There are quite a few highly paid professions where the main purpose of that profession’s union seems to be to prevent there being an adequate supply of the professionals.
Because they are overworked? Most of the physicians I talk to want more physicians. My understanding is that the limit on residencies is a huge bottleneck, which receive most of their funding through CMS.
The US docotor shortage is a myth. Wait times are the result of beauracratic nonsense has reduced the efficiency of the existing physician workforce [1, 2].
In my experience a big part of the problem is specialists. I remember many years ago people were saying that we shouldn't go to a Canadian style single-payer system because Canadians had rationed care and they had to wait six months for a hip replacement.
Well, guess what? I now also have rationed care. I have to wait six months just for a colonoscopy, plus I pay twice as much for the privilege!
Part of the specialist problem is they make so much they realize they can work for ten years and retire, instead of working the 20-30 years that used to be common.
Has nothing to do with wait times. AMA lobbies the government to keep number of seat at med schools low, number of residencies low, etc. as a result number of licensed doctors is low, and salaries remain high.
The AMA has been arguing for increased medical school seats and increased GME funding for about 20 years now. There have been 27 (!!) new medical schools opened in the last 15 years, in large part driven by the AMA in its capacity as one of the two primary stakeholders in the LCME, which accredits allopathic medical schools.
1 out of every 7 medical schools currently active in the US was founded in the year 2010 or after. That's a veritable bonanza in medical school creation, facilitated by the AMA.
What I find interesting is how often casual discussions about unionization on the internet will organically reinvent this concept. Especially on HN, Reddit, and Twitter the banter about unionization always seems to pivot toward using the union to force companies not to hire certain developers.
The obvious one that comes up in every discussion is thinking that unions will protect their jobs from being outsourced to other countries. People like to layer various more palatable explanations on top of this to make it sound better, but when you ask them if the employees who receive the outsourced jobs should get the same union protections you usually get their real motivation: They want to keep the jobs local to their own market and exclude foreign labor supply in order to improve demand for their services (and therefore their leverage, and therefore their own wages)
It gets interesting when different demographics start imagining that their ideal union would protect them from other demographics: Commonly, older people like to think of unions that will protect them from losing their jobs to young people.
Then when I’m working with college students and they start discussing hypothetical unionization, they come up with ways to think the union will give them more jobs by protecting them from the old people “hoarding” the jobs. (Sorry, that’s the least likely outcome for a union)
What’s most interesting is that the people I know who are in unions (non-tech industries) don’t hide the fact that decreasing labor supply to increase their own demand is exactly what they expect from a union. The first time you hear someone complain that a non-union worker is “taking food off their table” by simply doing their job you realize that it’s not as simple as Unions versus Corporations like we’ve been led to believe. The Unions are advocating for the people in the union, not workers everywhere.
> The obvious one that comes up in every discussion is thinking that unions will protect their jobs from being outsourced to other countries. People like to layer various more palatable explanations on top of this to make it sound better, but when you ask them if the employees who receive the outsourced jobs should get the same union protections you usually get their real motivation: They want to keep the jobs local to their own market and exclude foreign labor supply in order to improve demand for their services (and therefore their leverage, and therefore their own wages)
Bear in mind it's completely normalised for companies to charge higher prices in one market than another, and put barriers in place to make sure customers in the more expensive market can't just pay the lower price. So all the union is doing here is bringing it closer to a level playing field.
The cost of training is real. 15 ago a colleague did the training slowly while working for some training companies and it costed him just $42,000 to get ATPL, but you need to take trainings and flight hours and that is most of the cost. There are enough people willing to become airline pilots, but most don't have the money and the cost is not an artificial barrier.
Even the cost of PPL, the lowest license on the path, is around $10,000 while the ultralight (European)/sport pilot (US) is over $6,000. From that you need CPL (commercial), multi-engine, complex aircrafts, instrument rating (bad weather or night) etc., that takes time and money most people cannot afford.
Its just like nationality based employment rights(need to be citizens or have a visa/permit to work) but more granular.
It can have its place, i.e. a way to balance bargaining power with the employer. It’s inherently anti meritocratic though.
In some cases it’s not about merit or about limiting supply however. In some cases it’s impractical to test someones work continuously, so instead it becomes honor based. That is, you are expected to go through an elite track and succeed in an exam once and then you are good for life unless you commit fraud or show gross incompetency.
It's easy to have really good health outcomes at really low cost if you just fabricate the data. It's easy to export lots of doctors if you force them to work abroad, force them to pay most of their salary to the government and hold their families hostage to ensure compliance.
It's difficult to understand your point given how this was written. However, it's worth pointing out that the Cuban doctor export scheme is, in fact, very profitable to the Cuban government.
Much less so to the doctors themselves, which frequently have to work in what amounts to conditions of indentured servitude. And they have no other option, as working as a domestic doctor in Cuba typically pays less than being a taxi driver.
One has to wonder why they don't just copy the Cuban model of having a surplus of their own slave doctors, especially given the supposed immense profit potential!
To be honest, I'm not convinced of your explanation.
I'd call this soft power projection by medical means. Which is absolutely OK IMO, compared to lets say producing AK-47, or meddling in other countries internal affairs, invading and destroying them, and whatnot else.
I think you're overcomplicating things. Castro was very vocal about medical care being a top proority during and after the revolution. There's no coincidence or conspiracy.
When you try to build a society around human needs instead of capital needs, you end up with different priorities. It's that simple.
If anyone thinks they're making the big bucks and accumulating "soft power" by training a bunch of doctors then selling treatments to Americans for cheap, I'm not sure they can be helped.
Yah. Maybe I can't be helped. Shrug. I got aware of this, I don't know exactly when anymore, has to be about 15 years ago now, or even longer.
I wondered about why there were almost always cuban medics, doctors, nurses etc. in action, when there has been some larger catastropic event in the world, and you could see them in the media.
Why is that, I thought? That doesn't fit being sanctioned by the US(and vassals), being poor in general, and so on.
That's how I became aware of ELAM.
And made up my mind the way I described. Can't help it :-)
Maybe I should have written Why is that? According to the picture mainstream media is projecting, this shouldn't be, because they can't afford it?
I'd feel offended if the YOU in "You cannot imagine a motive beyond calitalist logic, but that doesn't mean nobody else can." was addressed to me, personally.
Or was it just meant as a general description of the concept?
