Sounds like an easy fix, Right?

聽起來很容易解決，對嗎？

We just need to train more doctors well as with most things in life.

我們只是需要像生活中的大多數事情一樣訓練更多的醫生。

It's not that simple dark ball med school insiders dot com.

這不是那麼簡單的黑球醫學院內部人士點com。

According to the double AMC, we can expect shortages of between 162,000 physicians by the year 2034.

根據雙重AMC的說法，我們可以預計到2034年將會有16.2萬名醫生的短缺。

But why is it so difficult to increase the number of physicians in the US here are five reasons why America has so few doctors to start.

但是，為什麼在美國增加醫生的數量如此困難，這裡有五個原因，為什麼美國的醫生這麼少，開始。

The United States has one of the longest training pathways to becoming a physician of any developed country.

美國是所有發達國家中成為醫生的培訓途徑最長的國家之一。

Becoming a doctor in the US requires you to complete a four year bachelor's degree, followed by four years of medical school and 3 to 7 years of residency.

在美國成為一名醫生需要完成四年的學士學位，然後是四年的醫學院和3至7年的住院醫生。

In contrast, many european countries, including the United Kingdom France Germany and Switzerland do not require a bachelor's degree and instead allow students to matriculate into medical school right after high school in general Medical school in these countries is 5 to 6 years in duration, after which students will complete residency training lasting an additional 3 to 8 years, depending on the country and the particular specialty.

相比之下，許多歐洲國家，包括英國、法國、德國和瑞士不要求學士學位，而是允許學生在高中畢業後立即進入醫學院學習，這些國家的醫學院為期5至6年，之後學生將完成為期3至8年的住院醫師培訓，這取決於國家和特定專業。

If we do some simple calculations, the shortest amount of time it would take to become a physician in the United States after high school is around 11 years, that's four years to get your bachelor's degree plus four years of medical school and three years of residency.

如果我們做一些簡單的計算，在美國，高中畢業後成為一名醫生最短的時間是11年左右，也就是4年獲得學士學位，加上4年的醫學院和3年的住院醫生。

In contrast, the shortest pathway to becoming a physician.

相比之下，成為醫生的最短途徑。

In many european countries, such as Switzerland, for example, would be six years of medical school followed by three years of residency for a total of nine years.

在許多歐洲國家，例如瑞士，將是6年的醫學院，然後是3年的住院醫生，總共9年。

Medical school admissions in the US are also highly competitive, which often adds additional years to the already long training process.

美國醫學院的錄取競爭也非常激烈，這往往會給本已漫長的培訓過程增加額外的時間。

According to data from the double AMC, double A comb and T.

根據雙AMC、雙A梳和T的數據。

M.

M.

D.

D.

S.

S.

A.

A.

S.

S.

In any given year, only around 36% of applicants to US, M.

在任何一年中，只有大約36%的美國碩士申請人。

D.

D.

And D.

而D.

O.

O.

Schools matriculated and only around 25% of applicants to texas.

學校預科，只有25%左右的申請人到德克薩斯。

Medical schools matriculated.

醫學院的預科生。

Although there are some countries where it is more competitive to become a doctor than in the US which we discuss in our medical school competitiveness by country video, it is not uncommon for US pre meds to apply to medical school multiple times before getting accepted because medical school applications occur once per year.

雖然在一些國家，成為醫生的競爭比美國更激烈，我們在我們的醫學院競爭力視頻中討論了這一點，但美國的預科生在被錄取前多次申請醫學院的情況並不少見，因為醫學院的申請每年一次。

Each unsuccessful application cycle adds an additional year to the already lengthy training process.

每一個不成功的申請週期都會給已經很漫長的培訓過程增加一年的時間。

Next is the exorbitant cost of medical training.

其次是高昂的醫療培訓費用。

Although physicians in the US earn higher salaries on average than their european counterparts at around $242,000 per year for primary care physicians and $344,000 per year for specialists.

儘管美國醫生的平均工資高於歐洲同行，初級保健醫生的年薪約為24.2萬美元，專科醫生的年薪為34.4萬美元。

The cost of becoming a physician in the U.

在美國成為一名醫生的費用。

S.

S.

Is also significantly higher.

也明顯較高。

As of 2022 the average cost of medical school tuition in the United States is approximately $55,000 per year, with some schools charging in excess of $70,000 per year at the upper end.

截至2022年，美國醫學院的平均學費約為每年55,000美元，一些學校的高端學費超過每年70,000美元。

It's no surprise then that the average medical student graduates with around 240 $2000 of student loan debt.

