COPN Monopolies Depress Income for Virginia Healthcare Professionals Without Lowering Costs

The Business of Healthcare

by James C. Sherlock

Virginia is among the richest states in the country.  

We are ranked ninth among states with the highest median household income in the 2019 (latest) Census Bureau American Community Survey. Virginia median household income was $74,222 and the U.S. as a whole was $62,843.

But Virginia has a Certificate of Public Need (COPN) law among the most stifling of competition in the nation. The law itself and the regional monopolies created combine to suppress both opportunity and income for healthcare professionals.  

The monopolies don’t just control the healthcare delivery market, they also control the labor market.  

This essay will illustrate the effects of COPN and COPN-generated monopolies in depressing wages, and thus on the willingness of medical professionals to practice here. And then show you those lower wages don’t save consumers a dime.

Overview of the environment for physicians. Virginia is ranked by WalletHub, which considered 19 key metrics, as 37th overall among the best states to practice medicine in 2021.

The American Academy of Medical Colleges for a 2018 report calculated

“the number and percentage of physicians who completed medical residency training from 2008 through 2017, were not currently active in any GME program, and were practicing physicians in or out of the state of residency training”.  

The results for over 130,000 physicians showed that over 54% of them were practicing in the state of their residency.  That same report showed that Virginia retained 47.7%. Only 14 states and territories (of 52) ranked lower.  

California, a non-COPN state, led at 77.7% retention. The three largest states without COPN laws — California, Texas and Florida — are among the seven states with over 60% retention.

Hospital wages in Virginia compared to other states – 2018 data. So let’s look at the mean annual wages by occupation and drill down to those wages for medical personnel employed by hospitals in Virginia to see the effects of regional monopolies on income, and see why some of those residents and other medical professionals seek greener pastures.

I will list hospital Mean Annual Wages by occupation based on a 2019 assessment by the Bureau of Labor Statistics. It contains a massive database of every state, every type of employer and every type of employee for every employer. (If you go to May 2019 and click on Sector 62, you will get the baseline spreadsheet from which I derived the following statistics for hospital employers in each state.)

Remember, the statewide mean annual wages calculated for the Commonwealth include the both the numbers and the wages of the very highly paid healthcare workers in Northern Virginia.

There are 75,230 hospital employees in Virginia classified under the major class Healthcare Practitioners and Technical Occupations. The mean annual wages of that class of workers in Virginia ranked 30th among the states (50 states, D.C. and Puerto Rico). Virginia’s wages for Healthcare support occupations ranked 34th.  

Virginia hospitals ranked 49th among states for the wages paid to the members of the subclass Physicians, All Other; and Ophthalmologists, Except Pediatric,

For psychiatrist employees, Virginia hospitals ranked 32nd. Registered nurses, 27th. Licensed Practical and Licensed Vocational Nurses – 31st.

Physician income overall regardless of employer – 2020. I will offer a couple of examples of the dual effects of the low hospital wages and COPN restrictions on the incomes of physicians statewide regardless of employer.

The hospitals’ low wages and the inability of surgeons to open their own ambulatory surgical centers because of COPN combined to drive down the median wage for a surgeon in Virginia in 2020 to $228,310 compared to a nationwide median of $251,650. 

Anesthesiologists in Virginia earned a median $253,150; nationwide the figure was $271,440.

Note:  Breaking news:   Virginia ranks 38th in Physician Assistant salaries.

Healthcare Spending. So, you say, tough for the healthcare professionals, and maybe we don’t have as many as we need, but at least Virginians are getting a break on healthcare costs, right? 


The World Population Review has published a study of per-capita health care costs by state 2021.

“Health care spending per capita in the data provided in this article includes spending for all privately and publicly funded personal health care services and products, including hospital care, physician services, nursing home care, and prescription drugs.”

Top ten:

  • Maine ($10,559)
  • Colorado ($10,254)
  • Texas ($10,190)
  • California ($9,859)
  • New York ($9,851)
  • New Jersey ($9,778)
  • Nebraska ($9,589)
  • Oregon ($9,551)
  • Kentucky ($9,531)
  • Virginia ($9,462)

The national average is $7,893.  

Summary. Those are real data. Virginia is among the ten richest states in the union with among the ten highest per capita healthcare costs.  

