Economics 101

What happens when the government imposes price controls? You can find out for yourself by a little research or simply by reading "Basic Economics" by Thomas Sowell. Now I know he's a black conservative with the Hoover Institution, so half of you can quit reading here because you care more about that fact than you do about logic, but here's what happens in my little branch of the world, medicine.

When price controls are imposed in medicine, EMTALA is a good example, then particular medical procedures and services lose any meaningful relation to their actual worth. Price and cost cease to have any real relation and an example of this follows...

When I worked in the ER I would work a ten-hour shift in which I might perform life and death procedures such as endotracheal intubation, cardiac resuscitation, lumbar punctures, central line placement, conscious sedation for painful procedures, and pronouncement of death. I was paid a base salary and had bonus money added based on something called RVUs... relative value units. Theoretically then, the more difficult and dangerous the procedures I did on a particular shift, the more money I made.

How did this work out? Well, on a busy, dangerous shift, I might make up to $170 an hour or so. Life and death stuff, $170 an hour. Fair? Maybe.

Now I work in an acute care clinic and the only people we see are either insured or they pay their bill up front. There are some very interesting things I have discovered. I am paid now, for the sake or round numbers, $100 an hour. Doesn't matter what I do, that's my salary. Fair? Oh, and anyone who is sick goes right away to the ER.

I think it's ridiculous because here's what happens... First, ALL of my patients that I see now have skin in the game. They are paying something for my services and guess what? Not a single one of them yells at me or spits on me or has to be escorted off the property by security... No one threatens to kill me and no one comes in and demands oxycontin for their acute on chronic overwhelmosis. In other words, it's easy.

Along with this, I have time to sit with all my patients and discuss their cases and guess what else... it's very pleasant. I feel more like a doctor in the snotty nose clinic than I did in the ER. In fact, I'm often able to give the patients more than they expected when they came in by taking a good look at their medical histories and problems and suggesting things they might do to improve their overall health. It feels good.

So, to all of you ER docs who are still in 'the pit', losing sleep and running on pure adrenaline and frustration, there is another way. The only problem is, the more of you that discover what I have discovered the less docs there will be in 'the pit' doing the life and death stuff that actually matters that instant.

And this is the result of price fixing and socialism... Value has no meaning, people take advantage, and systems that were built under a capitalist model that work very well, are replaced with impersonal, ineffectual, and dangerous shadows.

I'm happy with my pay cut and have no plans to go back and use my unique skills in the ER. The ER is a circus of pain and silliness and the same kind of silliness is being debated right now in our nation's capital. You better pray it doesn't pass, and now I find myself in agreement with 'Cat who said, a few years ago, that they could pay him four times what he was making and it would not be enough to make working in the ER worth it. Good luck all.