Changing Landscape of Medical School

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Who wants to vomit?  Well, here you go.  Per a recent article in the WSJ, “a wave of innovation is sweeping through medical schools, much of it aimed at producing young doctors who are better prepared to meet the demands of the nation’s changing health-care system.”  Are you ready for this?  Here is a list of innovative things mentioned in the piece:

  • At the new Hofstra North Shore-LIJ School of Medicine in Hempstead, N.Y, students spend their first eight weeks not in lecture classes but becoming certified emergency medical technicians, learning split-second lifesaving skills on 911 calls.
  • At Penn State College of Medicine in Hershey, Pa., first-year students work as “patient navigators,” helping the ill, injured and their families traverse the often-confusing medical system and experiencing it from their perspective.
  • At New York University School of Medicine, one required course delves into a database that tracks every hospital admission and charge in the state. Discussions center on why, say, the average tab for delivering a baby is $3,000 in a rural area and $22,000 in New York City.
  • To that end, in April, a new MCAT—the Medical College Admission Test—will be administered, the test’s first major revision since 1991. The new version is 2 hours longer (6 hours and 30 minutes) and tests knowledge of behavioral and social sciences as well as biology, physics and chemistry. One sample question has applicants read a passage, then asks which of four statements “is most consistent with the sociological paradigm of symbolic interactionism?” (Editor’s Note: WTF does that even mean?)
  • Mayo also is creating a new course of study, called the Science of Health Care Delivery, which will run through all four years and include health-care economics, biomedical informatics and systems engineering. With a few additional credits, students can graduate with both an M.D. and a master’s in health-care delivery from Arizona State University.
  • In a course called Checkbook, Mayo students will track all of the services provided to their assigned patients during clinical rotations and look for redundancies or routine tests that add little value.
  • “The old model was, you’d go on rounds; the attending would ask a question, and the young resident had to get the right answer,” says Dr. Decker in Scottsdale. “In the new model, you’re part of a team, and somebody else might have the right answer.” To understand the roles of team members who aren’t doctors, first-year Mayo students spend half-days shadowing clinic schedulers, registered nurses, nurse practitioners and physician assistants. They also assist in managing a panel of patients, as care coordinators do. Less Memorization
  • Some schools are placing far less emphasis on memorizing facts, such as which drugs do what and how they interact with other drugs. Such information is now readily available electronically.
  • Some schools are condensing the typical four-year curriculum into three years, to let students start their residencies sooner and graduate with less debt. The Association of American Medical Colleges is also studying ways to let students master needed skills and competencies at their own pace—an innovation that has come to medical residency programs as well.

I am not the typical old guy that states, “In my day, things were better”.  This crap, however, makes me want to lose my mind.  And I am not against learning from anyone.  But medical students being primed to study EMTs, become patient navigators, shadowing NPs/PAs/nurses are all techniques to marginalize future physicians.  What it is saying is that YOU ARE NOT IN CHARGE, DOCTOR and this just prepares them for learned helplessness in the future.  Instead, they are teaching them not to memorize (huh?) and graduate early so they can do what?  Be employed by a hospital somewhere?  Never be able to think independently? Work as a future Walmart doc?  I fear for our future.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  27 comments for “Changing Landscape of Medical School

