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"What do you call the person that finishes last in medical school? Doctor." Somewhat less snarkily, I was under the impression that medical schools hate not gr

"What do you call the person that finishes last in medical school? Doctor." Somewhat less snarkily, I was under the impression that medical schools hate not graduating their students, so once you're in, basically anybody who can physically survive the grind will become a doctor. Is this incorrect?

nradov 5y ago
In reality the person who finishes last in medical school is at serious risk of not being matched to a residency slot. So technically they're a doctor, but not able to practice medicine. Those people tend to go to work in related fields like pharmaceutical sales or hospital administration.
- ThePadawan 5y ago
  I'm not from the US, so this comes from curiosity and lack of knowledge of the system: Doesn't that suck for everyone? In Germany, there is a (apparently) large generation gap of countryside doctors. The old ones retire, but no one young shows up to replace them, even though they are very well paid. But what 30 year old would want to live and work in a village of 5000? Is that scenario not applicable in the US, or are the jobs you mentioned simply still considered a better deal.
  - chrisseaton 5y ago
    > But what 30 year old would want to live and work in a village of 5000? Married with kids and want to move to the country to settle down. Isn’t that what a lot of 30-year-olds do? Especially middle class people like doctors.
    - ThePadawan 5y ago
      Well, there's probably no work for your wife, and the daycare or school are probably miles away. That kind of moves it from "settling down in the countryside" to "getting away from civilization entirely" territory. (That's speaking in broad generalizations, of course. This isn't the usual case, but there are broad parts of (especially Eastern) Germany that are depopulating rapidly since there are so few job opportunities)
      - chrisseaton 5y ago
        I guess that problem just went away with work-from-home though?
        ThePadawan 5y ago
        I personally don't know, but I also can't imagine - German internet speeds outside of metropolitan areas is notoriously somewhere between non-existant and absolute garbage. https://breitbandmessung.de/kartenansicht https://breitbandmessung.de/kartenansicht has a scrollable map, but it doesn't say from when the measurements are, nor if "no coverage" means that there is no coverage, or if they have performed no measurements there. But you're probably lucky to get into the double digits of Mbps. Note how the whole map tops out at ">= 50Mbps".
        pedrosorio 5y ago
        Good thing starlink service was made available in Germany earlier this year.
        ThePadawan 5y ago
        All the sources I can find (like [0]) say "Starlink is currently available in some major cities especially in Western Germany, and promises to bring the network up mid-to-end-of-2021, but many, especially rural areas, are not in reach yet". So IMO not applicable. [0] https://www.handelsblatt.com/technik/it-internet/spacex-tochterunternehmen-starlink-elon-musks-satelliten-internet-startet-in-deutschland/26993108.html?ticket=ST-5074608-9mJSXGSAqnhB4dFx1GZB-ap3 https://www.handelsblatt.com/technik/it-internet/spacex-toch...
        inglor_cz 5y ago
        Starlink is still in its infancy and needs 10 times as many satellites up there before it can really provide a global coverage. I believe they will make it by 2024 or perhaps a bit sooner (if Starship development goes well - that ship has an enormous cargo capacity to LEO), but it isn't an option for most people yet.
  - nradov 5y ago
    There are programs in the US to encourage physicians to practice in under served rural areas through student loan forgiveness and other benefits. https://nhsc.hrsa.gov/loan-repayment/nhsc-rural-community-loan-repayment-program https://nhsc.hrsa.gov/loan-repayment/nhsc-rural-community-lo... But those programs generally only apply to physicians who have finished residency. We really need to increase funding for residency programs in general so that those are no longer a limiting factor in training new physicians.
  - pomian 5y ago
    There is exactly this problem in the USA and Canada. To the point that students that want to be rural country doctors have a very hard time getting to be so, because the system is set up to maximize for city specialists. Pay is worse, but acceptable to most, because of lower costs of living. Costs of education (indebtedness) are still astronomical. (System is slowly improving though.)
- OrvalWintermute 5y ago
  Being last-ranked is not a guarantee not to interfere with a residency slot. There are many more factors that go into matching. Being picky on specialty, or location, is going to make a match more difficult. A Competitive specialty like Ortho, Radiology, or Radiation Oncology trying for a big city that is popular would be a hard fit. Due to how few Radiation Oncology programs there are, even a class valedictorian may not get in - there are just not that many slots. A less desirable specialty like family practice or internal medicine would be a much easier fit for a lower ranked candidate.

nradov 5y ago

In reality the person who finishes last in medical school is at serious risk of not being matched to a residency slot. So technically they're a doctor, but not able to practice medicine. Those people tend to go to work in related fields like pharmaceutical sales or hospital administration.

