> "it was concerned that a large increase in the number of women posed a serious problem for the future of the university hospital, because female doctors tend to quit after marrying or starting families."
Japan does have a rapidly declining population because of the extremely low fertility rates and the increasrd aging putting its workforce into welfare reliance. I suppose desperate times call for desperate measures?
Desperate measures would be the government establishing, using the scientific method, that yes indeed there is a birth rate problem that is severe enough to justify drastic action, and then establishing an actual effective solution that did not inequally infringe on citizen rights.
If this article is an acceptable form of desperate measures, I think an equivalent would be Exxon deciding there are too many rich black people, and thus paying black engineers less. (private organization using unfounded information to take an action that doesn't make any sense outside the generally accepted social contract)
>"Instead of worrying about women quitting jobs, they should do more to create an environment where women can keep working," Maeda said in a statement, according to The Associated Press. "And we need working style reform, which is not just to prevent overwork deaths, but to create a workplace where everyone can perform to the best of their ability regardless of gender."
Somehow I doubt that this medical school has already implemented or tried every robust maternity leave, childcare, or other family support policy that would address their concerns about female doctors being forced to choose between quitting or having a family, and so the school simply has no other options left but to secretly deduct points from female applicants.
Being a mother in Japan can be miserable. You must give up everything you ever loved and confine yourself to a small apartment and a local park. You're no longer allowed to be an intellectual being or a participant in public life. Women don't want it, because women are people, human beings who want to live a full life. If having a child is the end of your life, it's not a good bargain for many women.
The US is deeply imperfect -- but no one will tell you that having had a child you can never, ever go back to your profession.
To put it in a slightly different context: part of the change is that women actually get to be doctors before starting families, and maybe after. This was not as common before due to birth control pill being accepted in Japan only in 1999! It changed the view for the recent generation a bit.
If you read the various sources linked, they don't have any reliable data showing this is happening, just "a strong sense" that it is the case. Without basing the decision on evidence, it's just another example in a long list of things medical professionals had a "strong sense" women can't handle.
And you're responding with your "strong sense" without considering that Japan might be different. In Japan, around 60% of women quit their jobs after having their first child [1]. In a country that still frowns on "job hopping" and still clings to the outdated notion of lifetime employment in one company, many of these women are unable to re-enter the workforce in anything other than menial part-time work.
It's not just the systemic gender discrimination but the fact that women in Japan aren't given a chance to balance careers with marriage/children is what's made this such a sensational story.
> "it was concerned that a large increase in the number of women posed a serious problem for the future of the university hospital, because female doctors tend to quit after marrying or starting families."
And I've got a bridge in Brooklyn for you.
This is the sort of prestigious medical school where sons and grandsons and nephews of wealthy families are expected to be able to graduate. When too many of them were suddenly not being admitted because smarter, harder-working women were outclassing them on their exams, the admissions department needed to "calibrate" the superior scores of the female applicants in order to maintain a healthy stream of legacy revenue.
I don't know how much of this is just the administration trying to come up with an excuse for their behavior, but this seems to say a lot about Japanese culture. In the West, discrimination was historically used to raise one above others and reinforce hierarchy. This behavior displays another very different, though equally abhorrent, practice. Japan's particular strain of collectivism is discriminating in order to create some perceived advantage for the country as a whole. Compare with American segregation, where a black person living near white people was seen as morally backwards because of the belief in racial superiority and hierarchy. This specific instance poses a more concerning behavior to me, because the people in question here did not think about discriminating in order to serve themselves; they were convinced that they were doing something good for everybody. Though attitudes have changed in Japan about gender, it seems like this will be something that will take a long time to go away because people don't only need to rationalize their discrimination, but instead they are convinced that they need to continue it as some kind of protection against societal issues even if they do (on the surface) believe in equality.
It's similar, but the bias here is against women having children and the effect is applied against the test output. In the US the most severe cases have been things like Harvard deciding there too many Asian people and creating a 'personality test' specifically designed to have Asians perform lower, ie modifying the test itself.
