889906 Good evening, thank you for another excellent critical essay. I guess I’m an aberration. Today is my 82nd birthday. I just returned from a very enjoyable and I think productive day at the office. I completed two research projects before medical school: one during the summer before I started medical school working as a lab assistant cutting off hundreds of innocent mice heads and removing the caudate nucleus of hundreds more rats as part of the basic research to assay brain amines which ultimately resulted in the production of l-dopa to treat Parkinson’s disease. The second project was aimed at trying to determine if there was decreased resistance to respiratory infection in Navy recruits given the stress of Boot Camp. Also another fairly successful project demonstrating how stress decreases our immune response. That’s it. No further research. From that day forward i.e. approximately 1966, I felt that most research done by premed, Med students and post grads is borderline worthless. And, perish, the thought, I did the research because I needed the money provided by these part-time jobs;I was already admitted to medical school. Now I have read that this busy work is done simply to get it in to medical school. What a waste of time and money. During my medical school interview to Loyola Stritch in Chicago, I think my answer to the question: “why do I want to be a doctor?” is what got me in. I stated I think I have the ability to assimilate information, the ability to physically perform the job, and the great desire to do something productive with my life, helping people with problems they can’t get through without my help. Medicine has been a great joy and continues to be so. No burnout problems but also no corporate entity is telling me what to do.
Thank you for your obstinate persistence in the pursuit of the acceptance of reality.
Vinay, All completely correct. But the real elephant in the room is the utterly broken admissions process. As one involved (shrieking the entire time) in the process for years, the migration from those who have the mental ability and the desire to do good to those most distinguished by demographics and "distance traveled" has been devastating. Of course everything moved to pass/fail (including boards) because the futility of admitting those who will never be qualified to be decent physicians immediately became obvious. The rest the powers-that-be hope gets lost in letting AI take care of patients for those who cannot. (Or something...I have never figured it out.)
Of course, there are marvelous students that get admitted as well. But in some schools (including some well known to you) it is a struggle to get the best admitted because they "have not slept in their trunks". And the system is designed to make sure that no one (other than faculty at the training institution) can figure out who are the stars and who are those who should never have been admitted. I advise all my friends to not see a doctor under 50. Not because there are not good ones under that age (because there are) but because my friends are likely in a position not to be able to tell and with no way to find out.
So the changes in admission need to go far beyond the ridiculous "papers to show I'm really cool" motif. They need to hark back to the whole point: find those with the mental ability to handle something as integrated and multifactorial and complex as medicine, match it with a desire to actually help people, and combine that with a willingness to be a professional -- which means hours way beyond "work/life balance" allows. We have a long ways to go to repair something that used to work quite well. Fixing the research thing is far from the first thing to be done. But any contribution will be good.
“The rest the powers-that-be hope gets lost in letting AI take care of patients for those who cannot. (Or something...I have never figured it out.)”
If you read the business literature in the “healthcare” sector, you will see that the opinion leaders are dead solid SOLD that the APP + AI model will increase profits (a/k/a “margin”), improve “quality” (more and better boxes checked, more guideline “compliance”), and make happier customers.
As far as it goes, I’m pretty sure they are correct about this.
“ Because my research has been challenging of conventional, entrenched interests”
You are so rare and precious, and such an aberration. Thank you for all you do!
Perhaps the reason med school admissions works the way it does today is precisely to protect those conventional interests, not to help future patients.
Think of the personality types you are attracting by demanding complete dedication to building a resume starting at age 14. No life experience, no wisdom, no time to read great books and think deeply about them, just checking internship boxes in between MCAT prep classes.
Is this a person more or less likely to follow whatever guideline Dr Fauci tells them to follow? Is this a person who will disobey medical guideline orders - and endanger their resume - if they might harm a child’s soul?
I think we all learned the answer to this the last few years.
When I wrote about this a while ago, I compared the medical recruitment process to the dirty dozen… trying to run a psych experiment to recruit the ones least likely to have a conscience…
And it works! Had I remained in the large, corporate/academic bureaucracy I was trained in, I would never have had a chance to speak out against trans madness, since I would have already been fired for speaking up about Covid…
All of us who were once medical students excelled at one thing, from an early age - discovering what “they” wanted, and delivering it.
