The current trend, as I understand it, is to reduce the independence of doctors. This is happening on 2 fronts:
1.) The FDA is imposing stricter limits on how doctors prescribe.
2.) The insurance companies are imposing limits on what doctors can do.
The trend has been developing for several decades, but it only came into clear focus during the 1990s, when the HMOs first gained prominence. Doctors have lost a great deal of independence compared to what they had 100 years ago, or even 50 years ago.
#1 has at least 2 parts:
a.) The War On Drugs: this has lead to limits on how aggressively doctors can manage pain. Too aggressive and the doctor comes under scrutiny.
b.) The widening powers of the FDA. Over the last 50 years the FDA has become a general clearing house for all new technologies that effect health. Whereas its focus was once on drugs, it now has substantial say over every kind of medial procedure, including such things as pacemakers.
A simple model of the contending forces might include these main actors:
1.) patients
2.) doctors
3.) government
4.) hospitals
5.) patient insurance companies
6.) doctor liability insurance companies
A simple model would simply assert that each of these is trying to lower their risk, partly by moving the risk onto one of the other players. (A more complicated model would have trial lawyers as their own element, but here the trial lawyers are assumed to be part of #1). In a simple model, you could assert:
risk = the power to make decisions
The more each group tries to get rid of its own risk, the more it also loses the power to make its own decisions. This is a simple model, but it clearly has some truth.
What we've also seen in the last few decades is that when risk in the system goes beyond what private sector actors can manage, then the risk, and the decision making, gets taken over by the government. This was a long term trend, but the trend was made very explicit and visible during the crisis of 2008/2009, when lots of private sector actors failed (Lehman, General Motors, etc) and were taken over by the government.
I keep looking for some sign that this trend might abate, but for now, it seems likely to continue, if in modified form.
Conclusions?
You can become a doctor. You will be respected. You will be well paid. You will lack the independence that has been traditionally associated with the role. But despite that, you may enjoy the work.