是以，醫學生畢業時平均欠下約240-2000美元的學生貸款也就不足為奇了。

With some students having in excess of $400,000 in student debt between tuition and living costs.

一些學生在學費和生活費之間有超過40萬美元的學生債務。

Over four years of medical school, it's only getting more expensive to as the average cost of medical school rises by approximately $1500 each year.

在醫學院的四年中，由於醫學院的平均費用每年增加約1500美元，它只會變得更加昂貴。

Although there are more pre meds than there are medical school spots as demonstrated by the roughly 36% matriculation rate.

儘管從大約36%的預科率來看，預科生的數量比醫學院的名額要多。

The cost of medical education can be prohibitive for many students, particularly minority students and those from lower socioeconomic backgrounds.

醫學教育的費用可能讓許多學生望而卻步，特別是少數民族學生和來自較低社會經濟背景的學生。

According to the U.

根據美國的說法。

S.

S.

Census, black and hispanic individuals are between 1.5 to 2 times more likely to experience poverty than white or asian individuals as such.

在人口普查中，黑人和西班牙裔個人比白人或亞裔個人更有可能經歷貧困，這是1.5到2倍。

Many of these students may be dissuaded from pursuing medicine due to the high cost of medical education.

由於醫學教育費用高昂，這些學生中的許多人可能會被勸退，不願意繼續學醫。

This is an important factor to consider as research has shown that physicians that come from poor or minority backgrounds are more likely to practice in underserved communities where the need for physicians is the greatest, perhaps the largest factor limiting our ability to produce more physicians, however, is the limited number of residency positions offered each year to practice medicine.

這是一個需要考慮的重要因素，因為研究表明，來自貧困或少數民族背景的醫生更有可能在對醫生需求最大的服務不足的社區執業。然而，限制我們培養更多醫生的能力的最大因素是每年提供的住院醫生職位數量有限。

As a physician.

作為一名醫生。

In the United States, you must complete 3 to 7 years of residency training after medical school.

在美國，醫學院畢業後你必須完成3至7年的住院醫師培訓。

The issue is that there are more medical students graduating each year than there are residency positions to accommodate them.

問題是，每年畢業的醫學生比容納他們的住院醫師職位要多。

During the most recent 2022 N.

在最近的2022年N.

RMP match.

RMP匹配。

There were approximately 6400 medical students that applied for residency that went unmatched even after the supplemental offer and acceptance program or soap.

大約有6400名申請住院醫師的醫學生，即使在補充錄取和接受計劃或肥皂之後，也沒有得到匹配。

That's approximately 15% of the total number of active applicants in 2020.

這大約是2020年在職申請人總數的15%。

To these students will have to put their training on hold for a year and do research or some other job while they strengthen their application for the following cycle.

對這些學生來說，他們將不得不把他們的培訓擱置一年，做研究或其他工作，同時加強他們對下一週期的申請。

There's a simple solution then we just need to increase the number of residency spots.

有一個簡單的解決方案，那麼我們只需要增加居住點的數量。

Easy.

容易。

Right.

對。

Not quite.

並非如此。

The majority of funding for residency programs comes from Medicare.

住院醫師項目的大部分資金來自於醫療保險。

The problem with this is that there were certain caps on Medicare GME funding imposed in 1997 which have largely frozen in place the facilities eligible to receive funding.

這方面的問題是，1997年對Medicare GME資金實行了某些上限，這在很大程度上凍結了有資格獲得資金的設施。

This in turn has greatly hindered our ability to open new residency programs.

這反過來又大大阻礙了我們開設新住院醫師項目的能力。

This is slowly changing with the recent 2021 consolidated appropriations Act, which will have Medicare provide an additional 1000 funded slots over five years starting in 2023.

隨著最近的2021年綜合撥款法案，這種情況正在慢慢改變，從2023年開始的五年內，醫療保險將提供額外的1000個資助名額。

However, many are concerned that the existing system still does a poor job at creating new residency programs for a variety of other reasons to start.

然而，許多人擔心，由於其他各種原因，現有系統在創建新的住院醫師項目方面仍然做得不好，要開始。

The majority of residency programs are in large metropolitan areas where the cost of living is high as such, each dollar spent on funding residency programs doesn't go as far as it would if these programs were in areas with lower cost of living, it would make much more sense to establish residency programs in rural communities where care could be delivered more efficiently to the patients that need it most.

