| Medicine, first and foremost, is a BUSINESS. It is also a game of super-sub-specialization. The entire field. There essentially numerous subspecialties within each specialty. Some surgeons do nothing but the same apnea surgery 5 times a day. Some oncologists do nothing but specific neuroendocrine cancers all day. Some diagnosticians are good for a specific area of their field - and utterly useless elsewhere, because they just couldn’t care less and want to work on what they find interesting. Just like anyone else. If you want to see someone who actually knows what they are doing, sees the same exact issue you are having 10 times per day instead of once per decade, you WILL travel. Of course, you can always settle for the clueless doctor nearby who will do the bare minimum, or maybe even nothing. Remember: patient outcomes are not part of the standard of care. There are no real incentives to do better than bare minimum, as a physician. Sometimes the talent is in Switzerland. Sometimes Germany. Korea has some leading talents in niche areas. It just so happens that the US pays the best, and just like engineers who can write their ticket that move to Bay Area, so do the physicians that move to the US. Real life example: many neonatal surgeons only begin practising on their own, independently, in literally their late 30s, if not 40s. In training until then, whew. Slightly different than picking up a new JavaScript framework. Would you seek to maximise your income if you had to study for 20 years after high school? Neonatal surgery is often $1-2 million per surgery. There are only a handful of such centres. Only some of them operated on a specific condition more than 10 times. The same really goes for anything else from diagnostic to operators. Even in the US, you’d often have to travel out of state if you want to get a proper opinion. Easier with imaging or biopsies because these can be mailed. Tons of people travel for surgeries.
250k Canadians every year travel to the US to get care they cannot get on time (or at all) at home. I’ve seen it all, even Saudis flying over for dental work. Next time you see your doctor ask them who would they pick for their surgery: someone who does the procedure 100x per year, or someone who maybe does 1-2 cases per year. Then guess where the most super-specialized talent can maximise their income. Probably not the remote Australia with a population of ~10% of the US. US simply has the best talent. If you can afford it. As for Canada/NHS/Australia being better - that’s just laughable. Canada is actually dead last among top 10 richest countries, and happens to have the second highest drug prices after Switzerland. Also has as many beds per capita as Mexico. You’d be better off going literally anywhere else. Mayo at Rochester has a larger diagnostic antibody library than anything in those three countries combined, and can arrive at your diagnosis within two days instead of two decades. Guess where your tertiary centre in Canada/Aus/Uk often mails your blood work and biopsies once they are at the end of the rope? That’s right. USA. |
It's a utility that exists to protect the investment in it's citizens such that their full productivity can be achieved.
It's in a country's best interest to achieve the highest possible standard of care for all citizens, not just those that can "afford it".
Treating medicine as a business only works for the very top of the totem pole and over time leads to increasing degradation of the labor force. i.e what you are seeing in America right now.
Nobody in Australia ever wonders if they should call an ambulance if they are injured or worried they could be very ill, they just pick up the phone and dial 000. They are guaranteed as citizens of Australia to have access to life saving care whenever and wherever in our borders. They do so with no fear that they will financially ruin themselves.
In Australia we would go as far to call this a basic human right.