7 ms·

Second-Chance Med School

46 points by dataminer 12y ago

angersock 12y ago
A really interesting bit is this photograph: http://static01.nyt.com/images/2014/08/03/education/edlife/03CARIB-BILL/CARIB-BILL-superJumbo.jpg http://static01.nyt.com/images/2014/08/03/education/edlife/0... Note that the currencies are local, and costs are listed up front.
- Grazester 12y ago
  The currency use is the Eastern Caribbean Dollar(XCD) or called the ec dollar. 1USD = ~2.71 XCD As for the safety concerns about Grenada. Its one of the fastest Caribbean islands. You should be pre-cautious since as a foreigner you may be more of a target but you wouldn't find yourself walking down a dodgy street at night in your home country then why do it here in Grenada?
  - vermontdevil 12y ago
    > fastest Caribbean islands Didn't know these islands can run. :) I presume you mean fastest growing. But like you said, if you are careful you'll be fine and that applies pretty much everywhere even North Korea.
    - chris11 12y ago
      I'm assuming he meant safest.
      - Grazester 12y ago
        ahahaha safest and fastest(we are the current 400 metre Olympic gold medalist) Yeah but I meant safest :)
lnanek2 12y ago
I never really understood why the US has quotas intentionally preventing students who are skilled enough from getting education here.
- kingnothing 12y ago
  The AMA has limits to protect the income and quality of doctors.
  - chimeracoder 12y ago
    First, quality is not the (only) reason the AMA used to limit the number of doctors. The AMA is a convenient scapegoat thanks to the catchy song about it, but it's actually not relevant here[0]. Secondly, the real limiting factor now is not the AMA but the AAMC[1]. They serve as the current bottleneck for increasing the number of people who receive the MD degree. However, getting an MD doesn't mean that you can practice medicine. Technically, you haven't even been trained to practice yet - that happens during residency[2]. The bottleneck for the number of practicing physicians (as opposed to the number of MDs) is what is really relevant. That is capped by the number of residency positions available. These are funded through Medicare, so the real limiting factor is the government spending allocated towards Medicare which funds residency positions. So, blame the AAMC, blame Medicare, blame the government, or blame Congress, but don't blame the AMA, since they aren't the bottleneck for increasing the number of practicing physicians. (And one can easily make the argument that increasing the number of medical school students while keeping the number of residency positions open constant is a waste of money). As for reducing the costs, that's easier said than done. The amount of time it takes to train someone to (e.g) be a good cardiologist is significant, and the length of time alone makes the costs very significant - trying to shave off a few pennies here and there is really just a drop in the bucket. The only way to lower these costs appreciably would be to lower the amount of time it takes to train in these specialties, but that comes with a number of risks. Already there have been a number of lawsuits arising from overworked and sleep-deprived residents making mistakes, and it's a tough sell politically to say "Your cardiologist spent 33% less time training to receive a bargain degree. Any loss in quality that impacts your health is just a side-effect of keeping health costs low."[3] [0] It's also misleading to imply that the AMA seeks to keep income for doctors high. The relationship between doctors and the AMA is complicated, but fairly rocky and sometimes downright acrimonious. Keeping incomes high is (if anything) a side-effect of the AMA's practices, not a goal. (And if it were, the AMA would be failing heavily at this goal, as physician income has been declining steadily for many years now in most states). [1] https://skeptics.stackexchange.com/questions/4561/does-the-ama-limit-the-number-of-doctors-to-increase-current-doctors-salaries https://skeptics.stackexchange.com/questions/4561/does-the-a... [2] Which only gives you the ability to practice in a limited capacity - any specialties or subspecialties will require a fellowship, which can be as much as 10 years of training after receiving the M.D.
HorizonXP 12y ago
I wanted to be a medical doctor. I volunteered at hospitals, local first aid groups, I even took the prerequisites (anatomy, organic chemistry, etc.) while I was in undergrad for electrical engineering. My pie-in-the-sky hope was to combine my knowledge and skillset in electrical and software engineering, with medical training to create new innovations in medical technology. I didn't know exactly what I was going to do, but I knew the path I wanted to take. Heck, it's even why I did a Master's in medical imaging (didn't write my thesis though.) I wrote my MCATs, got a 33S, which I was super proud of. Had a 3.5 GPA. Not stellar, but I thought it was good considering my workload and degree choice. I applied all over Ontario, in hopes of getting in. I never even managed to get an interview. I guess I shouldn't have bothered to believe the medical schools when they said they look at each applicant holistically. They just care about the raw numbers. I mean, it explains why the entrance average at some Ontario medical schools is higher than even Harvard. I gave up. Sure, I looked at the Caribbean schools. Plenty of my friends in the sciences went there. My sister is there now. I looked at going to the US. I didn't want to do that. I wanted to study in my home country. I mean, I am who I am because of the investment of my fellow Canadians in me through their tax dollars. I wanted to try and start to pay that back, while also continuing to reap those benefits. I lost hope in my Master's degree. I didn't see the point anymore. I