site banner
PaperclipPerfector  5mo ago (text post)   31401 thread views

Culture War Roundup for the week of December 9, 2024

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.

6
Top Bottom Old Controversial Comments
Jump in the discussion.

No email address required.

No not really, we aren’t a large enough slice of the pie and you’d cause a shit ton of new problems. We’ve already seen this a bit. More people are working part time, quitting, dropping out of residency, graduating from medical school and not doing medicine, not providing certain types of services or working in certain locations. That’s with a modest decline in salary and things like an increase in administrative burden and a decline in respect. This would shoot up if you dramatically cut salaries.

Yeah, this is the eternal threat, right? But ok, what are these people going to do? How many jobs in America are there that pay as much as medicine and aren’t ’top of the corporate pile after a 40 year career’ type jobs?

Very, very few.

A few jobs in big tech. A few jobs in front office high finance. A few jobs in big law. A relative handful in (other) professional services.

None of those professions have medicine-tier job security. All of them (save maybe big tech) have very long hours. All of them are ultra-competitive.

Doctors on the internet always seem to assume they could be investment bankers or deepmind engineers instead, but I don’t think they could. The truth is that medicine is a lot less competitive and more midwit than most of these jobs. Plus, most of these jobs have an extreme up-or-out career progression that medicine just doesn’t have. Of a thousand junior investment bankers at Goldman Sachs who already passed an application process with a 1% acceptance rate, how many become managing directors or seniors in PE? Maybe thirty or forty. Most end up failing out into comfortable PMC professions, often paid less than many medical specialties and again still with far, far less job security.

Plus, there’s status. Nobody in modern American society has higher status than doctors, not billionaires and certainly not bankers, lawyers or engineers. That also has value - socially and for one’s own ego - that can’t be measured solely in pecuniary terms.

Even if medicine paid half as much there would still be doctors. There are still huge numbers of bright eyed, intelligent college students with elite credentials who want to be journalists.

I know you hate that argument so I very specifically didn't make it this time.

Based off your historical unwillingness to update your understanding of anesthesia compensation and work duties I don't think we are going to have a fruitful discussion on the doctor skills/role and work alternatives side of things.

By the way, and I truly am sorry if you’ve gotten that impression, I have a great deal of respect for doctors. I think you do a great job, and I think you should be well-paid for it. And and, I think doctors’ pay is only one part of the issue with the US system’s immense inefficiencies, of which a great deal can be laid at the feet of Congress, insurance companies (not out of ‘evil’ or even the profit motive, but just because of the perverse regulatory and incentive environment they’ve been out in), the way big pharma is funded and to some extent the tragedy of the commons.

My only real ‘thought’ on doctor pay is that we should have more doctors. Let’s train them, let’s import them (from native english-speaking countries with decent standards, like our peers in the anglosphere), let’s do whatever it takes to increase residency spaces. And let’s make residency easier, let’s limit medical liability to bring down the ridiculous cost of malpractice insurance, let’s make medicine an undergraduate course like it is elsewhere so doctors don’t have to waste four years and more money going into debt.

But yes, ultimately, let’s work to bring down some salary costs. Is that so unreasonable?

let’s import them (from native english-speaking countries with decent standards, like our peers in the anglosphere)

Do these people want to come? I'm not sure they do.

Other stuff.

Usually when this conversation comes up what happens is that I say something like "sure increase supply just don't compromise quality" and then someone says "being a doctor is easy, there aren't really quality differences or problems" I recall this argument from you in the past but if you don't endorse it now no problem, but ultimately most supply increasing options involve compromising quality in some way. Americans are mostly uninterested in decreasing quality, but if we decide that's on the table then we have a lot more tools available to solve some of these problems without touching supply at all.

Also, right now we seem to be in a situation where shortages are pronounced enough that the market can absorb a much higher number of physicians without bringing salaries down. In fact we likely need to increase salaries (specifically: one of the biggest problems right now is that people will refuse to work in red states or rural areas, these jobs already offer higher salaries, sometimes as much as twice as much, but in some cases that's not enough).

We already have some evidence that salaries are too low for some needs, taking salaries down further is liable to make those issues first (and again does little to decrease the overall healthcare costs).

