Florida Eases Licensing Requirements for Foreign Trained Doctors
86 comments
·October 25, 2024OutOfHere
modeless
It's amazing how people just accept that it takes 6 months or more to see a specialist and don't realize that it is de facto rationing caused by intentional supply restriction.
silisili
When I lived in Florida it was about like that. I couldn't accept that so just asked for the soonest appointment anywhere, and was assigned a new Haitian lady about an hour away who wasn't booked up yet.
Given the circumstances I expected the worst, but I was so amazed with her. She was tall, pretty, and extremely well spoken. Not that this matters a ton, just recalling my first impression shattering expectations. And she's the first doctor I've met that realized that my main problem was more with health anxiety than health itself and just kinda bro'd it out with me for a half hour.
All of that is to say, if this is what to expect from foreign doctors vs the purposely supply constrained 'elites' I'm accustomed to, consider me 100% on board.
klipt
People prefer to argue endlessly about private vs state funded healthcare without realizing that issue is completely orthogonal to the massive doctor shortage.
Same thing with the housing debate really. People prefer to argue snot rent control instead of just building more housing.
Tade0
You can't outpace investment demand - especially not in the phase when housing is used as collateral to borrow in order to invest in more housing.
China reportedly has currently enough housing stock to house their population twice over. Did that make housing cheap? Hardly.
We're only seeing sustained price decreases now that the bubble is bursting, but it's not going to make real estate more affordable, as it comes with a heavy economic downturn.
tivert
Some level of supply restriction is probably warranted, though less than what we have now. It would be bad policy to have talented people train intensely for 8+ years, only to have them emerge on the other side with a "sorry, oversupply, no job for you."
I think availability of lengthy and highly-specialized training programs needs to be carefully calibrated to avoid other kinds of rackets (like have been seen with law schools and certain kinds PhD programs).
AnthonyMouse
> It would be bad policy to have talented people train intensely for 8+ years, only to have them emerge on the other side with a "sorry, oversupply, no job for you."
"Oversupply" isn't a thing in the absence of price controls. If there are more doctors then they get paid less and because they get paid less there is more work for them. Medical research or labor-intensive treatment or diagnostics that wouldn't have been cost effective at higher salaries becomes so and it creates more jobs for doctors at the lower salary.
Of course, if doctor salaries get too low then fewer people want to become doctors, and fewer people going to medical school would cause salaries to go back up. So you end up at an equilibrium where doctors get paid the amount necessary to encourage people to go to medical school, but not wastefully more than that.
throwup238
We do it all the time with lawyers and PhD scientists of all stripes. Why should doctors receive special treatment?
(Wrote this before your edit introducing the second paragraph)
seanmcdirmid
Why is medical school in the USA an 8 year vs 5 year program like in other countries? Yes, they still have residencies to go through, but a doctor in China is still through with their education and training much faster than in the USA.
Our system is overly expensive in terms of training requirements for doctors and nurses, and it doesn’t show much improvement in quality for those requirements.
fny
(1) The whole point is to prevent people from going to school for 8 years in the first place. Five years is only 1 more year than the average degree. You could do the same for law and other professional degrees like a PsyD. Or are we planning to supply cap every degree? (2) The debt from a four year bachelors plus medical school is wild, especially at current interest rates. (3) You’re assuming there are no other jobs for would be doctors like in pharma, tech, or consulting. (5) How exactly do you plan to “calibrate” this? Why isn’t a warning label enough.
m101
It is an 8 year programme in order to reduce supply.
eru
The rationing is 'caused' by price caps (whether by law or informally observed).
Supply restrictions just restrict available supply, they don't cause long waits by themselves.
(Of course, this assumes that you don't want to re-interpret prices themselves as a form of rationing. That's a decent approach to take in some contexts, but eg doesn't gel with the common usage like 'food was rationed during the war', where we use 'rationing' in contrast to the usual price mechanism.)
cameldrv
There are no price caps. If you're rich, you have concierge medicine, and you'll see a great specialist whenever you want. The supply restrictions (and other things that reduce doctor productivity) cause a lack of supply relative to the amount of medical care that would be medically useful for the population. For people of normal income with normal medical insurance, that means that their care has to be rationed, or it would be unaffordable.
Calavar
> In the US, medicine is a racket where the supply is intentionally constrained.
