This weekly roundup thread is intended for all culture war posts. 'Culture war' is vaguely defined, but it basically means controversial issues that fall along set tribal lines. Arguments over culture war issues generate a lot of heat and little light, and few deeply entrenched people ever change their minds. This thread is for voicing opinions and analyzing the state of the discussion while trying to optimize for light over heat.
Optimistically, we think that engaging with people you disagree with is worth your time, and so is being nice! Pessimistically, there are many dynamics that can lead discussions on Culture War topics to become unproductive. There's a human tendency to divide along tribal lines, praising your ingroup and vilifying your outgroup - and if you think you find it easy to criticize your ingroup, then it may be that your outgroup is not who you think it is. Extremists with opposing positions can feed off each other, highlighting each other's worst points to justify their own angry rhetoric, which becomes in turn a new example of bad behavior for the other side to highlight.
We would like to avoid these negative dynamics. Accordingly, we ask that you do not use this thread for waging the Culture War. Examples of waging the Culture War:
-
Shaming.
-
Attempting to 'build consensus' or enforce ideological conformity.
-
Making sweeping generalizations to vilify a group you dislike.
-
Recruiting for a cause.
-
Posting links that could be summarized as 'Boo outgroup!' Basically, if your content is 'Can you believe what Those People did this week?' then you should either refrain from posting, or do some very patient work to contextualize and/or steel-man the relevant viewpoint.
In general, you should argue to understand, not to win. This thread is not territory to be claimed by one group or another; indeed, the aim is to have many different viewpoints represented here. Thus, we also ask that you follow some guidelines:
-
Speak plainly. Avoid sarcasm and mockery. When disagreeing with someone, state your objections explicitly.
-
Be as precise and charitable as you can. Don't paraphrase unflatteringly.
-
Don't imply that someone said something they did not say, even if you think it follows from what they said.
-
Write like everyone is reading and you want them to be included in the discussion.
On an ad hoc basis, the mods will try to compile a list of the best posts/comments from the previous week, posted in Quality Contribution threads and archived at /r/TheThread. You may nominate a comment for this list by clicking on 'report' at the bottom of the post and typing 'Actually a quality contribution' as the report reason.
Jump in the discussion.
No email address required.
Notes -
You Did It To Yourself
Again, the endless seething by doctors over their ongoing replacement by “physician associates/assistants” (PAs) and “nurse practitioners” (NPs) rears its head. The many concerns that physicians have about NP/PAs are, of course, entirely valid: they’re often stupid, low-IQ incompetents who have completed the intellectual equivalent of an associates degree and who are now trusted with the lives of people who think they’re being cared for by actual doctors.
Story after story describes the genuinely sad and infuriating consequences of hiring PAs, from grandparents robbed of their final years with their families to actual young people losing 50+ QALYs because some imbecile play-acting at medicine misdiagnoses a blood clot as “anxiety”. Online, doctors rightfully despair about what NPs are doing to patient care and to their own ability to do their jobs.
But there’s a grand irony to the nurse practitioner crisis, which is that it is entirely the making of doctors themselves. If doctors had not established a regulatory cartel governing their own profession, the demand that created the nurse practitioner would not exist. The market provides, and the market demanded healthcare workers who did the job of doctors in numbers greater than doctors themselves were willing to train, educate and (to a significant extent) tolerate due to wage pressure. It is a well-known joke in medical circles that doctors often have a poor knowledge of economics and make poor investment decisions. This is one of them; the market invented the nurse practitioner because it had to. Now all of us face the consequences.
I had multiple friends who attempted to get into medical school. Some succeeded, some failed. All who tried were objectively intelligent (you don’t need to be 130+ IQ to be a doctor, sorry) and hard working. The reason those who failed did so was because they lacked obsessive overachiever extracurriculars, or were outcompeted by those who were unnecessarily smarter than themselves (there is also AA, especially in the US, but that’s a discussion we have often here and I would rather this not get sidetracked).
