Medical training should be free. Paid 100% by the government. It should also be extremely selective, with both an IQ test and a knowledge test before admission and rigorous knowledge tests every year after.
The reason why this is impossible is the Civil Rights Act. Instead of gatekeeping into the medical profession through IQ tests and knowledge tests, which would violate the Civil Rights Act, we gatekeep through extremely high costs of medical school.
People who decide to take on the exorbitant burden of debt to attend medical school are either supremely confident or mentally unwell. Often, these two groups intersect. We end up with a shortage of doctors because many people don’t want to take on the risk of saddling themselves with gigantic loans without the certainty that they can be successful in the medical profession. The field is attractive to foreigners who finance part of the medical journey overseas at a much lower cost but God knows in what conditions and with what degree of rigor. Many gifted Americans who want to be doctors never try going into the field because their afraid of ruining their lives by taking on huge amounts of debt.
This issue can be solved very easily by adopting the measures I listed above. But it’s not going to be solved because these measures will create disparate impact. We are willing to sacrifice our lives, literally, to avoid disparate impact. That is very, very crazy.
Clarissa's Blog 
“Medical Training costs ought paid by Somebody other than those getting the training”
Aside from that correction to the opening sentence, yes. The diagnosis of the problem is solid.
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We all need good doctors. What better use can there be of taxpayer money than training them? We pay taxes anyways. It all goes someplace. Why not redirect it to this excellent, crucial area of life?
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It would also get rid of the handy “but my student loans” part of the excuse for the exorbitant price of seeing a specialist for anything. POOF, now your education cost nothing.
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Yes. So many problems will be solved. We will have doctors who are not enslaved by the handouts from pharmaceutical companies and will finally treat instead of only prescribing.
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several schools in NY have made med school free. They are very DEI focused school though.
Amanda
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Without the IQ tests, it’s a terrible idea. What I’m proposing only works as a package deal. Free, but only for those who have the brains to learn.
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Absolutely.
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Why an IQ test, not an exam?
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It doesn’t make sense to admit people who don’t have the brains to complete the program.
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Kid, the problem is the training is not only expensive, but the number of positions are limited. In Canada, admission is not directly selected by IQ but by marks. Girls tend to be more scholarly, more get higher marks, so more get accepted. But fewer wish to work long hours, particularly when they have young children, There has been talk about more questioning/interviewing and/or possibly penalizing short hours, or those leaving the country or the field as a cost recompense, but nothing became of that.
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I agree with what you said but the AMA would never support such a proposal. The organization consistently opposes reforms that could lower healthcare costs, and it has long worked to restrict the supply of physicians to maintain high wages. If medical education was publicly funded, doctors would face greater accountability to taxpayers and the government and the the AMA has no interest in that. It’s a supremely evil organization.
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I’ve never understood the logic behind forcing residents into 24–36 hour shifts. It fucks them up, increases errors, and reduces productivity, but we’re told it’s absolutely necessary. There’s no reason one exhausted doctor should cover what three well-rested doctors could handle in normal shifts, just like every working place on the fucking planet. “Oh, we’re so special, we go through this extremely grueling process that benefits exactly nobody so we can then justify our inflated salaries.”
In terms of salary-to-intelligence ratio, medicine is an outlier. To make half a million dollars an year in any other field you’d have to be world class. But in this field, all you need is to memorize vast amounts of information and follow a well-established decision pipeline. Can’t wait for AI to disrupt this profession. Chatgpt usage is already prevalent among doctors anyway. Let’s just cut out the middleman.
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I have a lot of somewhat disjointed thoughts on this, but in short I don’t believe MDs are the biggest problem with the current healthcare system. It is a complex problem with hospitals and health insurance companies maximizing their profits- trust me, your doctor’s salary is a small blip in this money machine.
Moreover, doctors are forced to follow protocols and flowcharts, in many cases you would get the same care from an AI bot. My child needs an old, out of patent medication from 1960ies to control their asthma, but it is a nightmare to get it prescribed- the easiest way is to go to a physician outside of the insurance system. However, if I wanted to inject my child with super-expensive monoclonal antibodies I could do that tomorrow without much trouble. The system is broken and cannot be fixed by making med schools free. I would blow up the entire insurance system (outside of more complex hospital based services) and simply pay doctors directly for their services and allow them to use their brain instead of a flowchart, it would end up being cheaper.
