Why Are American Doctors Paid So Damn Much?

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57. Med school admissions increased throughout the '00s.

Med school graduates increased throughout the '00s.

Number of new doctors entering field per year stayed pretty constant.

The problem is that people assume "med school graduation" = "becoming doctor."

What training slots stayed constant during that time?

Residencies. They can only train so many per year. Oddly, that number is lower than the number of med school graduates so it's the bottleneck.

And for that, you get to blame a governmental decision to not increase the number of residencies--horribly expensive--because there was going to be a glut of doctors. Hospitals could, of course, add residency slots themselves, but so many already have razor thin operating margins (which the ACA is unlikely to help, as it tries to reduce costs by paying less) that they probably can't easily afford it.

So instead, we're going to vastly increase demand while holding supply constant. In 2010 the first decision should have been to increase the number of residencies.

The other problem along the way was restricting payments to GPs. Which caused more people to head for specialties. (In that horrible fit of selfishness that some people, but certainly nobody here, have called "trying to get higher pay" and "trying to get better working conditions.&quot The solution to that seems to be restricting payments to GPs.