The problem goes something like this: smart and capable people who just missed out on being doctors (say the 80th to 90th percentile of decent medical school candidates, if the 90th to the 100th percentile are those who are actually admitted) don’t become NPs/PAs. This is because being an NP/PA is considered a low-status job in PMC circles; not merely lower status than being a doctor, but lower status than being an engineer, a lawyer, a banker, a consultant, an accountant, a mid-level federal government employee, a hospital administrator, a B2B tech salesman etc, even if the pay is often similar. To become a PA as a native born member of the middle / upper middle class is to broadcast to the world, to every single person you meet, that you couldn’t become a doctor (this isn’t necessarily true, of course). This means that NPs and PAs aren’t merely doctor-standard people with less training, they’re from a much lower stratum of society, intellectually deficient and completely unsuited to being substitute doctors (the work of whom, again, doesn’t require any kind of exceptional intelligence, but it does require a little). Almost nobody from a good PMC background who fails to get into medical school or, subsequently, residency is going to become a PA/NP for these reasons of social humiliation, even if the pay is good.
Nobody who moves in the kind of circles where they have friends who are real doctors, in other words, wants to introduce themselves as a nurse practitioner or physician associate. A similar situation has happened in nursing more generally. Seventy years ago, smart women from good backgrounds became nurses. Today some of those women become doctors, but most go into the other PMC professions. Nursing became a working class job, and standards slipped. Still, nursing is still often less risky (although there are plenty of deaths caused by nurse mistakes) than the work undertaken by NPs and APs. Nursing became if not low status then mid status, and is now on the level of being a plumber or something - well remunerated, but working class.
The result is a crisis of doctors’ own making. Instead of allowing (as engineers, bankers and lawyers do) a big gradation of physicians, all of whom can call themselves the prestige title doctor but who vary widely in terms of competence, pay and reputation in the profession, doctors have focused on limiting entry, reserving their title for themselves and therefore turning away many decent candidates. (Of course there is a status difference between a rural family doctor and a leading NYC neurosurgeon, but the difference between highs and lows is different to the way it would be if medical school and residency places were doubled overnight.) The karmic consequence of this action is that they are now being replaced by vastly inferior NP/APs who deliver worse care, are worse coworkers and who will ultimately worsen the reputation of the broader medical profession.
What will it take to convince the medical profession, particularly in the US, to fully embrace catering to market demand by working to deliver the number of doctors the market requires, rather than protecting their own pay and prestige from competition in a way that leads to ever more NP/APs and ever worse patient outcomes? The US needs more doctors, especially in disciplines like anaesthesiology, dermatology and so on paid $200k a year (which, much as it might make some surgeons wince, is in fact a very respectable and comfortable income in much of the country). Deliver them, and the NP/AP problem will fade away as quickly as it began.
US physicians (I will not call them doctors unless they are an MD, the word doctor comes form the latin docere, meaning to teach; unlike how the uncultured may think about it, true doctors are those with a Ph.D, not those with a BChir, there's a reason why in places like Germany these people are not allowed to call themselves "Doktor" but instead go by "Arzt") are so far up their own ass with how highly they value themselves that it boggles the mind.
I have met many many doctors and the vast majority of them are sub 98th percentile mediocrities pretending they are the intellectual equals of the 99.5th+ percentile thinkers. I've said before that the 95th percentile human being has a lot more in common intellectually with a 10th percentile human being than he does with a 99th percentile human being and something similar applies for the average doctor who isn't much better than a 95th percentile human but has the ego of a 99.9th percentile one (not saying there are no amazing doctors, I've met some of those too but they are the exception, not the average and they tend to be MDs).
