self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
I'm a transhumanist doctor. In a better world, I wouldn't need to add that as a qualifier to plain old "doctor". It would be taken as granted for someone in the profession of saving lives.
At any rate, I intend to live forever or die trying. See you at Heat Death!
Friends:
A friend to everyone is a friend to no one.
User ID: 454
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
1hr ago
I don't think you've made a good case that what college you go to really matters, at least in th US.
I don't think I've said much, if anything, on that topic? That simply isn't an argument I've made. As far as I can tell, it's not even one I've made by implication.
All I have said is that the college you go to matters a great deal more in India, which really is true. That's the real reason everyone goes crazy trying to put their children into the better ones.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
12hr ago
I'd say they do. Med schools are full of students who come from not particularly well-off families. That ex of mine, who I lamented? Her dad was a minor clerk in a government post. Her mother was a housewife, who inherited his post when he died (that's the local approach to job security, they try and give the post to NOK if viable). Absolute middle of middle class by Indian standards, which means they lived in a small apartment and owned a rickety old car instead of a motorbike. She attended a significantly more reputable med school than I did, even if it wasn't the best of the best. Shame that my academic performance quickly eclipsed hers, and there's a reason I'm training in the UK and she's not. As much as she nearly ruined my life and drove me to near insanity, I loved her, and I mostly wish her well.
Anyway. She's a good representation of the typical med student in India. I'd be considered to have come from a relatively privileged background. Most of them come from humble backgrounds, and are the first doctors in their family. Parents were clerks, farmers, small businessmen, minor merchants, average engineers and so on. A doctor in the family was a big fucking deal to them.
In my cohort of about a hundred med students, maybe a dozen had medical parents? I'd say that that's the system working as intended.
(I will protest that I would have gotten into much better med school if my ADHD has been treated while still in school. Oh well, one of the many things I've forgiven my parents for. They're not perfect, they did their best.)
In other words, if you were a 120 IQ+ student in India, regardless of family background, you have a fair shot at climbing further up the rungs of the social ladder. It won't be easy, by any means, but it's expected.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
14hr ago
You're looking at polygenic selection, which would be significantly slower than selecting for traits dominated by a handful of genes. But in principle? Absolutely. It would just be a massive pain in the ass, but we've done it for dogs and cattle. There is evidence for weak selection for specific personality traits over human evolution, but I forget the specifics.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
15hr ago
Over saturation? Definitely. Anyone can get a CS degree, and it's not even strictly necessary. Medicine, on the other hand, is strictly regulated and there's a limit on the number of doctors entering the workforce.
The best paid programmers in India usually work for FAANG or adjacent companies, at the Indian branches. Some freelance, earning Western wages while at home. The majority just get by working shitty jobs for long hours with average pay (which means pitiful pay by Western standards). The worst off are TCS code monkeys, who really have nothing going for them.
Keep in mind that this isn't necessarily worse than many other professional careers. Engineers in India aren't enjoying themselves either.
The easiest way to get career or income mobility is to get hired by a foreign company, establish a reputation, and apply for a transfer to a foreign branch. I have a cousin in ML who makes big bucks (by Indian standards, which means close to my UK salary). He's been offered roles in the US, but only on a temporary "put out fires" basis, and not at comparable wages to what someone living and working there would make. I've encouraged him to take it, or simply apply directly at American companies for local full-time roles (H1B route, probably). He entered ML well before it was cool or over saturated, even if he wasn't involved in LLM work. That means he's extremely lucky/forward thinking, probably the latter. I remember him installing weird vision models on my gaming PC when he used to visit, back in 2017. Good for him, I want him to get out while he still can.
And yes, the quota system for H1Bs only worsens things. Everyone is desperate to get one of those.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
16hr ago
Not a martial people? That term is so poorly defined that I don't know what to with it. It's not like it's that different in Punjab, which is full of Sikhs, who are as martial as it gets.
Nepal? Full of Gurkhas. Similar grime levels.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
16hr ago
Any reason why?
There are millions of them. The median salary is shit. Hundreds of thousands are desperate to move abroad.
If you think getting out of India as a doctor is hard, oh boy...
