Technique

You may think I was exaggerating the problem and, by and large, the medical circle remains highly hierarchical.

That may be true. But my impression is that system of hierarchy is now sustained largely by administrative and resource considerations rather than clinical experience or capability, and the field of clinical medicine is moving towards an M-shape society at full gear.

*******************
How about mastering some exotic treatment technique? Wouldn't it be an edge or, in JW's term, give a good premium?

Very true. I have actually discussed this point some time ago with VW, (see http://ccszeto.blogspot.hk/2010/04/technology.html) and will not repeat my points here. My worry is, if you take a wider perspective and consider the medical profession as a whole (rather than the income of a few specific doctors), acquiring exceptional treatment skill would not protect our premium - because the treatment of most of our patients does not depend on a legendary dexterity. For that few who have acquired some glamorous handicraft, yes, they would certainly be very well paid. But, for the others, they treat their patients with simple basic remedies. The diagnosis of their patients is governed by technology. They do not have to make treatment decisions because that's dictated by some existing guidelines. The real premium that they add is, therefore, some human touch...

...like what clergy offer to their followers.