ebrso
1yr ago
From the article
One professor said that a student in the operating room could not identify a major artery when asked, then berated the professor for putting her on the spot.
She knows literally less than a decent butcher.
The qualifier major is carrying a lot of weight here. There are thousands of named arteries in the human body, ranging from the aorta (which every medical student in clinical rotations really should be able to recognize, at least when it's exposed to plain view) to tiny branches that exhibit tremendous variation across individuals, and which even the absolute best students (and expert physicians) won't be able to reliably identify in cadaveric dissection (never mind in the operating theater). Viewing angle, anatomical posture, and similar (physical) factors can also make it much easier or harder to identify individual vessels.
So, even if we take this anonymous source's claim at face value (i.e., we assume that some incident occurred in which a medical trainee failed to identify a "major" artery on request, and then reacted badly), how should we understand the term "major," and why do we assume that there was a clear presentation? (And of course, one case, however egregious, doesn't establish a trend.)
Sure, I don't doubt that many of the people you think about in consulting / finance / tech at even 2nd-rate places like Accenture / Deloitte / Oracle will make six figures as starting salaries.
Still, statistics show that the average American working in the consulting, finance, or tech industries will never make six figures - even if we restrict attention to the college educated. I think you're just really out-of-touch to not recognize that. This is wrong. Maybe I'm the one who's out of touch. The median American salaries in tech and finance are both around $100k, suggesting that most people will attain them at some point. The median consulting salary is still lower than $100k.
ebrso
1yr ago
you have yet to acknowledge that American doctors don't make what you think they do. The average American doctor probably has a lower net worth than the average Australian doctor . . . Doctors have relatively low net worths into their 50s, here's a citation. https://www.bfadvisors.com/net-worth-by-age-for-doctors/
This is grossly misleading. The first line of the article is literally, "When it comes to wealth-generating occupations, physicians usually make the top of the list." The graph shows that 50% of doctors ages 45-49 have a net worth of at least $1M, and that average physician comp is $350k/year. I appreciate that American doctors choose partners at Goldman Sachs as their peer cohort for compensation comparisons, but this is not based in reality.
Decreasing doctor salaries also does nothing substantial to decrease U.S. health care costs.
Physician compensation is roughly 9% of U.S. health care costs per here. If you slashed physician comp 50% (so that physicians were "only" averaging $175K/year), U.S health care costs would be reduced by 4.5%, or about $250B across the U.S. per year (4.5% of $5T total annual health care spend). A few $250B here, a few $250B there . . . pretty soon we're talking about real money.
And your solution [of importing physicians from other countries in order to drive down physician costs] seems to me to be wildly immoral and you make no effort to defend it.
Again, Is that your true rejection? If so, would you be satisfied with importing international physicians if those physicians pledged to remit some of their American comp to their countries of origin? Because I'm sure they'd be happy to do so.
ebrso
1yr ago
I think this nicely acknowledges some of the individual variation / tradeoffs involved. I've noticed a trend in life-advice-giving where people are often wrong, but never in doubt. So, you'll have someone ask whether he should pursue his dream of quitting accounting to become a painter, and one person will write back that he definitely, 100% should, and the next person will respond that he definitely, 100% shouldn't.
I don't understand the "clashing rocks" comparison. I understand (from Google) that it's a reference to the Symplegades from Greek myth, but what the relevance is of that story is lost on me.
ebrso
1yr ago
NPs have 500 hours of training and doctors have 10k-20k. That gap is enormous and even if each hour of training is mostly worthless....it's a lot.
This seems to refer to clinical hours. Per wikipedia: During their studies, nurse practitioners are required to receive a minimum of 500 hours of clinical training in addition to the clinical hours required to obtain their RN. Let's leave aside the RN component. If clinical hours are the focus, then a typical NP who's been practicing professionally for 10 years has more than a physician who's been practicing professionally for 5 years.
This conversation brings to mind Yud's Is That Your True Rejection. Doctors are better than NPs, they have more clinical experience. No? Well then doctors are better, they have better outcomes. No? Well then doctors are better, they cost the system less money. No? Well then, doctors are better, their training is more rigorous. No? Well then, doctors must be better for some other reason.
ebrso
1yr ago
You ignore the DNA evidence that Palestinians are the direct ancestors of ancient Canaanite and Levantine inhabitants of the land, and doubly ignore that Ashkenazim — the chief instigators of Zionism — are half-European in DNA.
How are Ashkenazim "the chief instigators of Zionism"? Mizrahi Jews in Israel make up over 60% of the nation's Jewish population, and their politics are to the right relative to the country.
ebrso
1yr ago
hockey has long had a culture of policing things that aren't quite illegal, but considered excessive via player-based enforcement in fights.
