Hopefully one day, we'll make it as easy to become a doctor as it is to -- say -- become an Engineer.
I am an engineer dating a surgical resident who has to go through so much training that an engineer would never even come close to an engineer. The room for error is quite small. If it was as easy to make a doctor as an engineer I would lose faith in the medical system and would never want such a doctor opening me up.
I'm less clear about which aspects of the current medical education system produce effective training and which are more of a hazing run selecting for the privilege and determination to survive it.
This is theoretically an easy change, since most complaints are about the unnecessary bureaucracy and not the pedagogy itself. Doesn’t matter how simple the solution is, it’s practically hard because the bureaucracy has so many incentives to make the process harder.
Yes, the room for error can be incredibly small. A surgeon might cut out a breast cancer that's 5 to 10 cm on a side. The margin, the distance between the cancer and the edge of the surgeon's incision, might be negative by 1 cell. The cancer might be 1 cell away from having been left in the patient's body. The room for error in medicine is in some ways disturbingly small, in others it is incredibly large. Factor of 10 errors are so common they are a standard outcome measure in trainee fatigue studies. Ask your SO about ACDF. Imagine driving screws essentially blindly, without tapped holes, a few millimeters away from a spinal nerve root, with an 8" torx driver. On 3 hours sleep, after standing on your feet for the last 7 hours. An engineer, hell, a carpenter, would have measured the system extensively, set up a jig, and spec'd the entire process, soup to nuts.
From that perspective the margins for error, in absolute terms can be, and often are, enormous. Which is what lets them run on 3 hours of sleep for months. In that setting, sleep-deprived, no exercise, terrible food, compounded by relentless moral injury, yes, it seems like the margins are miniscule. But a good cabinet maker, electrician, or pharmacist takes more care in many aspects of their work, in absolute terms.
Surgeons will always need to be extremely highly trained because they do not have the ability to hesitate. Most of healthcare simply isn’t anywhere near the acuity level of surgery.
By far, the biggest need is primary care. The exact opposite of acute. The rigor, effort, and expense of medical school simply doesn’t match modern primary care. Either the system needs to change to accommodate that or physicians are in for a reckoning.
Physician lobbies have a golden opportunity to ensure even higher pay and better product by building better care models. Instead they simple say “fuck your I got mine”
It shouldn’t be easy to become a doctor, but man the bar right now is so high.
There are many government and philanthropic institution-sponsored programs in the U.S. that repay 100% of medical school, dental school, or medical specialty tuition and expenses, in return for committing to five to 10 years of medical service, on site, to remote or under-served communities.
'Remote' can be rural communities in Appalachia. They can be 'under-served' and very remote, e.g. for American indigenous people who live on their sovereign nation's land.
Under-served communities can also be in economically devastated cities (usually due to offshoring of manufacturing) in the Midwest or East Coast where people of color and white people lack access to medical care that is within walking distance or public transport.
I am not sure how you are coming to that conclusion. Look at the latest metrics on scoring. Sure, Asians overall tend to score higher on average on standardized exams (which really ought to be split into different sub-ethnic groups because there is a disparity there too) and I'm not seeing the average MCAT score for Asians being disparately higher than the average score of Black Americans that would warrant such a statement.