became depressed. Things were going downhill. I left the program, and took a few months to pull myself together. I sought out help. I tried to go back to my Master's program, but it was all for naught; I couldn't get back into it. I tried going back to what I loved: creating things. I fleshed out my mobile payments startup idea, went through a whirlwind ChallengePost competition, lost, but had a ton of fun. Then I taught myself to create Android apps, and took on a contract for a friend in San Francisco. Proposed to my girlfriend in Rome with the money from that contract. Took on another contract doing Android development in Palo Alto. Decided to go full-time, moved to Palo Alto. Facebook bought us, and I worked at Instagram for a while. I left to pursue my own ideas back in Toronto, having tremendous amounts of fun and success doing it. Got married. Have an amazing wife, an amazing place, and amazing family. Like I mentioned, my sister went to a Caribbean school. She's in Chicago right now doing rotations. She went straight out of high school, so she'll be a doctor before she's 26. The Caribbean schools can definitely give a second-chance to folks really keen on becoming a doctor. If you're truly passionate about helping the sick and injured, do it. I decided I ultimately wasn't passionate enough about it. I found my passion in my old love of software. And I'm grateful that I did.
zxcvvcxz 12y ago
Two fundamental arguments are being made in this thread: 1) some organization is responsible for limiting MDs and this is a bad thing, and 2) MDs need to be limited because there are not enough residency spots, hence students shouldn't be allowed to start on a path leading to 4 years of study and massive debt but not enough jobs. I'd like to attack the counterpoint in #2, as I don't believe it to be in the spirit of free market economics. The argument basically presumes that if someone attains their medical education, they will have no career prospects except in those careers that already exist. Anyone with even a slight entrepreneurial bend must realize the ridiculousness of this. Ditto for anyone who understands the concept "creative destruction". Imagine for a second a parallel universe without an artificial cap on medical students, where MD numbers overflow such that a bunch of MDs don't get residency positions. Is it impossible to imagine new institutions, businesses and services forming as a result? Another question then is how much innovation could we be missing out on? There are some instances where artificial caps are a good idea. I don't believe education is one of them.
bkeroack 12y ago
Here's a big, dark secret: being a physician isn't really that hard. Sure, there's a lot to learn. Yes there are some physical techniques that must be mastered (lots if you want to become a surgeon). But the raw intellect required is not especially high--anybody above the 66th percentile would likely do just fine. A long time ago I was in pre-med. Similar to the article, I got a 35 on my MCAT. I know a lot of physicians. They're all very smart (because you have to be to get into medical school). The vast majority of them are bored with medicine. They do anything they can other than see patients. Some invest in real estate, some manage other physicians in a group practice--there's one guy who built a small datacenter and runs a business selling electronic medical records systems as a service to other medical practices! The point is--the practice of medicine kind of sucks. It's mostly the same things over and over, with a lot of paperwork thrown in. Med school lures in the young with the prestige attached to the magic letters "M.D." and because med school is an ultra-exclusive club for smart people. The sick joke is that after all the work and sacrifice and expense the job usually isn't worth it. If you want to be a doctor, imagine yourself working in subsaharan Africa helping the neediest, poorest people imaginable. If it doesn't sound like something you'd want to do, you don't like medicine enough for the career path to be worthwhile to you.
- tomwalker 12y ago
  Very good post and I agree. The job is stressful, the individual liability is extremely high and the sacrifice is not worth it for many. Often family expectations are involved.
  - cpwright 12y ago
    One of the things that struck me about the article was how many of these people wanted to take over a practice from a parent.
- hacknat 12y ago
  Reminds me of a dailybeast article from a while back: http://www.thedailybeast.com/articles/2014/04/14/how-being-a-doctor-became-the-most-miserable-profession.html http://www.thedailybeast.com/articles/2014/04/14/how-being-a... The article doesn't specifically cite boredom (that I remember) as a cause of unhappiness, but it wouldn't surprise me if it was.
lucidrains 12y ago
If there are any software engineers around the bay area who is thinking of going into medicine, please come talk to me first. Would be happy to share my experiences as someone who left after getting the degree.
- dataminer 12y ago
  mdcases.net looks like a very interesting idea and can become a very valuable resource, are you pursuing it full time?
  - lucidrains 12y ago
    not really, after a couple successful demos to UMich (we knew the doctors that wanted this software), they put us in their pipelines for procurement, and that was 6 months ago! we periodically poll them to see where we are in the bureaucracy, but they keep giving us vague answers. selling to hospitals suck dude, that's what i've realized. I am working on another medical idea at the moment, a crowdsourced medical expert system. I hope to unveil it on HN by the end of the summer!
- foobarqux 12y ago
  Why don't you just highlight the bad in a comment here? I'm not interested in medicine but I am interested in your experience with it.

