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>When Flexner researched his report, many American medical schools were "proprietary", namely small trade schools owned by one or more doctors, unaffiliated wit

>When Flexner researched his report, many American medical schools were "proprietary", namely small trade schools owned by one or more doctors, unaffiliated with a college or university, and run to make a profit. A degree was typically awarded after only two years of study. Laboratory work and dissection were not necessarily required. Many of the instructors were local doctors teaching part-time, whose own training left something to be desired. The regulation of the medical profession by state governments was minimal or nonexistent. American doctors varied enormously in their scientific understanding of human physiology, and the word "quack" flourished. Interesting Wikipedia article. And as I recall, the issue with medical colleges is more the residency, than the exams isn't it? I mean, that's why we trust doctors, because the bar is that high.

nojvek 10y ago
Is the bar really high though? I find doctors in US for common procedures use outdated methods and charge astronomical fees. My experience of going to Australian hospitals was 10x better. In US it feels like doctors want to get as much money as they can from you while proving the lowest level of service possible. A very capitalist view to human life.
- kbenson 10y ago
  You might be interested in a Freakonomics episode[1] that covers this to some degree. There's a wide range in care based on many factors, but unless you have quite a bit of experience in the healthcare industry in both countries, for similar ailments, I'm not sure what you experienced falls outside the normal variation for the field. The TL;DL is that the medical field changes quite a bit in the years since Docters graduate, and depending on the types of work they are doing, it seems to be fairly easy for them to get behind with the latest consensus unless they make a concerted effort. To that effect, relatively new doctors often have better patient health outcomes than doctors that have been out of school for longer. This is, to some degree, obvious after stated, as any field that sees rapid change will have some percentage of practitioners that are out of date. 1: http://freakonomics.com/podcast/bad-medicine-part-3-death-diagnosis/ http://freakonomics.com/podcast/bad-medicine-part-3-death-di...
- Chris2048 10y ago
  I feel there is also a big difference in motivation: reducing harm versus reducing personal blame. No doctor can be sued for a patient who doesn't see them, so raising prices high, and using it for insurance has the benefit of insuring patients who see you, while those who can't pay aren't your patients, so if they come to harm because they can't afford to see you, not your problem.
rosser 10y ago
> I mean, that's why we trust doctors, because the bar is that high. Two thoughts: 1. The old joke, "What do you call the person who graduated from medical school at the bottom of their class?" "Doctor." 2. The ordeal of residency isn't about setting the bar "high", nearly so much as it's about, "well, I went through this shit, so you have to, too". (Source: I have several doctor friends. All of them think it's bullshit. All of them have been explicitly told that, in some form or fashion, by their colleagues, superiors, teachers, or otherwise.)
- kbenson 10y ago
  1. What do you call the the person who graduated from SEAL training at the bottom of their class? A SEAL. I get the joke, but part of the point is that top and bottom of the class are only relevant for those who actually graduate, and who is capable of graduating can be entirely different based on the goals of the institution. From "everyone can, with work" as in High School, to "only those who are good enough" as (hopefully) in medical school. 2. Humanity, where we've institutionalized pettiness, and not just once, but throughout history. :/
  - rosser 10y ago
    There's a pretty staggering breadth of admissions requirements for the various accredited medical schools in the US, and plenty of offshore schools that effectively will take anyone — basically MD mills. The Dominican Republic, in particular, is well-known for this. (Yes, many of the offshore medical schools are LCME-accredited and legit, and have trained some fantastic physicians, but broadly speaking, they're taking people who couldn't get into an on-shore school.)
    - kbenson 10y ago
      Sure, I'm not really arguing that all medical schools have sterling reputations or high standards, just that the joke, as a way to illustrate the problem, unfortunately obscures the real problem. It's pithy and punchy, which makes it good joke and easy to repeat. It's sort of a peeve of mine when I see well intentioned but slightly misleading memes propagate. They're hard to fight for the same reason they are memes.

nojvek 10y ago

Is the bar really high though? I find doctors in US for common procedures use outdated methods and charge astronomical fees. My experience of going to Australian hospitals was 10x better. In US it feels like doctors want to get as much money as they can from you while proving the lowest level of service possible. A very capitalist view to human life.

kbenson 10y ago
You might be interested in a Freakonomics episode[1] that covers this to some degree. There's a wide range in care based on many factors, but unless you have quite a bit of experience in the healthcare industry in both countries, for similar ailments, I'm not sure what you experienced falls outside the normal variation for the field. The TL;DL is that the medical field changes quite a bit in the years since Docters graduate, and depending on the types of work they are doing, it seems to be fairly easy for them to get behind with the latest consensus unless they make a concerted effort. To that effect, relatively new doctors often have better patient health outcomes than doctors that have been out of school for longer. This is, to some degree, obvious after stated, as any field that sees rapid change will have some percentage of practitioners that are out of date. 1: http://freakonomics.com/podcast/bad-medicine-part-3-death-diagnosis/ http://freakonomics.com/podcast/bad-medicine-part-3-death-di...
Chris2048 10y ago
I feel there is also a big difference in motivation: reducing harm versus reducing personal blame. No doctor can be sued for a patient who doesn't see them, so raising prices high, and using it for insurance has the benefit of insuring patients who see you, while those who can't pay aren't your patients, so if they come to harm because they can't afford to see you, not your problem.

rosser 10y ago

> I mean, that's why we trust doctors, because the bar is that high. Two thoughts: 1. The old joke, "What do you call the person who graduated from medical school at the bottom of their class?" "Doctor." 2. The ordeal of residency isn't about setting the bar "high", nearly so much as it's about, "well, I went through this shit, so you have to, too". (Source: I have several doctor friends. All of them think it's bullshit. All of them have been explicitly told that, in some form or fashion, by their colleagues, superiors, teachers, or otherwise.)

kbenson 10y ago
1. What do you call the the person who graduated from SEAL training at the bottom of their class? A SEAL. I get the joke, but part of the point is that top and bottom of the class are only relevant for those who actually graduate, and who is capable of graduating can be entirely different based on the goals of the institution. From "everyone can, with work" as in High School, to "only those who are good enough" as (hopefully) in medical school. 2. Humanity, where we've institutionalized pettiness, and not just once, but throughout history. :/
- rosser 10y ago
  There's a pretty staggering breadth of admissions requirements for the various accredited medical schools in the US, and plenty of offshore schools that effectively will take anyone — basically MD mills. The Dominican Republic, in particular, is well-known for this. (Yes, many of the offshore medical schools are LCME-accredited and legit, and have trained some fantastic physicians, but broadly speaking, they're taking people who couldn't get into an on-shore school.)
  - kbenson 10y ago
    Sure, I'm not really arguing that all medical schools have sterling reputations or high standards, just that the joke, as a way to illustrate the problem, unfortunately obscures the real problem. It's pithy and punchy, which makes it good joke and easy to repeat. It's sort of a peeve of mine when I see well intentioned but slightly misleading memes propagate. They're hard to fight for the same reason they are memes.