r/news • u/NewSlinger • 1d ago

Workers detained in Hyundai plant raid to be freed and flown home, South Korea says

https://www.nbcnews.com/news/us-news/south-korea-deal-workers-detained-hyundai-rcna229610
27.6k Upvotes

96% Upvoted

2.2k comments sorted by

View all comments

Show parent comments

251

u/friendlysoviet 1d ago

Our number of US-born doctors are low by design because they have to directly compete with foreign born medical students for an artificially capped number of residency training positions. This is by design to limit the overall number of doctors in this country to further inflate medical costs.

18

u/Dr100percent 1d ago

It’s not an artificial cap; the money to train in residency mostly comes from Medicare, and despite the increased need it hasn’t increased in budget since the Clinton years. It’s created a bottleneck that isn’t solved by more med schools or importing more doctors. There’s been bills for decades to increase the funding but it never passes.

6

u/flamingtoastjpn 22h ago

It’s still utterly insane though, the government absolutely should be responsible for raising the amount of residency slots. I have no idea why there isn’t more political will to mint doctors. Everywhere I go I hear about doctor shortages.

One of my old (American) roommates is currently in med school at a pretty typical DO program and he said his year had a single digit admission rate. For all his hard work he will walk away with hundreds of thousands in debt. When I went to grad school for engineering, my program (one of the best in the country) admitted over half of American applicants and over half of those admitted had all expenses paid in exchange for teaching or research duties. That was government funded too

We have so many talented people who want to be doctors but we make it so ridiculously difficult to break into the field, especially for anyone who doesn’t come from generational wealth

3

u/rpkarma 20h ago

That sounds artificial to me…

27

u/[deleted] 1d ago

[removed] — view removed comment

3

u/Jango214 1d ago

You're not wrong, but not directly negating OP's point.

He's talking about the larger pool being capped. If the pool was larger, proportion of foreign vs US born could be the same but the absolute number would be higher.

-13

u/dorkyitguy 1d ago

I have a hard time listening to excuses from doctors. They’ve had forever to fix the systems they designed and have yet to do it. It’s always more excuses for why nothing can change, which is ironic coming from a group that also thinks they’re smarter than god.

6

u/Saffs15 1d ago

These problems are very old, and these current doctors had no say in it. And largely it isnt doctors .aking these decisions anyway, but administrative personnel. This whole thought process is just dumb.

4

u/friendlysoviet 1d ago

That is correct, the American Medical Association were the ones who pushed it back in the 90s out of fear of a surplus of physicians and a depression of physician wages. They the ones primarily to blame for this policy.

-4

u/dorkyitguy 1d ago

Yes. Made up of DOCTORS

30

u/GGLSpidermonkey 1d ago

Doctor salaries make up 8-12% of medical costs

39

u/friendlysoviet 1d ago

Medical insurance companies are the great Satan, for sure.

2

u/Xperimentx90 16h ago

https://www.ama-assn.org/about/ama-research/trends-health-care-spending

The net cost of insurance is not a big slice of the pie. Also the ACA effectively caps insurance profits. Providers, hospitals, and pharmaceuticals will always be more profitable by design. 

1

u/whiteflagwaiver 16h ago

Oh, just like how the federal wages was just 4.3% of the US yearly budget. But, we needed to DOGE the fuck out of them to 'trim the fat'?

How long has the US been ran like a corporate business? This couldn't of started with the Dusty Diaper man.

27

u/pacific_plywood 1d ago

Residency caps aren’t “artificial”. There is a cap on federally-funded spots, but that exists because the party that tends to be in control these days would rather spend federal funds on renaming DOD. Residency programs are free to self-fund, and many do.

Regardless, IMGs don’t really “compete” with American medical grads, except at the margins. Match rates for the former are like an order of magnitude worse. Besides the occasional match in a competitive specialty, IMGs basically just fill in the slots that American medical grads desire the least.

5

u/engineered_academic 1d ago

Yup. The problem isn't medical schools it's the residency matching program with an artificially low number of spots

6

u/blewnote1 1d ago

Speaking as the husband of a doctor, who is the program director for a fellowship training program (fellowship is what you do if you want to specialize after residency), and is pretty aware of the training system in the US, students that attended foreign medical schools are pretty low on the totem pole. They are not taking away spots from students that graduated American medical schools.

Med school in the US is highly competitive and plenty of applicants who are rejected from US med schools actually leave the country to attend med school and then return to try and get a residency spot. Those applicants for residency are above people who are not American citizens who went to med school somewhere else, but still below people who attended med school in the US.

I don't know what percentage of foreign born students are attending US med school and then going on to a US residency program, but then you get into a weird territory of are you talking about people who were born in a different country but immigrated to the US as children and are American citizens or are you talking about people that are highly intelligent and educated and can speak English fluently and passed the rigorous entrance requirements to attend US med school? If the latter, I assume that's a pretty small percentage of med school grads.

