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Home Publications Blogs Beat the Press Will the Protectionists Wipe Out Solo Practitioners in Medicine?

Will the Protectionists Wipe Out Solo Practitioners in Medicine?

Saturday, 23 April 2011 07:30
That is the implication of an NYT article on the decline in the number of physicians in independent family practices. The article argues that long hours and uncertain pay make it unattractive for physicians in the United States. This may be true given the extent to which the doctors' lobbies have been able to limit the number of people licensed to practice medicine in the United States. However, there is a huge supply of people in the developing world who would be willing and able to train to U.S. standards and work under the conditions described in the article. If the Obama administration and Congress were not so completely dominated by protectionists, they would be working to eliminate the barriers that are making it more expensive for people in the United States to get health care.
Comments (15)Add Comment
Complexity and compentence
written by tom, April 23, 2011 8:21
I don't think it is just long hours and uncertain pay. I find the three way relationship patient-insurance co-physican a nightmare. It is nearly impossible to reconcile provider bills and insurance statements. I can't imagine that a solo practitioner could negotiate this morass efficiently.

Given the situation, I am prejudiced against solos. I assume they are either fools or too incompetent to get a position with a group practice.

It's telling that the doctor can't provide health insurance for his employees. 'Eat your own dog food.'
Baker Leads Race to the Bottom for Americans with Immigration
written by izzatzo, April 23, 2011 8:26
The article argues that long hours and uncertain pay make it unattractive for physicians in the United States.

Economic conditions have worsened to such abysmal levels that even doctors are worse off and what does Baker recommend? To import more doctors like they were so many slaughter house workers from Mexico.

Baker hates America. He wants to use commie competition to import 'doctors' with slaughter house skills and wages to be your doctor, the same way corporate persons import cheap labor for slaughter houses.

Oust Baker and his socialist buddies. Vote for Paul Ryan health care reform and choose your own slaughter house insurer and physician with a slaughter house voucher for higher, not lower prices.

Good doctors don't work for nothing. They understand in free markets that supply curves slope up in order to cover their opportunity cost of not being a slaughter house butcher instead of an exquisite surgeon.

Stupid liberals.
Other solutions
written by Steve, April 23, 2011 9:26
Why not open more medical schools in the US? Why not broaden the ability of nurses, not much less skilled than doctors, to prescibe medicine, etc? For that matter, why force people to engage with the medical profession simply in order to access medications they want? How is that the 'free market'?
What NYT doesn't tell us, but should, about growing power of hospitals
written by Rachel, April 23, 2011 9:39

Earlier this month The New England Journal of Medicine came out with an article on how hospitals have been employing more and more doctors. So that's probably a big reason why the family doctor in the article can't find anyone to buy his practice. It's not because so many young MDs are, like the younger fellow they mention, off to work for DOD.

But it seems as if NYT only wants us to feel sorry for solo practitioners, wants us to feel that medical fees should be higher. Otherwise they might have contrasted the solo practitioner in the story with another one who shares his practice with an advanced nurse. Or they might have contrasted him with one in a state where they've been making an effort to rationalize administrative costs. (Now I don't know that any state that is working on that! Unfortunately, this issue has been dominated by a doctors' lobby that only offers the alternative of single-payer Canada, with, I think, 16% administrative costs.

On the larger scale, it might have been better if the NYT had discussed the increasing market power of the hospitals, which are getting hold of so many doctors, and how this could well mean that the Affordable Care Act won't be able to do much to help slow the increase of health care prices. (This was discussed last year in JAMA.)
Family Doctors
written by SLightner, April 23, 2011 11:16
I don't think the solution to the growing dearth of family doctors is to import more foreign doctors and drive prices down. I think the article/video validly pointed out that this was not a cost effective way to deliver care, nor was it a choice of a life style for most doctors today. HMO's like Kaiser Permanente are leading the way in innovative health care and by eliminating the fee of each service, and utilizing a yearly fee, puts the burden on them to come up with ways to maximize healthy outcomes at reasonable costs. Inside of trying to prop up what is no longer a cost effective delivery system by bringing in cheaper labor, maybe the solution is changing the delivery system itself.
written by PeonInChief, April 23, 2011 11:35
No sympathy. He employs people part-time, probably to keep his employment costs down, and is too cheap to provide them health insurance. And frankly (I know this is heresy), I've never found that having a close relationship with my doctor has improved my care.
Let's Have Free Trade and See Where the Market Ends Up
written by Dean, April 23, 2011 12:39
I don't have strong feelings about solo practitioners, but if foreigner doctors are willing to train to our standards and fill this role, and people here are willing to pay, why not?
If I can be H1B'd then soo too for the docs
written by The Trucker, April 23, 2011 4:19
I didn't see the doctors or the AMA raising a fuss when the invasion from India happened in 1999 and 2000. And Information Technology is not as critical as health care. IF there is a shortage of practitioners (there wasn't a shortage of technoids in 1999), then H1B should be used to fill the gap until we can "grow our own". And there are many physicians all ready trained and certified that would be willing to relocate here on a permanent basis.
Is there any reason to think that it would be difficult to train more doctors?
written by Yoram Gat, April 23, 2011 5:21
The number of MDs conferred in the US has stagnated over the last 25 years, leading to a significant decrease in the number of doctors trained per resident.