46 points by dataminer 12y ago

A really interesting bit is this photograph: http://static01.nyt.com/images/2014/08/03/education/edlife/03CARIB-BILL/CARIB-BILL-superJumbo.jpg http://static01.nyt.com/images/2014/08/03/education/edlife/0... Note that the currencies are local, and costs are listed up front.

Grazester 12y ago
The currency use is the Eastern Caribbean Dollar(XCD) or called the ec dollar. 1USD = ~2.71 XCD As for the safety concerns about Grenada. Its one of the fastest Caribbean islands. You should be pre-cautious since as a foreigner you may be more of a target but you wouldn't find yourself walking down a dodgy street at night in your home country then why do it here in Grenada?
- vermontdevil 12y ago
  > fastest Caribbean islands Didn't know these islands can run. :) I presume you mean fastest growing. But like you said, if you are careful you'll be fine and that applies pretty much everywhere even North Korea.
  - chris11 12y ago
    I'm assuming he meant safest.
    - Grazester 12y ago
      ahahaha safest and fastest(we are the current 400 metre Olympic gold medalist) Yeah but I meant safest :)

lnanek2 12y ago

I never really understood why the US has quotas intentionally preventing students who are skilled enough from getting education here.

kingnothing 12y ago
The AMA has limits to protect the income and quality of doctors.
- chimeracoder 12y ago
  First, quality is not the (only) reason the AMA used to limit the number of doctors. The AMA is a convenient scapegoat thanks to the catchy song about it, but it's actually not relevant here[0]. Secondly, the real limiting factor now is not the AMA but the AAMC[1]. They serve as the current bottleneck for increasing the number of people who receive the MD degree. However, getting an MD doesn't mean that you can practice medicine. Technically, you haven't even been trained to practice yet - that happens during residency[2]. The bottleneck for the number of practicing physicians (as opposed to the number of MDs) is what is really relevant. That is capped by the number of residency positions available. These are funded through Medicare, so the real limiting factor is the government spending allocated towards Medicare which funds residency positions. So, blame the AAMC, blame Medicare, blame the government, or blame Congress, but don't blame the AMA, since they aren't the bottleneck for increasing the number of practicing physicians. (And one can easily make the argument that increasing the number of medical school students while keeping the number of residency positions open constant is a waste of money). As for reducing the costs, that's easier said than done. The amount of time it takes to train someone to (e.g) be a good cardiologist is significant, and the length of time alone makes the costs very significant - trying to shave off a few pennies here and there is really just a drop in the bucket. The only way to lower these costs appreciably would be to lower the amount of time it takes to train in these specialties, but that comes with a number of risks. Already there have been a number of lawsuits arising from overworked and sleep-deprived residents making mistakes, and it's a tough sell politically to say "Your cardiologist spent 33% less time training to receive a bargain degree. Any loss in quality that impacts your health is just a side-effect of keeping health costs low."