Potato potato. They could modify the test by adding the question "What is your gender?" where the only correct answer is "male", à la "literacy tests" in the US.
I said "effectively". There are other ways of implementing a racially discriminatory policy than explicitly adding 20 points for minorities.
Let me put it this way: Tokyo Medical University was rejecting women who it would have accepted if all other things were equivalent except their reported gender was male.
Don't some US universities do that with Affirmative Action? Reject Asians or whites that it would have accepted if all other things were equal except their reported race was black?
Except all other things are not equal. Someone who has achieved at the same level while also fighting sexism/racism has had to work harder and be better to get there. They’re playing on hard mode.
I think deciding how best to counteract systematic bias at earlier stages of the pipeline is difficult, and I don't think we should accept widespread collateral damage. That said, I don't think we should use that as an excuse to blow up the whole idea and ignore the bias (I'm not saying that's what you're advocating, just expanding my point).
Except that you make a HUGE generalization based on the gender and the race. You expect Everyone in that group to have to work harder, and you expect that everyone not in that group to have it easy.
Stereotyping people based on their race//gender is exactly what we should not do, but exactly what most simple affirmative actions are aiming at.
I don't think it's a stretch to say that life is harder (on average) for minorities.
Ignoring the role of racism and sexism to try to put all the blame on socio-economic background is a gross oversimplification. The NYtimes had a really nice infographic [1] showing the racial disparities in class mobility. tl;dr - white folks who are born rich tend to stay rich more often than black folks, and those who are born poor are more likely to move upwards.
But as you say, it is on average. And you are entirely basing this assumption on the external skin//gender attributes. When you are doing decisions on the "Average" of a specific group, you are misrepresenting people that do not fit in the stereotype.
Yes, but not with modified test scores, as that is explicitly illegal. Instead, schools consider softer criteria which leave wiggle room for race to be de facto weighted as a factor:
Okay, so the end result is the same, in that some applicants have their outcomes flipped from accepted to rejected(or vice versa) due to no other factor than their race. That is what I meant when I said 'effectively' in my original comment.
you are being downvoted even though you are saying it the way it is.
I always find it interesting to see how people that want to use affirmative actions are in denials on the actual mechanics that are used in order to make it work.
Yes, that’s also a good example of obfuscated racial preference in college admissions (assuming the case has merit, and looking at the numbers I’m under the strong impression that it does).
Affirmative action programs seek to increase representation of minorities and to optimize the ethnic diversity of a program. They don't selectively retard admission from a particular ethnicity or gender based on a perceived substantive deficiency of people of that ethnicity or gender. Whatever else there is to say about the issue, the two practices are not the same.
Isn't that a non-sequitur response? Isn't Harvard doing what I'm saying all affirmative action programs do? I'm not demanding that you be ok with affirmative action.
They don't selectively retard admission from a particular ethnicity or gender based on a perceived substantive deficiency of people of that ethnicity or gender.
Harvard is systematically penalizing Asians on the grounds that they have lousy personalities. Of course this is almost certainly a scheme to implement affirmative action without publicly admitting to it; whether that makes it better or worse is debatable.
If that's actually the reasoning they're using, I strongly agree with you. But my understanding was that they, like most universities, are optimizing for ethnic diversity.
That article says that Harvard tends to describe Asians as "industrious" but "indistinguishable". That's bad! But that's not the same thing as having a formal standard that Asians, as a class, are indistinguishable, which is what the Japanese medical school did with women. The rest of their admissions program just aims to optimize ethnic diversity.
Again: while I am personally fine with affirmative action and see the rationale for it, my argument doesn't demand that you be OK with it. All I'm arguing is that it isn't the same as what this Japanese school did.
From the doctors I know, there are far more women than men working less than 40 hours a week (for what passes for full/part time in the medical industry, which can have some heinous working hours in any situation). I attribute this to the following metric - if you're in a career where even part time work is >100k USD a year, having free time soon becomes more valuable than extra money. Women seem to understand this, or at least aren't stuck in the "your job is your life" rut to burnoutville that many men get stuck in.
