Comment by kenjackson | Hacker News Reader

Comment by kenjackson | Hacker News Reader

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Most people are not able to do this, and most of those few who could don't want to put themselves through it.

Most people don't have to be able to do it, just more than are allowed to do it now, but a factor of say 10.

Furthermore, I don't think people would necessarily need to go through med school and residency.

It's like building a website. There's probably some parallel universe where programming requires certification and only a handful of schools have it. It requires doing MITs SICP as the intro course. Requires compiler construction courses, algorithms, theory of computation and complexity, etc... And then a 4 year apprenticeship with other programmers. And then you can start building webpages, if that's what you want to do.

But we live in a world where it is open and so there's instruction available at many different levels. Would you let someone without a PhD in CS build your website? Of course you would.

And then separately, how many people would trust a self-taught diagnostician?

I trust my car mechanics diagnosis despite the fact I have no idea what level of education he has. But I'm fairly certain he's not an ME from MIT or Berkeley. With good self-study tools, I think that one can self-teach in specialized areas and achieve good mastery rather efficiently. I could imagine Khan Academy for Radiology taught by JHU and Harvard professors to be quite good.

> I could imagine Khan Academy for Radiology taught by JHU and Harvard professors to be quite good.

You have got to be kidding me. How would this work for surgery? There are no short cuts to medical competency.

Sure, some of what I do is self-taught, I read books and articles, attend conferences, and complete Continuing Medical Education requirements. But I am able to do this because I attended medical school, then spent five years sitting less than a foot from experienced radiologists while they worked and answered every question I had.

Characterizing it as a "short cut" is disingenuous.

The argument here is that medical boards are too rigorous, and test things that do not matter practically.

To give a ridiculous example, if a medical school required you to climb Mount Everest before becoming a doctor that might result in only 1 person becoming a doctor per year. However that scarcity isn't proof that climbing Mount Everest is needed to become a doctor. Nor is it proof that cutting out that requirement will provide significantly worse doctors than previous.

Additionally, in many things we need quantity more than we need extreme compentancy. For example when cut, its better to have some kind of treatment (e.g. first aid, stitching) rather than waiting for a surgical specialist.

In fact, the medical licensing exams and board exams are too lenient. The general quality of people going to medical school in the US has been dropping for a generation. The standards are sliding, to our detriment.

I'd be quite interested to see evidence to support this assertion. Or is it just generally the case that everyone sees Osler's days as medicine's primetime, with a long slide since then?

I don't have any hard evidence, but I insist that it is true.

Bright and determined baby-boomers became doctors and lawyers and accountants. Today smart and determined people aren't even going to college. The HN demographic is a perfect example of this.

Intuitively, I think I get a different sense of the HN demographic. It's one thing to say that the brightest aren't going to medical school. It's another thing to say that the best and brightest aren't even going to college.

I might argue that going to college is no longer necessary for the purpose of learning, because the material is so widely available. Even though I think that's true (for some fields), I still wouldn't advise people not to go to college because of the signaling problem (which one then has to sidestep by starting their own business or by contributing impressively in open source, etc).

I get hyperbole for the purpose of making a point, but if you go too far, you come off sounding a bit incredible.

Have you seen a typical medical school class recently? The people getting in these days is almost shocking. I have a hard time believing that qualified people are being shut out of admission.

Yes? I mean, I am a medical student, and I'm routinely impressed by my peers. But I'm not trying to claim that my peers are better than their predecessors. I'm just doubting your assertion that medical students now are worse than before. The null hypothesis certainly is that things are the same as they always were.

Instead of writing out a long response, I'll just point out that to compare building websites with diagnosing life-threatening illness many times a day is pretty ridiculous.

Of course you don't need to have gone to MIT, etc to build a website. The room for error is just many many orders of magnitude different between that and radiology. There's a reason you don't generally hire self taught code monkeys to build software with real-time or life-ensuring requirements.

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