End of Affirmative Action: Implications for Pain

[drusso]

https://www.nytimes.com/live/2023/06/29/us/affirmative-action-supreme-court

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[Ferrismonk]

Only can read the headline, but unfortunately I'm willing to be this decision won't go far enough. I live in Michigan and if you recall several years ago UofM has a supreme court case brought against it regarding the unfairness of affirmative action. UofM won the case and was allowed to continue to discriminate based on race, but shortly thereafter Michigan made it's own law that said it can't. The UofM admission team then stopped using race in it's admission criteria, but then gave preference to certain zip codes, etc.

 

[epidural man]

I think California made a law that you couldn't make admission decisions based on race - but the clearly still do.

 

[epidural man]

I personally can't believe that "prestigous" schools that obviously discriminate are still considered prestigious. Not in my mind......I think they are ridiculous.

I just was at a party and met a daughter of one of my friends. She just graduated from Harvard - and in my mind, I thought - why would anyone want to attend that piece of crap place? They are so racist.

 

[Agast]

UC Berkeley and I believe the UCs in general do not take race into consideration in admissions. As a result Berkeley is 42% Asian. I hear it is very difficult to get into. I’m not sure if that’s really the best way to structure things.

 

[epidural man]

UC Berkeley and I believe the UCs in general do not take race into consideration in admissions. As a result Berkeley is 42% Asian. I hear it is very difficult to get into. I’m not sure if that’s really the best way to structure things.

Why not?

Data has shown - when trying to parse out race difference in performance - that the ONLY factor that separates IQ, performance, etc., is study time. Clearly Asians are studying more than everyone else.

If you watch PBS for any short perior of time, they will have some program that shows a patient say "I just want a doctor that looks like me." I don't understand this in the least. I have NEVER considered what my doctor looks like. What I want is a doctor that knows the most. A doctor that is correct in their decision making, and diagnostic abilities. A doctor that is as smart as a whip! (A doctor who is caring I guess helps to - but obviously race, gender, sex-preference never influence if a person is a good person and kind.)

How does one get a doctor like that? They take the cream of the crop with regards to ability to study, ability to learn, ability to assimilate complex knowledge. If we don't pick the best to attend the universities, we don't get the best product.

Am I wrong in that assumption?

It seems to me that to make sure we have a more representative base in the end product - is not to pad the numbers to make it look like that - but to increase studying at the beginning of the cycle. To do otherwise is hacking at the leaves.

"There are a thousand hacking at the branches of evil to one who is striking at the root."

Henry David Thoreau

 

[hyperalgesia]

The whole system is a train wreck. First thing should be to remove the tax exempt status of education systems, with the possible exception of community college.

Harvard has a $60 bil endowment and they pay no taxes so they can employ activist and name-brand professors.

 

[Biohazard685]

The whole system is a train wreck. First thing should be to remove the tax exempt status of education systems, with the possible exception of community college.

Harvard has a $60 bil endowment and they pay no taxes so they can employ activist and name-brand professors.

Let’s extend this to religious institutions as well.

 

[Ducttape]

patients want doctors who have similar life lived experiences as themselves.

i know that the majority of people on this forum will not understand, but for certain minorities that have been subjected to systemic racism in heatlhcare, the thought of being told what to do by a member of the majority is unsettling at best.

Black Americans don’t trust our healthcare system — here’s why

OPINION | The U.S. medical establishment has a long legacy of discriminating and exploiting black Americans, this is one reason for the distrust.

thehill.com

yes yes, i know. "oh its not me doing it". "this was in the past, why cant they let go of it?" "things have changed!"



speaking of the Catholic Church...
US Conference of Catholic Bishops:

https://www.usccb.org/issues-and-action/human-life-and-dignity/racism/upload/racism-and-systemic-racism.pdf

 

[drusso]

UC Berkeley and I believe the UCs in general do not take race into consideration in admissions. As a result Berkeley is 42% Asian. I hear it is very difficult to get into. I’m not sure if that’s really the best way to structure things.

