if the pathologists and docs you know in Europe/Canada have it so bad, why don't they come to the US and why do European and Canadian "kids" still go into medicine? you paint a sensational picture that reality doesn't substantiate (I didn't learn that big word in "med school statistics").
also, great perspective about something being great for the masses but bad for docs. there are more important things than money... i promise if you say that out loud you won't burst into spontaneous combustion. a lot of your comments seem driven soley by money, and that seems like a dangerous north star to follow.
I don't know your background, so I won't presume to judge you in my response, as you seem to have done in yours. Frankly, I will comment that your remarks smack of an idealism that oftentimes comes from inexperience.
I've been out of medical school for quite some time, and most of the physicians that I have talked to are wary of a universal payer system, especially one run by the government. You would reduce the argument entirely to money, but there is quite a bit more to the argument than that.
However, I will address that first, since it is a sticking point with you. The average cost of college nowadays runs around 35-40k a year, all fees included. That's about 150 grand for undergraduate work. Now, add medical school to that mix. When I went, I paid 24k a year and lived at home with my parents to save money. I got a 6k break per year being a state resident in PA, which, combined with free room and board (free for me, at least), amounted to a significant amount of chump change. Currently, medical school costs per year run somewhere around the similar 35-40k per year one would pay for a private college. I would also like to point out that this is roughly half of what it costs to educate a medical student per year; the government generally pays the schools for the other half per student, so in reality, medical education per student per year runs close to almost 80,000 dollars.
The overwhelming majority of students have to incur loans to cover both undergraduate and graduate work, oftentimes greater than $200,000 by the time of internship. As a resident, my biweekly salary after taxes was just over $1100-for rent, food, and miscellaneous expenses, like clothes. Fortunately, I had no school debt to pay off, so I was actually able to save a little bit. Now, if one isn't like me, a further amount of money has to go to paying off the loans. Residencies average anywhere from three to 10 years
after medical school, leaving many people dealing not only with the stress of training, but a bare-bones minimum for self and family while under pressure to succeed for very little appreciation or recompense. In residency, one generally will work harder for less appreciation than one ever has in any other time of their lives.
Most physicians undertake the journey for numerous reasons, money being one of them. You would berate me for listing money as the "sole" motivation for entering the medical field when what I was actually saying was completely different. I will get to that main point later but since you brought it up I will address it. Yes, some individuals become doctors just to make money (elective cosmetic surgery comes to mind) but to the majority this is only one of the reasons. If you look at any other profession or business in this country the amount of effort one puts into one's career generally tends to correlate with one's financial success. I am mystified as to why you would expect physicians to be any different. Indeed, doctors are oftentimes expected to be "perfect" and face a unique set of daily expectations that do not exist in other fields yet somehow they are "bad" people if they want earn a six-figure income. Expecting one to be happy with $80,000/yr with a mountain of debt 10 years or more after college with a 90-hr workweek simply for the sheer "altruism" of it all is delusional. Sorry to use such strong language, but that's the way it is, buddy. Solid data exists which show more and more physicians are getting right out of clinical medicine and going into health-care business and finance simply for the freedom from aggravation that the loss of compensation and autonomy has brought.
You are naive if you think that the doctor who wants a large paycheck is the exception, rather than the rule. I am trying to go back and do a second residency, and I would like to make a lot of money afterwards, and I am neither a bad person nor a bad doctor. My colleagues in two different hospitals will attest to that, and I resent any implication otherwise.
The fact is that medicine is a service profession, and that service is provided by individuals who put an extraordinary amount of time and effort to become proficient in a field with above-average responsibility and risk, and they are correct to expect above-average reward.
My next point goes to your statement "if it's good for the masses it must automatically be bad for docs". I never said that, you did, but in many ways, it's true. If you look at the countries where medicine has been socialized, you will notice several things:
1) Smaller population. None of the western european nations have anywhere close to 300 million people. NONE of them provide the level of free care to noncitizens that the US does, usually at the state level.
2) Taxes are much higher. Most americans already complain bitterly about the amount that they pay in total taxes. Good luck increasing taxes to 50% or more of gross income for everyone, which is the bare minimum of what you will need to provide a basic federal level of coverage.
3) Rationing is paramount. In England, if you're over 65 and have an MI, you may not necessarily get a telemetry bed while you are being treated as an inpatient-something that is unheard of in the US. The reasoning? Older people have lived more of their lives and it is "ok" if they get less care because they are closer to death. I don't agree with that philosophy but when you cover everyone for less than there is less for everyone-that is one of the basic laws of the universe ("there's no such thing as a free lunch").
In Canada, you might wait nine months for an MRI, and you have no recourse in that country, as private insurance is illegal. If you have the means, you come to the US for treatment.
Now, in America, this will never fly. There is a large gap between the haves, the have-nots, and those in-between. I am not here to solve the injustices of the world but I will tell you straight off that the wealthy will NEVER put up with having to wait months for a diagnostic test or to see their doctor. The best we will get in America is a two-tier system a'la England with doctors who take a higher fee for a higher level of responsibility. By universally capitating physicians you will get doctors who see their careers as jobs, not a calling, and the profession will change to reflect as such (this is already happening with many medical students to whom I have been exposed). That is certainly as much of a threat to the passion of medicine as anything else, and it shows. People will expect a 9-5, no weekends, no nights, and what-not, and the level of care will suffer for it.
I think state universal systems are a far better idea
if they are implemented fairly and physicians are allowed to opt out of taking government reimbursement if they choose. Medicare continually drops recompense to physicians to save money for elsewhere but the government has yet to understand that the majority of healthcare dollars wasted are not done so on overpayed doctors.
Anyway, I could make this post go on forever but you get the general idea. It isn't as easy as blind idealism would suggest, and doctors are human beings who are no less entitled to want "the good life" than anybody else. I'm not saying you will necessarily end up jaded but it will be hard to restore the "glory days" of medicine under a universal health care system. I think that getting everyone covered is better accomplished through competition and free enterprise than through strict government regulation and control.
But that's just me
😉
