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Time to kill some of my opsec. I have personally argued with Deb Koss at a conference in D.C. telling her to cut this shit out.
I won't say much about it but she (and others like her are) exactly as you'd expect.
It's not as worrying in the disciplines like Psych (hers), ID, and Peds where people are overwhelmingly left leaning but these advocacy people are still DEMANDING trainees participate in advocacy and politics (and it's always one specific kind of advocacy). Trainees who can't say no without negatively impacting their careers. It's gross and deeply unethical.
Furthermore these idiots seem fundamentally incapable of understanding how damaging this is to the long term health of the profession.
It's no different than any woke ideological capture but with a very damaging set up levers (ensuring incoming medical students are very left leaning, brainwashing them during vulnerable periods like residency, and mandating leftist political advocacy as part of educational curricula).
I hate it.
These pediatricians committing themselves to lefty advocacy understand that right wingers are the ones having babies and you do need to get parents to trust you to do your job?
Like normiecons used to never skip shots. Now my coworkers who only go to church when they're on call(widely believed that you can't be compelled to leave church early to go to work. I have no idea as to the accuracy of that belief per employment law but managers mostly respect it.) discuss it openly. The deep red tribe loss of trust in institutions is mostly from actions of those institutions that they can point to and it's driving radicalism and there is no outreach to these people to try to rebuild that trust. Just spinning bullshit to call us evil.
They expect, correctly, that trust is conferred by the degree. They expect to convert the right-wingers...or at least the children.
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Yup, when I started working the only anti-vaxxers were hippies, woo-moms, and low income blacks.* Now it is a mix of everybody.
Also the left hates doctors because they hate people who make money, now the right also hates us for lockdowns and political advocacy. Both sides are fucking doctors but it's impossible to have a discussion about this with most of my colleagues.
*Well and nurses are anti flu shot for reasons I have never really been able to get.
It's not complicated; the flu shot makes you sick and by the CDCs numbers (which I suspect are rather optimistic), is pretty poor at reducing the chances of getting the flu.
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Knowing a few nurses, there's a bunch of them that are anti-flu shot because it's an annual PITA with Christmas-level season creep and doesn't really have the efficacy to justify its hype.
I get the "I don't want to put in the effort to go get it" but I've seen them like actively hide from the roving flu shot team like children hiding under a desk. Sit still for 15 seconds and move on with your life for fucks sake.
I think it's the principle of it being an incredibly annoying theatrical production for a vaccine with so-so efficacy. Not saying nurses shouldn't get flu shots, obviously, but relentless overhyping gets irritating fast.
Most people get mild side effects if any and while the efficacy is low people in healthcare get the treat of watching people actually die from the flu (which is why most doctors seem to not give a shit).
Nurses are crazy though so....sigh.
Again, not saying it’s a rational decision as much as a bunch of women who feel put-upon(rationally or not) and overrate their own importance throwing a fit about a predictable annual annoyance.
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If it's any consolation, I'm sure right-leaning students handle this the way we always have: go through the motions, then make fun of it all behind their backs when we're hanging out on our own time.
But it is worrying. What separated us from the Soviets during the Cold War was you didn't have to be an activist to do things like medicine.
I highly recommend reading “Everything Was Forever, Until It Was No More: The Last Soviet Generation” by Alexey Yurchak. You can fully ignore Yurchak’s own postmodernist ranting, but at the same time he collected a fascinating account of what it was like to live in post WWII Soviet Union. In short, it’s a myth that you had to be an activist or even a believer. Regular people despised both true believers and open critics of Soviet Union. This sentiment is even more true for the STEM professions.
It's not a myth, it's a simplification, and it's still accurate when contrasted with the pre-awokening West. Yeah, they'd let you work as a lower rank doctor / engineer / whatever, but that doesn't mean they'd let you advance beyond a certain level without enough displays of party loyalty, or that the lack thereof wouldn't get you shitcanned even if you were incredibly talented.
