[kyouens]

The limiting factor to creating more skilled physicians is not medical school admissions. It's residency training slots. Most residency training slots rely on federal government funding. Pretty much everyone, including the AMA, agrees that there is a looming undersupply of physicians. There may be disagreement on the best way to address the issue, but there is little disagreement among physicians about the fundamental problem.

I have seen comments talking about "physician cartels" purposely encouraging a labor shortage to drive up physician pay. There is no physician cartel. Only about 15% of physicians even belong to the AMA, and only a subset of those have any political involvement at all. It just doesn't exist.

One of the things that I think contributes to the general dissatisfaction of physicians in 2017 is the increasingly negative public opinion of the medical profession and the imputation that there is some sort of evil conspiracy at work. A lot of the negative opinion is misdirected. It should be aimed at the for-profit health care system itself. Most physicians I know have very little control over the things people complain about, including cost.

[killjoywashere]

Depends on who's complaining about a bottleneck.

The AMA caters to a base that is not happy with the influx of IMGs and DOs. The AMA inflates their numbers by auto-enrolling every allopathic medical student. The AMA is equally unhappy that the government using large scale funding levers at the residency level to overwhelm their efforts to tighten supply. By using money and their exclusive access to legislate, the government creates such a Venturi effect that they suck up all the available MDs, and all the available graduates from two other pipelines: the DO programs and the IMGs.

In 2017, the dissatisfaction of the 85% of physicians who don't belong to the AMA is ultimately driven by too much work.

Source: am physician. Have worked primary care, seeing 40+ patients a day, now completing a specialist residency. My work as an underpaid primary care doc was enough to keep 3-5 people fully employed (reception, x-ray certified assistant (sometimes 2), office manager, owner) from 8 am to 10 pm 7 days a week, while sending overflow to others.

Every one of the 85% of physicians who aren't in the AMA declined to renew their membership at some point. Many align with other orgs: almost invariably their specialty's organization, which aligns with the AMA but they are more professionally beholden to (for CME, board certification, etc). Many try to offset the ill effects of the AMA by aligning with other orgs like PSR or MSF or their local public clinics.

But the AMA has a bunch of offices in DC, and has had people in those offices, paying mortgages in McLean or Chantilly, or Silver Spring, <insert DC suburb here> for a century. Those people are motivated to continue their mission of lobbying in support of the legal grip of allopathic medicine, long past their original call to arms (licensure laws to cleanse the field of snake oil salesmen).

[kyouens]

I'm also a physician. I am generally satisfied with my work, but I do feel distressed by what feels to me like erosion of the social contract between doctors and society that flourished during the second half of the twentieth century. It sounds like we agree that some of that erosion has occurred because of nakedly self-serving political action by medical professional societies.

When I made the decision to become a physician twenty years ago, I thought medicine was my calling. I believed that the personal sacrifices one makes to be a physician--and there are many--would be rewarded with professional pride, the respect of my community, the gratitude of my patients, and a secure and well-paid living. I have gotten a little wiser, I think. I make a good living, my work is interesting, and I still think medicine is a great career. But times have changed, and I no longer consider medicine a calling for which one should be willing to sacrifice one's personal well-being. I find myself defending my profession on the internet a little more than I'd anticipated :)

Those who control the business of medicine take economic advantage of the patient-first mindset of our medical tradition, and it cheapens what we do, both literally and figuratively. It is for that reason that, despite its many flaws, I do think organized medicine does have redeeming qualities. It gives physicians at least some voice in politics, where they would otherwise have none at all. Maybe one day health care reform will right the ship.