Sunday, March 03, 2002

The practitioners of what we call “high risk” medical specialties, such as cardiology, trauma surgery, and obstetrics, regularly create more value than almost any other professionals. For example, a good trauma surgeon, at the expense of a knife, some string, needles, and OR time, can create, for his patient, the opportunity to live for decades longer than fate might have otherwise decreed. Whatever such a saved patient creates for the rest of his life is possible only because of the work done by the surgeon. Multiply that by a few cases a night for forty years, and the value created by each surgeon really adds up.

Specialty physicians give away to their patients most of the value they create, asking only a few thousand dollars in exchange for making continued life possible, but enough value remains that specialists have traditionally been able to make a comfortable living. Even the small sums medical specialists charge, however, are now overshadowed by the amounts they pay to lawyers (via insurance companies).

It makes sense that lawyers would want to get a share of the value created by physicians. Who wouldn’t? Medical specialists make not-inconsiderable salaries. On the other hand, medical school is long, intense, and expensive. Practicing specialty medicine correctly is a difficult skill that requires constant updating of a physician’s knowledge. So it really doesn’t surprise me that lawyers would want to capture that value without having to go through medical school.

The part that saddens me is that our laws and procedures are becoming more and more arranged to make that possible. Huge jury awards for “malpractice” don’t punish bad physicians so much as they are a lawyer tax, collected on occasions dictated by the unavoidable vagaries of fate, on working doctors.

Some surgeons have noticed this, and have retired or gone into other fields. That’s a documentable result of lawyers claiming for themselves value that they didn’t create. What’s not so obvious, however, is the talented, intelligent people who would have been surgeons who have, instead, become tort lawyers or other parasites. The number of US medical school applications has dropped by 10% a year for half a decade now, and anecdotal evidence suggests that the quality of applicants has dropped even more precipitously.

Fifteen years from now, the young person who is starting medical school this September may be the surgeon you need after you get hit by a bus. Money is only part of the motivation to be a doctor, but does it make sense to reduce the expected income of that future surgeon, in order to pay a lawyer who will contribute nothing to the chance you survive that impact with the bus? Aren’t you just a little bit concerned that such a practice will reduce the chances that the very strongest potential medical students will become trauma surgeons in the first place? Reducing the lawyer tax might be a first step to saving your life.

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