17 August 2018

Our doctors are too educated.

This thoughtful piece in the Washington Post identified the shortage of physicians as a key problem and suggests a solution: fewer years of training for would be physicians, although it begs the question of why we don't simply open up more med schools when there is an ample supply of qualified would be med students.

Another way to shorten the amount of education to be a doctor would be to eliminate the requirement that pre-meds, like pre-law students, earn an unrelated undergraduate degree with only minimal prerequisite course work, before advancing to their professional educations.

In both cases, dispensing with undergraduate educational requirements would also make it easier for the women (who, if they want to establish themselves in profession before having children, are racing a biological clock), and the less affluent, for whom each year of educational requirements removed reduces the cost of getting that education.
An aging population with numerous health needs and a declining physician workforce have combined to create a physician shortage — the Association of American Medical Colleges projects a shortfall of up to 100,000 doctors by 2030. 
Policymakers have proposed many solutions, from telemedicine to increasing the scope of nurse practitioners. But I can think of another: Let students complete school and see patients earlier. 
U.S. physicians average 14 years of higher education (four years of college, four years of medical school and three to eight years to specialize in a residency or fellowship). That’s much longer than in other developed countries, where students typically study for 10 years. It also translates to millions of dollars and hours spent by U.S. medical students listening to lectures on topics they already know, doing clinical electives in fields they will not pursue and publishing papers no one will read. 
Decreasing the length of training would immediately add thousands of physicians to the workforce. At the same time, it would save money that could be reinvested in creating more positions in medical schools and residencies. It would also allow more students to go into lower-paying fields such as primary care, where the need is greatest
These changes wouldn’t decrease the quality of our education. Medical education has many inefficiencies, but two opportunities for reform stand out. First, we should consolidate medical school curriculums. The traditional model consists of two years of classroom-based learning on the science of medicine (the preclinical years), followed by two years of clinical rotations, during which we work in hospitals. Both phases could be shortened. In my experience, close to half of preclinical content was redundant. Between college and medical school, I learned the Krebs cycle (a process that cells use to generate energy) six times. Making college premedical courses more relevant to medicine could condense training considerably.  Meanwhile, the second clinical year is primarily electives and free time. I recently spoke with a friend going into radiology who did a dermatology elective. While he enjoyed learning about rashes, we concluded it did little for his education.
In the past decade, several schools have shown the four-year model can be cut to three. For instance, New York University offers an accelerated medical degree with early, conditional admission into its residency programs. The model remains controversial. Critics contend that three years is not enough time to learn medicine. Yet a review of eight medical schools with three-year programs suggests graduates have similar test scores and clinical performance to those who take more time. 
Finally, we can reform required research projects. Research has long been intertwined with medical training. Nearly every medical school offers student projects, and more than one-third require them. Many residencies do as well. Students have responded: The number pursuing nondegree research years doubled between 2000 and 2014, and four-year graduation rates reached a record low. Rather than shortening training, U.S. medical education is becoming longer. The additional years aren’t even spent on patient care. 
Done right, this could still be a valuable investment. Intellectual curiosity and inquiry drive scientific progress. But that’s not why most students take research years. I conducted a study showing that less than a quarter do so because of an interest in the subject matter. The most common reason was instead to increase their competitiveness for residency applications. 

16 August 2018

Sometimes a Cigar is Just a Cigar

Trump Tweets Aren't Well Liked

Justin Bieber tweeting about his breakfast gets more likes than the president. So I compared his likes to those of Obama, Hillary and Biden. All of them had massively more popular tweets than Trump--and it wasn't even a good week for them. Their tweets get 3 to 6 times the likes as Trump! While Trump occasionally breaks 130K Bidden hit nearly 700K last week, Hillary nearly 300K and every Obama tweet beat Trump--and Obama didn't even really say anything this week! When he does he's up around 1 million. I don't think a Trump tweet has ever come close to that. The dude has 53.7 million followers and he's averaging about 100K likes--that 1/10 of 1% of his FOLLOWERS likes what he says. And that should give us hope. This guy just isn't popular.
- Via a closed Facebook forum

Quote of the Day

Bacon is the most loved food in the universe and the route to all things swine and divine.
- Via Westword