From the article: ... More generally, maybe studying what's effective beats billionaires making large donations based on vibes.
From the article:
[I]n practice, eliminating tuition at elite medical schools is a terribly designed solution based on an intuitive but false premise. Rising tuition is not really the cause of the medical profession’s problems. Although medical students take out hundreds of thousands of dollars of loans, even the bottom quartile of physicians by income can expect to earn about $6 million in their lifetime. “Even for primary-care physicians, tuition is a fairly small share of their lifetime income,” Maria Polyakova, a health economist at Stanford, told me. Her research finds that the overall income differential between specialties—primary-care physicians can expect to make about $200,000 a year, compared with more than $500,000 for a specialist—is what dictates which fields people enter. The argument that making med school free would cause many more students to go into primary care “is just not supported by the data,” she told me.
The donations also appear unlikely to affect where people practice medicine. The schools that have gone tuition-free are all prestigious programs in major cities. None of them ranks even in the top 100 medical schools with the most graduates practicing in underserved areas. “You can’t take somebody that grew up in the suburbs and transfer them into New York City as a medical student and really expect that they’re going to take a job in Iowa,” Dinerstein told me. “Some will, but just not in general.” Although there’s plenty of need in the areas surrounding elite medical schools, making tuition free doesn’t create any new incentives for students to opt for community health centers over distinguished hospitals. “The medical schools that have gone tuition-free, they take strivers,” Dinerstein said. “And strivers, for all the things they had to do to get to medical school, are not going to stop now.”
In fact, tuition-free status could perversely be making it harder for low-income and underrepresented minority students to go to medical school. In the year after NYU went tuition-free, the number of applicants shot up by 47 percent. Because the number of slots did not increase proportionally, this made getting admitted dramatically more difficult. High-income applicants have extensive advantages at all levels of higher-education admissions, so making a school more selective virtually guarantees that its student body will become more wealthy, not less, which is exactly what happened at NYU.
...
Philanthropic money would be better spent expanding class sizes, establishing new schools, or lobbying Congress to allocate more federal funding to increase residency spots, instead of subsidizing demand.
More generally, maybe studying what's effective beats billionaires making large donations based on vibes.
I agree, but I don't think we'll see it. It's not just about the money. It's about that billionaire having the power to say how it's spent, whether they are right or wrong. That power is the real...
More generally, maybe studying what's effective beats billionaires making large donations based on vibes.
I agree, but I don't think we'll see it. It's not just about the money. It's about that billionaire having the power to say how it's spent, whether they are right or wrong. That power is the real draw of wealth, I think.
I have no real insight into how billionaires think, but some large donations seem better than others. The Gates Foundation has had some failures, but I'm guessing they did better on average?
I have no real insight into how billionaires think, but some large donations seem better than others. The Gates Foundation has had some failures, but I'm guessing they did better on average?
I imagine it would be better if they establish a foundation with other leadership to make the giving decisions because it takes the ego out of it. I don't know that much about the Gates Foundation...
I imagine it would be better if they establish a foundation with other leadership to make the giving decisions because it takes the ego out of it. I don't know that much about the Gates Foundation (or any others) though.
I find the framing in this article so odd. If the wages are still high, if there are limited opening in major cities because we have enough doctors to fill all opening, and if there are still...
The argument that making med school free would cause many more students to go into primary care “is just not supported by the data,” she told me.
I find the framing in this article so odd. If the wages are still high, if there are limited opening in major cities because we have enough doctors to fill all opening, and if there are still people looking for upward mobility then yes, someone will take a job in rural Iowa. We are still at an absolute deficit of doctors and removing barriers to entry will help us fill the gap.
I believe one bottleneck is limited medical residencies. If that’s true, increased competition at the medical school level won’t increase the number of doctors out there, unless that problem is...
I believe one bottleneck is limited medical residencies. If that’s true, increased competition at the medical school level won’t increase the number of doctors out there, unless that problem is also fixed.
Also, the system selects for people who are willing to move, both for school and for residencies. This is selecting for “strivers” rather than people with deep roots in ther home town. If you’re...
Also, the system selects for people who are willing to move, both for school and for residencies. This is selecting for “strivers” rather than people with deep roots in ther home town. If you’re already moving away, I think cities are going to be more attractive?
I. Choosing a career is more likely influenced by personality and personal story, and could be loosely modeled after the hedgehog principle in my opinion. This encompasses the idea that companies...
I. Choosing a career is more likely influenced by personality and personal story, and could be loosely modeled after the hedgehog principle in my opinion. This encompasses the idea that companies will move from good to great if they are passionate about their product, they are good at making their product and if the product makes enough money.
