First, there’s inequality of access to medical care. People with more money can and do pay more, which gives them better access to cosmetic procedures while diverting medical resources from procedures that do more to improve actual health outcomes for people in greater medical need.

This cosmetic channeling has a secondary effect within the medical profession, which is where this article comes in. All other things being equal, doctors would rather go into these named specialties: greater demand and a reasonably restricted supply lead to higher incomes for doctors in those fields.

But third, unlike some (e.g. surgical) specialties with high incomes that require exceedingly long hours, the cosmetic specialties also have a reputation as “lifestyle” fields. The procedures are primarily outpatient, comparatively short, and are rarely urgent. That means doctors performing them have relatively regular hours and less need to be available to respond to emergencies 24/7. That means they often attract doctors trying to get off the treadmill; ones who want to opt out of a system of constant competition and increasing work pressures, who want to have a balance between work and family.

The irony, of course, is that since the cosmetic specialties are so attractive for physicians, the competition to get into them becomes especially severe. Thus, to get a job in medicine with a balanced lifestyle often requires living as unbalanced a lifestyle as you can stand while in medical school (or really, in medical school. college, and high school) so that you can get into that hyper-selective residency.

It’s a bit like the tenure system.

Of course, there is only a meager barrier (bar exams which sometimes have 90% pass rates) to entry in law, and apart from patent, no real barriers to moving into specialties.

The AMA and state medical associations have been much more successful than law at cartelizing and limiting supply.

Just because profit motives might work well in a competitive market does not necessarily mean they improve a market that’s at an inferior equilibrium.

My ENT did a lot of good clearing my breathing passages and dermatologists treat skin cancer and many other genuinely harmful things.

So we need to know how many of these residents are choosing these fields to do “cosmetic things” and how many go in for the fact that they can do medical good and rarely get paged at 3 am.

As if the two were mutually exclusive.

Which is the preferable paradigm if you’re concerned about having an adequate supply of physicians: (a) where the best and the brightest flock to medical school because of “profit opportunities,” or (b) where the best and the brightest flock to law school for the same reason?