I agree that the AMA is an organization opposed to the individual goals of its members. I don't think that this is an active effort to keep doctors' pay high. It's a provocative headline and I guess it got me, so here comes some word vomit: From what I see, there are 3 main bottlenecks; acceptance into college, acceptance into medical school, and acceptance into a residency program. This article appears to suggest that we combine the first two hurdles, college and medical school, into a single six-year program probably added on to the offerings of an undergraduate institution. I have no idea how this would look in terms of testing, attrition rates, or overall learning experience, but it does sound pretty similar to some pre-pharmacy and pre-physical therapy programs I've heard of. The LCME, although controlled by the AMA and lambasted by the author, is instrumental in determining which institutions are meeting important criteria and would still need to be retained under this model. The decrease in investment time would be considerable to the future doctors, however, and that could be good. My main bone to pick is that the doctor positions that we really need in the coming decades are "primary care" roles - doctors that have a clinic and help patients avoid having to go to the hospital if possible. The type of doctor one becomes is decided by the third hurdle; acceptance into a residency program. Graduating medical students compete against their peers both domestic and international for a limited number of training spots which are required to progress to board certification. The most highly contested spots are generally for surgical or radiological specialties, meaning that primary care is implicitly de-emphasized. Of course, that wouldn't be a problem if there were more residency spots, but that part is actually not controlled by the AMA. Residency programs are funded by the federal government through Medicare [(Wikipedia, I'm lazy)](https://en.wikipedia.org/wiki/Residency_%28medicine%29#Financing_residency_programs) and this funding has been FROZEN FOR 10 YEARS, against the stated desire of the AMA. Add to that the fact that hospital systems use residents as underpaid, overworked, powerless versions of doctors that are "only" required to work 80 hours per week on the books, and you can see the abuse potential here. There's a whole bushel of problems surrounding medical education, and this article touches on a few facets of it but I feel that it points fingers the wrong way, for the wrong reasons, and offers a nonstarter as a solution. Expanding the number of residency slots is absolutely essential to help weather the demographic shift that we are undergoing now, but without careful oversight an expansion will just expand the number of burned-out physicians making life-threatening mistakes after their 20th hour on call. The need for a 4-year college degree is debatable and I could be persuaded on that point, but the 4-year medical school track is the best model we've got right now, and the residency programs are also an essential phase of the training.
William Halstead was a coke fiend who said that medical residents should practice like coke fiends in order to get their skills up. He's been dead for 97 years yet the AMA clings to standards and practices that kill 200,000 patients per year. Here's how the EU does it: ...yet medical outcomes in Europe have been consistently better for decades. a maximum work week of 48 hours a minimum rest period of 11 consecutive hours per 24-hour duty a minimum rest period of 24 hours per 7-day duty, or 48 hours of rest per 14-day duty a minimum of 4 weeks of paid annual leave a maximum of 8 hours’ work in any 24 hours for workers in stressful positions a minimum 20-minute rest period per 6 hours worked
Right on about Halstead, dude was crazy. It's a ridiculous model that definitely contributes to the rate of errors and burnout. So the obvious solution is easing the burden of care currently on US resident physicians, which will require hospital systems either to supplement heavily with midlevel practitioners or take on more residents. Midlevels still have to get physician oversight in most states, so even a solution pursuing strict midlevel expansion will require more residency spots. And after residency positions are expanded, there has to be some sort of incentive to ensure that the new attending doctors get to areas where they are needed, i.e. poor and rural communities. This will be a multi-decade transition process, and only tackles a part of the train wreck that is the American healthcare system.
The urgent care model is basically filling in around the gaps, providing an inefficient and expensive mirror of European care. Rather than have a community health clinic that goes "take an asprin/have a vaccine/go to the emergency room" we have strip malls full of nurse practitioners going "take an aspirin/have a vaccine/go to the emergency room." The AMA has effectively priced themselves out of the market - if you can run an urgent care facility with a nursing degree why the fuck would you go to medical school?
Well, if I'm not mistaken the prescription pad is still out of the domain of nurses. Urgent care is expensive and inefficient in comparison to Europe's model, but are their community care clinics run by NPs? Genuine question. I don't know much about European healthcare. In terms of being able to run an urgent care facility without doctors, I think the majority of centers in the US still keep a physician on site. Nurse practitioners, in our current model, function best to help multiply care access but are still linked to physicians. Whether we should change this is a different discussion, though. I'm not sure if you're saying that primary care physicians are too expensive or something else, but I think there's a theoretical model that ensures high pay for all medical professionals (nurses, doctors, technicians...) while keeping costs low for the patient. It involves drastic moves in the world of admin, insurance and pharma, though, so - not gonna happen.