Let’s say that you are equally interested in family medicine and dermatology and every other aspect is equal, except the amount of money you’ll be making. What would you do?
II. The field of medicine is romanticized to lure young and hopeful idealists into a pyramid scheme. Once inside, you would be a fool to not try and get to the top. Or at least get the most out of it. Getting free tuition gives you a lot of options, including leaving the field debt free. Maybe that’s the merit of these donations. And that people still continue to practice medicine even after having freedom of choice after medical school stems hopeful; maybe the selection process for these tuition free schools does select individuals that are more likely to stay.
III. Inequality in health care, but they meant inequality to get access to medical education. If your goal is to make health care more equal, how about changing how the system works.
IV. For which audience is this article written. What is the point? As long as medicine is a for profit zero sum game (as is everything in the - regulated - free market), nothing will really change. And somehow the diversity in physicians (i.e. primary care vs other) gets pulled into the discussion, as well as the diversity in races (white vs other) and diversity in income (poor vs rich).
V. Top down deciding how many vacant positions are available for preferred specialties and forcing the rest into primary care specialties might be an option, however, I am too unfamiliar with the US system to really guess at which place within the system such a policy has to be implemented. Alternatively, maybe a ‘forced’ period of employment might be an interesting solution, akin to obligatory military service and for example the Aravind Eye Hospital business case (getting top education in an unique hospital in India, in exchange for working for them for a certain period).
TL;DR Everybody wants to get money. Money is more easily got if you had it in the first place. Health care is no exception.
From the article:
...
More generally, maybe studying what's effective beats billionaires making large donations based on vibes.
I agree, but I don't think we'll see it. It's not just about the money. It's about that billionaire having the power to say how it's spent, whether they are right or wrong. That power is the real draw of wealth, I think.
I have no real insight into how billionaires think, but some large donations seem better than others. The Gates Foundation has had some failures, but I'm guessing they did better on average?
I imagine it would be better if they establish a foundation with other leadership to make the giving decisions because it takes the ego out of it. I don't know that much about the Gates Foundation (or any others) though.
I find the framing in this article so odd. If the wages are still high, if there are limited opening in major cities because we have enough doctors to fill all opening, and if there are still people looking for upward mobility then yes, someone will take a job in rural Iowa. We are still at an absolute deficit of doctors and removing barriers to entry will help us fill the gap.
I believe one bottleneck is limited medical residencies. If that’s true, increased competition at the medical school level won’t increase the number of doctors out there, unless that problem is also fixed.
Also, the system selects for people who are willing to move, both for school and for residencies. This is selecting for “strivers” rather than people with deep roots in ther home town. If you’re already moving away, I think cities are going to be more attractive?
I. Choosing a career is more likely influenced by personality and personal story, and could be loosely modeled after the hedgehog principle in my opinion. This encompasses the idea that companies will move from good to great if they are passionate about their product, they are good at making their product and if the product makes enough money.
Let’s say that you are equally interested in family medicine and dermatology and every other aspect is equal, except the amount of money you’ll be making. What would you do?
II. The field of medicine is romanticized to lure young and hopeful idealists into a pyramid scheme. Once inside, you would be a fool to not try and get to the top. Or at least get the most out of it. Getting free tuition gives you a lot of options, including leaving the field debt free. Maybe that’s the merit of these donations. And that people still continue to practice medicine even after having freedom of choice after medical school stems hopeful; maybe the selection process for these tuition free schools does select individuals that are more likely to stay.
III. Inequality in health care, but they meant inequality to get access to medical education. If your goal is to make health care more equal, how about changing how the system works.
IV. For which audience is this article written. What is the point? As long as medicine is a for profit zero sum game (as is everything in the - regulated - free market), nothing will really change. And somehow the diversity in physicians (i.e. primary care vs other) gets pulled into the discussion, as well as the diversity in races (white vs other) and diversity in income (poor vs rich).
V. Top down deciding how many vacant positions are available for preferred specialties and forcing the rest into primary care specialties might be an option, however, I am too unfamiliar with the US system to really guess at which place within the system such a policy has to be implemented. Alternatively, maybe a ‘forced’ period of employment might be an interesting solution, akin to obligatory military service and for example the Aravind Eye Hospital business case (getting top education in an unique hospital in India, in exchange for working for them for a certain period).
TL;DR Everybody wants to get money. Money is more easily got if you had it in the first place. Health care is no exception.
Mirror: https://archive.is/gxjR1