The Doctor Shortage

Imagine you are presented a few career options early in your life when normal men are sorting out what they wish to do with their lives. The first option is one that will require years of study and a high IQ. You possess a high IQ, but there is some risk that yours is not high enough. You cannot know until you get far along in the process. The eventual end point of the process is a career that may be spiritually fulfilling, but has decreasing social status and only an above average earning potential, but not extravagant earning potential. In other words, by mid-life you can have a big house, the sports car and the trophy wife, but you’re going to spend more than a decade slaving away in poverty. That’s option #1.

The next option is one that requires about half the study time as the first option and far less of an apprenticeship. You have to be smart, but not genius level smart. Standard test scores will tell you if you have what it takes to make it in this path. By the time you have established yourself, you will surely make an upper-middle class income and could easily be making much more. It’s a high status job and a lot of fun, but not spiritually fulfilling. It just lets you live a 2% lifestyle and get going at it by the time you’re in your middle twenties.. That’s option #2.

Now, we have the final choice. This is path that does not necessarily require a high IQ, but it helps. There’s really no way to wash out so you go as far as your skills will take you. It is never going to be high paying or high status, but you can have a nice middle class income. There will be times when you have to scrimp and save. You will have to do without some things. But, the spiritual and psychic rewards are limitless. This career will be your sanctuary from the world and bring you a lifetime of happiness. This is option #3.

In medieval times, these options would have been the choice between a high ranking clergyman, an aristocratic soldier and a monk. That’s if you were born with magic blood. Nobles had these choices, but even then the choices were often made for you by the patriarch or by circumstance. If you were born a commoner, then you spent your life harvesting filth and complaining about the violence inherent in the system. But, we live in an era in which there is still some effort to try and scoop up the talented from the lower orders.

That means young men and women take standardized tests so colleges and universities can begin to sort out who is and who is not managerial class potential. We’ve not yet reached the point where career paths are assigned and that may never happen as it is contradicts the interests of the managerial class, who pride themselves on being a self-selected meritocracy. Choosing your own path is a big part of their class identity so that is something that will likely remain a feature of their ideology.

The question then, getting back to where we started, is which of the three choices would most people choose. In modern times, physician is clearly option #1. Advancing far in the medical rackets requires a high IQ, a long time in school and a very long and unpleasant apprenticeship. The reward at the end is pretty good, but no better than option #2. In fact, bankers and banker’s lawyers usually make vastly more than comparable doctors. It is only at the low-end do we see doctors and nurse practitioners compete economically with lawyers and brokers. At the high end, no doctor can compete with a VP at Goldman.

The final option is the lifestyle option. You’re a smart guy from a good family, but you like smoking weed and surfing so you open a surf shop. Alternatively, you have what it takes for the first two options, but have a passion for some new business that is many years from taking off, but you’re going to be on the cutting edge, even if it means a long struggle. Think Ben & Jerry’s Ice Cream or custom bike frame makers. There are, of course, trust fund types who have the money to be as weird as they like. John Heinz IV is a blacksmith and Buddhist.

That brings us back to those first two options. We have made becoming a doctor impossibly difficult. Worse yet, we have made it unrewarding. Socialized medicine has this habit. The result is the native talent opts for the second option. Being a hotshot lawyer is just an all-around better  life than being a doctor. It’s why share holder meetings are packed with attorneys now. In the fifties, they were packed with doctors. In Britain, a quarter of physicians are foreigners. Not foreign born, but foreigners.

The same is happening in the US.

The United States faces a shortage of as many as 90,000 physicians by 2025, including a critical need for specialists to treat an aging population that will increasingly live with chronic disease, the association that represents medical schools and teaching hospitals reported Tuesday.

The nation’s shortage of primary care physicians has received considerable attention in recent years, but the Association of American Medical Colleges report predicts that the greatest shortfall, on a percentage basis, will be in the demand for surgeons — especially those who treat diseases more common to older people, such as cancer.

In addition to the growing and aging population, full implementation of the Affordable Care Act in all 50 states would increase demand for doctors as more people are covered by insurance. But Obamacare’s impact will be small — just 2 percent of the projected growth in demand, the organization said. The supply of doctors also will grow but not nearly as quickly as the need, officials said.

