Medical Supply and Demand

A recent news piece, "Primary care about to collapse, physicians warn," made me want to write a short note on doctors in the U.S., not an encyclopedia, mind you, which -- having been (formerly) married to a surgeon -- I could foolishly undertake.

Last time I was informed, insurance companies as well as Medicare paid a whole lot more for "procedures" than for mere office visits. This huge difference sets the prestige stage for many if not most medical students, who see surgical and other specialties like radiology and anaesthesia as the training programs to shoot for, while even the supposedly TV-glamorous field of emergency medicine is just a fallback, as is the unglamorous practice of primary care, or family medicine.

Much of doctors' training after medical school is done by voluntarily cooperating practitioners ("attending physicians") who exchange their supervision of "resident" physicians' work on their patients for call coverage at night and on weekends, and for other incentives. But these attending physicians are acutely aware, and make hospital administrators and medical school professors acutely aware, of the "danger" of "oversupply" in their specialties, so that the number of "spots" in their training programs are constrained.

Upon graduation from residency, new specialists are guided by recruiters to communities where they are actively desired, by hospitals or existing practices needing new staff. Sometimes there is disagreement about whether a new specialist is "needed" in a particular locality, and severe pressure can be exerted by the players in this control of supply. With a load of medical school debt and without skills in setting up a practice from scratch, recruiting incentives are all-important to new doctors. But still, before hiring a new physician, the hiring entity has traditionally demanded very restrictive non-compete agreements, which even lawyers have prohibited in their own hiring and which fortunately are coming under increasing disfavor in the courts.

The "law" of supply and demand means that the way to get the price of something down is to increase the supply of that thing. Yet I have seen no concerted general effort by our governments at any level to increase the supply of all kinds of doctors. We the patients cannot trust the medical establishment to cut their own, sometimes huge, incomes as members of the most powerful guild in our economy. To do nothing means we accept either that our current system of producing doctors is the best possible one or that we are powerless to do anything about it. I believe neither of these things to be true.

UPDATE: "Government isn't the best way to provide all Americans with health security. It's the only way. And it's time for liberalism to say so openly." -- The New Republic editorial

UPDATE: Needs of Patients Outpace Doctors.