Skip Navigation

You're viewing a single thread.

18 comments

  • But those new arrivals have found that trans-friendly laws don't necessarily equate to easy access. Instead, they find themselves added to ever-growing waitlists for care in a small state with a long-running physician shortage.

    An acute problem for trans-people. But the physician shortage is a long running consequence of ADA standards strangling the supply of MDs, combined with private payers constricting payments and private health providers constricting staff.

    When you hear "Trans-rights are human rights" its so much more than just treating Trans-people as people. Its about building a society where basic needs are met, generally speaking. It just so happens to have a knock-on effect that benefits the most vulnerable.

    • Honestly it's also probably an issue with for profit school as well. I think it's likely there are no shortage of people smart enough to be doctors, but many of them could never become doctors because of the overwhelming cost barrier to becoming a doctor in the US.

      For profit schools lock the population out of doing jobs that are needed, but that take a very long time to learn how to do. Being a doctor necessarily requires a long time to learn how to do because the body is complicated and it's important to get it right, but that doesn't mean that it should be prohibitively expensive to become one. I think the US specifically is going to see this more and more with highly specialized jobs... we'll have problems finding people to do them because less and less people can afford to learn how to do them

      • Honestly it's also probably an issue with for profit school as well.

        The modern higher education system has lots of tools in place to skim the "top" students from the mass of freshmen/sophmores. So you have these absolutely brutal courses that are deliberately constructed to fail X% of the incoming class, on the theory that they aren't worth the time to train through the end of the degree. Because of the high stakes nature of education, this creates some really perverse incentives around cheating, lots of student burnout, and a general waste of talent in the name of meritocracy.

        That's not just a for-profit education thing. Public schools use the same tricks. The end goal remains artificially restricting the volume of students entering medical school. And then medical schools perform the same trick, deliberately engineering the failure of another X% of the survivors.

        Incidentally, nursing schools and radiology schools and PA programs don't practice this kind of culling nearly so aggressively. They tend to be cheaper programs with lower bars to entry, and so we've got a steadily growing body for registered nurses and talented PAs who could have been doctors under a better system. Its an absolutely artificial class system baked into the medical training system.

        I think the US specifically is going to see this more and more with highly specialized jobs... we'll have problems finding people to do them because less and less people can afford to learn how to do them

        We're going to have people with high level degrees who do the administration and people with low level degrees doing the actual work. The talent to do the job will be just as common in both branches, but one will make 10x what the other earns, because that's capitalism for you.

        • It depends on the nursing school program as to how aggressive the culling will be. I went to a well regarded associate's program because it's cheap and has a good reputation in the region. The culling was ungodly. To even qualify to get into the program you needed to pass A&P I and II which were brutal classes requiring shitloads of study time because the tests were made to be "nursing school" difficult. You also needed at least a B+ if you were going to be considered for the program because entry is competitive. Then once you hit nursing school after all the prereqs and competitive entry, welcome to hell. My classmates that were successful tended to spend like 40-60 hours a week on school stuff between clinical rotations, studying, frequent classes, and whatever extra bullshit they threw at us like simulations. The tests were brutal intentionally doing trick questions and having 3 correct answers but having to pick the "most correct" because that's what the NCLEX did. Come the end of the first semester, like 2/3 of the class had been culled and that was normal. You picked up maybe 3-4 new people in semester 2 with LPNs picking up, but even then, by graduation it was like a quarter of the class that was graduating. Keep in mind that the obscene requirements never went away, if anything they got harder with requirements to pass with >78% or fail.

          If I had the scratch I absolutely would've gone to be a doctor.

          There's also the issue that even the medical field has been saying is probably not a good idea with the push for BSN qualified nurses to be the majority. 2 year programs provide a solid entry into the field especially with the level of 2 year education I got. The second two years are there for management and research based classes which has a purpose but doesn't make them "better" nurses. At my last job I worked with an LPN that had years of experience and picked up on stuff I would sometimes miss. Would bet good money that she was a far better nurse than those with fancy degrees that ran the place.

          And then you get countless quacks that somehow got into the field and do untold amounts of harm because hospitals will sweep it under the rug to protect their reputation. Just because they can get past all the culling doesn't always mean they're good for the job and there were several people I knew in my class that would've been great if they were given a bit more opportunity to blossom under a less aggressive program.

          • If I had the scratch I absolutely would've gone to be a doctor.

            TIL. Although, I've got a friend who recently made it through residency and it didn't sound any easier. I guess at least the pay is better.

            And then you get countless quacks that somehow got into the field and do untold amounts of harm

            I mean, a lot of the secret to being a good quack is to know when and how to lie. Go do a night school class at Harvard after getting your DO from a Caribbean college and then put "Harvard Educated Doctor" on your resume. Bomb out of your residency but still practice medicine under your degree. Straight up lie and say you have credentials that you never obtained. Then latch onto what marketing folks want to promote, look good in a lab coat, and hustle product.

            The other side of the AMA coin is how under-policed and under-regulated the medical-adjacent fields happen to be. You can make all sorts of claims under the label of herbal supplement. So there's a real economic incentive to cheat, lie, steal whatever makes money.

            Just because they can get past all the culling doesn't always mean they're good for the job and there were several people I knew in my class that would've been great if they were given a bit more opportunity to blossom under a less aggressive program.

            The culling definitely creates a certain kind of doctor. And the stress/debt/abuse on the front end followed by all the flowery language and formality and ego-inflating on the back end, really does a number on anyone who wasn't already that way.

    • But the physician shortage is a long running consequence of **_ADA _**standards strangling the supply of MDs

      Do you mean AMA (American Medical Association, the largest lobbying group for physicians)? If not I'm really curious about how the ADA comes into this

    • Do you mean AMA standards?

18 comments