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I see parallels with medical school in tech hiring. They put the students through hell because that's what they had to go through, and they're rent seeking. I

I see parallels with medical school in tech hiring. They put the students through hell because that's what they had to go through, and they're rent seeking. In most other countries, doctors don't have an accreditation board. Most things are simple, and it doesn't require years of school to set a bone or put in some stitches, or even diagnose the flu or pneumonia. Similarly, you don't need a rockstar or ninja to write your CRUD app. Anybody who knows what he's doing will be able to do that, he doesn't need to be the best of the best, he just needs to be competent.

ejstronge 10y ago
Which are the countries where doctors don't have an accreditation board? The history of physicians controlling who is allowed to join their ranks goes back centuries, at the very least.
- jimmywanger 10y ago
  In the US, medications are controlled through doctors. In most of Latin America (the countries I've been to), the pharmacists were the first source of triage. "Pooping too much? Here, take this pill. Oh wait, there's blood in there? You should probably go see somebody more informed."
  - ejstronge 10y ago
    This doesn't address the question of a country where physicians aren't trained/recognized by other physicians. Incidentally, the free availability of drugs in the way you described is being curtailed in Latin American countries.
rifung 10y ago
I have a friend in med school and his experience doesn't sound like tech hiring at all. From what I can tell, med school isn't hard because of rent seeking, but because there is frankly just a very large amount of things you have to learn in a short amount of time. They also have to work extremely long hours on certain rotations. I was shocked at how little sleep he could get on some days. On the other hand, he seems to not have experienced the bullying described in the article, so maybe that part of it is the rent seeking you describe. I do think that tech hiring is a little ridiculous at times, but if doctors mess up, people sometimes die. It would make much more sense for them to go through accreditation like engineers do, in my opinion of course.
- dmoy 10y ago
  Agree with most bits, but the hours thing is ridiculous in med, in a very bad way. It doesn't have to be either... (Slowly changing for the better).
- kcanini 10y ago
  Doctors do go through an accreditation process: https://en.wikipedia.org/wiki/United_States_Medical_Licensing_Examination https://en.wikipedia.org/wiki/United_States_Medical_Licensin...
  - rifung 10y ago
    The person I was replying to mentioned that some other countries don't have an accreditation board. I was trying to imply that I approve of its existence, not that there isn't one. Sorry for the misunderstanding.
- elboru 10y ago
  You described the exact same problems med school students have in Mexico, I used to think that was just a thing in my country, it's amazing how little they sleep since the beginning and how they have to keep doing it for years, depending on what specialization they have that could mean 5, 10, 12 years.
logicallee 10y ago
you put your conclusion first, and I must say I disagreed with it when I read your first couples of lines. Because medicine is actually hard - it's not that students have to "go through hell because that's what they had to go through." Medicine is really hard. I have a condition that affects my lifestyle, I have to learn about it, the more I learn the better my outcome. I'm not studying medicine and only "have to" learn one little part. All the same it is not easy. It would be as though all someone had to do in their entire life was (something specific) but computer science is so hard that this is not easy. I would say medicine is harder than computer science. DNA is 650 megabytes, not every underlying process is understood, drugs and their interractions have to be learned with tons of difficulty, even after you specialize you have to understand the entire system. But then I read the rest of your comment, and I must say - perhaps it is true that there is room for someone to "diagnose pneumonia" or something. Doctors are expert systems: but perhaps there is room for lesser expertise. (A small aside - it is certainly true that the long required training artificially reduces supply of doctors in the united states - however I think you are using an imprecise term "rent-seeking" and should pick a more specific term from economics since I think you are technically misusing it.)
- jimmywanger 10y ago
  I don't disagree with medicine being hard. I'm not going to get into the difference difficulty between learning medicine or computer science. I guess I should have mentioned my point first, which is that just like you don't need a star computer scientist to write an app for a restaurant, you don't need a doctor with all that training and theoretical knowledge to diagnose a sprained ankle. I'm sorry about your condition, but that condition probably is fairly rare. How many of your other health issues couldn't be diagnosed by somebody with less training? > however I think you are using an imprecise term "rent-seeking" I don't see how I am. Can you please elucidate? You have to pass boards to practice medicine in the US, which requires a huge investment of time and money, and after you do that, you want to restrict supply so that you're in high demand. That way for the rest of your career you can coast on your laurels and keep collecting a paycheck.
