About the author: Derek Thompson is a staff writer at The Atlantic and the author of the Work in Progress newsletter. He is also the author of Hit Makers and the host of the podcast Plain English.
B y the time Elizabeth Erickson was a freshman at Davidson College in 2002, she knew she wanted to become a doctor. Because she understood that the earliest health interventions are among the most important, she set herself on a pediatrics track. After four years of premed classes, she went straight to medical school at Wake Forest University, which took another four years. Then came three years of residency at Duke University, plus one final year as chief resident. In 2014, she joined the faculty of Duke’s School of Medicine. Her dream was realized at the steep price of 12 consecutive years of learning and training, plus about $400,000 of debt.
Erickson’s story would be exceptional in just about any other country. But it’s hardly unusual in the United States, which has the longest, most expensive medical-education system in the developed world, and among the lowest number of physicians per capita. There is a huge scarcity of primary-care doctors, like pediatricians, and many of us are operating in a scarcity framework without enough resources, Erickson told me.
In erica needs an abundance agenda-a plan to attack the problems of scarcity in our housing, infrastructure, labor force, and, yes, health-care system. As the pandemic has made clear, we need medical abundance in the 21st century. That means more high-quality therapies, more clinics, better insurance, and better access to medicine. But it also means more doctors.
As I dug deeper into the roots of America’s health-care scarcity, I realized that I had to start by answering a simple question: Why does America make it so hard for people like Elizabeth Erickson to practice medicine?
S. is one-third better than Switzerland
I magine you handy link were planning a conspiracy to limit the number of derica. Certainly, you’d make sure to have a costly, lengthy credentialing system. You would also tell politicians that America has too many doctors already. That way, you could purposefully constrain the number of medical-school students. You might freeze or slash funding for residencies and medical scholarships. You’d fight proposals to allow nurses to do the work of physicians. And because none of this would stop foreign-trained doctors from slipping into the country and committing the crime of helping sick people get better, you’d throw in some rules that made it onerous for immigrant doctors, especially from neighboring countries Mexico and Canada, to do their job.
Okay, I think you’ve cerica has already done all of this. Starting in the late 20th century, medical groups asserted that America had an oversupply of physicians. In response, medical schools restricted class sizes. From 1980 to 2005, the U.S. added 60 million people, but the number of medical-school matriculants basically flatlined. Seventeen years later, we are still digging out from under that moratorium.
What I’m asking is: What advantage do these additional years and loans get us?
The U.S. is one of the only developed countries to force aspiring doctors to earn a four-year bachelor’s degree and then go to medical school for another four years. (Most European countries have one continuous six-year program.) Then come the years of residency training. Medical education is a necessary good; nobody wants charlatans in the OR and snake-oil salesmen prescribing arthritis medication. I suppose it’s conceivable that American doctors are 33 percent better than Swiss doctors, given our 33-percent-longer medical schooling. But good luck trying to find a national health statistic where the U. Americans die earlier than their European counterparts at every age and income level.