Paula Hall: Don't Become A Primary Care Physician

Attorney/blogger Paula Hall has written an excellent post entitled, "An Open Letter to Medical Students: Please don't become primary care physicians!!":

An Open Letter to Medical Students: Please don't become primary care physicians!!
By Paula Hall
9 July 2008

All the talk about the health care crisis is about the costs. All the solutions proposed to the health care crisis are aimed at making it more affordable.

No one ever talks about access to health care. And with good reason -- because everyone knows, in their heart of hearts, that access to health care means access to physicians, and the only way to even attempt to guarantee access to physicians is to enslave them.

What is missing is a proud and open statement by physicians that they, too, understand that guaranteed access to health care -- government socialization of health care -- means enslavement of physicians. Physicians as a group need to stand up and be proud of the decades of hard work it took for them to become a physician -- and ask everyone clamoring for universal healthcare if they can conceive any mechanism, even brute force, that can make someone learn to be a doctor.

Many doctors are leaving the profession, because the bureaucracy is crushing them, preventing them from spending time practicing, and because they aren't getting paid enough for what they do. It is a senseless and useless argument to claim that doctors are being greedy and should accept whatever low payment we healthcare-needing consumers are willing to pay. It doesn't matter. There is nothing that can be done to stop a doctor from leaving the profession. You wouldn't even want to force a doctor to stay in the profession -- ask yourself if you would be willing to operated on a surgeon who didn't want to do the operation and was only there because he was threatened. Could you possibly trust the advice of a practitioner who hated what he did? Does anyone truly believe a mind can be forced, that good judgment can be elicited at gunpoint?

The healthcare access crisis is acutest at the primary care level and for the elderly on Medicare. Primary care physicians are the gatekeepers for all the bureaucracies and bear the burden of all the regulations and requirements. (Do not go on about how HMOs and insurance companies are greedy private concerns. They are subject to thousands of laws and regulations telling them what services they may or may not offer, what things can and cannot be covered. Anyone making this objection should know that, since they are the ones lobbying for all the laws.) Primary care physicians receive the lowest compensation. And primary care physicians are the ones everyone needs, they are the ones who get to know the patients and refer them on to specialists.

People clamor for more primary care physicians while at the same time clamoring for regulations and costs that drive them out of business. And no one seems to get what is happening, or be willing to admit what is happening. But it's happening -- we're losing primary care physicians. And we're losing the doctors who treat the elderly. I'm middle-aged. By the time I am elderly, there will be few doctors available to treat me. And I am scared. I am scared that primary care physicians willing to treat the elderly will be hounded out of the profession. And I cannot blame them one bit for leaving. I am completely sympathetic to the medical student who chooses a lucrative specialty, like plastic surgery or dermatology, over primary care.

I think perhaps the most effective means to get the message to people that the only way to increase the number of doctors is to free them is: drastically to decrease the number of doctors on the explicit grounds that they are not free. So, medical students of today, I beg of you -- don't go into primary care! Let everyone know that you are avoiding primary care because it is too regulated and doesn't pay you enough. If you are a primary care physician, find a way to quit, and scream from the rooftops the reason why! Doctors and doctors-to-be, find a way to leave the primary care profession altogether, because if you try to go on strike while retaining your right to practice, the bureaucrats will use the antitrust laws to destroy you. Just leave!

And hopefully, when there are no primary care physicians in a few years, everyone will see what must be done. Only when everyone sets the doctors free, should they come back to primary care. Hopefully, this process will be quick -- so that when I am old, I will be able to find a good doctor.

(Inspired by a column by Senator Tom Coburn (R-OK), appearing on the Real Clear Politics website -- and which does not go nearly far enough in making the case for doctors.)

Thank you, Paula!