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Culture War Roundup for the week of May 20, 2024

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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?

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.

Alright you have to pause and ask yourself "do I know anything about what I'm talking about" here. Even most doctor haters are well aware of at least some parts of how bad medical education is.

Yes undergraduate it's fundamentally more or less the same classes, with the caveat that you have to get pretty much only get As (average GPA is somewhere in the 3.7 to 3.8 range) and the fact that you have a ton of demands on your time outside of class work (shadowing, volunteering, MCAT prep).

It's less common these days but most residents will violate duty hour restrictions at some point, even in cushy specialties. Regularly to every week in rougher ones.

What are duty hour restrictions?

Don't work more than 80 hours in a week, 28 hours in a row, and get four days off in a month. The term "resident" literally comes from residing in the hospital.

No other job works that hard.

You also don't get to pick where you go to residency. If you quit or get fired your career in medicine is over. You spend tens of thousands of dollars taking multi-day exams.

You know any other jobs where you'll be sewing up a corpse on hour 36 of being at work and awake while your attending shouts at you "hurry up you useless fuckhead he's dead already anyway, we've got to move on" until you finish?

Doctors in training of no time, money, or energy.

Yes undergraduate it's fundamentally more or less the same classes, with the caveat that you have to get pretty much only get As (average GPA is somewhere in the 3.7 to 3.8 range)

The average GPA at a school like Brown is about 3.8. This is hardly exclusive tier. It reminds me of Mr. Evil (one milllllion dollars).

you have a ton of demands on your time outside of class work (shadowing, volunteering, MCAT prep).

Many students have, like, actual jobs outside of classes. And grad schools have grad school admissions test (LSAT, GRE, MBA, etc.) - test prep is hardly unique to medicine.

You know any other jobs where you'll be sewing up a corpse on hour 36 of being at work and awake while your attending shouts at you "hurry up you useless fuckhead he's dead already anyway, we've got to move on" until you finish?

Bullies exist in all professions. If someone said that to me in a professional environment, I'd look him in the eye and calmly explain why it was inappropriate, and why he couldn't treat me that way going forward. And then he wouldn't treat me that way going forward.