  1. Bridget Reidy MD
    March 2, 2015 at 12:51 am

    The question is, who is trained to think? Yeah it’s important to know that recommending a thousand dollar drug to someone with no resources, or an hour a day of exercise to a kid in a ghetto who is only safe inside can fail. We are the ones trained to think and know when we need to know these things and when we don’t. But when we suggest we blindly follow guidelines and forget that hypoglycemia can be dangerous until the guidelines incorporate it, we lose our edge. When we let guideline following become the benchmark, we admit that the LELT and the high school grad and Google are just as good as us. Medicine has been heading this direction for awhile and I’m afraid it started with some of us. Memorization is not more important than understanding. I don’t care about the MMSE or your Beck score, so I don’t memorize them or keep them on my smart phone. I care what my educated (guideline informed) and experienced gut thinks is the diagnosis after I have asked a series of questions based on the answer to my previous questions, and I consider the possibility of bias or phony science when learning new things, especially if they don’t fit my previous understanding of how things work. The person diagnosing depression needs to be someone who understands enough basic science to know the diagnosis doesn’t really change overnight when finally the symptoms have been around long enough to fit DSM criteria. And I like working with and learning from any other professional who knows something I don’t, especially if they know what they don’t know. That’s what makes me a physician, and it has nothing to do with being in charge but I sure hope when I’m sick there are physicians who think and people who let them. And the commentator who thinks anyone can do primary care because it’s “easier” has a lot to learn and I don’t want that person anywhere near me when I’m sick.

  2. Mandi
    February 25, 2015 at 10:00 am

    Just want to throw in my two cents–I have been an RN for a long time, and am now in PA school. I have been following Dr. Doug since I think 2004 and I happen to agree with him on most things. I think PAs and NPs are taking this autonomy thing too far in general and to the detriment of patient care–I do not think that PAs and NPs are remotely as qualified as MDs and that includes the primary care specialty. I assume the MDs with whom I work will appreciate my strengths and take my opinions seriously but I certainly do not expect to take control of anything. Yes, I have saved a lot of MDs’ “bacon” in my time but that is because we are all human and not because that person was incompetent and I should have been in charge. It’s supposed to be collaboration, helping, dividing talents and time, and there is no need for people who did not go to med school/residency/fellowship to get all jumped up about equality, and if they didn’t do so, maybe the MDs wouldn’t have to be so defensive! I am sorry, I do not mean to put down my own profession at all but I know my limits and I appreciate the input of people who are more experienced and knowledgeable than myself.

    • Doug Farrago
      February 25, 2015 at 2:59 pm

      Thank you – Doug

  3. Matt
    February 24, 2015 at 2:27 pm

    I’ll lead with the fact that I am a PA, and obviously not thrilled with the comment that med students shadowing PAs and other nonphysician providers somehow “marginalizes” docs.

    That being said, I would refrain from knee jerking about changes in education models because they are different. Sure some of it is psychosocial fluff, but having future providers understand the impact of resource utilization, cost, relative value, and the role of other health care professionals is a good thing.

    The (appropriate) trend in medical care moving toward team based/collaborative/interdisciplinary models works. Things have changed for providers. We used to order our own TPN or dose adjust our ABX and interacting meds. Now we have excellent clinical pharmacists to manage that work, to patient benefit. We were deciding when hospitalized patients could start eating, based on very loose criteria. Now we have Speech Language Pathologists and Nutritionists to provide their expertise. And of course we have the explosion of PAs, NPs, and CRNAs, who are consistently providing gold standard care. By definition these all marginalize docs by transferring work they used to do over to other professionals. There is no evidence that doing that has negatively impacted care, and enough evidence to show that it has improved aspects of it.

    This can no longer be about “who is in charge”, a physician-centric model. We are now (again, appropriately) in a patient-centric model. Training physicians to work in these teams, understand the fiscal impact of their decision making, and even bring specific skill sets such as EMT training into their education are different, but they’re not bad.

    • Doug Farrago
      February 24, 2015 at 2:55 pm

      Couldn’t disagree more. I will let the others respond in more depth, though. You are talking about training animals (doctors) so that they work better on the assembly line in an industrialized medicine model. Is it better? No. Does it make others more money? Yes. Your comment absolutely crystalizes what it the Kool Aid party line. And “consistently providing gold standard care”? WTF is that anyway? What scale are you using to measure gold standard care anyway? Do doctors provide platinum care? Give me a break.

      • Matt
        February 24, 2015 at 3:42 pm

        I can speak for PAs only since NPs profess to practice Advanced Nursing. PAs are trained and licensed to practice medicine. There is a gold standard that we are all expected to meet. It can be measured by EBM, internal practice policies/best practice etc, but either way there is a standard and we all must meet it. Put more simply a doc and PA evaluate and treat a UTI or abd pain or AMS the same way using the same tools. This may be anathema to docs but PAs and NPs have been around for 50 years and are doing the work (and doing it well…or should I say just as well).