The end of grades, and its replacement by outcomes, along with the end of evaluations by teachers and its replacement by those of patients and families, used to mark a major transition in our lives.
Changes in payment from payers and ownership of resources by healthcare systems have extended the grading period far, far past the end of second year.
The ability to keep getting excellent grades (coding, “documentation”, “billing requirements”, CME, MOC, etc) beyond the age of 26 has had a seductive effect on a certain type of mind.
Retreat to the warm comfort of your own cleverness, measured with precision, is an antidote to the existential dread involved in life, death, injury, madness, decay with age, and all the rest of the day to day job.
And, if “margin” increases sufficiently, there may even be something of a material nature in it for you.
Argh…the sad part of this article was for Dr. Ben having risked his early career by reporting scientifically. Which leads me to the saddest conclusion that politics is not correlated with real science.
I state the premise plainly: the social purpose of medical school, the claim it places on resources and esteem, is to produce the next generation of physicians and surgeons, SOME OF WHOM will have the desire and the talent to become the next generation of faculty.
Once overproduction of faculty becomes the mark of success, the process accelerates, the “stars” hang on while the lesser lights head out to do The Work.
Over my career, resentment over status has accelerated among both groups - for the former, because “many are called but few. are chosen”, and for the latter because the voluntary teaching model has decayed for many reasons, some but not all outside of the remit of medical school leadership.
Research is important but it has been to be viewed in terms of where American is today:
40 $TRILLION in debt and no way to pay the interest. 9 out of 10 have CKM. And 70% are WAISTED35-- or obese. So maybe it is also the TRADEOFF principle. I guess Triage. We can do so little given our universal health issues and our lack of money. 250 years was a nice long ride. Nothing lasts forever.
889906 Good evening, thank you for another excellent critical essay. I guess I’m an aberration. Today is my 82nd birthday. I just returned from a very enjoyable and I think productive day at the office. I completed two research projects before medical school: one during the summer before I started medical school working as a lab assistant cutting off hundreds of innocent mice heads and removing the caudate nucleus of hundreds more rats as part of the basic research to assay brain amines which ultimately resulted in the production of l-dopa to treat Parkinson’s disease. The second project was aimed at trying to determine if there was decreased resistance to respiratory infection in Navy recruits given the stress of Boot Camp. Also another fairly successful project demonstrating how stress decreases our immune response. That’s it. No further research. From that day forward i.e. approximately 1966, I felt that most research done by premed, Med students and post grads is borderline worthless. And, perish, the thought, I did the research because I needed the money provided by these part-time jobs;I was already admitted to medical school. Now I have read that this busy work is done simply to get it in to medical school. What a waste of time and money. During my medical school interview to Loyola Stritch in Chicago, I think my answer to the question: “why do I want to be a doctor?” is what got me in. I stated I think I have the ability to assimilate information, the ability to physically perform the job, and the great desire to do something productive with my life, helping people with problems they can’t get through without my help. Medicine has been a great joy and continues to be so. No burnout problems but also no corporate entity is telling me what to do.
Thank you for your obstinate persistence in the pursuit of the acceptance of reality.
Vinay, All completely correct. But the real elephant in the room is the utterly broken admissions process. As one involved (shrieking the entire time) in the process for years, the migration from those who have the mental ability and the desire to do good to those most distinguished by demographics and "distance traveled" has been devastating. Of course everything moved to pass/fail (including boards) because the futility of admitting those who will never be qualified to be decent physicians immediately became obvious. The rest the powers-that-be hope gets lost in letting AI take care of patients for those who cannot. (Or something...I have never figured it out.)
Of course, there are marvelous students that get admitted as well. But in some schools (including some well known to you) it is a struggle to get the best admitted because they "have not slept in their trunks". And the system is designed to make sure that no one (other than faculty at the training institution) can figure out who are the stars and who are those who should never have been admitted. I advise all my friends to not see a doctor under 50. Not because there are not good ones under that age (because there are) but because my friends are likely in a position not to be able to tell and with no way to find out.
