Private Equity Gloats Over A Doctor Glut

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      This “oversupply” of emergency physicians will likely never be apparent to the average patient sitting in an ER waiting room, where skeleton staffing has been thoroughly baked into the business model. As the APP presentation points out, 70 percent of hospital ERs are outsourced, and most contracts are awarded to the lowest bidder. Nearly all of the biggest bidders on ER contracts — Envision Healthcare, TeamHealth, SCP Partners, ApolloMD, and APP — are owned by private equity firms that have accumulated nine- or ten-figure sums of debt buying out smaller competitors. Making the interest payments required by that debt leaves no room for extravagances like higher doctor-patient ratios.

      Indeed, as the media will often remind us, we are by most standards a nation in the throes of an acute physician shortage. Most countries have far higher numbers of doctors per capita than the United States, partly because we force doctors to endure three or four times as many years of postgraduate education as most European countries, pay an average of $300,000 for the privilege to save lives, and partake in a cutthroat competition for a fixed number of residency positions.

      Each year more than a thousand new medical school graduates, most of them deeply in debt, fail to “match” into residency programs and fall into a kind of professional limbo. This is in part because Congress, in 1997, froze the number of residency slots it would allow Medicare to subsidize — a Republican policy the conservative Wall Street Journal editorial board last year shamed congressional Democrats for failing to reverse, in light of what it characterized as a rampant “shortage” of doctors, particularly emergency physicians.

      Assessing the physician labor market in February, The Atlantic argued that the barriers to achieving a medical license in America amount to “a conspiracy to limit the amount of doctors practicing in America.” And yet, younger ER doctors will tell you a starkly different story — one in which ER specialists toil four years in med school and another three or four in residencies, only to spend another six months looking for a job, during which they find that employers are delegating an increasing number of

      Jesus: Hey, Dad? God: Yes, Son? Jesus: Western civilization followed me home. Can I keep it? God: Certainly not! And put it down this minute--you don't know where it's been! Tom Robbins in Another Roadside Attraction

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