new article in NEJM on "non-trad students"

[viostorm]

This article is worth checking out, they even cite SDN in it!

"From All Walks of Life — Nontraditional Medical Students and the Future of Medicine

Sandeep Jauhar, M.D., Ph.D."

http://content.nejm.org/cgi/content/full/359/3/224?query=TOC

The last paragraph was pretty insightful and broght of lots of questions from the medical school side:

"Barnett of Mount Sinai acknowledges that the age and inclination of older students must be factored into admissions decisions. "I think it is in people's minds when they interview students: Will admitting this person, who may be taking the spot of a younger student, produce benefit to society?" he says. "I don't know of a cutoff, but maybe around age 50 you start to wonder if this is just an intellectual exercise.

"We're willing for older applicants to make a case of what they want to do for society," he goes on. "If they can't make a compelling case, then the application is not going to fly. But the same applies to the 21-year-old applicant."

Hofstra's Smith says: "This is . . . obviously a societal question. Does individual freedom take precedence over group needs? In some cases, committees may not think admitting an older student is a good use of the limited number of spots. But you have to be afraid of too much social engineering. Look at women physicians: they tend to work less than men. Does that mean we shouldn't be admitting female students?"

For now, medical school admissions committees continue to accept older, nontraditional students. Perhaps they believe that medicine needs new voices — and given the myriad problems of health care, it is hard to disagree. Nevertheless, I think we need more data before we can call this a viable strategy for the future. "

---

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[Law2Doc]

Hofstra's Smith says: "This is . . . obviously a societal question. Does individual freedom take precedence over group needs? In some cases, committees may not think admitting an older student is a good use of the limited number of spots. But you have to be afraid of too much social engineering. Look at women physicians: they tend to work less than men. Does that mean we shouldn't be admitting female students?"

Bear in mind that some of Smith's quotes are way out of touch with what others have been saying, so I think you have to read his quotes with a bit of skepticism. For instance, he says "that nontraditional students are often a challenge to medical educators. "They're more self-confident," he says. "They're more conscious of what they want to do with their time. They're less willing to just suck it up and go through the rote aspects of medical training. They are the ones you see in the dean's office saying, `Don't inflict this horrible teacher on me.'".

But In fact there have been quite a few articles published in the last couple of years saying that the current crop of TRADITIONAL students have an "air of entitlement", an expectation to pick and choose what they will and won't do, their hours, their pay. There was even a recent 60 Minutes story on the current generation of college graduates and their unrealistic expectations of employers and questionable work ethic. Thus some employers in medicine have embraced the nontrads because of a perceived better work ethic. They come out of med school understanding that the field requires long hours, and expecting the salaries they are offered. What Smith says in this article (apart from the potentially sexist comment above) thus seems to be the opposite of what others have been publishing the past couple of years. I'm inclined to believe the others, and am skeptical of Smith.

It is, however, interesting to know that there are warped perceptions of nontrads (and women) applicants at a handful of schools, and they have no problem broadcasting their biases. Tells me more about these folks and their schools than anything else the article purports to do.

 

[Krisss17]

thanks Viostorm, very interesting read. As a prospective medical student, I may only be around 50 when I graduate medical school. Considering the state of social security, 67 would be the earliest I would even be eligible and at that time, it may cover a gallon of gas and that is it!

I'm definitely a different person than I was 25 years ago and I think I'll be a better doctor because of it.

 

[DrJosephKim]

This is a great article.

 

[tianac2]

This article gave an interesting perspective on the idea of age as a factor in admissions. I must admit, that I often wonder what adcoms really think of other "non-traditional" traits as well. For example, I'm only 25 right now, but I got married to a Marine at 18, did the military spouse thing, and had kids all before I even started undergrad. I've always wondered what they really think of that...

 

[DrMidlife]

I fully expect to be pigeonholed, by some program directors, for being female and over 40. Nothing I can do about it but make the young boys look weak. Bring it, Suzies.

 

[BearGrappler]

Hi Everyone,

I found this article on the NEJM and I though I would just share it with everyone.

http://content.nejm.org/cgi/content/full/359/3/224

-Tom

 

[browncat]

That was really upsetting. He paints non-trads (AND trads) with a pretty broad brush. And, damn, the misogyny. I'm going to think on it before I write a detailed response.

Yay NEJM editorial board, btw. Personal anecdotes and unexamined assumptions: coming soon to a peer-reviewed journal near you!!

