Vanishing Physician: Heal No One

We are about to witness a disappearance similar to something the comic writer Douglas Adams envisioned in his sequel to the Hitchhiker's Guide to the Galaxy, called So Long and Thanks for All the Fish. In the sequel, whales leave the earth and take all the fish.

What we are about to witness is the departure of private healthcare that takes with it all the physicians.

We all have heard that government will cut their pay. Often that is where the discussion ends. In fact, that is where the real consequences begin.

A doctor suddenly thrown into Obamacare will see his time even more consumed by government paperwork than currently is with insurance paperwork and CYA anti-lawyer paperwork (which won't go away, either). His compensation per patient will be set by the government. His private-pay clientele will evaporate. In essence, the soon-to-be-gone are the patients whose bills hide the existing catastrophe of government care in TriCare (that is veteran), Medicare, Medicaid, and Social Security Parts A and B. Those private payors are where the profits are hidden.

When profits disappear, doctors, espcially in sole- or small-practices, will be forced to close existing practices. Many of those practices are in commercial buildings with 5-year leases with options for additional 5-year terms. If the doctor just signed up for another 5-years, he will lose his profits but keep his lease liability. He will have to file for bankruptcy. If the doctor was lucky and is at the end of the lease, he may be able to negotiate a deal. Those in between are going to have to roll the dice.

So we can safely say that doctor bankruptcies will be on the rise. Those small-practice doctors will lose their life savings and have little chance to recover.

Older physicians in larger-group practices will sell their practices for a song to the younger physician-partners. Those older physicians may only be 50 or 55 and have a good decade of service left in their bones, but the headaches and loss in compensation will drive them out of practice. Why not play golf than take these slim pickings?

The younger physicians will have a higher proportion that still owe med school loans or loans for starting their practices. Their compensation hit will make their predicted revenue very small compared to what the projections were when they took the loans. More bankruptcies.

Those that survive will be pressed into ever larger groups. The groups will have to restructure how new doctors are hired. Now many practices pay off the new doctor's student loans after a few years of service. Call it a deferred compensation package. These packages will go away, first slowly, then more rapidly.

That means that younger doctors will have less money to live like they wished when they entered med school. Disillusionment will drive some into the business world. They didn't sign up to be bureaucracts. They had better visions for life.

So where will the replacements come from? India, China, Latin America. Very quickly our health system will wither because the talent leaves the building.

We have a system built on real talent and real science that is the envy of the world. We can destroy it overnight, but it can only be rebuilt over decades. Why destroy it?