Contrast that with what exactly is provided by healthcare insurance executives, bankers, lawyers, lobbyists, and certain departments in government.

To be blunt: once you note the fact that other countries in the world can provide healthcare at fractions of the cost, it's obvious those insurance execs, politicians, and lobbyists are eating value, not creating it. The contrast is that Doctors actually produce something of value.

And even if I were to agree with your premises, do we really want a system that selects for the kind of doctors who are willing to put themselves and their loved ones through years of hell in exchange for an eventual high and stable paycheck? What kind of people are these? Are they the kind of people you'll trust to treat your scared child gently and empathetically?

It's not just hard work to become a doctor. It's hard work and sustained excellence. You don't just put in the hours, you have consume an enormous amount of information and are tested on it constantly through the education process. You have to take on enormous personal risk financially in loans. You very frequently have to make large personal sacrifice in your life to get to the point of board certification.

Some get paid great, most get paid well, but if you know more than a few doctors you would probably be less glib. /me not a doctor.

Why can't this be automated?

It isn't clear how much the grueling training actually factors in to limiting the supply.

I will say thought, that this is a really typical path in the US, at least:

* 4 years undergraduate ($200K debt, high competition/workload)

* 4 years medical school ($250K debt, high stress/workload, 50% odds of not being accepted)

* ~3 years residency (pay only $50K/yr, famously high stress/workload, possibility of being separated from loved ones or making hard choices in residency match)

So assuming starting undergrad at age 17, you have had a tough 11 years and are at least $300K in debt by the time you are 28 and getting your certification. This is ignoring specialties with fellowships. I don't have the time, but I'm sure it's possible to estimate the quality of the time sacrificed to education and lost compensation during that time and then amortize that over a typical career.

And the field is different... after all of that training they get to spend an inordinate amount of time doing paperwork/fighting with insurers, which (seems to be) leading to more group practices with workloads like those described in the article.

If you're a doctor who is "doing it for the money", you have simply not understood the concept of opportunity cost. :)

Congratulations to your partner (and you)! I for one still think its a noble and altruistic calling.

The hourly rate for some doctors (mostly non-procedural) are much much lower than people realise and is only made up for my doing ridiculous hours. This is just not right.

This delusion that all doctors do well financially draws more poor students into the long training commitment only to find out at the end that with all the debt and sacrificed family hours and stress (having been through this) they are going nowhere financially.

Looking after patients can be a great and fulfilling career but this depends so much on the particular speciality you choose and the work life balance that it provides.

Next time you see your ED physician or family practitioner feel sorry for them. The shit and conditions they deal with and poor renumeration is something you simply don't understand.

I wonder how many doctors would be up for "sharing work (and compensation)" - in other words, would a doctor be OK with dropping his comp to $150K (from $200K) so the savings can be used to add a third more doctors to the staff? The "relief" in working conditions may well be worth it, for the doctor's sanity of course, but also for the patients (and all of the benefits down the line from having fewer mistakes, etc).

It's obviously not the only dimension that can be played with to help, but it's one that could be fairly straightforward to implement, as long as there is enough supply of applicants to increase the workforce.

My wife is a pediatric emergency medicine physician and I get paid more than her because I'm in tech. Also, I started my career and began earning an income right after college, whereas she went to medical school and a fellowship before she could begin earning income.

I always joke with her that, in terms of income efficiency, my field is way more profitable than hers. And a lot less stressful too.