Why are fights between athletes considered just part of the game, rather than serious crimes? I assume that if I were to take a swing at someone in my office, in front of a million spectators and filmed from fifty angles, I would (quite appropriately) face jail time. But this doesn't seem to hold for, e.g., baseball players.
ebrso
1yr ago
Alcoholism, despite the stereotype, almost always has an emotional component which, if resolved, removes the driving compulsion to drink, though not always the urge.
I'm still struggling to understand what claim you're making about the nature of alcoholism. You stress that wants and needs are (imperative) emotional components. So is it just that people stop being alcoholics when they stop wanting/needing to drink alcohol? But that's almost tautological.
ebrso
1yr ago
Thanks. I think it's interesting that your husband would share this concern with you before marriage. I have what I believe to be a fairly honest-and-open relationship with my girlfriend, but this isn't something I would consider sharing (partly for fear of hurting her, but partly out of concern for how it might affect her conception of me - and the impact that could have on our relation).
ebrso
1yr ago
I think a major problem is that there’s a lot of wiggle room for motte and Bailey around the issue. When people want sympathy they talk about a guy just down on his luck. When they want to remove them, they’re drug using street shitters.
I agree that people describe homeless populations (indeed, all populations) as more or less sympathetic depending on their own sympathies. But I hardly see how that (alone) has anything to do with mottes / baileys. Not every form of intellectual dishonesty should be shoehorned into a motte-and-bailey framework.
So the motte-and-bailey doctrine is when you make a bold, controversial statement. Then when somebody challenges you, you retreat to an obvious, uncontroversial statement, and say that was what you meant all along, so you’re clearly right and they’re silly for challenging you. Then when the argument is over you go back to making the bold, controversial statement.
ebrso
1yr ago
Once you're in the real world, it's all about results, and if you can't hang, you aren't going to go anywhere.
The claim that professional promotion requires concrete accomplishments in a role is wrong or vacuous.
Plenty of people get promoted for "bad" reasons. Often they're just in the right place at the right time. Or they market themselves and their mediocre achievements effectively. Sometimes they sequester special knowledge, which makes them seem useful, even if they're not useful in any kind of wins above replacement sense. Sometimes they get credit for others' achievements, either because they take credit unethically, or because they're just kinda near an achievement and it falls on them by osmosis. Sometimes they've been in a role for a long time, and they're butting-up against the top of the compensation window for that level, so it's easier to promote them than not. Sometimes the panel making the promotion decision is sympathetic to them for various reasons. And on and on.
ebrso
1yr ago
The money is meant to compensate [Black and Hispanic members of the class]. Why would white applicants have a claim on the money?
I never suggested White applicants should have a claim to anything, I only suggested that this outcome potentially invites an equal protection challenge. If a Black guy and a White guy sit for the same test, and both fail, but legal recourse is available to the Black guy alone, based exclusively on immutable racial characteristics, then it seems to me (a non-lawyer, but a member of the educated laity) that the White guy has clearly been denied equal protection of the laws.
"Four teachers in 1996 first filed a suit over the test. . . . The test was ruled discriminatory in 2012 by the third Manhattan federal judge to handle the case — which included a two-month nonjury trial and repeated trips to an appeals court."
That sounds like a vigorous defense to me.
I don't see what bearing the length of the process has on the vigor of the procedure.
The plaintiffs were not paid not to work. Presumably most of them worked at other jobs since 1996 (when the lawsuit was originally filed). They are being compensated for the damages incurred as a result of the ostensible discrimination. If I dropped a hammer on your head while working on a roof, and as a result you had to quit your job as an accountant and work retail, would you frame a lawsuit settlement as paying you not to work?
I don't stand by my characterization of the lawsuit as paying teachers "to not work," although incidentally, NYC has done just this before. But certainly the plaintiffs were paid in return for nothing. If the settlement is intended merely to compensate for damages (i.e., make the plaintiffs "whole," i.e., to leave them in a similar state to where they might have been had the injury never occurred), then why wouldn't class members be eligible solely for the difference between what they actually earned and what they would have earned as NYC teachers (with adjustments for factors like difficulty of position)? If a hammer falls on my head at the fault of my employer, and I go and take another paid job while continuing to receive a paycheck from my original employer, then it's even better for me than payment explicitly for not working!
Did you change the link?
I haven't edited the original post since publishing.
ebrso
1yr ago
Every physician I know who doesn't have a financial stake in midlevels (and isn't in admin) tells their friends and family to only see doctors whenever possible. That's for a reason.
Every acupuncturist I know tells me to see an acupuncturist. It's funny how that works.
