because in america at least, the supply of doctors is kept artificially low. that combined with exploding administrative headcount, means patients are getting pretty terrible, expensive service.
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Physician compensation is around 9% of healthcare spending. The number of non-physician providers (NPs, PAs and specialists like physical therapists and podiatrists) has also exploded over the last 20 years. We have far more overall providers per capita than we did 20 years ago.
Lack of providers isn’t what’s driving up costs.
I don't think physician compensation per se is a good metric for capturing the effect of lack of providers, because some of the increased costs are due to the bottlenecks in the services per se, in terms of procedure costs and types of procedures offered. I also don't think the number of providers per se under the current regime, without deregulation or reregulation of practice boundaries, is representative of what would happen if there were changes in those boundaries. Adding more optometrists 5 years ago isn't the same as changing what they're allowed to do. It also doesn't address what cost increases would have been without an increase in the number of providers.
9% might also seem pretty big to me if it's out of all spending and doesn't include other provider compensation? What if overall healthcare costs went down, but physician compensation stayed the same? Would that then be a problem because it was an increased proportion of the total costs — fat left to be trimmed, so to speak?
There are many problems that don't have anything to do with providers per se, but I also don't think you can glean much by extrapolating to more of the same, especially compensation per se.
If lack of physicians is leading to an increase in costs, you’d expect to see physicians capturing a large part of that increase. There are situations where that wouldn’t hold, but it requires moving away from the simplest explanation that fits the data.
We don’t have to extrapolate from physician compensation though. We know that providers per capita have increased, but costs have continued to skyrocket. Therefore a lack of providers is not the immediate cause of the increase.
In addition to increasing the number of providers, the scope of practice for non-physician providers has almost universally increased.
All of this doesn’t prove that increasing the number of physicians wouldn’t lower costs some amount, but it does show that the increases over the last 20-30 years requires some other explanation.
9% is nothing when you consider that these people provide the value. With no physicians, there is no healthcare.