6 ms·

We should enforce rigorous qualifications for doctors. We've relaxed the standards far too much already.

by lilsoso 2y ago

amluto 2y ago
I suspect that, after some point, making the qualifications stricter actually drives away many of the best candidates.
- throwaway2037 2y ago
  I doubt it. They pay is high enough to attract more people than necessary. Most ultra high income jobs are the same.
  - amluto 2y ago
    Being a doctor is not a reliably ultra-high-income job, and many people don’t consider the slog of med school, an internship, a residency, and an eventual possible job at a hospital to be worth any amount of money.
archagon 2y ago
Qualifications should come at the end of your education, not at the start.
- Wowfunhappy 2y ago
  Educating doctors is really expensive. It would really suck to invest all that money in someone (or in yourself) just for them to fail a final test or whatever. For what it's worth, I do agree we should train more doctors, but I think it's a complicated problem.
  - ejstronge 2y ago
    > Educating doctors is really expensive. It would really suck to invest all that money in someone (or in yourself) just for them to fail a final test or whatever. This happens already, today. There are dozens of reasonable questions you can raise based on this fact - but I don't think it's obvious that the failures at the end of training can majoritarily be identified by pre-training metrics. Some countries allow any student to take the first two years of medical courses, and then impose restrictions on the following years. This seems a relatively fair system; you can imagine someone persevering over many years to attain the requisite knowledge - but this person would not have had the opportunity if there were a pre-medical school filter
casenmgreen 2y ago
We do not need all doctors to be uber doctors. We need a range of doctors, who range in price according to quality. That way for simple stuff, which anyone can get right, we go to a cheap, reasonable doctor. A similar example would be if we only had uber software engineers. Each one had to have a PhD. There were no cheap and okay developers who could do say web-sites but not write a programming language from scratch.
- Wowfunhappy 2y ago
  I think you're possibly describing nurse practitioners?
  - Scoundreller 2y ago
    Or maybe more of a "doctor minus" rather than a "nurse plus" system.
    - smugma 2y ago
      A Physician’s Assistant (PA) is exactly that.
  - senortumnus 2y ago
    Yes they are describing NPs and PAs. MDs are the PhDs of the medical world. Don’t get me started on “DNPs”
- nradov 2y ago
  That is not even remotely viable. There is little or no correlation between price and quality in healthcare. There are no reliable ways to accurately measure quality of individual doctors across the full spectrum of services that they deliver. In particular, it doesn't make sense to just look at outcomes because the doctors who take on more difficult cases will always look worse in the metrics regardless of the quality of care that they deliver. Your example doesn't even make sense. Having a PhD doesn't make software engineers more productive on average. PhD programs train researchers. Research skills have very little correlation with practical software engineering. What could actually work is to train more physician assistants and nurse practitioners, then have them deliver the bulk of simple primary care services under the supervision of physicians. This is more cost effective and usually works well enough, although there may be some degradation in service quality for edge cases.
CydeWeys 2y ago
Have we though? You got any source on that? There's already a severe shortage of doctors, so what happens if standards are significantly increased? Having a doctor available to treat you at all is still much better than having your very high standards and then not having a doctor available period.
GuB-42 2y ago
Sure, but no doctors is worse than lower skilled doctors as even lower skilled doctors are better than the average patient self-treatment attempt. We need doctors who are available to treat simple conditions and refer to a more qualified doctor for the complex ones. Such a job doesn't require being a genius, just people who are not complete idiots, and the qualifications required here are genius-level, not idiotproof-level.
- throwaway2037 2y ago
  > We need doctors who are available to treat simple conditions and refer to a more qualified doctor for the complex ones. This is most medical systems work in highly industrialised nations. First, you visit a GP. If necessary the send you to a specialist.
- sieabahlpark 2y ago
  [dead]
- mcmoor 2y ago
  I don't know, lower skilled doctors can be quite a pseudo science amplifier at worst. Sometimes it does feel like that no doctor is better lower skilled one, especially when self treatment (or more accurately, remote treatment) is getting better nowadays.
  - GuB-42 2y ago
    The problem is worse when there is a lack of actual doctors. It people can't see a doctor, or can't get decent care because doctors are overworked, they will go to the "pseudo doctors". "pseudo doctors" are usually much less regulated, because they don't really practice medicine, can't make prescriptions, are not covered by healthcare subsidies, etc... but they are available, and actually caring, because there is no shortage of them. This is actually good for the patients, sometimes, all you need to get better is someone who listens to you and points you to a healthier lifestyle something, something that "pseudo doctors" can do well. The problem is when they bring their pseudoscience to "treat" actual medical problems that can't just be solved by eating vegetables and getting some rest. Now imagine an actual doctor who is available and caring, giving you all the benefits of the "pseudo doctor", but in addition, can actually practice medicine. Maybe not to the highest level, but he would have attended an actual medical school and knows enough not to treat cancer with fruits. The problem now in many places is that it is not just hard to become a doctor, it is hard to access medical studies.
dmead 2y ago
this is completely wrong. there are not enough doctors at all levels. not everyone is going to be a brain surgeon.
bell-cot 2y ago
What sort of qualifications? 99th percentile talent in subjects like organic chemistry, which are actually not used by 99% of doctors in the real world? Willingness to work themselves so long and hard that their judgement is usually substantially impaired? And does the (my impression) widespread support for oh-so-rigorous qualifications for doctors reflect any real-world data about actual resulting quality of patient care? Or is it a way for prospective patients to vocalize a bunch of anxieties and emotions about medical care, plus a way for the doctors who've had to endure such treatment to say "all the noobs should have to suffer as much as I did"?
- xkcd1963 2y ago
  If your doctor is more clueless than you that speaks of itself.

