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 -
Sounds like a convenient way to set an arbitrary bar that limits the supply of doctors. Lawyers went through a rapid expansion in supply, and it did not reduce the quality of law. If anything, allowing the competition to take place in the open has increased the bar for getting into elite law-schools. But now, there is also a sufficient supply of mediocre lawyers who fulfill mundane legal duties.
I apologize for sounding harsh, but that is a bad justification. More so on a forum that prides itself in identifying collective incompetence and blind-spots in elite circles. This is the common excuse of Bureaucrats & careerists who love abstractions more than action.
Don't the abusive conditions of residency have a lot to do with why people drop out ?
Aren't mid-levels explicitly 'not cardiologists'. My understanding is that majority of issues are obvious and having a mediocre individual take care of it is a correct allocation of resources. I have a heart problem I have looked at by a cardiologist every 2 years (back in India). The most valuable thing he does is to look at my ultra sound. The ECG is taken by a mid-level and he does the ultrasound because I am long time customer, but a mid-level could do that too. The highest value thing he does is review the ultra sound, and then tell me that my heart is still okay and I am good to go.
His resources are best used for the last part of my checkup (the review) and to spend majority of his time on real emergencies. What's wrong with that ?
eh, I disagree on both points. The ethical problems have never been an issue in the US. Brain-gain is a fundamental national value. Practically, the USMLE + residency matching is hellish for international candidates. I'll let @self_made_human chime in, but it USMLE qualified doctors being incompetent is setting off a bullshit alarm for me.
If I had to speculate, the bottleneck for international candidates is the residency. And it is easiest to get residency slots in the least-desirable towns and cities. It's possible that top international candidates would never agree to waste 3 extra years in the middle of bumfuck nowhere, and therefore only mediocre candidates apply. Top candidates are in competitive fields like cardiology, which needs them to waste about 6-7 extra years in bumfuck nowhere, making it more unlikely that they'll apply."
You'd be surprised. The cutting edge of AI (complex agent swarms) is years ahead of what people think is the cutting edge. (chatgpt subscription).
For example, a chatgpt subscription is 20$/month. I routinely burn 100s of dollars/day in LLM costs. The strongest models are capable of insane things, but it feels like only people in some small circles have realized it so far.
It's still not ready yet, but objects in the mirror are closer than they appear.
The point is that most people who have an opinion on this wildly misunderstand the reality of the situation with respect to the role of the AMA, where the shortages are, how much physicians get paid (millions a year??? see down thread), how much of US healthcare spending is on doctors and so on.
Having an opinion does not mean one has a realistic understanding of what is happening and how to fix it.
To me this is a classic Gell-Mann amnesia issue. I see how firm and misinformed most people who post on this topic here are and it makes me trust the experts vs. posters here on topics I am not knowledgeable on.
More options
Context Copy link
This is the issue that gives me pause with medical education questions. What proportion of procedures are fairly trivial and easily enough handled by a mid-level, and furthermore what proportion of high complexity procedures are creating equivalent value to their cost.
It looks to me that getting population life expectancy up to the mid 70s is fairly trivial for modernized economies. I'd imagine a lot of that is picking the proverbial low-hanging fruit of basic sanitization, improving maternal health etcetera. On top of that, a bunch of public health considerations like diet and general longevity seem to be worth half a decade or so. How much is endless battling over medical funding actually doing
Unrelated bit first - great user name.
So the issue is that the triage is the work for a lot of medicine. That's basically a vast majority of what emergency medicine is for.
For a simple example (in the sense that triage nursing programs and AI can handle this one):
Someone comes in with chest pain. Do you give them some tums or give them a hundred plus thousand dollar cardiac work-up? Do they get better in three seconds or die.
Knowing to ask things like "hey did you just have a 3 pounds of spaghetti with red sauce?" lets you figure it out.
A more complicated question might be something like "this person fell, do you scan their head before sending them home?" which has a lot of research, debate, and need for asking patients (who may be unreliable) very specific questions.
Once you've triaged and diagnosed them things get simpler, but at that point to a large extent the work is already done.
Also - Americans need someone to sue.
More options
Context Copy link
More options
Context Copy link
Citation very much needed for that one.
The bar is still quite low for those with the correct skin color and/or genitalia, and many schools are trying to find ways to lower it even more by not requiring applicants to take the LSAT (which has also been watered down).
Not the case for many non-metro areas in the U.S. Law schools are cranking out all kinds of graduates, many underqualified, yet lots of rural areas have fewer lawyers per capita than they did in the 80s and 90s. See the whole "legal deserts" discussion.
More options
Context Copy link
I have been intentionally sitting this whole conversation out. It hits too close to home. There is also a lot going on atm, but if you do want my full take I can come back to this, probably as another comment. This only serves to let you know I noticed.
Leaving me hanging bro!
(no its okay I know you disagree with me on some of this, especially AI)
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link