If a professional organization wants to protect the incomes and job opportunities of its members — and if it wants to ensure the quality of the services being provided, thereby preserving the profession’s reputation — it needs to exert some control over who enters the field. A professional association should arguably do whatever it can, within the bounds of antitrust law, to protect its turf and to preserve a certain amount of exclusivity in the profession.
(Please note that we’re proceeding based on two assumptions: (1) professional organizations should act in the self-interest of their individual members (as well as the profession as a whole), and (2) there will be some regulation of entry into a profession. We set aside the libertarian vision of a world devoid of professional licensing schemes and regulation, in which anyone can practice a trade or profession, and the market weeds out the bad apples.)
Some commentators — like our very own Elie Mystal, currently on vacation (so we’ll attempt to fill his shoes in this post), or Mark Greenbaum, in a widely-read Los Angeles Times op-ed — have accused the American Bar Association (ABA) of not doing enough to regulate entry into the legal profession. As a result, the nation is flooded with lawyers — or, perhaps more accurately, law school graduates — who can’t get jobs (or jobs that pay well enough to cover gigantic student loan payments).
These critics point to other professions and professional organizations that have done a better job of preserving exclusivity. Take medicine. Historically, if you could survive the rigors of the cutthroat pre-med world, four years of medical school, and the underpaid toil of a residency, you’d be set for life. As noted yesterday by a commenter:
The average doctor is at least twice as [well] compensated as the average lawyer. And doctors do not know the meaning of unemployment.
But is that about to change? Are new medical schools going to flood the market with doctors, making them just as
useless vulnerable to income deflation and unemployment as their lawyer counterparts?
That’s the possibility hinted at in a recent New York Times article (which we mined for yesterday’s Quote of the Day). The piece starts off with the story of Peter Allen, a recent college graduate who got rejected by 28 out of 30 medical schools, en route to securing a place in the inaugural class of the Commonwealth Medical College in Scranton, Pennsylvania:
The Commonwealth is one of nearly two dozen medical schools that have recently opened or might open across the country, the most at any time since the 1960s and ’70s.
These new schools are seeking to address an imbalance in American medicine that has been growing for a quarter century. Many bright students were fleeing to offshore medical schools, or giving up hope entirely, when they could not get into domestic schools. Meanwhile, American hospitals were using foreign-trained and foreign-born physicians to fill medical residencies. During the 1980s and ’90s only one new medical school was established.
Hmm…. Might that explain why median salaries for physicians, even in relatively less lucrative fields like family practice and internal medicine, start at $200K and go up from there?
The proliferation of new schools is also a market response to a rare convergence of forces: a growing population; the aging of the health-conscious baby-boom generation; the impending retirement of, by some counts, as many as a third of current doctors; and the expectation that, the present political climate notwithstanding, changes in health care policy will eventually bring a tide of newly insured patients into the American health care system.
Think about it another way: with health care reform possibly becoming a reality, the incomes of health-care providers are already in danger of taking a hit. Does the medical profession need to accelerate the trend by setting up more med schools?
If all the schools being proposed actually opened, they would amount to an 18 percent increase in the 131 medical schools across the country. (By comparison, there are 200 law schools approved by the American Bar Association.) And beyond the new schools, many existing schools are expanding enrollment, sometimes through branch campuses.
So what’s the justification for the proliferation of new med schools?
Supporters of the expansion say that having more doctors will improve care, by getting doctors to urban and rural areas where they are needed, by shifting care to primary and family practice physicians rather than expensive specialists, and by reducing long waits for people to see a doctor and get the care they need.
This is akin to arguing that having more law schools will lead to more people of modest means getting the legal services they need, at reasonable cost. But is that what has happened in practice, as law schools have sprouted like weeds? Not exactly.
Perhaps informed by the law school situation, some question whether more is better with respect to medical schools:
[S]keptics say that although many parts of the country do need more primary care, American doctors tend to congregate in affluent, urban and suburban areas that already have a generous supply.
They say that doctors create demand for their own services, and that nurse practitioners and physician assistants could fill gaps in medical care at a lower cost.
This could be rewritten for Biglaw lawyers: “[Critics] say that large-firm lawyers create demand for their own services, and that contract attorneys and paralegals and outsourcing could fill gaps in legal services at a lower cost.”
Based on what’s happened in the legal profession, we’d like to offer some unsolicited advice to the medical profession. You guys have
a nice racket a good thing going; don’t ruin it. Becoming a doctor isn’t easy, but those who do make it into the profession enjoy prestige, societal respect (“please marry my daughter!”), six-figure (or even seven-figure) incomes, and unmatched job security [FN1].
From the perspective of the general public, the health care system could perhaps use some (judicious and carefully considered) reforms. From the perspective of doctors, however, the status quo — while not perfect — is pretty darn good. If the system ain’t broke, why fix it?
[FN1] How often do you hear about doctors getting laid off? The only case we can think of is the 32 medical residents — not even fully-formed physicians, just residents — who got laid off with the recent closing of St. Vincent’s Hospital here in Manhattan. We expect these laid-off residents to find new positions quickly, before going on to long and successful careers in medicine.
P.S. Some critics of the lawyer glut, such as Elie, are accused of being “anti-lawyer” (e.g., “you couldn’t cut it as a lawyer, and now you just throw stink bombs from the sidelines”). Such ad hominem attacks don’t detract from the substance of the points these critics make.
Furthermore, please note that we have nothing against law or lawyers. We love writing about lawyers. Some of our best friends are practicing lawyers. And we still practice ourselves: we maintain our New York law license and serve as in-house counsel to Breaking Media, Above the Law’s parent company.
In raising the possibility that the legal profession should constrict its ranks, we are acting out of love for the profession. We want being a lawyer to mean more, not less — perhaps comparable to being a barrister in England, an exclusive credential that still retains its cachet.
Expecting a Surge in U.S. Medical Schools [New York Times]