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By definition, a healthcare system based on insurance can’t be as efficient as a universal system. Profits for healthcare companies and hospitals are wasted resources. Also, why the hell is medical school and residency so selective? They basically cap the number of doctors that we can have. We should be increasing the number of doctors. Create a universal system like every other developed country has. Cut out the waste that is private insurance. We pay way more than anywhere else for worse outcomes.
From a medical student: There is a different problem coming up with the production of more physicians. There are more new medical schools opening and existing medical schools are increasing class sizes....but the number of residencies has barely moved in decades. Residencies are funded through Medicare and the number of them is determined by appropriation bills in congress. There are some privately-funded residencies being created, but a lot of those are hideously low quality and being used as a source of indentured servitude by for-profit health groups like HCA. (They won't even hire their own graduates from their emergency medicine residencies because the quality of the training is so poor.)
And if you don't complete a residency, you can't practice independently. You have to have a board certification from an accredited residency to be able to practice medicine, and the only alternatives are working under supervision like a PA/NP....or working for the insurance companies. And you still have a mortgage's worth of student loans to pay off.
A lot of the doctors working for the insurance companies are ones that couldn't get into residencies or ones that have not kept up with continuing medical education and likely do not have active board certification anymore.
Agree, these are serious problems. I did consider going in to medicine, but realized that after taking on, like you say, a mortgage payment in student loan debt and spending years making little to no money in school, residencies, and internships, that the “doctors” salary was not that high after all. Rather you’ll spend your first several years playing catch up and paying off debt. Not to mention the hours…
The Biden SAVE plan actually made a massive change that makes it a lot more viable, especially if you do the PSLF program. It's set up so that if you're on an income-driven repayment plan, any interest not covered by your payment does not capitalize. So you might not make any progress on the principal of the loan while you're in residency, but it won't spiral out of control and the reduced payments count towards the 120 PSLF payments. I'm planning on doing a 3 year residency at minimum, maybe more, and probably a fellowship as well, so I'll have 5 years of reduced payments, and then I'll be working in non-profit community/county hospitals after that so I'll be able to use PSLF. Running the numbers, I think the government will be eating about $275k-$300k of my loans.