Why are there so few doctors?

[hpowders]

When I call for an appt. quite often the choice is between a nurse/practitioner/medical assistant in a day or two or the MD in 3 weeks or so. I always choose the former-not only to speed up the appt. but because in my experience the former gives me a more satisfactory experience-they communicate better, have superior social skills, are younger and can diagnose and treat just as well. I'm not talking surgery here.

[Coffee]

Freedom is not free. Free men are not equal. Equal men are not free
Jerry Pournelle

I used to really like Jerry Pournelle (Chaos Manor, several of his sci-fi books) until I started running into him at conferences.  Just, ICK.

I'm always incredible disappointed when I meet someone famous or semi-famous of whom I'm a big fan and I find that they are a jerk (or worse) when you see them up close.  I always want to say to them: "I wish I could un-meet you."

This has only happened a few times, but it's always a jarring experience.  I'm not talking about bothering someone who is having dinner with his family; I'm talking about being at a reception or other event where the purpose of the event is to meet the person.

I just had that same very experience with Ari Fleischer.  LOL.

[AgAuMoney]

We are not talking some technical surgical procedure.  99% of those do not require the best and brightest, just a skilled technician.

While some of your points are valid, I think it is a stretch to say that 99% of medicine can be done by a 'skilled technician'. And even then, I would still want that skill level as high as possible.

Note I specifically limited it to a "technical surgical procedure" and such is what we were NOT talking about.  If I were needing a seldom-performed surgery or had any expectation that my procedure would be anything but ordinary, I'd be shopping for the most skilled experts I could afford.  But it is amazing what has become routine these days, especially once you get to doctors and hospitals that stay on the cutting edge (har, har) with modern (e.g. endoscopic advancements) procedures.

(BTW, I'm personally fortunate in that I've never been opened up, and I still have all my parts except for 4 bicuspids and hair loss associated with either male pattern baldness or teenage sons.  I've never even been treated for a broken bone, but that may yet prove to have been a mistake on a couple of now healed foot injuries...  but as I've been covered by my own medical insurance for nearly 30 years I suppose I've been subsidizing others, or was at least until my little girl was born and spent time in the neonatal ICU.  I think I recovered all my premiums on that one!)

Most of the surgeons in India that would do "medical tourism" procedures did a large part of their education and training in the U.S. and people who cannot afford such procedures in the U.S. report overwhelmingly good experience in India.  This is commonly such things as joint replacement, but lately I've been seeing reports of much more including simple cancer surgeries and even elective open heart procedures.

(Not to imply that reports are 100% positive...  But neither is the U.S.  Sure glad I did not have steroid injections for my back as I've been tempted to over the last few years!)

[Tortoise]

The situation you're describing in sports is largely a result of government interference in the market. Most pro sports teams do not have to pay for their stadiums; the local government typically donates them. If the sports teams had to pay for those stadiums, they would have far less money with which to bid up the superstar athletes' salaries. So in a sense, those astronomical salaries that the top-paid athletes receive are effectively coming from local taxpayer dollars.

That may partially explain the stupidity of athlete's salaries. What about movie stars and star musicians?

I'm not sure. But I do think Pointedstick is right that it ultimately boils down to supply and demand. Your original point was that doctors' salaries shouldn't be considered "ridiculous" when there are seemingly less deserving professionals out there (e.g., superstar athletes and actors) who get paid far more. I agree. It's very difficult to say who "deserves" what salary and why. Ultimately, each of us gets paid not what we deserve, but what we negotiate. And a big part of that negotiation is supply and demand.

I agree with those in this thread who have pointed out that part of why there are so few doctors is because their supply has been artificially limited. I don't think everyone who gets and MD degree and practices medicine needs to be one of "the best and brightest." As in most other professions and businesses, I think there should be a spectrum of services in medicine ranging from deluxe to basic, and the basic service should be much less expensive than the deluxe service. Those MDs who are providing the basic service will probably not be among the best and brightest, which implies that some less-than-Nobel-worthy students need to start being admitted to medical school to make that supply-and-demand dynamic work.

By allowing only the best and brightest to be admitted into medical schools, we are denying the consumers the basic (inexpensive) medical care that they are demanding. We are interfering with natural supply and demand.