Yet healthcare professionals who work for the COPN-granted and protected regional monopoly healthcare systems are significantly underpaid compared to their peers in other states. And many physicians don’t have the opportunity to work for themselves because the COPN system, controlled by the monopolies, won’t let them open their own businesses. 

That same system denies them the medical technology they need to practice their professions, forcing them to send patients to the monopolies for testing and imagery and use monopoly facilities for procedures.

If you think the independent insurers benefit from COPN, how would you like to enter price negotiations with monopolies? I have watched insurers work for years to get it repealed.

Then where does all the money go? The monopolies. And from them to the politicians.  

That is how COPN works. Enjoy.

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26 responses to “COPN Monopolies Depress Income for Virginia Healthcare Professionals Without Lowering Costs”

  1. John Martin Avatar
    John Martin

    same with pay for teachers. Virginia is anti-worker. It is disgusting

    1. James C. Sherlock Avatar
      James C. Sherlock

      Except these monopolies are all self declared “not-for-profit public charities”. The Virginia government just has both feet on the scales to protect them while the CEO of Sentara takes home $6 million a year.

      1. DJRippert Avatar

        The CEO of Sentara is worth 24 surgeons I guess. But, of course, that doesn’t bother the Virginia state government apologists on this board. Why? Because Sentara, like Dominion, is a quasi-government operation with special privileges and protections provided by the ruling class. That makes it semi-socialist which is what the liberals like to see.

        In 2019 Sentara’s net income nearly doubled. In the first half of 2020 it rose 81% from the same period in the prior year. They should be posting full year 2020 numbers in the very near future. We’ll see how much more profitable this poor non-profit has become.

  2. Dick Hall-Sizemore Avatar
    Dick Hall-Sizemore

    It is hard to have sympathy for folks who make $225,000 to $250,000 per year.

    1. vicnicholls Avatar

      Who have middle sized mortgages after they get out of school. I know a doctors’ son in law with $300K in loans, why don’t you mention that? They’ll be paying that off for at least 10 years, if not more. Now add a mortgage, car and kids on that, makes a big difference. Look at the whole picture – and not just the fact that a lot of that money also goes to taxes and insurance.

      1. Dick Hall-Sizemore Avatar
        Dick Hall-Sizemore

        My daughter is a doctor. I know the whole picture.

        1. vicnicholls Avatar

          You aren’t acting like it makes a difference, when it does. Taking down their salaries takes down the money they can put in the economy. That’s what we need: consumer spending and on things other than the basics.

          1. Nancy Naive Avatar
            Nancy Naive

            Student loans are part of the economy.

          2. WayneS Avatar

            Requiring me and every other taxpayer to pay-off his student loans for him because you and people like you have “forgiven” them takes down MY salary and takes down the money I can put in the economy. Please explain why you think your friend’s son-in -law has a stronger claim on my money than I do.

          3. vicnicholls Avatar

            Where do you get that I am asking for forgiveness for their loans? How about don’t tax people to the extent that it is a drag on the economy. Just because someone makes more than $250K a year doesn’t mean that they are so wealthy that you have to tax them to the point of no return. Maybe you should try getting the Dems to stop spending for those who aren’t inputting into society but becoming more of a burden on it that it requires more of our dollars to pay for them. WayneS go back and look at Dicks’ comment. It says people making the $225k or so a year don’t merit anything. Since when does someone with a $300K loan on med school, $300K loan on a house (which is regular here), on a tax rate of > 40% already, not deserve a break? You have no idea how much people worked hard for that $225K. If you don’t think people have a stronger claim on your money than you do, explain what cosmic deity appointed you and Dick to say YOU have a stronger claim on THEIR money than they do?!

      2. Nancy Naive Avatar
        Nancy Naive

        $20,000/month and they can’t afford their $2,500 student loan payment? Well, perhaps the his and hers Lamborghinis was a stretch?

      3. WayneS Avatar

        You’re barking up the wrong tree if you think you can get me to sympathize with such a person. If he borrowed the money then it is his responsibility to pay it back.

        Adding a mortgage a car and kids are CHOICES. If he can’t afford a 6,500 SF house and a 7-series BMW right now then perhaps he should drive a Honda and live in a 2,500 SF house while he pays back the money he OWES.