Do these people want to come? I'm not sure they do.

I would be interested to hear @self_made_human respond to this, if willing.

Doctors from the Anglosphere?

Yes. At least some parts of it.

For example, British doctors are massively disgruntled, and a significant portion of them are trying to leave the country, though as always, the majority of people anywhere don't really want to emigrate. When Brits run, it's usually easier to go to Australia or New Zealand, where wages are markedly higher, work life balance is better, and their credentials are recognized as equivalent with little faffing around. Some opt for Canada.

Aus/NZ doctors are largely content, and only a small number want to move, and when they do the US is their goal most of the time.

If licensing regimes like the USMLE were relaxed for these specific countries, I doubt you wouldn't see a 2-5x efflux, comparable to the boost in salary they'd see, even if the working hours are worse.

Hell, I'd go if I could, I opted for the UK because I didn't have a better choice for long and painful reasons. Depending on how the job market looks in 3-6 years and if the barriers go, I could well be tempted in the future.

I'd say doctors from these countries are competent, especially native ones, I've certainly been nothing but impressed. They make do with shit wages and a QOL that is worse in many ways because of the UK being a stagnant country, but they're sticking around both because of inertia and because the US isn't easy to go to. They're seeing their own wages stagnate, and face stiff competition from international medical graduates (like yours truly, I have to look out for my own interests), training is unnecessarily long and painful, and many don't need more than a nudge to reconsider.

Thanks! I guess for context I considered you as "part of the Anglosphere", although there are different degrees of centrality to that concept. I remember you had a couple (interesting, IMHO) posts a while back about how difficult the US regime would have made transferring your education credentials.

I'd imagine most people here would consider the "Anglosphere" to be the Commonwealth countries plus the US, I doubt India would come to mind for them. While we have a gazillion English speakers, it's not strictly the language of the majority! I would hope that I qualify for honorary membership nonetheless haha.

I'm uniquely screwed when it comes to practising in the US, I won't elaborate since you seem to recall my moaning before, but even in an ideal world, I'd be looking at the USMLE and 3 years of residency. I haven't heard of anyone actually getting those requirements waived if they're a credentialed specialist elsewhere, but that could be my ignorance as opposed to me denying @Throwaway05 's claims. It's not a formalized route at any rate.

I suspect what's happening is that in general you have to redo residency but they keep it open as a possibility to get things waived in order to potentially steal somebody important. That resolves the tension between the anecdote (which I agree with) and the language on the website.

What is this place?

This website is a place for people who want to move past shady thinking and test their ideas in a court of people who don't all share the same biases. Our goal is to optimize for light, not heat; this is a group effort, and all commentators are asked to do their part.

The weekly Culture War threads host the most controversial topics and are the most visible aspect of The Motte. However, many other topics are appropriate here. We encourage people to post anything related to science, politics, or philosophy; if in doubt, post!

Check out The Vault for an archive of old quality posts. You are encouraged to crosspost these elsewhere.


Why are you called The Motte?

A motte is a stone keep on a raised earthwork common in early medieval fortifications. More pertinently, it's an element in a rhetorical move called a "Motte-and-Bailey", originally identified by philosopher Nicholas Shackel. It describes the tendency in discourse for people to move from a controversial but high value claim to a defensible but less exciting one upon any resistance to the former. He likens this to the medieval fortification, where a desirable land (the bailey) is abandoned when in danger for the more easily defended motte. In Shackel's words, "The Motte represents the defensible but undesired propositions to which one retreats when hard pressed."

On The Motte, always attempt to remain inside your defensible territory, even if you are not being pressed.


New post guidelines

If you're posting something that isn't related to the culture war, we encourage you to post a thread for it. A submission statement is highly appreciated, but isn't necessary for text posts or links to largely-text posts such as blogs or news articles; if we're unsure of the value of your post, we might remove it until you add a submission statement. A submission statement is required for non-text sources (videos, podcasts, images).

Culture war posts go in the culture war thread; all links must either include a submission statement or significant commentary. Bare links without those will be removed.

If in doubt, please post it!


Rules


Recommended Posts And Communities

Recommended Realtime Chats