Thanks for your reply. I hesitate to continue this discussion because of apparent differences between the US and NZ.

I am sorry if I created the impression that I favor watering down medical education. I don't. What I favor is a system where studying and "work" aren't mixed up unless the work is part and parcel of the education. I actually thought that when you first mentioned work you were referring to outside employment, which I now doubt; that'd be insane for that type of education. What I most object to is mixing up education with sheer, physical fatigue.

I should have said "excellent" instead of "very good," for that is what I meant. Oops.

It is interesting that you didn't comment on what I said about medical licensing of doctors and schools. I favor private certifications only. Anything else is coercive limiting of medicine to the consumer and keeps prices artificially inflated, conspiracy or not.

There are of coursae big differences between excellent, good, poor and no medical care at all. Half of the graduates of medical schools are in the bottom half of their classes, btw. It is very hard to find an outstanding doctor that isn't a specialist and I generally agree with most of what you have said about the necessary rigor of his education. Most doctors don't do a decent job with a difficult diagnosis because they are not very good, not specialists and don't have enough time to dedicate to getting good histories and making proper evaluations of signs and symptoms.

--Brant

Brant

“A great many of the onerous, time-consuming requirements for your profession as you experienced them are unnecessary and undesirable”

Dear I say it (especially on an Objectivist site) but your point appears to be floating…

I would argue that a great many of those requirements were both necessary and highly desirable. At a time when there is an explosion of scientific especially medical knowledge now is not the time for truncation of medical training.

I know however New Zealand’s Labour government would agree with you entirely. It costs the state lots of money to train us. With scarcely a whimper optometrists have been given full medical prescribing rights. They can complete there basic four year university degree and with a two semester add on the “Ocular Therapeutics Course” they can prescribe all the medications they want.

To be honest, as an objectivist, such deregulation sits very comfortably with me. Any move towards a deregulated market generally is a good one in my book. Nevertheless I do hold that there is a hierarchy of knowledge and that the acquisition of facts following by their processing into a coherent body of knowledge takes time.
Developing the ability to practically apply such knowledge in the field also takes time and experience. Really and truly there are little shortcuts to be had if quality is to be maintained. There is a really great article in the first edition of the Objective Standard "The Hierarchy of Knowledge: The Most Neglected Issue in Education" by Lisa VanDamme. Sorry but she doesn’t advocate trimming of the education process.

Further your conspiracy theory that such requirements “are partially designed to limit the supply of qualified doctors and increase the income of those who make it through training” is an ugly old urban myth that is not even close to the truth. Really and truly there are not groups of doctors sitting down in dark smoking rooms comparing who has bought the most BWMs and quietly plotting to increase their income by influencing medical education. By way of example last year as Head of Department I was asked by my college if I could establish a new training post at my “public” hospital. There was a partially trained ophthalmologist in the system who was looking for a job. What a great idea. It appealed to me on so many levels. I lobbied hard initially with my colleges and once I had established a united front we went to the hospital managers cap in hand. The motion died quickly and quietly. “No money” we were told. Remember Doctors, nurses, Optometrists or practically any health professional are trained essentially by the state and hence the number of them is regulated by the state. Why is this not widely understood?

“His character and brains and natural inclination to competence carried the day.” That is a lovely old chestnut. I haven’t heard it in years. It took me all the way back to sitting in Shaddows, the Auckland University student pub, nursing a jug of beer and listing to the Doors. It was usually trotted out just before exam time, there was this student “who did not have to study” who “always got 'A's” and “remembered everything he ever read.” The student was never actually there of course. I did not believe the fairy tale then and I certainly don’t now, not in medicine. There is a large body of knowledge to be learnt. It does not fall like manna from heaven. Even with complete recall you would still have to read the material in the first place and then think about it. Last and not least you would then have to develop the skill and art of practically applying such knowledge. Most of the material can not be simply deduced from first principles like a mathematics problem can.

There is a great article in the August 2006 issue of Scientific American on precisely this topic “The Expert Mind” and I quote from this “The preponderance of psychological evidence indicates the experts are made, not born.” It turns out it generally takes about 10 years to be an “expert” in any demanding field. They looked initially at chess grandmasters and employed advanced neuroimaging techniques for assessing brain function. I invite you to look it up.

“There was no point in his having to suffer to get his competence in his field and he didn't.” Now there I agree with you completely. He does not sound like a bad person. You have made no reference to him initiating force against another, why should he suffer?

If however you imply that planning, working hard and consistently over time to achieve long term goals and backing yourself against the odds equates to suffering, then I pity you.

“Many of your failed fellow classmates, I suspect, would have made very good Ophthalmologists.” You may settle for good, but I don’t. It sounds very reminiscent of our infamous state school NCEA assessment system to me. When I settled back in New Zealand I realized it would be “good” to have a regular GP. When I sniffed around the hospital I did not ask other medics “who are the good GPs?” Sorry but I value my health and my families far more than that. I asked “Who are the best? Give me the shortlist.”

Finally “socialism that’s all you have described” No actually, that's all you have seen.

PS Do you work in the diary industry?

The pampered ignorance of pupils no
Tough disillusionments will undergo.

All hard attainments minimizing, give
Contemptuous children nothing formative.

A great many of the onerous, time-consuming requirements for your profession as you experienced them are unnecessary and undesirable, not to say that they shouldn't be difficult. They are partially designed to limit the supply of qualified doctors and increase the income of those who make it through training. But what you have described is going too far the wrong way with non-objective criteria. Doctors should not be licensed by government, nor medical schools.

I knew a young man who became a Radiologist--brains galore. He didn't have to work save in medicine. His character and brains and natural inclination to competence carried the day. There was no point in his having to suffer to get his competence in his field and he didn't. He did work very hard. Education should not be an extreme endurance contest. Many of your failed fellow classmates, I suspect, would have made very good Ophthalmologists.

--Brant

That's all you have described--and it's going to get worse. In regard to medicine most people have good health so they do not appreciate what is going to happen to them when their health goes bad and they can't get timely, decent care. So naturally they want "free" care not realizing the consequences of no care or bad care until it's too late. The same thing happens in education: government largess, control, and consequent degeneration all the while the costs, over time, go through the roof as they expand to absorb all the available third party (mostly government) money.

--Brant