You took the words right out of my mouth! Money is the elephant in the room here. Why doesn't the author quit surgery and start a small GP clinic? Oh, only half the pay? I see similar behaviour in law firms and investment banking.
Presumably, those who trained as surgeons, want to be surgeons. Sunk cost fallacy might come into play. A better analogy is someone who wants to be a software engineer, get burned out - and you say "hey, why not be a NOC technician if you can't handle it?"
Further, you assume a surgeon could just become a GP. They are different fields.
> They can try. But they would have no idea what they are doing. But legally, they could certainly practice as a primary care doctor. They would not be board certified, and could not sit for the ABIM exam, and would not be able to pass it if they did.
> The professions are also very different, primary care is more allied to the work of a physician, whilst a surgeon is trained to do serious surgery, not the kind a primary care doctor would do. So not sure even if you could be legally certified in both specialties you wouldn't loose your surgical skills if you spend a lot of time in primary care.
> Knowing what I know about the medical world in general I would advice against such a combination, a surgical residency is such a taxing one that you wouldn't have time to do anything else beside surgery, furthermore the required mental approach to do the work well as a surgeon or a primary care physician is also quite different.
The enforced scarcity in the market is what makes sure the money is always enough to prevent you from relaxing. Imagine doctors were as common as McDonald's managers. At the margin doctors would frequently be taking a slight cut in pay to do something fun like sports medicine. Now imagine there was only one doctor in the world. Even if he longed to relax and do pharmacy, ailing kings would offer him mountains of gold until he almost had no choice but to see them.
You're not wrong about the financial aspect but remember surgeons are completely incapable of being GPs. Surgery is its own residency (5 years I think?), and to be an actual GP you have to be either a family (3 years) or internal (4 years) medicine residency graduate. So in addition to the pay cut in absolute terms, you're taking 3-4 years off and making $60k/yr working 80+ hour weeks to do that other residency. So the opportunity cost alone is a few million even ignoring the pay cut.
Let's not pretend we're talking about the difference between $30k and $60k/yr here. We're talking about $400k vs. $800k. "I'll only make half a million dollars a year if I do this" does not set oneself up to be a sympathetic character.
I don’t think many doctors have much choice in the matter. The MBAization of hospital companies and practices bought up by private equity is strip mining the productive capacity of providers to juice profits. This is the MO of financial capitalism: find an established business that someone else built and extract maximum profits until the business collapses, then leave the rubble for others to clean up.