        We are all animals but fortunately we have insight and self-awareness- perhaps it’s what makes us great clinicians. And I’m not sure what your industrialized medicine model looks like, but patients benefit when providers communicate and collaborate in teams.

        The patient benefit, not who makes the money or who gets to claim to be in charge, is the goal.

        So I’m not really sure what specifically you disagree with.

        • Doug Farrago
          February 24, 2015 at 3:59 pm

          I guess you are new to the site then? As well, huh? So, really the extra training and education a physician gets really doesn’t matter?

          • Matt
            February 24, 2015 at 4:03 pm

            It is the first time I’ve seen this site, yes.
            And no, I don’t recall writing that anyone’s training “doesn’t matter”.

          • Doug Farrago
            February 24, 2015 at 4:16 pm

            Sure you did. I mean why even get a medical degree when you say it is proven a PA or NP does the work as well? It doesn’t make sense to do those thousands of hours more education and training, right?

          • Matt
            February 24, 2015 at 5:39 pm

            Sorry wouldn’t let me reply to your later comment.
            It requires a bit more discrimination to talk about comparing PA (and NP) to physician practice. The argument only holds up in areas where the scope of practice and level of privileging are likely to be most equal, and this is in the primary care fields. This is probably to most relevant point of the discussion since no one is arguing that a PA/NP should be coiling a cerebral aneurysm or replacing a hip independently.

            When you look at the primary care fields, for kids through geriatric pts, as well as occupational/federal/corrections/indian health, there is a good deal of PA/NP penetrance into these areas and the metrics all show high quality and dare I say gold standard care (the same standard physicians practice to). Reimbursement trends have pushed lower-cost providers like PA/NP into these areas, and we can claim that as the driving factor, but the outcomes can’t be refuted.

            So advanced training for subspecialty/tertiary fields remains vital, and thus absolutely “matters”.

            The matter at hand (from the original post here) is that med students are marginalized by learning about (and from) PAs or NPs. Which is just incorrect.

          • Doug Farrago
            February 24, 2015 at 6:07 pm

            Yes, you can swab a heck of a strep throat. The outcomes HAVE NOT BEEN STUDIED but in bullshit symptoms like ear pain, sore throat. You have now offended me to the core. But, that being said, what is to stop me from bringing in what I will call a “physician’s assistant”? Not the same thing as a PA but he has a high school degree and I can teach him how to swab that same sore throat? We create some bullshit metrics to prove he is as good as a PA because those studies are easy to fabricate. Training and education doesn’t matter and he did well in health class in high school so what the hell? Your argument and point is offensive to me and all the family docs who trained more, were educated more and put in the time and effort that you WOULD NOT do!

    • Pat
      February 24, 2015 at 5:12 pm

      Matt, gotta weigh in here.

      1. You note that “having future providers understand the impact of resource utilization, cost, relative value”, etc. might be good. That goes beyond mere information, but rather is programming to make new docs accept the mindset that has been so destructive to medicine at large. Under the banner of pragmatism, you would have new docs embrace the monstrosity of health care bureaucracy, justifying it as being “for the patient.” That is how physicians lost control of their profession.
      2. “PAs, NPs, and CRNAs …By definition these all marginalize docs by transferring work they used to do over to other professionals.” Your definition, not mine. For your definition to work, the other ancillary personnel must be elevated to a status equal to physicians. That is clearly what you favor, and what I oppose. Why? Because…
      3. …of this statement: “This can no longer be about “who is in charge”, a physician-centric model. We are now (again, appropriately) in a patient-centric model.” That is egalitarian nonsense dressing up as efficiency. In my first life I was in naval aviation, flying off aircraft carriers in all sorts of weather and tight-ass situations. I was not a pilot, but a flight officer sitting in the right-hand seat. When I was the designated mission commander, I was in charge of all aspects of the mission, however; there was only, ever ONE pilot in command, responsible for the aircraft. Yes, I was too, but not primarily. Even on missions when two pilots were in the plane, only ONE was the pilot in command. Confused?