 

[viostorm]

That was really upsetting. He paints non-trads (AND trads) with a pretty broad brush. And, damn, the misogyny. I'm going to think on it before I write a detailed response.

Yay NEJM editorial board, btw. Personal anecdotes and unexamined assumptions: coming soon to a peer-reviewed journal near you!!

Your statement really demonstrates your ignorance of the journal and YOUR intolerance of others opinions. This was part of the "perspective" section where authors write about hot topics in medicine. Reading scientific abstract after abstract really isn't that fun after a while.

The fact is there are lots of women who end up going into "mommy practices" that are part time. One of the reasons family practice average salaries are lower then what most full time people earn because there are a lot of part time women.

I think bring this fact up is a long way from "hatred of women."

 

[gman33]

I don't even know where to begin with that article.
Obviously, it was heavily biased against non-trads, but it's only conjecture, no facts to back up the statements made.

Personally, I think the whole non-trad term could be better defined. The author is hardly even non-trad in my book. No break in schooling, just got an extra degree before going to med school at 26.

One point that the article tries to make is that it might be a bad idea admitting older students because they will have less years to practice. I'd be interested to see some real data on this. My gut tells me that older students would be less likely to quit clinical practice early because they made a more informed decision.

I also liked the idea that women shouldn't be admitted.

 

[Nanon]

I fully expect to be pigeonholed, by some program directors, for being female and over 40. Nothing I can do about it but make the young boys look weak. Bring it, Suzies.

SWEET! And I'm so stealing that... "Bring it, Suzies..." Fabulous!

S.

 

[footballrules]

This article is worth checking out, they even cite SDN in it!

"From All Walks of Life — Nontraditional Medical Students and the Future of Medicine

Sandeep Jauhar, M.D., Ph.D."

http://content.nejm.org/cgi/content/full/359/3/224?query=TOC

The last paragraph was pretty insightful and broght of lots of questions from the medical school side:

"Barnett of Mount Sinai acknowledges that the age and inclination of older students must be factored into admissions decisions. "I think it is in people's minds when they interview students: Will admitting this person, who may be taking the spot of a younger student, produce benefit to society?" he says. "I don't know of a cutoff, but maybe around age 50 you start to wonder if this is just an intellectual exercise.

"We're willing for older applicants to make a case of what they want to do for society," he goes on. "If they can't make a compelling case, then the application is not going to fly. But the same applies to the 21-year-old applicant."

Hofstra's Smith says: "This is . . . obviously a societal question. Does individual freedom take precedence over group needs? In some cases, committees may not think admitting an older student is a good use of the limited number of spots. But you have to be afraid of too much social engineering. Look at women physicians: they tend to work less than men. Does that mean we shouldn't be admitting female students?"

For now, medical school admissions committees continue to accept older, nontraditional students. Perhaps they believe that medicine needs new voices — and given the myriad problems of health care, it is hard to disagree. Nevertheless, I think we need more data before we can call this a viable strategy for the future. "

If medical schools try to set a maximum age for being able to get into medical school, then I can see the case going to court. You shouldn't limit the right of a person to do what s/he wants based on age. The OP might be an IVY League educated liberal. We all know that those people make wise choices for our country.

 

[Law2Doc]

Your statement really demonstrates your ignorance of the journal and YOUR intolerance of others opinions. This was part of the "perspective" section where authors write about hot topics in medicine. Reading scientific abstract after abstract really isn't that fun after a while.

The fact is there are lots of women who end up going into "mommy practices" that are part time. One of the reasons family practice average salaries are lower then what most full time people earn because there are a lot of part time women.

I think bring this fact up is a long way from "hatred of women."

If you look at my comment in the other thread, you will note that this guy they quoted is pretty out of step with much of what has been written in the past year, so I'd take everything he says with a grain of salt. The other thread http://forums.studentdoctor.net/showthread.php?t=544314
has a better discussion.

 

[kanu9]

I think Sandeep Jauhar needs to take a few things from his own book called "INTERN" which I am sure made a lot of money for him into stock before publishing something like this article. To top it NEJM publication gives it a false credence it dosn't deserve. What seems to have happened is that Dr. Jauhar is stuck at 26. He needs to spend more time on SDN in the non trad section and maybe read it a little more carefully and learn from the backgrounds of people who have made the shift. If a marine fought for our country and could not make it to med school at the traditional age does that mean he does not deserve a share in the medicare dollars or whatever the government spends on training physicans. Oh I forgot they train doctors from countries who do not know english and the money works well there! He needs to chill out!
By publishing articles like this one he is only losing credibility. He needs to know 26 was a non trad age 20 years ago or whenever he was when he was in med school. Next he is going to come up with an article on how indian people go to medicine for 'izzath' and money and NEJM will publish it!!