“An increasingly older, sicker population, as well as people living longer with chronic diseases, such as cancer, is the reason for the increased demand,” Darrell G. Kirch, the AAMC’s president and chief executive, told reporters during a telephone news briefing.

In the study of collapse, there are few fixed rules. The one thing on which everyone seems to agree is the ruling classes are no longer able to cope and adjust to changing circumstances. Why this happens is tough to fathom, but simply being wrong is a good starting point. The Athenians were wildly wrong about the Syracuse campaign, despite warnings from respectable members of society. Wrongness has inertia.

With regard to health care the majority of the managerial class is locked into 19th century ideas about how to micromanage an economy. No one in charge can imagine anything other than a micromanaged system so they deploy all available resources in the effort to perfect their system. The more they try to fix the system, the worse it gets. We’ve reached a point where the inputs result in unexpected outputs. A few more cycles and the inputs have no result. The system seizes up and then it collapses.

 

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Duck Enlightment
Duck Enlightment
5 years ago

I think that most medics in ancient Rome were Greek or Greek educated, the Romans gave Roman citzenship to freed slaves, the Greeks tought that the Romans were crazy for doing this, when the Greeks freed their slaves it remained a residential alien.

bud
bud
5 years ago

NP’s (and to a much lesser extent, PA’s) can save us from this disaster, but only if the Doctor’s union can be convinced or bludgeoned out of the way.

parascribe
parascribe
5 years ago

NP’s aren’t going to solve this problem and they don’t need a dr’s union to block them, nurses are quite capable of fucking up their own practice, by the numbers and without MD input, thank you very much. See the current push by the nursing powers that be toward phd np’s vs. the blossoming number of diploma mills churning out barely qualified np’s.

Charming Richard
Charming Richard
5 years ago

Mrs. (doctor) Charming comes home frequently with frightening examples of this problem.

Backdoor deals and ‘who you know’ are already affecting access to competent medical care, it’s downhill from here.

She’s not ready to retire yet, but recently, she’s starting to talk about it. She doesn’t want to leave medicine, but she sees it’s beginning to leave her.

The foreigners situation is worse than you think.

DirtyJobsGuy
DirtyJobsGuy
5 years ago

One of my business partners has four sons, one is a resident MD now and one has just been accepted into medical school. I’ve gotten a pretty good feeling for the med school maze from talking to him. Bottom line lots of sharp US guys applying for med school, but rather than expand the schools to meet demand, lots of foreign MDs are imported for residencies. the Federal govnt funds all residencies so they control the system. Under Obama the affirmative action for med schools has gotten obscene.

trackback
5 years ago

[…] Doctor shortage: With regard to health care the majority of the managerial class is locked into 19th century ideas about how to micromanage an economy […]

UKer
UKer
5 years ago

I used to have a doctor as a near neighbour, years ago. He suddenly left home with his family (the kids toys were scattered on the back porch as if it was just another day at home) and fled because he had apparently overstepped the mark on some medical procedure. On this I am hazy, but his hospital didn’t like something he’d done (or not done) and so he felt it necessary not to stay and sort it out but to get the hell out as quickly as possible and back to a country where things were pretty unstable. IIRC,… Read more »

VinceVapor
VinceVapor
5 years ago

In Canada, the Canadian Medical Society has wielded it’s power to keep enrollment into medical schools much lower than the number who would like to attend. Enrollment was kept to 1975 levels until 2004. During this time the population had increased roughly 50%, and there are currently many people without a family physician.

And of course, the solution now, as in many sectors of the economy, is to import doctors rather than train willing youth.

Guest
Guest
5 years ago

And I was the “invisible person” (admin) at an American University conference with some ‘elite Canadian academics’ and heard them chuckling as they answered the American elites question of the reality of Can HCare “ha ha ha, we pay 17k a year and belong to a secret private network, a bit off-legal, but it works!” [intimating hauntingly that they don’t “do” healthcare with the little people, nor do they “do” waiting in line.]

Pretty much what it will come to here–for those that can afford it.

Kathleen
Kathleen
5 years ago

Concierge medical care is where it’s at if you want to be a Doctor in this country, rather than a Medical Establishment Slave. That is, until The Emperor outlaws any such service because it conflicts with his boondoggle socialist medical program AKA Obamacare. Who said all slaves are poor?