[3] [0] It's also misleading to imply that the AMA seeks to keep income for doctors high. The relationship between doctors and the AMA is complicated, but fairly rocky and sometimes downright acrimonious. Keeping incomes high is (if anything) a side-effect of the AMA's practices, not a goal. (And if it were, the AMA would be failing heavily at this goal, as physician income has been declining steadily for many years now in most states). [1] https://skeptics.stackexchange.com/questions/4561/does-the-ama-limit-the-number-of-doctors-to-increase-current-doctors-salaries https://skeptics.stackexchange.com/questions/4561/does-the-a... [2] Which only gives you the ability to practice in a limited capacity - any specialties or subspecialties will require a fellowship, which can be as much as 10 years of training after receiving the M.D.

HorizonXP 12y ago

I wanted to be a medical doctor. I volunteered at hospitals, local first aid groups, I even took the prerequisites (anatomy, organic chemistry, etc.) while I was in undergrad for electrical engineering. My pie-in-the-sky hope was to combine my knowledge and skillset in electrical and software engineering, with medical training to create new innovations in medical technology. I didn't know exactly what I was going to do, but I knew the path I wanted to take. Heck, it's even why I did a Master's in medical imaging (didn't write my thesis though.) I wrote my MCATs, got a 33S, which I was super proud of. Had a 3.5 GPA. Not stellar, but I thought it was good considering my workload and degree choice. I applied all over Ontario, in hopes of getting in. I never even managed to get an interview. I guess I shouldn't have bothered to believe the medical schools when they said they look at each applicant holistically. They just care about the raw numbers. I mean, it explains why the entrance average at some Ontario medical schools is higher than even Harvard. I gave up. Sure, I looked at the Caribbean schools. Plenty of my friends in the sciences went there. My sister is there now. I looked at going to the US. I didn't want to do that. I wanted to study in my home country. I mean, I am who I am because of the investment of my fellow Canadians in me through their tax dollars. I wanted to try and start to pay that back, while also continuing to reap those benefits. I lost hope in my Master's degree. I didn't see the point anymore. I became depressed. Things were going downhill. I left the program, and took a few months to pull myself together. I sought out help. I tried to go back to my Master's program, but it was all for naught; I couldn't get back into it. I tried going back to what I loved: creating things. I fleshed out my mobile payments startup idea, went through a whirlwind ChallengePost competition, lost, but had a ton of fun. Then I taught myself to create Android apps, and took on a contract for a friend in San Francisco. Proposed to my girlfriend in Rome with the money from that contract. Took on another contract doing Android development in Palo Alto. Decided to go full-time, moved to Palo Alto. Facebook bought us, and I worked at Instagram for a while. I left to pursue my own ideas back in Toronto, having tremendous amounts of fun and success doing it. Got married. Have an amazing wife, an amazing place, and amazing family. Like I mentioned, my sister went to a Caribbean school. She's in Chicago right now doing rotations. She went straight out of high school, so she'll be a doctor before she's 26. The Caribbean schools can definitely give a second-chance to folks really keen on becoming a doctor. If you're truly passionate about helping the sick and injured, do it. I decided I ultimately wasn't passionate enough about it. I found my passion in my old love of software. And I'm grateful that I did.

