Department of Uh-Oh

Or should this post be called "Markets in Everything"?

…there is plenty of anecdotal evidence that Germany has become less attractive for people in fields like medicine, academic research and engineering.  Those who leave cite chronic unemployment, a rigid labor market, stifling bureaucracy, high taxes and the plodding economy – which, though better recently, still lags behind that of the United States.

Here is the full story, which is an object lesson in what happens if you don’t pay your doctors enough…


Anecdotally, the preferred destination for German emigres is presently Sweden.

The primary subject of the article (the engineer) mentioned that his dealings with his unionized employees pushed him to leave Germany for Canada. Meanwhile, the last time I visited Canada, the owner of the inn I stayed at in Montreal told me she shuttered her own mechanical engineering firm because the unions were threatening her employees with violence if they didn't unionize. If that guy really wanted a change of pace he should move to a nice Right-to-Work state in the US, like Virginia!

Canada has an immigration system that was reformed in the early 90s to massive emphasize educational achievements. I hear that it's actually causing complaints that they aren't getting enough skilled trade workers, and that it has the downside of attracting lots of people who technically have advanced degrees, but from very poor Third World universities, degrees not worth the paper that they're printed on. But so it goes.

The US has an enormous number of applicants every year, so we basically have a lottery system, together with the employer sponsorship and student visa stuff.

Physicians cannot really set their own prices except for elective procedures. Physicians are limited by what the Center for Medicare/Medicaid Services reimburses for them. Physicians make more money by learning how to manipulate the the diagnosis codes and ensuring that they bill for all of their services.

Virtualy all oncologisit get paid the same price for the same procedure. The best surgeon does not really get to charge more because he is better.


If I want to buy a stock or mutual fund, I can call up my old friend the ob-gyn. I know three anesthesiologists who became financial analysts with investment firms. Two radiologists run imaging businesses, and a good orthopedist friend dropped out to put up magnetic resonance imaging (MRI) facilities. Each trained hard for at least nine years to join his field of medicine. In no case could leaving have been an easy divorce.

So here is the cause of your doctor's pain in 2007. Behind him or her is a 15-year trend of diminishing fees that shows no signs of abating. Graduating med students aren't blind; they see established physicians with busy practices dropping out. Looking ahead they see more headaches--more controls and regulations, more scrutiny, more liability, less money. So what has the resourceful American doc done?

From TIME.


Doctors in the US have less market power than they used to have, when they were self-employed professionals. Much of that power has transferred to the hospital chains and HMOs that now employ them, and as superdestroyer observes, to Medicare. It's no surprise that they're no longer as affluent in comparison to the rest of society as they used to be.

I think they should unionize to demand better pay, better working conditions and more autonomy. If we go to single-payer (which seems unlikely), unionization would be certain. I'm not sure how unionization would affect the quality of healthcare, but at some point doctors should look out for themselves, without changing careers. Heaven knows teachers' unions do. The other option would be to copy the ADA and limit medical school enrollment, but I'm not sure if they could get away with that.

thank you very much

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