Medical Malpractice

"Trying to determine what is going on in the world by reading newspapers is like trying to tell the time by watching the second hand of a clock."

I don't know what they teach in journalism school, but sometimes I think they learn how to use an entire article to avoid stating the obvious. The articles commenting on a report out of Massachusetts demonstrate this point. The report discusses the shortage of physicians, mainly primary care specialists, in Massachusetts, a state that trains more doctors per-capita than just about any other state.

The articles drone on about how to make more doctors and equalize salaries without ever addressing the real issue. I will put it in capitals: DOCTORS DON'T PRACTICE IN MASSACHUSETTS BECAUSE THEY MAKE MORE MONEY IN OTHER STATES.

There, I said it. Massachusetts, although a good place to train (I did), is a bad place to practice. It always has been. There are too many doctors coming out of training programs, and the state has a "model" healthcare plan which restricts salaries. Combined with a bad malpractice situation, people leave Massachusetts for better opportunities elsewhere.

The unacknowledged fact that doctors will act in their own self interest is yet another pesky problem for Obamacare supporters. Doctors are dedicated, hardworking and devoted to their patients, but they are not stupid. If you can work the same hours, see more sick patients, and make more money in Texas than Massachusetts, why not move? Doctors are mobile, both in location and practice type(in training), and will adjust to the market, just like any other people.

As long as the market is free, doctors will want to migrate to higher paying, more rewarding specialties. I became a Radiologist in part because it was far more intellectually challenging and enjoyable for me than general practice. I have previously discussed the attraction of specialty practice (July 8) and no amount of external manipulation or legislation will changes the facts of everyday medicine.

Government attempts to "adjust" salaries to encourage family practice are fraught with difficulties. Much of the way medical care is delivered in this country is the result of previous attempts to manipulate the relationship between compensation and the actual work being done. Such market distortions are characteristic of centrally planned economies and result in the mis-allocation of resources.

One could correctly argue that too much expensive sub-specialty care is being delivered in our country because of the overpayment for such services. However, further government intervention, without careful attention to unintended consequences, could result in even worse outcomes. A rapid, poorly conceived cut in specialty compensation could backfire by further exacerbating the doctor shortage, as specialists retire. It will take many years to replace them with family practitioners.

I don't expect honesty from the authors of the study, they have a political agenda to advance. I would hope the journalists reporting the study to at least mention the real issues, maybe next lifetime.

Emily P. Walker, "Mass. Primary Care Shortage: Lesson for National Reform?" MedPage Today, October 20, 2010