Sunday, November 9, 2008


A long time ago in a distant past my parents told me that if I became a physician I would always have work to do. They also told me I would probably never be a rich man.  I did not pursue medicine as a 'job'  My very worth is embedded in being a physician and surgeon... Like most physicians I wonder what I could do if I    could no longer care for patients. 

At times while it is exhausting and saddled with many 'duties' such as becoming a secretary filling out forms, entering data and patient histories into an electronic health record.  While most clerical personell earn about 10-15 dollars/ hour my pay grade is far above that figure.  For me it is a good deal. The downside for providers is less ability to see an increasing number of patients..For payors and medicare it is  poor economics to pay the physician  to do secretarial work.  As medicare and payors increase the bureaucracy and regulatory requirements there reaches a rate of diminishing return.

An analogy to this is what Hubbert calls "Peak  Oil".  named after Dr. M. King Hubbert, Geophysicist.


This eponym describes the phenomenon where it takes more energy to pump oil out of the earth than  what it yields in energy.  This is due to the necessity of pumping water into the well to force crude oil to the surface, drilling deeper, and drilling further offshore and in remote locations (cost of transportation)

Add to that, the political, ecologic, and economic aspects of legislative hurdles, environmental protection, and building infrastructure.

We are now entering the era of "Peak Medicine".

Dr. Phil Roth, unknown to me has already described this phenomenon in his blog, Peak Oil Medicine.

Peak Oil is well described in this video.

I think there are many parallels between Peak Oil and what is occuring in medicine and health care.

The emphasis has been to control costs by ratcheting down reimbursements, increasing bureaucracy and regulation, while at the same time ,demand is increasing due to aging, and increasing;y expensive  technology.


Health care employment is one area of the economy that continues to enjoy steady growth. Health finance experts tell us that medical care is increasingly a larger percent of the GDP. Is this because the remainder of the GDP is contracting due to outsourcing, an automobile industry in shambles, exporting production of telecommunications, electronics, and NAFTA.  Are the statistics skewed?


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