Monday, February 25, 2013

When Surgeons Go Galt

From our Surgeon Agent in the Field via an e-mail exchange:

Earnings potentia as a surgeon?  Obamacare will make once-self-sufficient privately practicing physicians into insurance and government lackeys, fully employed and owned by hospitals.  Those who have no exit strategy will work more and be paid less.  The number of demoralized and retiring doctors I am witnesseing now has spiked like nothing I have seen before.  Supposedly 1/3 want to get out within the next 10 years, half of these are under 55.  Many of these will talk a big game and do nothing, of course, addicted as they are to their big-spending lifestyles and status as physicians.  Due to the length and intensity of training doctors are more susceptible than most to living lives devoid of interests outside of work.  Sad.  But the resourceful ones will retool and do very well in non-clinical disciplines.  My advice to anyone I meet is to secure a good doctor now if you don't already have one.  As medicaid expands, patients rush in, and doctors rush out, it is going to get very interesting.

Sometimes life is about more than earning potential.  I would rather do meaningful work, performed freely on my own terms for less.  And I have no interest in being a functionary in Barack Obama's scheme to "redistribute" my skills to others by further corrupting the free market price of these services with ever-expanding insurance involvement.  Learning to be a surgeon took a decade of my youth and hundreds of thousands of dollars.  I have quietly gone Galt in my own way... withdrawing myself from any insurance or government payment schemes and performing procedures that are cash only.  I may get out entirely, who knows.  Obama thinks that if he dishes it out that doctors will be forced to take it.  Some, maybe, but not all.

Thanks again for the wonderful book.  The greatest benefit from your book really was psychological.  It is time Enjoy the Decline!

our agent also wrote:

Freedom-oriented people need to understand that a crisis of care is coming... Not now, but soon enough.  I can rattle off in a flash the names of friends and aquaintances who have either gotten out of the pipeline (dropping out during training to get MBAs or to take jobs in consulting.. One friend is selling real estate in NYC!) or very capable fifty-somethings who retired or are planning on retiring very soon.  In the case of the retiring docs these are people who really enjoy what they do.  These are very capable surgeons, not easily replaced by a nurse.  Think of the loss to a community of a single 50-something surgeon. That type of experience takes decades to acquire.  This is what liberals fail to understand because much of the work they do requires no skill per se.  They just assume that someone who knows how to "fix it" will always be around.

Not now, but in coming decades we will see more care delivered by fully-employed nurse practitioners, docs imported from abroad, and remaining US docs who either cannot leave (ie not brightest and best) or who have no level of discomfort working in a top-down inefficient Soviet-style bureaucratic hospital environment.  Brightest and best in the US will be in derm and plastics or running cash-only private practices at all price points.

The employed Soviet-style docs will gow ever more entitled and dissatisfied, taking on an SEIU sort of culture.  There will be strike attempts, a la the red-shirted Chicago Teacher's Union.  Then a law will be written prohibiting strikes.  Non-private Obama medicine will be the equivalent of public school.  Difference is, most people at least get out of public school alive.  Those with money will buy the best privately.
I only have one observation/comment:

You leftists are going to learn real soon the difference between a government mandated "entitlement" or "promise" and reality.


Anonymous said...

"Not now, but in coming decades we will see more care delivered by fully-employed nurse practitioners, docs imported from abroad..."

Not now? That is the way it is now. Add to that physician assistants who do the work only doctors did 20 or so years ago.

Roberto Severino said...

Just call them the Loony Left from now on. Haha! That's what many of them are.

daniel_ream said...

In other words, Canada.

Take The Red Pill said...

"...Obama thinks that if he dishes it out that doctors will be forced to take it. Some, maybe, but not all."
"...This is what liberals fail to understand because much of the work they do requires no skill per se. They just assume that someone who knows how to "fix it" will always be around."

To me, this sounds an AWFUL lot like how feminists and modern feminism-influenced women view men and what men do, and how men are 'Going Galt' via GTOW.

Anonymous said...

I'm another surgeon who has 're-tooled' - did it at age 50. And when the zombie apocalypse comes, courtesy of our statist brothers, I'm certainly open for business. But only for those bitter clingers to gold, guns & religion. Yonder statists can live by Obamacare and die by Obamacare. I hear that Obamabucks will make good TP, so at least they'll have good hygeine while they wipe his smile across their sphincters.
Bill K.

gaoxiaen said...

Well, it's not like there's a vestige of a free market in medical care now. The doctors happily use government guns to enforce the will of their labor union, the AMA ("suggested legislation" aka House Bill #xxxx), driving prices sky-high. Extract dollarus maximus. What goes around comes around, contract with the Devil, etc.. Should I feel sorry that at some time in the future they might have to watch their spending a little bit so Sonny can have a new BMW to drive to Harvard while I'm paying $125 for a permission slip to buy $10 worth of pills? What a scam.

jso said...

demand is going to go up a lot when the infrastructure collapses.