It seems like the solution here is "get more doctors through medical school if some want to work part time", but instead they came up with this discriminatory solution.
Why is having more female doctors preferable to more medical services in total? This seems like sentimentality getting in the way of a functioning medical system. I suspect that many here denouncing the Japanese goal of improving their medical system would defend the vague and unsupported "improve campus culture" goal for why women in the West get affirmative action.
> Why is having more female doctors preferable to more medical services in total?
This is a false dichotomy. They would have more medical services overall if they simply admitted the right amount of female applicants and then expand their training programs overall so that the less-qualified male applicants who are currently getting preferential treatment can simply train elsewhere to become doctors. Sure some female doctors might work less, but some won't, and there would still be more qualified medical professionals in the field overall.
I don't think you understand what a false dichotomy is. Yes. Training more doctors would mean having more doctors. But for any number of doctors trained, why not prefer to train people more likely to put their skills to good use for society?
We've over-qualified doctors to a ridiculous degree. After that, 4 years med school, then an internship, and then a few more years of residency. The average doctor finishes with almost $200,000 in debt (around 15% finish with $300,000+ in debt).
The biggest issue here is that the government has effectively fixed the price to become a doctor at $200,000 (via stupid requirements) which in turn, fixes the price they must charge patients in order to be profitable. This is in addition to all the unnecessary requirements artificially restricting the supply.
Consider Cuba. In 2016, they were spending $813/yr per person while the US was spending $9,403 per person. Despite this, life expectancy was/is about equal. They graduate loads more doctors than the US. Most of these doctor's don't specialize, but instead become primary care physicians. When there are a lot of them, the cost to visit your doctor for day-to-day complaints decreases and disease is caught and treated much earlier (an ounce of prevention).
Degree inflation is a real killer here. A doctor must have a Batchelor's because it was decided that nurses should have one (though everything past the first 2 years makes basically zero difference on the floor). Then there's a huge middle area, so we train nurses to be not-quite doctors in an attempt to deal with the problem, but the schooling requirements for everyone just keep soaring.
Eliminate the Batchelor's requirement and instead require only the classes that are actually pre-requisites for med school. These are more than sufficient to weed out all the really unqualified individuals, but would reduce the cost of schooling by many tens of thousands (allowing lower charges to patients) and reduce the time-to-market by 3-4 years.
That time to market is extremely important. That's an extra 3-4 years of work before retirement. That's also an extra 3-4 years of experience (experience often being the most important thing) and those years are shifted earlier to when learning is easier. For more dexterous (eg, surgical) professions with long residencies, that 3-4 years is a huge amount of the useful lifespan.
Finally, open a few more medical schools to allow more doctors to be trained. With lower costs and faster time to market, costs for all medical visits (but especially primary care).
The only potential concern here is "unqualified people", but none of the tests have changed. Med school hasn't gotten easier either. The big change is more people are able or willing to give it a try and the risk is much lower.
> [Cuban medical schools] graduate loads more doctors than the US
I'm guessing you mean per capita...?
> A doctor must have a Batchelor's because it was decided that nurses should have one
I'm not sure where you got that from. Nursing going to the BS model is extremely new compared to physicians doing so.
> open a few more medical schools to allow more doctors to be trained
The hold-up here is on training positions. New schools are opening every year, but that's just exacerbating the problem on graduation - we're getting to having (we might already be there, I'd have to check the numbers again) more graduates than we have training positions.
Medical colleges in india don't require a bachelor's degree.
also, no residency requires a bachelor's degree.
also, bachelor's degrees don't have to be expensive... people going into 200k debt to become doctor's are mostly over paying. The acceptance rate for 1st time applicants to med school in usa is around 50%. You can get a bachelor's from anywhere and get in, if you know you can do well on the mcat.
