Because the supply of doctors is artificially constrained, and so there is incentive to chase HCOL areas where they can get paid or higher margin patients/procedures.
Fun examples -
My dentist has a waiting list of like 3-4 months to schedule a cleaning, so if you don't schedule the next one as you leave, you'll be out of luck later. HOWEVER, if you opt for any of the elective procedures (ortho/veneers/etc) they have vast availability and can take you next week. Funny that. And this is the third or fourth dentist we've used in the city, after dealing with both negligence and worse overselling elsewhere.
In my condo there's a dermatologist specialist that makes enough money to own two homes before 40 and operate his own practice in Manhattan & in the rich suburb of his second home. He always seems to be home by 6, and the last time I saw him, he was wheeling one of those coolspa coolsculpting machines around in his newest truck..
My previous GP was great but she only worked 2-3 days/week.
My GI is great but while its hard to get in to see him, he'll get you booked for a colonscopy/endoscopy ASAP at the clinic he also owns across town.. and the followup appointment to read you the results. All about that ROI and $/hr maximization.
> after dealing with both negligence and worse overselling elsewhere.
Glad that I’m not the only one who notices this drop off in practitioner quality and focus on upselling. The only thing they even discuss at dentist visits are the optional, expensive cosmetic treatments. When you make it clear you have no interest they end the conversation and leave.
It’s like they have all bought the same practice management course. Once you realize what they are doing it feels very sleezy.
> incentive to chase HCOL areas where they can get paid or higher margin patients/procedures.
I can't speak to dentistry, but physician income tends to be lower in HCOL areas because they tend to be oversaturated with physicians and thus fewer patients per physician.
It's paradoxical. It's the reverse trend of almost every other profession.
As for why for physicians to live and work in HCOL areas, it tends to be more about personal life. For example, if your spouse has a tech job, you may find yourself to the Bay Area even though your income potential as a physician there is much lower than it would be in the Central Valley. Or you might prefer the public schools in the HCOL areas. Or maybe you prefer to live in an HCOL area to be close to family. Or maybe you like to travel and prefer not to be a 5-hour drive from the nearest international airport.