Now this is my shit right here. How do psychiatrists gauge whether they’re more or less on path to following a proper diagnosis? I still imagine there’s a rigorous process in place that’s more than just professional guesswork (although I’m sure sometimes it seems that way, it’s multidimensional).
I'm really sorry, but a proper answer here would take more time than I can reasonably spare. I really shouldn't be here in the first place :(
TLDR:
- We see if our diagnoses are consistent between different doctors for the same patient
- Standard psychometry, reliability and validity work. Does the written test that says you're depressed come back strongly positive for someone who is about to neck themselves? Oh god don't get me started on construct validity etc
- Do the drugs work? Do they reduce symptoms? The answer is mostly yes. Even antidepressants, where the Number Needed To Treat is between 5-7 when compared to. placebo.
Do you think it’s possible to have something like blood tests for depression in the future?
We mostly use blood tests to exclude other physical causes for depression, like hypothyroidism, anemia etc.
Technically? You can use low 5-HIAA levels, but nobody does, probably for good reasons I don't have time to Google. Maybe @reo or @Throwaway05 can show up and do the dirty work for me. Help a brother out, ya know.
Neuroimaging isn't entirely useless either, in the sense that there are things in the brain we can observe changing in the depressed. But it's not very reliable. Same with OCD, autism or schizophrenia.
You got this, 😤 ❤️ 👊.
So I hope. So I hope. Thank you.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
16hr ago
Can you counter-signal by appending a string to every comment saying "I'm not self_made_human" please?
To be fair, I haven't needed any dedicated tutoring since med school either. Turns out that Ritalin can help my brain convert the horsepower to actual propulsion. At the cost of wearing out the transmission, but we all make sacrifices.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
17hr ago
Is the occasional smart ‘poor’ kid [actually a middle class kid with tiger parents] who tried really hard getting an “elite” job really worth ruining the lives of tens of millions of children?
I question the premises here. They're faulty.
- What do you mean by the "occasional" smart kid? Numbers? It's convenient to use tens of millions while eliding that one.
- I didn't enjoy schooling, but I'm not against the idea. It depends on the school and the system it's embedded in. I don't think education is entirely credentialism, and my essay showed that the education/learning was still happening, just not primarily at the schools.
Why did you, the child of a doctor, have to work so hard to get the same job your father had and so would for fundamental genetic and cultural reasons likely also perform well at? Why did I have to work so hard to get into the same business as my father? And despite this, half the doctors I know come from medical families and half the people I work with also have or had a parent or both in finance. What a waste of everyone’s time.
Your sampling is not representative.
-Self-administered questionnaires were sent to 960 third-year U.S. medical students from 24 U.S. allopathic medical schools in January 2011. We asked respondents whether or not they had a physician parent or grandparent. We also tested associations between physician relative status and demographics, educational factors and career intentions. Results Response rate was 61% (564/919). Among the respondents, 124 students (22.0%) responded that they had a physician relative
https://discovery.ucl.ac.uk/id/eprint/10174736/1/Joanne%20Harris%20EdD%20thesis%20final.pdf
Medicine is described as one of the most heritable of professions. Data from the Labour Force Survey compares the professions of individuals with their parents and shows that those whose parents are doctors are 24 times more likely to be doctors than people whose parents did any other type of work (Friedman & Laurison, 2019). This same report showed that individuals were 17 times as likely to follow parents into the law profession and only twice as likely to become accountants if the parents were in this profession, showing that medicine has high levels of heritability compared to other professions (ibid.). These findings are also apparent in other European countries, where between 12 and 16% of medical students had one parent who was a doctor (Hansen, 2005; O’Neill et al., 2013).
From what I can tell, in the US and UK, somewhere around one in eight to one in four medical students/applicants have a doctor parent or close relative. In Indian samples, the figure looks similar, probably one in seven-ish, possibly higher in some cohorts.
That is very, very far from 50%. We are grossly overrepresented, but we are far from the majority. The actual data doesn't support claims that we could just give up on selection and admit them by default.
(a product of 1890-1950, whereas popular PMC meritocracy is a product largely of 1985-present).
Sui Dynasty China? You're off by 1400 years. Meritocracy is not new. The pains are not new. I'm swallowing the bitter pill.
