It’s extremely beneficial to the people who are already doctors (dramatically increases salary, prestige, power), and that is a powerful group in most societies.
I'm seconding 'viraptor here - this isn't a good enough explanation. It doesn't stand up to scrutiny, and doesn't mesh well with day-to-day experience. Individual doctors I know seem to have very little influence over anything, and they're first in line to the protests about working conditions and pay.
1. Doctors have a lot of political influence because they are popular. This means they can get away with things that other industries mostly can't.
2. State provision of medical care corrupts the system, as I describe sidethread: https://news.ycombinator.com/item?id=40030452
One way to drive "medical costs" down is to ensure that the supply of medical care is low. This also drives prices up. This means that the incentives of the regulatory body are directly contrary to the incentives of the people supposedly benefiting from the regulation.
(And doctors and hospitals are happy with this, because such a system boils down to telling them "we want you to do less work, but for more money".)
3. (Tangentially, note that the general model of "restrict supply, subsidize demand" is incredibly common. It's popular both ways; the first part helps a small but politically active and highly motivated group, and the second part pretends to help the populace in general.)
How is this at play (from the article we are commenting on)?
The article does not mention once: "medicare", "medicaid", "regulation", "law", "government" - once.
If anything, it's the inverse. You have it bass-ackwards, the private hospital, the for-profit system is driving things like:
> I delivered my third child with my own hands because the obstetrician was stuck in a traffic jam. The following morning I went to work because if I didn’t 12 patients have to miss their surgeries, 2 anaesthetists and about 8 nurses will miss out on their day’s income. More importantly, admin would not be happy because a cancelled operating list is a huge financial loss to the hospital.
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> 1. Doctors have a lot of political influence because they are popular. This means they can get away with things that other industries mostly can't.
Can you clarify how this doctor exerts any type of political influence? They have a sleeping bag in their car they sleep at their job so often and are lamenting they barely get to see their family. I don't see your point at all being illustrated in this article, at all.
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> "And doctors and hospitals are happy with this, because such a system boils down to telling them "we want you to do less work, but for more money".
I get the feeling this doctor is on the verge of suicide from being over-worked. Do you think the person that wrote this article would agree with your statement?
The culprit is the AMA.
> In the 20th century, the AMA has frequently lobbied to restrict the supply of physicians, contributing to a doctor shortage in the United States.[10][11][12] The organization has also lobbied against allowing physician assistants and other health care providers to perform basic forms of health care. The organization has historically lobbied against various of government-run health insurance.
The doctors are simply wrong; the state is correct from a pernicious point of view.
Because the state is responsible for buying so much of the total supply of medical care, they generally view things from the perspective of "how much are we spending on the category 'medical care'?", rather than the perspective of how much any given treatment costs.
Increasing the number of doctors lowers the cost of all treatments and is unambiguously good.
However, it does raise the total amount of medical spending, which, in the eyes of the state, is bad.
That’s the view of the government?
Or induced demand.
That said, likely individual medical outcomes would be better.
Large scale systems tend to produce… odd behaviors.
One reason you could imagine is that the health trusts determine roughly how many student doctors they are able to train and then the government limits graduation rates based on this. But I don’t know if that’s the actual reason, and it could be a half-reason, eg the number was set a long time ago and not updated.
If I sell garden gnomes wearing knitted hats, but I only make three a year and sell to only people who drive yellow cars, I doubt I could earn a decent living off this
The sub-text is that doctors are slightly corrupt and wish to be payed more, and therefore are incetivized to reduce the total number of doctors.
After reading the travails of what this doctor is going through, that seems like a very callous take, insulting even.
What's more, it seems that this article has triggered a reflexive anti-union stance, when it's more a hallmark of a place where capitalism does not work well. Why doesn't that hospital have more doctors? Surely, they could have found someone additional if they wanted. The hospital did not have to schedule every surgery as if they all required the average procedure time. The hospital could invest in better IT infrastructure and have software that was not a drag to use. Surely the hospital could have someone help the doctor not make 70+ calls over the course of a shift in addition to everything else they do. This blog post is not about a general scarcity of doctors; there's lots that could be done by the hospital investing in its staff and outcomes without hiring a single additional doctor.
Many hospitals are run by non profit organizations to help reduce this problem. However even they cannot run at a loss overall for long. Bankruptcy doesn’t help anyone actually provide services, after all.
Gov’t has different incentives - but then care is strongly controlled and limited by public policy, for better or worse.
And an organization that is able to optimize to produce more value than they consume (aka is more profitable) can take more risks, expand better, have more capital to invest in training, equipment, etc, be more competitive in who they hire, and have better and more comfortable facilities if they want.
And being a Dr. can be really miserable sometimes, and the training is also really hard and miserable.
Some (surgeons, esp. plastic surgery) optimize for maximum $$ for misery, usually. Others (pediatrics) optimize for maximum ‘feel goods’ for misery, usually. Most others are somewhere in between.
Either way, if they didn’t want/need the money, they’d be going to medicine sans frontiers or working in rural medicine eh?
Eg, businesses that cheat and get caught. Businesses that over consume and can no longer produce.Also, that optimization can have the opposite effect. Eg, optimize revenue by showing max ads, with max ads users start to flee. A hospital could optimize for patientoutcomes, and then do better because the patients stay around.
This overall though assumes that free market principles work in healthcare. Those principles tend to assume consumer choice.
Prestige is, of course, not a function of income alone. Plenty of software developers get paid at least as much as respected professors or top military brass. That doesn't mean they have equivalent prestige.
That doesn't make any sense. And not everyone has the capital or capacity to make their own business
Further, you assume a surgeon could just become a GP. They are different fields.
https://www.quora.com/Can-a-surgeon-also-practice-as-a-prima...
"Can a surgeon become a regular doctor?"
> They can try. But they would have no idea what they are doing. But legally, they could certainly practice as a primary care doctor. They would not be board certified, and could not sit for the ABIM exam, and would not be able to pass it if they did.
> The professions are also very different, primary care is more allied to the work of a physician, whilst a surgeon is trained to do serious surgery, not the kind a primary care doctor would do. So not sure even if you could be legally certified in both specialties you wouldn't loose your surgical skills if you spend a lot of time in primary care.
> Knowing what I know about the medical world in general I would advice against such a combination, a surgical residency is such a taxing one that you wouldn't have time to do anything else beside surgery, furthermore the required mental approach to do the work well as a surgeon or a primary care physician is also quite different.