> people going into 200k debt to become doctor's are mostly over paying
That's probably average combining undergrad and medical school. I go to one of the cheapest medical schools in the country, and it's > $240k in loans alone, let alone interest (plus the $130k from undergrad for me)
In any case, that's tuition alone, and at one public medical school in one state (i.e. most people applying to medical school each year won't qualify for that price; caveat is other states with low prices, such as Texas medical schools, which are routinely the cheapest in the country, but also take >95% instate residents).
Also, my medical schools calculates another $30k in fees and living expenses per year.
> In 2016, they were spending $813/yr per person while the US was spending $9,403 per person. Despite this, life expectancy was/is about equal.
What Cuba does not have, making this possible:
- huge, huge administrative overhead. Both at the healthcare providers themselves and in the insurance sector. In addition, "rich" patients are not needed to subsidize care for patients who are uninsured/underinsured/cannot pay in full.
- obesity: 35% of US population is morbidly obese compared to 25% of Cuban population. Obesity is a massive driver of medical issues.
- "perverse incentives" where doctors are financially incentivized or, worse, forced by administration to e.g. operate on a patient when conventional therapy would be sufficient (this problem is also endemic in Germany, e.g. https://www.ndr.de/ratgeber/gesundheit/Kaputtes-Knie-Muessen...)
- CYA policies, e.g. when out of fear for malpractice lawsuits, unnecessary tests/labwork are done on the patient
- malpractice lawsuits/damage awards driving insurance premiums through the roof
- a tendency, especially in elderly people, to prolong their life at immense cost, even if it only brings them half a year in utter misery and pain (which is fine from an ethics point of view, intensive care at that level is just expensive as hell)
- hard drug addictions across wide swaths of the population. Smoking and drinking are bad enough but only the US has a huge problem with hardcore drug addicts. They cause cost in the system due to e.g. overdose treatments or contamination-caused complications
- large amounts of homeless/untreated mentally ill people, who often enough
- only come to a clinic when their health is so fucked that it's enormously expensive to nurse them back to health (aka on the brink of death)
- have their illness cause injury in other persons (e.g. due to fights)
- are directly affected by a lack of protection from the elements (e.g. freezing in winter, lack of shade in summer, lack of hygiene during the whole year)
- "abuse" medical resources to have a warm bed (which I'm not mad about, everyone deserves a warm bed, it's just a mis-allocation of resources contributing to the high costs for everyone else)
I know the stats seemingly say different, but opiate addiction is a massive problem in the Netherlands too, and this doesn't seem to stop at the German border either.
rumor I heard: Cuban prices are cheap, yes because of good supply, but also because rates are fixed way below market. A doctor is paid some paltry rate; it’s the same amout a teacher or mechanic or anyone else would make, because communism.
can anyone refute this? it sounded a bit too slick to me, but I don’t know enough to say if it’s true/false.
The most surprising number in article is that the US % of female doctors in only 34%. The percent of med school grads has been near 50% for at least 15 years. I couldn’t find numbers going back further then that, so there must be a very large historical imbalance clearing out or a real career dropout problem. I suspect the former, but still.
Is it necessarily discrimination, or might there be other explanations?
For example, maybe it's discriminatory social expectations of men to be breadwinners, so they're forced to work at really hard jobs like being doctors while their wives can make a free choice to stay home with the kids.
I don't intend this reply to support either view. I'm just saying, discrimination is not necessarily the reason, and even if discrimination is the reason, there are two sides to that coin.
I specifically created a gendered counterexample to show the problem. I'm very much aware of the gendered use of language in my intentional counterexample.
In general, you are right. Amongst super highly educated pairs I don’t think this is the same issue- highly educated mothers overwhelming return to work, see http://www.pewsocialtrends.org/2014/04/08/chapter-2-stay-at-... which indicates mothers with a bachelors and higher work 79% of the time at any given time. Heck, assuming a 20 year motherhood window (2 kids in 2 years and stop) that translates to only 4 years out of the workforce per mother. It’s a fair assumption women with professional degrees leave to workforce on average even less. I guess you need to push up the numbers a bit because there are more women in the newer cohorts and those cohorts are in prime childbearing and rearing age, but that probably balances out with needing to take account of the women never having children (and not included in that statistic.)