 

[QofQuimica]

If you look at my comment in the other thread, you will note that this guy they quoted is pretty out of step with much of what has been written in the past year, so I'd take everything he says with a grain of salt. The other thread http://forums.studentdoctor.net/showthread.php?t=544314
has a better discussion.

Good call. I have merged the two threads, so now everyone can discuss the article together in one place.

 

[viostorm]

If medical schools try to set a maximum age for being able to get into medical school, then I can see the case going to court. You shouldn't limit the right of a person to do what s/he wants based on age. The OP might be an IVY League educated liberal. We all know that those people make wise choices for our country.

OMFG, all I did was post a paragraph of a new NEJM article.

I have no idea what your quote is implying that I'm an IVY league educated liberal.

After having been in medical school as a non-trad that started at age 29, I can say that most of his assessment is right on.

In my experience:

#1. Non-trads do cause a lot more problems ... if you want to know who were the people complaining to the dean and pissed when we had a bad lecture almost all of them were over 26 years old. Having worked for $5.25 / hour and paying for school damn right I was pissed if some prof blew off class or gave a crappy lecture ... I'm paying for it and I'm the customer.

#2. There is a shortage of physicians ... neurologists and neurosurgeons are in such high demand where I am you can't believe it. I do believe it is a valid question to address with a limited number of spots and a shortage of physicians should preference not be given to people who will be in practice longer? The way this country is going its hard to get primary care if it isn't from a PA or NP. I think this is a valid ethical debate for us to have as a society.

#3. Regardless of what may be fair or right, there is a bias against older students ... however it really won't show itself until after medical school. Just wait to try and get a ortho spot or derm spot if you are 45+. I know there is a UVA surgeon non-trad who posts here and may disagree, however, in the competitive surgical specialties I've been told by a PD basically "why would I train this guy as a resident when he will only be working for 5-10 years when I could hire this person who will be a surgeon for 30. My 2 or 3 spots are valuable" Most of the older non-trads (40+) do specialties that are 3 year residencies just so they have time to work.

After re-reading the article I don't think it is negative on non-trads at all or anyone on this board has a right to question "how non-trad the author is" ... I mean to me that is just ******ed. This is the pervasive medical culture and the realities of being a non-trad in medicine.

As a non-trad we have very specific challenges that we all have to embrace and others recognize those challenges, and some challenges of those don't show up until AFTER we get into medical school. Some of the stuff isn't right but my advice is to learn to deal with it and get on in your career. Is it right that now I'm a scut monkey fetching coffee from the cafe for some 25 year old intern when I used to run my own company? No, but does complaining get me anywhere productive? No.

Publishing is NEJM is a huge deal, and after some of you do it I'd be more inclined to listen to your view on how it should be run ... ie editorial board. In medicine you have to get credibility by actually doing something (like getting into medical school as a start) before people (at least me) care about what you say. Anyone can sit and sqwak on the sideline when they have never even seen a patient or don't know what end of the stethoscope goes in their ears.

 

[razortoy]

I have to say that I was actually a bit motivated by this article as a non-trad. It said to me that people are actually opening up their expectations as to what a med student looks like.

It felt to me like there will be more opportunities. He did mention what I feel is a valid question on an upper limit of age. At what point is there no longer a worthwhile ROI for this individual. I think as long as someone has a good 15-20 years to work in the field, then it is worth the investment.

That is a whole generation.

 

[QofQuimica]

Folks, please chill out; let's not have this thread degenerate into something worthy of the preallo forum. It's only an article. If it bothers you that much, write a letter to the editor, and you can be published in the NEJM too.

FWIW, I agree with L2D. I tend to be the one telling the trads to suck it up when they start moaning about this or that stupid thing we have to do.

 

[Trismegistus4]

Hofstra's Smith says: "This is . . . obviously a societal question. Does individual freedom take precedence over group needs? In some cases, committees may not think admitting an older student is a good use of the limited number of spots. But you have to be afraid of too much social engineering. Look at women physicians: they tend to work less than men. Does that mean we shouldn't be admitting female students?"