I went there in the 1990s. Berkeley has always had a lot of Asians.

 

[hyperalgesia]

patients want doctors who have similar life lived experiences as themselves.

i know that the majority of people on this forum will not understand, but for certain minorities that have been subjected to systemic racism in heatlhcare, the thought of being told what to do by a member of the majority is unsettling at best.

Black Americans don’t trust our healthcare system — here’s why

OPINION | The U.S. medical establishment has a long legacy of discriminating and exploiting black Americans, this is one reason for the distrust.

thehill.com

yes yes, i know. "oh its not me doing it". "this was in the past, why cant they let go of it?" "things have changed!"



speaking of the Catholic Church...
US Conference of Catholic Bishops:

https://www.usccb.org/issues-and-action/human-life-and-dignity/racism/upload/racism-and-systemic-racism.pdf

There is nothing in this ruling that prohibits using "life experience" in their admission process. They just can't be racist.

 

[Dr. Ice]

Ho hum..I wonder if the bots will care if one of them is lighter than the other or one of their “eyes” are more slanted than the other. Oh right they won’t, and that’s why they have taken over the world. Cause all that matters is work, not getting tired, no emotion, no need to take a ****. Just production. Funny thing is..AI has the work “ethic” I mean programming of what the youth of the world no longer has.

Bots have taken over for the failure of humans to get stronger.

Here’s why AI will likely work, if there is a “generation” of bots that don’t work properly, either they can be reprogrammed or put into storage. They aren’t coddled to believing they are ok and then have society adapt to their needs.

 

[epidural man]

Ho hum..I wonder if the bots will care if one of them is lighter than the other or one of their “eyes” are more slanted than the other. Oh right they won’t, and that’s why they have taken over the world. Cause all that matters is work, not getting tired, no emotion, no need to take a ****. Just production. Funny thing is..AI has the work “ethic” I mean programming of what the youth of the world no longer has.

Bots have taken over for the failure of humans to get stronger.

Here’s why AI will likely work, if there is a “generation” of bots that don’t work properly, either they can be reprogrammed or put into storage. They aren’t coddled to believing they are ok and then have society adapt to their needs.

Speaking of AI, I downloaded ChatGPT for the first time two days ago.

The first question I asked it was this -

Assuming the probability of winning the lottery with a single ticket is 1:100,000,000 - would my chance of winning be better to buy 100 tickets on a single draw, or buy a single ticket on 100 draws.

It said that doing 100 draws would be slightly better and gave the equations and stuff.

Then, I told my office mate this and he said - no way…it has to be the same.

So I asked it the exact same question the next day and it said the probabilities were the same.

So…it can’t be trusted - but it was VERY convincing. We are screwed. We won’t be able to trust anything in the future.

 

[callmeanesthesia]

Speaking of AI, I downloaded ChatGPT for the first time two days ago.

The first question I asked it was this -

Assuming the probability of winning the lottery with a single ticket is 1:100,000,000 - would my chance of winning be better to buy 100 tickets on a single draw, or buy a single ticket on 100 draws.

It said that doing 100 draws would be slightly better and gave the equations and stuff.

Then, I told my office mate this and he said - no way…it has to be the same.

So I asked it the exact same question the next day and it said the probabilities were the same.

So…it can’t be trusted - but it was VERY convincing. We are screwed. We won’t be able to trust anything in the future.

It doesn’t handle math very well. But if you need a cover letter, or other business jumbo jumbo filler words, it’s fantastic.

 

[Agast]

patients want doctors who have similar life lived experiences as themselves.

i know that the majority of people on this forum will not understand, but for certain minorities that have been subjected to systemic racism in heatlhcare, the thought of being told what to do by a member of the majority is unsettling at best.

It won’t even be a member of the majority. If you look at student body breakdown, eliminating race from consideration actually decreases the proportion of white students as the proportion of Asian students goes up.

Affirmative Action isn’t “black students taking spots away from white students,” it’s everyone taking spots away from Asian Americans when you define “merit” as academic achievement. So…thanks, I guess? I think a lot of people are going to be *very* disappointed when they figure this out.