      Years later, moonlighting during residency in small-town ER’s, I ran my first codes. The nurses, techs, and EMS personnel there had all been in many more codes than I, but there was only one doctor and they all looked to me. It was, and remains my obligation to listen intently to them all and adopt and direct their talents for the maximum benefit of the patient, as it was and is my responsibility to assert my ultimate authority in all decision making. I have been given good suggestions by the staff, and more than once have had my bacon (and the patient’s) saved by staff when I was about to make a wrong move or omitting a piece of the puzzle. And yes, on very rare occasions, I have had to straighten someone out on the spot in the middle of a critical scenario. That is what a leader does, in case no one ever shared that with you. Because I’m by nature an autocrat? No. Because to get the job done requires an effective team, which means one that is LED, not some amorphous, touchy-feely, we’re-all-equal, everyone-gets-a-trophy discussion group.

      I’ll grant you, yours is the way most of this sorry-ass industry is heading. But you can do it without my help, and with my contempt. Until someone has paid the dues, and gained the experience that I have in med school and residency-plus, any notion that they are an “equal member of the team” is delusional horseshit.

      • Sir Lance-a-lot
        February 24, 2015 at 5:44 pm

        Excellent, Pat.

        The similar, but less eloquent, thing that I was going to say, is that I am happy to work with a medical “team,” and glad that I have members of the “team” to help me care for the patient, but that it is my job to be the member of the team who makes the final decisions, and that one of the reasons for this is that I am trained to be able to replace any other member of the team (or all of them), myself, if I need to, and none of them can replace me.

        Nurse? I can check meds, talk to the pt., see how he’s doing, start IVs, even start Foleys and empty bedpans.
        Aide? I’ve been paid to clean the heads in a public restroom and to carry heavy sh_t. I can do that.
        Phlebotomist? Come on.
        Lab Tech? I can run some of the machines myself (have done so when the techs were indisposed), and can learn how to do most of the important stuff, if necessary, in 5-10 minutes. It may take half an hour for me to learn the calibration and service details.
        Rad Tech? I can run the X-Ray machine with about ten minutes’ training, and get the positioning and settings out of a book. I won’t be as fast, as smooth, or as pretty as the experienced techs are, but I could do it. Docs used to run their own X-Ray machines all the time in the “old days,” when they weren’t computerized and automatic.
        RT? I can drop a tube, set up a nebulizer, or run a vent (okay, I haven’t run a vent in years, but I know I can because I have, and the patients lived, most of them).
        Social Worker? Given the time, I can do that one just fine, too. Maybe not the therapy, which is more appropriately the job of an MD psychiatrist or a PhD psychologist, but the rest of it, sure.
        PA? No comment.
        NP? From what I’ve seen, I wouldn’t want to work at such a low level.
        Pharmacist? You’ve got me there, but they’re a phone call away at the drug store.

        All of those people are there to do what are, essentially, and were, traditionally, parts of my own job.
        It’s nice to have them help out, but doctors are trained to do all of that, and to be thinking at the same time – when I see the lab tech run the vent, I’ll be ready to talk about everyone of the team being equal.

        • Doug Farrago
          February 24, 2015 at 6:08 pm

          No, it’s the family docs he states he and other NPs/PAs are as good as and therefore useless. But your next.

