Sunday, May 15, 2005

UK Family Doctors' Salaries

The May 14-20 issue of the Economist has a fascinating short article, entitled "Practice Makes Perfect," detailing an extraorindary average boost of 50% since 2002-2003 in UK family doctors' pay.

Why, the reporter asks, is this happening? Because the Labour government and the NHS believe it should. The notion that markets can't level every playing field is still abroad, apparently, in some places where the state takes a role in managing some sector of healthcare.

Which leads one to ask: what's the trajectory in a "purer" market economy--ours--where CMS and other agencies determine so much of what we do, but have no purchase over the maldistribution of specialties. And no purchase, no controls (or none they're willing to exert) over training and retention of primary care physicians.

(Except for, historically, the early Bureau of Health Manpower's decisions, under the Johnson and Nixon administrations, to punch up sheer numbers of trainees, through bricks-and-mortar creation of new schools. Supposedly to address maldistribution, but of course, it didn't work out that way.)

Or are we just out of sync with our UK brethren?

The reason this article is so appealing is that it eliminates a counterfactual I've pondered for years. I noticed a pecking order among specialties--like cardiologists crowing about being the "internist's internist"--based always on cognitive-technical claims, never on greed-fed notions of "grab the brass ring, win prestige."

I always wondered what would happen if, suddenly, magically, people like family doctors and general internists or pediatricians were, in a different universe, compensated as well as or better than their consultant compadres. Would the extraorindary breadth of expertise demanded by these pursuits then, suddenly, magically, begin to attract large numbers of bright people?

This experiment is being carried out right now in the UK. It's the "price signal," baby.

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