Yes. Of course, he asks this as a rhetorical question to which the answer is assumed to be "no," and he still gets attacked for "misogyny."

It is, however, interesting to know that there are warped perceptions of nontrads (and women) applicants at a handful of schools, and they have no problem broadcasting their biases. Tells me more about these folks and their schools than anything else the article purports to do.

What does it tell us about you that you consider facts (e.g., that female doctors work less than men) "warped perceptions?"

 

[Lacheln]

Weird, am I missing something? The article looks pretty balanced to me - if anything, it is on the positive side.

 

[Law2Doc]

What does it tell us about you that you consider facts (e.g., that female doctors work less than men) "warped perceptions?"

My point was that his perceptions were warped as to nontrads. Women was in parentheses.

 

[Law2Doc]

Weird, am I missing something? The article looks pretty balanced to me - if anything, it is on the positive side.

It's not balanced because the author has sought out folks with fairly obscure viewpoints and quotes them as if they are mainstream. And basically gives himself license to do it by asserting how nontrad he is, despite being pretty close to the average age. I mainly object to the quotes of the Smith guy, because they conflict with not only what I've seen myself, but also everything that's been published over the past couple of years about the current "traditional" generation, including the referenced 60 minutes story.

 

[Lacheln]

It's not balanced because the author has sought out folks with fairly obscure viewpoints and quotes them as if they are mainstream. And basically gives himself license to do it by asserting how nontrad he is, despite being pretty close to the average age. I mainly object to the quotes of the Smith guy, because they conflict with not only what I've seen myself, but also everything that's been published over the past couple of years about the current "traditional" generation, including the referenced 60 minutes story.

Hmm, interesting. I didn't see the opinions quoted as being particularly out of line, although I can't comment on the obscurity of his sources. I read the Smith bit as being fairly accurate, and positive. I would agree with everything Smith said except perhaps the whole bit about being unwilling to suck it up for the rote stuff. Even that I could see being somewhat true. Running labs no doubt seems like a bigger waste of time when you have a family at home waiting for you.

Maybe I'm just unconsciously putting a positive spin on things though. It's true the author barely qualifies as non-trad, and he himself seems to have a negative bias, although the people he quotes do not. And the article is short - clearly incomplete in an analytical sense.

 

[Law2Doc]

except perhaps the whole bit about being unwilling to suck it up for the rote stuff. Even that I could see being somewhat true. Running labs no doubt seems like a bigger waste of time when you have a family at home waiting for you.

Nah. It's the nontrads who, as Q suggested above, are the one's who tell the younguns to suck it up and just do it. Once you've been in the working world you don't have such high expectations of only doing important stuff. So nontrads are often the quickest ones to roll up their sleeves and dive into the scut. The trads haven't realized their place in the hierarchy yet. According to 60 minutes, it's a generational thing -- an "air of entitlement" -- this newest generation expects better work environment, pay and hours than they are gonna get. Nontrads have been out in the rat race, and know it as such. And so yeah, this quote is just way out there.

 

[Lacheln]

Nah. It's the nontrads who, as Q suggested above, are the one's who tell the younguns to suck it up and just do it. Once you've been in the working world you don't have such high expectations of only doing important stuff. So nontrads are often the quickest ones to roll up their sleeves and dive into the scut. The trads haven't realized their place in the hierarchy yet. According to 60 minutes, it's a generational thing -- an "air of entitlement" -- this newest generation expects better work environment, pay and hours than they are gonna get. Nontrads have been out in the rat race, and know it as such. And so yeah, this quote is just way out there.

I agree that the older you are the fewer illusions you hold. I am personally dreading the scut and the hierarchy though - it's not something I've had to deal with in a long time. Dread or not though, there's not point in fighting it - suck it up attitude is definitely the way to go.

 

[QofQuimica]

I agree that the older you are the fewer illusions you hold. I am personally dreading the scut and the hierarchy though - it's not something I've had to deal with in a long time. Dread or not though, there's not point in fighting it - suck it up attitude is definitely the way to go.

