Agreed. I enjoyed Things Fall Apart and I'm glad we both see the irony. I only mentioned it because most people associate Kurtz with "Apocalypse Now" instead of the book. I wasn't calling you out.
I never said that those chasing money are harder workers, just that money was an additional incentive. If, as you recommend, you read my past posts, you'll see plenty of arguments for why high physician pay is good, but I'll explain again here. If you add the incentive of money to the incentive of medicine (composed of altruism, service, societal respecet, etc. that comes with being a doctor), you increase the total incentive to go into the field. Some people value money more, some value the other things more, but however it stacks up, if there is more total incentive to be in the field there will be more competition to enter it. Thus, with more competition for medical school from more total incentive, you will have better doctors in the long run.
If, as you say, a doctor ends up not in love with his work, one of three things will happen. Either, he will do less work and earn less money, continue to do the work because the love of money is enough for him, or figure out a way to change the work so that he likes it again. If the first situation is true or his work suffers, he will get less money and then another doctor will come in, see the opportunity, and take the patients and money that he neglected to keep up. Either way, the system (competition) is a self-correcting one: if the doctor finds that the burdens of the job outweighs the incentives, something will change, but if the incentives are high this will happen rarely and will be quickly fixed.
Going to your examples, when I worked in a restaurant, if somebody was being lazy and not working hard, they either made less money in tips or were fired. The incentive of making more money (and not getting fired) will outweigh the desire to slack off or you will find another job. If service suffers from time to time, this is usually because of a lack of competition for the jobs. Next, the example of NFL players is a bit of a stretch and can't be applied to the market as a whole. Yes, some players in the top 2% of wage earners will sacrifice for a team to win a championship (which notably is not an altruistic sacrifice, but a self-serving one), but when do the mid- or low-salaried players do this? Entire teams don't take a pay cut to win a championship, nor would the entirety of NFL Players, if the pay off was just to raise the level of play a bit (which is actually backwards - it would diminish it). It's a bit hard then to stretch this argument to saying that all doctors should take a cut to raise the level of care.
If more people went into medicine for altruistic reasons, the quality of care would decrease. There simply isn't enough altruism for it to outweigh money, and without the incentive of economic gain, altruism alone isn't going to raise the incentives enough that the most qualified and smartest go into this field over any other field. Again, I contend that if we want to keep the field of medicine strong, we need the best and brightest people in it. If this means transitioning some primary care positions to others, then let's do it. If we have higher quality care overall and higher quality physicians overseeing the primary caregivers (be they NPs or others), the quality of our primary care will increase (or stay the same at worst) while the quality of our specialty care will go through the roof. (again, see my old posts or pm me if the incentives part of this doesn't make sense)