We aren’t talking about dropping off the executive/promo track, it’s returning to work in the same profession at all.
Has any country come up with a suitable solution to the issue of maintaining a career before, during and after pregnancy for women? I know many countries have paid maternity leave (usually paltry) and some organizations will hold the job while they are away. Is this good enough?
If the issue is dropout because women are forced to make a decision between career and caring for/watching their child grow surely we can come up with a better solution?
In my mind, the root of the problem is that companies haven’t figured out a way (or refuse to figure out a way) to buck the 9-5pm, 5-day, butt-in-seat workday policy. At the extreme case, if people could choose exactly which hours in a week they wished to work, completely independently of the company or team or anything, and perform that work anywhere they’d like, this wouldn’t be an issue. Women could take whatever time off they need to physically deliver a baby, and people in the family could arrange their working hours in such a way that all adults involved could agree on a preferred work/parent schedule that maintains whatever level of employment the adults desire.
With 9-5 this doesn’t work. Remote work helps alleviate some of these issues, but not all. There need to be organizational innovations to make this happen.
I have noticed a trend of entrepreneurship amongst women I know that have babies and young kids.
They are essentially creating jobs for themselves that work around these constraints you mention. They seem fulfilled and happy with this because it works best for the work/life balance. But most of them had a safety net that allowed them to start these endeavours in the first place.
Perhaps one solution is to offer a safety net i.e. grant, incubator, accelerator etc. for women in this position that allows them to create the job that works best for them? I suppose not everyone is cut out for it but this will at least encourage some.
I've noticed the same. But I think one risk is that fulfilment and flexibility often comes at the cost of structure that comes from the typical, corporate world - sick days, insurance (in the US), superannuation (Australia), etc.
Kind of. Here in Norway the parents currently have around one year of paid leave, give or take. Out of this period, three weeks before and nine after the birth is for the mother, while the reminder is split threeways with one third dedicated to each of the parents while the last third can be used by either although not at the same time. The father also has one paid and one unpaid week during birth to help at home.
While there are some upper limits, parents usually get their full salary paid by their employer, who in turn get refunds from the government. There is a variation on this giving slightly more time off for less pay as well, plus some exceptions for single mothers, adoptions etc.
It's not a perfect system, and it's not created with the mother's career in mind, but it does accomplish some things:
-The father spends time with the newborn; if he chooses not to use his third of the parental leave it disappears. This leads to more involved fathers, and also help to even the score on who tends to the house.
-Parents can't be fired or refused employment for being pregnant. You also don't have to disclose this during interviews.
-Companies knows that having kids is natural, while smaller ones may struggle to find replacements during parental leave, the system is flexible enough to allow people to work a few days a week if they choose to. This is up to the parents to decide, employers can't dictate what they should do.
-Employers know that employees taking parental leave will come back, so any experience and work-related knowledge isn't lost just because they are having kids.
The article talks about Japanese discriminating against female candidates for medical training. There are likely high workhour requirements and poor childcare support systems / cultural norms against childcare done by non-parents that can be fixed to address this problem.
Regarding US training bottlenecks. Speaking of specialties more than general Doctor positions, it takes a certain number of cases per year to train a doctor and to sustain the skills of doctors that require specialized hand skills (surgeons of any kind, ortho etc). Those skills are perishable and many hospitals get lower number of cases of certain types than needed to sustain multiple good surgeons. For example, you wouldn’t want to go to a doc that does less than 4 Whipples per year if you need a Whipple. The bottleneck in training docs is the number of cases in the US in each specialty.
Medical schools fill an important role with limited training and teaching resources. I suspect they would be loath to admit someone that was planning to work as an MD for only one year after graduation. Women, of course work as doctors for more that a single year, but on average they do work less over their lifetimes than male physicians.
For a number of reasons, female physicians don’t work as much over their careers as men statistically. I’m guessing that this is why med schools might practice this unsavory discrimination against women. It’s really unfair to individuals that might or might not go on to make more important contributors to the field than the average male doctor.