It really isn't that big of a deal where you need to be dreading it. Just understand that you are starting over from scratch when you go to med school, and you naturally have to start at the bottom and work your way up. It gets easier as you prove yourself and reach certain goals. Consider also that medicine is a serious endeavor, because you will eventually reach a point where other people's lives literally depend on you. (Not so much during med school, but afterward.) This is the reason for having a hierarchy with an experienced person at the helm. Finally, you must understand that if you do have a family and you take off at every opportunity to go home instead of sticking it out with your team, some people will resent it. It may affect your evals in certain rotations where there is an implicit expectation that students will sacrifice their personal time and stick around even after the 80 hour work week is done. On the other hand, I can't fault a parent for deciding that their child is more important than honoring every clerkship. People have different priorities. But you just can't be home spending as much time as possible with your family and then be upset because you didn't honor surgery.

 

[QofQuimica]

The last paragraph was pretty insightful and broght of lots of questions from the medical school side:

"Barnett of Mount Sinai acknowledges that the age and inclination of older students must be factored into admissions decisions. "I think it is in people's minds when they interview students: Will admitting this person, who may be taking the spot of a younger student, produce benefit to society?" he says. "I don't know of a cutoff, but maybe around age 50 you start to wonder if this is just an intellectual exercise.

"We're willing for older applicants to make a case of what they want to do for society," he goes on. "If they can't make a compelling case, then the application is not going to fly. But the same applies to the 21-year-old applicant."

Hofstra's Smith says: "This is . . . obviously a societal question. Does individual freedom take precedence over group needs? In some cases, committees may not think admitting an older student is a good use of the limited number of spots. But you have to be afraid of too much social engineering. Look at women physicians: they tend to work less than men. Does that mean we shouldn't be admitting female students?"

For now, medical school admissions committees continue to accept older, nontraditional students. Perhaps they believe that medicine needs new voices — and given the myriad problems of health care, it is hard to disagree. Nevertheless, I think we need more data before we can call this a viable strategy for the future. "

The thought has occurred to me that this author's article went to the extreme concerning the issue of admitting nontrads. The vast majority of nontrads are people like me who begin med school in their 30s (or late 20s, if you count them as nontrads). There are a handful of applicants in their 40s, but applicants in their 50s or older are incredibly rare (at least for allo schools; not sure about osteo). After visiting 17 medical schools where I asked about nontrads to everyone I met, I had only heard of one such student. And yet, for some reason, the author is discussing whether there is justification for admitting 50-year-olds with these deans.

Here's why I think it's a bit of a straw man. Not very many 50-year-olds would present this dilemma to an adcom. The vast majority would self-select and opt not to try to go to med school. Of the ones who do try, most would come up short in terms of their stats or some other essential qualification and get screened out in favor of a plethora of trads and younger nontrads with significantly better qualifications. What would be really tough is if an adcom were faced with a nontrad applicant over 50 who had stellar stats and superior subjective qualifications, to the point where this person was a better applicant than most people half his or her age. Even if this scenario came up, it would be a very rare occurrence. There would almost certainly not ever be a time when any medical school would be considering whether to admit more than one stellar applicant in the 50+ age range. (Well, at least not unless people start living to be 150 years old. )

 

[Law2Doc]

And yet, for some reason, the author is discussing whether there is justification for admitting 50-year-olds with these deans.

Exactly. The author had an angle he wanted to present, so he focused in on the subset of nontrads that proved his point, and ignored the rest (a group he himself is apparently in) which actually would tend to refute this point. Then he searched around for folks to give him quotes to bolster his point, and yet with 120+ med schools, he ended up relying almost exclusively on current and former Mount Sinai administrators as being the voice of med schools, and had to rely on a guy who's no longer at Sinai and now a dean of a not yet existing med school to make his strongest points. The author had an agenda before he wrote the article, and found folks to rely on that fit his agenda. It would be pretty easy to write an article with the contrary viewpoint based on nontrads under than age 50, and using quotes form the over 100 other schools that don't share Smith's views.

 

[student1799]

There are a handful of applicants in their 40s, but applicants in their 50s or older are incredibly rare (at least for allo schools; not sure about osteo).

You're completely right. I'm very conscious of this issue, because I'm applying this year at the age of 45. I looked at the stats on the AAMC website and found that in '07, only 68 applicants in the whole country (out of 42,000) who would be 48 and above at matriculation. In my age cohort (46), there are probably 100 or so at the most. So if you add up ALL the applicants my age and older, it makes up a whopping 0.5% of the applicant pool.

To hear people talk, you'd think that med schools were absolutely bursting with old fogies like me. I only wish.

 

[Law2Doc]

To hear people talk, you'd think that med schools were absolutely bursting with old fogies like me. I only wish.

