Corporate Welfare

A Cartel of Doctors

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In a new paper for the Cato Institute, Shirley Svorny takes on medical licensing. Here's an excerpt:

CabalofDoctors
BBC

By almost all accounts, the quality of services consumers get from nonphysician clinicians is at least on par with what they would get froma physician performing the same services. Dozens of peer-reviewed studies compare outcomes in situations where patients are treated by a physician, a physician assistant, or an advanced practice nurse. Outcomes appear similar–an important factor, considering that nonphysician clinicians can provide many services at a much lower cost. There is also evidence that teams of clinicians outperform individual physicians. (Many physicians who are accustomed to working in teams are happy with the collaboration.)

Also worth quoting:

In the Federation of State Medical Boards' database, the nature of the investigation is not recorded in more than 65 percent of cases that ended in sanctions between 1994 and 2002. In those cases, the state board and the physician entered an agreement without the physician being found guilty. These dynamics deny consumers information that would help them avoid low-quality physicians….

If, as some suggest, concerns about financial and reputational consequences diminish efforts to discipline clinicians formally or publicly, or encourage confidential consent agreements, then one might conclude that licensure offers more protection to malfeasant clinicians than to consumers.

Read the whole thing.

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  1. Kind of reminds me of another absurd professional stranglehold: lawyers. It used to be that if you could qualify yourself to argue before a court by passing the court exam (the Bar), you could argue cases.

    Nowadays, though, you are *required* to attend law school. That’s…fucked up.

    If someone can pass the qualifying tests for a profession, then that should be the ball game. If registered nurse practitioners can, by the evidence, produce the same or better results than doctors, then doctors should not have the stranglehold they have.

  2. p.s. Awesome Doctor Who pic.

  3. The great thing about H&R is that you can have an insightful item like this and yet link it to an only-slightly-relevant pic that a large number of the regulars think is really cool. Which it is.

  4. Funny how the state of the nation’s health care industry is always measured by the number of people uninsured, not by the insane cost to get care if you are uninsured. It’s just accepted that prices HAVE to be this high (except for drugs, which are because of the evil drug companies).

  5. You know, while I like David Tennant, the current series has failed to hold my attention. Who else feels that way?

  6. lmnop,

    This may have changed, but doesnt CA still follow that – anyone can take the CA bar, with or without law school?

  7. … or how expensive it is to be insured. As though paying $500 per month plus $40 each visit is something those poor people without insurance should strive to.

    My best experience in seeing a doctor EVER, was one where I only found out after the fact that he was a PA. More direct communication and a whole lot better attitude than your typical MD.

  8. Oddly enough, there has been a recent flurry of articles about the disappearance of the “family practice” physician. I interpret this as the doctors’ cartel laying the public relations groundwork for more rent-seeking, as opposed to advocating expanded health care options.

  9. This may have changed, but doesnt CA still follow that – anyone can take the CA bar, with or without law school?

    IIRC, this recently changed to suck like the rest of the country.

    You know, while I like David Tennant, the current series has failed to hold my attention. Who else feels that way?

    Sorry to say, I only saw the Christopher Eccleston episodes of the new series, but what I saw I liked. Cannot speak to the Tennant incarnation.

  10. Jon Pertwee has always been my favorite Doctor!

  11. For twenty years my primary health care provider was a pecker checker (Hospital Corpsman). This guy could set bones, diagnose and treat infectuous disease, perform simple surgery in an emergency and do all sorts of other shit. Sometimes he had to refer to books while treating you and was not too proud to do it in front of you. MDs go to a different room to look up shit. For the majority of health care sevices doctors are not required.

    This just in. Master mechanics are not necessary for the majority of car care services either. Sometimes Jiffy Lube does it better and cheaper.

  12. IIRC, this recently changed to suck like the rest of the country.

  13. IIRC, this recently changed to suck like the rest of the country.

    I completely agree on the law school thing (and that comes from a law student!). Reform-minded people should be able to agree that turnstile-jumping does not need Johnny Cochrane to manage.

    More seriously, Vermont still allows you to “apprentice” your way to the bar. IIRC, WI as well.

    However, I believe that if you go to law school, they should eliminate or at least scale back the bar exam. Also, I think law school should be two years instead of three.

  14. Sorry to say, I only saw the Christopher Eccleston episodes of the new series, but what I saw I liked. Cannot speak to the Tennant incarnation.

    Eccleston was good too, but the whole format of the show is a little weak, in my opinion.

  15. Sometimes Jiffy Lube does it better and cheaper.

    QFMFT

    If people were really serious about the health “insurance” crisis, they might see that maybe finding out whether a common cold is strep and getting the necessary prescription isn’t something that should require a $300 doctor’s visit.

  16. Most of the professional licensing requirements became law around a century ago to protect established professionals from competition from skilled immigrant labor. It’s just another example of how government attempts to shut out competition from foriegners always harms consumers.

  17. You know, while I like David Tennant, the current series has failed to hold my attention. Who else feels that way?

    I too, would much rather discuss Doctor Who than whatever the topic of this post is.

    Well, there are a few problems with the new Who. Most of them are the direct result of the guy who brought it back. He’s big on treacly melodrama and has committed numerous sins against the earlier notion that the doctor doesn’t get “involved” with his companions. None of which stops me from watching religiously, of course.