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Oh, I’m not saying they’re the biggest problem, just that the system clarissa proposed would not be acceptable to them because they’re also corrupt (like every other component of our healthcare system).
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I agree that there’s a gigantic problem with the insurance industry but I was addressing the issue of medical schools either having to admit foreigners with shady degrees or scrape the bottom of the domestic pool because they can’t select based on rational criteria. It came up in a book I’m reading, which is why I decided to write about it.
But I’m totally with you on that the insurance system is nuts.
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It is not possible to practice medicine in the US with a shady degree. There is a very complicated system of exams outside of the medical schools that provide certification. To get licensed to practice medicine has to be done in each state separately and the requirements for foreign doctors are extremely strict. Moreover, I don’t believe there is a lack of Americans who want to study medicine – the premed majors work very hard to get good grades and do insane amount of extracurricular activities for a chance to get in. Many of them don’t get in. The system is simply broken, like almost everything else…
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Medical residencies accept foreign students. I asked AI, and it says that over 60% of foreign applicants for medical residencies get accepted in the US. This year, a record number of almost 7,000 were accepted. These are 7,000 Americans denied a chance to become a doctor.
I’m reading a true crime book where a serial killer was admitted into a medical residency because the shortage of applicants is so large. This is what got me interested in the subject.
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From chatgpt. This does not in any way confirm that the requirements for foreign doctors are extremely strict.
For examinees from non-U.S./non-Canadian medical schools (International Medical Graduates, IMGs):
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That’s exactly what I’m saying. We are not training enough of our own. And why? One of the reasons has got to be that it’s an insane gamble. You take on all this debt, and then if it turns out that you can’t do it, your life is completely ruined. The system is set up to repel anybody who isn’t a huge risk-taker. Are these the kind of personalities we want treating patients?
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We are not training enough doctors because med schools are not accepting enough students. The admissions to med schools are very competitive. There is plenty of qualified domestic students who want to study medicine despite the cost but are not being accepted, the small number is artificial.
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Are these schools allowed to accept the qualified without paying attention to the resulting racial imbalance? We all know they aren’t. They aren’t accepting because they don’t know how to fuss around with acceptances to mold them into the shape that won’t violate the Civil Rights Act.
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I was just about to write this exact comment. 36-hour shifts need to go. They are a barrier to entry in a field where IQ and professional knowledge should play that role.
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There’s no such thing as a free lunch — If every doctor’s training were 100% paid by the government, then the government would have the right to dictate every doctor’s specialty training, and where those doctors would have to set up their practice.
Socialized medicine is a common practice in Canada and Europe. It’s NOT a good idea!
Dreidel, M.D.
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I completely agree with this. Let’s not break the system even more than it already is.
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This isn’t socialized medicine but socialized education. The medical services wouldn’t be free. Only the education.
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If the $$$ expensive education were free, the government would still be able to obligate the doctors into specific specialties and initial post-education assignments.
Dreidel
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Would you take on a $250,000 loan without the slightest understanding of whether you’d be able to complete the studies? Would you take on such a bet as a young person?
I know somebody who did take on such a bet and now has $140,000 in debt and absolutely nothing to show for it.
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“Medical training should be free”
So many barriers…. among other things, while in much of the rest of the world medical education is more or less like a profession, US doctors act essentially like a medieval guild, which includes maintaining high barriers to entry and rites of initiation (those 24-26 hour shifts, clearly have little or nothing to do with medical training, they’re initiations meant to deepen the bond between the new member and guild traditions.
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The doctors have to do it because they are forced to graduate people like Antonio Garcia who read at the 5th grade level. But they couldn’t not accept or not graduate him because we all know why. So how else do they gatekeep if they are forced to accept illiterate morons?
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“because they are forced to graduate people…. who read at the 5th grade level”
The 36 hours shifts pre-date that (which is why I call them an initiation ritual). No one is able to clearly articulate why that’s so important in medical terms.
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The endless shifts are, indeed, stupid.
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It’s a nice plan Clarissa, but it’s lacking probably the most important part. How are rich billionaires and private equity going to make money off of this? It’s very selfish of you not to think of this beleaguered class.
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