There are a decent number of folks in their 30s, and more every year. But the folks above that range are pretty rare, mostly due to self selection. The more established you are, the less likely you are going to uproot and try something different that has a decade long training and schooling path. But those that do make this huge life change sure aren't the one's likely to be whining about the small stuff.

 

[Nerve]

Weird, am I missing something? The article looks pretty balanced to me - if anything, it is on the positive side.

I'm with you Breeak. This article was fascinating and well written. Thanks to OP.

 

[Lacheln]

It really isn't that big of a deal where you need to be dreading it. Just understand that you are starting over from scratch when you go to med school, and you naturally have to start at the bottom and work your way up. It gets easier as you prove yourself and reach certain goals. Consider also that medicine is a serious endeavor, because you will eventually reach a point where other people's lives literally depend on you. (Not so much during med school, but afterward.) This is the reason for having a hierarchy with an experienced person at the helm. Finally, you must understand that if you do have a family and you take off at every opportunity to go home instead of sticking it out with your team, some people will resent it. It may affect your evals in certain rotations where there is an implicit expectation that students will sacrifice their personal time and stick around even after the 80 hour work week is done. On the other hand, I can't fault a parent for deciding that their child is more important than honoring every clerkship. People have different priorities. But you just can't be home spending as much time as possible with your family and then be upset because you didn't honor surgery.

Thanks for the reassurance. It's just hard to think about going from a position of power to one of plebehood again, but I completely understand why it is the way it is. I'm sure I'll adjust.

 

[DrMidlife]

If folks are going to talk about how much less time nontrads will practice than trads, then let's see the data about how long trads are practicing. Oooh, here's a data point, young MD bails on his practice to work on his blog. We need to either specifically state that newly graduated physicians have a responsibility to repay their debt to society for residency training etc., or stop talking like this responsibility exists. At what point in a medical career, for example, are you free to golf on weekdays, given your debt to society?

If folks are going to talk about how damaging it is to the practice of medicine that young mother MDs want to work part time, then let's see some analysis on what the young fathers are doing and the impact of young fathers' careers on young children.

Jauhar effectively rewrote the premed thread "too many females admitted?" from last winter, where a delightful young man told me "YOU CERTAINLY should not have been admitted" because I'm not only female, I'm (gasp) over 40. I was very surprised to see such weak writing from Jauhar; "Intern" was quite good.

OK, Jauhar, put the keyboard away, you have a debt to society to repay, back to the wards now...

 

[njbmd]

The thing to realize is that nothing about the admissions process is "objective". Sure, we look at uGPA/MCAT scores but there is no shortage of people to pick from based on those criteria so we look at those hundreds of "other things" that make each applicant fairly unique. I have certainly run across some 24-year-olds with stellar uGPA/MCAT numbers that I couldn't recommend for admission based on their performance during interview. I have also run across some 45-year-old applicants with lesser (but adequate uGPA/MCAT numbers) that I prayed would take our offer of acceptance because we knew that they would be a positive and energetic addition to the incoming class.

Whining and complaining is not the exclusive property of either traditional or non-traditional students. There is an adjustment for everyone and most folks make that adjustment in one way or another. Traditional students get tired of practice and retire early; non-traditional students love practice and work into their eighties. Your whole attitude to work and practice is definitely an individual one traditional or non-traditional. When I stand in front of a medical class to teach, I can't see the any difference between the non-traditional or the traditional students. They all have to master the same material and it's not easy.

 

[lexrageorge]

If folks are going to talk about how much less time nontrads will practice than trads, then let's see the data about how long trads are practicing. Oooh, here's a data point, young MD bails on his practice to work on his blog. We need to either specifically state that newly graduated physicians have a responsibility to repay their debt to society for residency training etc., or stop talking like this responsibility exists. At what point in a medical career, for example, are you free to golf on weekdays, given your debt to society?

If folks are going to talk about how damaging it is to the practice of medicine that young mother MDs want to work part time, then let's see some analysis on what the young fathers are doing and the impact of young fathers' careers on young children.

Jauhar effectively rewrote the premed thread "too many females admitted?" from last winter, where a delightful young man told me "YOU CERTAINLY should not have been admitted" because I'm not only female, I'm (gasp) over 40. I was very surprised to see such weak writing from Jauhar; "Intern" was quite good.

OK, Jauhar, put the keyboard away, you have a debt to society to repay, back to the wards now...