Physicians spend years being abused and called idiots in order to develop caution, intellectual humility.
I don't consider American doctors as a model for intellectual humility. Do you?
ebrso
1yr ago
Figuring out the cause of dropping out is hard because people lie for ego defense reasons which complicates matters, I do know people who have claimed some other kind of hardship but it was academics.
I mean, sure, if someone leaves an academic program, then on some level it's related to academics. But even in cases where someone's involuntarily separated from their program due to bad grades, those bad grades don't necessarily indicate a failure of earlier-stage preparation or a deficit of natural ability. Often, bad grades are downstream from emotional problems, or from a general ambivalence about the training. I speak from some personal experience here, albeit outside of medicine (I don't think this is simply "ego defense").
I don't want to get too distracted from my main point, which is that, based on data and personal observation, I'm skeptical that American physician training requires as much intellectual horse power (or even hard work) as American physicians maintain it does. I do think it requires a high level of conscientiousness, which is surely related, but also different.
ebrso
1yr ago
Medical exams are hard (and not like most exams you see), someone who was in the top 5% of their class at a respectable undergrad institution can spend two years studying for Step 1 and still barely pass it.
In 2021, before USMLE Step 1 moved to pass-fail, 98% of 1st-time takers from MD programs passed per here. By comparison, the first-time pass rate for the California bar exam (to practice law in the state) is roughly 45% per here.
ebrso
1yr ago
Thanks. The Inca Trail seems interesting - I'll look into that tomorrow. I make $240K/yr. leading a team of ~15 engineers.
Yeah, I think in ice hockey especially, fights aren't seen as pathological, but rather as an important part of a self-policing culture. I can understand that. What I don't understand is why the local district attorney would take that stance (and not prosecute offenders).
Baseball doesn't have the same opportunities to deliberately inflict injury within the standard ruleset of the game, so the same sort of culture never developed.
Interestingly, and consistent with your theory, my sense is that the proximate cause for most professional baseball fights is a perception of inappropriately aggressive play on the part of the opponent: high-and-inside fastball, sliding into 2nd base with spikes up, and so on. It's also interesting to me that in both baseball and ice hockey, the culture broadly prohibits using weapons in fights. The first thing a hockey / baseball player will do at the start of his fight is throw down his stick / bat. Again, this is consistent with the theory that fights serve to self-police / enforce expectations for conduct.
ebrso
1yr ago
I like how this response emphasizes tradeoffs. Sometimes (or often, or always) the best realistic outcome isn't a perfect one.
ebrso
1yr ago
Thank you. I think this is very helpful. I look at various of the married guys I work with and it's hard to tell whether their boring-seeming (to me) lives are actually full of these hidden, rich wellsprings of "beauty and intensity," or whether it's all a lie I should run from without looking back. A lot depends on the person, I guess.
ebrso
1yr ago
[America has] 330 million people. A million [drug overdose] deaths in 10 years isn't even coming close to affecting the median.
Of course the median American didn't die from a drug overdose in the last decade. But if knowing a drug addict is to be affected, then I suspect the median American has indeed been affected by drug abuse.
ebrso
2yr ago
Using suboptimal methods because it just feels good is perhaps the most common failure mode for everything in all of history.
I think this quip is question-begging, and just serves to muddy the waters by conflating several distinct phenomena:
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Conflict between a society's short-term and long-term preferences.
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Conflict between the preferences of distinct groups in a society.
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How individuals/groups establish preferences, and how they understand and express these preferences.
There are important questions of fact involved:
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Are whole-language approaches more effective for teaching students literacy?
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Should effectiveness in teaching students literacy be the unique factor determining instructional approach?
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Are teachers well-positioned to evaluate the effectiveness of various instructional approaches?
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Do teachers have insight into how they arrive at their own preferences?
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Do teachers misrepresent the justifications for their preferences? Do they do so knowingly?
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Are whole-language approaches easier/more fun for teachers?
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Do teachers prefer whole-language approaches because they're more pleasant for teachers?
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Do students have effective political advocates for their interests?
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Etc.
If I say that Martin Shkreli is an asshole, I'm probably not exercising too much cognition. I'm certainly not consciously/explicitly characterizing anuses as bad. Indeed, there's a reasonable case that assholes (anuses) are good - after all, what's the alternative? Still, in context, there's some clear background knowledge: assholes are detestable.
So you're suggesting that broad principles of free speech require public colleges to treat student speech in a content-neutral way, with no special treatment for the communication of ideas we find abhorrent, including racial slurs? That seems fine, although it's not the position most public American colleges seem to take (certainly not in practice). It's hard to imagine how this would even function if implemented literally. How could student work possibly be evaluated in this context?
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