Thursday, November 21, 2013

American Doctors: Overworked, Overpaid, and that's the way they like it.

American doctors are by far the best paid in the world and the US has fewer doctors per capita than almost any other advanced country. Market failure? It's actually a cartel. Kevin Drum has some of the details.

The key point is that doctors are the ones controlling the number of doctors in the US and consequently the key people making medical care a scarce and very expensive commodity.

American doctors are paid far more than doctors anywhere else in the world, and yet we have fewer doctors per capita than nearly any other rich country. Why is that? One especially misguided tweeter suggested that this was, yet again, the fault of Big Gummint, which controls the number of residency slots for new medical schools grads, and therefore keeps the number of doctors low. There's a certain kernel of truth to this, because the federal government subsidizes residency programs to the tune of $13 billion per year, just as the federal government controls Medicare reimbursement rates via a committee called the RUC. But that's only half the story. Who controls RUC? Physicians do. They have a stranglehold on it. And who controls how many residency slots there are and what specialties they're in? Again, physicians do.

So the number and composition of residencies is controlled by doctors, even as they're subsidized by $13 billion in taxpayer money every year. And doctor pay, which almost everywhere is based on Medicare rates, is controlled by doctors. It's doctors who are directly responsible for both their own high pay and their own low numbers.

Another way of controlling the number of doctors is by making medical school extremely expensive, but the residency slots are probably the key gateway.

Ida Tarbell, where are you now? Break up Standard Oil - er the AMA.