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Information for people contemplating
a career in emergency medicine and
other medical specialties

By Kevin Pezzi, MD


Doctor competition: Medical outsourcing and fringe practitioners

by , MD

If you become a doctor, you will compete with other doctors for patients. Most of your competitors will be physicians in your area, but you will also compete with doctors in foreign countries such as Mexico and India. This medical outsourcing trend initially affected radiologists, pathologists, and plastic surgeons, but offshore surgical specialists are now siphoning patients from American doctors. For patients and their insurers, the impetus for outsourcing is simple: foreign doctors and hospitals typically charge much less than their counterparts in the United States. If you specialize in emergency medicine, you are relatively immune to this problem because patients with a heart attack, stroke, or gunshot wound cannot travel to a foreign country for medical care just to save money.

Now that I am discussing medical competition, I will also mention other practitioners who skirt the laws governing the regulated health professions. These fringe practitioners have discovered ways to shield themselves from the control that states normally exert over anyone from manicurists to medical doctors. Instead of practicing one of the regulated health professions, they present themselves to the public as a credible practitioner of some goofy therapy. It seems like every time I read the local newspaper, I see an ad by someone offering some scientifically ludicrous healthcare.

The latest quack I spotted billed herself as a “foot zone therapist.” Yes, it is just as preposterous as you think it is. I researched this on the Internet and found the sage who apparently taught my local charlatan, and others of her ilk around the country. If you visit her web site, you will likely leave it thinking that she is impossibly gullible and an inept proofreader in addition to either being stupid or unprincipled enough to dupe unsophisticated people into being treated by her. Would anyone with an ounce of common sense take his dog to a foot zone therapist? No. Then why take your spouse or child to one? I just checked to verify that there is no Journal of Foot Zone Therapy (unsurprisingly!), so I decided to publish it:

Doctors compete with quacks for patients

I've also seen ads by people who think that being a “life coach” is a clever way to sidestep the educational requirements for becoming a licensed psychologist or therapist. I have yet to see an ad for someone purporting to be a life coach which states that he or she is not a licensed psychologist, therapist, or physician, and is therefore not trained to handle the countless problems that those licensed practitioners are trained for. If I did not know better, the ads I saw might easily suggest that I would give up nothing by seeing a life coach instead of a psychologist, therapist, or physician.

These fringe practitioners don't compete on the basis of price, because many of them charge the same or more than mainstream practitioners. In general, fringe practitioners prey upon people who are either unsophisticated or frustrated by the care delivered by mainstream practitioners. This frustration has three primary roots:

Incidentally, if you want a better treatment for a problem than your physician can suggest, you can consult me to see if there is a helpful adjunctive therapy. You could also read one of my books, such as The Science of Sex, Fascinating Health Secrets, or my weight loss book. Whether you want more energy, a sharper mind, a hotter body, a larger penis (yes, really!), or more sexual pleasure, I have thousands of ways to make your life better. Unlike the fringe practitioners, I know what mainstream doctors know, but I also know countless other things, too.

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