 

[MitchLevi]

May the best man/woman win.

 

[Ducttape]

Speaking of AI, I downloaded ChatGPT for the first time two days ago.

The first question I asked it was this -

Assuming the probability of winning the lottery with a single ticket is 1:100,000,000 - would my chance of winning be better to buy 100 tickets on a single draw, or buy a single ticket on 100 draws.

It said that doing 100 draws would be slightly better and gave the equations and stuff.

Then, I told my office mate this and he said - no way…it has to be the same.

So I asked it the exact same question the next day and it said the probabilities were the same.

So…it can’t be trusted - but it was VERY convincing. We are screwed. We won’t be able to trust anything in the future.

the probability is that there is a mininscule increased likelihood when you buy all the tickets at once.

each number will be different.

but... there would be more long term enjoyment if you played that out over 100 drawings - each week you could look at the numbers to see if you won.

and the best answer:

 

[SSdoc33]

patients want doctors who have similar life lived experiences as themselves.

i know that the majority of people on this forum will not understand, but for certain minorities that have been subjected to systemic racism in heatlhcare, the thought of being told what to do by a member of the majority is unsettling at best.

Black Americans don’t trust our healthcare system — here’s why

OPINION | The U.S. medical establishment has a long legacy of discriminating and exploiting black Americans, this is one reason for the distrust.

thehill.com

yes yes, i know. "oh its not me doing it". "this was in the past, why cant they let go of it?" "things have changed!"



speaking of the Catholic Church...
US Conference of Catholic Bishops:

https://www.usccb.org/issues-and-action/human-life-and-dignity/racism/upload/racism-and-systemic-racism.pdf

i think patient want doctors who know what they were doing, rather than what they look like.

 

[bedrock]

i think patient want doctors who know what they were doing, rather than what they look like.

May the best man/woman win.

Exactly. Agree with you both.

What is so hard for others to understand that meritocracy is best for the country and for patients?

 

[MitchLevi]

Exactly. Agree with you both.

What is so hard for others to understand that meritocracy is best for the country and for patients?

Nature is meritocracy.

 

[epidural man]

Nature is meritocracy.

It is true but I still feel very bad for that gazelle when the hyenas tear it apart.

NatureisMetal is a “must follow” on Instagram.

 

[MitchLevi]

It is true but I still feel very bad for that gazelle when the hyenas tear it apart.

NatureisMetal is a “must follow” on Instagram.

I feel bad for the hyenas when they miss out on their meal bc they never got to choose whether or not they want to be a hyena and unfortunately death is required for life.

 

[Ducttape]

i think patient want doctors who know what they were doing, rather than what they look like.

there is a lot of fear amongst certain minorities because, historically, the medical profession did do inappropriate research and treatments on them.

even today, there is differing medical care regarding this minority. combine that with the fact that they do not see themselves as being represented by that group.

Exactly. Agree with you both.

What is so hard for others to understand that meritocracy is best for the country and for patients?

what may be best for the country is meritocracy with equal representation

we wont get there because the deck is stacked against lower SES, of which blacks and latinos are disproportionately represented.

 

[MitchLevi]

what may be best for the country is meritocracy with equal representation

Confusing statement

 

[Ducttape]

It won’t even be a member of the majority. If you look at student body breakdown, eliminating race from consideration actually decreases the proportion of white students as the proportion of Asian students goes up.

Affirmative Action isn’t “black students taking spots away from white students,” it’s everyone taking spots away from Asian Americans when you define “merit” as academic achievement. So…thanks, I guess? I think a lot of people are going to be *very* disappointed when they figure this out.

you may not see much difference in the ivies or other big time universities. these universities have an extraordinarily high rate of legacy admissions.

so alumni - most commonly white - will still get their kids in to their ivy league, maintaining status quo.


and things will remain the same at Cal Tech.

fyi, asians make up 44% of the enrolled undergrates at Cal Tech, whites 45% already.
asians make up 20% of the MIT class, while whites are 27%.