Dan Barry said...

This line of reasoning, when combined with Cappy Cap's "enjoy the decline" arguments for minimalism played a huge role for me in choosing to become a PA over a physician. Since Docs are basically going to be employees of insurance companies and government agencies from here on out, it made more sense (for me) to simply accept the loss of autonomy. I'm definitely giving up future income by making this choice, but I'm also going to be able to enjoy my thirties and get out of debt in far less time. At least I hope so.

Nikoloz said...

You'd think the DMV would be proof enough that as a rule the private sector does it better. Now we're going to have unqualified nurses operating on our hearts, lads!

Ah, well... pour a glass and enjoy the decline.

Anonymous said...

The Sheeple who have lived the Standard American Life are in for a nasty wakeup call. Be prepared. This is why I have been working hard on getting as healthy as possible. Went paleo diet, lost 30 pounds and feel so much better. Now working on the body. Leaving healthy does not guarantee that a problem will not show up, but it reduces the odds.

Got your book last week and will start reading it soon.


Anonymous said...

It seems like we're going the route of the movie Idiocracy. Where you can "buy" your medical degree to be a doctor.

Hey if that's what they want then that's where we're going.

Anonymous said...

There will always be good medical care available for the Nomenklatura.

Anonymous said...

I just hope my Dr. Galt accepts payment in .22LR, .45ACP, 5.56 or .308.

Anonymous said...


Maybe you could write about this sometime...

Anonymous said...

Dont forget that positions in med school are already partitioned out to allow 50% of spots to go to women ( and the choice seems to be women or no one gets it ) and the vast majority of those women will take 10-15 years off after having kids and having worked for maybe 5-6 years. Thats a lot of wasted special training.

Anonymous said...

If you want to see what happens when the State takes over provision of medical care, then try looking at Britains experience.

The Civitas Website has quite a few free essays on the system - website here :

As a minimum, read “Before Beveridge: Welfare Before the Welfare State ” to see the initial steps. "Why ration healthcare?" will make for "interesting" reading ... but I'll leave you to read through the rest.

These aren't "5 Minute reads" - they are scholarly, well researched and written in the main by ex-socialists (check out the credentials of the writers in the introduction to each essay)that have been up close or embedded into the system and seen it in all its horror.

Note also that the hospital properties and buildings will be essentially confiscated (can't have those nasty capitalists profiting from sick people, eh?).

Gaoxien's comment about the high cost of seeing a doctor will be addressed but not for the reasons you think. The American habit of suing for Millions of Dollars for trivial complaints means that the Doctor MUST, absolutely MUST, have insurance to cover the inevitable lawsuits that will be flung their way. Such insurance doesn't come cheap and therefore as an overhead, the Doctor must cover the cost of the premium even before your backside hits the seat.(Try googling The Stella Awards" for non medical examples of this stupidity). That'll be - what? - $100 just to cover the risk of you walking into his office. After that, they can start to charge for their skills and services. Hence the "rip off" fees charged which are not so bad IF you discount the cost of the insurance.

Under nationalised healthcare, it is unlikely that you will be allowed to sue for medical negligence. Suing the state rarely works out in favour of the plaintiff. Combine this with the best Doctors dropping out of the system, you will receive a much reduced standard of care. One good thing - the lawyers will have to tighten their belts ..

Phil B

Anonymous said...

Let us spin this as O'bumbles' desire to create an army of slaves to the state. Because that's what is really is, isn't it?

Chris said...

Well, I was at my college attending training in how to certify American Board Certified specailists for antipodean conditions last week.

Mainly for the Aussies: they still have a private system, while the Kiwi system is socialized and unionized.

Suits me: I'm a solo Dad and I can get home to cook dinner for my teenage boys most if not every night.

There are, however, some errors in your comments.

1. Almost no one belongs to the AMA. You belong to your college plus the socieites that are compulsory (medical assurance is a non profit here run by one such society). The AMA speaks for but a minority of docs.

2. There is no female quota for medical school. There is no need for a female quota. Girls do better at school in all undergraduate degrees, and this is reflected in medical school enrolments.

3. Medical training is not merely the basic degree. You need about another decade of supervised experience to become a specailist -- most junior consultants are in their late 30s or 40s before they qualify. You peak in your mid 40s and then hold that for 15 -- 20 years if you are lucky. (Surgeons have to retire earlier, physicians and psychiatrists work until they die or get Alzheimer's).

You thus need two decades to ramp up doctor numbers. NZ has increased its medical school class size. Australia has doubled the number of medical schools.

And the US... will not be able to import people, because the conditions will be better in Canada, Australia... and even Singapore and NZ.

You made your bed... hope you like sleeping there.