Demographics, Collapse of the Consumer Economy and the Fate of Healthcare

[LADoc00]

Im pondering more and more what healthcare will look like in the US and abroad in 20-50 years.

Right now physicians regardless of geography face massive governmental wage controls. UK, EU, Asia or US it doesnt matter. Even in the US system of fee for service, CMS tightly controls physician pay and has been consistently dropping payment as volumes go up due to the older demographic wave coming.

Now, fast forward to a massive coming drop in labor participation due to the collapsing fertility of US millennials which is estimated to be only 1.0 (Japan's population is crashing with a 1.3 replacement rate so this would be far more impactful). With the collapse of working age people, there will be corresponding collapse of consumer demand for goods. Older folks simply dont buy new iphones, eat out, go for drinks or spend on childcare like younger population do. This portion of the economy collapses. Housing demand? Less people, less housing needed. Housing collapses. Equity market collapses as well.

But services? Service demand would be massively increased by a shift to older demographics. And medicine is the key premium service in modern society. Would absolutely rabid demand for medical services cause healthcare to escape government price control?

I now predict medical services will escape government price controls based on one example: COVID testing. Cash COVID testing is the canary in the coal mine example of what happens when the demand for a medical service so immensely outstrips supply that populations are willing to pay outside normal insurance mechanisms for immediate care. Also look at traveling nurse pay which has inflated ALL nursing pay to literally now be exceeding primary care physician pay in my area (I'm not joking).

And the price of a PCR covid test at peak Omicron demand roughly equated 125 US dollars whether you got that test in Atlanta, Miami, Nairobi or Mexico City which is really fascinating.

Im now seeing the day in which healthcare providers everywhere will be able to say: I get out of bed for X compensation and anything offer less I will Netflix and chill today.

The pathology workforce will be able to hold until the very moment excess volumes collapse it. Healthcare is a dam that can and will break, COVID showed us this.

Then simply doing your job will be in such high demand you can refuse Medicare payments and take only cash. Imagine the bounty travelling nurses got during COVID but then 10x for every medical specialty. Mythological Shangri-la of labor leverage.

AI wont be a viable solution in the timeframe we are talking about. Maybe in 100 years it will but for decades it is possible junior pathologists who I had assumed were screwed by economic conditions that look worse everyday will actually find themselves the proverbial one eyed man in the land of blind and become kings.

I cant believe Im actually saying this but...maybe the future for younger docs is not as grim as I had imagined. This could be really wild over the next 20-30 years.

---

Members don't see this ad.

 

[wholeheartedly]

interesting theory. and surprising.

i kinda want to derail though and ask if you can share more about the internist who sold her startup for 17 billion…

 

[LADoc00]

interesting theory. and surprising.

i kinda want to derail though and ask if you can share more about the internist who sold her startup for 17 billion…

Teladoc to take over Livongo in $18.5B digital health deal

Telehealth giant Teladoc has moved to absorb the digital disease management company Livongo through a deal worth as much as $18.5 billion, reflecting the growing importance of virtual healthcare pl | The massive medtech deal reflects the growing importance of virtual healthcare platforms as the...

www.fiercebiotech.com

 

[wholeheartedly]

Teladoc to take over Livongo in $18.5B digital health deal

Telehealth giant Teladoc has moved to absorb the digital disease management company Livongo through a deal worth as much as $18.5 billion, reflecting the growing importance of virtual healthcare pl | The massive medtech deal reflects the growing importance of virtual healthcare platforms as the...

www.fiercebiotech.com

ah, to not be financially clueless and perpetually strapped for cash…

 

[LADoc00]

ah, to not be financially clueless and perpetually strapped for cash…

This is me from the heart: building wealth is identical to losing weight. Some people think they can exercise their way out of excess weight to just become "fit fat." Some docs try to out earn their way to financial success only to outspend their way to mediocrity.

In reality you have to create a daily calorie gap and a spending gap to accomplish both goals. Making a windfall billion+ dollar profit is far more luck than application of will. I have been part of several start ups that went nowhere so that shouldn't be a goal of yours.

In theory plainly simple and in reality gruelingly hard.

 

[Zarniwoop]

I'm not sure about this scenario...without more pessimism the predictions don't ring true to me.

 

[WEBB PINKERTON]

Did everyone quit their jobs and become travelers? I have never seen anything like it. I don't see how many health systems are going to survive paying the current traveler rates. Traveling histotechs, med techs, nurses, surgical techs and on and on. This is unsustainable. Our system is losing a ton of money in recent quarters.

 

[Alteran]

Did everyone quit their jobs and become travelers? I have never seen anything like it. I don't see how many health systems are going to survive paying the current traveler rates. Traveling histotechs, med techs, nurses, surgical techs and on and on. This is unsustainable. Our system is losing a ton of money in recent quarters.