I'm with you 100% on this one. One of Bill Clinton's staff had an interesting comment that comes to mind here: "Drag a $100 bill around a trailer park, and there's no tellin' what you'll find!".

Similarly, Jauhur probably trolled through numerous adcomm folks and finally got a couple to make some points on the record about age, which, was probably quite difficult to do given the potential legal issues involved. He throws up a couple of ridiculous stereotypes about age (medical training is too hard for older folks, older folks won't practice as long, etc.), and then decides to use a 50 year old applicants as strawman (an extreme case, given the tiny number of applicants that are 50 or older). Then uses the adcomm quotes to support his thinly veiled prejudices.

I wonder if Barnett and Smith knew how their quotes would be used in context. Barnett took great pains to point out that he will hold older applicants to the same standard as younger ones in showing a true commitment to practice medicine. Smith seemed to indicate that he is not comfortable with the whole "debt to society" argument, and used women applicants as an example of a slippery slope that could open up if he tried to go down that rathole. Unfortunately, those subtle points get lost in Jauhur's ridiculous arguments about older applicants.

As for that "debt to society" nonsense, take a few minutes to peruse the Residency boards, and you will see plenty of folks in their late 20's talking about dropping out of residency and clinical medicine altogether.

 

[Nasrudin]

If folks are going to talk about how much less time nontrads will practice than trads, then let's see the data about how long trads are practicing. Oooh, here's a data point, young MD bails on his practice to work on his blog. We need to either specifically state that newly graduated physicians have a responsibility to repay their debt to society for residency training etc., or stop talking like this responsibility exists. At what point in a medical career, for example, are you free to golf on weekdays, given your debt to society?

If folks are going to talk about how damaging it is to the practice of medicine that young mother MDs want to work part time, then let's see some analysis on what the young fathers are doing and the impact of young fathers' careers on young children.

Jauhar effectively rewrote the premed thread "too many females admitted?" from last winter, where a delightful young man told me "YOU CERTAINLY should not have been admitted" because I'm not only female, I'm (gasp) over 40. I was very surprised to see such weak writing from Jauhar; "Intern" was quite good.

OK, Jauhar, put the keyboard away, you have a debt to society to repay, back to the wards now...

Brilliant! Way to dismantle what's really being asked by the conjectural piece. Which was not on the surface taking a particular stake in the issue.

These were the same shady conjectures made of all groups as they tried to make their way into this profession, minorities, women, and so on. And evidently they show no signs of extinction.

What I thought was peculiar was the casual representation of the author as representative of "nontraditional." But I never thought that word has any descriptive power anyway. To me there are maybe...maybe a few people who are "nontraditional" in the sense that defy the logic of society to be in medicine. The rest of us are just older traditionals--the author included.

And thanks for giving a nice cross-check to the little pansy of an argument that thinks it can discern for all of us what is our debt to society. I hate that idea. And you see it pop up everywhere in this game. You hit it low i'll it high and i'll see you in the penalty box.

 

[MOHS_01]

I'm with you 100% on this one. One of Bill Clinton's staff had an interesting comment that comes to mind here: "Drag a $100 bill around a trailer park, and there's no tellin' what you'll find!".

Similarly, Jauhur probably trolled through numerous adcomm folks and finally got a couple to make some points on the record about age, which, was probably quite difficult to do given the potential legal issues involved. He throws up a couple of ridiculous stereotypes about age (medical training is too hard for older folks, older folks won't practice as long, etc.), and then decides to use a 50 year old applicants as strawman (an extreme case, given the tiny number of applicants that are 50 or older). Then uses the adcomm quotes to support his thinly veiled prejudices.

I wonder if Barnett and Smith knew how their quotes would be used in context. Barnett took great pains to point out that he will hold older applicants to the same standard as younger ones in showing a true commitment to practice medicine. Smith seemed to indicate that he is not comfortable with the whole "debt to society" argument, and used women applicants as an example of a slippery slope that could open up if he tried to go down that rathole. Unfortunately, those subtle points get lost in Jauhur's ridiculous arguments about older applicants.

As for that "debt to society" nonsense, take a few minutes to peruse the Residency boards, and you will see plenty of folks in their late 20's talking about dropping out of residency and clinical medicine altogether.

This has been an on-again, off-again topic for many years. Contrary to the opinion of those on both sides of the argument, there are valid points on each side.

Disclaimer -- I have not read the above article.

