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So going to school for a long time to learn an unusual skill well means that your services are more valuable. It's only a rare skill because of licensing/board

So going to school for a long time to learn an unusual skill well means that your services are more valuable. It's only a rare skill because of licensing/board requirements. I'm fairly certain if you told other people they could make $250k as a radiologist, they could self-teach. The same thing could be said of programming if the only people that could practice had to be certified.

sp332 15y ago
I really, really don't think that's true. Most people are not able to do this, and most of those few who could don't want to put themselves through it. And then separately, how many people would trust a self-taught diagnostician?
- kenjackson 15y ago
  Most people are not able to do this, and most of those few who could don't want to put themselves through it. Most people don't have to be able to do it, just more than are allowed to do it now, but a factor of say 10. Furthermore, I don't think people would necessarily need to go through med school and residency. It's like building a website. There's probably some parallel universe where programming requires certification and only a handful of schools have it. It requires doing MITs SICP as the intro course. Requires compiler construction courses, algorithms, theory of computation and complexity, etc... And then a 4 year apprenticeship with other programmers. And then you can start building webpages, if that's what you want to do. But we live in a world where it is open and so there's instruction available at many different levels. Would you let someone without a PhD in CS build your website? Of course you would. And then separately, how many people would trust a self-taught diagnostician? I trust my car mechanics diagnosis despite the fact I have no idea what level of education he has. But I'm fairly certain he's not an ME from MIT or Berkeley. With good self-study tools, I think that one can self-teach in specialized areas and achieve good mastery rather efficiently. I could imagine Khan Academy for Radiology taught by JHU and Harvard professors to be quite good.
  - roentgen 15y ago
    > I could imagine Khan Academy for Radiology taught by JHU and Harvard professors to be quite good. You have got to be kidding me. How would this work for surgery? There are no short cuts to medical competency. Sure, some of what I do is self-taught, I read books and articles, attend conferences, and complete Continuing Medical Education requirements. But I am able to do this because I attended medical school, then spent five years sitting less than a foot from experienced radiologists while they worked and answered every question I had.
    - true_religion 15y ago
      Characterizing it as a "short cut" is disingenuous. The argument here is that medical boards are too rigorous, and test things that do not matter practically. To give a ridiculous example, if a medical school required you to climb Mount Everest before becoming a doctor that might result in only 1 person becoming a doctor per year. However that scarcity isn't proof that climbing Mount Everest is needed to become a doctor. Nor is it proof that cutting out that requirement will provide significantly worse doctors than previous. Additionally, in many things we need quantity more than we need extreme compentancy. For example when cut, its better to have some kind of treatment (e.g. first aid, stitching) rather than waiting for a surgical specialist.
      - roentgen 15y ago
        In fact, the medical licensing exams and board exams are too lenient. The general quality of people going to medical school in the US has been dropping for a generation. The standards are sliding, to our detriment.
        carbocation 15y ago
        I'd be quite interested to see evidence to support this assertion. Or is it just generally the case that everyone sees Osler's days as medicine's primetime, with a long slide since then?
roentgen 15y ago
I'm going to respectfully disagree. This may be possible in some medical fields (I doubt it), but not radiology. There is simply too much to learn. I completed 4 years of medical school followed by a 5 year residency. Some radiologists go through additional sub-specialty training. I've been practicing for 5+ years, and I'm still learning everyday. I am a doctor's doctor, meaning my customers are doctors from every specialty, who order studies and read my reports looking for answers they can't answer clinically. I can talk to Orthopedic surgeons in their language, Neurologists in theirs, and Gastroenterologists in theirs. I'm familiar with the radiological manifestation of most pathological processes a human can experience. The notion that someone could self-teach what I know seems impossible. There are licensing and board requirements, but conspiracy theories aside they are not designed to create artificial scarcity, they're supposed to keep dangerously ignorant doctors from practicing.
- kenjackson 15y ago
  This may be possible in some medical fields (I doubt it), but not radiology. There is simply too much to learn. I completed 4 years of medical school followed by a 5 year residency. Some radiologists go through additional sub-specialty training. I've been practicing for 5+ years, and I'm still learning everyday. But what can you say that about? I did 4 years undergrad in CS, followed by 5 years for a PhD. Followed by more than a decade in industry. And I still learn everyday too. The notion that someone could self-teach what I know seems impossible. I should be clear, as the term is ambiguous, they'd likely learn from experts, but not by going to a board approved medical school. But through things like online schools, programs, books, etc... It wouldn't be someone trying to recreate a curriculum from scratch. There are licensing and board requirements, but conspiracy theories aside they are not designed to create artificial scarcity, they're supposed to keep dangerously ignorant doctors from practicing. Given the lack of policing after becoming a doctor I'm skeptical of this claim. At the college level I'd like to see a wider swath let in to medical school, and then a more rigorous approach to filterning, based on not only medical proficiency, but ethics. The big problem I see with doctors isn't in expertise or proficiency, but in ethics. And given the data on sleep deprivation and learning, I think loosening the requirements even a tad would result in less scarcity and better prepared doctors on average.

