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The U.S. educational system is needlessly slow and expensive. In other countries you don't need to pay for four years of college before starting medical school

The U.S. educational system is needlessly slow and expensive. In other countries you don't need to pay for four years of college before starting medical school or law school. For example, I think in India a woman can finish medical school at age 23, whereas in the U.S. it would be age 26, assuming she graduates high school at 18. If women and men complete their education earlier, it is easier to have both a high-powered career and a family.

kohanz 9y ago
> For example, I think in India a woman can finish medical school at age 23, whereas in the U.S. it would be age 26 Do they emerge with the same level of training & experience? Difficult to do an apples-to-apples comparison.
- BeetleB 9y ago
  In India, medical school is 5 years. In the US it is 4 years. Beyond that, I do not know. I will note, however, that when Indian doctors move to the US, do their USMLE and try to get into a residency program, they do not do any special training to "catch up".
- 8ytecoder 9y ago
  The first four years in the US is actually not in medical school. Basically you'll need the equivalent of a bachelor's degree in biological sciences to go to medical school. Most students do 4-yr college and then med. A total of 8 years. Then residency and on and on. If the biological sciences requirement is simply folded into a five year course that's the Indian model. MBBS - Bachelor of science and Bachelor of medicine.
- megaman22 9y ago
  It's really bizarre the way that pre-professional undergraduate programs in the US work. Pre-med is basically a smorgasbord of random stuff, with a slight inclination towards biology and chemistry, although from my remembrances with premed classmates, they didn't take a whole lot more sciences than the general requirements mandated. Pre-law is even worse, with people taking the most generic possible collection of liberal arts classes, usually ending up with Econ or History almost by default. There's some perverse incentives to take less-demanding courseloads, in order to boost your GPA for graduate school admissions, and expend most of your efforts training for the MCATs or LSATs. If you actually wanted to produce medical professionals in an efficient way, there is no way that you would do it in the way that this currently works in the US.
  - eesmith 9y ago
    Your description "random stuff" is what in the US is considered a "well-rounded education." https://www.theglobeandmail.com/news/national/time-to-lead/why-university-students-need-a-well-rounded-education/article4610406/ https://www.theglobeandmail.com/news/national/time-to-lead/w... (picked mostly arbitrarily from a DDG search for 'well-rounded education') states the usual reasons for that approach. For example, is the goal only 'to produce medical professionals in an efficient way'? Or does education also include 'acquiring general knowledge' and 'training in citizenship' (quoting that link). There's also a complaint about 'what Duke University professor and interdisciplinary-studies expert Cathy Davidson describes as "the duck, duck, goose model."' I had an odd exchange once, over lunch at a UK research site with mostly European graduate students. I found out that I knew more about European history than the others. My education in the US included a European history course, while most of the Europeans had specialized in science since they were teenagers. Not that that knowledge has really proved useful ... but then again, neither has my training in quantum mechanics.
    - megaman22 9y ago
      It's a luxury, and a remnant of outdated conceptions of what the purpose of university education is. As much as some hate reality, and wish for some never-existent golden age of well-rounded liberal arts education, people engage in higher education because it is the gateway to a career, and as such, what they really want is relevant vocational training, which, outside of a few rare disciplines (engineering, namely) they rarely get, and instead faff around with trivialities for most of four years, at a toll of 35-60k per year.
      - eesmith 9y ago
        Outdated, out-shmated. The concept of a university has changed enough times that whatever "new" view is in vogue now is a repeat of what came before. Once upon a time universities were a place to get relevant vocational training as a cleric, doctor, administrator, and a handful of other fields. The advice you give - "it is the gateway to a career" - has rather large built-in flaw. The student loan industry, and the increasingly profit-oriented universities, have basically looked at the overall earnings difference of getting a degree and exclaimed "I want me some of that!" Young adults who start life $30,000 in debt, for that is the current average outstanding student loan balance per borrower, make for a more compliant wage slave. Your complaint does not seem to be about universities, but rather concerns the lack of a respected vocational training path. Since you appear to understand the historical context of what 'well-rounded' is supposed to mean, I think your use of 'bizarre' was facetious. Moreover, you have changed what you are talking about. In your previous comment you were focused on students who "take less-demanding courseloads, in order to boost your GPA for graduate school admissions, and expend most of your efforts training for the MCATs or LSATs." Most people who attend a 4-year college as 'a gateway to a career' do not plan on additional post-college education. As such, they do not have the perverse inventive you described.
randomdata 9y ago
The long process to becoming a medical doctor (or lawyer) plays a large part in why they tend to be high-powered careers. Not being able to start a career until later in life is a disincentive to follow in that path, and the fewer people willing to still go through with it, the more power those careers will possess. There are other ways to limit the numbers, like a lottery, but not all of those are given the same social acceptance in North America. We are socially okay with extending time in academia. Not that everyone would become a doctor even if it were easier to attain, but to take it to the logical extreme, if everyone went through med school, doctors would have no more power than a sales clerk at Walmart. Power comes from scarcity.
- jeffreyrogers 9y ago
  > if everyone went through med school, doctors would have no more power than a sales clerk at Walmart. Power comes from scarcity. This is only true if every doctor coming out of med school is exactly the same or if you can't tell the difference in skill among doctors.
  - randomdata 9y ago
    It still holds true. If this were the case, the scarcity of those who have observably more skill will hold the power. But there is an expectation that med school produces doctors who are sufficiently equal in their ability (in that you should not need to worry about which doctor you end up with). That you are suggesting this is not the case is quite interesting.