Why did you, the child of a doctor, have to work so hard to get the same job your father had and so would for fundamental genetic and cultural reasons likely also perform well at?
You do recall that essay where I said that my dad didn't come from a pedigree of doctors right? That he was a refugee without two rupee coins to rub together? That meritocracy lifted him out of the gutter? I hope you do. After all, it was the largest salvo I've fired in our ongoing debate about meritocracy. You should realize that this standard, applied honestly, would mean that he never became a doctor, and that I wouldn't be here because of it.
I did not enjoy the selection process required to become a doctor. I have been vociferously complaining about the further selection required for me to become a shrink. I still support strong meritocracy, because my commitment to my principles is stronger than my desire to make my life easier for myself.
It's the same reason I never bothered to apply for reasonable accommodations on my exams. I'm fully eligible, because of the ADHD. Call it a chip on my shoulder, call it a struggle with impostor syndrome or an inferiority complex, psychoanalyze me the way I psychoanalyze everyone else (look at what I'm doing here). I don't mind. I'd rather suffer in a fair system than flourish in a biased one.
If I couldn't hack it as a doctor? Too bad. If I can't hack it as a psychiatrist? That would suck. But while I have a laundry list of issues with the way British psychiatry pipelines work, the meritocracy isn't one of them.
With narrow-sense heritability of intelligence in the 0.5 to 0.7 range, children of two parents at +2 SD will average around +1.2 SD, with substantial variance. So even in your preferred world where you select by parentage, you'd need a filter to catch the kids who regressed below the competence threshold. Otherwise you get incompetent doctors who happen to have a doctor father. And I know a lot of fail-sons and fail-daughters of doctor parents. I was always scared of becoming one. I still am, even with all the objective evidence against it. Mostly because the further I go, the stiffer the competition becomes.
Do I really have to dig out the citations on the strong correlation between intelligence and performance for doctors? Or simply grades (which are IQ+conscientiousness)? I have the Paper B. You've nerd sniped me already. I can't afford the time, but I'm here nonetheless.
If heritability did all that you claim, the children of doctors would breeze through medical entrance exams and the selection would be costless. The fact that they don't, that even doctor-parented children grind in coaching alongside everyone else, is itself evidence that selection does something beyond filtering for pedigree.
My dad worked his ass off (and still does) so he could give me a headstart. The money for extra tuition. The general support and comfort of knowing what the hell you're supposed to do in a med school. I consider these entirely legitimate advantages, because I had to sit the same tests as everyone else. He also didn't hand me as many of his SNPs as I'd like, or perhaps he waited too long and his swimmers became senescent. ADHD with above average intelligence is an unpleasant combination.
I intend to do everything I can for my kids. Money. Emotional support. A proper childhood. Hopefully a smart partner so they get another helping of the alleles that contribute to intelligence (and maybe better looks). I am happy with that. I am tolerating the pain of the struggle to get there, because I'm dangerously close to preferring death over hypocrisy.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
20hr ago
I understand residency, I’m just loosely thinking about your career trajectory more broadly. Residency can’t be pretty brutal, sorry to hear what you’re going through.
Thank you. Yeah, it can be an uphill struggle. But when I feel like crying myself to sleep, I remind myself I didn't become an OBGYN resident and the smiles sort themselves out. Psychiatry is probably the least taxing? I don't know, maybe the Public Health or Occupational Medicine people sleep at their cubicle all day.
But don’t be down on yourself to think you didn’t have the bravery to go into programming when you entered fucking medical school. Passion is what allows you to endure and if you’re going through that, you’re a very capable guy. My like of healthcare as a subject matter rests at the floor. I couldn’t do what you’re doing.
Very kind of you to say. I will note that being a programmer in India is not a good time. The opposite even. If I'd grown up in the States, maybe I'd have been more open to the idea, but life is what it is. I even seriously considered a career pivot and was grinding MIT OCW and Leetcode (I did one medium successfully!) before I matched into psych, but I desisted when I realized that GPT-4 was better than me and would stay that way. Good call. I'd be so screwed right now.
I haven’t read the ICD-10. My mother was a homemaker all her life but her small library was filled to the brim with a lot of medical literature that she liked to read and study about (for some reason).
