Monday, February 25, 2013

When Surgeons Go Galt

From our Surgeon Agent in the Field via an e-mail exchange:

Earnings potentia as a surgeon?  Obamacare will make once-self-sufficient privately practicing physicians into insurance and government lackeys, fully employed and owned by hospitals.  Those who have no exit strategy will work more and be paid less.  The number of demoralized and retiring doctors I am witnesseing now has spiked like nothing I have seen before.  Supposedly 1/3 want to get out within the next 10 years, half of these are under 55.  Many of these will talk a big game and do nothing, of course, addicted as they are to their big-spending lifestyles and status as physicians.  Due to the length and intensity of training doctors are more susceptible than most to living lives devoid of interests outside of work.  Sad.  But the resourceful ones will retool and do very well in non-clinical disciplines.  My advice to anyone I meet is to secure a good doctor now if you don't already have one.  As medicaid expands, patients rush in, and doctors rush out, it is going to get very interesting.

Sometimes life is about more than earning potential.  I would rather do meaningful work, performed freely on my own terms for less.  And I have no interest in being a functionary in Barack Obama's scheme to "redistribute" my skills to others by further corrupting the free market price of these services with ever-expanding insurance involvement.  Learning to be a surgeon took a decade of my youth and hundreds of thousands of dollars.  I have quietly gone Galt in my own way... withdrawing myself from any insurance or government payment schemes and performing procedures that are cash only.  I may get out entirely, who knows.  Obama thinks that if he dishes it out that doctors will be forced to take it.  Some, maybe, but not all.

Thanks again for the wonderful book.  The greatest benefit from your book really was psychological.  It is time Enjoy the Decline!

our agent also wrote:

Freedom-oriented people need to understand that a crisis of care is coming... Not now, but soon enough.  I can rattle off in a flash the names of friends and aquaintances who have either gotten out of the pipeline (dropping out during training to get MBAs or to take jobs in consulting.. One friend is selling real estate in NYC!) or very capable fifty-somethings who retired or are planning on retiring very soon.  In the case of the retiring docs these are people who really enjoy what they do.  These are very capable surgeons, not easily replaced by a nurse.  Think of the loss to a community of a single 50-something surgeon. That type of experience takes decades to acquire.  This is what liberals fail to understand because much of the work they do requires no skill per se.  They just assume that someone who knows how to "fix it" will always be around.

Not now, but in coming decades we will see more care delivered by fully-employed nurse practitioners, docs imported from abroad, and remaining US docs who either cannot leave (ie not brightest and best) or who have no level of discomfort working in a top-down inefficient Soviet-style bureaucratic hospital environment.  Brightest and best in the US will be in derm and plastics or running cash-only private practices at all price points.

The employed Soviet-style docs will gow ever more entitled and dissatisfied, taking on an SEIU sort of culture.  There will be strike attempts, a la the red-shirted Chicago Teacher's Union.  Then a law will be written prohibiting strikes.  Non-private Obama medicine will be the equivalent of public school.  Difference is, most people at least get out of public school alive.  Those with money will buy the best privately.
I only have one observation/comment:

You leftists are going to learn real soon the difference between a government mandated "entitlement" or "promise" and reality.

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