Healthcare Heading towards Mediocrity

An anonymous comment on my blog:
Doctors are working harder and harder to make a living and the cost of medical education is just about 60k per year. I believe declining medical school applications suggest that the word is out that medicine, while rewarding in many ways, is not a great way to make a living, much less pay off education related debt. In fact, the decline in physican incomes shows no signs of abating. Soon, a primary care physician in our area (Northeast US)will make less than 100K per year (many probably do already). When you consider that median family income in the US is about 50K, that is astounding. What effect will this have on future physician supply?

I agree, physicians earn dramatically less than 20 years ago, and the incomes just keep dropping and dropping and dropping with no end in sight.
What message does this send to physicians?
"We do not value what you do" or "We do not want you to earn much" "we do not care about your overhead" and "we do not care if and how you make ends meet"
This is what our patients are actually telling us physicians, yes, the same patients that demand to receive more attention, more time, more care, more presence, more sensitivity, more quality, more efficiency, more of everything.
Actually medicine has been called "the worst business", because overhead increases, liability increases and you cannot pass on any of these increases to your clients and you get paid less and less!

The message Americans are sending physicians is "We do not care about you, just give as great service, now".

Where does this lead? We compensate, work more, harder, smarter, improve, improve more and then, when there is no more room for improvement, here comes "P4P", another thinky veiled slogan that allows HMOs to pay us less, the same old abuse, just with a different slogan, a different disguise.

I have a better idea for quality impovement: pay more, and physicians will be happy, proud and eager to work.

This is obviously not going to happen. What will happen is what has happened in Germany, where I have seen the future of American healthcare: Lower pay to physicians lowers quality, lowered quality spawns more bureaucratic supervision, more hassle and indirectly less income, this again lowers quality and so on. In 15 years we will be in the realm of mediocrity in medicine. Money will be scarce, research will be superficial and less rewarding, clinical practice will be an 9-5 affair, and afterwards everybody goes to the ER. Your doctor does not see you when you are in the hospital, a hospitalist does. Training of physicians will be difficult, since it will be hard to get enough cases to gain sufficient experience, and training will be handicapped by the separation of office based and hospital based medicine. And everybody will complain and nobody will understand why.

Here is the explanation: You get what you pay for. And doctors are the crucial element in healthcare. We see the patients, we diagnose, we treat, we write the prescriptions, we decide.
Until Americans return to understanding that crucial point and return to taking care of those who care and decide over their health, we will continue on the path to mediocrity.

MEDIOCRITY. Continuing on the present path of decrasing pay and increasing bureaucratice hassle for physicians will lead straight to medicrity and over-administration - the two evel twins.

And that is exactly what the above quoted commentator thought. Pay physicians less and you chase them away. And why do we have a "primary care physician shortage" in Massachusetts? Easy to explain: Cost of living one of the highest in the US, housing cost one of the highest in the US, reimbursement one of the lowest in the US. Result: Physicians leaving the state. How stupid do expect doctors to be? Work for dramatically less than everywhere else in the US? There is a kind of silent agreement among doctors that you only stay in Masssachusetts if you work in academia (in this regard the state is a great place to be) or you have family that keeps you here.