        • Steve O'
          February 24, 2015 at 10:19 pm

          It is neat to imagine all dreamy, jolly little groups that work together in harmony. Let’s all sing the team song, amigos! What a marvy concept!
          Medicine might be more complex than the automobile assembly plant, but look…. um…. look what’s happened there. The Golden Goose and the Cash Cow that made effortless profits in Detroit quit working, when, despite everyone’s personal interest, nobody could handle working together in harmony. We can hold up Detroit to be the American Eden with the streets paved with gold, no? Sadly, many streets aren’t even paved anymore, crinkled asphalt running for miles through empty neighborhoods and housing clusters where the cops won’t even go any more.
          If assembly-line CARS, for God’s sake, can’t be made in America anymore, what makes people get all dewy-eyed about the future of mechanized MEDICINE?
          When the duty for success, the responsibility for failure, and the power to control becomes all blurred and incalculable, the world turns into the command version of a street riot. Everyone can question everyone else’s performance and motives, and nobody cares if everything grinds to a halt, as long as some other schmuck can take the blame. That’s the heart of bureaucratic management in the private sector and the public, and almost every organization is in different levels of failure because of that. Medicine – we’ll be endstage before the decade’s out. I give it four more years until most of the healthcare workers start showing up drunk and looting whatever’s not nailed down.

      • Matt
        February 24, 2015 at 6:00 pm

        Hi Pat,

        It’s funny because I moderate over at the PA forum, and on-and-off contribute to allnurses just to keep up with what’s going on in their world…..and everyone feels like they’re losing control of their profession (only Pas and NPs say it’s due to docs +/- legislators). Perhaps more in common than some may think?

        1. Healthcare systems, especially one of our size, will be inherently bureaucratic. There’s certainly too much history of perverse incentives influencing bad medical citizens to make the wrong choices, so regulation and standard guidelines are necessary. I just don’t agree that learning the relationship between medical decision making and health care finance stewardship is bad.
        2. PAs and NPs are not docs, and it’s probably a false argument to say that anyone wants to be “elevated” (your word not mine!)…In speaking with many PAs and NPs, they want to do what they have been trained to do.
        3. This seems to be dancing around the issue of medical home leadership, which is obviously a touchy subject for physicians. It also relates more directly to the real world practice of PAs and NPs today. If running codes, delegating authority to other staff, making use of the available talent, and managing other “tight ass situations” is the litmus test for leadership then I can tell you that PAs and NPs unequivocally pass it. You are mistaken in calling it egalitarian since it doesn’t relate to all members of the team, only those who are licensed to practice (MD/DO/PA/NP). Furthermore it does not advocate anarchy, only saying who is qualified to lead. We have learned (in specific areas of medicine) that it is not driven solely by credentials. Being and MD doesn’t automatically make you a good leader, and being a PA/NP doesn’t automatically exclude you from it.

        Thanks,
        Matt

        • Pat
          February 24, 2015 at 6:29 pm

          Matt, you are dissembling, first claiming that you don’t seek to “elevate” the LELT’s, then doing just that, disclaiming egalitarianism and then professing it: “You are mistaken in calling it egalitarian since it doesn’t relate to all members of the team, only those who are licensed to practice (MD/DO/PA/NP).” These are the sort of word games that practitioner-assistant-lobbyists practice for legislators anxious to provide on the cheap, while the rest of us are scrambling to pay our bills. The frightening thing is that you might be sincere, and actually believe what you just wrote. Like the “team docs” you would promote, you have been properly programmed.

          It is not simply about running codes, or leading in an emergency. It is more about the layers of training depth that make one the BEST qualified to be ultimately responsible to the patient. Your very own words above show that you believe one license is worth the next; if that is true, then the years, and dollars, and wear, and even loss all through medical training wasn’t worth it. But if it is false, then there is something extra to gain from better training, and as a patient (I am also that), I’d rather see a doctor.

    • Steve O'
      February 24, 2015 at 11:04 pm

      The Carnegie Foundation has had plenty of time to “fix” American education starting at the ground-level up. Over the last hundred years, the best minds using best practices have made the American Public Education system one of the top fifty in the world. So be wary when you think about “teaching.” And “Best Practices.”

  4. Perry
    February 24, 2015 at 11:17 am

    ” BULL**T like this to take time away from that critical learning and let’s LESSEN the time in medical school.”