I was married to a brilliant woman that went to medical school at a time when there was much more overt sexism in the field. Her abilities were unusual; she was always near the top of her class, and in a field like medicine this provided some protection from prejudice. However, women shouldn’t have to be better than their colleagues to simply survive medical training.
Personally, about half my doctors are now female and I’m very happy with them.
85 comments
[ 4.0 ms ] story [ 207 ms ] threadIf this article is an acceptable form of desperate measures, I think an equivalent would be Exxon deciding there are too many rich black people, and thus paying black engineers less. (private organization using unfounded information to take an action that doesn't make any sense outside the generally accepted social contract)
The US is deeply imperfect -- but no one will tell you that having had a child you can never, ever go back to your profession.
It's not just the systemic gender discrimination but the fact that women in Japan aren't given a chance to balance careers with marriage/children is what's made this such a sensational story.
1. https://www.works-i.com/column/panelsurveys/%E8%90%A9%E5%8E%...
And I've got a bridge in Brooklyn for you.
This is the sort of prestigious medical school where sons and grandsons and nephews of wealthy families are expected to be able to graduate. When too many of them were suddenly not being admitted because smarter, harder-working women were outclassing them on their exams, the admissions department needed to "calibrate" the superior scores of the female applicants in order to maintain a healthy stream of legacy revenue.
https://en.wikipedia.org/wiki/Gratz_v._Bollinger
Let me put it this way: Tokyo Medical University was rejecting women who it would have accepted if all other things were equivalent except their reported gender was male.
Don't some US universities do that with Affirmative Action? Reject Asians or whites that it would have accepted if all other things were equal except their reported race was black?
https://www.usatoday.com/story/opinion/2018/06/18/harvard-ad...
But you admit asians who affirmative actions hurts the most face more racism than whites.
Did I misunderstand?
Stereotyping people based on their race//gender is exactly what we should not do, but exactly what most simple affirmative actions are aiming at.
What really matters is socio-economic background.
Ignoring the role of racism and sexism to try to put all the blame on socio-economic background is a gross oversimplification. The NYtimes had a really nice infographic [1] showing the racial disparities in class mobility. tl;dr - white folks who are born rich tend to stay rich more often than black folks, and those who are born poor are more likely to move upwards.
[1]: https://www.nytimes.com/interactive/2018/03/19/upshot/race-c...
But as you say, it is on average. And you are entirely basing this assumption on the external skin//gender attributes. When you are doing decisions on the "Average" of a specific group, you are misrepresenting people that do not fit in the stereotype.
(I work in LSAT prep, and need to know a bit about admissions. But I'm not american, so I have a lot of gaps in my knowledge of the system.)
https://www.npr.org/2015/06/23/416736883/race-conscious-admi...
I always find it interesting to see how people that want to use affirmative actions are in denials on the actual mechanics that are used in order to make it work.
Harvard is systematically penalizing Asians on the grounds that they have lousy personalities. Of course this is almost certainly a scheme to implement affirmative action without publicly admitting to it; whether that makes it better or worse is debatable.
Again: while I am personally fine with affirmative action and see the rationale for it, my argument doesn't demand that you be OK with it. All I'm arguing is that it isn't the same as what this Japanese school did.
It seems like the solution here is "get more doctors through medical school if some want to work part time", but instead they came up with this discriminatory solution.
This is a false dichotomy. They would have more medical services overall if they simply admitted the right amount of female applicants and then expand their training programs overall so that the less-qualified male applicants who are currently getting preferential treatment can simply train elsewhere to become doctors. Sure some female doctors might work less, but some won't, and there would still be more qualified medical professionals in the field overall.
If you'd review https://news.ycombinator.com/newsguidelines.html and stick to the rules when posting to HN, we'd appreciate it.
The biggest issue here is that the government has effectively fixed the price to become a doctor at $200,000 (via stupid requirements) which in turn, fixes the price they must charge patients in order to be profitable. This is in addition to all the unnecessary requirements artificially restricting the supply.