I'd be very interested in comparing the average outcome of a NP with the latest AI models trained on giving medical diagnoses vs a lone doctor. My prior is that the NP+AI performs at least as well as a doctor in most non-surgical specialties. If so then the optimal thing for humanity is to cry havoc, give NP+AI combinations the same powers and responsibilities as "full" doctors and let slip the dogs of war on the protection racket US "doctors" are running. Of course this is a pipe dream (never mind the extreme litigiousness of the US meaning NP+AI malpractice insurance costs will be through the roof but that's a discussion for another day) but yeah, either we all grasp the nettle and do something like this or the economic rent seeking of the AMA will continue to extract blood from the rest of society.
Really? How many 10th percentile people do you meet?
The 10th percentile are the ones breaking into bald men's heads looking for gold or deflowering virgins to cure their AIDS. Or they star in the genre of youtube videos exposing how stupid and ignorant American university students are: https://youtube.com/watch?v=AkIUqH498PQ
The more cerebral of this cohort might subscribe to conspiracy theories about how the earth is flat, how everything is actually naval law and most countries are secretly enrolled as corporations in Delaware... They still cannot string a sentence together though, nor can they spell.
Yeah, people tend to flatter themselves that there is a huge gulf in abilities between their own tier and the tier immediately below them (but, strangely, never the tier immediately above them).
It's why so much internet energy is spent talking about "midwits".
A simpler and more accurate model : intelligence matters a lot at every level with no high or low cutoff.
I freely and openly admit that the people above me are much more exalted than I could ever hope to be. I recently interviewed a candidate at work who was applying for a quant job and he absolutely floored me with how intelligent he was, telling me things I hadn't realized about the mathematical question I ask people a few short tens of minutes after seeing the question for the first time. I came away from that interview thinking that I had just come into contact with someone blessed with true shape rotator greatness.
At least I am at the level where I could appreciate what I had just seen, unlike the average 95th percentile person who is so far removed from it that he wouldn't be able to tell the difference between me and this person had he been the one taking the interview instead.
What intellectual percentile would you rate yourself?
If I'm flattering myself probably 99.8, but in reality more like 99.5 or 99.4. (normalized to white western levels, compared to my own people I'm significantly higher).
One in 200 is probably how unique I think my intelligence really is. I'm quite conscientious and like learning about basically everything so I think I present as smarter than I really am because I can talk decently about a lot of things.
Back when I was a child I had delusions of being Great. Those were shattered very quickly when I began my maths degree at Oxbridge and got a chance to mingle with IMO hall of famers.
They were just at another level to me and despite initially foolishly thinking all I had to do was work harder and then I too could reach their level (note: I did not succeed, all that happened was I burnt out) eventually after getting smacked around enough by reality I learned to love my lot in life and go down a gear. I had a lot more fun too after I did this.
My dharma is not to achieve great things but at least I am at the point where I am capable of truly appreciating greatness when it is presented to me (unlike most humans) and I am thankful for that. It's much better to get into a state of resonance with the music of the universe ather than try and fight against it vainly. That way lies the path of Morgoth and we all know how that worked out...
I scored in the 99th percentile on verbal tests and somewhere around the 92-95th on spatial, so I’m not sure where that puts me overall, probably below you. Still, while I’ve met many much smarter people I find them generally easier to speak to and understand than people in the lower third of the population. Of course if the conversation turns to a niche special sub-field in theoretical physics or math or formal logic that I have never studied I’m not going to be able to follow, and my middling shape rotation ability means I’m not going to be able to hold my own with star traders at the poker table or when it comes to logic puzzles. But they don’t ever feel ‘foreign’ to me; I can understand the ideas even if I can’t derive them, if you want.
More options
Context Copy link
Well, you're doing better than Salieri, then.
Honestly I think Salieri gets unfairly maligned a lot. Modern scholarship (forget that movie, I'm talking academic scholarship) thinks there was no real beef between him and Mozart but the rumours, even during his life, led to him having a nervious breakdown and even now in the modern day the general public (to they extent they know of him) still boo him even though they wouldn't be able to distinguish a piece by Mozart vs one by him.
The dude tutored both Schubert and Beethoven, give him some respect!
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link