medicine and medical services would be related to outcome.
To the extent this generalization is true, then when cost is not related to outcome, this is not a normal situation, and then the question would be "why?" - what's going on to make a situation which on the face of it is not normal.
Having a doctor available to treat you at all is still much better than having your very high standards and then not having a doctor available period.
We need doctors who are available to treat simple conditions and refer to a more qualified doctor for the complex ones. Such a job doesn't require being a genius, just people who are not complete idiots, and the qualifications required here are genius-level, not idiotproof-level.
> We need doctors who are available to treat simple conditions and refer to a more qualified doctor for the complex ones.
It people can't see a doctor, or can't get decent care because doctors are overworked, they will go to the "pseudo doctors". "pseudo doctors" are usually much less regulated, because they don't really practice medicine, can't make prescriptions, are not covered by healthcare subsidies, etc... but they are available, and actually caring, because there is no shortage of them.
This is actually good for the patients, sometimes, all you need to get better is someone who listens to you and points you to a healthier lifestyle something, something that "pseudo doctors" can do well. The problem is when they bring their pseudoscience to "treat" actual medical problems that can't just be solved by eating vegetables and getting some rest.
Now imagine an actual doctor who is available and caring, giving you all the benefits of the "pseudo doctor", but in addition, can actually practice medicine. Maybe not to the highest level, but he would have attended an actual medical school and knows enough not to treat cancer with fruits.
The problem now in many places is that it is not just hard to become a doctor, it is hard to access medical studies.
For what it's worth, I do agree we should train more doctors, but I think it's a complicated problem.
This happens already, today. There are dozens of reasonable questions you can raise based on this fact - but I don't think it's obvious that the failures at the end of training can majoritarily be identified by pre-training metrics.
Some countries allow any student to take the first two years of medical courses, and then impose restrictions on the following years. This seems a relatively fair system; you can imagine someone persevering over many years to attain the requisite knowledge - but this person would not have had the opportunity if there were a pre-medical school filter