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OpEd in the Medical Post

Guest therealcrackers

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Guest therealcrackers

This article appeared in the Medical Post June 10 of this year.

What are people's thoughts about this doctor's point of view?

And does where you are in the medicine process (thinking, applying, in med school, finishing) have a bearing on people's thoughts?




"OPED: Ending subsidies


Is it really such a shocking idea to suggest medical students pay the full cost of their education and their admission be based on marks alone?


By John Hostetler


In "Should there be age limits for med school" (the Medical Post, May 6), Dr. Richard Gruneir wrote of his encounter with a 51-year-old medical student. I'm sympathetic with the general thrust of Dr. Gruneir's argument that the desirability of having medical students that old needs consideration, but I would also go much further.


In an enlightened society, the decision of that student to attend medical school would occur in the only forum time-proven to create durable benefits from such decisions: the free market. In an enlightened society, that 51-year-old would either already have the means to pay for his total medical education or he'd have to learn some of the principles of the market, put together a business plan, take it to a lender and justify with his future earnings the borrowing of $200,000 to $300,000 over the next four years. That's a lot of money, but in the type of society I'm discussing, his future earnings would also be set by the market, not by the government, and would be much higher than the earnings he faces in a few years.


In an enlightened society, he wouldn't decide to study medicine just because it seems like a challenging, self-gratifying field, it's at least 70% subsidized and there's a prevailing political correctness throughout our universities, so that they play the "-isms" of genderism, heterosexism and racism like so many cards, including one of the latest, agism.


Canadians, including physicians, have been inculcated with fear of ideas like the suggestion medical students should pay the full cost of their education, so I can sense all the reflex reactions now: Education would be elitist, only the rich could become doctors and so on.


Basically, this is a fear of monopoly by the wealthy. In North America, this fear stems from the 1930s Depression, which cast a long shadow over the next several decades. Then, mainly the rich went to university and mainly the rich had many other privileges.


I have four comments on this. One, many economists now feel the 1930s began with a particularly sharp recession that was actually converted to a prolonged and severe depression by state intervention against the corrective capacity of the market.


Two, the whole notion that large numbers of people from middle-income backgrounds might go to university at all did not exist before the sponsorship of returning veterans in 1945.


Three, the existence of past monopolies in education, first class-based and then wealth-based, does not mean the current government monopoly is any less restrictive in outcome.


Four, these past monopolies existed at a time when understanding of markets and the problem of monopolies were much less advanced than they are now. It's ridiculous to continually react to current proposals with emotions triggered by events of 70 years ago, events free markets could have ameliorated anyway. It suggests we've learned nothing since.


Apart from this argument against fear of elites, there is another, more controversial one. Having some disproportion of university students in favour of high-income backgrounds is not bad, per se. It would be the inevitable outcome of a system based on pure merit in any case. The correlation between personal income and IQ is about 0.30, which is not shabby in the social sciences, and the correlation between parent and child IQ is about 0.45, which is downright respectable, even in biology.


Therefore, there is some tendency for smart people to have high incomes and to have smart children. Certainly, these correlations are well below 1.00, so there's plenty of reason to encourage smart people who don't happen to be wealthy to go to professional school, but the correlations show there is no good reason to be prejudiced against the wealthy just for being wealthy.


Essentially, this elderly student has been admitted through an undeclared program of affirmative action. The factors contributing to official quotas I'm aware of are province or region of origin (usually), premedical university attended (often), and ethnic status as to aboriginal or non-aboriginal background (some programs). Unfortunately, in typical Canadian fashion, there is plenty of room for undeclared affirmative action.


When I attended Queen's University, the admissions committee apparently weighted the applicant's academic record 50%, and other factors 50%. Officially, all Queen's had for "other" in those days was a personal statement, a CV and letters of reference.


A classmate suggested that, since everybody had done just the right things to get into medical school, or at least written about them in just the right way, it all boiled down to marks anyway. Maybe he was right, but I can't help suspecting the 50% leaves a wide margin for social activism in the committee chambers.


For example, someone decides there aren't enough women in Canadian medicine. Presto, volunteering at a woman's shelter counts more than an athletic career in amateur wrestling. Someone decides there aren't enough pentagenarians in Canadian medical schools. Presto, 25 years of working in international aid counts more than being an earnest young kid who always wanted to be a doctor.


My own feeling about admission to medical school is that marks should be far and away the most important factor; in the sciences, nothing else available comes close for estimating an applicant's intelligence and capacity for hard work.


Let marks provide the standard for qualification to medical school, and let financial worth, or willingness to borrow, provide the means to attend.


Everything else is less fair. Basically, what Dr. Gruneir is suggesting is conservative notions are a better foundation for social tinkering than the leftist notions of an admissions committee that would provide a 51-year-old with a state-subsidized medical education. What I'm saying is: a pox on both schools of tinkering and all such tinkering. The market is much smarter, and more beneficent, than any committee of experts."


John Hostetler is a physician in Victoria



My own little editorial:


I have to admit that I, myself, got rather incensed when I read it, but that's just my opinion. I'm graduating with likely $100K in debt, near the upper limit of what the banks will lend any professional student, and I'm supposed to be thankful? And all of medicine is supposed to be about the almightly dollar? I read that Bertrand Russell has said that of all the sciences, medicine is king, because it deals specifically with us as persons and human beings. Market forces notwithstanding, I'd rather be treated by a human being than someone's economic theory of a doctor.

