The headlines are hard to reconcile. This week, the journal Health Affairs published an article showing that American doctors are paid more per service – in some cases double! – than any of their foreign counterparts. American primary care physicians are paid approximately seventy percent more per office visit than doctors in other developed countries. And American specialists rake in even more: US orthopedic surgeons earn approximately 120 percent more for a hip replacement than surgeons in other countries. The study went on to find that these higher fees earned by American doctors are not connected to higher practice costs (such as malpractice premiums, rent, office staff salary). It’s no wonder that our doctors are, far and away, the world’s best paid.
Yet a week earlier, the Mayo Clinic published a study finding widespread burnout among young physicians.
How is it that doctors are both handsomely paid and burned out on their profession?
I think the answer ties into some of my recent posts on abolishing licensure requirements for lawyers.
The medical and legal professions’ regulation of their members is a carryover of the medieval guild system in which artisans were required to be guild members in order to ply their trade. The guild system operated primarily for the benefit of those at the top of the profession – the master craftsmen. The others involved in the guild system – apprentices and journeymen – worked long and hard to pay their dues.
Medicine is the same way. Young residents work 100 hour weeks to pay their dues and work their way up. Doctors in the early stages of their careers work long hours to build up practices on their own, or to cover for older doctors if they are part of a group practice. Finally, in the last leg of their careers, many older doctors simply kick back and cash their large paychecks.
And those large paychecks are possible only when a guild system artificially constricts entry into the medical profession. The fact that many young doctors are concluding that the rat race is not worth it and that we have a looming shortage of primary care physicians suggests that the guild system is broken in medicine. The solution – one which would lower our health care costs as well as improve the happiness of medical professionals – is to let medicine be practiced by more than those who went to medical school.

This blog in maintained by the Boston medical malpractice lawyers at The Law Office of Alan H. Crede, P.C.