    Exactly right, by the same token, I don’t think it’s such a bad idea to expose some of today’s med students to the “real world”, but these extracurricular experiences could be done during a summer break for instance. As far as increasing the MCAT time frame with even more esoterica, seems like torture to me.

    For all this, why not let med students be a “patient” for a day, see what that feels like?

  5. RWatkins
    February 24, 2015 at 10:00 am

    “In the new model, you’re part of a team, and somebody else might have the right answer.”

    Translation: you don’t give a fuck if anybody knows the right answer because it’s not your responsibility anymore.

  6. Steve O'
    February 24, 2015 at 9:15 am

    My Rx is a read of February’s article in the SSI / Army War College: “LYING TO OURSELVES: DISHONESTY IN THE ARMY PROFESSION, Leonard Wong and Stephen J. Gerras.” An endless number of bureaucrats-in-uniform demonstrate their importance by inserting training and performance mandates on the Army (and other military force.) When there is 40 hours a week of mandated field training (really!) added on to the duty of deployed personnel, there is just not enough time to bring a platoon back from ACTUAL patrol and then sit them down for a few hours of classroom review of the revision of sexual harassment policies, before shut-eye. Therefore, the prudent commander “pencil-whips ” (i.e. falsifies) the training, and shoehorns the things that won’t get his personnel killed in ahead of things that don’t matter.
    The world imagines that the Medical School is the propaganda factory where all learning occurs in medicine, and “hours of training” translates into control over the minds and behaviors of the next generation of doctors, as though it were downloading lines of code into blank storage. And the problem is hardly restricted to medicine; the preponderance of American university training seems to focus on how to criticize others by applying faulty reasoning to a massive and unquestioned catalog of rules. The IRS auditor is the Superman of the 21st Century. And the ability to force one’s self upon the unwilling and unconsenting is an exercise of narcissistic power in medical education – and in sexual assault.
    If it does not matter what you learn, it does not matter what you teach – and if medicine is the ability to Google factoids, then really it should be over and done with in fifth grade nowadays. If healthcare is measured in terms of symbolic interactionalism, e.g. “the meaning of such things is derived from, or arises out of, the social interaction that one has with others and the society,” and “these meanings are handled in, and modified through, an interpretative process used by the person in dealing with the things he/she encounters.” then we can teach medical students by mime or sock puppets. [sorry for the verbal lard salad quoted, but “things” is never defined in SI – just interpretively cast out there.]
    Groupthink is the new solution; and we kick sand over the fact that groupthink brought us My Lai and many other atrocities committed by groups under stress, that individuals would never do alone. [ref. Extraordinary Popular Delusions and the Madness of Crowds, nearly 200 years old but still brilliant.] If people are trained to define whether they value something as Right or Wrong depending on the pleasure of the Leader, they are only fit for survival as totalitarian slaves.
    If, however, the practice of medicine involves “hurry in there and draw on the most you know and the best you can figure to make that person not-dead. Nobody is in command but you – and nobody can help either,” a reason-driven but socially sterile action, one faces the challenge of a massive amount of learning, study and humility.
    Since in 21st century America, to “do” is the hallmark of the lumpen-proletariat, the dirty-fingernail lot, being able to “do” medicine is as pitiful as being able to “do” housewares in Target or stocking in Wal-Mart.
    Hurrah for the New Paradigm! It is as simple as sh*t and about as useful.

    • Sir Lance-a-lot
      February 24, 2015 at 11:07 am

      I second the recommendation of the Army War College report – in fact, I posted a link to it on Authentic Medicine last week.

      As far as the rest of your thesis regarding groupthink and physician loyalties being bent away from the patient and toward the government’s aims, there is no need to look to My Lai or 200 year old texts – Just read “The Nazi Doctors,” by Robert Jay Lifton, MD (ca 1986, if I recall), in which the author makes a very deep, very lengthy study of the motivations and feelings of the doctors who advocated and carried out the Final Solution (which was, at its heart, medically based), and how they believed that their work was helping their country.

