When choosing a primary physician at one of the San Francisco Kaiser Permanente campuses, I noticed that a substantial number of doctors had overseas medical training. Which was fine by me--I'm an enthusiastic Kaiser member and support their cost management strategies--but I found it interesting.
> So they're now using a mixed strategy of both out-sourcing and in-sourcing medical training to address high costs.
Not as much as they could though - there are still federal caps on the number of fellowship seats available as well as pretty strong restrictions for physicians coming from overseas (although if I recall correctly, California has less stringent restrictions than most)
We discuss insurance as a big part of the cost problem, but regulatory capture on the supply end is another huge (and unnecessary) factor.
You don't need full MDs for respiratory therapy, or for many medical treatments. PAs and RNs can do a lot, and it's far easier and less expensive to attain those certifications than full MD.
Doctors wouldn't let either of those things happen because it would lower their salary. The AMA is a powerful lobbying association, no way any law that lowers doctor salary would pass.
Lobbying power can be confronted by other considerable lobbying interests. Large healthcare conglomerates would seem to have considerable interest in reducing labor costs.
A crisis like this would be the perfect opportunity to fix some of these supply side issues. Lobbying is less effective when voters are paying attention and the government is in crisis-response mode.
