Why Are American Doctors Paid So Damn Much?

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96. Drastically dropping doctors' pay would result in a number of changes

-- With less incentive to put in the long years of study to become an MD, the system would require the influx of para-medical personnel to take over the work, such as P.A.'s and N.P's. For simple things like blood pressure checks, diabetes monitoring, well-baby checks, this would probably be fine. But as soon as something gets complicated, and they have to send it to the M.D., do you think that doctor is going to want to be paid the same per-patient rate as the N.P. when the MD's patients are far more complex and take a lot more time? Absolutely not.

-- We'll need to open up medical school admission to a wider range of students. (In Europe, just about anyone with decent grades can get into medical school, where the winnowing-out process takes place, so they have a high drop-out and fail rate. In the US, the winnowing-out process takes place at the time of admission (based on grades and MCATs) and you have a very small drop-out rate.)

--States and universities have to bear the cost of setting up new medical schools. Just for Anatomy class alone, you need specialized equipment (morgue tables, dissection tools, highly-skilled faculty, refrigeration units, facilities to handle biohazards, etc.) and very few universities or state budgets are prepared to spend that kind of money right now. Add to that expensive clinical faculty, lab equipment, etc. A large part of the hold-up in producing more doctors is the sheer cost of starting new medical schools.

-- We need more residency positions opening up to accommodate all those graduates.

-- We need to protect doctors from malpractice costs. Doctors cannot work for less on behalf of the government, plus still be liable for millions of dollars in damages. And who is going to cover NPs and P.A.s? Will they have to have their own malpractice insurance? What will malpractice attorneys say about all this?

-- There will eventually be a two-tier care system. There'll be "Walmart" care for most people, where you can only see an NP or PA (unless you have a complex problem.) But the wealthier patient can go to a private-pay M.D. and use concierge care. In fact, most highly trained M.D.s will probably opt for concierge or fee-for-service care, because it will simply be more lucrative. There's something of this now in the UK, where patients who opt for additional premiums can go to private doctors.