大多數住院醫師項目都在大都市地區，那裡的生活成本很高，是以，花在資助住院醫師項目上的每一美元都不如在生活成本較低的地區所花的多，在農村社區建立住院醫師項目會更有意義，在那裡可以更有效地為最需要的病人提供護理。

Despite this, residency programs are much more abundant in large metropolitan areas compared to rural areas.

儘管如此，與農村地區相比，大都市地區的住院醫師項目要多得多。

This is largely a consequence of large teaching hospitals in metropolitan areas having more leverage with private insurers to gain higher reimbursement rates for residents, residents implicitly finance a portion of their training through their contributions to patient care.

這主要是由於大都市地區的大型教學醫院對私人保險公司有更大的影響力，可以為住院醫生獲得更高的報帳率，住院醫生通過對病人護理的貢獻隱性地資助了他們的部分培訓。

As such.

是以。

There's often less financial risk to hospitals starting residency programs in these big metropolitan areas as they often receive higher reimbursement rates for services provided by residents.

在這些大都市地區開辦住院醫師項目的醫院通常會有較小的財務風險，因為他們對住院醫師提供的服務通常會有較高的報帳率。

In addition, there is often more financial incentive to fund specialized residency programs as opposed to primary care specialties, despite the latter being in greater need.

此外，儘管後者的需求更大，但相對於初級保健專業而言，資助專業住院醫師項目往往有更多的財政激勵。

As reimbursement rates for spec analysts tend to be much higher for these reasons.

由於這些原因，規格分析員的報帳率往往要高得多。

Just throwing more money at the problem of the limited number of residency positions may not be sufficient.

僅僅向有限的住院醫師職位問題投擲更多的錢可能是不夠的。

That being said, increasing the number of physicians trained in the U.

也就是說，增加在美國培訓的醫生的數量。

S.

S.

Is only one solution to the physician shortage.

是解決醫生短缺的唯一辦法。

Another solution is to import physicians from other countries to practice in the United States.

另一個解決方案是，從其他國家引進醫生到美國執業。

The issue is that there is a lot of red tape that foreign trained physicians must navigate in order to practice medicine in the United States.

問題是，為了在美國行醫，外國訓練有素的醫生必須穿過許多繁文縟節。

In many states, foreign trained physicians are required to take the US Emily step exams and repeat residency training.

在許多州，外國培訓的醫生被要求參加美國的艾米莉階梯考試並重覆住院醫師培訓。

Which can be a huge barrier to entry for physicians who have been practicing for many years and are well established in their specialty.

這對那些已經執業多年並在其專業領域有良好基礎的醫生來說，可能是一個巨大的進入障礙。

According to a 2020 article in the annals of Internal Medicine International medical graduates or I MGs constitute about 25% of all actively participating specialists in the United States and most work in rural and underserved areas throughout the country.

根據2020年《內科學年鑑》上的一篇文章，國際醫學畢業生或I MGs佔美國所有積極參與的專家的25%左右，並且大多數在全國的農村和服務不足的地區工作。

This may sound like a lot, however many I MGs are only here on temporary H one B and J one Visas while completing residency training, I MGs that hold a J one Visa are required to return to their home country for two years after completing their residency or finish a three year waiver position in an underserved area before they can apply for permanent status or a green card.

這聽起來似乎很多，然而，許多I MG只是在完成住院醫師培訓時持臨時的H 1 B和J 1簽證，持有J 1簽證的I MG在完成住院醫師培訓後必須返回本國兩年，或在服務不足的地區完成三年的豁免職位，然後才能申請永久身份或綠卡。

I MGs holding an H one B Visa may apply for a green card and permanent residents after they complete their residency.

持有H one B簽證的I MG在完成居留後可以申請綠卡和永久居民。

That being said just because they are eligible for a green card does not mean that they will receive one green cards issued under the employment based category, such as for residents have a total cap of only 140,000 green cards per year with a fixed cap of 7% allotted to each country.

也就是說，他們有資格獲得綠卡並不意味著他們會收到根據就業類別發放的綠卡，比如居民每年只有14萬張綠卡的總上限，每個國家有7%的固定上限分配給。

In addition, I MGs do not receive any preferential treatment in obtaining their card for being a physician and even after receiving a green card, there are multiple hoops to jump through to practice as a physician permanently in the US.

此外，I MG在獲得醫生卡時沒有得到任何優惠待遇，即使在獲得綠卡後，要想在美國永久從事醫生工作，也需要跳過重重障礙。

Lastly, a growing and aging population, combined with an aging workforce of doctors nearing retirement, has further exacerbated the issue of physician shortages.

