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PaperclipPerfector  6mo ago (text post)   25597 thread views

Culture War Roundup for the week of May 20, 2024

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Medical exams are hard (and not like most exams you see), someone who was in the top 5% of their class at a respectable undergrad institution can spend two years studying for Step 1 and still barely pass it.

In 2021, before USMLE Step 1 moved to pass-fail, 98% of 1st-time takers from MD programs passed per here. By comparison, the first-time pass rate for the California bar exam (to practice law in the state) is roughly 45% per here.

I mean what I say quite literally, you can be a top of your class science student at a reasonably good institution, study for two years specifically for the test (including a multi-month "dedicated" period where your only job is to study for this test), spend thousands of dollars on incredibly well designed test prep material and that still might not be enough.* Keep in mind that this is after multiple filtration points designed to weed out people who aren't good at hard work and studying.

The bar is designed to be acceptable to fail multiple times, law school is not set up exclusively around passing the bar, and while admissions can be rigorous at top institutions it's got nothing on the adderall snorting madness which is med school.

*and while the fail rate is low, failing it fucks you over incredibly, and getting an average score looks you out of entire specialities and regions for residency.

I mean what I say quite literally, you can be a top of your class science student at a reasonably good institution, study for two years specifically for the test (including a multi-month "dedicated" period where your only job is to study for this test), spend thousands of dollars on incredibly well designed test prep material and that still might not be enough.

That might qualifier is doing an awful lot of work here. The same student might also get crushed by a falling piano on the way to the test center. The point of statistics is to evaluate likelihoods, not possibilities.

and while the [USMLE Step 1] fail rate is low, failing it fucks you over incredibly

This seems hysterical (marked by hysteria). The same data set showed that re-takers had an almost 70% chance of passing. Substantially anyone who manages to drag himself across the finish line will be able to make $200k/year as a GP in a high status profession (more if they're willing to live outside a major city, where the money will go further). I don't know in what universe this qualifies as being fucked over incredibly. Even the small minority of medical students who can't gain licensure to practice will still have fine life outcomes, by and large.

If you fail Step 1 (well back in the day, the new situation is evolving quickly) you are relegated to Family Medicine in a poor location or a malignant Internal Medicine program unless you have something very very strong going for you. The vast majority of students don't want family medicine, and they don't want to be in Iowa, and they don't anything to do with those IM programs.

If you went to medical school to be a surgeon (or a dermatologist, or an oncologist, or to live with your girlfriend in LA) then failing the exam can be pretty catastrophic. Some do drop out after failing "because the dream is dead." Not that I necessarily agree with that decision.

I think if you'd framed it in these terms originally, then I wouldn't have objected.

I agree. Failing your medical licensing exam (as 2% of test takers do) limits your ability to earn $1M/year as an LA plastic surgeon.

Again, any specialty other than (IM/FM, and historically psych) off the table.

Programs that aren't going to violate duty hours (work more than 80 hours a week) off the table.

Good locations (well, other than NYC shitty IM programs, which have high suicide rates) off the table.

Great outcomes are gone yes, as are the good and okay.

And many people go into medicine with sharp expectations as to what they want to do again, "all my life I've wanted to be a surgeon...."

Great outcomes are gone yes, as are the good and okay.

Just to be clear, is your position that a life making $200k/year practicing internal medicine in a small town 50 miles outside Philadelphia is not an okay outcome? Why not?

If you sacrificed your college experience and didn't have any fun of any kind in your 20s and took on a half a million dollars in debt in order to become a surgeon then yes, obviously.

As I said in my other comment we don't need to speculate about this. Many medical trainees will refuse to practice in that environment and will drop out or just choose to make less money practicing in a bigger city with a worse patient population or job.

Granted your specific example isn't a good one because being in mid-Atlantic is attractive and there are a few nice healthcare providers in the area. Change it to anywhere in Indiana.

If you sacrificed your college experience and didn't have any fun of any kind in your 20s and took on a half a million dollars in debt in order to become a surgeon then yes, obviously.

I guess I just don't understand this mentality. I don't see why you can't have fun in your 20s and also become a doctor. You seem to maintain that American medical training is uniquely hard and awful, and I'm just not convinced. I appreciate that many pre-meds think their training is hard, but I took orgo and biochem in college, and I can tell you, it wasn't any harder than the classes for my math major.

I also think there's some distortion in the choice of comparison group. If anything, it sounds like a lot more fun to spend your 20s in medical school and residency than to spend this period in a cubical farm. Sure, it's probably more fun to spend your 20s relaxing on a beach somewhere in Mexico than either of these options, but this plan faces its own challenges.

Separately, this $500k debt figure seems like misdirection. It seems manageable for a normal doctor. More manageable, certainly, than a $100k debt figure for an MFA.

Many medical trainees will refuse to practice in that environment and will drop out or just choose to make less money practicing in a bigger city with a worse patient population or job.

I'm extremely skeptical that medical trainees leave the profession at rates higher than any other profession. And this complaint that doctors are forced to make financial tradeoffs in choosing where to practice seems bizarrely out-of-touch to me - who among us doesn't face financial considerations in choosing where to live?

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