The important part is "displays of party loyalty". You did not want "true believers" next to you, when some high ranking general or other party member wanted something not exactly communist-like, such as expensive western gadget or other contraband. I think it is similar to HR ladies today - you want to have good activist cred by posting the right flag on your social media and all that, but you should also not interfere if the CEO has some fun with his assistant on his business trip. It's the same logic why Trudeau surfed through his blackface episode so easily - everybody just pretended it does not matter, because if you said anything, then maybe you would garner some level of (whispered) sympathy, but then find yourself suddenly redundant and replaced.
This is what is so comical about all the activists: the corruption and nepotism is not the bug, it is the feature of all these stupid systems. Communism was tried so many times and it always devolves into some kind of nightmare, often of fascist variety. It is because it is baked into the system.
Yeah, it was the "actiivist" part I was taking an issue with, not the "true believer" part. I'm also prepared to concede it's a peculiar definition of "activist" that I'm using, that the Western mind might not quite be able to grasp, but I struggle to find another word for someone who participates in all these totally spontaneous shows of support. "Ass kisser" communicates the level of cynicism and opportunism, but I think it only tells half the story.
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Yeah, not being a party member certainly was a career barrier, but it’s not the case that you had to become a true believer if you became a party member. In fact, in the book author describes a guy who became a party member just so that he had more leverage to do really important things in his profession (sorry I’m fuzzy on details, read it a while ago) and privately even condemned the party. That’s also the case for the people in my life.
Condemned?
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They do still exist but changes to the pre-matriculation "requirements" have decreased their numbers, and being "outed" as conservative or woke-questioning will kill your social life so they tend to be super locked down.
Add on the requirements to publicly go through the motions during times of profound stress and exhaustion.... you get people who legitimately convert or experience permanent changes.
Remember that medical school clinicals and residency is not far off from outright torture in a lot of ways and people get 1984'ed while going through this.
Salary and taxes walk some people over a few decades but it is less than it used to be.
Ok, ways to find a conservative doctor?
From the layman’s perspective it’s pretty simple- antivaxxers and the prolife movement will both give you a list of doctors sympathetic to their ideas. The former have been swimming right and the latter already were.
What’s the insider perspective?
Male, old, rural or otherwise red tribe location, etc etc all point more conservative in just the ways you'd expect.
Certain specialties are more or less conservative. Psychiatry, Pediatrics, Infectious Disease are extremely liberal, surgical stuff more likely to be conservative. Anything higher paying more likely to be conservative.
We are supposed to keep our noses clean and stay out of politics....but as usual the left doesn't listen, people who do more likely to be moderate or conservative.
More or less what I’d expected. Whites more likely to be conservative, or do they have to be ultra-woke to overcome the lack of affirmative action? I can see both possible worlds.
It's not worth worrying about.
Ultimately the politics of your doctor isn't going to matter 95 times out of 100, putting aside the more complicated issue of the COVID vaccine all the doctors are going to want you to get recommended vaccines, it's just conservative ones will add a heaping of "I support your right to be a fucking moron" on top of "you are a fucking moron." If it's about child healthcare well then no, they are all woke liberals (IDK maybe some of the ones over 55 aren't?).
If you go specifically looking for people contra narrative you run the risk of finding charlatans catering to that market or actual people. Neither provide good care.
A more practical concern is "does the demographics and background of this person suggest something about their proficiency. I won't comment on this here but it's more important than political leanings.
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Explain
For a few decades Medicine has felt angsty about claims of bad bedside manner in practicing physicians (never mind that this is as much about inherent pressures in the field and foreign trained doctors as it is about individual physician temperaments). The solution was to deemphasize grades, MCAT, and other traditional measures of academic success (and also research prowess). As we've pushed into the woke era this has turned more into looking for students to be engaged in specific types of volunteering and political advocacy. About ten years ago the MCAT was heavily updated to include woke content (although obviously this was pre "woke" era).
Additionally affirmative action* has gotten more and more egregious - troublesome given drop out rates and early retirement/exit from the field in some of those demos. On a less official note you'll schools pushing for "does this student match our mission" behind closed doors in admissions committee meeting. Of course this primarily impacts people from less affluent backgrounds and less prominent schools, since people with good backgrounds manage to slide in as usual.
Between affluent American children naturally becoming more woke and deliberate fingers on the scale with respect to who gets admitted theirs been less complaints about explicitly woke curriculums (sometimes removing traditional educational content and replacing those content hours on more trans health or whatever) some of which gets to the point where even the supporters are like...eesh man that's a lot.