Would it be so difficult to create more medical schools?
written by mje, April 23, 2011 5:36
Sorry but burst your bubble Mr. free market, but the US market is not that free. the AMA says who can be a Dr. or cannot be a Dr. What do we have to show for it. The US healthcare system is most expensive system in the planet the least qualatative. Per the UN , its report ranks it to be number # 37. what other industry costs too much and delivers so little and keeps growing? Certainly, not an industry subjected to the competetion of the free market.
written by bill, April 24, 2011 4:26
What would be the problems with importing doctors trained elsewhere? Might it relieve pressure on medical schools/AMA to train more docs? What happens to a country when you take away most of it's trained healthcare professionals for what is higher paying work in the US (see nurse experiences)?
US medical candidates
written by Uncle Bruno, April 24, 2011 9:16
There are plenty of people in the US who would be willing to train to train to US standards and would be delighted to work under those conditions. Many qualified candidates are denied admission to med school.
written by andrew, April 24, 2011 10:40
Wow, I nearly always agree with your take on things, but this seems truly misguided.

1. The doctor in the article is a relic --- his world has nothing to do with the world of today's young physicians. He worked very hard, undoubtedly, but was very well paid for his work over the years, when unions were healthy and Americans had actual benefits. New US-trained doctors must take on truly shocking amounts of debt for medical school (on top of "normal" astronomical college debt) and spend years thereafter receiving merely subsistence pay as residents/fellows before finally entering a world of jobs that, save for a few specialists performing procedures, will never be more than modestly paid, and for which indeed all payment is increasingly the object of wrangling with powerful insurance companies. To become indignant at the attempts of young doctors to manage their accumulated debt, their great responsibilities, and the realities of their profession is knee-jerk stupidity. You want to fix the supply of doctors by introducing an H1B-equivalent importation program, fine; but then you must also reform medical education and health insurance in this country, or you will literally destroy the profession.

2. I say "destroy the profession" without qualifier because I don't believe importation of a commoditized class of medical practitioners from the third world is an effective way to build it back up. The H1B program is by and large a woefully inefficient and ineffective way to address technological needs in this country; to wish to model our response to health care on such a program is lunacy. Go spend a week in the IT pool of one of our TBTF banks, trying to have even basic discussions of what's important, how to negotiate risks, how to handle bad news, and then tell me that this is how you want your health care delivered. Madness.

3. Besides being a practical disaster, the H1B program is a moral obscenity, yet another means to hand power to the corporatocracy at the expense of middle-class America. You write, "there is a huge supply of people in the developing world who would be willing and able to train to U.S. standards and work under the conditions described in the article." Jeffrey Immelt couldn't have put it any better.

Here's what happened, Dean. The New York Times is a corporate propaganda rag. This piece is an attempt to build public opinion against the cushy lives of doctors, now that we've finished off the cushy lives of unionized autoworkers, American engineers, Wisconsin teachers. You got jiu-jitsu'd into taking the same position. Less protectionism in America has to come with meaningful system-wide reform. Otherwise it's just stripping the people to feed the upper 0.1%.
written by liberal, April 24, 2011 1:08
Yoram Gat wrote,
Would it be so difficult to create more medical schools?

Yes, it would, because doing so would decrease monopoly rents in the medical profession.
Try local monopolization
written by FoonTheElder, April 25, 2011 2:50
The local doctor is being eliminated by the continued increased monopolization and oligopolization of health care by local hospitals.

They've acquired every doctor practice they can get ahold of. They then use that power to force price increases through insurance companies and of medical pricing groups.

Insurers who dominate their state have little choice but to sign up every hospital group in their state, or else lose their dominant status. Their dominance allows the insurance company to pass along the costs without much worry about losing significant market share.

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About Beat the Press

Dean Baker is co-director of the Center for Economic and Policy Research in Washington, D.C. He is the author of several books, his latest being The End of Loser Liberalism: Making Markets Progressive. Read more about Dean.