sp332 15y ago

I really, really don't think that's true. Most people are not able to do this, and most of those few who could don't want to put themselves through it. And then separately, how many people would trust a self-taught diagnostician?

kenjackson 15y ago
Most people are not able to do this, and most of those few who could don't want to put themselves through it. Most people don't have to be able to do it, just more than are allowed to do it now, but a factor of say 10. Furthermore, I don't think people would necessarily need to go through med school and residency. It's like building a website. There's probably some parallel universe where programming requires certification and only a handful of schools have it. It requires doing MITs SICP as the intro course. Requires compiler construction courses, algorithms, theory of computation and complexity, etc... And then a 4 year apprenticeship with other programmers. And then you can start building webpages, if that's what you want to do. But we live in a world where it is open and so there's instruction available at many different levels. Would you let someone without a PhD in CS build your website? Of course you would. And then separately, how many people would trust a self-taught diagnostician? I trust my car mechanics diagnosis despite the fact I have no idea what level of education he has. But I'm fairly certain he's not an ME from MIT or Berkeley. With good self-study tools, I think that one can self-teach in specialized areas and achieve good mastery rather efficiently. I could imagine Khan Academy for Radiology taught by JHU and Harvard professors to be quite good.
- roentgen 15y ago
  > I could imagine Khan Academy for Radiology taught by JHU and Harvard professors to be quite good. You have got to be kidding me. How would this work for surgery? There are no short cuts to medical competency. Sure, some of what I do is self-taught, I read books and articles, attend conferences, and complete Continuing Medical Education requirements. But I am able to do this because I attended medical school, then spent five years sitting less than a foot from experienced radiologists while they worked and answered every question I had.
  - true_religion 15y ago
    Characterizing it as a "short cut" is disingenuous. The argument here is that medical boards are too rigorous, and test things that do not matter practically. To give a ridiculous example, if a medical school required you to climb Mount Everest before becoming a doctor that might result in only 1 person becoming a doctor per year. However that scarcity isn't proof that climbing Mount Everest is needed to become a doctor. Nor is it proof that cutting out that requirement will provide significantly worse doctors than previous. Additionally, in many things we need quantity more than we need extreme compentancy. For example when cut, its better to have some kind of treatment (e.g. first aid, stitching) rather than waiting for a surgical specialist.
    - roentgen 15y ago
      In fact, the medical licensing exams and board exams are too lenient. The general quality of people going to medical school in the US has been dropping for a generation. The standards are sliding, to our detriment.
      - carbocation 15y ago
        I'd be quite interested to see evidence to support this assertion. Or is it just generally the case that everyone sees Osler's days as medicine's primetime, with a long slide since then?

roentgen 15y ago

I'm going to respectfully disagree. This may be possible in some medical fields (I doubt it), but not radiology. There is simply too much to learn. I completed 4 years of medical school followed by a 5 year residency. Some radiologists go through additional sub-specialty training. I've been practicing for 5+ years, and I'm still learning everyday. I am a doctor's doctor, meaning my customers are doctors from every specialty, who order studies and read my reports looking for answers they can't answer clinically. I can talk to Orthopedic surgeons in their language, Neurologists in theirs, and Gastroenterologists in theirs. I'm familiar with the radiological manifestation of most pathological processes a human can experience. The notion that someone could self-teach what I know seems impossible. There are licensing and board requirements, but conspiracy theories aside they are not designed to create artificial scarcity, they're supposed to keep dangerously ignorant doctors from practicing.

kenjackson 15y ago
This may be possible in some medical fields (I doubt it), but not radiology. There is simply too much to learn. I completed 4 years of medical school followed by a 5 year residency. Some radiologists go through additional sub-specialty training. I've been practicing for 5+ years, and I'm still learning everyday. But what can you say that about? I did 4 years undergrad in CS, followed by 5 years for a PhD. Followed by more than a decade in industry. And I still learn everyday too. The notion that someone could self-teach what I know seems impossible. I should be clear, as the term is ambiguous, they'd likely learn from experts, but not by going to a board approved medical school. But through things like online schools, programs, books, etc... It wouldn't be someone trying to recreate a curriculum from scratch. There are licensing and board requirements, but conspiracy theories aside they are not designed to create artificial scarcity, they're supposed to keep dangerously ignorant doctors from practicing. Given the lack of policing after becoming a doctor I'm skeptical of this claim. At the college level I'd like to see a wider swath let in to medical school, and then a more rigorous approach to filterning, based on not only medical proficiency, but ethics. The big problem I see with doctors isn't in expertise or proficiency, but in ethics. And given the data on sleep deprivation and learning, I think loosening the requirements even a tad would result in less scarcity and better prepared doctors on average.