While President Clinton is blithely proposing a huge expansion of the teetering Medicare program, there is a looming health-care crisis that has yet to show up on radar. It is not reflected in statistics because it is just beginning to unfold: We are about to lose a whole generation of our most skilled and senior doctors to early retirement.
Early and, in a way, forced. My evidence is anecdotal, but my sources are good. Over the last few years, I have talked to many doctors who graduated medical school in the mid-1970s when I did. They are now in the prime of their medical careers and they are desperate to get out.
Typical is a highly respected cardiac surgeon I saw at Christmas. He is in his 40s. His plan is to leave medicine in his 50s. Most ominous is the fact that every cardiac surgeon in his practice group is trying to do the same.
This is unheard of. With all their skill and training, doctors have traditionally stayed on into their late 60s and even beyond. Most of us can remember a family doctor who died while still practicing. It is not going to be that way anymore.
Why? Three major pressures are driving these doctors to quit. The first is money. These doctors are at the peak of their careers. As they watch similarly situated colleagues in law and business enjoy rising salaries and often exploding compensation, they are getting hammered by the new health care economics. With Medicare decreeing ever shrinking reimbursement–and insurance companies following suit–they find themselves losing ground even as they work harder. Since 1992, for example, real median income for M.D.s has fallen.
Last year a member of my family needed surgery for a serious foot injury. It was a very specialized reconstructive procedure that took several hours to perform. The insurance company sent the surgeon a check for $388. If I’d hired a plumber, he’d have taken home more.
The second cause is the loss of independence. More than money, this is what is driving these senior doctors crazy: some 24-year-old HMO functionary who knows as much about medicine as he does about cartography demanding to know why Mr. Jones, the diabetic in renal failure, has not been discharged from the hospital yet. Dictated to by medically ignorant administrators, questioned about every prescription and procedure, reduced in status from physician to “provider,” these doctors want out.
Again, the contrast with sister professions is profound. Lawyers would never put up with a whole layer of bureaucracy telling them how to practice, let alone setting their fees. And no wonder: Lawyers tend to run the legislatures that pass the laws that regulate the professions. Doctors don’t.
And finally there is malpractice insurance, another little aggression of the legal on the medical profession. My cardiac surgeon friend devotes about 60 percent of his entire overhead to malpractice insurance alone. Some obstetrician-gynecologists pay $100,000 a year, which accounts for the fact that many towns have no OB-GYNs at all.
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Declining income. Lost independence. Confiscatory malpractice insurance. Put them together, and you’ve got pediatricians and surgeons and orthopedists who have had enough. They will work another five or 10 years to put away something for retirement, and then leave.
Most people will find it hard to shed a tear for hotshot surgeons who complain about making only, say, $200,000 a year. But there is something fundamentally unfair in having people give their youth to years of relentless training and sleepless nights, and then changing the rules on them in the middle of the game. This generation of doctors entered a system that promised compensation and independence commensurate with their skills–a deal that, as my doctor friends never tire of pointing out, still holds for lawyers, who charge for every phone chat in six-minute blocks.
Too bad, you say. We need to control health-care costs and doctors have to take their hit. Well, it is true that the former rate of growth of health-care costs was unsustainable. But we pay a price for the new cost-conscious regime. We may think the price is just rationed care, rushed care, standardized care. But there is another price: inexperienced care, because of the coming dearth of medical elders.
You remain unmoved by the humbling of a formerly sovereign, and often arrogant, profession?
OK. Forget the doctors. Think only of yourself. Think of what a health-care system loses when its most experienced practitioners–the ones who, having seen it all, won’t panic when a major vessel ruptures during surgery–are gone, and peering into your chest, sweat rolling down his mask, is the junior associate. Learning. On you.