  - logicallee 10y ago
Lordarminius 10y ago
Wait a minute... Im a doctor and I disagree with this. > They put the students through hell because that's what they had to go through... True. But the reason is that it toughens you up and winnows the wheat from the proverbial chaff. The forced marches through the wards at 2am in the morning prepare the budding doctor for the real world where he can be called upon as say, the sole doctor for miles in a rural area to attend to a mass casualty event. >In most other countries, doctors don't have an accreditation board. ... I do not know of any country that does not have an accreditation board. The difference between countries is the process of accreditation. Sometimes it is direct: the student takes centralized a board exam; sometimes indirect: the student takes a uni exam approved/supervised by the board. > it doesn't require years of school to set a bone or put in some stitches Maybe. But it requires erudition and experience to anticipate that a poorly set bone can heal with complications(malunion, non-union,infection etc.) Fun fact: when Admiral Nelson was wounded in the battle of Santa Cruz de Tenerife in 1797 field surgeons had his arm amputated but mistakenly trapped his nerve in a ligature that caused him great pain until the mistake was corrected ) > it doesn't require years of school ...(to) diagnose the flu or pneumonia That pov is exactly how people get misdiagnosed and killed (by quacks). There are many different diseases that present alike and even subgroups of the same diseases that have different management regimes. While it may seem obvious for instance, that a patient has pneumonia, one would also do well to ask what kind of pneumonia he has, why he has it (immunocompromise?, zoonosis?) and what the alternatives could be( the differential diagnosis). More than once has "ordinary pneumonia" been found to be lung cancer. It takes years of post graduate training and practice to become proficient enough to identify different disease conditions and manage them with confidence. Medical school hazing is not done because the seniors are sadists. Some aspects of the process could be improved but the rigor works and makes for good doctors.
- jimmywanger 10y ago
  > The forced marches through the wards at 2am in the morning prepare the budding doctor for the real world where he can be called upon as say, the sole doctor for miles in a rural area to attend to a mass casualty event. When has that happened to you, or anybody you've known? > There are many different diseases that present alike and even subgroups of the same diseases that have different management regimes. Sure, how frequent is that? My point is that we're training doctors like they have to be Navy Seals, equipped and prepared for every situation, whereas in real life, a grunt with 3 months paramedic training would be up for the task.
northern_lights 10y ago
"Most things are simple, and it doesn't require years of school to set a bone or put in some stitches, or even diagnose the flu or pneumonia." The thing is...when that fracture extends into the joint capsule, or is in multiple pieces and needs a surgical repair, you'll want the doctor around to manage that. When that flu weakens your immune system and causes you to get a superimposed bacterial pneumonia, you'll want the doctor around to manage that. The days when a doctor could make a living managing only simple problems are long gone, if they ever existed. These days, PAs and NPs handle the majority of healthcare's equivalent to CRUD applications, and physicians handle the complicated cases. I have noticed that it's become popular on HN to refer to parts of the healthcare industry as "rent seeking," and while I agree to some extent, I haven't seen much evidence that doctors or medical schools themselves are rent seeking.
- flukus 10y ago
  > I have noticed that it's become popular on HN to refer to parts of the healthcare industry as "rent seeking," and while I agree to some extent, I haven't seen much evidence that doctors or medical schools themselves are rent seeking. If we get a cold and need time off we need to visit a GP, this is rent seeking that could easily be handled by a non doctor for half the price. As for the other points, that's just a matter of having escalation procedures. The current system has highly paid specialists doing front line technical support.
  - northern_lights 10y ago
    >If we get a cold and need time off we need to visit a GP, this is rent seeking that could easily be handled by a non doctor for half the price. I'm not sure where you work, but I have never needed a doctor's note to get off work for a simple cold. That's a company policy issue, not the fault of the medical industry. As I said, a lot of the front-line work is now handled by NPs and PAs. There are still physicians in primary care, but they spend much of their time handling the more complicated patients.
    - jimmywanger 10y ago
ljk 10y ago
> They put the students through hell because that's what they had to go through, and they're rent seeking. that's what i think too, especially when students go through rounds in the hospital they get "pimped"[1] it's like hazing on top of rent seeking [1] https://drottematic.wordpress.com/2009/11/30/pimping-in-medicine-the-delicate-art-of-making-someone-feel-small/ https://drottematic.wordpress.com/2009/11/30/pimping-in-medi...