    Tennant’s OK, but he’s starting to grate on my nerves. He’s very shouty and preachy.

  18. Non-physician medical care could be even better and more comprehensive, but certain medical tasks are restricted by law and can only be performed by medical doctors or doctors of osteopathy. That’s good and bad, I guess, although I suppose lots of charlatans and quacks have degrees and licenses.

    The best medical care I’ve ever (imho) received was from a nurse practitioner. Bless that woman.

  19. Sorry, “osteopathic physician.” My bad.

  20. I too, would much rather discuss Doctor Who than whatever the topic of this post is.

    Great. Maybe you should start your own blog.

  21. None of which stops me from watching religiously, of course

    It stopped me from watching. And I’ve found that, other than Billie Piper being okay, his companions are boring as shit.

  22. I’m sorry. That was really douchebaggish of me. I’m sure I’ve strayed from the topic about a million times here.

  23. TAO

    Law school in most of the British Commonwealth is still a four year undergraduate professional school like engineering or architecture. The first two years are “fundamentals” followed by two years of legal stuff.

    Some law schools in Canada have changed to the postgraduate model I’ve heard.

    IIANM law was one of the last professions to get itself totally schoolified. Until a century or so ago most lawyers learned there craft by reading the law with an established practice.

  24. Great. Maybe you should start your own blog.

    Um. I’m not the one who posted a gratuitous Dr Who image.

  25. That was really douchebaggish of me.

    Heh, OK.

  26. And I’ve found that, other than Billie Piper being okay, his companions are boring as shit.

    The last one, Donna, was fantastic IMHO. She explicitly ruled out any puppy love for the doctor. She put him in his place numerous times. And her acting was much better than the others.

  27. You know, while I like David Tennant, the current series has failed to hold my attention. Who else feels that way?

    Can’t say I agree. I like the newest incarnation — although this last season felt a little disjointed.

    I also really liked Christopher Eccelson as the Doctor. And I preferred the Billy Piper and Morgana Freeyman companion to the “Donna” character.

    But overall, I think the series and it’s tie ins to Torchwood (and the Captain Jack character)

  28. But overall, I think the series and it’s tie ins to Torchwood (and the Captain Jack character)

    Should read:

    But overall, I like the series and it’s tie ins to Torchwood (and the Captain Jack character)

  29. This is why I love Reason. I suppose I agree with the practice of medical licensing, but I love the idea of questioning it.

  30. However, I believe that if you go to law school, they should eliminate or at least scale back the bar exam.

    That makes no sense! Just because you can coast your way through law school you shouldn’t get a pass on the exam. The exam should be the same for everyone and if you can pass it without school, great.

  31. As a future physician, I like medical licensing as a way of ensuring quality. I also like NP and PAs and I think they are important and useful.

    I think most doctors will tell you (at least the ones I know have) that NPs, some other master’s level nurses, and PAs are equally good for the vast majority of care. They are also trained to have a good idea of when to talk to someone with more advanced training, although I think this is a hard thing to know for sure.

    The problem with saying that the vast majority of care is equivalent is that it could be interpreted incorrectly. Doctors may be better at seeing a less common possibility, with the more advanced training, but as those are rare, most of the time it won’t matter. It doesn’t mean you still might not be safer choosing a doctor. That’s why I go to one, and one that is very well respected clinically for that matter.

    I work with a NP that is supervised by a doctor I work with. She can handle 99% of her caseload fine, but she discusses about 5-10% of it a week with him for anything she is worried she might be missing (which, as the 99% indicates, is pretty rare even for what she brings to him). I think that model works great: it’s what I would want to do in primary care or outpatient psych.

  32. By the way, I think that’s whats best personally. I am completely positive about the idea of NPs and PAs having additional autonomy if they so choose to. I imagine their insurance rates will rise to be similar to doctors if they choose to, though.

  33. As a future physician, I like medical licensing as a way of ensuring quality.

    I assume you’ve seen the post on the College of American Pathologists saying that Dr. Haynes is just fine with them? Its not licensing, precisely, but board certification is generally held up as the real indicator of quality doctoring anyway.

    State licensing boards are notorious for being captives of their licensees, anyway. I guess things could be worse without them, but, man, they let a lot of bad actors keep their licenses.

  34. Yup, it’s a travesty. Still, even the possibility of barring even WORSE people from obtaining board certification would seem a good thing. I wish they did a better job, however. From my colleagues, and my view as a recent medical school applicant: it may be hard to get into medical school, but it’s pretty hard to fail out, too. I’d like it to be harder, honestly.

    SLD: I would be happy with a free-market alternative to our current medical licensing situation, but it’s not high on my list of things to work on.

  35. I wish there were no licensing board in Texas. While they drag their feet on licensing a new doc from out of state, my husband’s been on call every other night.

    (Ok, I admit that the licensing board is good for a laugh every now and again when the booklet comes out with doc transgressions. This one dude was doing a little more than scoping if you know what I mean.)

  36. You know, while I like David Tennant, the current series has failed to hold my attention. Who else feels that way?

    Me. Screaming constantly does not necessarily make it more exciting.

  37. he last one, Donna, was fantastic IMHO. She explicitly ruled out any puppy love for the doctor. She put him in his place numerous times. And her acting was much better than the others.

    Ugh, no. I watch sci-fi for escapism, not to watch the heroine imitate my wife.

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