The correct solution in that case would be to increase CMS funding for US residency and fellowship spots (which was frozen for ~25 years).
You should see this for what it is, salary suppression by importing foreign labor, in a similar vein to what the tech industry did with abusing the H1B system until fairly recently. It's easy to lower costs by cutting corners on quality, but that is not a pro patient move.
tivert
> It's easy to lower costs by cutting corners on quality, but that is not a pro patient move.
They're doing that, too. See the proliferation of physician assistants and nurse practitioners.
eru
Foreigners are also people.
IG_Semmelweiss
Can you imagine a Federal law that makes state Medicare or Medicaid funding contingent on the state jurisdiction recognizing all professional licenses granted by all other US-states ?
So that a practicing doctor etc could easily move their practice and their skills from say NJ to FL, without the hassle of maintaining multiple state licenses ?
That would make an incredible revolution, and its not even touching the actual constraints inherent with the MD education barrier!
Another one - bring back apprenticeship!
masklinn
The US is far from alone in that.
numerus clausus is very common in med-related fields (medicine, pharmacy, dentistry, and vet).
Now some limitation does make sense as there’s only so much space for rotations and internships, but the limits tend to be artificially low.
ww520
Yes, the boards of different states have quotas to limit the number of people passing the medical board exam each year.
BTW, more doctors should follow what this doctor does. https://www.youtube.com/watch?v=yCtAdgpW_Vs. Their website shows they're charging $40 per visit currently, vs $35 4 years ago.
jakub_g
It's the same in Europe as well. It's maddening. Every year I read of massively missing doctors, and at the same time, universities reject 90% of applicants or so because they don't have more places. So those doctors get "imported" from poorer countries, leading to brain drain and making situation in _those_ countries even worse.
It's especially bad now that the societies are getting older and boomer generation retiring. I routinely read news like "the doctor in town X is 70 y.o. and wanted to retire but his patients couldn't find a new doctor, so he came back from retirement".
In France every doctor wants to live and practice in big cities, there's even a term "medical deserts".
In Poland on the other hand, it's very common that a doctor either works in multiple hospitals at the same time (and sometimes also has a private practice); or having cabinets in different towns and every day being in a different town. So in those small towns you can see a specialist like "once month on Wednesdays".
Tade0
My neighbour is working towards qualifying to specialise in urology. Problem is, there are just 43 openings a year for the entirety of Poland. That puts a hard limit of less than 2k specialists total at any given moment unless we expect people to work in retirement.
Currently there are around 1300 such people. How are they supposed to provide services for a country of 40mln residents?
sunshine-o
True, and from what I have heard there is really a "lower cast" of staff being taken advantage of because they were trained abroad but working in EU hospitals.
So as usual it is very hypocritical. In that sense Florida's move make sense.
As always, it is that way of thinking that has been dominant in the west for at least 50 years: why bother making anything here if we can just import it for cheap?
kurthr
I'd take this generally more seriously, if the number of licensed physicians in the US wasn't growing 3x faster than the population, or if the number of international medical graduates wasn't already 23%.
The US population grew by 8% from 2010 to 2022, increasing from 309,327,143 to 333,287,557. The number of licensed physicians grew 23% from 850,085 to 1,044,734. So it's not retirements, or graduations and general licensure. It's the number of General Practitioners, and the number people they treat and amount of time they spend (not necessarily the care the patients receive) that makes wait times longer.
The fact that almost all of them are now in larger (private equity controlled?) groups rather than working as independents. That many more choose to specialize for higher pay so that they don't have to work with the masses. It is in the interests of the insurance groups for the price of healthcare to rise since they make a percentage of that cost as profit. As long as everyone has to pay more the insurance companies can pay their executives more money and provide dividends to stockholders. They want all patient care to be a hassle. They want to mandate additional busy work to every transaction. They want drug prices to rise. It improves the bottom line.
I don't know that brining in a few more doctors from Barbados or Australia or the UK is going to improve that, and it's probably going to make it worse in other places (that don't have for profit healthcare insurance).
https://meridian.allenpress.com/jmr/article/109/2/13/494447/...
blindriver
It's even worse in Canada.
floydnoel
> Specifically, Alabama, Colorado, Idaho, and Washington already have enacted such legislation. Many other states are considering similar bills.
