A physician is held responsible for a patient's outcome. But the patient cannot choose his physician. The patient must select from a limited list chosen by the health plan. The physician does not have adequate time to be with the patient. Providers must follow benchmark standards, viz., 15 minutes for an established patient. Failure to achieve the standards can produce a scorecard that could take away hospital privileges. The regulatory burden takes away even more patient time from a physician. Before electronic prescribing, it required less than one minute to write an Rx and give it to the patient. Now (unpublished data) it takes roughly ten minutes to get through all the screens, security protocols, and data input to use e-prescribing. Keep in mind that the efficient physician has only 15 minutes total with the patient, and the doctor still must fill out insurance forms and HIPAA compliance directives! The physician cannot choose the best drug for his patient — the pharmacy benefits manager chooses. During COVID, Washington decided medications for all Americans, one-size-fits-all. Physicians who tried to use their best judgment on a specific patient rather than follow Fauci edicts were stopped. Some were subject to disciplinary action, even firing. The doctor does not choose the patient's intervention. The health plan and/or insurer decides what procedure will be performed, where, who does it, when, and even if it is done. The patient or consumer does not pay the doctor or seller — the third party does. Washington dictates "allowable reimbursement" and then repeatedly reduces the amount.
All of the above results in an M.D. shortage that, taken to its furthest-most outcome, could and probably has lead to death by waiting and regulations, like a human "queue." Hopefully, no Americans die waiting in line for technically possible care that does not arrive in time to save them. Those statistics are hard to track. Hopefully, enough American continue to become doctors not because of the paycheck, but because of the belief in the Hippocratic Oaths and the joy of helping others.