        PS – I took out student loans to attend college and I paid back 100% of them, on time, so do not accuse me of not seeing the whole picture. I know what it’s like to live without things I want because of other obligations.

        1. vicnicholls Avatar

          I know of those who don’t get the large homes and cars you are talking about, especially in medical marriages, in first generation doctors’ lives. They do live in apartments or the like until settled and yes have paid down on the mortgage. There’s a big difference between an extra house payment and having to have a car or two that has to be reliable because you are on call and must be there (contract obligations), and what you might have gone into.

    2. Nancy Naive Avatar
      Nancy Naive

      Especially when most of it is QD and LTCG.

    3. DJRippert Avatar

      Obviously not the point. The point is that Virginians pay a high cost of health care while the physicians employed by the providers earn less than the national average. Why? Because …

      “Then where does all the money go? The monopolies. And from them to the politicians.”

      That’s the point.

    4. James C. Sherlock Avatar
      James C. Sherlock

      It is if you want to have enough of them to treat Virginia patients.

  3. Nancy Naive Avatar
    Nancy Naive

    Wow California led with Resident Physician retention at 77% while Virginia sucked at 47%…

    Hard to imagine why persons most likely to be in the top 1% of income would want to live in a State with a AAA rating on quality of life.

    1. Dick Hall-Sizemore Avatar
      Dick Hall-Sizemore

      Ironic that many commenters on this blog like to talk about how horrible a place California is and how the rich are leaving and here Mr. Sherlock is, touting California’s retention rate of medical residents.

      1. James C. Sherlock Avatar
        James C. Sherlock

        I try to report the facts as I find them, Dick.

        I lived in California for eight years in the 70’s and loved it then.

        Still visit occasionally, but we like to start at Pebble Beach and drive down Big Sur to the beach towns at the south end and then to the hills overlooking the ocean north of LA. It is among the world’s most glorious topography. But two-lane U.S. 1 is a constant risk of closure because parts of it tend to collapse into the ocean. I also don’t recommend trying it south to north. The backups getting into Carmel are legendary.

        That hardly qualifies me to describe the “new” California. So I don’t.

        The retention of med school graduates is a fact. I find no need to speculate as to why, other than lifestyle (we used to call the cost of living there the sunshine tax) – the beauty of the coastal regions and for example, the access to skiing and ocean swimming on the same day in San Diego, where I spent five years.

      2. Nancy Naive Avatar
        Nancy Naive

        If all you’ve ever seen of California is LA, you might come away wondering why anyone would live there. A week driving the PCH with a return by an inland mountain route would leave most Virginians stunned speechless.

        There are only 3 real cities in the US, New York, New Orleans, and San Francisco. All the rest are just Cleveland in varying sizes.

        Great adage that is so true. One should live in two cities at sometime in their lives. Live in New York City, but not so long as to make you calloused, and in San Francisco (San Diego, my preference), but not so long as to make you soft.

  4. Nancy Naive Avatar
    Nancy Naive

    Correlation is not causality.

  5. Nancy Naive Avatar
    Nancy Naive

    Here Captain, have some supporting documentation.

    Like you they conclude that the cost of CON laws exceeds the benefit, but unlike you they researched it and also acknowledge that more extensive research is necessary.

    Make sure when you cherry pick their analysis to support your theories that you also state their conclusions.

    1. James C. Sherlock Avatar
      James C. Sherlock

      First, my conclusions were my own backed up with hard data linked in the piece, mostly from Census Department and Bureau of Labor Statistics data.

      Second, the word “Virginia” does not appear in the study you reference, nor are any Virginia data used in their footnoted assessments. In others words, Virginia’s COPN law was not a subject of their work.

      Third, consider the joint statement to the Virginia General Assembly by the Obama DOJ and FTC on Virginia’s COPN law.

      But then, you try never let your comments or your references have any relevance to the subject at hand.

      Otherwise, good comment.

      1. Nancy Naive Avatar
        Nancy Naive

        Uh yep.

  6. […] way they want to with the facilities and equipment they need and that in turn is depressing their incomes.  Reversing Robin Hood, COPN takes from the physicians and gives to the […]

  7. […] way they want to with the facilities and equipment they need and that in turn is depressing their incomes. Reversing Robin Hood, COPN takes from the physicians and gives to the […]

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