Medical students and residents continue to endure hardships and forgo earning power for many years to become highly trained. In years past, they exchanged self-sacrifice as bright young adults for higher income and enhanced social status when they were older. But, this exchange has become a shell game; physician earnings and prestige are declining as bureaucratic control of their lives increases.

Bond suggested that:" Young physicians become so well trained in deferring gratification that many give up on ever getting any meaningful rewards for their sacrifices. With their resilience worn away, many just give up the fight. A dispirited acceptance of one's individual fate seems to be the dominant mood of physicians nowadays rather than a motivated mobilization toward a better lot for the individual practitioner and the profession as a whole. Changing socioeconomic conditions are undeniable, yet medical education has not adapted. Virtually none of the training programs in the country offer courses on business administration or modern medical economics. The rigors of medical training prevent young physicians from acquiring economic survival skills on their own. Instead, medical training effectively places young doctors in a "cocoon," shielding them from the lessons of the real world.  Meanwhile, residents and fellows are working all the time, living on subpar wages, and amassing mammoth debt from student loans."

In both Canada and the US, medical care insurers and providers have assumed more of an adversarial status. In the US, hospitals and insurers often merge into enlarging corporations that manage the care of their subscribers to  maximize their profitability. 

Physicians, accustomed to a role of the prime decision maker, and receiving fees-for-service have been moved into contractual relationships with health plans that limit their freedom and their authority. They are treated as indentured servants even when they are the highest authority in the hospital who decide what  investigations and treatments their patients require.  

Bond suggested that physicians failed to comprehend the implications of the social and economic changes in the control of medical care. He stated:" Doctors received no training in adapting to the market conditions that occurred around them and remain ill-equipped to function in this radically changed economic -- and ethical -- landscape. These changes unavoidably are undermining the core of the physician-patient relationship."

In Canada, government agencies arbitrarily assumed all the powers and control that US companies are acquiring. While not for profit, governments tend be autocratic and wasteful. As medical care costs escalated, more controls appeared to limit physicians' autonomy and patients access to medical resources. In the past two decades medical school enrolments we cut back and now the country faces critical shortages of MDs, nurses and hospital technicians.

The call to expand enrolment in medical schools suggests that bureaucrats think that high IQ humans can be programmed to be medical robots under their control. At the moment, high IQ students still enrol and borrow large sums of money to get through arduous years of training. There are undeniable attractions to becoming a medical doctor. When medical schools fail to provide enough docs, they are imported from foreign countries in increasing numbers.

Bond, C. The Training of the "Helpless" Physician. Medscape General Medicine.  2007;9(3):47. Online.

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