Free Markets, Free People

Central Planning And Health Care

One of the little discussed but probable consequences of making health care both universal and less rewarding monetarily for doctors is an inevitable shortage of doctors. The UK has had such a problem for years. They recently raised compensation for doctors by 50% in hopes of attracting more (the average salary is now 108,000 pounds). They also hoped that the raise in pay would see more British doctors working the odd shifts and weekends.

Apparently the opposite has happened:

The NHS is having to rely on doctors from overseas because a lucrative new contract for British GPs has resulted in more than 90 per cent opting out of responsibility for their patients in the evenings and at weekends.

Consequently, one-third of the primary care trusts (PCT) are flying in foreign doctors (from Poland, Germany, Hungary, Italy, etc) to treat patients “off hours” and on weekends. That obviously drives up costs, and the exhausted doctors have been killing patients, unfortunately.

So there’s a lot of hand wringing going on about the use of foreign doctors. But for anyone who has studied markets, what has happened there is a natural reaction to centrally imposed salaries. If the average is now 108,000 pounds and it is a 50% raise, you can figure that doctors previously were making less than a good auto mechanic. Why spend the time and effort to become a doctor for such mediocre compensation?

Probably more interesting is the fact that the same doctors now making better money for their type of work, have opted not to participate more in “off hours” and “weekends” figuring they’re still not being compensated enough to do that. Call it a passive but effective way of protesting their wages.

The NHS feels that its increase in wages will help solve the problem of the internal doctor shortage:

A spokesman for the Department of Health said: ‘The NHS has always used professionals trained abroad because until recently we did not train enough for our own needs.

The phrase “until recently” implies that now they are. And it stands to reason the new wage will attract more to the profession than the old wage did. However, will they be “enough”? And will they too “opt out” of “off hours” and weekend care? If so, the problem remains – central planning will decide their work is worth “X”, the doctors will decide it is worth “Y” and until they get “Y”, they will continue to opt out.

That of course means the importation of foreign doctors will continue to grow as it has in recent years. The money that could be going to British doctors will go to the foreign ones. And British doctors will continue to refuse work on off hours and weekends while foreign doctors kill their patients.

A lovely system, wouldn’t you say?


8 Responses to Central Planning And Health Care

  • This can’t be possible! It’s the opponents of reform that want people to die, isn’t it???

    Now I’m confused…

  • 108,000 pounds is close to 170,000 USD….auto mechanics make that much? Really?

    I would say that allowing public servants the chance to opt out of weekend and night work would immediately have them do so, regardless of salary.

  • For those unfamiliar with the details of becoming a doctor, it involves:

    – 4 years of undergraduate, and unless you’re pretty well connected in the medical community you’d better get exemplary grades

    – 4 years of all-consuming medical school

    – 3 years of internship and residency, which is best described as indentured servitude – low pay, grueling 12 hour shifts, etc.

    And at the end, the typical budding doctor is perhaps $200,000 in debt.

    Traditionally, we’ve expected some of our brightest to take on this obstacle course, with the promise of high income, respect, and some degree of autonomy.

    Taking away or reducing those benefits has effects. Many of them have already been taken away. The autonomy is mostly gone; most doctors have to be connected to large organizations and go by their rules. The income is subject to stratospheric malpractice insurance and difficulties in billing. You would be surprised how many doctors offices submit every single bill immediately to factors who do the collection for a fat fee, because the doctor needs the money right now. It’s hard to believe you are respected when you spent a large chunk of your day doing paperwork to satisfy the government and the insurance companies, while cutting back to a couple of minutes or so of actual interaction per patient.

    Smart people don’t suddenly become dumb just because they are called on to provide “public service”. They find something else to do. They have options, because they’re smart. We’ve already lost some because of the increasing socialization of healthcare. Oh, sure, some stay from their devotion to the profession, but some leave, and fewer savvy people go into the profession because the costs are no longer worth the benefits.

    The result is inevitable: less savvy doctors. There’s not really much of a way to measure the effect of that on our healthcare system, but I’ve heard plenty of anecdotes (along with a couple of my own) about doctors who didn’t know nearly as much as they pretended to know. Do we really think this is likely to get better under a system that’s more dominated by government?

  • I presume you all are aware that roughly 25% of physicians in the U. S. are foreign-trained and in many cities a majority of internists are foreign-trained.

    France, Germany, and the United States all have the problem of not educating enough physicians to meet the demand. It’s not a problem unique to the United States.

    • Yes, I certainly understand that Dave – but I also understand that it is the market here in the US filling the gap and not the state trying to guess the minimal price point necessary to fill the gap as in the case of the UK. And, if I’m not mistaken, we’re not flying our foreign born docs in for the weekend – they’re coming here because there’s actually an opportunity to earn what they think they’re worth.

    • Dave SchulerI presume you all are aware that roughly 25% of physicians in the U. S. are foreign-trained and in many cities a majority of internists are foreign-trained.

      Having seen the experiences of my friends and students who were trying to get into med school when I was in grad school, my belief is that the American education system is principally to blame, followed very closely by our culture that emphasizes instant gratification and does little to reward (much less demand) hard work. Most Americans come out of high school completely unprepared for the competition to get into med school: they have neither the academic background nor the work ethic. So, it’s no surprise to me that foreigners, especially from India and China where hard work is DEMANDED from students, are filling more and more of our med school classes and doctor’s offices.

  • The last two words of my previous comment should have been “United Kingdom”.