There are a couple of things which must be addressed and should be answered prior to being able to formulate an informed opinion based in fact, not ideology nor political leanings. The first is defining to what extent the medical education process is truly subsidized vs how much of the tab is picked up by the individual. Next this ratio must be compared to other occupational / educational career tracts so that we can accurately ascertain whether or not medical education is a predominantly societal sponsored undertaking or if tuition covers a proportionate amount. Graduate medical education is a completely different matter -- it would be difficult to argue that "society", in particular state-run health care organizations do not get their money's worth (and then some) from the institution that is graduate medical education.

Once those questions are answered it would be much easier to formulate a responsible, intelligent, and informed opinion.

I would like to point out, however, that there are many (particularly in primary care circles) who actively lobby for increased subsidies for medical education; when asking for increased subsidies you are inviting and strengthening the "societal debt" argument.

As far as the problem of "young docs leaving medicine" -- probably overstated, but more power to them. Some are smart enough to see the writing on the wall, some have the insight to see that medicine was not the right career choice for them, and some will find a career path that contributes much more to the house of medicine than what being a simple provider could do.

 

[CultureDoc]

Good discussion here . . . I'm surprised no one has yet commented on this part of the article (because it really jumped out to me, perhaps because of personal interests):

"But more generally, are the diverse backgrounds and interests of nontraditional medical students really what the profession needs? Today, most experts believe that medicine needs more doctors who are able and willing to do the difficult work of primary care, especially since shortages of front-line physicians are expected at the same time as the baby boomers begin reaching Medicare age."

I had to read the article a couple of times because I thought I must have missed something. I don't get why the author assumes that non-trads are less likely to be "willing to do the difficult work of primary care." I'm having a hard time equating "diverse backgrounds and interests" with no interest in primary care. Although I don't want to be close-minded, I'm certainly leaning WAY toward primary care. I think it would be pheomenal to see patients over the course of their lives and to see their family members. (My greatest bummer in shadowing is knowing that I probably won't be there to see the doctor follow up with each patient, so I won't get to see their hypertension, diabetes, cholesterol, etc. get under control - or whatever the case may be). And I think primary care is certainly a place where innovation (fostered by diverse interests) needs to happen! (IMHO, if there's a "stodgy" area of medicine, it's got to be primary care.) I've had exposure to some of these innovations - like group medical visits - and just think it's so darn cool . . . so heck yeah, I want to be a part of that! Why not?

Oh, and then there's the matter of time in training. I would actually think a higher percentage of non-trads than trads would be interested in primary care because in most cases, you'll spend less time in training than you would to specialize. If you already feel "behind," or already have family responsibilities, wouldn't primary care make more sense for you? I know that's certainly in the back of my mind. I wouldn't let it dictate what I end up doing, but I think it will be something I'll take into consideration.

If folks are going to talk about how damaging it is to the practice of medicine that young mother MDs want to work part time, then let's see some analysis on what the young fathers are doing and the impact of young fathers' careers on young children.

Hurrah!! I couldn't agree more DrM!!

 

[Non-TradTulsa]

Oh, my, I thought this kind of arrogance had disappeared from professional literature. I think the author meant well, but my ears were belching smoke when I read the last paragraph.

I would like the author to know... there is a reason that older applicants who apply for admission to medical school with credentials equivalent to younger applicants have to be considered equally for admission:

It's the law, and it has been for many years.

Considering whether or not an older applicant will make the same contribution to society as a younger applicant in admissions decisions is illegal. And, I agree with CultureDoc - anecdotally, from my experience I'd say that the non-traditionals I know (including me) are less worried about salaries - we came to medical school with a mature ideology - and are very interested in primary care.

Laws can be changed, and I suppose it's fine to suggest that equal opportunity laws might have to be changed for medicine. But some of these guys seem awfully casual about the fact that equal opportunity laws apply to medical education in this country and that admissions committees do not have a right to ignore the law.

OK - done with rant now.

 

[squiggle]

hi folks, love the discussion. i am older than most of my instructors by many years, and most of the nurses i work with, yet i still need to respect the 'student' role. i do agree with one poster, once you have been out there working for a while, it's hard not to speak up as a 'consumer' of education when something is crappy. i get shocked looks in my class (20 somethings) when i question process or exams, ie. unfair subjective questions, or un-evaluated teaching methods in which we are guinea pigs. they're all like "shut up, don't you want a good mark in this class?" certainly i question authority more, but i choose my battles wisely and remember that i am a student and signed up for this willingly.