      It is a long book, but I strongly advocate that anyone interested in the direction that US health care is taking read it, because it shows exactly what can happen when the medical schools begin teaching that your patient is not an individual, but the entire people of your country (der Volk, you know…), and that the health of the “body” of the nation is more important than the health of any of the individual “cells” that make up that body.

      It can’t happen here?

      • Pat
        February 24, 2015 at 11:58 am

        This keeping with the IOM recommending that doctors start tracking “financial resource strain” and “neighborhood median income.” We are government agents, just without the badge or gun.

      • Steve O'
        February 24, 2015 at 10:45 pm

        Of course it is – when anyone disengages respect for humans from the delivery of medical care, the fascist future is determined. Human nature seems to have a dark perversion for trying totalitarianism of some sort every few generations.
        Here today, we have people looking at the question – “How long should people live into old age?” which is “How long should they survive after they turn net-negative to aggregate worker productivity?” One writer put in the Atlantic Monthly the proposition that 75 years old was fine for him. You’ll be hearing that number quoted more and more in the future as a standard.
        We have the scientific ability now to track the genetic basis of the subtle disabilities – not just the grossly deformed, but the mildly slow and physically weak. Such a shame that the Reich peaked just a few decades before they could have put a master plan to action? Himmler with a PCR machine – how excellent! The Übermann is simply a concoction of übergenes. He can be manufactured.
        Perhaps we will have a productivity passbook that tracks our quantitative utility to societal prosperity, and we “pay into it” metaphorically while young and productive; and drain it down after we become old and tired. And when the balance gets to zero….pfft!
        Those who harbor inferior genes – think of Tay-Sachs and HbS (sickling hemoglobin) – will have to pay a “productivity tax” into the utility pool for carrying damaging genes forward. We will no longer discriminate against inferior races – just extinguish the carriers of inferior genes!
        And when the glass starts breaking, a few of us will ask ourselves, how the HELL did we get to THIS point?

  7. Pat
    February 24, 2015 at 8:48 am

    Dead on, Doug. This is not education, this is programming.

    • Steve O'
      February 24, 2015 at 9:33 am

      Not just programming, but programming that is DEEPLY evidence-based to fail utterly. For instance, in Watertown, Massachusetts, the Army owned an arsenal for the manufacture of weapons. It produced a tremendous amount of the small arms and other weapons for the Civil War, and up through the early 20th century. “Taylorism” or ‘scientific management’ came in – the substitution of the skilled and expert craftsman for the “programmable ant,” “the idea that human activity could be measured, analyzed, and controlled by techniques analogous to those that proved successful when applied to physical objects.” (F.W.Taylor) You are not even an ant – an ant gets respect for being alive and having neurons. You are a lump.
      Scientific management was implemented at the arsenal between 1908 and 1915. It was considered by the War Department as successful in saving money over the alternatives; but it was so hated by the work force that the Congress eventually overturned its use. Many of these loyal craftsmen – some whose families had worked there three and four generation – quit in disgust when “Taylorism” took root there. By the 1920’s, Taylorism was the laughingstock of the business environment – people don’t work like ants or roll like lumps.
      As some have observed [see http://www.qualitydigest.com/inside/quality-insider-column/revisiting-taylorism-watertown-arsenal.html%5D, the mean and sad principles of Taylorism, like Leninism, are too awful to ever really go extinct. They survive in many approaches to the “creative destruction” of healthcare.
      Our future is simply the past – look back from 1908-1915 at the Watertown Arsenal, and you could be looking at 2008-2015 at the American Healthcare system.
      Yes. It is programming. No. It does not work. It has never worked.

  8. Dr Bonz
    February 24, 2015 at 6:52 am

    In a world where there are SO many more things a doctor NEEDS to know (to effectively treat sick people that is), and when the medical student’s training time is even MORE critical (let’s face it, there is little time to learn an awful lot of stuff), let’s LESSEN that time by adding BULL**T like this to take time away from that critical learning and let’s LESSEN the time in medical school. Wow. Just wow.

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