OP-ED

Are Doctors Shifting to the Left?

A recent story in the New York Times (As Physicians’ Jobs Change, So Do Their Politics) highlights the political shift underway within the physician community. While doctors used to be mainly male small businessmen, who were a natural fit with the Republican Party, they’re now much more likely to be female and employed by larger organizations. According to the Times, that’s making doctors more likely to be out of sync with the GOP, and the article cites examples from around the country. The American Medical Association came out in support of the Patient Protection and Affordable Care Act, which was a surprise to many. State medical societies find themselves increasingly allied with liberal activist groups, and even historically “red meat” issues like malpractice reform aren’t that big a deal for those whose malpractice premiums are paid by their employers.

It seems to me there’s an important facet missing from the article. When I was growing up in the 1970s, being a doctor was viewed as one of the surest ways for an ambitious person to make money. That started to change as the advent of managed care made medicine less lucrative and the explosion of the financial services industry provided opportunities to make a lot more money in investment banking, hedge funds, private equity and venture capital. As I observe my own generation and those somewhat younger than me, it seems that those intent on making a lot of money aren’t as drawn to the physician path.

My father in law, of blessed memory, used to compliment certain physicians by saying, “he’s not a money doctor.” That really boiled it down to the essence.

On the whole, younger doctors –and older ones who are sticking with the profession– seem to have the patients’ interest increasingly at heart. And that’s no bad thing.

David E. Williams is co-founder of MedPharma Partners LLC, strategy consultant in technology enabled health care services, pharma,  biotech, and medical devices. Formerly with BCG and LEK. He writes regularly at Health Business Blog, where this post first appeared.

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Jackson CamareroTimsteverbaerBarry Carol Recent comment authors
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Jackson Camarero
Guest

Hello could I reference some of the content found in this site if I reference you with a link back to your site?

Tim
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Tim

“Doctors” are not shifting left. Primary care is shifting left, because the Left has adopted them and is working hard to re-distribute (part of) the money from specialists to primary care. Why?

The AMA accepted this Faustian bargain, because it looked like it had the promise of boats all around.

Wait till the PCP’s notice the rhetoric has shifted from “we’ve decide the surgeons make too much and we are going to take it away” to “we have now decided to discuss YOUR income.”

Barry Carol
Guest
Barry Carol

Margalit – Matthew or Jonathan could probably speak to this more accurately because they’re in Kaiser’s backyard, but my understanding is that they pay their primary care docs at least 10% or so above the market average. Moreover, unlike many other large multi-specialty provider organizations, Kaiser doesn’t use any of the standard productivity metrics to evaluate their doctors’ performance. There was a time when Kaiser had a more significant cost advantage vs. its competitors than it has now. If there were a large cost advantage, it would be reflected in lower insurance premiums which would benefit members as well as… Read more »

Barry Carol
Guest
Barry Carol

”There is no risk of not having enough talented people being motivated to apply to medical school and become doctors to fill all the available med school slots.” Jonathan – What about the primary care residency slots? Don’t we need to attract a significant number of foreign born doctors to fill those? Also, you may have better data than I do but my understanding is that there are currently only about two applicants for every medical school opening. It was considerably higher in years past, no? At the undergraduate level, the most selective schools have from five openings for each… Read more »

Margalit Gur-Arie
Guest

First, I am not certain that Kaiser is paying PCPs more, or using PCPs more than others, where the last P is for Physician not provider.
Second, the problem with corporations and closed systems is that whatever savings are realized are not immediately obvious to consumers. This would not be the case for the traditional Medicare program.

Craig "Quack" Vickstrom, M.D.
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Craig "Quack" Vickstrom, M.D.

Wow, Ms. Gur-Arie. You get it.

Margalit Gur-Arie
Guest

“I don’t know that we even need the best and the brightest in primary care…” “…..as h/she evaluated my health and coordinated my care with specialists as needed.” Mike, how do you envision this system of treatment by specialists and traffic directing by second rate professionals, being any cheaper than what we have now? The big bucks are not currently spent on primary care, which is probably why we spend so much on unnecessary specialty care. I would prefer that the best of the best of the best…with honors, be in primary care and actually treat patients instead of handing… Read more »

Mike
Guest
Mike

I would reject your assertion that we are talking about “second-rate” professionals, when for example we might be discussing Nurse Practitioners, or perhaps a reemphasis on a level of physician training that does not involve specialty training or board certification. I think it is an important to ask whether the level and cost of medical education is appropriate to the intellectual and practical requirements of primary care. Might be, but my personal experience with NPs and PAs has all been positive, and there is a lot of economic self interest at play in physician objections to allowing people with these… Read more »