What is not sustainable is nurses making more than physicians. There will shortly be zero incentive to become a primary care doc and probably some specialties if you could just do 4 years of school, no residency, no real liability, ability to work anywhere USA, and work a schedule to your liking for a boat load of money.

Soon, the only people going into primary care will be congenitally insane or irretrievably stupid - neither of which you would want treating you or your family members.

 

[Fpg1245]

What is not sustainable is nurses making more than physicians. There will shortly be zero incentive to become a primary care doc and probably some specialties if you could just do 4 years of school, no residency, no real liability, ability to work anywhere USA, and work a schedule to your liking for a boat load of money.

Soon, the only people going into primary care will be congenitally insane or irretrievably stupid - neither of which you would want treating you or your family members.

Or those who desperately want US citizenship. Plenty of GPs living in countries where electricity and clean water isn’t a guarantee willing to jump higher and higher just to get out of that

 

[Med Director New England]

I am envious of RNs. Traveling RNs at my shop were making > 100 bucks / hr, living at Hilton and having streak dinners as part of their per diem package for signing up to travel.

Lots of resentment from the normal RN staff making half that and no real short term negotiating power b/c of union contract. I am sure they will eventually get there cake too next negotiation.

 

[wholeheartedly]

I am envious of RNs. Traveling RNs at my shop were making > 100 bucks / hr, living at Hilton and having streak dinners as part of their per diem package for signing up to travel.

Lots of resentment from the normal RN staff making half that and no real short term negotiating power b/c of union contract. I am sure they will eventually get there cake too next negotiation.

and the quality of travel staff has often been less than ideal

 

[WEBB PINKERTON]

You never know what you will get with travelers. I've worked with some great ones and some that had to be escorted out on their last day.

Work environments are the most toxic I think I have ever seen due to the wage discrepancies. Seems like daily the normal techs complain to me about the large amount of money the travelers are making. I encourage them to start their own businesses to make some extra cash.

 

[Spikebd]

What is not sustainable is nurses making more than physicians. There will shortly be zero incentive to become a primary care doc and probably some specialties if you could just do 4 years of school, no residency, no real liability, ability to work anywhere USA, and work a schedule to your liking for a boat load of money.

Soon, the only people going into primary care will be congenitally insane or irretrievably stupid - neither of which you would want treating you or your family members.

Soon??

 

[Napoleon1801]

What is not sustainable is nurses making more than physicians. There will shortly be zero incentive to become a primary care doc and probably some specialties if you could just do 4 years of school, no residency, no real liability, ability to work anywhere USA, and work a schedule to your liking for a boat load of money.

Soon, the only people going into primary care will be congenitally insane or irretrievably stupid - neither of which you would want treating you or your family members.

A wave of international graduates have entered the chat.

 

[Iceman24]

Soon??

Guys, in my Universe PCPs (who I personally know) making more, than my co-residents in surgpath.

 

[B***F*****]

What is not sustainable is nurses making more than physicians. There will shortly be zero incentive to become a primary care doc and probably some specialties if you could just do 4 years of school, no residency, no real liability, ability to work anywhere USA, and work a schedule to your liking for a boat load of money.

Soon, the only people going into primary care will be congenitally insane or irretrievably stupid - neither of which you would want treating you or your family members.

I think this is already happening. Not a coincidence that more and more states are allowing NPs to deliver primary care independently. Clinics being manned solely by NPs are starting to emerge.

I know some seniors in my community who are frustrated with primary care physicians due to limited time spent with them, difficult access to care, inefficient/inadequate timely followup care, etc. I am seeing more articles that discuss Family Practice docs who are burned out, undercompensated, and quitting their jobs.

Should be interesting where things stand with primary care in 20-30 years.

 

[Alteran]

I think this is already happening. Not a coincidence that more and more states are allowing NPs to deliver primary care independently. Clinics being manned solely by NPs are starting to emerge.

I know some seniors in my community who are frustrated with primary care physicians due to limited time spent with them, difficult access to care, inefficient/inadequate timely followup care, etc. I am seeing more articles that discuss Family Practice docs who are burned out, undercompensated, and quitting their jobs.

Should be interesting where things stand with primary care in 20-30 years.

As a physician I can't get into see a primary care physician in a timely manner and NP and PA appointments are also getting to be more difficult to schedule. And professional curtesy only goes so far these days - my colleague tried to get one of the primary care docs to see his wife and was told by the family doc to schedule with their PA, who is "very good". Ironically this very same physician is complaining that mid-levels are replacing their practice in the hospital and aren't up to snuff. Very ironic indeed.

Sadly, my personal primary care reality these days is mostly my license, NPI number, and UpToDate.