ejstronge 10y ago

Which are the countries where doctors don't have an accreditation board? The history of physicians controlling who is allowed to join their ranks goes back centuries, at the very least.

jimmywanger 10y ago
In the US, medications are controlled through doctors. In most of Latin America (the countries I've been to), the pharmacists were the first source of triage. "Pooping too much? Here, take this pill. Oh wait, there's blood in there? You should probably go see somebody more informed."
- ejstronge 10y ago
  This doesn't address the question of a country where physicians aren't trained/recognized by other physicians. Incidentally, the free availability of drugs in the way you described is being curtailed in Latin American countries.

rifung 10y ago

I have a friend in med school and his experience doesn't sound like tech hiring at all. From what I can tell, med school isn't hard because of rent seeking, but because there is frankly just a very large amount of things you have to learn in a short amount of time. They also have to work extremely long hours on certain rotations. I was shocked at how little sleep he could get on some days. On the other hand, he seems to not have experienced the bullying described in the article, so maybe that part of it is the rent seeking you describe. I do think that tech hiring is a little ridiculous at times, but if doctors mess up, people sometimes die. It would make much more sense for them to go through accreditation like engineers do, in my opinion of course.

dmoy 10y ago
Agree with most bits, but the hours thing is ridiculous in med, in a very bad way. It doesn't have to be either... (Slowly changing for the better).
kcanini 10y ago
Doctors do go through an accreditation process: https://en.wikipedia.org/wiki/United_States_Medical_Licensing_Examination https://en.wikipedia.org/wiki/United_States_Medical_Licensin...
- rifung 10y ago
  The person I was replying to mentioned that some other countries don't have an accreditation board. I was trying to imply that I approve of its existence, not that there isn't one. Sorry for the misunderstanding.
elboru 10y ago
You described the exact same problems med school students have in Mexico, I used to think that was just a thing in my country, it's amazing how little they sleep since the beginning and how they have to keep doing it for years, depending on what specialization they have that could mean 5, 10, 12 years.

logicallee 10y ago

you put your conclusion first, and I must say I disagreed with it when I read your first couples of lines. Because medicine is actually hard - it's not that students have to "go through hell because that's what they had to go through." Medicine is really hard. I have a condition that affects my lifestyle, I have to learn about it, the more I learn the better my outcome. I'm not studying medicine and only "have to" learn one little part. All the same it is not easy. It would be as though all someone had to do in their entire life was (something specific) but computer science is so hard that this is not easy. I would say medicine is harder than computer science. DNA is 650 megabytes, not every underlying process is understood, drugs and their interractions have to be learned with tons of difficulty, even after you specialize you have to understand the entire system. But then I read the rest of your comment, and I must say - perhaps it is true that there is room for someone to "diagnose pneumonia" or something. Doctors are expert systems: but perhaps there is room for lesser expertise. (A small aside - it is certainly true that the long required training artificially reduces supply of doctors in the united states - however I think you are using an imprecise term "rent-seeking" and should pick a more specific term from economics since I think you are technically misusing it.)

jimmywanger 10y ago
I don't disagree with medicine being hard. I'm not going to get into the difference difficulty between learning medicine or computer science. I guess I should have mentioned my point first, which is that just like you don't need a star computer scientist to write an app for a restaurant, you don't need a doctor with all that training and theoretical knowledge to diagnose a sprained ankle. I'm sorry about your condition, but that condition probably is fairly rare. How many of your other health issues couldn't be diagnosed by somebody with less training? > however I think you are using an imprecise term "rent-seeking" I don't see how I am. Can you please elucidate? You have to pass boards to practice medicine in the US, which requires a huge investment of time and money, and after you do that, you want to restrict supply so that you're in high demand. That way for the rest of your career you can coast on your laurels and keep collecting a paycheck.
- logicallee 10y ago

