Make the best use of what is in your power, and take the rest as it happens.
– Epictetus (55-135)
In early 19th Century England – during the Industrial Revolution – there developed a radical and secret, oath-based organization of textile workers that would destroy machinery and beat up less skilled workers as a protest. The group did this because they believed that machinery was being used in a “fraudulent and deceitful manner.” Known as Luddites, this group complained that the time spent learning the skills of their craft would go to waste as machines would replace them. The Luddites complained that the owners of mills and factories were using skilled artisans to train less-skilled workers to replace the skilled workers with machines.
After about 5 years of protests and breaking machines – and getting shot at by the mill and factory owners – the Luddite movement was eventually suppressed by military force.
But, the term “Luddite” stuck. It has come to be used to describe those who are opposed to indsutrialization, automation, computerization, new technologies, or, in general, new ideas.
How does this story from history relate to American doctors?
Many American doctors are waking up and realizing that the world around them has changed. Some are beginning to complain about it; a very small number of doctors are actually doing something about it.
The field of medicine is changing. Frankly, it’s been changing for a long time but most doctors are just now starting to wake up to this reality. There is a revolution taking place that only a few are fully aware of.
Many doctors are becoming Luddites. No, doctors are not breaking machines or beating up Nurse Practitioners (NP) or Physicians Assistants (not yet, anyway). Doctors are complaining that they, as more highly trained and skilled “artisans,” are being replaced by those with less training and inferior skills.
Like the Luddites before them complained during the Industrial Revolution, American doctors have a legitimate gripe: hospitals and insurance companies are replacing those with MD, DO, and MBBS training with those with less training: NPs and PAs.
The harsh reality is that most hospital administrators and insurance companies don’t care that doctors have more training.
The hospital administrators and insurance companies simply don’t value the skills and training as much as the doctors do. (For a discussion on the “value” doctors provide, check out last week’s post What Doctors Don’t Understand About the “Value” of the Service They Provide.)
In fact, it is a stated objective of both the technology and insurance industries to eliminate 80% of doctors and replace them with algorithms and robots. (Don’t believe this? Read The Minimization of the Physician, Part 1: It’s Not the Strongest That Survive and The Minimization of the Physician, Part 2: The Brutal Facts.)
To the hospital administrator or insurance company, today’s doctors are, at best, White Collar Factory Workers and, at worst, interchangeable – and more expensive – parts than NPs and PAs.
So, what’s the answer?
To unionize would be moronic. Unions, while serving their purpose at one time, would be the worst thing to happen to healthcare at this point. Unions, in reality, restrict the supply of workers to artificially inflate the value of the worker because of limited supply. The irony is that the “skilled” union worker actually becomes less attractive in the open market.
There’s a pretty strong argument that this is already being done (restricting the supply of doctors into the marketplace) by medical schools, medical societies, and state boards, to name just a few. Ultimately, this leads to lower wages and less freedom. And encourages competition (for example, using NPs and PAs to provide services traditionally provided by MDs and DOs).
That’s all changing now. If you can’t see that then you’re lying to, or fooling, yourself.
Some doctors are going to be able to hold on for a few more years until they retire or quit medicine completely. Many are going to continue to be White Collar Factory Workers.
A few are going to make the tough decisions. These physicians – those skilled in the art of healing – are going to find their way to a new freedom that they always believed existed, but never knew how to get there.
How does a real physician find this freedom?
Start by reading reading the following eBook:
You can also read the following blog posts:
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