    - jeffreyrogers 9y ago
      I think there are large differences in ability between doctors even within specialties, but most doctors meet a minimum level of competence because the requirements for med school effectively filter out people who are not intelligent and conscientious enough to become doctors. If you don't think there are differences in skill between doctors just ask a friend or family member who is a doctor which doctors they would not recommend you see.
ardit33 9y ago
The problem is that people don't fully mature until 25-ish. I wouldn't trust a 23yo lawyer or doctor, no matter how smart they appear. Some things are learned only by experience, and not just by books. Also, a huge chunk of tech's HR issues are mostly created by startups having very young founders and young managers that don't have real life experience. (to me, young is anybody younger than 30). Half of the firing/issues I have seen in real life could have been easily avoided if the people in the room had more experience.
- ghaff 9y ago
  Way back when, there was some limited experimentation in the US with 6-year combined college/MD programs. They still exist but very few are 6 year--and they're schools you've probably never heard of. My understanding is that part of the issue was that there was a general feeling that students benefited from the additional time even if it wasn't strictly necessary with respect to coursework.
- heliostatic 9y ago
  While I think your contention is valid in 2018, it's important to consider how much of this is culturally and historically contingent. Consider the ages of some key figures in the American Revolution in 1776 (https://kottke.org/13/08/the-surprising-ages-of-the-founding-fathers-on-july-4-1776 https://kottke.org/13/08/the-surprising-ages-of-the-founding...) Marquis de Lafayette, 18 James Monroe, 18 Gilbert Stuart, 20 Aaron Burr, 20 Alexander Hamilton, 21 Betsy Ross, 24 James Madison, 25
- nailer 9y ago
  > I wouldn't trust a 23yo lawyer or doctor, no matter how smart they appear. Some things are learned only by experience, and not just by books. I wouldn't trust a 26 year old or 40 year old newly graduated doctor either, for the same reasons.
- jeffreyrogers 9y ago
  This is a good point, but I don't think that means we should stick young people in schools while we wait for them to mature. It seems more useful to have them doing some sort of productive work, where they can start learning by experience.
andrewl 9y ago
Freeman Dyson has commented on how long and wasteful it is for most people to get a doctorate I’m very proud of not having a Ph.D. I think the Ph.D. system is an abomination. It was invented as a system for educating German professors in the 19th century, and it works well under those conditions. It’s good for a very small number of people who are going to spend their lives being professors. But it has become now a kind of union card that you have to have in order to have a job, whether it’s being a professor or other things, and it’s quite inappropriate for that. It forces people to waste years and years of their lives sort of pretending to do research for which they’re not at all well-suited. In the end, they have this piece of paper which says they’re qualified, but it really doesn’t mean anything. The Ph.D. takes far too long and discourages women from becoming scientists, which I consider a great tragedy. So I have opposed it all my life without any success at all. https://www.quantamagazine.org/a-math-puzzle-worthy-of-freeman-dyson-20140326/ https://www.quantamagazine.org/a-math-puzzle-worthy-of-freem...
- asabjorn 9y ago
  I took one, and although it gives me a great advantage to be trained in research when exploring complex problems it feels like it took too many years that I could have spend on my passion for creating things.
Eire_Banshee 9y ago
Yeah... but nobody books a trip to India just for medical care either.
- ranko 9y ago
  "Foreign patients travelling to India to seek medical treatment in 2012, 2013 and 2014 numbered 171,021, 236,898, and 184,298 respectively" (https://en.wikipedia.org/wiki/Medical_tourism_in_India https://en.wikipedia.org/wiki/Medical_tourism_in_India)
  - Eire_Banshee 9y ago
    Yeah, and 500,000 seek treatment in the US every year. https://www.imtj.com/news/bringing-medical-tourists-usa/ https://www.imtj.com/news/bringing-medical-tourists-usa/
- lotsofpulp 9y ago
  There are many people that do, and they save thousands. It is especially good for common procedures, like LASIK, dental work, etc.
  - Eire_Banshee 9y ago
    You save thousands for a reason.
    - nugi 9y ago
      By not paying non-negotiated rates for medical care? Sounds like a good reason to me.
rayiner 9y ago
It's not just India. A law degree is a 3-year undergraduate degree in the U.K. as well. It works fine. In the U.S., in contrast, there has been a push towards extending the process that has a disparate impact on women. Now, it is typical for a lawyer to get a 4-year college degree, spend a year or two working, spend three years in law school, and graduate around 27 or 28, putting them into their mid to late 30s by the time they are established enough for many women to feel comfortable having kids. It's an enormously sexist feature of the profession, caused by the fetishization of schooling and academia.
- PurpleBoxDragon 9y ago
  >It's an enormously sexist feature of the profession Just because something may have an impact that differs based on sex doesn't make it sexist. Would we call pregnancy sexist because it works differently for each sex?
  - rayiner 9y ago
    https://en.wikipedia.org/wiki/Disparate_impact https://en.wikipedia.org/wiki/Disparate_impact.
    - PurpleBoxDragon 9y ago
      >This form of discrimination occurs where an employer does not intend to discriminate; to the contrary, it occurs when identical standards or procedures are applied to everyone, despite the fact that they lead to a substantial difference in employment outcomes for the members of a particular group and they are unrelated to successful job performance. Are you making the claim that an extended education has no impact on performance? If I require my developers to have a degree, it doesn't violate this concept even though a degree isn't required to be a good programmer.
      - rayiner 9y ago
        > Are you making the claim that an extended education has no impact on performance? Yes. E.g. in the U.K., you can start practicing law around age 21. In the U.S., typically it's 25 if you go straight through. Somehow the U.K. still manages to be a center of commerce and finance.
clairity 9y ago
i'd be ok with medical/law training to start as early as 16 (for those who can finish high school early). for med school, you could still have 5 years of academic training (as with the Indian model) and then do 4 years of apprenticeship (internship /residency) and be a fully qualifed doctor by 25. for law school, 4 years of academic training and 3 years of apprenticeship and be a fully qualified lawyer by 23. these are professional trades, so the apprenticeship piece is a crucial transition period to learn from those who came before you.

