Transforming American Medicine
Robert Frank is relatively optimistic that American medicine can be transformed away for our current fee-for-service model into something more like the Mayo Clinic:
Another factor militating against quick expansion of the Mayo model is that many current doctors chose their profession hoping to earn lucrative pay, which they might not be able to do in a nonprofit clinic. But across the economy, we see talented professionals whose career choices are driven by concerns far broader than pay. Many top graduates from elite law schools, for example, turn down lucrative positions in corporate law to work for public-interest groups paying a third as much.
Doctors who choose to work in nonprofit clinics seem to view their professions more as a calling than as a job. There is evidence that when medicine was less adversarial than it is now, American doctors were both happier and more respected, even though their incomes were much lower. Doctors elsewhere also remain satisfied and respected, though they are paid less than their American counterparts.
In time, medical schools will be able to attract plenty of talented people willing to accept positions under the Mayo model, where they would spend more time healing patients and less time fighting insurers. Any of the current health reform bills would help start this transition.
Maybe yes maybe no. But one salient fact about both other countries and the United States of the past is that there was much less inequality in general. A doctor in 1963 had a much lower income than a doctor in 2009, but he was closer to the top of the income distribution. Frank’s excellent Falling Behind is largely about the interplay of rising inequality and status competition, so he doesn’t need me to point this out, but I bet that relative income point is important. Which I think is less a reason to be pessimistic about health reform than it is yet another reason to think that higher taxes on the very rich are a good idea (a component of the House bill, I note).
24 Responses to “Transforming American Medicine”
Register
RSSLogin
Topic Cloud
ArchivesBlog RollAbout Matt YglesiasContact Me
Donate
November 9th, 2009 at 2:46 pm
It’s been said before, but the conversation regarding doctor (and lawyer) pay must include the cost of receiving a medical or legal education. Many doctors simply do not have the ability to take a job at a non-profit clinic no matter how much they would like to. Coming out of medical school $200k in debt closes a lot of doors to young doctors and forces them to seek a bigger paycheck. When comparing doctor pay in the US to that in some European models, the amount of American doctors’ paychecks that go to paying off loans must be factored in. Doing so closes the gap drastically.
November 9th, 2009 at 2:49 pm
It’s been said before, but the conversation regarding doctor (and lawyer) pay must include the cost of receiving a medical or legal education.
Agreed, I have decided to be a Public Interest law but with my student loans I doubt I’ll do it more than 3-5 years
November 9th, 2009 at 2:51 pm
In these discussions about pay signaling status, I wonder why academics aren’t brought up. Very few folks in academia get the sorts of salaries doctors get, but they are in school longer and presumably have high social status.
November 9th, 2009 at 2:55 pm
A lot of parts need to re-align: the cost of training doctors (and the specifics of the med-school and qualification process), the denigration of primary care, the incentive to follow the money for specializations.
To expand upon what Atul Gawande noted, an American medical student has to start thinking about money the moment he/she signs that loan agreement, and that means buying into the distortions of healthcare provision in the US.
November 9th, 2009 at 2:57 pm
Well also you come out of law school and medical school with an ocean of debt, far more than in other countries.
Self-preservation dictates you spend a few years crushing the peons or proceduring the hell out of old folks until you break even.
November 9th, 2009 at 3:08 pm
I think reforming fee for cost needs to be coupled with reforming the cost to attend medical school as well as lowering standards for admission.
November 9th, 2009 at 3:08 pm
I wonder when all of these hugely in-debt people realize that they’re in a peonage situation and all dem sun scorched desert preachers ranting about usury have more than a kernal of truth to them?
What will they do then?
November 9th, 2009 at 3:25 pm
I for one am grateful that MattY lets us know that this post has to do with health care, by means of a visual aid in the form of a photograph of a stethoscope.
November 9th, 2009 at 3:42 pm
Many top graduates from elite law schools, for example, turn down lucrative positions in corporate law to work for public-interest groups paying a third as much.
lol…no.
November 9th, 2009 at 3:46 pm
Many top graduates from elite law schools, for example, turn down lucrative positions in corporate law to work for public-interest groups paying a third as much.
lol…no.
Presumably, this is a question that can be answered by *data*, rather than by assertion and counter-assertion. Does anyone have this data? Anyone? Anyone? The Hawley-Smoot Tariff.