We should enforce rigorous qualifications for doctors. We've relaxed the standards far too much already.

amluto 2y ago

I suspect that, after some point, making the qualifications stricter actually drives away many of the best candidates.

throwaway2037 2y ago
I doubt it. They pay is high enough to attract more people than necessary. Most ultra high income jobs are the same.
- amluto 2y ago
  Being a doctor is not a reliably ultra-high-income job, and many people don’t consider the slog of med school, an internship, a residency, and an eventual possible job at a hospital to be worth any amount of money.

archagon 2y ago

Qualifications should come at the end of your education, not at the start.

Wowfunhappy 2y ago
Educating doctors is really expensive. It would really suck to invest all that money in someone (or in yourself) just for them to fail a final test or whatever. For what it's worth, I do agree we should train more doctors, but I think it's a complicated problem.
- ejstronge 2y ago
  > Educating doctors is really expensive. It would really suck to invest all that money in someone (or in yourself) just for them to fail a final test or whatever. This happens already, today. There are dozens of reasonable questions you can raise based on this fact - but I don't think it's obvious that the failures at the end of training can majoritarily be identified by pre-training metrics. Some countries allow any student to take the first two years of medical courses, and then impose restrictions on the following years. This seems a relatively fair system; you can imagine someone persevering over many years to attain the requisite knowledge - but this person would not have had the opportunity if there were a pre-medical school filter

casenmgreen 2y ago

We do not need all doctors to be uber doctors. We need a range of doctors, who range in price according to quality. That way for simple stuff, which anyone can get right, we go to a cheap, reasonable doctor. A similar example would be if we only had uber software engineers. Each one had to have a PhD. There were no cheap and okay developers who could do say web-sites but not write a programming language from scratch.

Wowfunhappy 2y ago
I think you're possibly describing nurse practitioners?
- Scoundreller 2y ago
  Or maybe more of a "doctor minus" rather than a "nurse plus" system.
  - smugma 2y ago
    A Physician’s Assistant (PA) is exactly that.
- senortumnus 2y ago
  Yes they are describing NPs and PAs. MDs are the PhDs of the medical world. Don’t get me started on “DNPs”
nradov 2y ago
That is not even remotely viable. There is little or no correlation between price and quality in healthcare. There are no reliable ways to accurately measure quality of individual doctors across the full spectrum of services that they deliver. In particular, it doesn't make sense to just look at outcomes because the doctors who take on more difficult cases will always look worse in the metrics regardless of the quality of care that they deliver. Your example doesn't even make sense. Having a PhD doesn't make software engineers more productive on average. PhD programs train researchers. Research skills have very little correlation with practical software engineering. What could actually work is to train more physician assistants and nurse practitioners, then have them deliver the bulk of simple primary care services under the supervision of physicians. This is more cost effective and usually works well enough, although there may be some degradation in service quality for edge cases.

CydeWeys 2y ago

Have we though? You got any source on that? There's already a severe shortage of doctors, so what happens if standards are significantly increased? Having a doctor available to treat you at all is still much better than having your very high standards and then not having a doctor available period.

GuB-42 2y ago

Sure, but no doctors is worse than lower skilled doctors as even lower skilled doctors are better than the average patient self-treatment attempt. We need doctors who are available to treat simple conditions and refer to a more qualified doctor for the complex ones. Such a job doesn't require being a genius, just people who are not complete idiots, and the qualifications required here are genius-level, not idiotproof-level.

throwaway2037 2y ago
> We need doctors who are available to treat simple conditions and refer to a more qualified doctor for the complex ones. This is most medical systems work in highly industrialised nations. First, you visit a GP. If necessary the send you to a specialist.
sieabahlpark 2y ago
[dead]
mcmoor 2y ago
I don't know, lower skilled doctors can be quite a pseudo science amplifier at worst. Sometimes it does feel like that no doctor is better lower skilled one, especially when self treatment (or more accurately, remote treatment) is getting better nowadays.
- GuB-42 2y ago
  The problem is worse when there is a lack of actual doctors. It people can't see a doctor, or can't get decent care because doctors are overworked, they will go to the "pseudo doctors". "pseudo doctors" are usually much less regulated, because they don't really practice medicine, can't make prescriptions, are not covered by healthcare subsidies, etc... but they are available, and actually caring, because there is no shortage of them. This is actually good for the patients, sometimes, all you need to get better is someone who listens to you and points you to a healthier lifestyle something, something that "pseudo doctors" can do well. The problem is when they bring their pseudoscience to "treat" actual medical problems that can't just be solved by eating vegetables and getting some rest. Now imagine an actual doctor who is available and caring, giving you all the benefits of the "pseudo doctor", but in addition, can actually practice medicine. Maybe not to the highest level, but he would have attended an actual medical school and knows enough not to treat cancer with fruits. The problem now in many places is that it is not just hard to become a doctor, it is hard to access medical studies.

dmead 2y ago

this is completely wrong. there are not enough doctors at all levels. not everyone is going to be a brain surgeon.

bell-cot 2y ago

What sort of qualifications? 99th percentile talent in subjects like organic chemistry, which are actually not used by 99% of doctors in the real world? Willingness to work themselves so long and hard that their judgement is usually substantially impaired? And does the (my impression) widespread support for oh-so-rigorous qualifications for doctors reflect any real-world data about actual resulting quality of patient care? Or is it a way for prospective patients to vocalize a bunch of anxieties and emotions about medical care, plus a way for the doctors who've had to endure such treatment to say "all the noobs should have to suffer as much as I did"?

xkcd1963 2y ago
If your doctor is more clueless than you that speaks of itself.