MD as HELL
Guest
MD as HELL

Primary care providers need experts to defend them in court. Until a defense can be successful with only primary care witnesses, there will be no change in the practice and cost of healthcare.

rbaer
Guest
rbaer

I am still unconvinced re. the assertion that medicine incl. non procedural specialty care has become financially unattractive. Where are the hard facts, i.e. availability and compensation of finance jobs, and what the failure rate is (i.e. people who either do not stay in the field or are struck with unattractive compensation). The same applies for law. And yes, job security is a big deal, esp. these days. My personal belief is that these 1.5% owho make 300K+ are mostly “entrepreneurs”, people with inherited wealth and physicians. I think that the percentage of lawyers and finance people in this income… Read more »

Barry Carol
Guest
Barry Carol

I think the issue of constrained or declining physician income mainly affects primary care doctors, pediatricians and the like. I don’t hear many dermatologists, radiologists, orthopods, etc. complaining that they’re underpaid. It’s quite obvious why a relatively small percentage of U.S. medical students opt to go into primary care. We could probably address the issue, at least in part, by paying somewhat more for E&M codes and less for procedures but the RUC remains dominated by specialists so significant progress is unlikely on that front.

Barry Carol
Guest
Barry Carol

rbaer – I think Steve summed it up pretty well. Much of Wall Street pays very well. The same is true for the capital markets segment of commercial banks. There are lots of opportunities to make significant money in real estate, corporate law and the management positions track at large corporations. As Steve noted, the docs probably have a higher income floor and a lower ceiling, along with, I would say, better job security. As for primary care doctors, I think we will see more of their function at least supplemented and, in some cases, disrupted by nurse practitioners. Computer… Read more »

Jonathan Halvorson
Editor

Barry, when you deal in vague generalizations like this, it is easy to retain false beliefs. There is no risk of not having enough talented people being motivated to apply to medical school and become doctors to fill all the available med school slots.

rbaer
Guest
rbaer

Barry, you usually know what you write about, but “There are too many other attractive fields that pay a lot better with less time and expense needed to acquire the requisite credentials and expertise”? , I think requires some examples and possibly references with regards to income levels. One reminder: residency is paid – not well, but sufficiently do have an OK life in most US metropolitan areas/cities.

steve
Guest
steve

Tournament theory. Top grads have been going into the financial sector for quite a while. They make good salaries with a chance to make billions. Sort of true for law also. Medicine still pays very well, but there is a ceiling not seen in some other fields (granted the floor is substantially higher). The other part that many miss is not just total hours. How do you count call hours? If you take call from home for a weekend, how do you count those hours? Next, what about nights and weekends? How many other fields require that you be able… Read more »

Jonathan Halvorson
Editor

Steve, the billionaires in finance probably number in the hundreds, at most. And we really don’t want more of that. The big bucks in finance these days is not coming from improving the liquidity and efficiency of markets, providing finance to industry, etc. It is coming from high stakes gambling where the ones who make money are those with better information about future outcomes and who arbitrage their way to success in win-lose bets, rather than win-win scenarios more common in traditional finance. Also, this income “ceiling” exists for almost anyone who works for a corporation, or on a contract… Read more »

Margalit Gur-Arie
Guest

“There are too many other attractive fields that pay a lot better with less time and expense needed to acquire the requisite credentials and expertise. ” And there are all sorts of fields that pay a lot worse and require plenty of credentials. I know several best and brightest that are immersed in astrophysics and have no prospects in the area of boat acquisition. Considering the number of best and brightest that are routinely rejected from medical schools due to limited space, and considering the number of best and brightest that don’t even apply because of the perceived enormity of… Read more »

Jonathan Halvorson
Editor

Well said.

Barry Carol
Guest
Barry Carol

Margalit – As I’m sure you must know, “best and brightest” is an expression that means smart and highly capable people. Nobody expects them all to go to medical school. However, given the time, effort and expense it takes to complete medical school and residency, there has to be a good financial return to justify the effort. There are too many other attractive fields that pay a lot better with less time and expense needed to acquire the requisite credentials and expertise. Sure doctors get lots of satisfaction from helping people stay healthy or recover from illness just as successful… Read more »

Jonathan Halvorson
Editor

Barry, what are these “many” other attractive fields that pay “a lot” better, and how many budding or current physicians could really move into those fields? I don’t believe these higher-yield fields exist today in any numbers. Certainly not with respect to medical specialties that earn north of $300,000 a year. Yes, hedge funds pay better. Do you know how many people work in hedge funds? Way, way less than the 700,00 to 900,000 practicing physicians. And to get into the really high paying hedge funds and other financial industry positions, you already have to not only get your MBA… Read more »

MD as HELL
Guest
MD as HELL

300K was a lot of money in 2001. It is not in 2011.

