The Law of Unintended Consequences

Four years ago, the New York Times reported that many of the best medical students in the country are seeking out residencies in dermatology and plastic surgery. Many of those students cite the low rates of physician pay and their high student loans as reasons to avoid fields like family medicine.  Yesterday, NPR confirmed the same – that the U.S. is facing a critical shortage of primary care physicians due to medical students’ desire to be able to make a living.

Now, even primary care doctors are moonlighting as plastic surgeons to make extra money (no, that does not always work out well for those who get plastic surgery), or ending their primary care practises and going into plastic surgery instead.  Their reasons for doing so functionally amount to under-payment by insurance companies and the government.

Medical school, even at state universities, is expensive. UMass Medical School charges in-state residents almost $200,000; UConn charges between $220,000 and $330,000 (the latter for out of state).  Private schools are similar: over $300,000 for Tufts, Harvard, and BU.  Nationwide, medical school tuition and fees (note: the above figures account for living expenses) at public medical schools average $28,812 per year.

I don’t think that many medical students started school with the intention of going into plastic surgery or dermatology.  However, when doctors report that they lose money on every Medicare patient they see, or that some procedures have such low reimbursement rates that physicians can barely break even, aspiring doctors will understandably look to fields that do not require them to be at the mercy of with Medicare/Medicaid or insurance companies.   Thus, they gravitate towards cash-pay specialties; unfortunately, cash-pay specialties are exactly the ones that are least needed by the sick.

Ideally, we would create a system for delivering primary care that looks more like plastic surgery from a physician’s perspective: reasonable hours, relatively high salaries, straightforward payment and reimbursement.


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Filed under Economics, Miscellanea, Reforming health care

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