[MachineGhost]

in this category no matter how much it pays. And I really don't think that with this profession, financial gain is the ultimate motivation. Considering everything they have to go through I think they have to view it as a sort of "calling" like those going into the ministry or they wouldn't do it (I am not a doctor or involved in the medical profession in any way, BTW).

99% of those with the calling or humane reasons drop out during their first year of medical school once the barbaric reality of what "medicine" really is nowadays becomes evident.  The 1% just stay in for the money.

[Benko]

99% of those with the calling or humane reasons drop out during their first year of medical school once the barbaric reality of what "medicine" really is nowadays becomes evident.  The 1% just stay in for the money.

What are you basing this on?  Medicine was much more barbaric when I trained, before the restrictions on working long hours in a row were instituted.

There are certainly some doctors in it primarily for the money, but they are not the majority.

[MachineGhost]

99% of those with the calling or humane reasons drop out during their first year of medical school once the barbaric reality of what "medicine" really is nowadays becomes evident.  The 1% just stay in for the money.

What are you basing this on?  Medicine was much more barbaric when I trained, before the restrictions on working long hours in a row were instituted.

There are certainly some doctors in it primarily for the money, but they are not the majority.

I can't remember the source but it was a news article or study a few years ago about medical school freshman and the drop-out rate.  I don't know what goes on in the beginning of the first year, but the idealists get disillusioned about the reality of the system.

[Bean]

Do want a Doctor who got a C in Biology?

Do you want to pay more? More profit, more incentive.

Remember these guys go to school for many years into their prime earning lifetime. They have to pay those loans somehow.

[BearBones]

99% of those with the calling or humane reasons drop out during their first year of medical school once the barbaric reality of what "medicine" really is nowadays becomes evident.  The 1% just stay in for the money.

What are you basing this on?  Medicine was much more barbaric when I trained, before the restrictions on working long hours in a row were instituted.
There are certainly some doctors in it primarily for the money, but they are not the majority.

I can't remember the source but it was a news article or study a few years ago about medical school freshman and the drop-out rate.  I don't know what goes on in the beginning of the first year, but the idealists get disillusioned about the reality of the system.

Another well supported answer... We trust you, though. If you saw it somewhere on the internet and it supports your crony capitalism hypothesis, it must be true and worthy of posting here.

[hpowders]

If the doctor went to the San Juan University of Medicine, then yes, I want him to have received a Si in Biology.

[Pointedstick]

In other threads, many ridicule young people who have gone to university and studied a subject which has left them with inadequate job prospects.  Generally, these graduates do not receive much sympathy.  How is the plight of the potential physician (many years of school, overbearing debt, and a job that doesn't pay them enough) any different?  Why do such students "deserve" a different fate?

I would imagine the social importance of their respective fields has something to do with it. Society needs a certain amount of doctors very badly, so their plight is tragic. Society needs very few philosophers, sociologists, and east Asian historians, so the plight of students who study these fields but can't find work seems more preventable.

[FarmerD]

Couldn't one reason that medical malpractice premiums are so high be an increase in medical malpractice?

I think one reason there are so many medical malpractice lawsuits is because doctors no longer have a monopoly on medical knowledge.  When I was a kid, you took the doctor's advice without question.  Nowdays, I can do intensive medical research on the internet (New England Journal of Medicine, National Institute of Health, etc) from primary sources.  I can also access the blogs/forums of medical specialists like Dr Richard Bernstein, Steve Guyenet, Williams Davis.  In many ways, the mainstream medical advice is often just based on hearsay or myth.

To ward off lawsuits, the last thing a profession wants is a knowledgeable customer base.   

[MachineGhost]

Another well supported answer... We trust you, though. If you saw it somewhere on the internet and it supports your crony capitalism hypothesis, it must be true and worthy of posting here.

Don't shoot the messenger!

[MachineGhost]

Do want a Doctor who got a C in Biology?

Just remember, half of all doctors graduated below the average class rating.  Do you want to be treated by a below average doctor?  50% probability you will.  Because its not a free market where the customer is king, we don't have very good or effective systems in place to deal with the incompetents anymore than we do those generals in the military.

[hpowders]

Do want a Doctor who got a C in Biology?

Just remember, half of all doctors graduated below the average class rating.  Do you want to be treated by a below average doctor?  50% probability you will.  Because its not a free market where the customer is king, we don't have very good or effective systems in place to deal with the incompetents anymore than we do those generals in the military.

Yes. They all seem to be employed by my health plan!