Comments on: Should It Really Take 14 Years to Become a Doctor?

By: Al Fin

Al Fin — Thu, 20 Mar 2014 16:09:39 +0000

Females got in on the affirmative action bandwagon just like blacks and “hispanics,” whatever they are. Females do not intrinsically have meaningfully lower IQ or conscientiousness, so affirmative action in female medical school admissions is not necessarily dangerous to patients on the surface level.

Barnabas points out that more females work shorter hours as physicians, and can leave the field for years or decades at a time to raise children. This can put a strain on those who keep working, in particular areas, but that problem is nothing compared to what Obamacare is bringing to the States.

Affirmative action (preferential treatment) in medical admissions for groups with lower average IQ and executive function, on the other hand, is potentially extremely hazardous to patients. I have personally had to clean up a number of messes caused by some of those. That problem is only going to get worse.

As for Dan Kurt’s sister, we should respect her experience. At the same time, remember Daniel Kahneman’s research on expertise and its limitations. If an expert says something is possible, it probably is. If an expert says something is impossible, then the thing is most likely still possible. Experts become boxed in by their experience at the same time that most of what they do is facilitated by their experience.

You don’t know what you don’t know. And besides, everything you think you know just ain’t so.

By: Barnabas

Barnabas — Thu, 20 Mar 2014 11:41:18 +0000

Many medical schools now graduate more female students than male. Experience tells us that many of those female doctors will choose to work less hours and see less patients than male doctors, they will take maternity leave, and some will marry and leave the field all together. That doesn’t bode well for supply of MDs.

By: Dan Kurt

Dan Kurt — Wed, 19 Mar 2014 18:06:21 +0000

Showed this to my sister, an internist, a retired medical school professor, a former director of an internal medicine residency program, a seventeen year member of a medical school admissions committee, and who also is retired from executive position in giant HMO who was directly concerned with quality control of the practice patterns of the HMO’s physicians and nurse practitioners.

Her response to the article: when it all is reduced to what is important in medical education there are three factors that limit the supply of good MDs: 1) IQ of candidates; 2) conscientiousness of candidates, and 3) length of hands on experience under supervision of candidates during training. Good, competent MDs will always be in short supply. Four years of college helps mature candidates as well as prove competence and conscientiousness if done in a hard science. Residencies should be incredibly hard in content and time spent with patients especially during the first two years and government edicts on how many hours a resident can work limit drastically the learning experience.

She scoffed at measures to shorten training time and at the same time increase quality. She also said that affirmative action has been counterproductive as to quality of output. She ended with a sarcastic remark that it is stupid to assume that those in medical education have ignored the problem of constrained supply of MDs. She repeated the three points listed above. She said that if one wanted excellent or even good MDs it takes TIME. Rare students may proceed faster but even those super bright need the hands on experience that can not be shortened. The experience in WW2 was that those fast tracked MDs got their experience as if from a fire hose under combat conditions with the wounded and sick from the battlefield, something not remotely possible in peacetime.

Dan Kurt

By: Zhai2Nan2

Zhai2Nan2 — Wed, 19 Mar 2014 05:38:59 +0000

Don’t forget that medical students are routinely forced to make life-or-death decisions while working under severe sleep deficit!

Take young people, allow them about four hours of sleep, and put them in charge of people’s health! Brilliant!

By: Al Fin

Al Fin — Tue, 18 Mar 2014 21:13:03 +0000

Agree with Barnabas that many, many cases must be seen and worked with to build expertise. Also, undergraduate training is not important enough to require 4 years.

But this will become a moot point, as more and more physicians will be replaced by PAs and NPs in the US. Not to mention other paramedical and non-medical occupations, gradually but inevitably infringing on the medical profession.

The economics of the “Obamacare — ageing population confluence” makes drastic changes in the profession unavoidable. Countries should not elect clownish ideologues as presidents, senators, and congressmen.

By: Toddy Cat

Toddy Cat — Tue, 18 Mar 2014 19:14:35 +0000

I know that we trained a lot of pretty good doctors on pretty short notice in WWII. Obviously, medicine is a lot more complicated these days, and, as Barnabas says, there’s no substitute for experience, but I’d be shocked if we couldn’t streamline the process by at least a couple of years.

By: Barnabas

Barnabas — Tue, 18 Mar 2014 18:25:29 +0000

In medical training there is really no substitute for seeing many many cases. Reading, good professors, more responsibility put on the resident all help but typically more years of training and more hours worked per week will result in a better doctor in the long run.

By: Barnabas

Barnabas — Tue, 18 Mar 2014 18:19:32 +0000

I went through all those years of training. All of it was useful and probably necessary with the exception of 4 years of useless undergraduate work and a year of research. Foreign medical grads often go straight into a 7 year medical school program. Those programs are typically subsidized so no huge debt load.