kohanz 9y ago

> For example, I think in India a woman can finish medical school at age 23, whereas in the U.S. it would be age 26 Do they emerge with the same level of training & experience? Difficult to do an apples-to-apples comparison.

BeetleB 9y ago
In India, medical school is 5 years. In the US it is 4 years. Beyond that, I do not know. I will note, however, that when Indian doctors move to the US, do their USMLE and try to get into a residency program, they do not do any special training to "catch up".
8ytecoder 9y ago
The first four years in the US is actually not in medical school. Basically you'll need the equivalent of a bachelor's degree in biological sciences to go to medical school. Most students do 4-yr college and then med. A total of 8 years. Then residency and on and on. If the biological sciences requirement is simply folded into a five year course that's the Indian model. MBBS - Bachelor of science and Bachelor of medicine.
megaman22 9y ago
It's really bizarre the way that pre-professional undergraduate programs in the US work. Pre-med is basically a smorgasbord of random stuff, with a slight inclination towards biology and chemistry, although from my remembrances with premed classmates, they didn't take a whole lot more sciences than the general requirements mandated. Pre-law is even worse, with people taking the most generic possible collection of liberal arts classes, usually ending up with Econ or History almost by default. There's some perverse incentives to take less-demanding courseloads, in order to boost your GPA for graduate school admissions, and expend most of your efforts training for the MCATs or LSATs. If you actually wanted to produce medical professionals in an efficient way, there is no way that you would do it in the way that this currently works in the US.
- eesmith 9y ago
  Your description "random stuff" is what in the US is considered a "well-rounded education." https://www.theglobeandmail.com/news/national/time-to-lead/why-university-students-need-a-well-rounded-education/article4610406/ https://www.theglobeandmail.com/news/national/time-to-lead/w... (picked mostly arbitrarily from a DDG search for 'well-rounded education') states the usual reasons for that approach. For example, is the goal only 'to produce medical professionals in an efficient way'? Or does education also include 'acquiring general knowledge' and 'training in citizenship' (quoting that link). There's also a complaint about 'what Duke University professor and interdisciplinary-studies expert Cathy Davidson describes as "the duck, duck, goose model."' I had an odd exchange once, over lunch at a UK research site with mostly European graduate students. I found out that I knew more about European history than the others. My education in the US included a European history course, while most of the Europeans had specialized in science since they were teenagers. Not that that knowledge has really proved useful ... but then again, neither has my training in quantum mechanics.
  - megaman22 9y ago
    It's a luxury, and a remnant of outdated conceptions of what the purpose of university education is. As much as some hate reality, and wish for some never-existent golden age of well-rounded liberal arts education, people engage in higher education because it is the gateway to a career, and as such, what they really want is relevant vocational training, which, outside of a few rare disciplines (engineering, namely) they rarely get, and instead faff around with trivialities for most of four years, at a toll of 35-60k per year.
    - eesmith 9y ago
      Outdated, out-shmated. The concept of a university has changed enough times that whatever "new" view is in vogue now is a repeat of what came before. Once upon a time universities were a place to get relevant vocational training as a cleric, doctor, administrator, and a handful of other fields. The advice you give - "it is the gateway to a career" - has rather large built-in flaw. The student loan industry, and the increasingly profit-oriented universities, have basically looked at the overall earnings difference of getting a degree and exclaimed "I want me some of that!" Young adults who start life $30,000 in debt, for that is the current average outstanding student loan balance per borrower, make for a more compliant wage slave. Your complaint does not seem to be about universities, but rather concerns the lack of a respected vocational training path. Since you appear to understand the historical context of what 'well-rounded' is supposed to mean, I think your use of 'bizarre' was facetious. Moreover, you have changed what you are talking about. In your previous comment you were focused on students who "take less-demanding courseloads, in order to boost your GPA for graduate school admissions, and expend most of your efforts training for the MCATs or LSATs." Most people who attend a 4-year college as 'a gateway to a career' do not plan on additional post-college education. As such, they do not have the perverse inventive you described.