zxcvvcxz 12y ago

Two fundamental arguments are being made in this thread: 1) some organization is responsible for limiting MDs and this is a bad thing, and 2) MDs need to be limited because there are not enough residency spots, hence students shouldn't be allowed to start on a path leading to 4 years of study and massive debt but not enough jobs. I'd like to attack the counterpoint in #2, as I don't believe it to be in the spirit of free market economics. The argument basically presumes that if someone attains their medical education, they will have no career prospects except in those careers that already exist. Anyone with even a slight entrepreneurial bend must realize the ridiculousness of this. Ditto for anyone who understands the concept "creative destruction". Imagine for a second a parallel universe without an artificial cap on medical students, where MD numbers overflow such that a bunch of MDs don't get residency positions. Is it impossible to imagine new institutions, businesses and services forming as a result? Another question then is how much innovation could we be missing out on? There are some instances where artificial caps are a good idea. I don't believe education is one of them.

bkeroack 12y ago

Here's a big, dark secret: being a physician isn't really that hard. Sure, there's a lot to learn. Yes there are some physical techniques that must be mastered (lots if you want to become a surgeon). But the raw intellect required is not especially high--anybody above the 66th percentile would likely do just fine. A long time ago I was in pre-med. Similar to the article, I got a 35 on my MCAT. I know a lot of physicians. They're all very smart (because you have to be to get into medical school). The vast majority of them are bored with medicine. They do anything they can other than see patients. Some invest in real estate, some manage other physicians in a group practice--there's one guy who built a small datacenter and runs a business selling electronic medical records systems as a service to other medical practices! The point is--the practice of medicine kind of sucks. It's mostly the same things over and over, with a lot of paperwork thrown in. Med school lures in the young with the prestige attached to the magic letters "M.D." and because med school is an ultra-exclusive club for smart people. The sick joke is that after all the work and sacrifice and expense the job usually isn't worth it. If you want to be a doctor, imagine yourself working in subsaharan Africa helping the neediest, poorest people imaginable. If it doesn't sound like something you'd want to do, you don't like medicine enough for the career path to be worthwhile to you.

tomwalker 12y ago
Very good post and I agree. The job is stressful, the individual liability is extremely high and the sacrifice is not worth it for many. Often family expectations are involved.
- cpwright 12y ago
  One of the things that struck me about the article was how many of these people wanted to take over a practice from a parent.
hacknat 12y ago
Reminds me of a dailybeast article from a while back: http://www.thedailybeast.com/articles/2014/04/14/how-being-a-doctor-became-the-most-miserable-profession.html http://www.thedailybeast.com/articles/2014/04/14/how-being-a... The article doesn't specifically cite boredom (that I remember) as a cause of unhappiness, but it wouldn't surprise me if it was.

lucidrains 12y ago

If there are any software engineers around the bay area who is thinking of going into medicine, please come talk to me first. Would be happy to share my experiences as someone who left after getting the degree.

dataminer 12y ago
mdcases.net looks like a very interesting idea and can become a very valuable resource, are you pursuing it full time?
- lucidrains 12y ago
  not really, after a couple successful demos to UMich (we knew the doctors that wanted this software), they put us in their pipelines for procurement, and that was 6 months ago! we periodically poll them to see where we are in the bureaucracy, but they keep giving us vague answers. selling to hospitals suck dude, that's what i've realized. I am working on another medical idea at the moment, a crowdsourced medical expert system. I hope to unveil it on HN by the end of the summer!
foobarqux 12y ago
Why don't you just highlight the bad in a comment here? I'm not interested in medicine but I am interested in your experience with it.