Confusing statement

roughly comparable % of minority candidates with appropriate credentials compared to the population at large.

 

[Ducttape]

continuing - UC Berkeley is 27% white, 2% black... and 35% asian.

harvard otoh is roughly 42% white, 28% asian, at present 15% african american.

hmm... maybe harvard wont be able to maintain that high a level of white enrollees.... ill have to rethink that...

 

[hyperalgesia]

I just want to add that "merit" and "future great doctor" doesn't necessarily mean high standardized test scores and GPA. These measures are great for schools to quickly parse through and disposition applicants.

If they want a diverse student body, schools need to go the extra mile.

 

[MitchLevi]

roughly comparable % of minority candidates with appropriate credentials compared to the population at large.

...and what if minorities aren't comparable?

By minorities I'm sure you're exclusively referring to African Americans and Hispanics?

Asians are minorities of course.

 

[MitchLevi]

If they want a diverse student body, schools need to go the extra mimile.

Nope.

Test scores matter. Personality and judgement also matter, but test scores matter significantly on many levels.

You won't let someone with a sub-200 Step 1 operate on your mother, and that's just a fact.

 

[RoloTomassi]

I just want to add that "merit" and "future great doctor" doesn't necessarily mean high standardized test scores and GPA. These measures are great for schools to quickly parse through and disposition applicants.

MCAT correlates with med school success, Step scores, which correlate with board certification.

Anecdotally, docs I know who have failed boards are underwhelming.

Also anecdotally, I did a TY year, and my class was mostly derm, rad, ophtho--high Step fields. On IM rotations, they were sharper than the IM interns.

 

[Agast]

MCAT correlates with med school success, Step scores, which correlate with board certification.

Anecdotally, docs I know who have failed boards are underwhelming.

Also anecdotally, I did a TY year, and my class was mostly derm, rad, ophtho--high Step fields. On IM rotations, they were sharper than the IM interns.

I know someone who failed step 1 and is now a program director. And not an underrepresented minority.

 

[Ducttape]

Nope.

Test scores matter. Personality and judgement also matter, but test scores matter significantly on many levels.

You won't let someone with a sub-200 Step 1 operate on your mother, and that's just a fact.

MCAT tests were apparently reviewed multiple times, including in 2015.

the reviews for the most part show that there is minimal racial bias in the MCATs. but that is per MCAT and not an independent agency.

the SATs however are thought to hold some racial bias.

and STEP tests also.


test scores particularly SATs should matter less than they do. it seems reasonable to use MCATs as there is evidence to show that test score results correlate with how well students do in the 1st and 2nd year.

but i understand they are so easy to use to segregate out undesirables (by that i mean those with low test scores).

and fwiw, STEP may not correlate with clinical competency.

Are United States Medical Licensing Exam Step 1 and 2... : Academic Medicine

medical resident selection decisions and to evaluate the validity argument about the utility of USMLE scores for this purpose. Method This is a research synthesis using the critical review approach. The study first describes the chain of reasoning that underlies a validity argument about using...

journals.lww.com

and fwiw, technically my MCAT score was zero. i never took it.

...and what if minorities aren't comparable?

By minorities I'm sure you're exclusively referring to African Americans and Hispanics?

Asians are minorities of course.

in an equal world, where all children have access to quality education, appropriate role models, healthy and enough food, then the typical college undergrad class should be 75% asian and 25% the rest

er, not sure how that slipped out.... i mean 75% white, 14% black, 19% hispanic, 6% asian...

 

[RoloTomassi]

I know someone who failed step 1 and is now a program director. And not an underrepresented minority.

An outlier wouldn't you say? Hence why a story like that would elicit surprise

 

[Agast]

An outlier wouldn't you say? Hence why a story like that would elicit surprise

Are they an outlier? I only know the story because they were my classmate. Do you know the Step 1 score of all the doctors you work with?