randomdata 9y ago

The long process to becoming a medical doctor (or lawyer) plays a large part in why they tend to be high-powered careers. Not being able to start a career until later in life is a disincentive to follow in that path, and the fewer people willing to still go through with it, the more power those careers will possess. There are other ways to limit the numbers, like a lottery, but not all of those are given the same social acceptance in North America. We are socially okay with extending time in academia. Not that everyone would become a doctor even if it were easier to attain, but to take it to the logical extreme, if everyone went through med school, doctors would have no more power than a sales clerk at Walmart. Power comes from scarcity.

jeffreyrogers 9y ago
> if everyone went through med school, doctors would have no more power than a sales clerk at Walmart. Power comes from scarcity. This is only true if every doctor coming out of med school is exactly the same or if you can't tell the difference in skill among doctors.
- randomdata 9y ago
  It still holds true. If this were the case, the scarcity of those who have observably more skill will hold the power. But there is an expectation that med school produces doctors who are sufficiently equal in their ability (in that you should not need to worry about which doctor you end up with). That you are suggesting this is not the case is quite interesting.
  - jeffreyrogers 9y ago
    I think there are large differences in ability between doctors even within specialties, but most doctors meet a minimum level of competence because the requirements for med school effectively filter out people who are not intelligent and conscientious enough to become doctors. If you don't think there are differences in skill between doctors just ask a friend or family member who is a doctor which doctors they would not recommend you see.

ardit33 9y ago

The problem is that people don't fully mature until 25-ish. I wouldn't trust a 23yo lawyer or doctor, no matter how smart they appear. Some things are learned only by experience, and not just by books. Also, a huge chunk of tech's HR issues are mostly created by startups having very young founders and young managers that don't have real life experience. (to me, young is anybody younger than 30). Half of the firing/issues I have seen in real life could have been easily avoided if the people in the room had more experience.

ghaff 9y ago
Way back when, there was some limited experimentation in the US with 6-year combined college/MD programs. They still exist but very few are 6 year--and they're schools you've probably never heard of. My understanding is that part of the issue was that there was a general feeling that students benefited from the additional time even if it wasn't strictly necessary with respect to coursework.
heliostatic 9y ago
While I think your contention is valid in 2018, it's important to consider how much of this is culturally and historically contingent. Consider the ages of some key figures in the American Revolution in 1776 (https://kottke.org/13/08/the-surprising-ages-of-the-founding-fathers-on-july-4-1776 https://kottke.org/13/08/the-surprising-ages-of-the-founding...) Marquis de Lafayette, 18 James Monroe, 18 Gilbert Stuart, 20 Aaron Burr, 20 Alexander Hamilton, 21 Betsy Ross, 24 James Madison, 25
nailer 9y ago
> I wouldn't trust a 23yo lawyer or doctor, no matter how smart they appear. Some things are learned only by experience, and not just by books. I wouldn't trust a 26 year old or 40 year old newly graduated doctor either, for the same reasons.
jeffreyrogers 9y ago
This is a good point, but I don't think that means we should stick young people in schools while we wait for them to mature. It seems more useful to have them doing some sort of productive work, where they can start learning by experience.