November 9th, 2009 at 3:47 pm
That money=social status money obession post is a perfect explanation why this insane financial crisis could happen, in this one country. Sure, money can buy you social status in every country. But really a doctor mainly gets the social status from his degree, not his paycheck.
Once you make money obsession a social norm, the egomanic homo oeconomicus comes true from the backdor.
November 9th, 2009 at 4:11 pm
The American med school student was thinking about money long before he or she signed any loan documents.
Average med school debt $155K
Average income family practice $160K
Average income anesthesiologist $314K
Average # of years needed for a physician to pay off
all student loan debt: 7
Amount of debt repaid per year of service in the
National Health Services Corp: 25K (two year commitment)
Number of health care providers who have participated in the program since 1970: 28K
November 9th, 2009 at 4:13 pm
But really a doctor mainly gets the social status from his degree, not his paycheck.
If that was the case people would respect Humanities PhDs who were naive enough to think they could actually land a tenure tract teaching position with their degree.
November 9th, 2009 at 4:26 pm
I’d be totally fine if people didn’t think of the practice of medicine as a money making venture and more of a “sacrifice” and thus we got less maximum achievers as doctors… but you got to think of the unintended consequences, since then we’d be funneling more and more Ivy Leaguers to Wall Street… and haven’t they done enough damage all ready?
November 9th, 2009 at 5:27 pm
There will always be some subset of achievers going to wherever the maximum compensation is. The people who want to practice medicine will still become doctors even if they will earn 20% less. There are many people who are as smart and hard working as your maximum achieving doctor who will most likely never earn more than $150,000.
November 9th, 2009 at 6:59 pm
Better the maximum achievers go into medicine than wall street…after all, why should they be redistributed to law school or wall street? is that really what we think would benefit society more? As for academia, that definitely draws from a very differently motivated pool of candidates in my opinion…
November 9th, 2009 at 7:26 pm
There will always be some subset of achievers going to wherever the maximum compensation is.
That’s also a side-effect of the idiosyncratic way medicine is taught as a grad-school subject in North America. There are pros and cons to each approach, but med students who start their pre-clinical work at 18 hardly ever end up as bankers or accountants, whereas chemistry and physics PhDs often do.
November 9th, 2009 at 8:54 pm
“The people who want to practice medicine will still become doctors even if they will earn 20% less.”
Though this may be true for many people who go into medicine, it is not true for all people. It seems self evident that salary is a significant factor people consider when deciding which occupation to enter. The fact is that even now, with the current system, we face a physician short fall that is only going to get worse. This is not to say that reform isn’t necessary, but that we need to be realistic about the consequences and propose methods to offset the possible damage. I think the best way to address this would be to focus on trying to lower the astronomical price of attending medical school and also lower the standard of getting in.
November 9th, 2009 at 10:39 pm
I agree with lowering the cost of medical school being necessary as it is a huge barrier, especially to students from low income families who realistically decide the path is too long to justify that sort of debt risk but why should we lower standards? After all, we are all patients (or prospective ones) and despite my pro physician bias (as seen in other posts), there are clearly a lot of bad doctors out there already. There is a reason for this strict quality control…Moreover, the idea of replacing them with less qualified and knowledgeable nurse practitioners seems risky enough…
November 9th, 2009 at 11:25 pm
I agree with lowering the cost of medical school being necessary as it is a huge barrier, especially to students from low income families who realistically decide the path is too long to justify that sort of debt risk but why should we lower standards?
If we face a doctor shortage, then I suppose it depends on whether you think that a doctor who is held to a lower standard is better or worse than not getting medical care at all.
November 10th, 2009 at 6:29 am
“Though this may be true for many people who go into medicine, it is not true for all people. ”
As if you could become a good doctor, or actualy anything if you are just in it for the money.
November 10th, 2009 at 7:23 am
Sure, money can buy you social status in every country and many people who are as smart and hard working
November 10th, 2009 at 2:25 pm
Odd feature of life in America: Ivy Leaguers with BAs can go to Wall Street with little debt and have a good chance of making tons of money doing nothing useful whatever, while MDs emerge with horrific debts burdening their careers in protecting peoples’ health.
November 12th, 2009 at 8:34 pm
Thanks. I liked your post, do you have more like this? The topic needs lots of research, most people don’t have it.