Doctors choosing lifestyle

According to the NY Times, a new study in the Journal of the American Medical Association reveals that doctors are choosing specialties more based on lifestyle considerations than in years past.

Lifestyle considerations accounted for 55 percent of a doctor's choice of specialty in 2002, according to a paper in the Journal of the American Medical Association in September by Dr. Rutecki and two co-authors. That factor far outweighs income, which accounted for only 9 percent of the weight prospective residents gave in selecting a specialty. [...]

The field may have acquired its newfound chic from television shows like "Nip/Tuck" and the vogue for cosmetic treatments like Botox, but for young doctors it satisfies another longing. Today's medical residents, half of them women, are choosing specialties with what experts call a "controllable lifestyle." Dermatologists typically do not work nights or weekends, have decent control over their time and are often paid out of pocket, rather than dealing with the inconveniences of insurance.

"The surgery lifestyle is so much worse," said Dr. Boldrick, who rejected a career in plastic surgery. "I want to have a family. And when you work 80 or 90 hours a week, you can't even take care of yourself."

Speaking as a former surgical resident who worked 120 hours a week, the medical 'establishment' is walking a fine line here. It has pretty much absolute control over the number of people that can train at any given time. Thus, there is a financial incentive to keep the number of surgeons practicing at any one time low to have a lucrative market. This results in an undersupply of residents in training who work under extremely stressful conditions, which in turn results in the best and brightest choosing other more benign specialties as the article points out.

In the end, the patient loses because no competition is allowed. If I were to channel my entrepreneurial instincts to try to create a training program for surgeons with better working conditions and shorter length of training, I would be shut down before I could start. There would be cries of 'inadequate preparation', accusations of lax regulation, and appeals to tradition. A union monopoly established under the guise of 'standards' worsens patient care.

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". A union monopoly

". A union monopoly established under the guise of 'standards' worsens patient care."

So these folks operate pretty much like unions in trying to control entry to the field.

Are you aware of any good discussion around the idea of how to actually break this monopoly?

Are you aware of any good

Are you aware of any good discussion around the idea of how to actually break this monopoly?

The problem with any true monopolies is that they are enforced at the point of a gun. As such, they are almost impossible to break. The two most effective methods for breaking monopolies are:

1)Going around them and making them irrelevant. Email, instant messaging, chat rooms, UPS, etc are making the post office monopoly on first class mail irrelevant. I'm not sure if there is a way to do this with the medical monopoly, although the best chance (as with most things IMO) is probably with the internet and strong cryptography. The end goal is to be able to receive reputable medical advice with privacy and making licensing irrelevant. Other things like reading medical images by a skilled non-licensed provider anonymously over the internet will also be possible. That genie is already out of the bottle. Of course things like surgery and chemotherapy are less easily freed through this method, but numbers are key.

2)Civil disobedience, or a variation thereof, in large numbers. This is how homeschooling has semi-broken the public school monopoly although there are still many battles to fight. The number of homeschooled children is so large that it is pretty much impossible for child abductors to coral them up if they wanted to. I'm not sure a similar method is available in medicine, but combined with strong crypto, large numbers may be sufficient to at least put a dent in things.

One way to avoid the problem

One way to avoid the problem is to go overseas for healthcare.

During my time in South Africa, I saw the medical insurance business go through a shakedown after the liberalization of government in 1994. Mostly because of insurance fraud, premiums nearly doubled for two consecutive years. As rates would go up, insurance would be unaffordable for a new group of people who were too healthy or too honest to ever see value for the amounts they were spending on monthly premiums. The result was that they would drop out and the more sickly and those abusing the insurance company (usually by submitting claims for their friends who weren't covered) would be left in the system, causing another rate increase.

The result? A private doctor's visit (no subsidies, no insurance coverage) now costs about $15. When you check into a private hospital with a heart attack, they estimate the total cost at $5000.

The government did not require mandatory health insurance, so the old system had a way of dying gracefully. Also, the amount of resources available to maintain the old system was much smaller than in the US. South Africa is a wealthy country with a population of 5 million inside a poor country with a population of 40 million.

Attitudes toward liability are also different in South Africa. My doctor in the US says that a significant part of her expenses are for liability insurance premiums.

The South African government does maintain its own system of subsidized low-cost (~$1/visit) hospitals which are basically warehouses where you wait to die--if you do some research into SA medical care, make sure you distinguish between the private and public system.