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Paradox: Emergency Medicine Residents are having a hard time finding jobs when they graduate. Never were they needed more, nor less wanted.


The Washington Post has a new article, dated January 4, 2021, titled “Young ER doctors risk their lives on the pandemic’s front lines. But they struggle to find jobs.” It is about emergency medicine residents and their job prospects during the pandemic.

The gist of the article is that ER doctors are having a hard time finding jobs, at a time when you would think they are in great demand. The root cause of this paradox is that the doctors are employed by outside agencies, not the hospitals nor the federal government. The employers are experiencing lower profits due to a reduced number of paying patients– despite the greatly increased proportion of patients and the record numbers with COVID-19 and respiratory distress– and therefore are reducing hours and number of employees.

This paradox is due to the perverse economics of medicine in this country. Medicine is not supported by the demand of patients for necessary services– instead it is paid for by people who demand services for which they are well able to pay (either by cash or through insurance.) People who demand services are not the same as those who need services to save their lives or relieve their suffering. Instead, they are the people who have money and want medical services that make them more satisfied with their lives.

The fact that people suffer and need medical help for survival does not support medicine in this country. Insurance companies and investment groups support medicine. This situation is different from that in most other countries, in which government officers organize and pay for medical practice based on their assessments of what services are needed by the most people for the good of the general populace.

In this pandemic, the greatest number of sick people and the greatest suffering is being experienced by disadvantaged people with the fewest resources. Money and insurance is concentrated among those least affected by the virus. Thus there is a basic imbalance between resources and need.

Government supported medicine, at least theoretically, is based upon the strategy that overall life expectancy is the primary goal. The development and provision of vaccines is the ultimate expression of this strategy. Capital-supported medicine instead pays for what the people with the most money demand, regardless of their actual needs. At the top, the “warp-speed” vaccine program serves this strategy, but the abdication of responsibility by the federal government in favor of states contradicts it.

Thus the paradoxical situation in the US: emergency room doctors are not in demand by the organizations that pay for the provision of medical care. Vaccines that have been distributed to states are not being administered because the states do not have sufficient resources. This is why life expectancy in the US lags behind that in most other well-developed nations.

(photo by pedro wroclaw via

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