Given the financial incentives presented to doctors I have always wondered why Americans aren’t getting surgery on a weekly basis. This New York Times article answers the question: at least in some parts of the U.S., we are!
Related:
- posting on American Economic Association conference (scroll down to the paragraph starting “Are doctors with their Hippocratic Oath immune to financial incentives? “)
Because they screen for signs of a moral compass during the med school application process?
You could say the same for dentists, lawyers, accountants, engineers and anyone else presumed to have professional knowledge of their subject. Maybe the reason is because many doctors actually do practice with the benefit of their patients foremost, and that professionalism and beneficence actually are real and functioning principles that guide most doctors, incentives or temptations to do otherwise notwithstanding.
G.B.Shaw made a fool of himself with his idealization of Stalin and the USSR but this observation remains pertinent:
” That any sane nation, having observed that you could provide for the supply of bread by giving bakers a pecuniary interest in baking for you, should go on to give a surgeon a pecuniary interest in cutting off your leg is enough to make one despair of political humanity.”
Shaw indulged in reductio ad absurdum, ignoring the reality that the reputation of the surgeon who operated to save the leg and succeeded would carry far better than the surgeon whose name went with the amputation, and the surgeon who managed the patient successfully without having to resort to surgery–keeping the patient out of the operating room–would do even better. It is utterly irrational to expect that a system that doesn’t incentivize quality work, or reward investment, or compensate for risk would produce a better quality result or any interest in the welfare of patients than a system that does. The systems of socialist states that starved their providers of resources only to develop the inevitable black markets and privileged limited-access clinics are enough evidence of that. I see that creeping effect even in the capital area, where it is increasingly difficult to find a surgeon in private practice willing to perform glaucoma surgeries on typically frail patients because payments for the care required are already inadequate.
Abuse of trust and fraudulent conduct should be exposed and prosecuted, but to conclude that a system that provides no incentive to take on risk or make effort will magically produce cheaper and better outcomes would be laugh-out-loud funny if it weren’t for the fact that so many supposedly intelligent people actually believe it to be true.
I think that in many cases it is not avarice but habit, i.e., entrenched convention, that leads to procedures that may be unnecessary.
About three years ago I declined a double bypass recommended by a cardiologist who I believe sincerely thought it medically necessary. My decision was based on my own research. I instead radically changed my diet. I am now symptom-free and in the best cardiovascular condition of my life w/r physical endurance.
I did lose my FAA medical certificate. I was assured by an FAA medical examiner who had connections within the FAA that if I declined the bypass I would never get a waiver. –More entrenched convention.