Is There a Doctor in The House?

Consider that the better question may be, “Is there a decent doctor in the house?”

The Medical Board of California has recently asked the State Legislature to amp up the ability to discipline doctors who have run afoul of the system. Included in the request was a petition asking for lowering the burden of proof standards for bad doctor prosecutions while at the same time increasing medical licensing fees, the primary source of revenue for the State Board.

So, what is driving these and other requests for reform? Assertions have been made that the Medical Board has been too lenient with doctors accused of malpractice or worse.

Perhaps, though, there is reason to ask whether California and other states are now finding that the profession that historically attracted our best and brightest is failing to do so for good reasons.

Studies and reports are showing that the nation will experience a significant shortage of physicians in the coming years primarily due to an expanded need to serve an aging population with greater life expectancies.  For the time being, applications to medical schools are increasing, but the capacity to admit them to U.S. schools has not which forces lesser qualified applicants to train in foreign programs.  But can we realistically expect our best and brightest to seek a career in medicine moving forward?  Consider:

• As with most post high school education, the cost of attending medical school continue to skyrocket yearly to an average now of nearly $55,000/year. While these staggering numbers reflect the cost of tuition, fees and insurance, they do not take into account the cost of living expenses. Ultimately, a medical school graduate will leave school with an average student loan debt of nearly a quarter of a million dollars.
• After graduating medical school, the loan repayment begins, but the training does not end. Post-doctoral residency programs will last between 3 to 7 years and the average resident compensation will average around $60,000/year—hardly making the new doctor a 1 percenter.
• After enjoying relative stability for a decade or so, medical malpractice insurance premiums are on the rise again….precipitously. Whereas doctors in Los Angeles County tend to experience lower premiums relative to other metro areas in the U.S., the overall numbers can be daunting. Depending upon specialty and geographic location of practice, premiums can range from approximately $7500/year to well past $200,000/year. This can account for 3-4% of a doctor’s income.
• Aside from financial issues associated with the costs of education and establishment of a medical practice, there are certainly other stresses that might make a prospective physician think twice before entering the field and most definitely causing the doctor to look back after choosing a career in medicine and lament that choice. A 2019 American Federation of Family Physician (AFFP) survey indicates that 39%

  

  of physicians would not choose a career in medicine if given the choice again.  The survey further cited that the greatest source of unhappiness in their medical practice were a lack of control, and clerical burdens.  There can be no doubt that the influence of managed care insurance and the corporatization of health care directly contribute to these particular leaders in unhappiness.

Perhaps the most important if not startling development of late is proposed Assembly Bill 1400 authored by Assemblyman Ash Kalra (D- San Jose) which would ultimately establish CalCare, a first-in-the-nation single-payer state universal health care system. The plan would be funded by the largest tax increase in California history through a state constitutional amendment ultimately needing approval of California voters.

Not surprisingly, influential organizations such as the California Medical Association and California Hospital Association are highly critical of the proposal. While the merits of this monumental proposal, which would have government assume control of roughly 10% of the California economy require significant exploration and debate, for now it is reasonable to consider whether a purely government run state health care system will attract the best and most competent physicians to California in a time where doctor shortages are projected and the Medical Board of California is finding a need to amp up their ability to root out and prosecute less than adequate doctors.

As a California taxpayer, but perhaps more importantly as a California patient or future patient, the debate centered around Assembly bill 1400 and a potential referendum to amend the State Constitution merit continuing scrutiny.