Gifted Issues Discussion homepage Forums General Discussion Against the bachelor's degree

With the differences in health systems around the world, I doubt that you could make a meaningful regression analysis about whether the two years‘ worth of classes required by gen Ed’s or distribution requirements or core classes or non-STEM majors taken by US premed students make any difference in outcome.

However, considering that the US appears to be the only country in the world doing it this way and considering how easily health care professionals can move between systems once bureaucratic hurdles are overcome, my educated hunch would be „none whatsoever“.

My DH, who teaches science, has referred to studies done in the kind of „proxy education“ that Dude has referred to (so, just hearsay, no citations, sorry). The results being that the outcomes are best if you are actually specifically taught and practice what you are supposed to be able to do. Eg, if you want students to be able to read, understand and work with complex scientific texts, make them read, understand and work with complex scientific texts. As opposed to making them read Jane Austen. If you want them to effectively communicate with patients (or other health care professionals!) from Hispanic communities or countries, teach them exactly that. Don’t make them read and talk about Cervantes.

Would I want to be treated by a doctor who doesn’t care about literature or cultural issues at all? Frankly, it wouldn’t be my priority, nor do I think a college class enforced by distribution requirements could change that in a meaningful way.

It’s the doctors who cannot weigh scientific evidence or apply independent scientific thought as opposed to presenting cookie cutter solutions who scare me.

Another point of evidence: I understand that med schools simply do not care about those parts of their applicants education at all, basing admittance on a recalculated GPA excluding non STEM subjects and on MCAT results.

So, 2 years worth of classes, for up to 140.000 $ (plus 2 years’ reduction of earning potential, probably twice that sum if not more) , just to make med students/doctors appear more well rounded than they presumably were after high school? Who does it really benefit? It’s not like anyone is stopping these students from reading and enjoying Jane Austen on their own, after all.

My point is that if your goal is to reduce healthcare costs, simply doing away with the bachelors degree requirements for MDs will not have a meaningful impact. My husband made it through 4 years of undergrad with zero debt, but we have a wagon load of debt from med school. And the idea that parents will help with tuition is such a privileged idea, especially with costs being what they are today.

IF the goal is to lower healthcare cost we need to fix the system and not blame the doctors, many of whom struggle with crippling debt for years after they finish school. If we’re just talking about streamlining the process for medschool to make things easier for doctors, there are interesting points to be made, but I was referring to the discussion about healthcare. There seems to be 2 separate conversations going on.

Granted, the complexities are significant, but they're not insurmountable.

There are some effective methods to study within-state and within-local health authority differences in clinical outcomes that could be mapped reliably to doctor credentialing. This is already done when piloting new medical school subjects across jurisdictions and specialties to justify the new program expenditure.


Canada has a blended model.

In Quebec, lower tier med schools require a CEGEP diploma (equivalent to a 2-year college certification). Lower quality medical schools in Alberta require 2 years of undergraduate study. Upper tier Quebec and rest of Canada medical schools generally require at least a 3-year bachelor's degree, with a prescribed set of science and math course requirements as prerequisites to an MD.

Foreign MD credentials are only sparsely accepted in Canada, with the majority of foreign doctors accepted being specialists from Australia, New Zealand, Britain, the US, Singapore, Switzerland, Hong Kong, and South Africa, largely from the mid-1990s onward. That excludes a lot of foreign doctors, and almost all GPs. There has been a concerted push within the Canadian medical community to build bilateral credential recognition mechanisms, even in the face of GP shortages, and the needle hasn't moved much on recognizing doctors outside a limited range of institutions. So, at least within the Canadian context, physician regulatory bodies have judged the additional training to be beneficial for patients.

(In case you're curious, I've linked the Royal College of Physicians and Surgeons of Canada credential recognition criteria below.)

http://www.royalcollege.ca/rcsite/c...gs/jurisdiction/accepted-jurisdictions-e

PM'd you on the off-topic stream!

No, it’s actually the same conversation, because you are creating an artificial line between whether the cost of your husbands education was incurred at the undergraduate or the graduate level and whether the education happened to be free at the point of delivery for your husband.

Whether he came out of the undergaduate part debt free or not, *somebody* paid for those two years worth of general ed. Your husbands parents, other students parents, tax payers, endowment donors. It wasn’t free, the costs just have been shifted. And don’t forget to opportunity costs - how much money does your husband make, on average, within a year of his professional life, times two?