The first part of the medical boards (Step 1) was also made pass/fail, which was sold as a way to increase diversity since minorities didn't do well on it, but was basically a move by top tier medical schools to make the bottom of their class look better, which absolutely worked leaving talented people from mid and low tier medical schools unable to differentiate themselves and move up a tier for residency. Anti-meritocratic bullshit.
*I'm going to throw women in here even though they are better candidates by most metrics but the problem is that they have a tendency to eat a training slot and then get pregnant a year or two into their career and then never return to the work force or work reduced hours, which is a huge issue with doctor allocation and shortage problems.
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Why do they torture students so?
A lot of things are going on here, some of which are a bit more complicated to get the full picture on like the historical issues with hierarchy and abuse.
Two simpler bits:
-You don't decide where you work and learn during training and if you leave, quit, or get fired you are done. Sometimes with upwards of 500k in debt. Programs know this and will mistreat trainees knowing they can't vote with their feet and their lives are pretty close to over if they don't suck it up. Suicides and deaths from things like sleep deprived car accidents aren't common per se but are frequent enough that we all know multiple people who went out those ways.
-Unlike most high education/high skill labor you need a lot of 24/7 coverage and physicians are very expensive and in high complexity specialties like surgery you have to do a FUCKING LOT of stuff to become independently proficient in a reasonable number of years. The solution is typically to rely on trainees and long hours. On paper Residents aren't allowed to work more than 80 hours a week, must get at least 4 days off in a month, and aren't allowed to work more than 24+4 hours in a row. On paper. Very common for people to violate one or more of those in an easy specialty at an easy program. In something harder like procedural specialties? You might work 80-100 hours a week with an average of four days off a month.
For 5 years.
Shockingly!!! Substance abuse, mental illness, and medically measurable premature aging (fun study that one) are rampant.
This breaks people down and I think could be reasonably considered torture.
Add on the fact that you can't leave, and many other aspects of the training can be considered abusive (said things that are a bit harder to explain)...
I can't believe we even have doctors, given this system. I wouldn't live like that for 5 years even if the payoff was a trillion dollar lump sum.
This is why you'll frequently see us claiming the ability to easily retrain into other jobs if healthcare collapses. Effort substitutes well for a lot of talent and getting through medical education is tremendously difficult and outright traumatic, but if you can do it you'll be able to do most things.
This year a U.S. medical student got two olympic gold medals. She had to pause training to do it but that is the kind of aspirational insanity you'll often see in the field.
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Wow I had no idea the state of medicine was so bad. Jesus.
So are you saying that the state of residency is sort of justified by the difficulty of the profession?
How would you do it differently if you had the magic wand of 'fix up the medical training system'?
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Plenty of other crap is going on and much of that presents easier targets - excess regulatory burden, administrative overreach, wellness modules, U.S. malpractice environment, etc.
A large swathe of the central problem is that Americans doctors are expensive (so hiring more staff for instance is...difficult) and at the same time Americans won't work in American healthcare without those salaries (because of things like the American patient population, malpractice and so on). It makes bigger fixes extremely hard.
Many kinds of surgeons are just fucked - medicine has improved, which means we do surgery less often and the types of surgeries we do are more complicated and harder to learn. It's an order of magnitude or more easier to learn how to remove something from an option approach (think just cutting someone open) than a laparoscopic approach but the latter is much much much better for the patient. Finding ways to make this not extend training time is a nearly intractable problem.
However, a sensible target is malpractice insurance. Doctors do fuck up and do fuck up in ways that should involve penalties but functionally these seems to be entirely separated from who actually pays and gets penalized in our current system. Malpractice insurance alone for OB can be over 150,000 dollars a year. That's insane.
Stronger unions for residents and attendings is probably also a good idea. Unions can absolutely be bad but we are far off from the point where that's an issue.
Likewise kill some various forms of rent seeking and other bad behavior like egregious non-competes, physician boards that costs of tens of thousands of dollars, substance abuse programs that also costs tens of thousands of dollars if you somehow manage to get caught smoking weed, etc.
