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We're no stranger to the immigration hot button here; we all want some way to filter for attractive women and investment dollars where we live and less competition for labor, but the want for those things proves weaker than the iron laws of supply and demand for both. However, here's a problem in the immigration debate that I don't think has come up in discussion before: ladies and gentlemen and undecideds of the Motte: how do we fix the doctor shortage?
And I mean globally. The solution many places settled on after it became clear that it was difficult to impossible to train more doctors locally is to import them, but this simply moves the problem around and causes brain drain as market efficiencies mean doctors move where they can get paid more.
Accounting for inflation, apparently physician pay growth is lagging although I'm not sure if anyone has more up to date information on whether this is still the case.
The easy low effort swipe is to make it easier to qualify as a doctor, but doing so without lowering medical standards and/or quality of care seems more difficult. There's also the simple calculus where people are less willing to take on, in the US, large amounts of student debt and to commit to the many years of study it takes to become a qualified doctor. After which you can look forward to high stress, long hours, dealing with patients, and potential lawsuits. It's no surprise that people would rather hustle sneakers or crypto or streaming when the effort to do so is significantly less.
Previously, governments would subsidize medical training as they saw medical professionals as a necessary function. Now, why bother? If there are opportunities and more money to be made elsewhere, they'd just move elsewhere after being trained, which would be happy to take them. Is there a low effort politically achievable band-aid fix, like making mandatory provision of medical care within the country a necessary precondition of qualification? But that'd make the profession even less popular - if you're a Kenyan doctor, fuck staying in Kenya if you can get paid multiples of that elsewhere.
Disclaimer: I'm asking for entirely selfish reasons. Working on a new investment thesis after the last one turned out spot on although with limited rewards so far for being right. I foresee this problem getting much, much worse as doctors retire, populations trend upwards in age and require increased medical care.
Doctor pay feels like something “when the data doesn’t fit the anecdotes usually the data is wrong” - which I think was a Bezos management philosophy.
I feel like I have a lot of friends dads who are doctors and clearing low 7-figures. My gut says the data isn’t capturing a lot of Doctor pay. Health care spending has exploded; granted a lot of this is the expansion of the administrative state; but are you telling me Doctors have failed to capture any of the increased spending?
Biotech stocks, pharma, etc haven’t done great the last decade. Who’s getting rich in medicine? We all know overall spending has exploded.
Not sure how old you are but if you are in your 30s or 40s then you are looking at an old problem, if you are younger I'm not sure what that's about very, very few doctors make 7 figures even in the U.S.
Physicians used to make considerably more relative to inflation, have much lower debt (which later snowballs into wealth) and had other options to bring in money - medical inventions, ownerships of practices and other stuff, less regulation of conflict of interest and advertisement, and so on. Loopholes have been patched, reimbursement has been adjusted, and wages have declined relative to inflation.
Neurosurgery is the only specialty (and maybe vaguer things like spine) that is making 7 figures without something weird happening like fraud, sketchy cash practice, charing a department, or ownership. But ownership is.....gone.
People who already had a bag are doing great but the young aren't catching up.
It is possible you are living in a good area with the most successful people, but up until recent a few specialties still had averages below 200k in the big metro areas.
This is apocryphal so not sure how true it is, but a friend who does recruitment for a large hospital on North Dakota told me they are trying to pay rare specialists upwards of 900k to move there and stay. Something about how its ND which makes it hard to actually get these people, forcing them to pay them obscene amounts of money. How true is something like that?
If only there were a lawyer equivalent of this. jesus_ive_seen_what_youve_done_for_others.jpg
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