The Buck Stops

Being a physician has served me well. It has given me purpose and identity throughout my career. It has also provided me with a stable income. I knew, however, from the beginning that things were changing. From the earliest days of practice, I pursued lazy side hustles and real estate. I learned about investing. You might suspect that I did this all out of pure personal interest. But there also was an aspect of self preservation. I didn’t like what I was seeing in medicine. The overreaching arch of compliance, the predominance of Medicare, and the rise of the administrator class all gave me pause. The buck stops. Not here, but in the pockets of the people running our healthcare system. The days of the primacy of the physician are waning.

I knew that I would never be able to stay in the traditional primary care practice, and make a reasonable living. I planned my escape in those early days. As the healthcare climate shifts, I see physicians getting caught in the crossfire. I suspect there will be a major wage readjustment.

Private practice

Compliance and healthcare policy have pushed physicians out of private practice and towards a group or hospital setting. These groups lag in efficiency by as much as twenty percent as the old practice models. As efficiency drops, costs spiral with expensive electronic medical records and costly compliance and training.

The solution is not to hire more physicians, they are already becoming less efficient and effective. So the system employs more administrators. More consultants. The healthcare dollar is seeping out of the clinicians hands and landing straight into the pockets of the mid level manager.

Every cent not spent on actual care is wasted in our system. The buck stops. Well before it reaches the clinicians hand.

The Replacements

Physicians are expensive. They are expensive to train. Expensive to employ. And there is a large barrier to entry into the field. This has created the perfect environment to support less educated intermediaries. Nurse practitioners and physician assistants get paid less to do some of the traditional physician roles. The barrier to entry is much lower. Many nurse practitioner schools are now online and create graduates with no consistent clinical oversight over the short duration of training.

Whether right or wrong, this creates a much more direct path to clinical practice. Given these new clinicians accept lower pay than physicians to do the same job, the buck stops at the clinicians door.

It finds its way into other pockets quickly.

Healthcare Reform

No matter who is in office, the cost of healthcare is spiraling. Our system threatens to topple over onto itself. The ballooning number of administrators, compliance officers, coders, and other support staff is rising.

Government begets more government. Compliance begets more compliance. Theses administrative costs will only rise in the future. To contradict these changes, the only well available to draw from is the physician compensation well. Not only have doctors been much maligned in the public culture, but are also the only major shareholder in the system without proper lobbying power.

The buck stops with the least politically powerful. If you haven’t noticed, that is the doctors.

Final Thoughts

The writing has been on the wall. Physician compensation is on the chopping block. Although we haven’t seen the effects yet, I imagine they are soon coming. I truly believe this. I spent the last decade building non traditional revenue streams, maintaining a private practice, and extirpating my pay source from Medicare and direct patient care.

It has served me well in my career and economic goals.

I was also lucky to not be saddled with a huge amount of educational debt.

I worry about how this will all play out for the young and newly graduated physicians of today. It can’t be good.