7 ms·

The limit of residency slots is in the article. > A much more sensible system would to make medical school free so that the salaries don’t have to start off s

The limit of residency slots is in the article. > A much more sensible system would to make medical school free so that the salaries don’t have to start off so high. That's not how any labor market works. Your salary isn't determined by how much debt you rack up. Doctor's salary's are high because the supply of doctor's is so low (especially primary care). The article covers all the points you're debating (much better than I).

N1H1L 5y ago
> That's not how any labor market works. Your salary isn't determined by how much debt you rack up. True, or else college dropouts from a private school will have higher incomes than a state school undergrad, which is not the case at all.
syki 5y ago
My response was about the claim that OP is a health economist while not understanding where the bottleneck in the supply for doctors comes from. I believe you are incorrect as it pertains to doctor salaries. Demand is high and supply relatively low. That is true but this isn’t the only factor that goes into determining pay. That’s an overly simplistic view of things. Supply/demand does not account for everything in this situation. If med students came out of med school with zero debt then the healthcare industry could make being a doctor sufficiently lucrative with salaries that are smaller than they currently are. Lowering the salary a bit in this scenario would not lower supply. You should read about David Carr’s work.
- vsskanth 5y ago
  I don't agree the cost of university is driving the salaries here. It's all about how many doctors are available to meet demand. If there are less, it's going to drive up salaries. There are other countries where the cost of getting a degree in a certain specialty is very low due to state subsidies but the salaries are very high once they graduate since they are scarce.
  - syki 5y ago
    In countries with mostly free higher education doctor’s salaries are less on average than in the U.S. You really think having several hundred thousand dollars in student loans doesn’t in any way affect salaries?
    - huitzitziltzin 5y ago
      There are important differences in most of those countries including (importantly!) direct government regulation of prices, including salaries in the medical market. British doctors, for example, work under a contract negotiated between a British version of the AMA and the British government. The government and the providers both have leverage, but the British government is the primary purchaser of services in that country. Salaries are lower since the government exerts pressure on them, as they are paid for out of direct taxation. I understand that you feel very strongly that student debt for doctors is unjustifiable or too high or something. Student debt is not the main driver (or even a driver) of high salaries among US doctors. The level of their student debt is a completely separate topic.
      - syki 5y ago
        There are private doctors in Canada and the UK and they don’t make as much as their American counterparts. Anecdotal evidence. My wife has $400,000 in med school debt. She needs a $300,000 salary to afford paying that debt off whilst also maintaining a “good” lifestyle. Med school, residency, etc. were hard and sacrifices were made to go through them. It would not be worth it to go through that without a reasonably high salary. She’d gladly have gone through the process for a $200,000 a year job. It is certainly the case that highly motivated, highly intelligent people take into account the ability to service med school debt when deciding to become a doctor vs. another going into another field. It is obvious that high med school debt has an effect on the salary needed to attract talent. David Carr won the Nobel Prize in part for his work questioning the traditional supply/demand view of labor economics. Here is a link to an interesting (to me) paper. https://www.jstor.org/stable/24695058 https://www.jstor.org/stable/24695058
- CogitoCogito 5y ago
  I believe you have it backwards. The high salaries increase the levels of debt potential doctors consider acceptable.
lupire 5y ago
Primary care is a low paying job because nurses and PAs can provide primary care.

N1H1L 5y ago

> That's not how any labor market works. Your salary isn't determined by how much debt you rack up. True, or else college dropouts from a private school will have higher incomes than a state school undergrad, which is not the case at all.

syki 5y ago

My response was about the claim that OP is a health economist while not understanding where the bottleneck in the supply for doctors comes from. I believe you are incorrect as it pertains to doctor salaries. Demand is high and supply relatively low. That is true but this isn’t the only factor that goes into determining pay. That’s an overly simplistic view of things. Supply/demand does not account for everything in this situation. If med students came out of med school with zero debt then the healthcare industry could make being a doctor sufficiently lucrative with salaries that are smaller than they currently are. Lowering the salary a bit in this scenario would not lower supply. You should read about David Carr’s work.

vsskanth 5y ago
I don't agree the cost of university is driving the salaries here. It's all about how many doctors are available to meet demand. If there are less, it's going to drive up salaries. There are other countries where the cost of getting a degree in a certain specialty is very low due to state subsidies but the salaries are very high once they graduate since they are scarce.
- syki 5y ago
  In countries with mostly free higher education doctor’s salaries are less on average than in the U.S. You really think having several hundred thousand dollars in student loans doesn’t in any way affect salaries?
  - huitzitziltzin 5y ago
    There are important differences in most of those countries including (importantly!) direct government regulation of prices, including salaries in the medical market. British doctors, for example, work under a contract negotiated between a British version of the AMA and the British government. The government and the providers both have leverage, but the British government is the primary purchaser of services in that country. Salaries are lower since the government exerts pressure on them, as they are paid for out of direct taxation. I understand that you feel very strongly that student debt for doctors is unjustifiable or too high or something. Student debt is not the main driver (or even a driver) of high salaries among US doctors. The level of their student debt is a completely separate topic.
    - syki 5y ago
      There are private doctors in Canada and the UK and they don’t make as much as their American counterparts. Anecdotal evidence. My wife has $400,000 in med school debt. She needs a $300,000 salary to afford paying that debt off whilst also maintaining a “good” lifestyle. Med school, residency, etc. were hard and sacrifices were made to go through them. It would not be worth it to go through that without a reasonably high salary. She’d gladly have gone through the process for a $200,000 a year job. It is certainly the case that highly motivated, highly intelligent people take into account the ability to service med school debt when deciding to become a doctor vs. another going into another field. It is obvious that high med school debt has an effect on the salary needed to attract talent. David Carr won the Nobel Prize in part for his work questioning the traditional supply/demand view of labor economics. Here is a link to an interesting (to me) paper. https://www.jstor.org/stable/24695058 https://www.jstor.org/stable/24695058
CogitoCogito 5y ago
I believe you have it backwards. The high salaries increase the levels of debt potential doctors consider acceptable.

lupire 5y ago

Primary care is a low paying job because nurses and PAs can provide primary care.