Comment by roentgen | Hacker News Reader

Comment by roentgen | Hacker News Reader

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I'm going to respectfully disagree.

This may be possible in some medical fields (I doubt it), but not radiology. There is simply too much to learn. I completed 4 years of medical school followed by a 5 year residency. Some radiologists go through additional sub-specialty training. I've been practicing for 5+ years, and I'm still learning everyday.

I am a doctor's doctor, meaning my customers are doctors from every specialty, who order studies and read my reports looking for answers they can't answer clinically. I can talk to Orthopedic surgeons in their language, Neurologists in theirs, and Gastroenterologists in theirs. I'm familiar with the radiological manifestation of most pathological processes a human can experience.

The notion that someone could self-teach what I know seems impossible.

There are licensing and board requirements, but conspiracy theories aside they are not designed to create artificial scarcity, they're supposed to keep dangerously ignorant doctors from practicing.

This may be possible in some medical fields (I doubt it), but not radiology. There is simply too much to learn. I completed 4 years of medical school followed by a 5 year residency. Some radiologists go through additional sub-specialty training. I've been practicing for 5+ years, and I'm still learning everyday.

But what can you say that about? I did 4 years undergrad in CS, followed by 5 years for a PhD. Followed by more than a decade in industry. And I still learn everyday too.

The notion that someone could self-teach what I know seems impossible.

I should be clear, as the term is ambiguous, they'd likely learn from experts, but not by going to a board approved medical school. But through things like online schools, programs, books, etc... It wouldn't be someone trying to recreate a curriculum from scratch.

There are licensing and board requirements, but conspiracy theories aside they are not designed to create artificial scarcity, they're supposed to keep dangerously ignorant doctors from practicing.

Given the lack of policing after becoming a doctor I'm skeptical of this claim. At the college level I'd like to see a wider swath let in to medical school, and then a more rigorous approach to filterning, based on not only medical proficiency, but ethics. The big problem I see with doctors isn't in expertise or proficiency, but in ethics.

And given the data on sleep deprivation and learning, I think loosening the requirements even a tad would result in less scarcity and better prepared doctors on average.

We see things differently.

Radiology is a very difficult field to get into after medical school, something like 2/3 of American grads who apply get turned away. Additionally, for those who get in, up to 1/3 never pass all the board exams. It almost seems like you want to lower the bar, and I'm telling you it needs to be raised.

My guess is that if your system was developed and worked, the intelligence and drive required to complete it, the time spent studying and working to become competent in radiology would end up being no different than the current system. There are no short cuts.

Radiology is a very difficult field to get into after medical school, something like 2/3 of American grads who apply get turned away. Additionally, for those who get in, up to 1/3 never pass all the board exams. It almost seems like you want to lower the bar, and I'm telling you it needs to be raised.

All you've said is that some tests aren't being passed. Can you correlate them with improved medical care? Again, in my alternate world, I can construct a CS test that 90% of those w/ undergrad CS degrees would fail. That's not hard to do. The question is "does my ability to pass such a test correlate with my ability to do a website?"

You're pointing to scarcity and arguing that this is proof that we require scarcity. I'm saying that if you dropped the bar on these tests, but increased other policing practices that yielded a net increase in the number of doctors, I think you'd see an increase in medical care. My thesis is purely speculative, I grant you that.

I suspect we're likely to find out if this does work out in non-US countries once as medical information and training becomes more prevalent on the web.

You make some good points.

Of course, I cannot prove that the tests insure quality. In fact, this is not what the radiology board exam does.

The board exam is designed to weed out dangerous doctors, which is probably the best we can hope for. So, I guess you can take my word for it or not, but dropping the bar at all would let dangerous people practice, which I see as a mistake. The people that I know who failed the exam should not be working in Radiology.

"Radiology is a very difficult field to get into after medical school, something like 2/3 of American grads who apply get turned away."

I don't agree with kenjackson that the field can be self-taught, but saying that most people don't get into Radiology residencies tells me only that there aren't enough Radiology residencies to go around. The 1/3 board failure rate notwithstanding, my intuition is that there are far more people capable of practicing radiology than are currently allowed to try to get into the field. The intelligence level of medical students does not exceed that of PhD students in engineering, math, chemistry, etc., but the medical profession puts up much, much higher economic barriers to entry.

If the government decided to tax radiology providers and use the profits to increase the number of radiology residencies by 10 or 100-fold, I find it hard to believe that the lucrative profit margins of your industry wouldn't decline. Medicare reimbursement rates would go down as the number of providers increased.

>There are licensing and board requirements, but conspiracy theories aside they are not designed to create artificial scarcity, they're supposed to keep dangerously ignorant doctors from practicing.

Thanks for the comments in this thread, they've been very informative.

I'm happy there are certifications, and I believe you that the bar should be raised, but given the huge demand for doctors, why aren't we increasing the number of medical schools?

If we have a supply problem, and we don't want to lower the bar, it seems like the answer is to let more people in at the front end, and let the filter do its job.

Just wanted to point out that while it may seem intuitive that increased supply = cheaper prices, thats not how it works with doctors

Doctors have the ability and incentive to increase demand, and I remember seeing data that this is what actually happens historically when you increase doctor supply.

BINGO. You win the thread. The Clintons learned this the hard way, but most people don't understand how this could be true.

How do these ability manifest? I suspect what you might be seeing is latest demand. There are a lot of people that would see the doctor more often, but often don't due to prices. Once access and prices become more reasonable they seek out medical services they normally wouldn't have.

Or doctors see their profit-margins / wages declining, and lower the threshold level for various kinds of specialised testing. So, you complain about a mole or a lump, and instead of a quick diagnostic poke and an "It's probably fine", it's off for an invasive biopsy, "Hmm, the results were inconclusive, better safe than sorry" surgical removal, and maybe a few extra scans for follow-up.

I'm sure that there a many areas where a GP would like to schedule a follow-up, but can't justify it on the current evidence, and lets it slide.

Because there's this level of subjectivity in medicine, any increase in supply can easily be countered by the suppliers pumping up demand, keeping D/S exactly the same.

(I'm not a doctor, although I'm friends with a few)

I'd argue this happens today at almost the maximal level they can extract. In fact this was my point earlier. The problem with doctor's is less proficiency, but more ethics. I honestly have more faith in my car mechanic than virtually any doctor I've worked with. I'm not sure how increasing supply can make an already worst problem worse -- except to expose more people to it.

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