So the changes in admission need to go far beyond the ridiculous "papers to show I'm really cool" motif. They need to hark back to the whole point: find those with the mental ability to handle something as integrated and multifactorial and complex as medicine, match it with a desire to actually help people, and combine that with a willingness to be a professional -- which means hours way beyond "work/life balance" allows. We have a long ways to go to repair something that used to work quite well. Fixing the research thing is far from the first thing to be done. But any contribution will be good.
“The rest the powers-that-be hope gets lost in letting AI take care of patients for those who cannot. (Or something...I have never figured it out.)”
If you read the business literature in the “healthcare” sector, you will see that the opinion leaders are dead solid SOLD that the APP + AI model will increase profits (a/k/a “margin”), improve “quality” (more and better boxes checked, more guideline “compliance”), and make happier customers.
As far as it goes, I’m pretty sure they are correct about this.
“ Because my research has been challenging of conventional, entrenched interests”
You are so rare and precious, and such an aberration. Thank you for all you do!
Perhaps the reason med school admissions works the way it does today is precisely to protect those conventional interests, not to help future patients.
Think of the personality types you are attracting by demanding complete dedication to building a resume starting at age 14. No life experience, no wisdom, no time to read great books and think deeply about them, just checking internship boxes in between MCAT prep classes.
Is this a person more or less likely to follow whatever guideline Dr Fauci tells them to follow? Is this a person who will disobey medical guideline orders - and endanger their resume - if they might harm a child’s soul?
I think we all learned the answer to this the last few years.
When I wrote about this a while ago, I compared the medical recruitment process to the dirty dozen… trying to run a psych experiment to recruit the ones least likely to have a conscience…
https://gaty.substack.com/p/when-the-job-descriptions-for-doctors
And it works! Had I remained in the large, corporate/academic bureaucracy I was trained in, I would never have had a chance to speak out against trans madness, since I would have already been fired for speaking up about Covid…
All of us who were once medical students excelled at one thing, from an early age - discovering what “they” wanted, and delivering it.
The end of grades, and its replacement by outcomes, along with the end of evaluations by teachers and its replacement by those of patients and families, used to mark a major transition in our lives.
Changes in payment from payers and ownership of resources by healthcare systems have extended the grading period far, far past the end of second year.
The ability to keep getting excellent grades (coding, “documentation”, “billing requirements”, CME, MOC, etc) beyond the age of 26 has had a seductive effect on a certain type of mind.
Retreat to the warm comfort of your own cleverness, measured with precision, is an antidote to the existential dread involved in life, death, injury, madness, decay with age, and all the rest of the day to day job.
And, if “margin” increases sufficiently, there may even be something of a material nature in it for you.
What could go wrong?
Argh…the sad part of this article was for Dr. Ben having risked his early career by reporting scientifically. Which leads me to the saddest conclusion that politics is not correlated with real science.
Prima facie assumption:
NEVER is a politician speaking about actual science.
It needn’t be a crap shoot.
And there’s a great need for good research by those who do understand the broader implications.
Unfortunately, the system can be counted on to throw those individuals out.
I state the premise plainly: the social purpose of medical school, the claim it places on resources and esteem, is to produce the next generation of physicians and surgeons, SOME OF WHOM will have the desire and the talent to become the next generation of faculty.
Once overproduction of faculty becomes the mark of success, the process accelerates, the “stars” hang on while the lesser lights head out to do The Work.
Over my career, resentment over status has accelerated among both groups - for the former, because “many are called but few. are chosen”, and for the latter because the voluntary teaching model has decayed for many reasons, some but not all outside of the remit of medical school leadership.
Research is important but it has been to be viewed in terms of where American is today:
40 $TRILLION in debt and no way to pay the interest. 9 out of 10 have CKM. And 70% are WAISTED35-- or obese. So maybe it is also the TRADEOFF principle. I guess Triage. We can do so little given our universal health issues and our lack of money. 250 years was a nice long ride. Nothing lasts forever.