At least in my area, huge medical groups or insurance companies have bought nearly all primary care practices. They’ve cut costs and raised prices and it’s virtually impossible to see an MD for an acute medical condition. All procedures need to be scheduled out months now.

It reminds me of what some Canadian friends described their healthcare system being like 20 years ago. If we’re paying more and getting the same service, I’m not sure there’s much reason not to socialize healthcare now (health care, not insurance).

While getting less service, as a marketplace insurance purchaser my premiums are doubling next year. It’s still “cheap”, but that would be a significant shock for most families.

In mid-2023 I decided it would be good to have a primary care doctor since I was 74 years old at the time and hadn't been to a doctor in decades.

Full disclosure: I am a retired board-certified anesthesiologist.

I asked around town (Charlottesville, Virginia) and got two names from doctors I trust.

The first was not taking new patients; the second was, so I made an appointment: first available appointment was January 2025 (i.e., in 18 months). I happily took it.

I figured maybe this was a way of triaging old people like myself: if we're forced to wait long enough before being seen, maybe we'll die in the meantime so slots will open up.

Had the same thing in the Midwest about 8 months ago. Had to call a half dozen offices before one would take me and appointments had to be scheduled long in advance. I had not been to the doctor as an adult either and was quickly surprised by how frustrating healthcare is.

Primary care has the opposite problem right now. Practices are closing faster than new ones are opening, and doctors are leaving the profession faster than new doctors are joining. There is an actual shortage of primary care docs.

I laugh to myself whenever I read some disclaimer that says “ask your doctor” because… how? I’m supposed to call the office, wait six to nine months, and then ask about a mild health concern I had that’s long past?

I had this experience when shopping for a highly rated doctor. Luckily I was able to get in on a great doctor after a few weeks of casually calling around, and now can get appointments no problem.

When I was younger on crap insurance, I was able to quickly find one by having no standards other than "be a medical physician". And the doctor I went to was definitely lower rung.

No, it's not a matter of referral.

It's a matter of "current patients have filled the schedule indefinitely."

There is absolutely an artificial cap on the number of residencies (across specialties, not unique to dermatology). The majority of residency slot are funded through Medicare - Congress has effectively placed an artificial cap on the number of spots.

From what I gather, Congress set the current low limit due to lobbying from the AMA something like 30 years ago. The AMA has since changed its tune and wants more slots to alleviate shortages in some regions and specialties, but the funding has not materialized.

They dont need 600 dermatologists on staff. They need residency slots. These people aren't asking to work for the hospital permanently, they just have to check the residency box that is artificially limited by gatekeepers.

>Other developed countries seem to have said

The other developed countries doing this don't pay dermatologists 500k though.

I am not sure how you connect the first part of your idea to the last.

Would this not also be a problem in single payer systems? The article does not do a great job of it but it would be interesting to see the billings split between cosmetic and medical. The article is already on how the field is booming because of cosmetics, one of the interviewed doctors does not even accept insurance. This has nothing to do with capitalism vs socialized healthcare and all to do with cosmetic procedures which would mostly not be covered under a single payer style system anyway.

> Hospitals don't need 600 dermatologists on staff.

But imagine how available and inexpensive dermatologists would be.

(Okay, let's not say 600, but let's say 2x or 4x the current #)

My wife is a physician and she knows one or two otherwise very intelligent, well-respected, skilled surgeons who just do Botox because it's more lucrative.

seems like that's been the trend -- a lot of those set up around here, it seems. like, I can think of three off the top of my head, and I don't recall seeing em 3+ years ago.

Increasing the time and cost of the training is how the supply is limited.