By Dutch Rojas
The deal was simple – sacrifice over a decade of your life in school and residency, take on crushing debt, work inhumane hours, and in return, you’d be set for life as a respected physician.
Except the deal is broken.
Doctors realize their hard-earned MD / DO is a valuable chip to be cashed in somewhere other than at the hospital or clinic.
With reimbursements shrinking, malpractice premiums soaring, and the burnout rate rivaling that of air traffic controllers, smart ones are voting with their feet.
They’re cashing out and getting jobs at hedge funds, biotech companies, Big Tech; you name it.
They realize their degree is an elite credential that opens doors beyond the traditional medical path.
The skills imparted – analysis, grind, problem-solving under pressure – are valued everywhere.
It’s the tremendous skinny jeans and haircut migration, except this time, it’s doctors peeling off their white coats.
The physician shortage is about to become a bounty hunt, with deep-pocketed corporations raiding medical schools for top graduates before hospitals even get a shot at them.
Students are being romanced with riches, untold and sane hours, and a first-class life instead of changing bedpans.
Is this the end of the family physician?
Are rural areas destined to become medical deserts?
Someone should have seen this coming – when you take the best and brightest and grind them into disillusioned shift workers, it’s a talent vacuum waiting to happen.
The white coats are leaving the medical industrial complex, and no one has a miracle cure to stop the exodus.
FROM PHYSICIAN
I’ve been on the Board of Trustees at my medical school for 2 years now. The demand for spots in our class of about 172 continues to be off the charts. We have at least 600 qualified candidates for those spots. That’s after winnowing the applicant pool down from about 1500. It is the key issue that drove the school to build a new $215 M campus that they just moved into last fall.
The real issue for physicians is specialty choice. The reimbursements are abysmal and have been getting worse. Physician practice consolidation helps boost pay, but most of the time it’s private equity that’s creating the economies of scale and scraping off money that would ordinarily go to docs.
There are still a few specialties that do well – most of the surgical specialties, and those that limit their government reimbursements. Ob/gyn, dermatology (cash services), ophthalmology, orthopedics, and plastic surgery are some that do well. Those specialties that are dependent mostly on Medicare (think Cardiology, Cardiothoracic Surgery) are wanting for qualified applicants for their residencies. Why go to medical school for 4 years, a Cardiac Surgical residency for 5 years so you can get paid $1500 for a quadruple bypass – in the middle of the night? Who wants to do that? The DeBakey Cardiothoracic residency and fellowship program in Houston had hundreds of applicants for 3 (or maybe it was 4) slots each year. Now they can’t fill those slots. Are the government bureaucrats listening?
It leaves family practice as almost a default specialty if you can’t get into one of the higher paying ones. But the burnout rate is high and the pay is pretty low, although the stress is a little less. A record low number of pediatric residency programs matched with graduates this year. The reimbursements are lousy. Plumbers and experienced auto mechanics make more. What’s wrong with this picture.
This is all because the government has interfered intentionally in the marketplace with their reimbursements. They always over react. When the free market is not allowed to work, and government bureaucrats dictate what the market will pay, there is always going to be a misallocation of resources. It may take years to play out. But, we’re there now. Now, instead of a top medical graduate taking care of your kids, you’ll get someone from overseas who barely speaks English. They may be smart, but is that what Americans want? Well, that’s what they’re paying for.