On a structural level you can probably free up money that can be use to improve healthcare and reduce burden on doctors by targeting various middlemen and administrative horseshit. Fire the front desk staff to pay for an extra useless diversity or infection control administrative and the doctor just adds that job to the list of things they do.
Walk that back, the ratio of clinical to administrative staff is insane and grows worse every year.
I'll try not to blather too much but however bad you think it is it's a lot worse. A classic example is the fact that the population of people we've selected to be doctors might be offered the option of working in NYC or getting paid 300k more a year to work 2.5 hours to the northwest and they'll pick the city. Shit's fucked.
Sidebar: 24+ hour shifts were taken away and then brought back because most people (including residents) thought they were better than the alternative. Which sounds insane and is.
Do you know how the medical system ended up in this fucked state in the first place?
On the training end it's relatively easy, residents are called residents because they live in the hospital, attendings are called attendings because they attend rounds (and then go home). This was initially somewhat sustainable because the level of respect associated with being a doctor was very high (therefore allowing the whole thing to not be a total social catastrophe) and because work was small (because billing and admin requirements were low and we didn't.....have many meds or other shit we could actually do). The whole thing got started by a guy (William Stewart Halstead) who was a huge coke addict but we didn't realize until his training model became the thing). It stuck around because things like the U.S. is wealthy and this process sucks so salaries are high which means that hiring actual night staff to replace is hard. Add in U.S. pro business decisions (lots of our bodies have antitrust exemptions and so on) and it becomes sticky.
Larges swathes of this stuff exist elsewhere though, because being a doctor has several fundamental shitty elements. You deal with the worst parts of society. You are at physical risk in a variety of ways that does not apply to most high education labor. People die, that's traumatizing and so on and so on.
Lots of the other stuff is harder to explain.
Where did America's obsession with lawsuits come from? Not entirely sure, but it's possible to get sued and objectively done the right thing but to have your malpractice settle or end up in a ten year lawsuit that you eventually lose (or win with a lot of stress).
Ya got something specific you want to target and I'll try and comment.
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Wait but you were saying earlier that it's hard to hire people and doctors need more support because it's expensive. Wouldn't the admin staff help with this??
Oh trust me I am pretty severely blackpilled on the Western medical institution, although I do admit that modern medicine has miracles aplenty. My mother's life has been saved on three different occasions by relatively recent medical inventions. So I'm grateful.
But I also wasted over $20k in my early twenties trying uselessly to figure out my chronic pain issues with TMJ, sciatica, RSI, and other various health stuff. Was told by multiple doctors I'd need surgery if I ever wanted to use a keyboard and mouse again. I'm pretty close to recovered now but... anyway that's a story for another day lol.
I didn't realize they were taken away! Ugh yeah it's so fucked. I've seen studies on like the efficacy of doctors based on how long they've been on shift and it's terrifying. Going to the hospital seems like such a crapshoot luck of the draw type situation in some respects.
Think admin like university admin - hospitals are laden with nursing executives, management and so on who at best ensure compliance with various regulations but often are just money drains. Admin in the sense of support staff would be great. Feminism has caused some of the pain here - support staff used to be competent women because it was women's work, now it is often people who can't get other forms of work (not saying I think the change is bad, just noting it).
says nothing about aggressive, trigger happy proceduralists
With respect to patient safety basically the research says that hand offs (to new doctors) are bad and sleepy doctors are bad. About as bad. It's cheaper to overwork the doctor so we go with that. If you've ever studied overnight or stayed up late gaming it is tempting to think of it as the same thing. It is not. Saving (or risking) a patient's life in a fugue state on hour 30 of no sleep and not realizing you'd done anything at all until 20 minutes after the fact is fucking horrifying.
In any case the specific thing with duty hours is that in the 16 hour max shift world you'd just be expected to stack 16 hour shifts indefinitely. With 24s you typically manage to get a "post-call day" meaning you'll do something like 8am-to 10am the next day, but have the rest of the day off "to live your life" aka pass the fuck out, which enables something resembling recovery.
These days the option is typically to take the sleep deprived resident/fellow or have a midlevel who works nights. I don't know a single doctor who'd ever take the midlevel over the physician, no matter how tired.
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