Consider Cuba. In 2016, they were spending $813/yr per person while the US was spending $9,403 per person. Despite this, life expectancy was/is about equal. They graduate loads more doctors than the US. Most of these doctor's don't specialize, but instead become primary care physicians. When there are a lot of them, the cost to visit your doctor for day-to-day complaints decreases and disease is caught and treated much earlier (an ounce of prevention).
Degree inflation is a real killer here. A doctor must have a Batchelor's because it was decided that nurses should have one (though everything past the first 2 years makes basically zero difference on the floor). Then there's a huge middle area, so we train nurses to be not-quite doctors in an attempt to deal with the problem, but the schooling requirements for everyone just keep soaring.
Eliminate the Batchelor's requirement and instead require only the classes that are actually pre-requisites for med school. These are more than sufficient to weed out all the really unqualified individuals, but would reduce the cost of schooling by many tens of thousands (allowing lower charges to patients) and reduce the time-to-market by 3-4 years.
That time to market is extremely important. That's an extra 3-4 years of work before retirement. That's also an extra 3-4 years of experience (experience often being the most important thing) and those years are shifted earlier to when learning is easier. For more dexterous (eg, surgical) professions with long residencies, that 3-4 years is a huge amount of the useful lifespan.
Finally, open a few more medical schools to allow more doctors to be trained. With lower costs and faster time to market, costs for all medical visits (but especially primary care).
The only potential concern here is "unqualified people", but none of the tests have changed. Med school hasn't gotten easier either. The big change is more people are able or willing to give it a try and the risk is much lower.
I'm guessing you mean per capita...?
> A doctor must have a Batchelor's because it was decided that nurses should have one
I'm not sure where you got that from. Nursing going to the BS model is extremely new compared to physicians doing so.
> open a few more medical schools to allow more doctors to be trained
The hold-up here is on training positions. New schools are opening every year, but that's just exacerbating the problem on graduation - we're getting to having (we might already be there, I'd have to check the numbers again) more graduates than we have training positions.
Medical colleges in india don't require a bachelor's degree.
also, no residency requires a bachelor's degree.
also, bachelor's degrees don't have to be expensive... people going into 200k debt to become doctor's are mostly over paying. The acceptance rate for 1st time applicants to med school in usa is around 50%. You can get a bachelor's from anywhere and get in, if you know you can do well on the mcat.
That's probably average combining undergrad and medical school. I go to one of the cheapest medical schools in the country, and it's > $240k in loans alone, let alone interest (plus the $130k from undergrad for me)
And that’s without the hope scholarship which anyone getting into MED school in georgia likely qualifies for making (gpa >3.0)
Most state schools are not that expensive at least for their residents.
In any case, that's tuition alone, and at one public medical school in one state (i.e. most people applying to medical school each year won't qualify for that price; caveat is other states with low prices, such as Texas medical schools, which are routinely the cheapest in the country, but also take >95% instate residents).
Also, my medical schools calculates another $30k in fees and living expenses per year.
Here's another datapoint for you: SUNY Upstate in New York. Tuition alone for instate residents: $43k. Taken from: http://www.upstate.edu/currentstudents/document/com_budget_y...
I'm actually curious now what the costs are for each states' public schools. I can't seem to find a single reference for that though.
What Cuba does not have, making this possible:
- huge, huge administrative overhead. Both at the healthcare providers themselves and in the insurance sector. In addition, "rich" patients are not needed to subsidize care for patients who are uninsured/underinsured/cannot pay in full.
- obesity: 35% of US population is morbidly obese compared to 25% of Cuban population. Obesity is a massive driver of medical issues.
- "perverse incentives" where doctors are financially incentivized or, worse, forced by administration to e.g. operate on a patient when conventional therapy would be sufficient (this problem is also endemic in Germany, e.g. https://www.ndr.de/ratgeber/gesundheit/Kaputtes-Knie-Muessen...)