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Guest macMDstudent

What was not acknowledged at all in this editorial was that in the last couple decades, the average person has been living much longer that in the first part of the 20th century. Today, the average age that people can be productive has increased significantly and assuming that the 51 year old medical student wanted to work for 20 years or more by more by the time he finishes residency, then that is entirely possible. Surely someone who is calling for such "market value" standards would not agree to having a minimum number of years of service as a physician regulated on all future grads. How many years of service is enough? How about the years of residency, with long hours of patient care and little pay? Is that enough "payback" to the system? Or is a certain number of years required after residency?


By tinkering with the cost of education and the allusions to having a market value renumeration when in practice as a physician, this piece has massive implications. It sounds like the author not only want to remove government funding for education, but wants the Canada Health Act scrapped so we can follow the road that the USA has gone with its 40 million people without health care coverage but excellent care for those who are rich enough or lucky enough to have coverage. This would help doctors make lots of money serving the elite and lucky few who have enough coin to pay, therefore any cost of education would be minor in the long run. This is not the way our society should go, in my opinion.


As for marks being the "only" criteria, I think that would be a massively regressive step. So much of medicine is dealing with people. The movement to patient centered care as grown in lockstep with the selection of better rounded individuals to medicine. Going back to a paternalistic system would benefit nobody expect the egos of those were chosen for their ability to excel at academics, which is only one part of a person's ability to provide good patient care.


I sure hope this author has no official role on an admissions committee or any government liason group. This sounds like someone pining for the "good old days" to me and is unwilling to change with the times.

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Guest ploughboy


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Some additional data, here's the oped piece referred to by Dr. Hostetler. Didn't know if I should post it here or in a seperate thread, since it's more of a "medical school is a young (wo)man's game" article, where Hostetler's piece focuses on the admission process itself. Mods, feel free to relocate it...


I'll scribble down my reaction to both pieces later (maybe tomorrow, when I've peeled myself off the ceiling).


Let me just say that I'm not surprised that someone (Hostetler) who, in his writing style at least, doesn't come across as much of a human being wouldn't see the value in a personal interview.


How's that for an inflammatory statement?






* * *


OPED: Should there be age limits for med school?


By Richard Gruneir



I met a 51-year-old medical student recently. He will finish when he is 53 and will ultimately get to practise as a family doctor when he is 55.



It got me wondering whether this was a good use of the scarce resource of medical school slots when we have a shortage of doctors in this country.



At 55, when his practice will start, he will have only 15 years or so to practise before retirement sets in.



His classmates, finishing at about age 28, will have 40 or more years in front of them (much like a prison term in my estimation some days).



This assumes good health of course. But he will be less likely to commit suicide than his younger classmates in the next few years. He is less likely to die from trauma of any kind. He is less likely to get divorced. Substance abuse will either be there now or not likely happen at all.



He is more likely to stay in one place to practise. He has roots because of his former work life and likely will stay to work in the place he already lives. He provides a perspective that experience only can give, as he has been through a lot in his 55 years and during his other careers. He has an older person's calmness and clarity and focus.



But. There is always a "but."



He remains 55 when he finishes! He doesn't have a lot of time left to contribute to his community.



Medical school is a very expensive and very limited opportunity. His costs to the system will be in the tens of thousands of dollars per annum of working life. His classmates will cost only in the thousands. (Medical school costs well over $300,000 per student divided by number of years of working life.) His return to the system in taxes based on income will be much lower for the total of his working life because he earned much less until age 55 when he is finally able to practise medicine.



This is the dollars and cents side.



Another problem will be his retirement occurring at the same time as the mass of retirement of the baby boom doctors over the next 15 years. All those that graduated in the late 1960s to late 1970s will retire at the same time as this relatively new graduate.



- From the societal side, should we take long-term jobs away from youth? Should we put in place people who are generally slowing down rather than younger people who have drive and can be expected to "ramp it up?"



Hmm. Something to think about.



Richard Gruneir is an ob/gyn in Leamington, Ont.





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Guest UWOMED2005

Dr. Hostetler's society enlightened!?!?


Yeah, based on what I read I'm not sure the author (Dr. Hostetler) knows anything about economics. He seems like the kind of guy who read somewhere that "Adam Smith wrote a book that proves the invisible hand ruins the perfect system of free enterprise" and "David Ricardo is cool as he proved free trade's the jewel" and that "Capitalism rules, and communism drools." Somewhere along the line he missed the fact that half of Adam Smith's "Wealth of Nations" actually discussed the social implications of his economic theory, that both Ricardo and Smith had to be tempered in the early half of this century after widespread economic instability and repeated depressions (in the 19th century, not just the great depression) were a direct result of unbridled capitalism (ie the repealing of the corn laws in the UK in ?1846?,) that the longest period of continuing prosperity was directly influenced by John Maynard Keynes, who advocated capitalism tempered by targeted government spending, and that the whole communism vs capitalism dichotomy is ridiculous as not even the US operates a complete capitalism.


As for how all this relates to medical education, access to medical education would NOT be about borrowing more if we deregulated tuition and had students pay the full $40k, $50k or whatever it is for their training. I'm just barely able to borrow enough at $14k. . . to jack up tuition like that WOULD mean that only those whose parents could afford it could attend medical school. As for the whole wealthier=smarter argument, there is a correlation. But I'd also strongly argue there's a correlation between wealth and lack of ethics. . . I wouldn't want to be selecting for that group as well. And I know a number of stupid people (parents and kids) who have a lot of money.

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