How to Solve the Doctor Problem

I spent a consoling hour this morning on the receiving end of the ministrations of a Palookaville physical therapist.  Unlike your dentist or the anesthesiologist, these masseuse-types can actually carry on a conversation while they work you over.  And when she found out I (used to be) a bankruptcy lawyer, the conversation just naturally turned into a discussion of doctors and other med pros who go broke.  Interesting part is, we didn't discuss malpractice--does it just not happen any more?  Or is it all farmed out to the carrier.  Anyway, no, the discussion today was of straight economic failure.  Which could mean young doctors who feel they've deprived themselves for too long and begin their post-student lives by tanking up on fancy toys.

More often, though, so I learn, it's the guy who gets nailed by an embezzler: apparently there is a non-zero quantum of cases where Palookaville practitioners have furnished the penitentiaries with once- (seemingly) loyal bookkeepers, office managers and such like who helped themselves to the swirling river of cash that floats through a medical office.

Reimbursements.  Co-pays, especially cash co-pays  And taxes.  Oh lordy, taxes. The kind that don't go in bankruptcy not (hardly) ever.   Income taxes.  Payroll taxes.  The list does go on and on, eh?  Why you need a good bookkeeper.  And honest.

Bear with me, we are getting to the kicker here.  But for background: forget all my snide cracks about Palookaville, it's actually a pretty nice place.  Yet I hear tell of one Palookaville practioner who has pulled up stakes and moved his wife and three daughters to--well, I suppose I ought to be a little coy here.  Let's just say it is not Western Kansas and it is not Owsley County, Kentucky, but it might as well be.  Indeed I suspect maybe people in destination X sometimes dream of getting to Western Kansas or Owsley County.

Why, you ask?  Why leave the delights of Palookaville for internal exile to our own homegrown Moldava?  The answer is they bailed him out.  I'm foggy on the details, but apparently they needed a doctor so bad that they agreed to stump up the money to get this particular fiscal monkey off his therapeutic back.  "I wonder," said my interlocutor, "how his wife is going to take it when she figures out where he has moved their daughters."

Where the Doctors Are

Today's chart porn: cool interactive map of where the doctors are.    Doesn't tell you much you wouldn't have guessed but it does provide dramatic evidence of one of my favorite points.  Specifically, that a genuine wasteland is the swath of round down through western Nebraska and Kansas and environs.  No surprise that there are so few doctors in that part of the world; the amazing part is that there are any people.

If memory serves, western Kansas and Nebraska also rank at or near the top of farm subsidy recipients.  But I believe the checks go mostly to places where the drinks have little umbrellas.

H/T Ezra Klein.  For ag subsidies, ,the go-to source is Mark Perry.

Oh, and speaking of ag subsidies, go here.

Are there Libertarian Doctors?

Mark J. Perry at Carpe Diem is the scourge of cartels everywhere. Refreshingly, he doesn't restrict himself to the standard libertarian shibboleths. He's a also a great source on, say, farm subsidies, which so many of the sideshow libertarians in the RepublicanParty work so hard to protect.

A few weeks ago I posted a somewhat snarky comment asking if he'd ever taken on the medical sodality. I still don't know the answer to my precise question (I could have, but did not, search the archives). But whatever his past behavior, he's in the fray now with a typically challenging post on the costs of medical cartelization. It's a start, although I'd have to concede that it is a complicated issue, not likely to be blown away by a single blog screed (the commentators on this post, generally unsympathetic, raise some important questions).

But it does prompt me to wonder: how do libertarians feel about medical licensure? Does Ron Paul want to abolish the Board of Medical Examiners? Does the von Mises Institute advocate freedom of movement for medical professionals (giving new meaning, I suppose, to the phrase "Doctors Without Borders")?

And come to think of it, what's the attitude to other health-related nanny interference? Somehow I gather that the Food and Drug Administration is in the crosshairs. But how about the Center for Disease Control? Are we to infer that this is just another "government function" that can be served, if people want it, by a private market?

As I imply, there may be readily available answers to all these questions that I been just too passive and indolent to suss out. And I'll be frank to admit that I am so retrograde as to believe that yes, there may be some residual social purpose for these troglodyte artifacts of our dark socialist past.

But are the libertarians with me on this? And if they are--if they want to save the Board of Medical Examiners and the Center Disease Control--what business do they have calling themselves "libertarians"? Wouldn't their support for institutions of this sort imply that they, like the rest of us, are just cafeteria libertarians, picking and choosing those places where we want government service and where we do not? Put briefly, are there libertarian doctors? I mean, real libertarian doctors, not just some kind of wuzz?

Lawyer Jobs and Earnings Again

Re my discussion of attorney earnings and job satisfaction the other day, I find that one tiny link from AbovetheLaw.com increases my daily hits by a factor of about 10. I suppose it's flattering, although a humbling reminder that roughly nobody gives a rat's patootie about this simple barefoot country weblog, and whether I keep school or not.

On the other hand, while we're maundering on about the difficulties of the life of the lawyer, we might get a bitch slap reality check from the good folks at CareerCast.com, as reported in the Wall Street Journal, with their annual survey of "best and worst jobs"--a survey which I assume is every bit as reliable as the US News ranking of law schools (joke--ed.). For ATTORNEY at #80, we have a median income of $111,000, with a range from $54,000 go $171,000. For PLUMBER at 150, we have a median of $46,000, with a range from $28,000 to $49,000. So if that plumber makes $425 for 45 minute, he's billing just 81 hours a year. No wonder he's got a beer belly.

For comparison, general practice physician weighs (#128) weighs in with median of $162,000, just a tad under the lawyer's max. I do note that the physician's maximum is only 29 percent above the mean; the comparable number for attorneys is 54 percent, confirming my suspicion that the spread is greater for lawyers than for doctors (downside spread is just the mirror image--attorney min is about 51 percent of the mean; for doctors, 75 percent)..Oh, and surgeons (#136) weigh in with a mean of $300,000, so it looks like Carla made a smart move to choose Turk over JD.

Update: And h/t to David for this link to an opinion piece by a guy who thinks we need a tighter lawyer oligopoly.

More on Doctors

Guess you can't expect too much from Slate's answer person, but their answer to the question "where have all the doctors gone?" seems pretty thin to me (link). Okay, baby boom doctors are burning out (or rich enough that they can go play golf). And okay we imported a raft of foreign doctors a few years ago. But this is only scratches the surface. Are we still importing doctors? if not, why not? How much "doctor" work are we shifting to nurse practitioners and physician's assistants? Enough? Too much?

And here's a thought: with the collapse of banking, will some of our bright young things begin to rediscover their inner Marcus Welby (or at least J.D. Dorian)? A lot more to be said on this topic, and I'm waiting with watchful eye, or ear.

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Greenspun on Doctors

A Second Thought on the Supply of Doctors