If the cost for two years of general ed, delivered at huge cost at sleep away college by PhD carrying lecturers (as opposed to high school, as per the educational model of most other countries in the world) were not incurred in the first place, there would be no need to shift it around.

It doesn’t mean that you don’t still need 6 years of targeted medical education, with 4 years of clinicals and stuff, after the premed stage. It will be expensive anywhere and it doesn’t matter whether the institution that delivers say, year 3 and 4, happens to be called college or med school. But you basically shave off 25% of the cost of education the most highly paid staff in the system. It must make a difference somewhere - where, that’s up to the system.

This is one of those things that's a bit odd.

If you're doing a PhD in a STEM subject and you're paying for it, that's a very bad sign (meaning that you're probably studying at a for-profit or other very low status university).

PhD students get paid to do a PhD, but MD students have to pay a king's ransom.

One could argue that PhD students are "doing work" by doing research, and therefore should be paid. However, this simply isn't true at first, especially in the US model where they have to take classes. And med students start doing work when they get into the clinic in year 3. Sure, they're relatively clueless, but so are PhD students.

Sounds like the criteria are, quite simply: first world country, English language education (the latter partially including Switzerland, which appears to have moved further towards using English in STEM education than other European countries). Of the cuff, I can say that both Britain and Switzerland have targeted medical education right after the high school level. Britain actually stops general ed after GCSEs, at the age of 16. A student may have seen nothing but STEM subjects from 11th grade onwards. Higher ed in all of the other countries tends to be modelled after Britain.

If you were to compare outcomes across Canada, you’d have to make a regression analysis removing the differences in both quality of student intake and of premed education at CEGEPs (which are really 12th year of high school and one year of college) and other 2 year colleges compared to the 3 years bachelors degrees at more reputed colleges, And then, specifically doctors whose extra year(s) of post secondary education have been spent with subjects related to medicine as opposed to general ed.

*everything else being equal*, I challenge you to find a significant improvement in health outcomes with doctors who have spent another two years in college taking general ed classes.

It's an artefact of the monetization models.

Doctors have a guaranteed, highly predictable client base with a strongly validated proof of concept in their field. Also, demand for health services is more inelastic (less sensitive to prices) than R&D activities because of the universality and the perceived immediacy of need for what they're offering.

PhD researchers are developing the PoC and generally must make a case for financing their activities to serve a largely undefined client base. Also, because their activities are more detached from the every day experience of most of the population (especially in early stage development), it's more politically challenging to build support from non-traditional sources.

Differences in the incidence of tuition fees across MDs vs PhDs is largely about compensating PhDs on a risk-adjusted basis. The stream of income for most PhD researchers is more variable than for MDs over time and across disciplines. So, high risk equals high reward, in a nutshell.

Nope, these are credential recognition criteria for specialties. Within those countries, recognition is done on an institution-by-institution basis.

ETA for clarity: International GP intake is funneled at the provincial level and based on a standard of meeting "Canadian or US equivalency" as designated by either the Committee on Accreditation of Canadian Medical Schools or by the Liaison Committee on Medical Education of the United States of America.

It's not arbitrary. These are the Canadian checklists used, and individual site-selection and evaluation is done on a per-institution basis--

https://www.afmc.ca/accreditation/interim-accreditation-review-process-irp/checklists


Correct, and that's what's done.


Ah, but you're mis-specifying the base case if you're referring to Canada.

As I mentioned above, in Canada, these doctors aren't taking gen ed classes--they're taking mostly prescribed science and math subjects as prerequisites to med school. So it's not +2 years in gen ed vs not, it's +1/2 years of undergraduate level science training at the third or fourth year vs non-US international models where students do not take a separate gen ed undergrad.

If we're talking the US, then yes, base case is no gen ed vs +2 years gen ed to med school. You'd need to specify a vector of elective courses and weight their quality by institution.

My hunch is that, even in the US, you'd have significant improvements in clinical outcomes for some psychology and pre-pharmacology courses, because there's good research out there to support empathy training among family practitioners and enhanced pharmacy training for high-risk patient populations.

Where there's significant cultural or linguistic variability in a patient population, the presence of multiple language credits would correlate strongly with patient compliance for treatment regimens simply by dint of more effective doctor-patient communication. This is something of substantial value in major cities with diverse populations. Similarly, if doctors are working among at-risk populations, courses in social work that link medical patient outcomes to community-based program offerings and home-based care can improve medical outcomes through partnership with tertiary service providers. It's all relevant.

You've got me curious. Any chance you work for a grant-issuing organization that's interested in funding this research?