Thursday, March 20, 2008

Where Are the Best and Brightest Medical Students Going?

The March 19, 2008 New York Times has an interesting article on the recent popularity of fields like dermatology and cosmetic surgery amongst the top graduating medical students. Here are some excerpts:
For Top Medical Students, an Attractive Field

...As thousands of medical students await word this week on residency programs, two specialties concerned with physical appearance — dermatology and plastic surgery — are among the most competitive.

...Seniors accepted in 2007 as residents in dermatology and two other appearance-related fields — plastic surgery and otolaryngology (ear, nose and throat doctors, some of whom perform facial cosmetic surgery) — had the highest median medical-board scores and the highest percentage of members in the medical honor society among 18 specialties, the report said.

The vogue for such specialties is part of a migration of a top tier of American medical students from branches of health care that manage major diseases toward specialties that improve the life of patients — and the lives of physicians, with better pay, more autonomy and more-controllable hours.

...Dermatologists say they enjoy the variety of a specialty that encompasses serious illnesses like skin cancer and psoriasis as well as conditions like uncombable hair syndrome.

But students interested in such work also often factor in personal benefits. Internists, for example, worked an average of 50 hours a week in 2006 while dermatologists worked about 40 hours, according to an annual survey by Medical Economics magazine. Dermatology also offers more independence from the bureaucracy of managed care, because patients pay up front for cosmetic procedures not covered by health insurance.

And while an internist earns an average of $191,525, a dermatologist earns an average of $390,274, according to an annual survey conducted by the Medical Group Management Association, whose membership includes more than 21,000 managers of medical practices. Dermatologists who specialize in cosmetic treatments or in skin-cancer operations can earn much more.
These medical students are acting in their rational self-interest when they choose not to deal with the bureaucratic headaches of Medicare and Medicaid associated with primary care, and instead go into fields where patients and doctors have the freedom to voluntarily contract for goods and services according to their best rational judgment. The higher pay and increased autonomy of those fields is a direct result of them being subject to the least government interference.

Hence, in the (relatively) free markets of dermatology and cosmetic surgery, we see the typical pattern of falling costs and rising quality that we take for granted in the rest of the American economy.

If we want to attract the best medical students to fields like primary care and general surgery, then we need a free market in all of medicine. Any American who thinks that he or she might need good quality health care someday in the future (which is basically everyone) should therefore support a free market and individual rights in medicine.