Fantastic. Licensing requirements are often insane and provide no value to consumers.
triyambakam
Hawaii is the worst (in many regards, actually). There are "certificate-of-need laws"
> CON laws require businesses that want to build a new medical facility or offer a new service to go through an arduous state approval process. Moreover, they must prove their service is “needed.” [1]
[1] https://www.grassrootinstitute.org/2023/10/hawaii-healthcare...
eru
Aren't those common in most states in the US for new hospitals?
dinobones
Does this mean Caribbean medical school is less of a scam now?
garrettgarcia
Does anyone know which and how many foreign medical schools qualify?
tivert
> Does anyone know which and how many foreign medical schools qualify?
This is about residency programs, not medical schools. IIRC, graduates of pretty much any foreign MD program can already practice in the US, they just need to complete a US residency.
ghufran_syed
check the ecfmg website
nine_zeros
It would really help for primary care doctors to start more private businesses - much like dentists. There is no reason to be stuck in hospital systems that grind doctors so much.
The revenue savings from the hospital not taking cut might even make primary care a highly paid profession - enough to incentivize more people to take up this specialization.
rediguanayum
Hospitals don't provide primary care, and they are not the problem. The high cost of hospitals is due to insurance system incentivized for profits over efficiency and service to the patient: https://www.propublica.org/article/why-your-health-insurer-d... It does not help that private equity has also discovered hospitals as a source of revenue: https://www.propublica.org/article/investors-extracted-400-m....
To understand the true cost of the American medical system, I think you need to look over the border at most any other 1st world country's medical system. Doctor's training is lot cheaper, so more people are incentivized to go into primary care. Insurance is better regulated or single payer. Hospitals are not forced to provide free care (US EMTALA) that causes financial uncertainty. Patients are typically incentivized to not abuse the system unlike the US (e.g. Dilaudid drug abuse enabled by EMTALA)... etc etc...
2Gkashmiri
in india you can go to a government hosipital and you get a big line but you are seen by top doctors. you go into an accident, you are met with the top most doctors of that area.
the only thing upfront cost is to get a "Card" or a prescription number from the registry outside. costs Inr 10 normally or $ 12 cents.
that gets you infront of a doctor who can decide what to do with you. blood tests or some radiology or something else.
if you are to be admitted, they ask you to get a "file" that costs around $ 1 or $2. that gets you a bed in a general ward where you are monitored by good doctors.
surgery if you have a health card, you dont have to pay anything. there is a line for non-essential procedures but if its an emergency, you are prioritized and taken care of.
i have relatives working in government hospitals and their opinion is to not do procedures in private hospitals. it just costs an arm and a leg (without insurance) and you dont even get best care because consultants/top doctors arent even available during nights for example.
seanmcdirmid
Sounds similar to China. One issue is that they don’t provide many nursing/nurse assistant services, so you have to bring your own (usually family members, but you can hire someone to do it).
I just used private hospitals in China which are very western, and not very costly with private insurance. Yes, the ER is only staffed by a couple of doctors at night, but that worked for me.
Calavar
> It would really help for primary care doctors to start more private businesses - much like dentists.
You're talking about reversing tidal currents that have been in effect for over 30 years. It isn't happening. The financials make it increasingly difficult for lone hospitals to stay independent of big health systems, let alone small group practices and partnerships.
Medicine has been corporatized and commoditized. Next comes enshitification. For example, dropping the requirement for American doctors to complete their training in America.
DrammBA
Does anyone know how would this interact with the USMLE, does it override it?
Not sure why the downvotes for an honest question, could you at least point out what's wrong?
aspenmayer
In case anyone else was, like me, unfamiliar with the abbreviation USMLE:
https://en.wikipedia.org/wiki/United_States_Medical_Licensin...
ghufran_syed
no, you still need usmle to get ecfmg certification. the difference is that you wont need US residency to get a state medical license
2Gkashmiri
would this help doctors get a visa now that there is a "need" for them because local doctors are incapable of doing the work themselves?
sawTinMoe
[flagged]
sawTinMoe
[flagged]
sawTinMoe
[flagged]
johnnymonster
Why don’t they ease up or streamline their zoning and permit process so people can build back their homes after hurricane damage?
Larrikin
Will that be combined with less tax payer funding to those who build back their homes in places constantly hit by hurricanes?
In the US, medicine is a racket where the supply is intentionally constrained. Changes such as these should help ease the burden of doctor cost and availability.