Lordarminius 10y ago

Wait a minute... Im a doctor and I disagree with this. > They put the students through hell because that's what they had to go through... True. But the reason is that it toughens you up and winnows the wheat from the proverbial chaff. The forced marches through the wards at 2am in the morning prepare the budding doctor for the real world where he can be called upon as say, the sole doctor for miles in a rural area to attend to a mass casualty event. >In most other countries, doctors don't have an accreditation board. ... I do not know of any country that does not have an accreditation board. The difference between countries is the process of accreditation. Sometimes it is direct: the student takes centralized a board exam; sometimes indirect: the student takes a uni exam approved/supervised by the board. > it doesn't require years of school to set a bone or put in some stitches Maybe. But it requires erudition and experience to anticipate that a poorly set bone can heal with complications(malunion, non-union,infection etc.) Fun fact: when Admiral Nelson was wounded in the battle of Santa Cruz de Tenerife in 1797 field surgeons had his arm amputated but mistakenly trapped his nerve in a ligature that caused him great pain until the mistake was corrected ) > it doesn't require years of school ...(to) diagnose the flu or pneumonia That pov is exactly how people get misdiagnosed and killed (by quacks). There are many different diseases that present alike and even subgroups of the same diseases that have different management regimes. While it may seem obvious for instance, that a patient has pneumonia, one would also do well to ask what kind of pneumonia he has, why he has it (immunocompromise?, zoonosis?) and what the alternatives could be( the differential diagnosis). More than once has "ordinary pneumonia" been found to be lung cancer. It takes years of post graduate training and practice to become proficient enough to identify different disease conditions and manage them with confidence. Medical school hazing is not done because the seniors are sadists. Some aspects of the process could be improved but the rigor works and makes for good doctors.

jimmywanger 10y ago
> The forced marches through the wards at 2am in the morning prepare the budding doctor for the real world where he can be called upon as say, the sole doctor for miles in a rural area to attend to a mass casualty event. When has that happened to you, or anybody you've known? > There are many different diseases that present alike and even subgroups of the same diseases that have different management regimes. Sure, how frequent is that? My point is that we're training doctors like they have to be Navy Seals, equipped and prepared for every situation, whereas in real life, a grunt with 3 months paramedic training would be up for the task.

northern_lights 10y ago

"Most things are simple, and it doesn't require years of school to set a bone or put in some stitches, or even diagnose the flu or pneumonia." The thing is...when that fracture extends into the joint capsule, or is in multiple pieces and needs a surgical repair, you'll want the doctor around to manage that. When that flu weakens your immune system and causes you to get a superimposed bacterial pneumonia, you'll want the doctor around to manage that. The days when a doctor could make a living managing only simple problems are long gone, if they ever existed. These days, PAs and NPs handle the majority of healthcare's equivalent to CRUD applications, and physicians handle the complicated cases. I have noticed that it's become popular on HN to refer to parts of the healthcare industry as "rent seeking," and while I agree to some extent, I haven't seen much evidence that doctors or medical schools themselves are rent seeking.

flukus 10y ago
> I have noticed that it's become popular on HN to refer to parts of the healthcare industry as "rent seeking," and while I agree to some extent, I haven't seen much evidence that doctors or medical schools themselves are rent seeking. If we get a cold and need time off we need to visit a GP, this is rent seeking that could easily be handled by a non doctor for half the price. As for the other points, that's just a matter of having escalation procedures. The current system has highly paid specialists doing front line technical support.
- northern_lights 10y ago
  >If we get a cold and need time off we need to visit a GP, this is rent seeking that could easily be handled by a non doctor for half the price. I'm not sure where you work, but I have never needed a doctor's note to get off work for a simple cold. That's a company policy issue, not the fault of the medical industry. As I said, a lot of the front-line work is now handled by NPs and PAs. There are still physicians in primary care, but they spend much of their time handling the more complicated patients.
  - jimmywanger 10y ago

ljk 10y ago

> They put the students through hell because that's what they had to go through, and they're rent seeking. that's what i think too, especially when students go through rounds in the hospital they get "pimped"[1] it's like hazing on top of rent seeking [1] https://drottematic.wordpress.com/2009/11/30/pimping-in-medicine-the-delicate-art-of-making-someone-feel-small/ https://drottematic.wordpress.com/2009/11/30/pimping-in-medi...