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Comment by jnsie | Hacker News Reader

I have nothing but respect for physicians but my experience is that each acts as a more narrow filter than the last and, beyond their direct expertise they have very little expertise in billing, pharmacy or anything outside of their direct domain, nor do they have the bandwidth for it. Add to that the advertising phenomenon of 'ask your doctor about X' and I suspect that anything beyond the immediate care you're receiving has very little chance of receiving thought/cogent answers.

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I respect doctors (and people in general), but I don’t give the medical profession a passing grade. To speak in generalities (there are exceptions), their training is somewhat insane: long hours, sleep deprivation, knowledge cramming, and more. Their daily practice leaves little time or incentive for keeping up with studies. Most were not adequately taught statistics in the first place. To vent a bit more, I don’t think it is unfair to say the system is crap. If we could redesign it from scratch, understanding human nature, how people learn, and the need for ongoing learning, and evidence-based medicine, it would not be this. None of this is meant to assign blame to individuals.

>Their daily practice leaves little time or incentive for keeping up with studies.

Their certification requires it, at least to some extent.

Two responses. First, CME is criticized as being largely influenced by industry rather than primarily intended to advance medical learning. [1]

Second, assuming medical continuing education is something like 20 to 40 hours depending on the region [2], this feels meager and insufficient. In contrast, think of how much learning a software developer does during a year -- perhaps close to 5+ hours per week on average! [3] Very different contexts, very different incentives.

[1]: https://www.chronicle.com/article/lessons-from-a-professors-...

[2]: Based on very quick research: could be off -- corrections are welcome

[3]: There are many differences, of course. Just to pick one example: to what degree does a software developer's continuing exploration into an area (such as a specific business process that their application needs to understand) help their craft? Does it improve their skill level? Does it result in transferable skills? Does it improve the quality of their work?

A software developer is not required to do any continuing education at all.

Ok, but you are moving the goalposts relative to my original quote: “Their daily practice leaves little time or incentive for keeping up with studies.” My first point is that software developers (generally, more often than not) have the time and incentive to learn on an ongoing basis.

Second point: if continuing education has to be mandated, it is likely a symptom of a system that lacks proper incentives.

On the positive side, as more patients educate themselves and press doctors for statistical understanding and synthesis across studies, “Dr. Expert’s” stale knowledge will no longer fly.

Mandated continuing education isn't a sign of missing incentives, it is the incentive. Being required to do something to keep working in the field seems like a pretty strong incentive to me.

But I certainly won't dispute that doctors in most systems in the US are overworked starting at least in residency.

We both know there is a difference between intrinsic and extrinsic incentives. This difference underlies so many things, including: (i) justification for regulatory frameworks; (ii) individual motivation; and (iii) likelihood of follow-up / compliance.

> if continuing education has to be mandated, it is likely a symptom of a system that lacks proper incentives

I’m a pilot and work in finance. They both have continuing-education requirements. The ones in the former are practical and helpful. The ones in the latter are mostly performative. (In some cases, arguably counterproductive.) The existence of continuing-education mandates per se tells you almost nothing about the system as a whole.

Point taken. Interesting example. Do you have some theories about why continuing education requirements are so different in aviation compared with finance? Some factors might include: individual skin in the game, observability, feasibility, and the temporal and causal distance from action to consequences.

> Do you have some theories about why continuing education requirements are so different in aviation compared with finance?

Culture of professionalism. That’s kind of a bullshit answer, but it’s the closest phrase I can come to that encapsulates pilots taking the rules seriously, both because they’re there for a good reason and the FAA isn’t afraid to yank your wings, but also because the FAA isn’t usually making rules to seem tough on pilots or otherwise infantilise them, it’s following an evidence-based approach that’s explicitly endorsed by pilots. (After a crash, you aren’t trying to find who to blame. You’re trying to prevent the next crash.)

Software developer doesn't hold a certification from a trade group that has a government violence backed monopoly on deciding who can make a buck performing said craft.

Yes, they're missing a pretty strong incentive.

It is a rubber stamp cert. I’ve been to a continuing medical education talk. It is your bog standard visiting scholar giving a 45 min talk of their research. Lecture hall is sleepy aside from the usual suspects. Sheet pizza from the cheapest place in town is being served. People are nodding off in the back. About the only way you can tell this is a continuing medical education event is the clipboard and pen being passed around for MDs to sign their name along with a signature.

It is a far cry from actual class. Learning isn’t required only saying you were there.

I have plenty of criticisms for the physicians lobby in the US, but kind of agree this is one area where I'm not sure the problems lie in physicians (outside of some very general sense that they tend to be in key positions of influence in healthcare systems in government and elsewhere).

I do think it's a good example of why pharmacists should maybe have more power in the drug prescription process, and also wonder why insurance companies or pharmacies don't ban drugs from certain places and/or sue them themselves more often.

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