Even Surgeons Aren't Cutting It Anymore

It's pretty obvious the "fee for service" system doctors have enjoyed for decades, making many of them well-to-do and Republican in the process, is just about done for.

Not that health care is going to be cheaper thanks to the greedheads running both the hospitals and health insurance companies, but private practice doctors are going the way of home visits.

Another thing that will certainly happen is medical schools will no longer have limited spaces, which helped drive up doctors' annual salaries because the supply of doctors had been artificially limited, thus creating an artificial demand.

In other countries, there are still plenty of physicians, but they don't make the big bucks so many of them do here.

American physicians, worried about changes in the health care market, are streaming into salaried jobs with hospitals. Though the shift from private practice has been most pronounced in primary care, specialists are following.

Last year, 64 percent of job offers filled through Merritt Hawkins, one of the nation’s leading physician placement firms, involved hospital employment, compared with only 11 percent in 2004. The firm anticipates a rise to 75 percent in the next two years.

Today, about 60 percent of family doctors and pediatricians, 50 percent of surgeons and 25 percent of surgical subspecialists — such as ophthalmologists and ear, nose and throat surgeons — are employees rather than independent, according to the American Medical Association. “We’re seeing it changing fast,” said Mark E. Smith, president of Merritt Hawkins.

We all knew that was going to happen. Let's see: It appears we have a pattern here of the gutting of professions. Lots of legal work is being "outsourced" to other countries; teaching in all grade levels, including college, is under relentless assault; and now the medical profession, which seemed to be resistant to "globalization" and other neoliberal crap, seems to be headed toward the same fate.

After all, the pie is only just "so" big, and we can't allow the billionaires to share any more of that wealth and provide more crumbs from the crust to us peons.

The gradual removal of the medical profession from the high middle class or top five percent of income earners is far more likely than we ever get single-payer in this country. This despite more and more support for single-payer from many doctors.

The Gravy Train May Soon Run Dry

For once in his life (maybe twice or three times), Matt Yglesias is right in his point of view, this time about doctors making way too much money. The reason they make too much, as I mentioned on this blog a long time ago, was that they limit the supply by limiting enrollment in medical schools. Open up the enrollment and create more medical schools, and the income is sure to lower drastically for physicians as a group.

It always reminded me of the Jockey Club's requirement that all thoroughbred foals had to be conceived by natural means rather than by artificial insemination. By limiting the supply, the price of thoroughbred racehorses could stay high. AI would drastically lower the price of racehorses because there would be too many of them.

Getting back to doctors, there might some who make and will continue to make seven figures in areas like cosmetic surgery, but for the garden variety doc, the income will go down quite a bit.

Doctors in the old days loved the fee-for-service system because insurance companies back then would simply shell out the money and didn't question the prices the docs charged. But then things got out of hand, and we got stuck with HMOs and the like. It didn't make too much dent in the profitability of physicians' practices or in the for-profit hospital sector.

Fear of the gravy train running dry is the biggest reason why the American Medical Association was adamant in its opposition to national health insurance or single-payer. It's that simple.