> our healthcare outcomes are poorer than other countries, people still can’t afford their healthcare, and our healthcare providers are burnt out.
> How can this be, and how can we change it?
This is a great problem to tackle but has many different angles at play. I just wanted to share my sentiments.
I am a lay person, but have you considered lobbying Congress to fund more residency positions? These are paid by the government, and limits the number of residents that may exist in any given year. It seems hospitals do not want to fund salaries of residents themselves (why???). This trickles back to medical school acceptance rates: schools want to maintain high "placement rates" (no. of graduates who place at a residency). Growing numbers of potential young folks wanting to be doctors cannot make it because of an artificial limit on residencies, and schools thus examine increasingly arbitrary metrics of their applicants. Doubling or tripling the number of residencies would seem very useful.
Second, cost of medical schools is so high that students and residents increasingly pursue specialties. The majority of the population first interact with a generalist, of which there are fewer.
Third, due to the above shortages, our system has created very weird solutions such as Physician Assistants, and giving them and NPs more responsibilities like an MD or DO would have, but they have less rigorous training.
Fourth, we have a merging of residency paths between DO schools and MD schools, increasing the pressure of individuals on residency slots, too. New schools cannot be created nor grown without allowing for a greater number of residency slots to be funded.
We need to open the "flood gates" holding back all the would-be doctors in our country, and allow them to enter schools. I'd be curious to see a ratio between residency slots and overall US population as a graph over time. Are they diverging? etc.
Incentives is also a great angle to work on.
Thanks for reading.