Goodness. I only read that stuff because I'm paid to. Tell her it's not too late to become a shrink, I've seen junior doctors in their late 40s in the UK. Why do all of that for free?
There’s actually quite a sizable minority of people in the US that truly believe that. Maybe it’s the case that psychiatrists over-diagnose people(?); don’t know. I’ve never seen one. A lot of people seem to think psychiatrists are just glorified counselors that deal drugs. I don’t know if it’s still a common practice to think you can establish a working hypothesis on someone in 15 minutes. That seems completely absurd to me. But I’d take your word on the matter as a psychiatrist over mine any day of the week.
Psychiatrists both overdiagnose and underdiagnose people. We misdiagnose people too. We're only human. Some of us are better than others (for example, I'm worse). It depends on a lot of considerations, and most importantly, we don't really have blood tests for depression or a brain scan we can do to declare schizophrenia. You have to consider all kinds of nitty-gritty details like the tradeoff between sensitivity and specificity, ROCs, cost-benefit analyses etc, inter-rater validity for diagnoses etc. But there is no obvious rampant abuse where I can see it.
Really hope you do well.
Thank you! So do I :(
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
20hr ago
Uh.. Probably more lax than in the West? The important exams, like the NEET/JEE or the post graduate NEET for higher training in medicine are heavily proctored and surveilled. Cheating there is extremely difficult, and usually takes incredible levels of gumption or a dedicated cheating ring and bribery. That is not the norm. If you're caught, you're screwed. Barred from the test. Legal action.
It's far more heterogeneous when considering all institutes of higher learning. I have only attended one med school, after all, and I can tell you that people were caught and subject to disciplinary action for cheating on the test. Of course people try to cheat. I can only point out that they can and do get caught and subjected to serious punishment.
Funny story, a very good friend of mine was unfairly accused of cheating during our med school finals. She'd taken a box of stationery with her into the test, and forgotten that she'd left in a tiny strip of paper with a list of things to revise (chapter names and page numbers) from last night. She was subject to a random search during the med school finals, this was detected, and she was sent to a disciplinary committee with accusations that she'd been carrying a literal cheat sheet. I wrote a letter defending her, which she shared with the board. They were flabbergasted and asked her if she'd hired a lawyer. Nope, just me. I suppose you'd use ChatGPT for something like that today, but back then it was just ChatGP-me.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
21hr ago
This is all academic to me. Do you think I was kidding about not worrying about a college fund for my kids? Elite overproduction or over-expansion of higher education rank low on the list of things I care about.
You could do the testing at two or three, but prior to formal education at the very latest.
The longitudinal validity of IQ testing for toddlers is not great. 6 is just about the very earliest where this makes a reasonable amount of sense. 2 or 3 is... why bother?
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
21hr ago
I feel like they were slightly exaggerating for dramatic effect. Isn't the default expectation in higher education that you try and grapple with most of the material yourself, including through auto-didactic approaches or reference to online material? I seriously doubt there's a single reputable college anywhere where the students come in, get taught literally everything they need in a lecture hall, and aren't expected to do anything when they leave.
The situation your friends describe wouldn't apply to any med school. The lectures are thorough, but you still have to go home, crack open the books and make things stick.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
21hr ago
Believe it or not, many talented Indians stay back in India because they want to, not because they're forced to. I know medical peers who are simply better doctors than me on every single front, and they're happy living and working in India. That is the norm. Only a minority of doctors, engineers or programmers try to leave, even considering those who have the resources and credentials to leave.
India is not Somalia. It is perfectly possible to have a decent life there.
But that just takes us right back to the big obvious question. If India has so many great engineers, doctors, scientist, etc, why can't they achieve great things in India? Why do they need to come here with all the externalities they bring with them?
I won't deign to answer this question. It's beneath me.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
21hr ago
How are the additional subjects assessed? Is it “you must have done 200h of humanities”, or additional end-of-year exams?
No idea. I presume there are written standards somewhere, with each recognized board setting their own requirements and then getting signed off by the government. My best guess, without devoting more time to the question than I can afford, is both. Mostly the latter.