Jonathan Halvorson
Editor

Wow. that belief helps me to understand where you are coming from, though.

Only about 1.5% of Americans make $300,000 or more. This is a lot of money to the average American, who makes about $32,000. Even the average American with a professional degree (includes docs and lawyers) “only” earns $100,000. Who doesn’t regard three times as much income as they are currently making “a lot” of money?

MD as HELL
Guest
MD as HELL

The only primary care doctors earning less than 250k per year are the employee docs. Lok at any ED doc ad and do the math…$200 per hour times 2000 hours per year = a lot more than $100k. Only trouble is the remuneration is flat with a lot more work due to deadbeats getting care without paying; something about EMTALA, I think. “Specialists” like radiologists and nephrologists make north of one million per year. Didn’t used to be that way, but along came CT guided procedures that used to be done by surgeons. Same with cardiology. Everyone used to get… Read more »

Margalit Gur-Arie
Guest

OK, I am going to commit blasphemy here.

What does “best and brightest” mean? Is there one uniform set of “best and brightest” and should they all go to medical school?
Aren’t those math wiz kids that choose to go somewhere else because medicine may not be where they can make the most money really a loss to the profession and to the public?

MD as HELL
Guest
MD as HELL

I still have two weddings and another college education to go (total of four), after private secondary school for my fourth child. I have a boat. I see it four or five times a year. A little boat. I have been doing this for 29 years. My income has been flat for the last 5 or 6 years because of squeezing payments with rising costs and the shrinking dollar. Pay me in 1999 dollars and I will be fine. Pay me in 2012 dollars and I won’t be fine If you think you can pay me less you are wrong.… Read more »

DrWonderful
Guest
DrWonderful

Why shouldn’t a doctor own a boat? In America the best and brightest are always going to make a very good living. Do we want them in health care or doing something else? Right now the best and brightest are choosing other careers. Do expect that to somehow change for the better if we keep slashing physician pay? Fairly soon, when the Boomers retire, we will see how just thin the health care talent pool is getting. The smart kids are choosing computer science, finance and engineering careers (or HMO, Hospital or Pharma executive positions, of course) instead of medicine.… Read more »

Craig "Quack" Vickstrom, M.D.
Guest
Craig "Quack" Vickstrom, M.D.

I would be happy with the respect and deference to which I am professionally due. I already own a nice kayak.

Mike
Guest
Mike

Don’t mind if you own a boat, but I would not choose to be part of your boat financing scheme – the one that was implicit in the bargain for physicians graduating 20 years ago and is increasingly not part of the deal. I’d rather be treated on a routine basis by a physician who is an employee of a large organization and who is part of a team and whose idea of health includes the population as well as the individual. I would rather know that that physician had a balanced work and family life and was rested and… Read more »

Jonathan Halvorson
Editor

Nicely said, Mike.

You know, somehow every other developed nation manages to get an adequate supply of physicians while paying about 1/2 to 2/3 as much as we do, and they don’t have worse quality in primary care or chronic disease care, in general.

If we do pay less, we will have to change medical school substantially, because right now that is the supply choke point. They are both too expensive and graduate too few physicians.

Margalit Gur-Arie
Guest

Then why don’t you see an NP for primary care Mike? They are available now.

Mike
Guest
Mike

I often do. Never bothers me, so long as I’m being seen in a practice that functions as a team. In fact it was an NP, and not a physician, who first made a critical diagnosis for me, the only one I’ve ever had. Could have been a physician… but the NP took a little more time and probed a little more deeply than any physician I’ve ever seen. The main thing I’ve come to believe after years as a patient and as health information technology person is in well functioning systems of care, not individuals. See: http://www.newyorker.com/online/blogs/newsdesk/2011/05/atul-gawande-harvard-medical-school-commencement-address.html

Mike
Guest
Mike

They are available, and I’ve had only good experiences with them. Never bothers me to see an NP or a physician, so long as I’m being seen in a practice that functions as a team. In fact it was an NP, and not a physician, who first made a critical diagnosis for me, the only one I’ve ever had. Could have been a physician… but the NP took a little more time and probed a little more deeply than any physician I’ve ever seen. The main thing I’ve come to believe after years as a patient and as health information… Read more »

James Smith
Guest

Hi…

Its really a nice piece of writing..!! keep posting so we could be benefited like this….! ! !