Money
Tuesday, September 16 2008
Dr. Whitecoat summarizes an article about the lack of med students choosing primary care thusly:
The survey found that:
1. They don’t want to deal with all the paperwork…
2. They don’t want to take work home with them… to make ends meet, so they have to complete their charts at home), and
3. They aren’t willing to deal with all the demands of chronically ill patients
I’ll ignore for a moment number three on this list, which you could restate as: “I don’t want to help the people who need me most.” Instead, let me point out that the article Dr. Whitecoat is summarizing actually spends a lot of time talking about money – specifically how little generalists make compared to specialists. The money angle is something several doc blogs spend time on – see for example, the end of this post by Kevin, MD – and seems to have two components: first, the insurance companies (and Medicare, I gather), and second, the cost of medical school. The Kevin, MD post talks about “mortgage-sized” debt, a common refrain for him.
What I never see in these arguments is any critical evaluation of the cost of medical school – as though it is inherently so expensive. It seems far more likely to me that med schools have discovered that they can charge pretty much what they want, and people will still come to their schools. The reason they can do this is because there’s so much money in medicine. The for-profit insurers have been pretty good at getting their cut, but med schools might be a close second – and no surprise, then, that doctors are feeling the squeeze.
I have particular, limited amount of sympathy for doctors, but I also think they’ve helped create this system. A doctor complaining about the primary care crisis in one breath and denouncing universal care in the next pretty much deserves whatever punishment he finds in this system. The problem is that so many sick people are trapped in there with him. If you think doctors have it bad, you have no clue what it’s like to be sick.
