I’m working on an English degree– no way can I do medicine, but write to my lawmakers and support AMA initiatives and try my best as a citizen to help fix the problem at the top. I’ve chatted up doctors about what things cost vs. what the government pays and what insurance pays. Last time I saw our family doctor, I felt like I was at a hair salon with the products he tried to push on me, promising to make us healthier. It was add-on sales at their finest. I felt bad for the office and wondered if this would come up.

You could become a Nurse or PA. You’re still in the healthcare field. except now you are an employee. You may not make as much as a physician (unless you become a nurse anesthetist) but you also have far less headache.

Their is demand for physicians, nurses, and PA’s everywhere. Physicians should be making more money than they are. The advantage of nurses and PA’s is they are employed by reasonable people like doctors and hospitals. Doctors are employed by insurance companies whose first job is to make as much money as possible. The insurance companies don’t have to worry about pissing off one doctor who may leave, because there are plenty of other doctors to contract with. A hospital or doctor employing a nurse of PA wants to make the person happy so they can avoid the costs of employee turnover. The insurance company doesn’t pay the cost of employee turnover: pay a doctor to train? No, residency took care of that, Pay a doctor to learn their billing rules? No, the doctor has to learn or he gets no money. An employer has a vested interest in the nurse of PA after the initial training is done, so they pay good money, and give raises and benefits. Doctors will get paid less and less until they stop taking insurance. Then insurance companies will raise reimbursements slightly and we’ll be back to the same bullshit system.

The real reason is that there are laws preventing doctors from organizing and collectively bargaining with insurance companies for better payments. So we’re all solo docs or small groups who have no power against what can arguably be called an insurance oligopoly. We cannot demand better reimbursements because each group is too small to matter to an insurance company that is contracted with thousands of doctors. The solution as I see it, is for doctors to form much larger practice groups or join large healthcare corporations. In this way you will essentially have formed a legal “union” of doctors in large enough numbers to matter to an insurance company: insurance payments from one company not high enough? end the contract, see what happens next year when that insurance company doesn’t have enough doctors contracted to service their customers who expect healthcare to be accessible.

I own and manage a marketing firm.