- CYA policies, e.g. when out of fear for malpractice lawsuits, unnecessary tests/labwork are done on the patient
- malpractice lawsuits/damage awards driving insurance premiums through the roof
- a tendency, especially in elderly people, to prolong their life at immense cost, even if it only brings them half a year in utter misery and pain (which is fine from an ethics point of view, intensive care at that level is just expensive as hell)
- hard drug addictions across wide swaths of the population. Smoking and drinking are bad enough but only the US has a huge problem with hardcore drug addicts. They cause cost in the system due to e.g. overdose treatments or contamination-caused complications
- large amounts of homeless/untreated mentally ill people, who often enough
can anyone refute this? it sounded a bit too slick to me, but I don’t know enough to say if it’s true/false.
Source: ex-USSR experience.
For example, maybe it's discriminatory social expectations of men to be breadwinners, so they're forced to work at really hard jobs like being doctors while their wives can make a free choice to stay home with the kids.
I don't intend this reply to support either view. I'm just saying, discrimination is not necessarily the reason, and even if discrimination is the reason, there are two sides to that coin.
See for example, your own gendered language on who does the "hard job" and who makes a "free choice".
We aren’t talking about dropping off the executive/promo track, it’s returning to work in the same profession at all.
All that being said, it looks like it’s the backlog, not dropout. Less than 10% of US med school grads were women in the 70s (https://www.theatlantic.com/sexes/archive/2012/12/more-women...).
Assume a 40 year career and 34% female is right about where you’d expect the numbers to be.
Or, the US has lots of male doctors from non-US medical schools.
(I actually think all three are factors.)
If the issue is dropout because women are forced to make a decision between career and caring for/watching their child grow surely we can come up with a better solution?
With 9-5 this doesn’t work. Remote work helps alleviate some of these issues, but not all. There need to be organizational innovations to make this happen.
Ask to work 4 ten hour days, for instance instead of 5x8. The state will force the employer to pay overtime for the hours past 8 in a day.
Perhaps one solution is to offer a safety net i.e. grant, incubator, accelerator etc. for women in this position that allows them to create the job that works best for them? I suppose not everyone is cut out for it but this will at least encourage some.
While there are some upper limits, parents usually get their full salary paid by their employer, who in turn get refunds from the government. There is a variation on this giving slightly more time off for less pay as well, plus some exceptions for single mothers, adoptions etc.
It's not a perfect system, and it's not created with the mother's career in mind, but it does accomplish some things:
-The father spends time with the newborn; if he chooses not to use his third of the parental leave it disappears. This leads to more involved fathers, and also help to even the score on who tends to the house.
-Parents can't be fired or refused employment for being pregnant. You also don't have to disclose this during interviews.
-Companies knows that having kids is natural, while smaller ones may struggle to find replacements during parental leave, the system is flexible enough to allow people to work a few days a week if they choose to. This is up to the parents to decide, employers can't dictate what they should do.
-Employers know that employees taking parental leave will come back, so any experience and work-related knowledge isn't lost just because they are having kids.
This practice is whidespread in the US. Why is this news?
Regarding US training bottlenecks. Speaking of specialties more than general Doctor positions, it takes a certain number of cases per year to train a doctor and to sustain the skills of doctors that require specialized hand skills (surgeons of any kind, ortho etc). Those skills are perishable and many hospitals get lower number of cases of certain types than needed to sustain multiple good surgeons. For example, you wouldn’t want to go to a doc that does less than 4 Whipples per year if you need a Whipple. The bottleneck in training docs is the number of cases in the US in each specialty.
For a number of reasons, female physicians don’t work as much over their careers as men statistically. I’m guessing that this is why med schools might practice this unsavory discrimination against women. It’s really unfair to individuals that might or might not go on to make more important contributors to the field than the average male doctor.
I was married to a brilliant woman that went to medical school at a time when there was much more overt sexism in the field. Her abilities were unusual; she was always near the top of her class, and in a field like medicine this provided some protection from prejudice. However, women shouldn’t have to be better than their colleagues to simply survive medical training.
Personally, about half my doctors are now female and I’m very happy with them.
What data supports this statement, or is it good old fashion common sense and gut instinct?