I don't know about medical, but for engineering, the competitiveness level for professorships is so high that there is quite a lot of talent distributed pretty widely. If one looks around for, I don't know, top quantum researchers, you might be surprised how widely you'll find them. There's still a lot of garbage being published, sure, but that's more a product of the incentive structure demanding more more more in terms of publications. Moreover, while academia hasn't been entirely immune to the general homogenization effects that happened to much of the rest of society, there are still somewhat distinctive flavors that can be seen. For example, (being a bit reductive here), one could say that there's something of a "Berkeley way" of approaching learning problems that is more distinctive on the west coast. Obviously, some of their successes filter over to other folks, but they have sort of a different mindset (purely technically speaking, not about their weird political bubble).
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I don't know about medical, but for engineering, the competitiveness level for professorships is so high that there is quite a lot of talent distributed pretty widely. If one looks around for, I don't know, top quantum researchers, you might be surprised how widely you'll find them. There's still a lot of garbage being published, sure, but that's more a product of the incentive structure demanding more more more in terms of publications. Moreover, while academia hasn't been entirely immune to the general homogenization effects that happened to much of the rest of society, there are still somewhat distinctive flavors that can be seen. For example, (being a bit reductive here), one could say that there's something of a "Berkeley way" of approaching learning problems that is more distinctive on the west coast. Obviously, some of their successes filter over to other folks, but they have sort of a different mindset (purely technically speaking, not about their weird political bubble).
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