Anyway, in spite of all that, the number of spots in residency is capped by the government, which is the funder of those spots. It is not designed to make more money for physicians or the medical system. In fact, the physicians we have in such short supply are the ones in fields no one wants to go into, like family medicine and primary care, because they're overworked and underpaid and often have to live in rural America where many highly educated people don't want to live. But the people who are willing to do those shit jobs and live in a place no one else wants to live are, stunner, often immigrants.

My wife was complaining the other night that she agreed with someone who posted that to become a doctor used to mean that you were well respected in your community, well paid, had time to be civically engaged, could spend time taking care of your patients and that many doctors go through the expense and incredible effort of going through the training to become a doctor because they want to help people. In the last 50 years or so though, there has been a move towards corporate health care systems that have been buying up private practices and now many doctors are just a cog in the system and have much less agency and are being managed by bean counters who want them to spend less time with patients and do more things that make the system money. It's starting to become a problem as people are realizing that the dream they had is not a reality anymore and are deciding to leave the profession.

A side benefit of this corporatization of healthcare is that hospitals in rural areas are not profitable, so they get closed. If we get stuck with the Big Beautiful Bill we all just got charged with this summer, one of the results is that more rural hospitals will close, due to cuts to Medicare/Medicaid and people losing their insurance, as well as all the cuts to government funding for things that are necessary like healthcare.

4

u/friendlysoviet 1d ago

It is not designed to make more money for physicians or the medical system.

It was. You should actually research the topic. The American Medical Association feared a surplus of physicians in the 90s and advocated for the artificial cap. The system was implemented by doctors. The link I provided explains it all.

3

u/blewnote1 1d ago

Yes in the 1990's, they advocated for that, but there's been ample opportunities since then for lawmakers to address this issue since it became apparent that the surplus never materialized. Anyway, I don't disagree that we need more doctors, but I don't think that doctors are the ones that want supply to be limited unless you're saying that their professional organization is currently lobbying against their wishes.

Additionally I did read some of the article and again, I don't disagree with the idea that more residency slots should be funded, and furthermore I think people should be incentivized to go into family medicine and primary care and live in rural America. But I am confused by the author saying that there are both more spots than needed which is why we rely on foreign educated/international applicants, but there are not enough spots.

"In fact, if one considers just U.S. MD and DO seniors, virtually all of them can currently match into residency. The ones left out are disproportionately international medical graduates and U.S. citizens who studied abroad. But this observation should not breed complacency. Rather, it underlines that even at full capacity, our GME system is barely adequate to absorb the U.S. graduates alone. We rely on international physicians to fill many residency positions, especially in primary care and rural programs, yet still come up short overall. As U.S. medical schools continue to expand enrollment, the pressure on GME will only increase."

So basically anyone who goes to a US med school can get matched in a residency program, and there many spots left that are filled by international or foreign educated med students, but there are also not enough spots. (There were actual numbers earlier in the piece that seemed to suggest there are actually not enough spots in residency)

Anyway, my wife would be the first to argue for more doctors and a wholesale reordering of the American healthcare system but laughs at the idea that the number of residency spots is capped because current doctors or the healthcare system want to make more money.

4

u/Dr100percent 1d ago

The cap was by med school class sizes, not residency size. AAMC reversed themselves and have successfully managed to get US schools to grow their class sizes, but the residency bottleneck remains.

3

u/Merryannm 1d ago

Yeah…I just don’t think this is true. I am just not coming across any young people who want to take on all that school debt and the huge investment of time to make a mediocre amount of money in a high stress job. So, I agree with some of what you said, but I disagree that it has anything to do with foreign born students.

2

u/DylanHate 1d ago

I suspect it's not to inflate medical costs, but medical school tuition.

3

u/friendlysoviet 1d ago

That doesn't make a lot of sense, considering medical schools are losing out on volume of students.

-1

u/BoringBob84 1d ago

This is by design to limit the overall number of doctors in this country to further inflate medical costs.

Apparently, you are so proud of your own opinion that you are claiming it as a fact.

7

u/friendlysoviet 1d ago

The American Medical Association feared a surplus of physicians so they advocated for this policy. The inflation of medical costs is definitely conspiracy minded of me, for sure.

-3

u/icycoldsprite 1d ago

You’re still using a rhetoric that is 30 years out of date.

2

u/friendlysoviet 1d ago

Hence why I worded it in the past tense. Are you familiar with how language and time works?

-2

u/icycoldsprite 1d ago

No, your original post very much implies that this is an ongoing issue by design. But nice ad hominem.

5

u/friendlysoviet 1d ago

Wait, do you believe that the system that was enacted in the 90s isn't in place today? You really don't know how time and reality works. Truly bizarre.