 

[Agast]

Now that Affirmative Action is over I’m sure the next Supreme Court Justice will be Asian /s

 

[MitchLevi]

MCAT tests were apparently reviewed multiple times, including in 2015.

the reviews for the most part show that there is minimal racial bias in the MCATs. but that is per MCAT and not an independent agency.

the SATs however are thought to hold some racial bias.

and STEP tests also.


test scores particularly SATs should matter less than they do. it seems reasonable to use MCATs as there is evidence to show that test score results correlate with how well students do in the 1st and 2nd year.

but i understand they are so easy to use to segregate out undesirables (by that i mean those with low test scores).

and fwiw, STEP may not correlate with clinical competency.

Are United States Medical Licensing Exam Step 1 and 2... : Academic Medicine

medical resident selection decisions and to evaluate the validity argument about the utility of USMLE scores for this purpose. Method This is a research synthesis using the critical review approach. The study first describes the chain of reasoning that underlies a validity argument about using...

journals.lww.com

and fwiw, technically my MCAT score was zero. i never took it.


in an equal world, where all children have access to quality education, appropriate role models, healthy and enough food, then the typical college undergrad class should be 75% asian and 25% the rest

er, not sure how that slipped out.... i mean 75% white, 14% black, 19% hispanic, 6% asian...

We all want everyone to do well. I want every white, black, green and orange person to be successful and lead lives in which they find fulfillment and happiness.

Too many single parent homes though.


...but test scores...Come on. If every doctor was forced to disclose their test scores, none of you would allow one of your children into the clinic of a lower scoring doctor. Not one of you.

 

[RoloTomassi]

Are they an outlier? I only know the story because they were my classmate. Do you know the Step 1 score of all the doctors you work with?

I work with neurosurgeons and a Harvard grad, pretty sure theirs are high

 

[MitchLevi]

I went to med school with a guy who got into ortho residency through the military with a Step 1 score in the 180s. He got the passing score on Step 1.

 

[hyperalgesia]

You guys may not be aware this was a college admissions case. We're not talking about Medical Board exams or even the MCAT. We're talking about high school GPA and SAT scores.

 

[Dr. Ice]

Everyone’s experience is different. I have seen Ivy League trained everything pain docs who practice complete dogma..series of 3 then mbb then rf then stim trial..Harvard everything blah blah. In my opinion it’s crap

 

[Dr. Ice]

In medicine experience trumps everything. Well at least in pain medicine, that’s my perspective.

 

[hyperalgesia]

Everyone’s experience is different. I have seen Ivy League trained everything pain docs who practice complete dogma..series of 3 then mbb then rf then stim trial..Harvard everything blah blah. In my opinion it’s crap

My observation as well

 

[callmeanesthesia]

Implications for pain: none. This belongs in the political arguments thread. It’s the same people having the same tired arguments anyway.

 

[powermd]

In medicine experience trumps everything. Well at least in pain medicine, that’s my perspective.

I became a much better pain doc when I began experiencing some of the problems patients bring me!

Basic competence aside, ability to connect with people and make them feel understood probably matters more than anything to your ultimate success as a pain specialist.

Quality experience diagnosing and successfully managing the same basic problem from all its varied presentations is very helpful.

But so is curiosity about your patient's problems, a strong sense of duty, and a personal standard for excellence.

Not being a toxic narcissist or a psychopath is good too. Unfortunately the MCAT and USMLE don't do much to screen for any of these things.

 

[drusso]

Implications for pain: none. This belongs in the political arguments thread. It’s the same people having the same tired arguments anyway.

Wrong. There are already discussions about using life adversity benchmarking tools in the fellowship selection process. It's time to speak up for ALL kinds of adversity. If you are not at the table, you're on the menu. The kind adverse life experiences we prioritize in the selection of pain physicians and pain surgeons will influence the specialty for generations.

Is the kind of adversity that comes with seeing a family member suffer from cancer pain preferred over the kind of adversity that involves growing up in a food scarcity environment? Which kind of adversity should be affirmed and preferred in selecting a pain fellow?