My question is mainly, why don’t the coaching centres become accredited schools where you fly through the government mandated curriculum in like the first hour of the day, then spend the rest of the day on the important tutoring? If there’s lax schools where they don’t even measure attendance that well, wouldn’t a combined coaching centre + high school be possible and an immense success?
It's a big country. I've only attended one school, and that was well over a decade ago. It's entirely possible there are places like this, all I can say is that they're not the norm even today. There could be minimum teaching hours per subject, and pushback from the teachers who would feel miffed if they were only expected to conduct a single class on Shakespeare once a week for 5 minutes. Students and their parents aren't the only relevant stakeholders, teachers do have some degree of say in things.
It doesn’t have to be administered by the parent, my thought was that you could have the same tutor you’d be paying for coaching at the start of the day, then you just need basic supervision to ensure they’re studying and not playing on their phones.
See my earlier point about needing to have completed an accredited course through a school board before you're eligible for the college entrance exams. In practice, you need a school to sign you off for that. In the kind of school my younger cousin went to, attendance wasn't required. He'd come home early and attend private tuition. The best private tutors organized larger classes instead of 1:1 lessons, much more money that way. The distinction between that and "pure" homeschooling is academic.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
21hr ago
You actually do get taught things in colleges or uni. I've restricted myself to describing the conditions up till high school.
How well are you taught? Depends. But the prestigious institutions everyone fights over are prestigious for a reason. They have excellent teachers and the resources and time to teach to proper standards, even if I can't make a direct comparison to the West.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
21hr ago
No, he was suffering from malaria. Which I hope is not a heritable condition. All that afforded him was the opportunity to write the paper with an IV drip running, with a proctor physically present. I am unsure if the exam had a section on the prophylaxis or management of malaria, which is about the only scenario where this might provide an undue advantage.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
1d ago
What would be the point of designing a house that you can't build?
The only houses I've ever built were in the Sims or Rimworld, and I doubt they were up to code. If they were built in real life, I'd be sued. I'm glad that this is only an academic concern, I'm a doctor and the House of God has all the planning permits it requires.
But yes, if you're designing a house you intend to build and then live in, code compliance isn't something you should ignore. I'm just wistfully observing that even your recreational activities are incredibly pragmatic.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
1d ago
Hobbies can delay cognitive decline in old people. Try designing a code-compliant dream house.
This is the most ToaKraka sentence I can possibly imagine. I'm not sure if the emotion it evoked in me is surprise, per se, I'd need to consult that stupid book Tumblr loves, "A Dictionary of Obscure Sorrows".
Occhiolism? Adronitis? They're all made up words anyway, more made up than words normally are.
Your "dream house" is code-compliant. Of course it is. It could never have been otherwise.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
1d ago
why not have a private school where the curriculum is just exam coaching in the first place?
The officially recognized curricula for most boards till 12th grade mandate additional subjects that don't get assessed on pre-med or engineering entrance tests. You'd have to enroll your kid in a school anyway, and you'd need them to study subjects that aren't cram-worthy. STEM-track subjects are implicitly strongly weighted even inside normal schools.
Exams like the NEET/JEE also require that you graduate from specific accredited boards, usually government-recognized ones. Homeschooling probably doesn't count if you mean exclusive homeschooling without signing up with an "official" school.
Homeschooling is legal only after the age of 14, and how many parents do you think have the time for that here? It's not even super common in the States, where the existing culture is more favorable.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
1d ago
IQ at 6 is more stable than a pre-school test, but that is still not the ideal age for tracking. You're looking at r of 0.77 with a test done at 18, versus r of 0.89 if done at 12 and compared to 18.
https://www.mun.ca/biology/scarr/APA%201985%20Intelligence%20-%20Knowns%20and%20Unknowns.pdf
My point is that 6 is likely too early to make drastic decisions about tracking, and you probably want to revisit things several years later anyway and before 16. "Not reliable" is stronger wording than I should have used, but if you're going to use "top 10%" scores at the age of six for that kind of high stakes decision making, you've lost me. A far more sensible approach would be to at least administer tests 2-3 times in between, with gaps long enough to reduce practice effects.