andrewl 9y ago

Freeman Dyson has commented on how long and wasteful it is for most people to get a doctorate I’m very proud of not having a Ph.D. I think the Ph.D. system is an abomination. It was invented as a system for educating German professors in the 19th century, and it works well under those conditions. It’s good for a very small number of people who are going to spend their lives being professors. But it has become now a kind of union card that you have to have in order to have a job, whether it’s being a professor or other things, and it’s quite inappropriate for that. It forces people to waste years and years of their lives sort of pretending to do research for which they’re not at all well-suited. In the end, they have this piece of paper which says they’re qualified, but it really doesn’t mean anything. The Ph.D. takes far too long and discourages women from becoming scientists, which I consider a great tragedy. So I have opposed it all my life without any success at all. https://www.quantamagazine.org/a-math-puzzle-worthy-of-freeman-dyson-20140326/ https://www.quantamagazine.org/a-math-puzzle-worthy-of-freem...

asabjorn 9y ago
I took one, and although it gives me a great advantage to be trained in research when exploring complex problems it feels like it took too many years that I could have spend on my passion for creating things.

Eire_Banshee 9y ago

Yeah... but nobody books a trip to India just for medical care either.

ranko 9y ago
"Foreign patients travelling to India to seek medical treatment in 2012, 2013 and 2014 numbered 171,021, 236,898, and 184,298 respectively" (https://en.wikipedia.org/wiki/Medical_tourism_in_India https://en.wikipedia.org/wiki/Medical_tourism_in_India)
- Eire_Banshee 9y ago
  Yeah, and 500,000 seek treatment in the US every year. https://www.imtj.com/news/bringing-medical-tourists-usa/ https://www.imtj.com/news/bringing-medical-tourists-usa/
lotsofpulp 9y ago
There are many people that do, and they save thousands. It is especially good for common procedures, like LASIK, dental work, etc.
- Eire_Banshee 9y ago
  You save thousands for a reason.
  - nugi 9y ago
    By not paying non-negotiated rates for medical care? Sounds like a good reason to me.

rayiner 9y ago

It's not just India. A law degree is a 3-year undergraduate degree in the U.K. as well. It works fine. In the U.S., in contrast, there has been a push towards extending the process that has a disparate impact on women. Now, it is typical for a lawyer to get a 4-year college degree, spend a year or two working, spend three years in law school, and graduate around 27 or 28, putting them into their mid to late 30s by the time they are established enough for many women to feel comfortable having kids. It's an enormously sexist feature of the profession, caused by the fetishization of schooling and academia.

PurpleBoxDragon 9y ago
>It's an enormously sexist feature of the profession Just because something may have an impact that differs based on sex doesn't make it sexist. Would we call pregnancy sexist because it works differently for each sex?
- rayiner 9y ago
  https://en.wikipedia.org/wiki/Disparate_impact https://en.wikipedia.org/wiki/Disparate_impact.
  - PurpleBoxDragon 9y ago
    >This form of discrimination occurs where an employer does not intend to discriminate; to the contrary, it occurs when identical standards or procedures are applied to everyone, despite the fact that they lead to a substantial difference in employment outcomes for the members of a particular group and they are unrelated to successful job performance. Are you making the claim that an extended education has no impact on performance? If I require my developers to have a degree, it doesn't violate this concept even though a degree isn't required to be a good programmer.
    - rayiner 9y ago
      > Are you making the claim that an extended education has no impact on performance? Yes. E.g. in the U.K., you can start practicing law around age 21. In the U.S., typically it's 25 if you go straight through. Somehow the U.K. still manages to be a center of commerce and finance.

clairity 9y ago

i'd be ok with medical/law training to start as early as 16 (for those who can finish high school early). for med school, you could still have 5 years of academic training (as with the Indian model) and then do 4 years of apprenticeship (internship /residency) and be a fully qualifed doctor by 25. for law school, 4 years of academic training and 3 years of apprenticeship and be a fully qualified lawyer by 23. these are professional trades, so the apprenticeship piece is a crucial transition period to learn from those who came before you.