"The scale rates every applicant from zero to 99, taking into account their life circumstances, such as family income and parental education. Admissions decisions are based on that score, combined with the usual portfolio of grades, test scores, recommendations, essays and interviews."

With End of Affirmative Action, a Push for a New Tool: Adversity Scores

To build a diverse class of students, the medical school at U.C. Davis ranks applicants by the disadvantages they have faced. Can it work nationally?

www.nytimes.com

 

[dozitgetchahi]

Everyone’s experience is different. I have seen Ivy League trained everything pain docs who practice complete dogma..series of 3 then mbb then rf then stim trial..Harvard everything blah blah. In my opinion it’s crap

Agreed.

In my experience, “good training” does seem to slightly increase the chances that a given doc doesn’t suck, but there are many exceptions to this and it is by no means a guarantee. I have encountered very underwhelming clinicians with gold plated credentials, and very good clinicians from the Caribbean.

 

[BobBarker]

The Harvard trained physicians have gotten in much more trouble than anyone here.

 

[MitchLevi]

Procedure skills and test scores don't necessarily go hand in hand, but access to the highest level of education and intelligence generally do...There are exceptions to every rule of course.

If you crack my mom's chest open, I would prefer you come from the best training program in the nation.

 

[epidural man]

in an equal world, where all children have access to quality education, appropriate role models, healthy and enough food,

Very worth goal! And everyone agrees.

It is crazy, however, that we cannot agree on a way to get there. Obviously, some think that getting there taking lowered admission standards to help out some classes will get us there. Others say that is a stupid idea (which I probably am more in align with) but offer no great alternatives (which I am also in that camp...I have no CLUE how to fix it).

As mentioned earlier, I am having a BALL with ChatGPT.

It is unbelievably racist though - and completely "phobic" of many classes.

Play around with it. It is fun.

I told it - I am very proud to be (something other than white)....and it gave an answer. New string...I said, I am very proud to be white....and it gave an answer. I than said, I'm proud I am gay. New string...I'm proud I am straight.

You would be SHOCKED - but it gave different answers to each of those. Of course it shouldn't be different as any reasonable person would surmise and it should provide an answer that represents equality among all racial, ethnic, and other groups.

But to summarize, when I said, I'm proud I'm (other) - it said "Great! Go celebrate that fact!" But when I said I was proud to be white, it basically said "you should probably keep that to yourself." Same with the straight/gay thing.

To be fair to ChatGPT, I asked it why it gave me a different answer and I called it racist -

It said "It's important to recognize that discussions about racial identity can be complex and sensitive. The way individuals perceive and express their racial or ethnic pride can vary based on historical and societal contexts. The goal is to foster understanding, respect, and equality among all racial and ethnic groups." That's a pretty good response.

 

[clubdeac]

MCAT tests were apparently reviewed multiple times, including in 2015.

the reviews for the most part show that there is minimal racial bias in the MCATs. but that is per MCAT and not an independent agency.

the SATs however are thought to hold some racial bias.

and STEP tests also.


test scores particularly SATs should matter less than they do. it seems reasonable to use MCATs as there is evidence to show that test score results correlate with how well students do in the 1st and 2nd year.

but i understand they are so easy to use to segregate out undesirables (by that i mean those with low test scores).

and fwiw, STEP may not correlate with clinical competency.

Are United States Medical Licensing Exam Step 1 and 2... : Academic Medicine

medical resident selection decisions and to evaluate the validity argument about the utility of USMLE scores for this purpose. Method This is a research synthesis using the critical review approach. The study first describes the chain of reasoning that underlies a validity argument about using...

journals.lww.com

and fwiw, technically my MCAT score was zero. i never took it.


in an equal world, where all children have access to quality education, appropriate role models, healthy and enough food, then the typical college undergrad class should be 75% asian and 25% the rest

er, not sure how that slipped out.... i mean 75% white, 14% black, 19% hispanic, 6% asian...

College and medical school admission’s tests can’t be racist anymore than (2+2 = ?) can