IQ tests are only reliable when given that early, I don't know what you're on about. Testing adults only gives you a proxy score.
?
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
1d ago
IQ tests that early are not reliable, and there will be significant test-retest variability. You would, at the bare minimum, want to repeat the process several times. Adult IQ is much more stable.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
1d ago
My trusted and properly-accredited accountant/financial planner (ChatGPT) tells me that the answer is no. We don't have those in the UK.
The closest you can get is something called a Junior-ISA, which is very different, and not education specific. It'll only be a reasonable option after I have kids, which looks to be 3-5 years away. ChatGPT even said:
"If your position is “I want to save for future children, but not lock it into the assumption that university/college will matter,” then a Junior ISA may be worse than just using your own ISA, unless you actively want the money to become theirs at 18."
If I send my kids to school, which I will, it'll be for reasons like:
- It's legally required (the big one)
- It's functional daycare, which a professional couple would need to pay exorbitant rates for anywhere (another big one)
- Networking and credential games
- I'd rather they be well-socialized, all else being equal.
I'll worry about college funds when the kids actually exist, or in about 10 years. It's not nearly as expensive as in the States.
What's next, performance enhancing drugs? Anything for the extra edge.
You'd think so, but no. This was surprising to me, especially after I learned about the ADHD pill-mill in the US. The same thing just doesn't happen in India. I wager it's because the stigma around mental illness is so strong, and awareness so limited, that parents are unwilling to even pretend that little Ramesh could do with stimulants, or they don't even know it's an option.
Seriously, most people don't know anything about ADHD back in India. Most doctors knew fuck-all about it. My own peers in med school didn't take the pills, I only did because I had a legitimate diagnosis. They didn't even look at me and go "huh, maybe it's a good idea to go ask a psychiatrist for some?".
Also, we don't have the casual/easy to abuse reasonable adjustments system seen in the West. Unless you're legally blind or similar, you're not getting extra time on the test. Med students or pre-med applicants are known to give their exams from the hospital bed. My own cousin did that while in med school.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
1d ago
Huh? I could have sworn it cut me off halfway when I tried opening it yesterday, but that doesn't seem to be the case. I'm not quite sure what's going on here, and I hope it's not a psychotic break.
I have little to say on the topic of the regulatory and cultural failures that prevent stricter discipline within Western classrooms. Which is why I didn't get into that topic. What can I add that someone here can't do better? This is more of a comparative analysis of a very different system, with minimal focus on discipline because classroom discipline isn't what makes that system what it is.
I don't think that selecting for entrepreneurial tendencies is mutually exclusive with selecting for better didactic skills. Quite the opposite. If you're a poor teacher, you are simply not going to be able to pull off the moves I've described.
Note that I went to a good school, whatever that means. High tuitions, teachers with stronger credentials, above average students to be taught. There was a massive gulf in skills between what they taught and what the better class of private tutors (including the ones with larger class sizes) had.
In fact, the best tutors had bigger classes. I remember cramming in 20 to a room for some of them, the main limit on class sizes beings the size of the room. Many of these private tutors taught from their homes! They physically couldn't fit in more students! 1:1 teaching was never their core concern, at best, they'd be more open to talking to individual students and clearing up idiosyncratic confusions or answering questions.
The ones who specialized in 1:1 tutoring at home (theirs, or the student) were usually not as talented. If they were, they'd be organizing larger classes.
Even the comparison to AP lessons is somewhat misguided. The syllabus for normal schools and what gets tested on those college entrances exams are the same. The private tutors simply tend to teach it better. They put more effort into making things intuitive, they devote more time to teaching specific tricks. The teachers at even the best normal schools are phoning it in, even if they could technically go to such lengths. They don't, because they know that would be somewhere between pointless and redundant, for the better students, since they're going to private coaching anyway.
Remember, nobody cares about the dull ones. Their failures are on them. They may or may not go to the private lessons, but that's usually just their parents being unwilling to give up on them.
I agree with your last points. After all, I do know that you don't have to go to a top 1% or even top 5% institute in the States to have a good life or make a lot of money. Even a mediocre doctor makes a whole lot more than I do in the UK, let alone India. The competition is nowhere near as stiff to have a decent life in general.
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