Damn Greedy Doctors by Pat Conrad MD

If you are reading this, and are a doctor, then admit that you are grossly overpaid, and are a huge obstacle to providing high quality, cost effective, and equitable care for a deserving population.

At least that’s what Dean Baker of the Center for Economic and Policy Research thinks.  His premise is that U.S. doctors are paid twice as much as in other developed nations:  “Because our doctors are paid, on average, more than $250,000 a year (even after malpractice insurance and other expenses), and more than 900,000 doctors in the country, that means we pay an extra $100 billion a year in doctor salaries. That works out to more than $700 per U.S. household per year. We can think of this as a kind of doctors’ tax.”  I’m not that deft with big numbers so I got my calculator out, and simply can’t get to the figure Baker concocted.  Then I went back to the article, assuming that I had misread.  Then I deduced that the author was either drunk, a liar, or both, which is resume’ standard I suppose for a left-wing economist.

So let’s stick with this interesting premise, that greedy doctors making too much is the driver in health care costs.  Baker does not trouble himself with how much hospitals, administrators, Big Pharma, or Big Insurance make.  He does not discuss the truckloads of unfunded mandates whose costs are passed on to the physician, and indirectly to the patient, and the enormous inflation and waste added by government medicine.  He does not acknowledge that Medicare effectively price-caps physician income per unit of work; but, he does see how Medicare could – and should – limit expenditures by more tightly controlling the supply of specialists, and mandating more residency slots for family practitioners (who better quit bitching, because “even family practitioners clock in as earning more than $200,000, enough to put them at the edge of the top 1 percent of wage earners in the country”).  There’s nothing like stirring in a little class warfare to make a serious policy argument.

“The other reason that our physicians earn so much more is that roughly two-thirds are specialists. This contrasts with the situation in other countries, where roughly two-thirds of doctors are general practitioners. This means we are paying specialists’ wages for many tasks that elsewhere are performed by general practitioners.”  I assisted on plenty of c-sections in residency, so really, how tough would it be to save on all those unnecessary OB charges?  Doesn’t a cardiac catheterization just involve squirting a little dye in a line?  There really isn’t a good reason that a competent nurse practitioner couldn’t do that, instead of some lordly cardiologist distracted by her next Mediterranean cruise.

This “expert” also has some good ideas about overcoming the increasing doctor shortage, caused by our “doctors’ cartel”:  bring in more foreigners, lower residency requirements, and allow those who have not done a residency to practice as “assistant doctors.” And of course, Baker would reduce costs and increase access by allowing expanded prescribing and procedural independence for “nurse practitioners and other lower-paid health professionals.”

Baker sends us out with one three sneers for doctors who he claims “generally enjoy a great deal of respect in society” (I could not disagree more):

“But if we want to stop paying a $100 billion premium for health care that doesn’t make us healthier, we’re going to need to overcome those political barriers. Getting U.S. health care costs down is a herculean task; getting doctors’ pay in line is a big part of the solution. It’s time we broke up the doctor cartel.

The fact that most people like their doctors will make the effort harder. Most of us like our letter carriers too, but that doesn’t mean they should make $250,000 a year.”

Part of me really hopes Baker gets his wish, and the inexpensive “doctor” that he deserves.

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108170cookie-checkDamn Greedy Doctors by Pat Conrad MD