Megan McArdle wonders what will happen if we turn physicians into middle class employees:
The first thing to point out is that under the hoped-for models, we’ll probably need more doctors. The payment reforms being proposed are going to push us much farther down the road towards corporatized large practices capable of bearing substantial capital and regulatory burdens, and pooling risk over a large group of patients. Doctors will become employees, rather than small business owners.
But if it’s hard to maximize their income, doctors are going to want to maximize lifestyle instead, working a lot fewer hours in exchange for their lower pay. This may be better for patient care (I don’t really like the idea of my surgeon working twelve hours a day, six days a week). But unless you really believe that doctors are creating most of the demand for their own services, this implies that more doctors will be needed.
The second thing to point out is that it will be difficult to get people to give up 10 years of their life and $250,000 in exchange for a salary that will top out at, say, $150,000. Yes, some people want to be doctors because they just love doctoring. But ten years is a long time, and $250,000 is a lot of money. If you’re good enough at school to get into med school, it probably doesn’t make financial sense to go.
She paints a pretty dour picture. It’s not completely unwarranted. There are at least some things we can do that might help immensely. The biggest thing is to collapse medical school into undergraduate as much as possible so that doctors aren’t having to wait ten years. It might be hard to accurately predict good future doctors straight out of high school, but I don’t think you have to wait until they have an undergraduate degree in something else (Clancy majored in bio-chem and psychology)
Importing doctors from abroad is an attractive possibility. They’d be willing to work for less. Or would they? It seems to me that we can attract a lot of doctors from overseas with the offer of money, but it would become notably harder if we try to do it at regular middle class wages. Especially if we expect them to go through residency. Of course, we can consider bypassing residency, but we would only want to do that for doctors from similarly situation nations, who are the least likely to want to come here for diminished wages.
We hear a lot about how other countries pay for their citizens’ medical care, but hear very little about how they make their doctors. Given the shortage, as well as the desire to reduce physician wages, it’s something we need to start giving a lot of thought to.
I have my ideas, though I think it’s ultimately - if we do anything - going to involve redefining “doctor.”