Dr Perry at Carpe Diem suggests it is the Medical Cartel. Dr Perry seems to have forgotten about RVU/RUC/SGR economics. It doesn't matter if there are two physicians or 200 million physicians in this country, there is no market pricing of their services. All we have is a government monopoly that signs off on the RUC cartel which establishes the value of all physician services in this country. And that has nothing to do with how many medical students or residency slots there are.
One explanation is the restriction on the number of medical schools, and the subsequent restriction on the number of medical students, and ultimately the number of physicians.
3 Outbursts:
Dr. Perry's faulting low/restricted admissions is flawed. For the purposes of time, I'll ignore the gross oversimplifications he makes in his comparison of physician salaries in other countries. I'll also ignore the fact that there's a gaping difference between an increase in applicants and an increase in qualified applicants.
Nobody questions the physician shortage, but I strongly feel that his idea to merely increase supply in order to decrease demand so that we can concomitantly decrease pay and thus lower costs is misguided, at best.
Take, for example, the Navy SEALS. As an elite unit, their work demands nothing but the absolute best of the best soldiers. In the midst of a shortage and recruiting crisis, the last thing the Navy should do is lower its standards in BUD/S to get more graduates to fill the demand. Lives are dependent upon the quality of the work that the SEALS do. In order to meet the growing demand for the SEAL ranks, the Navy has gone to ultra-marathons, 24 hour adventure races, and Ironman-type competitions to recruit the kinds of people who can hack it as a SEAL.
Medicine is no different. At a time when there are shortages across the board, why does it seem like the government and the industry have created less and less incentive for the best and the brightest to join our ranks? Arduous paperwork, debt, lawsuits, lack of emotional reward due to minimal patient contact, and the ever increasing leftist drone to decrease our income are some extremely powerful motivators to keep the best of the best looking somewhere else for satisfaction in life.
The real problem is that you can't increase supply through more medical schools and residency spots and yet maintain exceptionally high standards unless you're also making the profession more appealing than it currently is. Decreasing pay, for one, certainly doesn't accomplish this.
I was all set to go to medical school, exceptional grades, great mcat score, ECs, LORs. Everything.
Sent off applications, invited to interviews. But then I realized, if I didn't get out now,
I would never forgive myself, I knew just how screwed up the practice of medicine was becoming, and I was about to walk into it blindly hoping for the best.
I would love to be a physician, but I knew dealing with the circumstances in this day and age surrounding physicians would drain the life out of me.
Why would I spend the prime of my life, studying and slaving away in a hospital only to
waste my time filling out paperwork, dealing with legal issues, decreasing reimbursement
and respect, with less and less time allowed for me to do what I wanted to do in the first
place...you know...be a physician, see patients, talk with them, treat them.
Let's see....
-more government control in the future
-no tort reform in sight
-reimbursements that not only don't keep up with inflation, but are actually going down, while
the overhead only continues to increase
-encroachment by midlevels that say they are just as well trained as physicians
-enough paperwork that I would need to clear cut a forest
-a system that encourages patients to not take responsibility for their actions (smoking, eating unhealthy)
-and the kicker...a system that encourages less time spent actually helping patients
medicine, huh,... no thanks
It sounds sad, but I actually hope most pre-meds don't realize this, because
that physician shortage will get a whole lot more real (and don't tell me about record amounts of applicants to medical school, cause guess what, they might be crazy enough to
shrug it off before medical school, but I'll bet you they won't after school+residency. They'll either cut their hours and take less money for less hassle or look for greener pastures in other industry jobs, overseas, etc.)
I was looking at numbers for salaries because someone told me physicians were earning less than they used to. I compared incomes for internests from 2000 to 2008, with adjustment for the consumer price index. All the numbers and the CPI calculator are on the bureau of labor statistics web site.
Internests earned in 2008 0.7% less than they did in 2000
RN's earned over 16% more than they did in 2000
Lawyers earned over 9% more than in 2000
CEO's earned over 22% more than in 2000
Yes, the doctors are earning way too much.
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