ThePadawan 5y ago
I'm not from the US, so this comes from curiosity and lack of knowledge of the system: Doesn't that suck for everyone? In Germany, there is a (apparently) large generation gap of countryside doctors. The old ones retire, but no one young shows up to replace them, even though they are very well paid. But what 30 year old would want to live and work in a village of 5000? Is that scenario not applicable in the US, or are the jobs you mentioned simply still considered a better deal.
- chrisseaton 5y ago
  > But what 30 year old would want to live and work in a village of 5000? Married with kids and want to move to the country to settle down. Isn’t that what a lot of 30-year-olds do? Especially middle class people like doctors.
  - ThePadawan 5y ago
    Well, there's probably no work for your wife, and the daycare or school are probably miles away. That kind of moves it from "settling down in the countryside" to "getting away from civilization entirely" territory. (That's speaking in broad generalizations, of course. This isn't the usual case, but there are broad parts of (especially Eastern) Germany that are depopulating rapidly since there are so few job opportunities)
    - chrisseaton 5y ago
      I guess that problem just went away with work-from-home though?
      - ThePadawan 5y ago
        I personally don't know, but I also can't imagine - German internet speeds outside of metropolitan areas is notoriously somewhere between non-existant and absolute garbage. https://breitbandmessung.de/kartenansicht https://breitbandmessung.de/kartenansicht has a scrollable map, but it doesn't say from when the measurements are, nor if "no coverage" means that there is no coverage, or if they have performed no measurements there. But you're probably lucky to get into the double digits of Mbps. Note how the whole map tops out at ">= 50Mbps".
        pedrosorio 5y ago
        Good thing starlink service was made available in Germany earlier this year.
        ThePadawan 5y ago
        All the sources I can find (like [0]) say "Starlink is currently available in some major cities especially in Western Germany, and promises to bring the network up mid-to-end-of-2021, but many, especially rural areas, are not in reach yet". So IMO not applicable. [0] https://www.handelsblatt.com/technik/it-internet/spacex-tochterunternehmen-starlink-elon-musks-satelliten-internet-startet-in-deutschland/26993108.html?ticket=ST-5074608-9mJSXGSAqnhB4dFx1GZB-ap3 https://www.handelsblatt.com/technik/it-internet/spacex-toch...
        inglor_cz 5y ago
        Starlink is still in its infancy and needs 10 times as many satellites up there before it can really provide a global coverage. I believe they will make it by 2024 or perhaps a bit sooner (if Starship development goes well - that ship has an enormous cargo capacity to LEO), but it isn't an option for most people yet.
- nradov 5y ago
  There are programs in the US to encourage physicians to practice in under served rural areas through student loan forgiveness and other benefits. https://nhsc.hrsa.gov/loan-repayment/nhsc-rural-community-loan-repayment-program https://nhsc.hrsa.gov/loan-repayment/nhsc-rural-community-lo... But those programs generally only apply to physicians who have finished residency. We really need to increase funding for residency programs in general so that those are no longer a limiting factor in training new physicians.
- pomian 5y ago
  There is exactly this problem in the USA and Canada. To the point that students that want to be rural country doctors have a very hard time getting to be so, because the system is set up to maximize for city specialists. Pay is worse, but acceptable to most, because of lower costs of living. Costs of education (indebtedness) are still astronomical. (System is slowly improving though.)
OrvalWintermute 5y ago
Being last-ranked is not a guarantee not to interfere with a residency slot. There are many more factors that go into matching. Being picky on specialty, or location, is going to make a match more difficult. A Competitive specialty like Ortho, Radiology, or Radiation Oncology trying for a big city that is popular would be a hard fit. Due to how few Radiation Oncology programs there are, even a class valedictorian may not get in - there are just not that many slots. A less desirable specialty like family practice or internal medicine would be a much easier fit for a lower ranked candidate.