最後，不斷增長的老齡人口，加上接近退休的醫生隊伍，進一步加劇了醫生短缺的問題。

The double AMC estimates that within the next decade, more than two out of every five practicing physicians will be over the age of 65.

雙重AMC估計，在未來十年內，每五個執業醫生中就有兩個以上的人將超過65歲。

In addition, physician burnout is a huge issue within medicine which has been further exacerbated over the past few years As a result of the covid 19 pandemic, these issues may lead some physicians to decrease their hours or even leave the profession as a whole earlier than anticipated.

此外，醫生的職業倦怠是醫學界的一個巨大問題，在過去幾年中進一步加劇。由於covid 19的流行，這些問題可能導致一些醫生減少工作時間，甚至比預期的更早離開這個行業。

Further straining our physician workforce.

進一步加劇了我們醫生隊伍的壓力。

This is another big reason why we need to take steps toward increasing the number of physicians in the United States.

這也是我們需要採取措施增加美國醫生數量的另一個重要原因。

The long hours and difficult schedules that resident physicians and attendings work are not a matter of necessity, but rather a byproduct of our lack of physicians.

住院醫師和主治醫師的工作時間長，時間安排困難，這並不是不得已而為之，而是我們缺乏醫生的副產品。

Some physicians oppose training more medical students and residents or recruiting foreign doctors as they fear it will decrease their salaries.

一些醫生反對培訓更多的醫科學生和住院醫生，或招募外國醫生，因為他們擔心這會降低他們的工資。

Although this is a reasonable concern having more doctors is likely to make life better for US doctors by sacrificing a bit of pay.

雖然這是一個合理的擔憂，但有更多的醫生可能會讓美國醫生的生活變得更好，因為他們會犧牲一些薪酬。

They may be able to avoid 60 plus hour work weeks and having to spend nights and weekends on call.

他們可能能夠避免每週60多個小時的工作，以及不得不在晚上和週末待命。

That being said, the one area that we need to remain cautious about as we take steps to address the physician shortage is the rising cost of medical education.

儘管如此，在我們採取措施解決醫生短缺問題時，我們需要保持謹慎的一個領域是醫療教育成本的上升。

If the cost of medical education continues to increase at the current rate and salaries for physicians start to decrease, we may end up with a generation of physicians with massive debt that they struggle to pay back.

如果醫學教育的成本繼續以目前的速度增長，而醫生的工資開始減少，我們可能最終會有一代醫生揹負大量債務，難以償還。

This is one of many factors that we will need to consider as we work to solve this problem.

這是我們在努力解決這一問題時需要考慮的許多因素之一。

As you can see solving the issue of physician shortages in the US is not just a matter of training more doctors.

正如你所看到的，解決美國醫生短缺的問題不僅僅是培訓更多醫生的問題。

It is a complex issue with many different factors that will require an equally complex and multifactorial approach.

這是一個複雜的問題，有許多不同的因素，需要採取同樣複雜和多因素的方法。

We need leaders and policymakers to take a good hard look at the state of medical education and physicians in the US and start making steps towards addressing issues like the rising cost of medical education, physician burnout and the lack of residency positions.

我們需要領導人和政策制定者認真審視美國的醫學教育和醫生狀況，並開始採取措施解決醫學教育成本上升、醫生職業倦怠和缺乏住院醫師職位等問題。

Only then will we be able to meet the growing demand for physicians in the United States?

只有這樣，我們才能夠滿足美國對醫生不斷增長的需求？

If you enjoyed this video, I know you'll love my free weekly newsletter where we cover these and similar topics in medicine, productivity and study strategies.

如果你喜歡這段視頻，我知道你會喜歡我的免費週報，在那裡我們討論這些和類似的醫學、生產力和學習策略的話題。

You'll also get access to the best study music with my study with me playlist that's updated each week as well as special sneak peeks and exclusive offers only available to Med School Insiders newsletter subscribers.

你還可以通過我的 "與我一起學習 "播放列表獲得最好的學習音樂，該列表每週都會更新，以及只有醫學院內部人士通訊訂閱者才能獲得的特別偷拍和獨家優惠。

Sign up today at Med School Insiders dot com forward slash newsletter.

今天就在Med School Insiders dot com轉發斜線通訊上註冊吧。

Thank you all so much for watching.

非常感謝大家的觀看。

If you enjoyed this video, be sure to check out our medical schools overcharging you or this other video.

如果你喜歡這段視頻，請務必查看我們的醫學院向你多收費或這一其他視頻。

Much love.

非常愛。

And I'll see you guys there.

我將在那裡見到你們。