An Engineered Shortage

I tag teamed KU Med today; the artist formerly known as Frau Lobster has been working on getting Mo's medication adjusted in the wake of this latest jag of seizures.

'There's got to be someone besides this doctor who's on vacation. It's a teaching hospital for crying out loud. Where are the interns and residents?'

Not only does he have no students at this medical school, he's not even full time. Being one of a literal handful of pediatric neurologists in the state, he divides his time between KU Med and Topeka. KU has been, I was told, trying to recruit more pediatric neurology help for four years.

I would aver that some of this unacceptable situation is actually the fault of KU Med and all the other medical schools in America. With an oligopoly over the licensing of all doctors, medical schools are effectively in a position to control the supply of specialists. The overall supply of doctors is a little more open because the school profits from additional students. Which doesn't make garden variety GPs common, really, because the intense and lengthy schooling and training to get even the most basic, hang-out-a-shingle-and-do-some-doctoring license is so brutal.

But of those full-fledged doctors, the positions in medical schools to become a particular sort of specialist is tightly controlled. A massive spike in demand for pediatric neurologists does not mean doctors who want to cash in on this suddenly valuable specialty can simply train for the gig and move into that area.

And who is a primary decision maker in how many new ______ists to mint? The head of ______ology at a medical school. Meaning someone who's own income would be adversely affected if the market suddenly flooded with ______ists.

If there was a spike in demand for plumbers, and if the plumber's union ignored this and simply relied on the high demand to raise prices, what would happen? Non-union plumbers would eat their lunches, and an increasing number of people would come into the trade.

But for a medical specialist, or for a doctor of any kind, the analogous non-union worker is committing a felony: you can't do it without a license that is essentially controlled by the 'union.'

And if you're dubious that there could be a sudden spike in the need for a particular specialty, one medical schools would be slow to respond to, consider this: autism affected 1 in 10,000 kiddos 25 years ago. Now it's 1 in 150. And about 1 in 3 autistic kiddos also have seizures.

Even a truly free market would strain to meet that kind of spike in demand, and the market for medical expertise is far from a free one.